Clinical Implication of Cough CPR in Cardiac Cath Lab

A 60 year-old-male with inferoposterior ST-elevation myocardial infarction (STEMI) was shifted to cardiac cath lab for primary percutaneous coronary intervention (PCI). Coronary angiography revealed right coronary artery (RCA) dominance with complete occlusion of the RCA in mid vessel. During angioplasty, the patient developed reperfusion induced Bezold Jarisch Reflex (BJR) with profound bradycardia along with decrease in systolic pressure. The patient was asked to cough. The use of cough-CPR maintained the consciousness as the patient was getting syncopal. This report focuses on BJR and cough-CPR specific to interventional cardiology practice within the catheterization laboratory. Awareness of the fact that BJR may develop due to successful restoration of flow which can be managed with cough CPR, atropine and fluids can avoid the administration of vasoconstrictors.