increase sports performance - oxygen...
TRANSCRIPT
CARDIO
BY PATRICK MCKEOWN
THE HEART
THE HEART
bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
THE HEART
bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Dr Jeremy Morris who studied the incidence of heart
attacks in 31000 transport workers
bull Bus conductors averaging between 500 and 700 steps
per day had far less heart disease than their bus driving
counterparts
bull Morris JN Heady JA Raffle PAB et al Coronary heart disease and physical activity of
work Lancet 1953265(6795)1053-1057
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull In 1863 the Swedish chemist inventor and industrialist
Alfred Nobel invented dynamite by combining the
chemical nitro-glycerine with silica to form a more volatile
paste
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull In the human body nitro-glycerine ndash which is the same
material used to make explosive ndash converts to the gas
nitric oxide to provide amazing benefits for
cardiovascular health
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Nobel suffered from heart disease and when doctors
tried to prescribe nitro-glycerine he declined it writing to
his friend Isnt it the irony of fate that I have been
prescribed nitro-glycerine to be taken internally They
call it Trinitrin so as not to scare the chemist and the
public
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Sometimes referred to as the mighty molecule nitric
oxide is produced within the 100000 miles of blood
vessels throughout the human body including the
paranasal sinuses surrounding the nasal cavity
bull Dr Louis Ignarro
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Nitric oxide sends a signal for the blood vessels to relax
and widen If there is too little nitric oxide blood vessels
narrow and the heart has to raise the pressure to send
blood throughout the body
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Persistent high blood pressure or hypertension damages
the arterial blood vessels causing a build-up of plaque
and cholesterol and also causing blood clotting
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull If the blood clots the obstruction causes the heart or
brain to be deprived of blood and oxygen resulting in a
heart attack or stroke
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Nitric oxide plays a monumental role in human health by
reducing cholesterol reversing the build up of plaque in
the blood vessels and helping to prevent blood clotting
all of which significantly increase the risk for heart attack
and stroke
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull As we partake in physical exercise blood flow increases
and stimulates the inner lining of the blood vessels to
produce more nitric oxide
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Low-intensity exercise ndashwasnrsquot enough to optimally
increase blood flow Conversely high-intensity exercise ndash
which includes vigorous activity at a fast pace ndash actually
worsened blood flow
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Moderate-intensity exercise ndashincreased production of
nitric oxide and provided a positive improvement of blood
flow throughout the body
bull Goto C Higashi Y Kimura M Noma K Hara K Nakagawa K Kawamura M Chayama K Yoshizumi M Nara I Effect of different intensities of exercise on endothelium-dependent vasodilation in humans role of endothelium-dependent nitric oxide and oxidative stress
Circulation 2003 Aug 5(108(5))530-5
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull University of Exeter A study group of men aged between
19 and 38 drank half a litre of beetroot juice every day for
a week
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows
httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Drinking the beetroot juice resulted in a ldquoremarkable
reductionrdquo to the amount of oxygen required to
perform exercise in comparison with a control group
who drank water the beetroot-drinking group were
able to cycle 16 longer before tiring
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Furthermore blood pressure within the beetroot group
dropped (within normal levels) even though it wasnrsquot
high to begin with
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
The Heart
bull ldquoThe reduction of oxygen required for submaximal
exercise ldquofollowing dietary supplementation with
inorganic nitrate in the form of a natural food product
cannot be achieved by any other known means
including long-term endurance exercise trainingrdquo
bull University of Exeter (2009 August 7) Beetroot Juice Boosts Stamina New Study Shows httpwwwsciencedailycomreleases200908090806141520htm (accessed 2nd Oct 2014)
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull In 1909 American physiologist Dr Yandell Henderson
produced ground-breaking work on the relationship
between breathing and heart rate that remains relevant
today Henderson was director of the Laboratory of
Applied Physiology at Yale University and considered an
ldquoexpert on gasesrdquo at the time by The New York Times
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Henderson describes how he was able to regulate the
heart rate of dogs to any rate he desired from 40 beats
or fewer per minute up to 200 or more
bull Henderson Y Acapnia and shock- 1Carbon Dioxide as a factor in the regulation of the heart rate AJP - Legacy Content February 1 190821 no 1()126-156
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Hypocapnia can affect cardiac functioning by
decreasing the circulation of blood in the blood
vessels and reducing blood flow to the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
THE HEART
bull Since low levels of carbon dioxide in the blood lead to a
strengthening of the bond between the red blood cells
and oxygen the result is reduced delivery of oxygen to
the heart
bull Rutherford JJ Clutton-Brock1 TH Parkes MJ 2005 Hypcapnia reduces the T wave of the electrocardiogram in normal human subjects Am J Physiol Regul Integr Comp Physiol July 289R148-R155
bull Hashimoto K Okazaki K Okutsu Y 1990 Apr39(4)437-41The effect of hypocapnia and hypercapnia on myocardial oxygen tension in hemorrhaged dogs Masui
bull Kazmaier S Weyland A Buhre W et al 1998 Effects of respiratory alkalosis and acidosis on myocardial blood flow and metabolism in patients with coronary artery disease Anesthesiology89831-7
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC
ARREST
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull When the heart beats abnormally ndash either too fast or too
slow or irregularly ndash this condition is termed arrhythmia
Cardiac arrest happens when the electrical signals that
control the timing and rhythm of the heartbeat become
completely chaotic
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull When this happens the heart is no longer able to
effectively pump blood around the body and unless
treated promptly death is inevitable
bull Jameson J N et al 2005ISBN 0-07-140235-7 Harrisons principles of internal medicine New York McGraw-Hill Medical Publishing Division
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull An electrocardiogram (ECG) is a test used to interpret
the electrical activity of the heart assessing the rate and
regularity of the heartbeat as well as the presence of any
damage to the heart muscle
bull ST-depression
bull T-wave inversion
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull Studies have found that certain ECG changes in young
athletes are common and usually reflect adaptations of
the heart as a response to regular physical training
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull However certain abnormal ECG readings such as T-
wave inversion were found to be potential precursors to
sudden and unexpected cardiac arrest during sport or
exercise
bull Corrado D Electrical repolarization changes in young athletes what is abnormal httpspoescardioorgeslidesviewaspxeevtid=33ampid=2616 (accessed 15th April 2013 )
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull ST-segment depression is considered to be a sign of
reduced circulation in the blood vessels of the heart and
it has been suggested that there is a link between ST-
segment depression and the risk of sudden cardiac
death
bull Kligfield P Lauer M Exercise Electrocardiogram Testing Beyond the ST Segment Circulation2006 114 2070-2082
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull In a study including 1769 men a total of 72 deaths
occurred in the 18 years of follow-up ndash all of whom
showed asymptomatic ST-segment depression on their
ECG readings
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull ldquoAsymptomatic ST-segment depression was a very
strong predictor of sudden cardiac death in men with any
conventional risk factor but no previously diagnosed
CHDrdquo
bull Jari A Laukkanen Timo H Maumlkikallio Rainer Rauramaa Sudhir Kurl (2009) Asymptomatic ST-
segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men a population-based follow-up study Eur Heart J (2009) 30 (5) 558-565
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull 474 healthy volunteers with no heart disease increased
their breathing rate to over 30 breaths per minute for five
minutes to create the effects of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull ECG readings reported abnormalities in 72 volunteers
including findings of ST-depression and T-wave
inversion with 805 of abnormalities occurring within
the first minute of hyperventilation
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
CARDIAC ARREST
bull Interestingly the study found that age gender smoking
and hypertension did not influence the overall incidence
of the abnormalities
bull Alexopoulos D Christodoulou J Toulgaridis T Sitafidis G Manias O Hahalis G Vagenakis AG Repolarization abnormalities with prolonged hyperventilation in apparently healthy subjects incidence mechanisms and affecting factors Eur Heart J 1996 Sep17(9)1432-7
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL
INFARCTION
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull Myocardial infarction otherwise known as a heart attack
occurs when blood flow to the heart is severely reduced
or cut off altogether This stoppage of blood results in
oxygen starvation and damage or death to part of the
heart muscle
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull Heart attacks often occur during or following physical
exercise or emotional stress
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull ldquoIn addition to causing peripheral and cerebral
vasoconstriction hyperventilation has also been shown
to cause diminished coronary blood flow Oxygen
delivery to the myocardium and other tissues is further
decreased in alkalosis because of increased
haemoglobin oxygen affinity according to the Bohr
effectrdquo
bull Chelmowski MK Keelan MH Jr 1988 Hyperventilation and myocardial infarction Chest
May93(5) 1095-6
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull Fifty-five men were examined two months following a
heart attack Following a practice of breathing exercises
ventilation per minute significantly decreased from 185
to 98 litres
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull Carbon dioxide increased from 332 mmHg to 442
mmHg (normal CO2 is 40 mmHg)
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J
Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull The paper recommended that breathing retraining could
be an additional rehabilitation measure after heart
attacks
bull Vasiliauskas D Jasiukeviciene L 2004 Impact of a correct breathing stereotype on pulmonary minute ventilation blood gases and acid-base balance in post-myocardial infarction patients Eur J Cardiovasc Prev Rehabil Jun11(3)223-7
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
MYOCARDIAL INFARCTION
bull ldquoBreathing retraining has lasting effects on respiratory
physiology and is highly correlated with a reduction in
reported functional cardiac symptomsrdquo
bull Deguire S Gervirtz R Kawahara Y And Maguire W 1992 Hyperventilation syndrome and the assessment of treatment for functional cardiac symptons American Journal of Cardiology Sep 170(6)673-7
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
HYPERVENTILATION
DURING CPR
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
HYPERVENTILATION DURING CPR
bull In 13 adults receiving CPR the average ventilation was
30 breaths per minute None of the 13 adults survived
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
HYPERVENTILATION DURING CPR
bull Survival rates in the groups were as follows six out of
seven pigs treated with 12 breaths per minute one out of
seven treated with 30 breaths per minute and one out of
seven pigs treated with 30 breaths per minute plus
carbon dioxide
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening
problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
HYPERVENTILATION DURING CPR
bull ldquoAdditional education of CPR providers is urgently
needed to reduce these newly identified and deadly
consequences of hyperventilation during CPRrdquo
bull Aufderheide TP Lurie KG 2004 Death by hyperventilation a common and life-threatening problem during cardiopulmonary resuscitation Critical Care Medicine Sep32(9 Suppl)S345-51
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation
HYPERVENTILATION DURING CPR
bull ldquohyperventilation was common and that the persistently
high airway pressures are likely to have a detrimental
effect on blood flow during CPRrdquo
bull ONeill JF Deakin CD 2007 Apr73(1)82-5 Epub 2007 Feb 7 Do we hyperventilate cardiac arrest patients Resuscitation