Hollywood Myth: Heart Injections Actually Do Something!


Myth: Injecting medicine straight into your
heart can be beneficial in some way. Ah, the dramatic scene that ends with an actor
stabbing a needle straight into their heart, narrowly escaping death and magically curing
whatever ailment just befell them. While very dramatic, it’s also very untrue and an exceptionally
bad idea if your goal is to get better. In the end, it doesn’t matter whether or
not the medication attempting to be delivered would actually work in the described situations;
this myth comes down to one thing: if you stick a needle in your heart, you will bleed
to death from the small hole you just placed there. Just like a balloon, if you put a hole
in it, it’s really hard to keep the air from escaping. The other problem with this
method of delivery is your lungs. The chances of you putting a hole in one of them, as well
as your heart, is pretty good. Not only would you be bleeding to death, you would be really
short of breath while you slowly died. The truth is that there are much easier ways
to get medication to your heart. Medication requiring a needle has two options that are
much better than a hole in your heart. The preferred method is starting an IV and giving
it to the person through their veins. Considering most people have their entire blood volume
pumped throughout their body in about a minute (depending on a person’s heart rate and
left ventricular ejection fraction), medication delivered this way would reach the heart rather
quickly. If you can’t get the medication in a vein, numerous types can simply be placed
in any muscle group and have it reach your heart in under 5 minutes. Currently, there is no treatment in modern
medicine that requires a doctor to stick a needle into your heart. The closest is called
a pericardiocentesis. This procedure involves a doctor sticking a needle into the sac surrounding
the heart (pericardium), in an effort to remove excess fluid that’s putting pressure on
the heart (cardiac tamponade). They even take great care not to advance the needle too far,
causing it to rupture the heart itself. As they know, a hole in your heart is a bad thing. While the method of medication delivery in
this myth is easily debunked, it does make one wonder what else about this treatment
presented in movies is also false (or true). Never to be one that leaves a person wondering,
let’s break apart arguably the two most famous Hollywood scenes that used this treatment
and see if we can’t reveal some other interesting facts while doing so. Scene #1- Pulp Fiction: In which John Travolta
needs to give an injection of “adrenaline” straight into the heart of Uma Thurman’s
character, presumably altering the effects of the heroin she just snorted, thinking it
was cocaine. After stabbing her heart, she immediately wakes up and is completely fine. When a medical professional gives a person
an “adrenaline” shot, the medication in question is called Epinephrine. Epinephrine
has many uses in medicine, including cardiac arrest, allergic reactions, asthma attacks,
and helping with acute low blood pressures, to name a few. It’s a hormone and a neurotransmitter
that acts on several different types of nerve cells. The response involves the stimulation
of your “fight or flight” nervous system (sympathetic nervous system). While beneficial
in many aspects, it’s usually never given in a heroin overdose. Unless of course the
person’s heart has stopped, then maybe. Even in that situation, you would also need
to preform CPR and defibrillation (shocking) to be helpful. Heroin is in a drug class called an opioid.
Other opioids include codeine, morphine, oxycodone, methadone, and fentanyl to name a few. (Aside:
Heroin was originally marketed as a non-addictive cough medicine by Bayer. You can learn more
about this in Episode #182 of this podcast: When Heroin was Marketed as a Cough Medicine) In any event, one of the biggest problems
with these types of medications, and usually the cause of the person’s death in an overdose,
is respiratory depression or failure. When the person takes too much, the person can
begin to breathe slower and shallower, or stop breathing all together. The heart will
soon stop once this happens. Giving a person epinephrine in this situation wouldn’t help.
While theoretically you might get some respiratory increase, although I can’t find any study
that shows this, epinephrine would wear off long before the heroin, leaving the person
still dead. There is, however, a medication that can have
the same effect as adrenaline did in the movie. It’s called Naloxone. Developed in the 1960s,
it’s known as an opiate antagonist. It’s the drug of choice for treating any opiate
overdose. When given, it will bind to the receptor site’s opiate drugs do, in effect,
knocking them off the cells and not allowing the drug to work its magic. The effect is
rather quick and nearly absolute. It can take a person from not breathing and unconscious,
to completely awake and “sober” in about a minute. There can, however, be some complications
from using it. The drug itself doesn’t last as long as
an opiate does, so there is a chance the person could stop breathing again. Due to the fact
that the result is so absolute, if the person is an addict, completely taking away all of
the effects of the opiate could cause them to immediately go into withdrawals. The results
of those can be things like nausea, vomiting, muscle cramps, diarrhea and seizures. From
the author of this piece’s personal experience treating these types of overdoses, he states
that the two most common problems are the person’s violence just after they realize
you took their “high” away, followed almost immediately by them throwing up all over you.
Don’t do drugs kids! In the end, this movie had Uma Thurman’s
reaction to an antidote correct. They simply chose the wrong medication and a completely
wrong delivery method. Scene #2- The Rock: In which Nicholas Cage
has to inject Atropine straight into his heart to counter the effects of VX poison gas. In this scene, the movie makers got most of
it right. There is such a thing as VX poison gas and part of the treatment for an exposure
is Atropine. VX is classified as a lethal nerve agent.
Like most nerve agents, VX works by inhibiting an enzyme called Cholinesterase. The result
is a build up of a neurotransmitter called Acetylcholine within the body. This build
up causes an over-stimulation of glands and muscles. The results are things like dilation
of your blood vessels, slower heart rates and constriction of the bronchioles in your
lungs. All of this happens while simultaneously you’re subjected to what is known as SLUDGE-
“SLUDGE” being an acronym for excessive Salivation, Urination, Defecation, Gastric
irritation and Emesis caused by exposure to the toxin.
If you become exposed, the toxin causes you to stop breathing due to the over-stimulation
of your diaphragm (and many other muscles)- all of this while leaking fluids from most
every orifice of your body. The treatment for this does include atropine.
It also includes a drug called Pralidoxime. Pralidoxime helps by reversing the effect
on Cholinesterase thereby helping to reduce the amount of Acetylcholine in the body. Atropine
helps by competing with Acetylcholine at its receptor sites, reducing its affect.
The recommended treatment for exposure to this type of toxin includes the use of both.
The military, and some civilian emergency services, use what is called a “Mark 1 kit”
that has both medications in an auto-injector. No, it doesn’t inject anything in to the
heart for the aforementioned reasons. The recommended sites are on the thighs and hips.
While this movie did get some of the treatment right, it got the delivery method completely
wrong, but a gigantic needle to the heart is certainly slightly more dramatic I suppose.
Just don’t try that at home kids.

96 comments

  1. So, SergeantSprinkles was full of horse apples and Pinkie Pie would've killed Rainbow Dash outright.

    Cupcakes reference.

  2. Adrenaline is called epinephrine only in North America. The rest of the world calls adrenaline just adrenaline. And yes, I know, some people will point out that "epinephrine" is documented earlier than "adrenaline", just as with "aluminum" vs. "aluminium". You're still alone though.

  3. If you use an auto-injector on someone's chest in the heart area due to ignorance what happens? Would it kill them if it missed the rib cage? How long are auto-injector needles? Why on the thigh?

  4. My dad told me stories of when he was in the Navy, there was a group of guys who would steal the atropine syringes, stick themselves in the leg and spend the weekend spaced out of their minds. Future presidents, I'm sure.

  5. had an epinephrine pen in my gas mask bag in the Navy. Also had another pen as I recall it was referred to as 2 pam chloride to be used if the epinephrine was ineffective.

  6. There is a 'myth floating around' that you should shock a heart when it has gone into asystole (stopped beating). This is untrue. Electric shocks (defibrillation) are used to treat fibrillation; Where the heart muscle fibres contract in an uncoordinated fashion. The shock will temporarily override the chaotic signals in the heart, hopefully allowing them to contract in a coordinated fashion again.

    Also what a bizarre choice the picture at 5:38 was, it looks like some kind of bird spine maybe?

  7. I know that today the proper way to counteract an opiate/opioid overdose is to use naloxone, but before naloxone became widely used they did use adrenaline for opiate overdoses.
    I can't remember the name of the documentary but it takes place in the US in the early 90s where the film crew follows a group of Heroin addicts throughout their lives, anyway when one of them overdoses and they can't wake him up the paramedics gives him what they say is adrenaline and I'm not sure why they would lie.

  8. I know that today the proper way to counteract an opiate/opioid overdose is to use naloxone, but before naloxone became widely used they did use adrenaline for opiate overdoses.
    I can't remember the name of the documentary but it takes place in the US in the early 90s where the film crew follows a group of Heroin addicts throughout their lives, anyway when one of them overdoses and they can't wake him up the paramedics gives him what they say is adrenaline and I'm not sure why they would lie.

  9. I was thinking that I have never seen such a thing happen in a movie and then you come up with two movies I have seen. Now that I think of it isn't there such a scene in either Crank or Crank 2?

  10. I am curious where the needle to the heart idea came from. I do remember questioning the scenes but I had assumed someone had at least asked a doctor how to administer the medicine so I let it pass as a plot point not instruction. Aside from the hole in the heart/lungs which did occur to me I also thought it a bit clumsy in that while stabbing a knife into the heart could be certain of hitting the target, stabbing a needle into the heart chanced that the needle would be deflected by the ribs into another direction and/or possibly breaking the needle on the rib bone which would mean that the medication would not reach the heart at all.

  11. I think you need to explain why this video almost completely contradicts the Wikipedia article on intracardiac injection. In my opinion the mere fact that the phrase 'intracardiac injection' exists suggests there's more to it than you've implied, Irrespective of whether you believe Wikipedia as a reliable source or not.

  12. Actually I have done transthoracic intracardiac (left ventricular) injections of epinephrine many times during resuscitations.

  13. I knew the atropine part. My parents worked on one of the military bases in Germany that serviced the nuclear bombers and they were trained in case of chemical attacks on the base.

  14. CORRECTION: Pralidoxime does not "reverse the effect of cholinesterase" but reactivates cholinesterase which was previously deactivated by the organophosphate gas. Otherwise, well explained.

  15. I watched the pulp fiction scene and said out loud "isn't there a lung in the way and isn't there now a massive hole in her heart?"

  16. Interesting video – one question though: in most needle-to-the-heart scenes, the needle is long, but very thin. Wouldn't clotting action seal such a tiny hole before you had a chance to bleed out?

  17. in the US adrenaline shots are used and done straight to the heart but only as a last resort and has fallen out of last resort use in the past decade.

  18. I had an IV in my heart once. I was really dehydrated and the nurses couldn't get an IV in my veins so the doctor had to do a mini surgery and put an IV in one of the arteries in my neck. The doctor put it too far in so he had to pull it back a bit.

  19. The real kicker about The Rock's scene is that the VX is falsely shown as being intensely corrosive. In that situation, an injection would do squat to stop you from melting.

  20. I wonder if any of this confusion relates to intramedullary transfusion? That procedure does involve forceably jamming a great big needle into someone's chest. It's very rarely performed, though.

  21. Do you think it comes from people seeing the treatment for a pneumothorax and were just mistaken about what was happening?

  22. Pharmacologic Cardioversion. They usually thread a catheter so it dumps the medication directly into the heart, but a direct injection could work. Apparently hurts like hell as it works by stopping the heart for a few seconds.

  23. I thought of another "secret" movie which features a reviving injection of epinephrine/adrenaline straight into the heart, and was also immediately followed by defibrillation shocks to maximum effect. Here's the key clue: both of them were administered automatically.

    Can you guess the movie?

    Of course, it's the live-action "Street Fighter", with Jean-Claude Van Damme, Raul Julia, and Kylie Minogue…one of my favorite "shameful secret" movies along with "Johnny Mnemonic" and others.

    When it appears Gen. M. Bison is done for at the hands of Col. Guile, computers detect his waning life-signs and command his sophisticated (and ridiculously stylish) suit of armor to administer both an auto-injection of adrenaline and shocks to the heart to revive him. Thusly restored, he fights on against Guile, revealing his suit's powers of electromagnetic energy control.

    So, did you get it?

  24. Not to mention the place where Uma Thurman is "injected" wasn't even the heart. It would have likely punctured her left pulmonary artery. Heaven forbid you miss the spot between the ribs. From the height travolta started at there was a good chance the needle would have hit a rib and bent all to hell.

  25. In CSI, they accidentally start cutting into a man that is merely unconscious rather than dead. They end up injecting a clotting agent directly into his heart to stop the bleeding. It seems like the clotting would make the hole less deadly, but I imagine clotted blood in your heart would stop it altogether.

  26. I was woken up from an OD with an injection before and it definitely wasn't naloxone. I didn't go into "rapid withdraw". I was intensely alert but my equilibrium was gone. The EMTs were aware of all of my reactions to the drug like they had a play by play. They saved my life. What I'm saying is there was no heart resuscitation needed. I jumped up like uma did.

  27. As a medical student who is studying anatomy of the heart right now, I can confirm that you got everything 100% right (and also helped me to remember some stuff I often forget).
    Love your videos, keep up the good work.

  28. "…reducing its affect." Illiteracy strikes once again in the subtitles of this video series. "Effect" dear boy, not "affect." God give me strength!

  29. This does actually do something. I don't get what you mean by death by inter-cardiac hemorrhage being a certainty, when we have the thoracotomy-and-suture technique. One well known technique is using a Foley urinary catheter and giving fluids directly into the heart.

  30. I liked this video. However if "injecting" a medication straight to the heart isn't a "good" delivery method why are PICC lines used?

  31. Inter cardiac Injections used to be part of Cardiac Arrest Treatment in hospital. Has not been part of the protocol since early to mid 1970s. Same technique as Pericardiocentesis

  32. bullshit. I was revived from technical death with an adrenaline shot in the heart. This guy talks so much crap and should stay off medical topics to avoid getting sued – apart from possibly killing someone. This is one of those YouTube channels doctors roll their eyes about

  33. Those 2 step military auto-injector pens are nuts, by the way. We used to trigger them through sheets of plywood to demonstrate to be recruits how much per they have… INSANE!

  34. Regarding Pulp Fiction, Uma Thermans character seems to be a frequent drug user and would have known the problem as soon as she started snorting because Cocaine and Heroin taste completely different.

  35. You might do a video on the fact that almost all so-called opioid overdose deaths are actually the result of mixing opioids with alcohol or benzodiazepines

  36. "Here it comes again, straight through the heart! In the middle of the heart! Yeah, don't stand still, they'll get you right through the heart!" Guess the band/singer.

  37. Injections into the heart are done as part of resuscitation procedure. So not a myth but shown incorrectly by Hollywood.

  38. This is how my uncle died, he had to get a penicillin injection into the hart to cure his malaria , in the army. years later he died because of the blood leaking into unwanted cavitys in the hart

  39. At ~7:10 I'm not sure what is being shown, it looks like fish bones in the guys neck…? Fairly sure we aren't fish people… 😕

  40. Another de bunkable Hollywood BS, is when they inject a moderate amount (10-20ml) of air in a peripheral IV thereby killing the person.

  41. I think i heard there is a procedure that injects to the heart but its highly discouraged for the obvious reasons.

  42. From:
    https://www.reddit.com/r/askscience/comments/miay4/how_accurate_is_the_adrenalineshottotheheart/

    Former paramedic that used to work in a very heroin-heavy town… First problem with the movie scene was that they used Epinephrine (Adrenaline). Under most treatment protocols you would only injection epi via inter cardiac injection if the patient was in full arrest and no other treatment was working. They had actually stopped all inter-cardiac injections about a year after I got my license (around 1991).
    As was stated, Narcan is used for opiate ODs. In can be administered IV (fast usually within 30 seconds), sublingual injection (works within a few minutes), Inter-muscular (works within 10-15 minutes). It can also be administered via Endotracheal tube and via inter cardiac injection although there are usually better avenues to utilitze first.
    Over my 10 year career I probably gave 200+ doses of Narcan. Most people slowly wake up over the course of 30 seconds however I have had a few sit bolt upright like Ms. Wallace did after her injection.
    It's fairly easy to send an opiate addict into withdrawals so ideally you want to slowly titrate it to where the patient was breathing but still enjoying their buzz. In practice, it wasn't always practical. I had patients passed out in sewer pipes, wedged behind toilets and almost everyone had destroyed most of their IV access

  43. They did the adrenaline to the heart thing in Firefly a couple of times too. Not a movie, I know, but that's what stood out in my mind when clicking the vid.

  44. I think the saying "you will bleed to death from the hole you just placed there" is a bit misleading. Intracardiac injections of epinephrine were used successfully in the most extreme types of cardiac arrest from 1983-1990, with 7.7% of people who received the procedure actually being discharged from the hospital alive. https://www.ncbi.nlm.nih.gov/pubmed/2156705

  45. Normally I love this channel, but there have been a couple of videos with inaccurate information, and this is one of them. Intracardiac injections are a real thing, they just aren't really done anymore and definitely not the way Hollywood portrays it. Until about the 70s (when advances in medicine made them obsolete) intracardiac injections were given in absolute emergencies of cardiac arrest. So, the "shot to the heart" the way it is portrayed in movies is completely false, however the procedure is not.

    http://accessemergencymedicine.mhmedical.com

  46. Current AHA Guidelines (2010) on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommends:

    Use of intravenous/ intraosseous (into the bone) route of adrenaline infusion.

    However, intracardiac injection of adrenaline can be given during open heart surgery (when there is minimal risk of lacerating an artery), and/or when no other route is available. (Ref: Aitkenhead AR (1991) Drug administration during CPR: what route? Resuscitation 22: 191-195)

  47. Speaking of things you've seen on screen and wondered about, was trial by combat ever actually real, or is it another Hollywood invention?
    https://www.youtube.com/watch?v=Lns303qI7NY

  48. The “debunk” video must be debunked. As someone stated down below, it seems like the adrenaline into the heart was in practice in the 70s.

    In Martin Scorsese’s documentary American Bot Steven Prince retells using it with his fellow addicts. He revisits the story years later in 2009.

    https://youtu.be/yV-tXWwohAU

  49. I got poked in the heart! I had to have a PICC line put in( a small tube that goes in the vein in an arm and stops right before the heart) to inject potent antibiotics to treat Lyme disease. The second and last time i had it put in they went a little far and poked me in the heart with it. That was very unpleasant, tho not as unpleasant as 3 months of treatment. Don't get Lyme disease kids. That was 10+ years ago and i still have a bit of bells palsy from it. Among other reasons. Damn US govt!

  50. Paramedics used to do direct cardiac injections for full cardiac arrest and surprisingly it brought a lot of them back

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