Heart patients should not delay hospital visits due to Covid-19 fears
Over the last three months, the coronavirus disease (Covid-19) has brought the world to a standstill. That Covid-19 affects the respiratory system is known; in its milder form, which is the case in more than 80% of those infected, it causes fever, sore throat, cough, and body aches that abate over a couple of weeks without any treatment. But some of these cases may get serious because of pneumonia, leading to breathlessness, which may need ventilator support. Many of these patients don’t survive. Over the last six weeks, doctors have realised that Covid-19 also affects the heart in many ways, leading to the creation of treatment protocols by several national societies to manage cardiac cases during the Covid-19 pandemic.
It is now evident that patients with pre-existing heart diseases, previous heart attacks, or low-pumping efficiency of the heart (heart failure) are at a greater risk of developing serious Covid-19 infection. Those above 60 years with hypertension or diabetes have a five times greater risk of dying from it. On the other hand, even a mild coronavirus infection can lead to the worsening of previously stable heart disease, needing urgent medical care for stabilisation. Therefore, heart patients must protect themselves from Covid-19 by social distancing, wearing masks, washing hands, and using sanitisers.
Heart patients also need to maintain a healthy lifestyle during the lockdown by following indoor exercise and yoga regimes, a healthy diet, sleeping, engaging in recreational activities, taking medications regularly, and staying positive. Going forward, these protective habits should become the new normal lifestyle.
There has been a realisation that the virus can affect the heart in previously healthy individuals. The virus can cause severe inflammatory responses in the body that affect the arteries and, in addition, cause an increased tendency for clotting. This can lead to heart attacks and strokes, and these can occur in a younger age groups. The virus can also infect the heart muscle, causing myocarditis, which can be confused with a heart attack. This leads to decreased pumping efficiency of the heart, acute heart failure, shock, heart rate, and rhythm irregularities, and in rare instances, sudden death. This heart muscle injury is seen in 20%-30% of Covid-19 patients hospitalised with breathing problems, and is reflected in markedly raised levels of a commonly available blood marker (Troponin I) test and contributes to 50% of the deaths. Such serious patients require advanced in-hospital supportive care.
Experts agree that patients getting admitted now with acute cardiac problems should be tested to exclude the coronavirus. Following recovery from Covid-19, those with myocarditis may recover over weeks, but knowledge of this is limited.
Finally, there is an intriguing paradox observed during this pandemic that has implications for heart patients. Hospitals around the world including India have noted an approximately 50% decrease in the admission of patients with acute heart attacks, a medical emergency requiring life-saving treatment. Cardiologists have debated on the causes for this. While pollution-free and stress-free lifestyles during the lockdown could have resulted in lower heart attack rates, the inability to reach hospitals for treatment because of movement restrictions could be another reason.
But the biggest concern across the world seems to be that despite their heart condition deteriorating, many patients may be delaying medical attention and treatment because they are scared to go to the hospital for the fear of being infected by the coronavirus. Evidence of this has been seen in Europe and the United States, where everyone calls for an ambulance in case of medical emergencies, and accurate and centralised data is maintained of all medical events in the community.
While there are fewer acute heart attack cases being admitted to hospital emergency units, there is a marked increase in deaths from cardiac arrest at home , probably due to the postponement and delay in seeking medical attention. It is, therefore, important to emphasise that heart patients must not ignore any deterioration in symptoms and/or delay medical attention.
Telemedicine consultation is now possible with most doctors for immediate advice. Furthermore, heart patients should feel reassured that the hospitals are open, doctors are working, and the medical facilities are safe places with well-defined protocols laid down for both elective and emergency treatment to keep the patients protected from infection. So the clear message is: No heart patient should delay or postpone any treatment due to undue fears over Covid-19 if the need arises. Timely treatment saves lives.
While we fight the coronavirus together and take care of Covid-19 patients, millions of heart patients should be reassured that their safety remains a priority for those of us in the medical profession.