Heart patients’ guide to Covid-19

Having being diagnosed with a complication that has resulted long term heart treatment, means you need to be aware and mindful of anything that would trigger a complication. On behalf of you and your loved ones, we reached out to an Interventional Cardiologist and Physician at Mount Elizabeth Hospitals, Singapore. In this article, he has answered your questions on what could happen and how you can stay safe during this Covid-19 epidemic.

  1. Will my existing heart condition put me at higher risk of getting COVID-19?

COVID-19 is a highly infectious disease and can affect patients with or without existing illnesses. A large proportion of patients with COVID-19 may be asymptomatic or have mild “flu-like” illnesses. However, an estimated 10-20% of infected patients may become very unwell, develop pneumonia and life-threatening complications, including acute respiratory distress syndrome, multisystem organ failure, and death.

Patients with existing heart conditions are equally at risk of getting COVID-19 as patients without heart disease. However, if they get COVID-19, they are at much higher risk of becoming very sick and may develop severe complications. It is estimated that the risk of dying from COVID-19 is 5 times greater for a patient with underlying heart disease.

  • I have an existing heart condition, will getting COVID-19 deteriorate my current heart condition or cause complications?

Patients with existing heart conditions such as coronary artery disease, previous heart attack, heart failure or congenital heart disease are at high risk of becoming very sick if they have COVID-19 infection. Underlying conditions such as hypertension, diabetes mellitus and smoking habit will also increase the risk of an adverse outcome if a patient gets infected.

Patients with severe COVID-19 infection may develop cardiac complications such as myocardial injury, irregular heart rhythm and heart failure. If you have underlying heart conditions, there is a risk that COVID-19, like other severe acute infections, may worsen the underlying heart disease and trigger heart attack, life-threatening irregular heart rhythm or acute heart failure. The long-term impact of COVID-19 on heart conditions is currently not known.

  • How will doctors treat me if I have COVID-19 and complications from heart disease?

The management of complications from heart disease such as heart failure, heart attack or irregular heart rhythm is no different with or without COVID-19 infection. You will still need the necessary medicines, surgical procedures and supportive treatment that are guided by clinical evidence. Your doctors and nurses will however take special precautions and use personal protective equipment to ensure that the healthcare workers do not get infected as well.

The primary problem in COVID-19 is lung infection. Cardiac complications are usually a consequence of the overwhelming lung infection, hypoxaemia (inadequate oxygen) and systemic inflammation, and less commonly due to direct injury or infection of the heart. The cardiac complications in COVID-19 from reported cases mainly stem from the hypoxic injury due to pneumonia, septic shock and multi-organ failure.

Therefore, the main objective in treating COVID-19 is to deal with the lung complications and any systemic inflammatory response by using supportive measures. This involves (i) providing adequate oxygen supply through facemask, non-invasive ventilation, mechanical ventilation, or even extra-corporal membrane oxygenation (ECMO), and (ii) dealing with hyper-inflammatory response. Various therapies including immunosuppressants, steroids, antiviral therapies, immunoglobulin and anticytokines infusion have been used but it is still unclear what the optimal approach would be to target the severe systemic inflammation.

  • Due to the COVID-19 situation around the world, should I delay the treatment for my heart condition?

If your doctor has determined that your heart condition is serious, urgent or is an emergency, then you should not delay your treatment. This is especially important if it is your doctor’s opinion that delay in treatment may endanger your life. For example, if you have unstable symptoms such as chest discomfort or shortness of breath at rest, or if you have new and worsening symptoms, then you should certainly seek medical attention and treatment early. There have been reports that patients with suspected heart attacks have delayed going to hospital and this may have resulted in more severe complications such as heart failure and having to undergo more complicated cardiac procedures.

However, if your doctor has determined that your medical procedure or surgery is not urgent, and if your cardiac symptoms are stable (such as stable angina, mild chest discomfort or breathlessness on exertion), then you can delay your surgical or interventional procedure. It is still important to continue with the medicines your doctor has prescribed. You can also improve your condition by achieving good control of risk factors such as diabetes, hypertension, high cholesterol through healthy diet, regular exercise and by quitting smoking.

aDr. Stanley Chia

Credits: Dr. Shanley Chia

Dr Stanley Chia is an interventional cardiologist and physician at Mount Elizabeth Hospitals, Singapore.

He is experienced in managing complex coronary artery disease and a variety of other cardiovascular diseases and conditions. He also handles difficult coronary interventional procedures such as left main disease, chronic total occlusions and calcified lesions.

Dr Chia made significant contributions to cardiology education and training. Currently, he is the deputy chairman of the SingHealth Institution Research Ethics Committee, and previously also served as a member of the National Medical Research Council Scientific Review Panel.

He has published extensively on cardiovascular research in international peer-reviewed journals. He continues to play a major role in organising and speaking at numerous international and local cardiology conferences.

Hospital Credits: Parkway Hospitals, 389 Avissawella Rd, Nugegoda, Tel: 0112809000 | Hotline:+94 077 346 0000 | Mob: 0773508894 (Shuvo Hridayesh)

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