While each day brings new insights regarding COVID-19, there are still unanswered questions, especially from those with underlying heart conditions. With the help of Dustin Thomas, MD, PPG – Cardiology, we’re able to provide answers to those inquiries while taking a closer look at how the coronavirus can affect the heart.
There have been several cardiac complications reported in patients infected with COVID-19 including the following:
- Heart attacks: The COVID-19 virus can create an increased risk for further myocardial infarctions.
- Myocarditis: A virus can directly infect heart muscle cells. The body’s inflammatory response to COVID-19 can also damage heart function, which can increase the risk for potentially dangerous arrhythmias.
- Abnormal heart rhythms: There’s no specific arrhythmia that seems to be predominant, but arrhythmias have been reported in 17% of hospitalized COVID-19 patients. Additionally, many of the medications being publicized as potential treatments for COVID-19 infection can significantly increase the risk of fatal heart arrhythmias. Therefore, these medications should not be utilized without a prescription and close monitoring by a physician or provider.
- Blood clots: A severe infection can both increase the risk for blood clotting in the leg veins (deep vein thrombosis/DVT), lungs (pulmonary embolism) and arteries (heart attacks). An infection can also impair clotting mechanisms in the body leading to increased bleeding risk.
Does having a heart condition put me at higher risk?
Yes, patients with pre-existing cardiovascular disease appear to have an increased risk for severe disease and death if they become infected with COVID-19. Published data from Wuhan, China reported that patients with heart disease, high blood pressure and diabetes were more likely to require ICU admission if they became infected with COVID-19. The death rate amongst these patients is 3-5 times higher with these underlying medical conditions.
Am I at an increased risk of coronavirus if I have high blood pressure?
Yes, there appears to be an association with high blood pressure and severe COVID-19 infections. Information from Italy and Wuhan, China suggests that high blood pressure was present in 15-20% of patients with a confirmed COVID-19 infection. A significantly higher number of these patients required ICU care than those patients without high blood pressure. Also, the death rates from a COVID-19 infection in patients with high blood pressure were reported at 6%, compared to 2% for the general population.
Could my heart medication make me more vulnerable to coronavirus?
There have been several reports suggesting that one of the receptors within the body, utilized by a common high blood pressure medication, may also play a role in the mechanism for the virus to enter and infect cells. However, keep in mind, this data is very preliminary and certainly not a confirmed fact. Multiple experts have weighed in on this and unanimously recommended that patients currently on ARBs and ACE inhibitors should continue taking those medications without change. Additionally, these medications should continue to be offered to patients who develop medical conditions during the pandemic and in the future. Your cardiologist will keep you updated if newer information emerges that would change this recommendation. Please remember, ARBs and ACE inhibitors are very important, life-saving medications for many patients. Therefore, research would need to come to light proving that these medications create an increased risk of severe COVID-19 infection before these recommendations would change.
Should I continue my cardiovascular rehab if I contract COVID-19?
Yes, but with a caveat. In order to maintain social distancing and decrease the exposure of potentially high-risk patients, formal cardiovascular rehab in a hospital or facility setting should be postponed at this time. While quarantined, however, you should continue to perform as many daily cardiac rehab exercises as possible and gradually escalate your activity level as tolerated.
Are children with a congenital heart defect at increased risk?
There is limited data regarding COVID-19 infections in children with congenital heart disease. Data, primarily from China, suggests that children, in general, are much less susceptible to this infection. Possible reasons for this include stronger immune systems, fewer medical problems, cellular differences that may reduce the ability of the virus to infect and recent prior exposures to other coronaviruses. Despite this, moderate to severe illness has been described in children and it would stand to reason that children with significant underlying medical conditions would have the greatest risk in this scenario.
Does mild plaque build-up put me at an increased risk or lead to a worse outcome?
Unfortunately, that is unknown. Currently, much of the data in association with heart disease and COVID-19 is focused on patients with well-defined heart disease. This includes patients with heart attacks, heart stents, bypass surgery, heart valve surgery, heart failure, etc. Patients with mild heart artery plaque build-up, whether discovered by heart catheterization or coronary artery calcium scoring (HeartSmart CT Scan), are more accurately labeled as “pre-clinical” heart disease. If you fall into this category, I would recommend continuing to follow standard precautions including social distancing, wearing masks and gloves when in public, frequent hand washing and regular exercise.
If I am otherwise healthy, will contracting COVID-19 put me at increased risk for heart disease later?
This is also unknown. Currently, there is no evidence from prior endemic and pandemic coronavirus infections such as SARS, MERS, H5N1 or H1N1 that infection places people at future risk of heart disease. There is, however, clear evidence that the foods we choose to eat, the amount of exercise we get and the control of underlying risk factors for heart disease will affect your risk. Focusing on these things will have a much greater impact than COVID-19.
If I have heart issues, does my ethnicity increase my risk of Coronavirus?
Also unknown, but there appear to be indicators that African Americans with heart disease may be at risk for more severe illness, need for ICU admission and death with COVID-19 infection. Much of our data on racial and ethnic outcomes from this infection are limited because racial and ethnic information was not routinely obtained during testing. Additionally, current screening and testing rates are limited and vary greatly from region to region.