(uplifting music)
- Why do people with pre-existing heart disease
seem to have a greater risk of severe COVID-19?
We know from epidemiologic study
that patients with severe COVID-19 are more likely to have
high blood pressure or hypertension,
coronary artery disease, diabetes,
congestive heart failure and obesity.
We know that anyone with pre-existing heart disease
is always at a higher risk for doing poorly
when they develop anything that's a stress to the body,
like a bacterial or viral infection.
The combination of diabetes, high blood pressure
and obesity may confer a poor outcome
but the reasons for this are still not well understood.
Is high blood pressure a risk factor
for severe COVID-19 infection?
We have observed during the COVID-19 pandemic
that patients with high blood pressure
are at higher risk of severe disease.
However, there are several caveats to this.
First of all, hypertension is a highly prevalent disease
in our population meaning that many people have
high blood pressure and are being treated
with medications for this.
Second, we know that as people age
the prevalence of hypertension increases with age.
Since COVID-19 has more serious effects on older adults,
it is not unusual to see that more patients
will have high blood pressure.
Are certain blood pressure medications,
such as ACE Inhibitors and ARB's,
also a risk factor for COVID-19 infection or illness?
ACE Inhibitors and ARB's are commonly used medications
to treat hypertension or high blood pressure,
coronary artery disease and congestive heart failure.
The SARS-CoV-2 virus, also known as the novel coronavirus,
enters cells in the lung through the
angiotensin converting 2 enzyme.
When the virus attaches it to the cells
and then enters the cells through this enzyme.
Doctors and scientists have been investigating
whether there is a link between the use of medications
like ACE Inhibitors and ARB's
and the development of coronavirus.
As of right now, we have no evidence to say that the use
of these medications leads to severe COVID-19 illness.
The American Heart Association
and the American College of Cardiology,
both large societies here in the United States,
have recommended that patients
do not stop these medications.
These medications are very important
in the treatment of heart disease
and stopping these medications may lead
to the decompensation of your heart disease.
As of right now, we recommend that you continue
taking your medications and speak to your physician
if there are any changes in your condition.
If you are having newly diagnosed high blood pressure
or heart disease your physician may decide
which medication is best for you for treating
these conditions in the setting of the COVID pandemic.
Is there truth to reports that COVID-19 infection
can impair heart function and even cause heart attacks?
The short answer to this question is yes.
Let me explain to you why.
First, in the setting of COVID-19 illness
your body is going to work very hard to combat the disease.
In patients with pre-existing heart disease
the heart is going to have to work harder during the illness
and in the setting of this it may lead to some heart damage.
We measure a enzyme called troponin,
which is found in your heart muscle
and is released into the bloodstream during heart damage.
We do know that any elevation in this heart enzyme troponin,
can lead to serious poor outcomes.
Second, we know that the virus
can cause critical illness in patients.
It is well known that when the body
is working very hard under the stress
of illness, that the heart function may decrease
and this is called stress induced cardiomyopathy.
This type of illness typically improves as the body heals.
The virus itself can also effect the heart muscle.
It can infect the heart
and also causes decreases in heart function.
Finally, we know that the body can have
a profound inflammatory response
to the virus
and this is something called cytokine storm.
In the setting of all the inflammation in the infection
we have also noted that patients
can have a hypercoagulable state.
This means that the blood has a higher propensity to clot
and this can lead to things like heart attacks and strokes.
What is a pulse oximeter, and is this a good
at-home diagnostic tool for COVID-19?
A pulse oximeter is a small portable device
that can measure the oxygen saturation
in your red blood cells.
It is typically a small device
that slips over the top of your finger.
The device emits light and through this light
it is analyzed and you can measure the saturation of oxygen.
You can make this measurement while you're
sitting in a chair or laying in your bed
but it is also very helpful to take this measurement
while walking around in your home.
If you notice changes with your oxygen saturation
while you're walking around or while you're at rest,
you can then call your physician
to take the next steps in your treatment.
When would you recommend heart disease patients
use video visits to see their doctor?
During the COVID-19 pandemic
telemedicine has really taken off.
This has been a great way for patients
to connect with their doctors during this time
when we are practicing social distancing.
We encourage all of our patients to reach out
to their physicians offices and schedule a video visit,
both for sick visits and routine follow-ups.
Please take note of your symptoms
like chest pain, shortness of breath,
decreased ability to walk around or lightheadedness.
Experiencing any of these symptoms should cause you
to call your doctor's office
and schedule a visit to speak with your physician.
Routine follow-ups are also extremely important
to help ensure that all of your patients
stay healthy during this time.
Some tips to help you get the most out of your video visit
is to measure your blood pressure and heart rate
on a home blood pressure monitor, check your weight
and have all of your medications close by
in order to review with your physician.
Not only can your physician review all the things
that are needed to keep your heart healthy,
but you can review the prevention of coronavirus
and all the signs and symptoms of COVID-19
and in this way make a plan with your physician
in case you start to feel ill.
What should people do if they feel they are having
a cardiac event, heart attack or stroke?
If you are experiencing any of the signs of a heart attack,
such as chest pain, shortness of breath, lightheadedness,
dizziness or loss of consciousness,
please do not ignore these symptoms
and do not hesitate to call 911
or go to the closest emergency room.
In addition, if you are experiencing
any signs or symptoms of stroke, such as slurred speech,
asymmetric facial symmetry, numbness or tingling
on one side of your body or the inability
to move your arm or leg again,
please do not hesitate to call 911
or go to the closest emergency room.
I want to reassure all of you
that you're emergency room physicians
are ready to evaluate you
and treat you for these conditions.
Please do not be afraid to come to a hospital.
We will take care to prevent the spread of COVID-19,
take all of the proper precautions
and we are ready to do all the necessary procedures
to treat patients who are having heart attack and stroke.
(uplifting music)