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- Hello, I'm Susan Arnold.
I'm a cardiologist
with Saint Luke's Mid America Heart Institute
and UMKC in Kansas City, Missouri,
and a volunteer for the American Heart Association.
We know there are a lot of concerns and questions out there,
about what the Coronavirus, or COVID-19, could mean
to people living with heart valve disease,
such as aortic stenosis.
Let's take a look
at some of the common questions we're hearing.
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At most hospitals, the scheduling of surgeries
and procedures is constantly being monitored,
balancing the risk of waiting
until there are fewer COVID-19 issues
versus the risk of proceeding now,
despite these infection concerns.
Generally, people who are at higher risk
in terms of their valve disease
are continuing to have their procedures done.
Whereas it may be safer for people
who are at lower valve risk
to wait a few months until things settle down a bit
at the hospitals.
I encourage people to discuss this more
with their physicians if there are any questions.
Trust that the physician is weighing many factors
when deciding whether to proceed or to wait,
including the ECHO, frequency of hospitalizations,
symptoms, other comorbidities,
as well as the local conditions in terms of infection risk.
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This is unfortunately a unique time,
when there are both risks of proceeding
and risks of waiting,
and we are constantly trying to balance these risks
in each individual patient.
When you're exposed to the health care system right now,
or you have a longer hospital stay,
there's a greater risk of being exposed to COVID-19.
People should be reassured
that hospitals are trying to keep all patients
with suspicion of, or with, COVID-19
separate from other patients,
as well as doing extra cleaning and sanitizing
to reduce this risk as much as possible.
If you get COVID-19 while recovering from a surgery
or procedure, either in the hospital
or when you return home,
the infection could be more difficult to beat.
However, it's also important to recognize,
that there's also risk
in waiting to do the surgery or procedure
until the infection issues are lower.
There's a reason we have scheduled the surgery or TAVR.
Severe aortic stenosis increases the risk of sudden death.
And so we wouldn't want to wait too long to intervene.
If the physician thinks it's important to proceed
with the surgery or TAVR during this time of COVID-19,
it is probably because he or she thinks
that the risk of you waiting is higher
than the risk of proceeding.
Understanding that this can be a tricky balance
between those two risks.
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The most important thing is to stay healthy
and stay as active as possible.
Physical distancing is important
so you don't get COVID-19 prior to surgery
or the procedure.
Therefore you should stay home as much as possible.
But it is also critically important
to maintain good nutrition, and keep up physical exercise
during this time.
The healthier you are going into the surgery or procedure,
the quicker the recovery.
And this means fewer complications, shorter length of stay,
and faster recovery after returning home.
It is also important to monitor symptoms
from the valve disease,
and notify the physician if things start to worsen,
as scheduling of the surgery or procedure
may need to be adjusted,
or the person may need to be seen,
either virtually or in person,
at the clinic or hospital,
for further medication adjustment.
While it's a good idea in general
to avoid the health care system at this time
to limit exposure to COVID, it is also really important
not to wait too long to get care if you need it
just because of these fears.
Finally, all people waiting to have surgery
or a procedure, should check their temperature daily,
and let the healthcare team know if it's over 100 degrees.
And many places are routinely testing people for COVID-19
before coming in for these surgeries or procedures
to avoid exposing staff to the virus.
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Generally speaking, we would expect COVID-19
to present fairly similarly in a patient with valve disease,
with fever, dry cough, shortness of breath
being the major things to look out for.
Due to the underlying aortic stenosis,
the shortness of breath may be worse
than in a person without valve disease.
But it's also important to note,
that not all shortness of breath is COVID-19.
People with aortic stenosis are still at risk
for progression of the valve disease or heart failure,
which would also often present as shortness of breath.
It is important in this situation
to not self-diagnose, but to seek care,
as either COVID-19 or worsening heart failure
from valve disease would be important things to treat
as early as possible.
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COVID-19 should not impact the severity
of the actual valve stenosis,
or make the valve more calcified.
However, as both COVID-19 and aortic stenosis
often impact breathing, the two conditions
could compound each other.
While COVID-19 can attack anyone,
people with underlying medical conditions
are at greater risk for developing serious illness
with COVID-19.
This is likely the bigger concern.
Not that COVID-19 makes the aortic stenosis worse,
but that the aortic stenosis could make COVID-19
harder to beat.
People with aortic stenosis,
or those who have just had a big surgery or procedure
and are recovering, have decreased reserves,
meaning they will have a more challenging time recovering
from any big illness or injury.
It is therefore incredibly important
to be extra cautions during this time
to avoid contracting COVID-19
with physical distancing, hand washing with soap
for at least 20 seconds, or hand sanitizer
containing at least 60% alcohol if soap is not available,
wiping down surfaces with disinfectant, wearing a mask
whenever in public, and avoid getting out in public
as much as possible.
You should also avoid touching your eyes,
nose, and mouth with unwashed hands.
We realize this is a challenging situation for patients,
but we're here to help with reliable information
based in credible science.
For the most up-to-date resources relevant to heart disease,
health and well-being, visit the American Heart Association
at heart.org/coronavirus.
And for the latest developments about coronavirus
precautions and government guidelines,
visit cdc.gov.
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