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What This Cardiologist Is Telling His Patients About COVID-19

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R. Todd Hurst, MD, FACC, FASE - Blogs
By R. Todd Hurst, MD, FACCBoard-certified cardiologistMarch 19, 2020

The COVID-19 coronavirus has turned the world upside down. My heart disease patients are particularly concerned because of reports that they may be at even higher risk. 

Here are the most common questions I am hearing from my patients and what we know so far. However, I will emphasize that new information is becoming available regularly, and opinions and recommendations are subject to change.

I’m concerned about the coronavirus, what are the most important things I need to know?

Five critical things that we all need to do:

  • Stay home as much as possible. Minimize your social contacts.
  • Quit shaking hands.
  • Wash your hands — a lot. Wash them with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer.
  • If you have a fever, respiratory symptoms, or even stomach symptoms, isolate yourself and call your doctor.
  • Keep up your good health habits. Continue to exercise, eat nutritious food, and especially focus on your effective stress management techniques. 

While it is true that the majority of people will have mild illness with COVID-19, the reason we all need to follow the above recommendations is two-fold: To protect our more vulnerable population, and to do whatever we can to lower the risk of overwhelming our healthcare system and our healthcare professionals. 

I have heart disease, am I at higher risk?

The answer appears to be yes. Although it is too early to say what the death rate from COVID-19 is (and it likely is lower than reported due to lack of ability to test everyone), the American College of Cardiology notes that those with heart disease may have the highest mortality rate at over 10%. The point is not to cause more anxiety, but to emphasize the importance of infection avoidance if you have heart disease.

I have high blood pressure, am I at higher risk?

Again, the answer appears to be yes. Those with high blood pressure may have a higher risk from COVID-19. And, also like those with heart disease, we don’t know at this point if having heart disease and high blood pressure causes worse outcomes, or if these conditions are just associated with worse outcomes. Because heart disease and high blood pressure are so common, it is likely they are frequently found in those who have mild illness also.   

Should I continue to take my blood pressure medications, particularly ACE inhibitors and ARBs?

The short answer is yes. These are potentially life-saving medications, and there is currently no convincing evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) are associated with better or worse outcomes. Because the virus enters the target cells in the lungs through the ACE-2 receptor (and ACE inhibitors and ARBs increase these receptors), these medications have been called into question. Combined with early indications that high blood pressure is a risk for worse outcomes, it led to a hypothesis that these medications may be harmful. However, there is also evidence that these medications may actually be helpful. At this point, we don’t have any compelling information one way or another, and we know that stopping these medications can lead to serious adverse effects. Therefore, I strongly recommend to my patients to continue these medications until we know more.     

Does COVID-19 affect the heart itself?

Early information suggests that the heart may be affected by COVID-19.  Inflammation of the heart (myocarditis), the sack around the heart (pericarditis), heart failure, heart attack, and heart rhythm problems have all been reported. However, it is not always clear whether heart-related signs or symptoms are directly related to a primary issue with the heart, or related to the heart reacting to other problems in the body such as low blood pressure or low oxygen levels. Until we know more, the answer is that the heart may be affected in some people with COVID-19, but there is much more to learn.

Lastly, I want to express my deepest gratitude and support for my colleagues on the front lines in healthcare, the first responders, emergency room, intensive care, and primary care staff. These remarkable individuals who are already stretched thin in many cases are now being asked to give more at a time when they know that they are particularly vulnerable. Please support all of these heroes that you come across.

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About the Author
R. Todd Hurst, MD, FACC

R. Todd Hurst, MD, FACC, FASE, is a board-certified cardiologist, director of the Center for Cardiovascular Health at Banner – University Medicine Heart Institute, and associate professor of medicine at the University of Arizona. He has written more than 50 publications in peer-reviewed journals and regularly speaks nationally and internationally at medical meetings, primarily on the prevention of heart disease.

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