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Cardiac patients should not delay hospital visits due to Covid-19 fears – analysis


In the past three months, coronavirus disease (Covid-19) has stopped the world. Covid-19 is known to affect the respiratory system; In its mildest form, which is the case in more than 80% of those infected, it causes fever, sore throat, cough, and body aches that subside for a couple of weeks without any treatment. But some of these cases can be serious due to pneumonia, leading to dyspnea, which may need ventilation support. Many of these patients do not survive. Over the past six weeks, doctors have realized that Covid-19 also affects the heart in many ways, leading to the creation of treatment protocols by various national societies to control cardiac cases during the pandemic of Covid-19.

It is now clear that patients with pre-existing heart disease, previous heart attacks, or poor heart pumping efficiency (heart failure) are at increased risk of developing a serious Covid-19 infection. People over 60 with hypertension or diabetes have a five times greater risk of dying from it. On the other hand, even a mild coronavirus infection can lead to the worsening of previously stable heart disease, which needs urgent medical attention for stabilization. Therefore, cardiac patients should protect themselves from Covid-19 through social distancing, wearing masks, washing hands, and using disinfectants.

Cardiac patients should also maintain a healthy lifestyle during confinement by following indoor exercises and yoga regimens, a healthy diet, sleeping, participating in recreational activities, taking medications regularly, and staying positive. In the future, these protective habits should become the new normal lifestyle.

It has been realized that the virus can affect the heart in previously healthy individuals. The virus can cause severe inflammatory responses in the body that affect the arteries and, in addition, cause an increased tendency to clot. This can lead to heart attacks and strokes, and these can occur in younger age groups. The virus can also infect the heart muscle, causing myocarditis, which can be mistaken for a heart attack. This leads to decreased heart pumping efficiency, acute heart failure, shock, heart rate, and rhythm irregularities, and in rare cases, sudden death. This heart muscle injury is seen in 20% -30% of hospitalized Covid-19 patients with respiratory problems, and is reflected in markedly elevated levels of a commonly available blood marker test (Troponin I) and contributes to 50 % of deaths. These critically ill patients require advanced supportive care in the hospital.

Experts agree that patients now admitted with acute heart problems should be screened to exclude the coronavirus. After Covid-19 recovery, people with myocarditis can recover for weeks, but knowledge of this is limited.

Finally, there is an intriguing paradox observed during this pandemic that has implications for cardiac patients. Hospitals around the world, including India, have seen an approximately 50% decrease in the admission of patients with acute heart attacks, a medical emergency that requires life-saving treatment. Cardiologists have debated the causes of this. While pollution-free and stress-free lifestyles during the blockade could have resulted in lower heart attack rates, the inability to get to hospitals for treatment due to movement restrictions could be another reason.

But the biggest concern worldwide seems to be that, despite the fact that their heart condition is deteriorating, many patients may delay medical attention and treatment because they are afraid to go to the hospital for fear of being infected by the coronavirus. Evidence of this has been seen in Europe and the United States, where everyone requests an ambulance for medical emergencies, and accurate, centralized data is maintained for all medical events in the community.

While there are fewer cases of acute heart attack admitted to hospital emergency units, there is a marked increase in deaths from heart failure at home, likely due to postponement and delay in seeking medical care. Therefore, it is important to emphasize that cardiac patients should not ignore deterioration of symptoms and / or delay medical care.

Telemedicine consultation is now possible with most physicians for immediate advice. In addition, cardiac patients must feel confident that hospitals are open, doctors are working, and medical facilities are safe places with well-defined protocols established for elective and emergency treatment to keep patients protected from infection. So the clear message is: no cardiac patient should delay or postpone any treatment due to undue fear of Covid-19 if the need arises. Timely treatment saves lives.

As we fight coronavirus together and care for Covid-19 patients, millions of cardiac patients must be assured that their safety remains a priority for those of us in the medical profession.

Dr. Ashok Seth is a prominent clinical leader and president of the Fortis Escorts Heart Institute and president of the Asia Pacific Society of Interventional Cardiology.

The opinions expressed are personal.

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