Dr. Schechter, there is a lot written online about how COVID-19 affects the heart, but isn’t it a lung disease?
Dr. David Schechter: The primary issue for the sick COVID-19 patient is respiratory failure (failing lungs). The secondary, and related, cardiac issues are due to the heart being exposed to poor oxygen levels and having to pump blood against a high resistance into the lungs. Thus, in the acute setting, the heart issues are mostly likely due to the effects of the COVID-19 lung problems. Lacking more definitive studies at this time, I cannot speak to increased cardiac issues in the acute but uncomplicated COVID-19 patient.
I was short-of-breath while I had COVID-19. What should I do to make sure that my heart is okay?
Dr. Schechter: Firstly, congratulations on your recovery from COVID-19. Residual symptoms (shortness of breath, chest discomfort, palpitations) require prompt attention. Special attention should be given to patients who have baseline risk factors for heart disease, including, but not limited to, diabetes, high blood pressure, and positive family history. Immediate consultation with your physician is required for any new symptom development.
If I did not have cardiac symptoms while I had COVID-19, can I assume that my heart was not affected?
Dr. Schechter: People with baseline risk factors for cardiovascular disease, like high blood pressure and diabetes, etc., are at higher risk for cardiovascular complications in the short term. We do not have sufficient information for recommendations in the long term. However, caution is warranted and medical surveillance is recommended. More importantly for the general public, it is a well-known phenomenon following any viral pulmonary illness or bacterial pneumonia that a higher incidence of heart attacks and other cardiovascular problems occur in the ensuing few months following recovery. Please discuss your individualized situation with your physician.
I was not feeling well a few weeks ago and thought it could have been COVID-19, but my antibodies are negative. Do I still need to have my heart checked?
Dr. Schechter: It is now documented that COVID-19 antibody response may be short-lived and not documented on routine antibody testing. However, caution is warranted and medical surveillance is recommended. Please discuss your individualized situation with your physician.
Is there any connection with blot clots and COVID-19?
Dr. Schechter: The natural way that someone’s cut or wound stops bleeding is via blood clot formation. Unfortunately, blood can clot inside of arteries and veins in a diseased state. Virchow’s Triad is a well-known concept stating that blood clotting occurs in three ways, namely, slow blood flow (hemodynamic changes), diseased vessel wall (endothelial dysfunction), or an increased tendency of the blood itself to clot (hypercoagulability). For example, someone who sits on an airplane flight without getting out of the seat for many hours may develop a blood clot in the leg, presumably from a low blood flow state. COVID-19 patients are at higher risk for blood clots firstly due to lying in bed sedated. Although not documented, the vessel walls may be diseased and the blood may have a higher tendency to clot from the viral illness.
I heard something about COVID-19 patients being put on “ECMO”. What is this?
Dr. Schechter: ECMO, short for Extracorporeal Membranous Oxygenation, is a life support machine. ECMO is used in people with severe lung damage from infection or circulatory collapse after a major heart attack. Simply, ECMO replaces the function of the heart and lungs. This ECMO machine is connected to the patient through plastic tubes using the veins of the neck, chest, or legs. The blue (low oxygen level) blood is taken from the veins, then oxygenated outside the body, and finally pumped back into the arteries. This is similar to the heart lung bypass machine used in heart surgery.
I’m scared of catching COVID-19 at the hospital and want to avoid going. I also heard that there were long wait times. Should I still call 911 if I’m having chest pain in case I may be having a heart attack?
Dr. Schechter: Most inpatient hospital cardiac facilities are now fully available for acute heart attack care. The number one cause of death in this country is cardiovascular illness, so if you think you are having a heart attack, please do not hesitate to call 911 and seek immediate attention.
Q: My mother has heart failure and I have not seen her in a few months. If I tested negative for COVID-19, how long do I have to wait to see her?
Dr. Schechter: If you are negative for a COVID-19 swab and do not have symptoms, you can see your at-risk family member immediately with the understanding that no test is 100% accurate. It is important to keep social distance, making outdoor meetings more desirable. Face masks are added precautions.
Q: Is there any hope for medical treatment for COVID-19 infection, or do we have to wait for a vaccine?
Dr. Schechter: The World Health Organization is currently conducting a most needed study in 400 hospitals across 35 countries to establish the benefit and safety of Hydroxychloroquine, also known by the trade name Plaquenil. Plaquenil has been a safe medication for many years, used by many physicians, for the treatment of malaria and long-term treatment of rheumatoid arthritis and systemic lupus erythematosus. Unfortunately, given the very cheap cost of Plaquenil, the drug pharmaceutical industry today is desperately searching for more financially rewarding medications. Interestingly, the holy writ of medication in the US, namely the Physicians’ Desk Reference, clearly states its safety in pregnant women, while the vast majority of medications do not hold this honor. We all await the WHO investigation on safety of early Plaquenil treatment in the setting of COVID-19.
Q: My wife and I are in our 70s. Is it safe for us to go to a hotel?
Dr. Schechter: People who are at risk for developing severe, life-threatening COVID-19 infections must take added precautions in order to not contract a COVID-19 infection. Some known risk factors include, but are not limited to, age, high blood pressure, diabetes, and heart and lung disease. It is true that hand washing, gloves, masks, and social distancing are mainstays given that virus’s respiratory spread via air droplets and its prolonged lifetime on common surfaces. Please discuss your individualized situation with your physician in order to maintain your safety wherever you may be.