A Column by Olena Shapovalova, Interventional Cardiologist at "Dobrobut" Medical Network
Your heart during the COVID-19 pandemic: How to maintain your health and emotional well-being
The COVID-19 pandemic has affected all aspects of our lives. It’s hard to find a person who is not feeling anxious about themselves or their loved ones, who isn't stressed due to uncertainty, economic challenges, and the need to quickly adapt to new habits and rhythms of life.
In times of prolonged stress and information overload, critical thinking can decrease. Today, it’s not uncommon for people with cardiovascular diseases to stop taking their essential medications based on misinformation and emotions. Meanwhile, some patients who need urgent care, such as for a myocardial infarction, may avoid seeking medical help out of fear of getting infected. The consequences of such decisions can be severe. Beyond the clear human and economic losses caused by the pandemic, we will also need to assess the impact of self-treatment and delays in seeking specialized care for chronic conditions, particularly cardiovascular diseases.
In this article, I’ve compiled answers to the most common questions regarding COVID-19 that concern people with cardiovascular diseases.
Is it true that people with cardiovascular diseases have a higher risk of contracting the coronavirus?
Currently, there is no convincing data showing that chronic diseases increase the risk of contracting COVID-19. This also applies to various age groups. However, the severity of COVID-19 and the risk of complications can indeed depend on age and the presence of chronic illnesses.
The media is full of information that people with cardiovascular diseases are at risk. What does this mean?
According to most publications, patients with severe COVID-19 symptoms are predominantly older adults and those with chronic conditions, including cardiovascular diseases. It’s still unclear whether the more severe course of COVID-19 is due to the presence of underlying conditions, older age, or a combination of both factors.
However, it’s essential to remember that the data we have is incomplete. For instance, we don't know how many older cardiac patients had mild cases of the disease or were asymptomatic and never sought medical attention.
Which cardiovascular diseases could lead to a more severe course of COVID-19?
The virus damages the lungs and triggers a systemic inflammatory response. To ensure adequate oxygen supply to the body's tissues, the heart has to work faster and harder. People with heart failure, especially those with impaired blood flow in the pulmonary circulation (the lungs), may be at higher risk. Examples of such conditions include:
- Significantly reduced left ventricular ejection fraction, regardless of cause (dilated cardiomyopathy, ischemic cardiomyopathy, large post-infarct left ventricular aneurysm);
- Decompensated valvular heart diseases (mitral regurgitation, mitral stenosis, aortic stenosis, aortic regurgitation);
- Arrhythmogenic right ventricular cardiomyopathy;
- Unoperated cyanotic congenital heart defects.
I have ischemic heart disease. Do I have an increased risk of myocardial infarction if I contract the coronavirus?
A myocardial infarction occurs when an atherosclerotic plaque in a coronary artery ruptures. Theoretically, it could be triggered by the systemic inflammatory response that develops with COVID-19 (similarly to other acute respiratory diseases).
However, the number of hospitalizations for acute coronary syndrome has decreased worldwide, sometimes by 40-70%. This phenomenon is associated with the fact that many cardiac patients who truly need help are avoiding medical care due to fear of contracting the virus.
Is the coronavirus more dangerous for patients who have had coronary stenting, coronary artery bypass grafting, valve replacement, or pacemaker implantation?
There is no evidence that the virus can affect implants such as coronary stents, valve prostheses, or pacemaker leads. Data on poorer outcomes in patients after cardiac surgery procedures is also currently lacking.
If you’ve undergone cardiac surgery, contracting the coronavirus could, on the contrary, reduce your risk of complications, as the cardiovascular disease is under control and heart failure is compensated.
Given the current epidemiological situation, should I postpone my scheduled surgery?
Some cardiovascular diseases remain stable for years, while others can quickly progress and lead to severe health consequences. The best course of action is to consult with your cardiologist. Your doctor can objectively assess your situation and advise whether it’s safe to delay the procedure without jeopardizing your health.
I have a cardiovascular disease. What should I do if I experience shortness of breath or chest discomfort that I haven’t had before? Could this be a sign of COVID-19 infection?
Shortness of breath, chest discomfort, and chest pain can be symptoms of a coronavirus infection.
However, these symptoms are also characteristic of worsening cardiovascular conditions. In any case, if you experience new symptoms, you should inform your doctor and seek advice. If the deterioration occurs suddenly, with severe burning chest pain or extreme shortness of breath, don’t waste time—call an ambulance immediately.
I’ve heard that my blood pressure medications could worsen the course of a coronavirus infection. Is that true? Should I reduce the dosage as a precaution?
All global cardiology associations recommend continuing to take blood pressure medications, including ACE inhibitors and ARBs, during the pandemic. Reducing the dose or skipping doses could lead to poor blood pressure control, which may increase the risk of cardiovascular complications.
Is it true that taking ACE inhibitors during a coronavirus infection protects the lungs? What about statins?
Reports of potential protective effects of these drug groups in COVID-19 are still theoretical. Therefore, prescribing them specifically to protect against coronavirus disease is not advisable.
However, these medications are effective in preventing complications of ischemic heart disease and hypertension. Thus, people who were prescribed these drugs before the pandemic should continue taking them.
What drugs are used to treat COVID-19? Are they suitable for patients with chronic cardiovascular diseases?
Currently, no drugs specifically target COVID-19, and the presence of a medication in treatment protocols only indicates that it is permitted for use at the discretion of the physician. Specialists can prescribe such treatment to patients with cardiovascular diseases, but only after carefully weighing the pros and cons for each individual patient.
Should patients with cardiovascular diseases take vitamins for prevention? Do high doses of vitamin C help?
There is currently no data supporting the effectiveness of vitamin C in preventing COVID-19 in healthy individuals. Similarly, there is no evidence that high doses of this vitamin benefit patients with severe cases of the disease. For now, the best prevention remains social distancing, and the best medication strategy is to continue taking the medications you were prescribed earlier.
My relative is in the risk group. How can I help?
Your loved ones may be experiencing significant stress and anxiety right now. Help them navigate isolation and reduce the risk of cardiovascular problems:
Reassure them.
Yes, statistics show that people with cardiovascular diseases are at higher risk of complications from COVID-19. But this virus is new for all of us. We don’t have all the information, and age or chronic conditions should never be seen as a death sentence.
Provide nutritious food and medications.
This will help them avoid unnecessary trips to the store or pharmacy and allow them to feel your care and support.
Help organize a daily routine that includes physical activity and fresh air.
Physical activity is beneficial for both heart health and psychological well-being. Depending on the living conditions, this could involve a simple set of physical exercises, a “walk” on the balcony, or simply spending time near an open window. WHO recommends at least 150 minutes of moderate-intensity exercise per week.
Protect them from excessive negative and unreliable information.
Constant monitoring of pandemic news and applying statistics to themselves can be emotionally draining. Tell your loved ones about official sources of information. Try to establish a routine of checking the news only once a day—this will help them stay informed without compromising psychological well-being. The rest of the time can be spent on physical exercise, creativity, or reading books.
You can’t control everything in the world, but you can control your blood pressure. Follow simple hygiene rules, practice social distancing, and support each other. The time will come when the pandemic will recede.
If you need a consultation with a cardiologist, call us at 044/097 4952888.
This article was prepared and published for the “Novoe Vremya” resource.
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