Coronavirus is especially threatening for people with heart disease


As the novel coronavirus spreads around the world, it primarily sickens people by affecting their lungs. But it is now becoming clear that the finishing blow for people who don’t survive might be to the heart. For the more than 120 million American adults living with heart disease, including many of my patients, these are understandably distressing times.

The experience of intensive care doctors managing covid-19 points to a dangerous turn many patients take. While the syndrome initially develops slowly, in some vulnerable people it can accelerate quickly, causing respiratory arrest and requiring artificial breathing with mechanical ventilators. Yet the patients who end up dying, says James Town, an intensive care doctor who has been in the thick of it in Seattle, actually die of cardiac rather than respiratory failure.

“A few of the patients we’ve had have also developed pretty profound cardiogenic shock, and those are the ones who have passed away so far,” he told NPR’s Lulu Garcia-Navarro. This cardiogenic shock was “more dramatic than just the respiratory failure that we kind of expected to see.”

The Centers for Disease Control and Prevention lists older adults and people with heart disease, lung disease and diabetes as the main high risk groups in this pandemic. Data published in the journal Lancet from patients admitted to hospitals in Wuhan with covid-19 shows that while not all patients have damage to the heart, it can be an ominous sign in those who do: evidence of cardiac injury was noted in 59 percent of those who died vs. only 1 percent of survivors.

Severe covid-19 infection can cause massive inflammation throughout the body, and if it affects the heart, the consequences can be dire. Fast, abnormal heart rhythms were responsible for 44 percent of Wuhan patients being transferred to the intensive care unit.

Laboratory tests of human proteins called troponins, which can indicate damage to heart muscle, can indicate which patients will probably do poorly.

While menacing heart complications usually occur late in the course of most patients with covid-19, some rare patients are presenting initially with extensive inflammation of the heart.

The CDC recommends that people at high risk, such as those with heart disease, take all the same precautions that apply to everyone right now — stay at home, avoid crowds, clean your hands and your surroundings often — but they should do some additional things:

●Make sure they and their caregivers have a phone number to access their medical team. For those who don’t have an established relationship with a heart care team, they should call their primary care physician or hospital or public health department hotline.

●Stock up on any medications, and if they’re running short, call the clinic or get your doctor to have refills called or routed in to a pharmacy.

●Make sure that basic medical equipment, such as a thermometer, a blood pressure machine and a weighing scale, is accessible.

●Monitor your body closely for signs and symptoms common in covid-19, including temperatures above 100 degrees, difficult breathing, coughing. A runny nose is much less common and more likely a sign of a cold or allergies.

●Let caregivers and a medical team know about these symptoms — they do not necessarily require going to the emergency room. Danger signs include worsening shortness of breath, chest pain, confusion or drowsiness and bluish lips. If any of these symptoms develop, call 911 or go to the nearest emergency room.

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