Heart disease is the leading cause of death in the United States. During February, American Heart Month, Keck Medicine of USC experts discuss how the pandemic has affected people with heart disease and what patients can do to protect their health.
What physicians have learned about COVID-19 and its effect on the heart
“Those with cardiovascular risk factors, from hypertension or high cholesterol to more sophisticated presentations such as coronary artery disease or heart valve problems, are at a higher risk of complications from COVID-19. This is because the SARS-CoV-2 virus tacks on a respiratory illness to an already taxed cardiovascular system.
“For some patients, even those without a prior heart condition, COVID-19 can cause blood clots to form in the lungs, known as pulmonary embolisms, which block the flow of oxygen to the lungs and can damage the heart. In addition, the body’s aggressive inflammatory reaction to the virus, where the immune system floods the bloodstream with inflammatory molecules called cytokines, can lead to serious cardiac issues, including heart failure and death.
“Another way the pandemic has affected heart health is that many patients are deferring care when they have life-threatening heart issues. Hospitals and clinics are very safe, with multiple precautions in place to protect patients from possible COVID-19 infection. We urge people to seek medical attention at the first sign of a heart problem.”
Special considerations for women’s heart health
“Although some may think of heart disease as a man’s disease, cardiovascular disease claims the lives of one in three women, with African American and Hispanic women at especially high risk of having undiagnosed cardiovascular disease.
“During the pandemic, one thing we are noticing is that women in particular are forgoing self-care because they are taking care of their immediate and extended families — working from home, overseeing virtual learning for their children and constantly multi-tasking to maintain their family’s safety and well-being during these unprecedented times. They may ignore or delay care for heart-related issues because they aren’t aware that heart disease can present differently in women than men.
“For example, when women have a heart attack, they are more likely to present with symptoms such as neck or jaw pain, shoulder, upper back or abdominal discomfort, shortness of breath, vomiting or unusual fatigue rather than the typically expected chest pain or angina. We continue to urge women to be attuned to their bodies and make their health care as much of a priority as everyone else’s in their lives.”
— Vivian Mo, MD, is a cardiologist with Keck Medicine and director of the USC Women’s Cardiovascular Center. She serves as interim chief of the Division of Cardiology and as chief medical officer of the USC Care Medical Group.
How COVID-19 is affecting cardiac surgery
“We seriously weigh the risks and benefits of proceeding with treatment of patients with heart disease during the pandemic. For some patients, such as those needing valve or coronary artery surgery, it’s important to move forward because we feel these patients will be in a better position to withstand COVID-19 after surgery should they become infected.
“If a patient with heart disease is COVID-19-positive, in general, we would wait to do surgery until the patient is COVID-free, unless we determine the surgery is lifesaving. As long as physicians are in communication with their patients and monitoring them regularly, many patients can safely wait for surgery until their COVID-19 is resolved.”
— Vaughn Starnes, MD, is a cardiac surgeon with Keck Medicine and surgeon-in-chief at USC Norris Cancer Hospital and Keck Hospital of USC. He is also chair of the Department of Surgery at the Keck School.
Steps patients with heart issues can take to protect their health during the pandemic
“The main question we get from patients is, should I continue to take my heart medications, such as aspirin or blood pressure or cholesterol medication. The answer is yes. These drugs not only treat heart disease, which is a major risk factor for severe COVID-19 illness, but research also shows they may be beneficial should a patient come down with COVID-19. If patients have any questions or concerns, they should consult their physician. Telehealth has made it especially easy to touch base with doctors.
“Given patients’ high-risk status, we also advise them to follow all COVID-19 public health recommendations such as mask wearing and physical distancing. And when they are offered the vaccine, they should take it as soon as possible.”
— Ajay S. Vaidya, MD, is a heart failure cardiologist with Keck Medicine specializing in heart transplants and an assistant professor of clinical medicine at the Keck School.