Sunday, 15 March 2020

Coronavirus & Heart Disease: What You Should Know

Patients with pre-existing heart disease are concerned and confused about the potential impact of the coronavirus, known as COVID-19.  Here are some questions I get asked and their answers. The challenge is that there is much about COVID-19 that we do not fully understand just yet.  
Query 1:  What Is A Coronavirus? This name has been around for quite some time. In fact, it is important to understand that there are several strains of coronaviruses that have been identified by researchers over the years. These viruses begin by infecting animals, evolve, mutate, and are eventually transmitted to humans. These viruses are responsible for causing an array of illnesses from a common cold to SARS and MERS (Middle Eastern Respiratory Syndrome)  
Query 2:  What Is COVID-19? COVID-19 is the abbreviated name of this virus which stands for “coronavirus disease 2019”.This is a new, or novel, virus of which we know little about. Corona refers to the crown-like appearance of the virus as seen when magnified. According to the Centers for Disease Control (CDC), the origin of the COVID 19  is from bats. While the initial detection of COVID-19 was in  China, the virus has quickly spread across the globe. COVID-19 spreads from person-to-person through droplets when a person coughs or sneezes close to another person – exactly similar to the common cold.
 Query 3:  What Happens When A Person Becomes Infected With A Coronavirus? Generally speaking, coronaviruses target the respiratory system of their host. These viruses reside within the airway of its host and begin to replicate by injecting their genetic code into host cells. Most of those infected will experience mild-to-moderate symptoms that do not require major medical intervention. Some may have no symptoms. However, in about 20%  there maybe more severe symptoms, organ failure, and death.  
Query 4:  What Are The Risk Factors of COVID-19? Persons aged 60 and over, men, in particular, are more likely to experience severe symptoms and possibly fatal outcomes after contracting COVID-19. Those with pre-existing underlying health conditions, acute or chronic – including heart and lung disease and diabetes - are more likely to develop complications from the virus. Health care workers that care for patients People with an already compromised immune system  
Query 5:  What Are The Symptoms of COVID-19? Symptoms of the virus include fever, dry cough, fatigue, and shortness of breath. There have been reports of muscle aches, sore throat, abdomen discomfort, and nausea.  Query 6:  How Contagious Is COVID-19? It is highly contagious. It is shared between an infected individual and others by close (less than 2 meters) contact via respiratory droplets. These droplets do not stay for long in the air but do survive on surfaces like tabletops, door handles, etc and can be picked up by hands touching the same and then the person touching his/her face, mouth, eyes or nose with the contaminated hands. The incubation period of the virus can be anywhere from 1-21 days.  However, the majority of cases are detected through testing between 2 and 14 days.  Unfortunately, the virus can and often is shared with others before the afflicted are aware of the need to seek testing and treatment. 
Query 7:  Can Coronavirus Infections Be Prevented?  The only way to avoid becoming infected by COVID-19 is to not come in contact with it. Currently, no vaccine or cure is available to combat this coronavirus. Monitoring and supportive care such as oxygen therapy, IV fluids, antiviral medications, and fever reducers are given to patients in a clinical setting. These efforts appear to help boost a person's ability to recover. 
The CDC and WHO have repeatedly stated it is not a matter of 'if' but of 'when' the virus will reach your town. That said, here are some ideas that might help you prevent contact with an infected person: 
 Avoid handshaking – use Namaste, hand wave or Jai Hind. 
Avoid large gatherings as much as possible.   
Be alert to travel restrictions and bans issued by your country's health ministers.  
Look into whether video conferencing is an option where you are employed. 
Besides reporting to the health authorities and quarantine of a potentially infected person, it is recommended that we all follow the same precautionary steps we do for the flu season.
 Avoid contact with those that are infected or have contact with those that are infected.
 Frequently washing your hands with soap and water for 20 seconds will do wonders to keep the virus at bay. It is especially important to wash upon entering your home after being out in the "world", before meals, after using the bathroom and after sneezing, coughing, or blowing your nose.  Soap dissolves the outer oily layer of the virus thus killing it. Washing with just water may not work as the virus can just stick on. Use disposable paper towels to blow your nose into or to sneeze. Dry your hands after washing. Hand sanitizer (over 60% alcohol) can be used as a stand-in for soap and water if none is readily available. Clean and disinfect daily items and areas used frequently. Mucous membranes are ports of entry for this virus. Avoid touching your face, eyes, nose, and mouth. Specific to masks: Wearing a properly fitting mask is mandatory only if you are already infected. However, mask-wearing has not proven to be effective in preventing infection if worn by the uninfected ie the general public. Mass buying and using masks is of no use for normal people  Query 8:  How Does Coronavirus Impact The Heart? A lot of my patients ask  “I have heart disease. Am I more susceptible to contracting this coronavirus?” and “Does COVID-19 impact patients with heart disease differently than people without heart disease?" The coronavirus can impact the heart in several ways. Viruses are known to attack the heart and can cause viral cardiomyopathies in which the pumping chambers of the heart get weak and may fail to pump effectively. The coronavirus per se has been widely used in rabbit models to study cardiomyopathy so it is certainly capable of damaging the pumping chambers of the heart. However, no such specific case has been reported so far. However, patients who have heart valve abnormalities are indeed more susceptible to heart failure if they were to become infected with the coronavirus.  Query 9:  Is It Common For Infected Patients With Heart Disease Patients To Be Hospitalized? The presence of underlying diseases of the heart, lungs, or other major organs predisposes patients to more severe infection and symptoms, as well as increased risk of death. That does not mean people with heart disease are more likely to contract the coronavirus. It just means that those folks are more likely to have complications once they do get it.  Query 10:  Is It Safe To Have Heart Valve Surgery Considering The Spread Of Coronavirus? In my Clinic, one of my patients asked  “You have scheduled my aortic valve replacement in two days. I am concerned about a coronavirus infection during surgery and in the hospital? Should I wait to have my surgery? Is it safe?”  There is absolutely no reason to postpone elective or scheduled surgery. At the same time, it is very important to note that patients should not proceed with surgery if they are experiencing any symptoms related to a potential infection. If you are scheduled for heart valve surgery, or in fact any major procedure, and become ill with a flu-like illness, you should reschedule your surgery if possible. Ideally, you should be fully recovered from any illness before having any elective surgery.  Query 11:  Am I at a higher risk to contract  COVID-19 if I already have had Heart Valve Replacement Surgery?  Again several patient questions about the risks of being infected after heart valve replacement surgery with either a tissue valve or a mechanical valve. People who have already had heart surgery and who are otherwise healthy should have normal immune systems.  So, they should be no more susceptible to complications from a viral infection.  Query 12:  Are Patients With Mitral Valve Repair Rings More Likely To Get Infected With COVID-19?  We now perform more valve-sparing repair procedures which entail using devices called rings. You are  NOT at increased risk for viral infections. Yes - bacterial infections (a bacteria is different from a virus) could damage your repair – hence we do prescribe antibiotics for patients who have an artificial heart valve or ring if they have to undergo any procedure eg tooth surgery.     To summarise – a heart patient is not specifically prone to COVID-19. So – do not panic at all. Just take appropriate general precautions and stay Heart Smart. What precautions would you suggest for preventing coronavirus?
Dr. Harinder Singh Bedi
Director CTVS , Ivy Hospital, Mohali, Punjab

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