What I’m telling my heart patients about coronavirus

As a cardiologist, my heart skips a beat (figuratively, of course!) every time I read about research linking heart disease and COVID-19. What reassures me is knowing that most of my patients are safe at home, isolating and taking care of themselves, reducing their risk of acquiring coronavirus in the first place, while increasing their chances of a good outcome if they do contract it. Nevertheless, emerging data on heart involvement is concerning. Here’s what we know so far about the connections between the coronavirus and the heart…

Gasoline and smoldering embers

Case studies from China confirm that patients with coronary heart disease face higher risks when sick with COVID-19. This isn’t surprising. The flu and other infections also impact patients with heart disease in similarly disproportionate ways. Researchers suspect that the bodily stress from COVID-19 destabilizes fatty plaque buildup, which can then rupture.

Add to that the fact that fever and inflammation make blood more likely to clot, and it’s like “throwing gasoline on smoldering embers,” for causing a heart attack, Harvard researchers say. There also appears to be more physical demand on the heart when your body is fighting off an infection, making any heart muscle damage potentially more extensive.

Related: 3 conditions that signal a heart weakness coronavirus can exploit

This increased risk is not confined to people with known heart disease. It also applies to people who have incompletely controlled risk factors. This is why it’s so important to make sure you’re doing everything possible to keep your risk factors under control!

And since the vast majority of heart disease risk factors are related in part or in whole to the foods we eat, being extra vigilant about what lands on your plate is more important than ever.

Researchers are also considering other, less obvious possible links between heart disease and COVID-19. For example, they’re looking at whether certain heart medications affect the outcomes of COVID-19 patients.

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Turns out the virus grabs onto the same receptor — ACE2 — that regulates blood pressure and interacts with some blood pressure medications. Understandably, there was concern initially that continuing to take certain medications (ACE inhibitors such as lisinopril, for example) increased the risk of developing complications from coronavirus infection. Fortunately, this concern has largely now gone by the wayside with further research — good news given how many people take these drugs.

Additionally, there have been multiple cases of myocarditis (inflammation of heart muscle) related to coronavirus reported and cases of people developing serious rhythm abnormalities — sometimes from the antibiotics used to treat the disease.  Risk factors for those complications are currently being defined.

Clearly COVID-19 doesn’t just attack the lungs — it also affects the heart. The good news is that multiple medical organizations are fast-tracking COVID-19 research, so we’re learning more about the disease every day. However, until we know a lot more about how it affects people with heart disease and people with risk factors for heart disease, it’s definitely best to play it safe.

What I tell my heart disease patients

Here’s what you can do to dramatically decrease your chances of complications from the virus — and to make sure you remain in optimal health:

  • Stay home! Avoiding unnecessary social contact is key. Order groceries in (watch for an upcoming blog on tips for online food shopping) and dig into a good book (or 25).
  • Eat well and exercise: Keep your mental and physical health in check by keeping up your heart-healthy diet and working movement into your day (we’ll cover exercise-while-quarantining in a future blog).
  • Stay in touch with friends and family: The silver lining of quarantining is strengthening our social connections, whether it be in person or online.
  • Continue taking your medications so as to keep all your risk factors as best controlled as possible. And be proactive in refilling your prescriptions so you don’t run out.
  • Consider a Vitamin D supplement if you don’t regularly get outside. Vitamin D deficiency is being increasingly linked to coronavirus complications. 2000 IU per day of Vitamin D3 is a reasonable dose. Double up if you are dark-skinned.
  • Contact your physician’s or cardiologist’s office if you are due for a follow-up appointment. Many medical practices are using telemedicine to minimize interruptions in care.

MOST IMPORTANTLY:  Remember that heart disease itself doesn’t stop for a pandemic. So if you experience symptoms that are new or worrisome (chest pain, chest pressure, unusual shortness of breath regardless of whether it’s associated with a fever, new/unusual palpitations especially if associated with lightheadedness or chest pain, new neurologic symptoms) — for heaven’s sake seek urgent medical attention!  It’s understandable that we’re all trying to avoid hospitals at this time, but everything is being done to keep ALL patients safe at health centers and time is of the essence if you are in the midst of a cardiovascular emergency. A good way to decide if you should go in?  If, before the pandemic, you would have sought urgent medical attention for the symptoms you’re currently experiencing, do so now!

Dr. Elizabeth Klodas MD, FACC

By Dr. Elizabeth Klodas MD, FACC

"Diet is a major driver of high cholesterol, but instead of changing the food, we prescribe medications. This never seemed logical to me.” Dr. Klodas has dedicated her career to preventive cardiology. Trained at Mayo Clinic and Johns Hopkins, she is the founder and Chief Medical Officer for Step One Foods. Dr. Klodas is a nationally sought out speaker and has an active role at the American College of Cardiology. Her clinical interests include prevention of heart disease and non-invasive cardiac imaging and she has published dozens of scientific articles throughout her career. Dr. Klodas has been featured on CNN Health for her mission to change how heart disease is treated. An independent study performed at leading medical institutions affirmed the ability of Step One Foods to deliver measurable and meaningful cholesterol-reduction benefits in the real world. The results of the trial were presented at the 2018 American Heart Association’s Scientific Sessions. Dr. Klodas has also authored a book for patients, "Slay the Giant: The Power of Prevention in Defeating Heart Disease," and served as founding Editor-in-Chief of the patient education effort of the American College of Cardiology. In addition to her practice and her duties at Step One Foods, she also serves as medical editor for webMD.