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Leading Cardiologist Dr (Col) Manjinder Sandhu Gives Alerts in Times of COVID19

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The COVID19 virus has proven to be a health hazard for all sections of the population across the world. In particular, heart patients or people with cardiac ailments are supposedly at a higher risk and more vulnerable.

SUBURB In-Conversation with Dr (Col) Manjinder Sandhu, Director- Cardiology and Cardiac Care at Artemis Hospital to know more about the Covid19 impact on cardiovascular health as well as the dos and don’ts for a heart patient.

Q:  What are the cardiovascular complications associated with COVID 19?

MS:  COVID 19 can affect the heart in many ways. Most commonly, COVID19 virus causes inflammation of heart muscles – known as myocarditis. In some studies, myocarditis found to be present in 30 per cent of cases admitted in ICU, and approximately 7 per cent of deaths attributed to it. It presents with variable severity, and the common manifestations are chest pain, breathlessness along with ECG changes, the elevation of cardiac biomarkers and echocardiographic abnormalities. As a result, many patients who suspected of heart attacks were COVID infected patients. It is posing a challenge for cardiologists as the presentation of myocarditis very closely mimics a heart attack.

1.       Acute Heart Failure is another complication of COVID19 infection which can either be a new-onset primarily as a result of myocarditis or it can be deterioration of patients having a previous cardiac disease.

2.       Acute Heart Attacks are also associated with COVID infection. Also, inflammation related to viral infection leads to rupture of plaques in coronary arteries and can cause severe heart attacks.

3.       Rhythm related issues documented with this viral infection; hence heart rate can both go high and low because of effect on the electrical conduction system of the heart.

4.       Venous Thromboembolism is another common manifestation of COVID19 infection. It means that there is a tendency of blood clot formation in the veins of the body, and the clot can go to the lungs, causing a life-threatening disease – pulmonary embolism. Most of the patients with moderate to severe symptoms are administered with blood thinners to mitigate the complication.

Q:   Are cardiac patients with diabetes or hypertension at increased risk?

MS:   Definitely. People with diabetes and hypertensive patients are much more prone to get affected and also have shown poorer outcomes in COVID19 infection.

Q:  How patients with cardiovascular should conditions manage workplace exposure during these times?

MS:  Since they are at high risk of catching the infection; they should follow the precaution protocols strictly. Ensuring that everyone at the workplace is wearing masks properly, maintaining social distancing, regular hand sanitization and following cough etiquettes will go a long way in ensuring the safety of everyone, including cardiac patients. These patients should take their medicines regularly, exercise daily at home and keep in touch with doctors frequently to monitor their health. en

Q: What are the considerations around older adults with cardiovascular disease in COVID19?

MS: Interactions with non-infected older adults during the pandemic should focus on disease prevention and COVID19 preparation. Role of technology should be informed and used to engage these patients. It is mandatory to maintain a healthy diet, hydration and daily exercise.  

Q: Is undergoing any form of heart or elective surgery advisable during this high-risk period for patients with heart ailment?

MS: In Artemis, we do not deny emergent or essential surgeries to patients who can get worse without surgical treatment. We cannot deny treatment to patients suffering from medical emergencies from other ailments. We should take precautions and go ahead, and we have been able to develop such systems which are robust and aim at zero cross-infection rate amongst non-COVID patients as well as HCWs.

Heart patients should defer surgeries which are not emergent as they run a high risk of getting infected as well as they may not have access to complete cardiac care during the pandemic.

Q. Should there be any addition or change in ongoing heart medication or drugs?

MS. In general, without confirmed COVID19 diagnosis, no change in treatment is mandated, and medical therapy will need to continue as before. Patients must avoid over the counter drugs, how much soever widely advertised they might be, and especially painkillers (NSAIDs) which have shown to complicate the course of COVID19 illness.

At the time of initiating the therapy to treat Coronavirus, some existing treatment may need modification in patients with heart ailments, but under the direct supervision of the treating physician.

Q. Is the mortality rate higher among patients with heart diseases when infected with COVID19?

MS. COVID19 can trigger destabilization of almost all chronic cardiac illnesses. In cardiac patients, specific characteristics are associated with worse clinical outcomes and decreased likelihood of survival, namely age>65 years, patients with chronic heart failure, arrhythmias and coronary artery disease while there is no evidence for increased severity or mortality in hypertensive patients.

Q. As a patient with cardiac issues, can I step out to the park or go for walks?

MS. As a general rule, cardiac patients, since they are at high likelihood of severe infection, should stay home as much as possible and avoid crowded places and meeting sick people as they are more prone to infection.

However, prolonged inactivity increases the risk of venous thrombosis (clotting in leg/lung veins), particularly in patients with multiple comorbidities (usually present in cardiac patients). Hence, physical activity should be strongly encouraged, preferably in a home setting or outdoor areas practising safe social distancing.  

Three alerts for people with cardiovascular disorders to keep in mind during these unparalleled times:

1) Continue with prescribed medications, unless told otherwise.

2) Do not neglect symptoms; seek immediate care if experiencing breathlessness, chest pain or giddiness/loss of consciousness.

3) Do not interrupt cardiac follow up, preferably making use of teleconsultation wherever feasible.

If any elderly or a patient with cardiac history experiences any discomfort or the difficulty, do not delay consultation. Often Covid-19 may be asymptomatic in patients and might require immediate treatment to avoid deterioration of the patient’s health.

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