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Questions related to your own treatment should be directed to your physician.
Should you experience any of the following symptoms, call emergency services immediately. Let them assess your symptoms.
Remember: Even during the pandemic, do not delay. Every minute counts. Hospitals will do their utmost to treat you in a segregated, safe environment.
Read ESC President's message to heart patients 'Appeals to “stay at home” during COVID-19 do not apply to heart attacks'
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No - the infection can be caught by anyone. However, people with underlying heart conditions might be more likely to show symptoms of the infection or to have a more severe infection than others.1
So far, most people that get COVID-19 have a mild viral illness including sore throat, cough and aches and pains and a fever, but some people (up to 5%) develop a chest infection/pneumonia. We are not yet certain if people with heart conditions are more likely to get a chest infection with COVID-19, but it is likely since they do get chest infections with other viruses like the flu.1
The basis of contracting the infection is the same for all individuals. The virus is transmitted via droplets in the air from an infected person coughing, sneezing or talking; or through touching contaminated surfaces as the virus can survive for several hours or even days on surfaces such as tables and door handles.1
Once the virus enters the body it causes direct damage to the lungs and triggers an inflammatory response which places stress on the cardiovascular system in two ways. Firstly, by infecting the lungs the blood oxygen levels drop and secondly, the inflammatory effects of the virus itself cause the blood pressure to drop as well. In such cases, the heart must beat faster and harder to supply oxygen to major organs.
Particularly at risk are the following groups:
There is no evidence that the virus infects implanted devices such as pacemakers and cardioverter-defibrillators or causes infective endocarditis in those with valvular heart disease.
Patients with Brugada Syndrome are particularly vulnerable to fatal arrhythmias in situations where the body temperature exceeds 39°C. Such patients must treat fever aggressively with paracetamol and cool/tepid sponging.
However, there is nothing you can do to prevent these problems. You should strictly follow the recommendations to prevent becoming infected such as personal distancing or even better, self-isolation, frequent hand washing, etc.
Data from China, where the disease emerged, indicate that a significant proportion on non-survivors and those who developed severe disease had comorbidities such as diabetes and hypertension. The exact reason for this remains unclear. It is likely both hypertension and diabetes are prevalent in the general population particularly in the age group (over 70 years) where the mortality from COVID-19 infection is highest.
There has been an article linking this observation to the use of Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (A2RB/ARB) which are common medications used to treat high blood pressure.7 It is important to emphasise that this is a theory which has yet to be substantiated by evidence. Major health organisations such as the European Society of Cardiology, British Cardiac Society and the American Heart Association recommend continuing these medications (since their beneficial effects are well known) whilst monitoring the disease progress of patients with hypertension and diabetes.8,9
There is no evidence that an individual who has suffered from myocarditis or pericarditis in the past is at higher risk of developing the same complication with COVID-19. It is recognised that some cases of myocarditis have a relapsing and remitting course. To date there is no evidence that the virus responsible for COVID-19 directly infects the heart; however, the acute inflammatory response caused by the infection may worsen cardiac function and exacerbate symptoms in patients with heart failure.
So far, older age and the presence of underlying conditions - including heart conditions - have been risk factors for death. Nevertheless, it is important to emphasise that most patients, even those with underlying heart disease, have had mild infections and have fully recovered.
If you think you have COVID-19 infection, ask yourself if you can manage the symptoms at home. Fever can be managed with paracetamol. Important: If you feel uncomfortable managing the symptoms at home, particularly if you feel shortness of breath, please seek medical help.
There are news reports, especially on social media, suggesting that medications such as ibuprofen (so-called non-steroidal anti-inflammatory medicines or NSAIDs) used to lower fever and treat pain could worsen COVID-19. Based on currently available information, the World Health Organization (WHO) and the European Medicines Agency (EMA) do not recommend against the use of ibuprofen as there is, at the moment, no scientific evidence establishing a link between ibuprofen and worsening of COVID 19.4 If in doubt, please ask your physician which medication is safe for you to take to treat fever and/or pain.
Follow the advice from your country’s health authorities - this will be slightly different in each country depending on how many cases there are in your country.
There are things that everyone should do to limit their risk. If you have a heart condition, the following are important:
No. Vaccines against pneumonia, such as a pneumococcal vaccine, and flu vaccine, do not provide protection against the new coronavirus.
The virus is so new and different that it needs its own vaccine. Researchers are trying to develop a vaccine against the Coronavirus, but it is unclear when this will become available.
Although the flu and pneumococcal vaccines are not effective against COVID-19, vaccination against respiratory illnesses is highly recommended by major health organisations such as the World Health Organization (WHO) to protect your health.
For the general population wearing a mask is only recommended if you are experiencing symptoms, such as a cough or a fever, or if you are caring for someone with these symptoms.
Wearing a mask if you have a heart condition is not recommended as this may make breathing more difficult. If you have a heart condition and are concerned about catching COVID-19, discuss this with your doctor.
To prevent shortages of face masks it is important to only use them if needed. When wearing a mask, it is important to use and dispose of them in the correct way. The World Health Organization (WHO) has useful information about this.11
Taking formulated vitamins will not protect you against COVID-19.
Several agents (including vitamin C, hydroquinone and antivirals) are currently being tested for their effects in COVID-19, but no trustworthy confirmatory data are available as yet.
A diet rich in fresh vegetables and fruit is generally recommended at all times - not just during COVID-19 - to help your body maintain a working immune system. Fresh vegetables and fruits contain a much broader range of necessary nutrients than vitamin pills. Therefore, it is always better to eat a lot of fresh vegetables and fruit than trying to compensate with formulated nutrients.
Having said that, some individuals might indeed lack specific vitamins or (micro-)nutrients. In this case, your GP or attending physician will be able to offer advice.
When taking formulated vitamins, please make sure your intake does not exceed the recommended daily dosage. Some vitamins might harm you if taken in too high doses, and some supplements can interact negatively with your heart medicines.
There is currently no evidence that humans can catch the disease from common household animals such as cats and dogs.
The current research suggests that immunity to COVID-19 develops after the first infection, so it is not possible to catch it again. There are examples of viruses, like flu and the common cold, which can be caught more than once because of the way the virus changes over time. We won’t know for a while whether this can happen with COVID-19.
What is clear is that stopping or changing your medication could be very dangerous and could make your condition worse. These drugs are very effective for heart failure, and to control high blood pressure to help prevent a heart attack or stroke, and so on. Any changes to your treatment that have not been recommended by a healthcare professional could put you at higher risk of a flare-up of your heart condition.
There have been reports in the media suggesting that some commonly used drugs to treat high blood pressure (so-called ACE-Inhibitors and Angiotensin Receptor Blockers) may increase both the risk of infection and the severity of infection with the Coronavirus. However, this warning does not have a sound scientific basis or evidence to support it. Therefore, it is strongly recommended that you continue to take your blood pressure medication as prescribed.8
Patients who are on immune compromising medications, for instance after a heart transplant, should continue to take these medications as prescribed. Reducing the doses is associated with a high risk of suffering a rejection of the transplanted heart.
Please take all your medications exactly as prescribed. If in doubt, please contact your doctor or nurse but do not make any changes before having spoken to them.
Patients with Long QT Syndrome need to make sure their attending physician is aware of their heart condition, if they are admitted to hospital. Long QT is an inherited condition where there is a delay in the heart’s electrical signals which makes people vulnerable to arrhythmias (irregular heartbeats). Some of the experimental drugs that are being assessed for treating COVID-19 patients may lengthen the QT interval and cause arrhythmias in some individuals. These drugs include chloroquine, an anti-malarial agent, and anti-retroviral drugs.12
Additionally, there are some drugs used to treat, for instance, atrial fibrillation or depression, which may lengthen a person’s QT interval. Therefore, it is important for your doctor to be aware of all the medications you are taking.
If you need to be admitted to hospital, please always make sure you take a complete and up-to-date list of all your medications with you!
Everything is being done to ensure that the supplies of essential medications are maintained. There is no cause for concern. The European Medicines Agency is monitoring the situation and to date have reported no shortage of essential medications.
If your hospital is still running scheduled outpatient appointments, it would be a good idea to contact them and ask if you should still attend. Many places are cancelling routine appointments or conducting them over the phone or via video online chat wherever possible. There are certain conditions where face-to-face visits are still required and you should not miss a visit without first consulting your consultant, doctor, nurse or other healthcare provider.
Yes. The virus is caught from people who have the infection and so there is no problem in going outside by yourself. What is important is to avoid contact with anyone who might be ill. Events bringing together a large number of people have been cancelled around Europe, to prevent the spread of infection. If you have to leave your home (e.g., for food shopping), please keep a two-metre distance between yourself and others.
Please pay attention to guidelines published by your national and local authorities. In many countries, all non-essential travel has been forbidden and citizens have been asked to stay at home. In many places, it is recommended to avoid using public transport, if possible, or to keep at least a distance of at least two metres from other passengers.
This is an anxious time for everyone and we are providing tips to help you cope with the uncertainties surrounding a pandemic that none of us was prepared for only a few months ago.
Our mission: To reduce the burden of cardiovascular disease.
© 2020 European Society of Cardiology. All rights reserved.