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COVID-19 and Heart Patients (Q&A)

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The ESC Patient Forum has received many questions about coronavirus (COVID-19). This document pools together useful recommendations from international authorities and medical societies.
 

Questions related to your own treatment should be directed to your physician.

 

 

Important: Heart attacks and strokes during COVID-19

Should you experience any of the following symptoms, call emergency services immediately. Let them assess your symptoms.

Heart attack

  • worsening chest pains
  • palpitations
  • shortness of breath
  • fainting

Stroke

  • facial dropping
  • arm weakness
  • speech difficulties

 

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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'

 How to recognise heart attack symptoms: 

Watch the video

Downloadable versions of FAQ below (pdf)Updated November 2021

English

Frequently asked questions

I have a heart condition. Am I at more risk of getting COVID-19 than somebody who doesn’t have a heart condition?

No - the infection can be caught by anyone. However, we now know from several studies that people with underlying heart conditions are more likely to show symptoms of the infection or to have a more severe infection than others, including a higher risk of dying from COVID-19. This observation is also true for people with risk factors such as diabetes, hypertension, or obesity.16, 17

 

Is the risk of developing severe COVID-19 symptoms similar for all patients with a heart condition or are there differences?

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.

Provided that even cardiovascular risk factors (such as diabetes, obesity, chronic kidney disease and hypertension) are associated with increased severity and higher death rates of COVID-19, there are some groups of patients who carry a prohibitive risk of developing severe and fatal forms of the virus infection:

  • Individuals who are immunosuppressed, such as transplant patients, patients with cancer who are receiving chemotherapy or extensive radiotherapy, patients with concomitant leukaemia or lymphoma who have heart disease are theoretically at greatest risk of contracting and succumbing to the effects of the virus.3
  • Other high-risk groups include elderly and frail people as well as pregnant women with concomitant cardiovascular disease.3
  • Individuals with heart conditions, such as heart failure, dilated cardiomyopathy, advanced forms of other cardiomyopathies and patients with congenital cyanotic heart disease are at highest risk.

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.

 

 

I have Brugada Syndrome, are there any special precautions I must take?

Patients with Brugada Syndrome are particularly vulnerable to fatal arrhythmias in situations where the body temperature exceeds 39oC. Such patients must treat fever aggressively with paracetamol and cool/tepid sponging.

 

 I have atrial fibrillation. Am I at greater risk of getting the coronavirus infection? 

Atrial fibrillation by itself does not increase the risk of infection. Nevertheless, many atrial fibrillation patients are older and have other conditions, such as heart failure, hypertension and diabetes, which make them more likely to have a more severe disease, if infected. All patients are advised to take general protective measures such as social distancing and washing hands frequently and appropriately to prevent infection.13
 

I have read that the coronavirus can cause heart problems such as heart attack or arrhythmias, is this true?

  • Based on the inflammatory effects of the virus, there are theoretical risks that the viral infection may favor coronary atherosclerotic plaques (fatty deposits) rupture leading to heart attack. Individuals who experience severe chest discomfort during symptoms of Corona virus should call the health care advice team immediately.
  • Severe systemic inflammatory conditions may aggravate arrhythmias or even trigger atrial fibrillation in some individuals.
  • The acute inflammation caused by the virus infection can worsen both cardiac and kidney function.
  • The virus may also cause myocarditis, an inflammation of the cardiac muscle.

However, there is nothing you can do to prevent these problems. You should strictly follow the recommendations to prevent becoming infected such as undergoing vaccination, maintaining personal distancing or even better, self-isolation, undergoing frequent hand washing, etc.

 

Are cardiac patients who also have diabetes and/or hypertension at greater risk?

Data from China, where the disease emerged, indicate that a significant proportion of 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 emphasize that this is a theory which has yet to be substantiated by evidence. Major health organizations 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 are reports that COVID-19 may induce myocarditis or pericarditis.  If you have had myocarditis/pericarditis previously, are you more vulnerable to contracting it a second time? 

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.

There is, however, some  evidence suggesting that the virus responsible for COVID-19  can directly infect the heart and cause myocarditis. Because of a lack of data, it currently remains unclear in how many patients this complication happens and how well the heart recovers after a myocarditis caused by COVID-19.16, 17   

Furthermore, an acute inflammatory response caused by the infection may worsen cardiac function and exacerbate symptoms in patients with heart failure.

 

Are people with heart disease more likely to die of COVID-19 than those without?

So far, older age and the presence of underlying conditions - including heart conditions - have