As the new Coronavirus (COVID 19) spreads across the globe with nearly a lakh affected and a few thousands dead from the illness, it is still a very long time before the pandemic peaks. Till date, India has reported around 40 infected cases without any reports of death. With the spread of the virus and the panic that accompanies it, patients with heart diseases need to be aware of the risks that pose to them from the virus and the precautions that they need to take to stay healthy.
Viruses and heart disease
Patients with heart disease, especially those with multiple comorbidities like diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, etc are in general more susceptible to problems with any infections. Infection with a virus of any kind has a deleterious effect on the health of patients with heart disease, making them sicker and prone to complications. Influenza virus infection, commonly called the “FLU” is the most common viral infection and is known to increase hospitalizations in heart patients and even cause death. A viral infection can have the following effects on the cardiovascular system:
1. Infection with a virus sets up an inflammatory response in the body which increases the risk of plaque ruptures in patients who have blocks/ plaques in their coronary arteries. These are often patients who have had previous heart attacks or undergone an angioplasty or bypass surgery. The plaque rupture can trigger another heart attack during the course of infection.
2. Patients with poor heart function and heart failure may experience worsening of symptoms. They may face greater shortness of breath, swelling in the legs and may require hospitalization. In fact during the flu season, there is a significant rise in the number of heart patients getting hospitalized with heart failure. This is due to the excessive overload that the infective process places on the already weak heart as well as myocardial depression that causes further weakening of the heart pump.
3. Arrhythmias or abnormal heart rhythms can occur in an infected patient. Some arrhythmias can be life threatening and can cause sudden death. The inflammatory process as well as the electrolyte abnormalities that accompany the infection are responsible.
4. Some patients with a viral infection develop a pneumonia which can be complicated and result in kidney failure, liver failure and dysfunction of multiple organs. Patients with underlying heart disease tolerate these complications very poorly with higher chances of death.
Is the COVID-19 different?
While it may be too early to fully characterise the effects that the COVID-19 may have in patients with heart disease, it would be reasonable to believe that the virus will have the same impact as the influenza virus or for that matter the SARS and MERS. COVID-19 appears to have a greater infectivity as compared with the influenza virus, but these are estimates and knowledge is still evolving. The statistics available from the laboratory confirmed cases in China show that the case mortality is around 3.4%, higher in hypertensives, diabetics, patients with underlying cardiovascular disease, and the elderly. Although this may seem very high as compared to influenza virus, it could be because the data is from the most severe cases of the disease. As the pandemic evolves and more data is available, the mortality rate should mellow down. The case mortality rate is still far lower than that with SARS or MERS.
What should I do?
Running frenziedly to the pharmacy to get a mask is definitely what you do not need to do. It is necessary to be cautious rather than paranoid. A person with heart disease should be following all the necessary precautions that they need to follow otherwise when dealing with exposure to a viral infection.
1. Use good hand hygiene. Washing hands with soaps or using an alcohol based sanitizer (w/v 60%) will help prevent transmission.
2. Use the 2 arm’s length rule. Stay 2 arm’s length away from someone who is suspected to have a viral infection like someone who is coughing or running fever.
3. When present in closed spaces like travelling with unknown people in a car or an airplane, in a theatre, etc; one may consider using a protective face mask. Masks that can protect against viruses like COVID-19 are the N-95 protective masks. Any other mask will be futile.
If you are experiencing fever, cough or shortness of breath, you should get yourself tested for the novel virus as there is clinically nothing to differentiate between a COVID-19 and an influenza virus infection. It is necessary to see your physician to understand whether the infection is affecting your heart condition. While influenza virus infection has treatment available in the form of an antiviral drug, no such drug exists for the COVID-19. Also, all patients with heart disease should discuss with their physician regarding the role of influenza vaccine. Vaccination will prevent infection and its dreaded complications in heart patients. No such vaccine is available for COVID-19 though.
To summarize, it is imperative that patients with heart disease need to be vigilant rather than fearful regarding the Corona virus disease. Simple protective measures will go a long way in keeping you from getting sick.