Covid-19 and Your Heart

written by Dr Lim Choon Pin

During this Covid-19 virus outbreak, many patients with chronic heart diseases may be worried about how their underlying heart conditions can be affected by the virus. While there is still much to be discovered about the short- and long-term effects the Covid-19 virus, here is a summary of what we know about the virus and the heart so far and how you can protect yourself.

Effects of Covid-19 on the heart

1. Patients who have a heart condition are at the same risk of catching the virus as any other person. The virus is spread by breathing in respiratory droplets in the air or touching your face, eyes or mouth after coming into contact with contaminated surfaces. Therefore, EVERYONE is at risk.

2. Patients with chronic heart conditions are at a higher risk of developing more severe forms of the infection if they do catch the virus.

3. The main organ that Covid-19 virus affects is the lungs. However, it can also cause damage to other organs. The virus can affect the heart in the following ways:

   1. by causing inflammation of the heart muscles (myocarditis and pericarditis)

   2. triggering abnormal heart rhythm (arrhythmias)

   3. triggering heart failure symptoms

   4. triggering a heart attack

This can happen even in people without pre-existing heart conditions.

4. ACE-inhibitors (e.g. Enalapril, Perindopril etc) and ARBs (e.g. Valsartan, Candesartan etc) are common medications used to treat hypertension, heart failure, heart attacks and kidney diseases. There are some debates that suggest that these medications could theoretically increase the risk infection by the Covid-19 virus; however, these same drugs may also protect from the severe form of illness. There is currently no convincing clinical evidence supporting these hypotheses, therefore many international professional bodies such as the World Health Organisation, American Heart Association, European Society of Hypertension and the Ministry of Health of Singapore have recommended patients should continue taking these medications in view of their beneficial effects for these chronic medical conditions.

5. Medications such as Hydroxychloroquine and Azithromycin are still unproven in the treatment of Covid-19. Moreover, they could also result in life-threatening arrhythmias, especially in patients with underlying heart disease. Therefore, you should not self-medicate with these unproven medications.

6. Vaccinations against influenza and pneumococcus are important for patients with heart disease. While they do not protect against Covid-19, it is still important to be current with these vaccinations as cardiac patients are still susceptible to these infections even during the Covid-19 outbreak.

You cannot prevent the effects of Covid-19 virus on your heart. However, you can do the following to protect yourself from catching the infection during this outbreak and keeping your heart healthy.

1. Practice good hygiene practices like:

   1. Regular and thorough handwashing with soap, especially before eating or touching your face.

   2. Avoid people who are sick.

   3. Avoid crowded places. Go out only for essential activities.

   4. Wear a mask when going outdoors.

   5. Practise physical distancing. Stay at least one metre away from people around you when you are out.

2. Continue regular exercises 30 minutes a day for 5 days each week. Consider switching to indoor static exercises if you are unable to do walks alone or with a mask on in your neighbourhood. 3.Continue to eat a healthy diet. Do not binge on snacks and instant noodles when you are confined in your home. 4. You may consider delaying your reviews with your doctors if you feel completely well. Speak to your cardiologist whether it is safe to do so. 5. It is also important that you have enough supply of medications. Do not stop any cardiac medications without first consulting your doctor – this can potentially be harmful to you. 6. Do not delay seeing your doctor or going to the emergency department if you have symptoms such as worsening chest pain, palpitations, shortness of breath or fainting. While patients are recommended to avoid non-essential visits to the hospital, if you have any active heart-related symptoms, it is not safe to delay assessment. You can be assured that the hospitals will still be able to care for you safely during this period.

We hope that this information can enable all cardiac patients with the necessary information to tide through this difficult period.

Wishing all of you good health. Stay Home and Stay Safe!

From all of us at The Heart and Vascular Centre