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Cardiovascular Emergencies and COVID-19

Northwestern Medicine
Cardiology May 04, 2020

Attribute to: Charles Davidson, MD, clinical chief of cardiology at the Northwestern Medicine Bluhm Cardiovascular Institute
For a .pdf of this article, click here.

Tightness of pain in the chest, neck or arms. Dizziness, clamminess, or sweating. Shortness of breath. All are common heart attack symptoms that should warrant a call to your doctor or a trip to the emergency room.

Worldwide, physicians have noticed with concern one group of patients is not coming to the hospital during the COVID-19 pandemic: those suffering myocardial infarction, more commonly called heart attack. Charles Davidson, MD, clinical chief of cardiology at Northwestern Medicine Bluhm Cardiovascular Institute and vice chair for clinical affairs in the department of medicine at Northwestern University Feinberg School of Medicine, talks about what to do if you think you are experiencing a heart attack.

 How concerned are you that people aren’t coming to the hospital with heart attack symptoms?This is a major concern.  There has been an increase in cardiac arrests seen by EMTs throughout the world with high prevalence of COVID-19. COVID-19 is known to create a hypercoagulable state, where there is an increased tendency toward blood clotting. Thus, heart attack symptoms are being ignored or dismissed. Reopening of the blocked heart artery with stents will prevent death, but it must be done soon after symptoms occur.

Is it safe to come to the hospital if you do have COVID?
Yes. We are able to test patients and quarantine patients appropriately.  Also our staff wears personal protective equipment to prevent the spread of the virus.

Shortness of breath is a common COVID symptom. What does this mean for heart disease?
This is also a common symptom for heart attacks and heart valve disease. It is important for patients to be evaluated soon after their symptoms appear to ensure the best and most appropriate treatment

For valve disease patients, should they be putting off surgery?
It can be dangerous to postpone surgery for valvular heart disease particularly if symptoms are progressing. Patients should be in contact with their cardiologist to determine whether it is safe to postpone. Also, should you contract the virus with severe valve disease, the risk of serious morbidity and mortality are likely higher. If valve replacement is recommended, patients should be confident that the hospital and providers will be able to protect them properly from the virus.

Besides death, what are the consequences of not coming to the hospital after a heart attack?
Without early proper treatment, the risk of significant irreversible heart muscle damage is likely. This will effect longevity and quality of life.

What else should we know on this subject? 
There is marked decline in heart attack patients coming into hospitals.  Although typically there can be minor variability from week to week, the sustained decrease indicates that patients are staying home. This is unfortunate as this leads to increased early death rates. The treatment window is only about 12 hours from the onset of symptoms to receive the benefit of reopening the blocked artery with a stent. Routine testing of patients is needed to alleviate patients concerns about seeking help.


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