Heart Matters during COVID-19

heart matters during covid19-4

Reports about COVID-19 deaths related to heart diseases had turned the spotlight on whether the pandemic will put cardiovascular disease (CVD) patients at higher risk of infection. More baffling is whether the SARS-CoV-2 virus affects the heart.

We asked our cardiologists, Dr. Ruth Kam and Dr. Bernard Kwok, to provide insights about heart matters during a time where community infection cases are still being reported.

Am I at a higher risk of getting COVID-19?

According to our transplant cardiologist Dr. Kwok, the infection can be caught by anyone. Having CVD does not increase one’s risk. Instead, he emphasized the complication in the case of a CVD patient if infected. 

He draws a parallel with the flu where the risks of complications in CVD patients are higher than normal individuals. 

“If you have an underlying cardiovascular condition, you are six times at a higher risk of getting hospitalized when infected. Your symptoms are likely to be more severe and the risk of dying is about 12 times higher,” he clarified. 

Dr. Kam, cardiologist and cardiac electrophysiologist added that other than SARS-CoV-2 virus, there are other viruses that can also cause severe damage to the heart. 

“Even the common cold virus can result in myocarditis or cause your heart to stop. This is why doctors always advise you to rest and not exert yourself by exercising when you are having the flu,” she said.

Why is there a relationship between CVD and severe COVID-19 infection?

“The virus hijacks the cells to reproduce itself. In so doing, the infection kills cells. If the virus enters the heart muscle cells, destruction of the heart muscle cells will cause permanent heart damage. Another mechanism for heart damage is due to collateral damage when the body’s immune system goes into hyperdrive and starts attacking the host cells in order to fight the infection,” Dr. Kam said. 

Citing obesity, hypertension and diabetes as risk factors for getting more severe COVID-19 infection, Dr. Kam explains that patients diagnosed with these conditions would be at a higher risk of getting heart damage from COVID-19.

“Obese patients already have higher comorbidities like high blood pressure, diabetes, heart disease and breathing disorders. This means they have decreased reserves to cope with the added stress of COVID-19. Hence, they can go into multi-organ failure easily when they are pushed beyond the threshold,” she explained.

“Under these severe conditions, there tends to be the most symptomatic, maybe breathless and a persistent high fever. Hence with COVID-19, the chance of complications is higher,” Dr. Kwok added. 

“As a result of the additional stress on the heart, the patient may decompensate and their underlying medical condition worsened. They will be short of breath and feel tired easily. If we don’t treat the patient in a supportive manner or adjust necessary medications, such patients can go downhill rapidly,” he said.

Does COVID-19 damage my heart?

Reports cited MRI evidence of a study that inferred a possible inflammation in the heart in a large number of recovered COVID-19 patients. Dr. Kam adds that at this time, more research is needed. 

“These are interesting findings but we still do not know whether the inflammation can resolve over time or will it lead to long-term complications like heart failure or arrhythmias,” she added.

Her advice is to wait for more data before reaching any premature conclusions. 

“I don’t think that we should cause widespread panic by making too many hypothetical claims without evidence to back it up.”


Heart precautions

According to Dr. Kam, everyone and not just patients with pre-existing heart conditions, should remember that prevention is the best defense. 

Wearing a mask whenever you leave home, abiding by safe distancing guidelines and frequent hand washing are the fundamental must-dos.  

“Many of my patients with chronic conditions are clinically stable. So long as they stay at home, take necessary precautions in terms of personal hygiene, most of them are fine,” Dr. Kwok shared.  

“During this time, it is difficult to have face-to-face contact with my patients. I have converted patients whose conditions are more stable to consult via telemedicine. This way, I will still see them face-to-face via digital media to stay in contact while monitoring their health status,” he added. 

Dr. Kam advised the same for heart patients: “Continue your scheduled appointments via telemedicine or face-to-face consultations. Keep up with regular screening and monitoring routines as specified by your specialists.” 

Dr. Kwok said that one of the biggest challenges of managing CVD patients during the pandemic is that many fear seeking medical attention because of a possible infection. Some may avoid going to hospitals or visiting a doctor even when there is a need to do so.

“As a patient, you will notice if there are any irregular signs that require further checks. When in doubt, I do advise you to come back to the hospital as early as you can,” Dr. Kwok reminded. 

“Keep abreast of your health status, especially during this period. And for those with preexisting heart conditions, consider a flu vaccination to avoid other possible respiratory complications.” Dr. Kam advised.

This Article Was Reviewed By:

Dr. Bernard Kwok obtained his basic medical degree from the National University of Singapore (NUS) in 1990. He further qualified in internal medicine with Master of Medicine from NUS. He became a Member of the Royal College of Physicians (U.K.), after qualifying with a diploma from the Royal College of Surgeons of Edinburgh. He trained in cardiology at the National University Hospital in Singapore, and completed a fellowship in Heart Failure & Heart Transplantation at Stanford University School of Medicine in the U.S. Dr. Kwok is Singapore’s first qualified transplant cardiologist.

Dr. Kam began her medical career at the National Heart Centre where she last served as Senior Consultant in 2004. She obtained her basic medical degree from the National University of Singapore (1986) and was a President’s Scholar (1981 to 1985). She did her training in Internal Medicine and obtained her MRCP (UK) in 1990 and Master of Internal Medicine (Singapore) in 1991. She then obtained her specialist training in Cardiology at the Singapore General Hospital (1991-1994), and proceeded on to a scholarship to Massachusetts General Hospital (USA) where she was further trained in Cardiac Electrophysiology and Catheter Ablation (1994-1995) and in Cardiac Pacemaker and Defibrillator Implantation (1995-1996). She was also a research fellow in Medicine at Harvard University (1994-1995). In 1997, she passed the special competency examination in cardiac pacing and defibrillation set by the North American Society of Pacing and Electrophysiology (NASPE). In 1998, she obtained her Fellowship in the Academy of Medicine, Singapore. In 2000, she obtained her FRCP from the Royal College of Physicians in Edinburgh. As a private practitioner, Dr. Ruth Kam continues to serve as visiting consultant in many public hospitals in Singapore where she is actively involved in the training of the next generation of aspiring electrophysiologists.

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