COVID-19 Makes American Heart Month More Important Than Ever
Heart damage prevalent in patients, at any age and health condition
Since 1964, February has been American Heart Month, focusing our attention on heart disease, its symptoms, causes and complications, and disease prevention. With COVID-19 still infecting thousands each day, it may seem that Heart Month is not as important this year.
"Not true", says Cardiologist Yogesh Tejpal, M.D., of Premier Suburban Medical Group. “COVID-19 is affecting the heart health of patients of all ages, including young people with no pre-existing conditions. Patients who had COVID-19 with mild or no symptoms, who were never hospitalized, are experiencing heart abnormalities and complications.”
Cardiac Related Covid-19 Symptoms
Initially, patients may feel like their asthma is acting up, or they’ve contracted pneumonia. They may feel heart palpitations, chest pain or shortness of breath. Fatigue, even when accomplishing light daily tasks, is also a symptom.
When feeling these symptoms, Dr. Tejpal says, see a cardiologist immediately. “We’ll start diagnostic testing as soon as possible, so we are better able to halt or reverse the damage to your heart.”
Initial tests will include a screening for an active COVID-19 infection or evidence of antibodies of a previous infection. Patients will also undergo a complete overall physical exam and blood tests. A BNP test, which measures the levels of brain natriuretic peptide proteins in blood, can indicate heart failure. An elevated troponin level may indicate an inflamed heart muscle or heart damage. An EKG may reveal an abnormal heart rhythm problem.
“We may also perform a chest x-ray to look for fluid in the lungs. Excess fluid suggests heart failure. We’ll also look for evidence of an enlarged heart,” says Dr. Tejpal, “which means your heart’s main pumping chamber, your left ventricle, is occupying more space than it should and may be a sign of a weakened heart muscle.”
An echocardiogram may be ordered to examine the heart’s pumping function and to detect any weakness. In COVID-19 patients, heart failure is usually systolic, meaning that the heart is not squeezing properly and can’t contract to empty efficiently. The heart is not pumping forcefully enough to move blood throughout the body as necessary for robust health. “We’ll measure your ejection fraction (EF), which measures how much blood leaves your heart with each pump. When you have a 50-70% EF, that’s normal. In some COVID-19 patients, we’ve seen EF as low as 20%.”
Dr. Tejpal says, “Atrial fibrillation, an irregular or rapid heart beat, is also commonly seen in COVID-19 patients experiencing heart failure.” Afib, as it is also known, happens when the electrical circuits of the heart are not beating in a cohesive manner, leading to worsening heart failure symptoms. This also increases the risk of blood clots forming within the heart chambers and ultimately leading to strokes.
Long-term Covid-19 Side Effects
COVID-19 causes inflammation in the body, which affects lungs, the vascular system, other organs and the heart. When inflammation occurs in the heart, it causes a weakness of the heart muscle. It can also cause ischemia, or inadequate blood supply. COVID-19 is also known to cause blood clots. While large clots can cause strokes and heart attacks, the heart may also be damaged by tiny clots that block capillaries, very small blood vessels, within the heart muscle.
Researchers are finding that 78% of people who have recovered from COVID-19 have heart abnormalities such as palpitations or arrhythmia, an irregular heart beat, and nearly 60% will experience ongoing myocardial inflammation, even when they had mild COVID-19 symptoms or no symptoms at all.
For those hospitalized with COVID-19, nearly 25% have cardiovascular complications. For those who have died of COVID-19, about 40% of those cases have involved cardiovascular issues.
Treatment depends upon the severity of the condition and the overall health of the patient. “If the heart muscle is weak, we may prescribe diuretics or water pills to eliminate excess fluid, and other medications such as ACE-1 or beta blockers to prevent the hormonal system from causing further detriment to the heart,” says Dr. Tejpal. “If there is evidence of ischemia or poor blood flow through the heart, procedures to evaluate this such as stress testing and angiographic imaging may be conducted. Subsequent interventions may need to be done to help improve blood flow.”
Dr. Tejpal also stresses lifestyle as a way to improve heart complications from COVID-19 and improve heart health in general. “Cut salt/sodium intake, reduce weight and increase physical activity, and of course, don’t smoke or use other tobacco products.” During treatment, Dr. Tejpal recommends consuming fluids at your physician’s direction to keep oneself hydrated, getting enough rest and adequate sleep, managing stress, and eating a healthy menu of fresh fruits and vegetables, lean proteins and whole grains.
Need for Continued Care
Because COVID-19 infections have only been documented within the last year or so, no one is really sure about recovery. “Long term, we believe that patients who get diagnosed and treated quickly, who have no real underlying health issues and who can improve with treatment - they should do very well,” says Dr. Tejpal. For patients with more severe damage and complications, Dr. Tejpal says that Premier Suburban Medical Group can offer more advanced treatments.
“We doubt that these conditions will heal themselves,” says Dr. Tejpal. “Without treatment, COVID-19 patients may be at an increased risk of heart failure, associated with morbidity and mortality, for decades.”
The goal, Dr. Tejpal says, is to prevent heart failure and SCD, sudden cardiac death. “Many of our patients will improve with treatment within a couple of months. Some patients, however, will develop a reduction in their heart pump function. When that function drops below 35%, they are at risk for developing SCD, due to life-threatening heart rhythms. These patients may ultimately need a life-saving device such as an AICD or defibrillator. A LifeVest may be worn to bridge treatment until either the heart muscle strengthens or there is a need for an implantable device.”
Cardiac Testing at Premier Suburban Medical Group
Premier Suburban Medical Group’s brand new cardiac laboratories gives patients the convenience of on-site testing with trusted providers by their side. “We can perform x-rays, blood tests, stress tests, and echocardiograms. These tests can help us evaluate the overall condition of the heart by assessing blood flow reductions or blockages, and the overall function of the heart muscle and valves. We can also assess the electrical circuit of the heart to diagnose electrical rhythm problems. We have a full range of monitoring equipment that can be worn by the patient 24/7 to track heart rhythm activity and status.”
Premier Suburban Medical Group is a new practice in Chicago’s south and southwest suburbs, anchored by fourteen physicians and specialists with over a dozen advance practice providers who have been caring for families for decades. “Our patients have followed us because they understand our care philosophy,” says Dr. Tejpal. “We have built a reputation for listening and caring for patients’ and families’ overall health and for their heart needs; generations of family members have put their trust in us. Premier Suburban allows me to provide compassionate care in a cost-effective manner, meeting the health needs of our community in a friendly environment. This is personal health care rather than corporate medicine.” The practice has locations in Blue Island, Orland Park, Lemont and Woodridge.
Going forward, researchers may recommend screening for heart damage in all recovering COVID-19 patients, but Dr. Tejpal urges anyone who is experiencing symptoms to see their physician immediately, even if they’re not sure they had COVID-19 at all.
“Call your physician if you have shortness of breath, with mild exertion or while you’re laying flat, if you are waking up at night short of breath, if you’re lightheaded or feeling dizzy, if your ankles swell or you are noticing any type of irregular heart beats - whether it’s very rapid, fluttering, skipping or palpitating,” says Dr. Tejpal.
“It’s vital to prevent COVID-19 in the first place,” says Dr. Tejpal. “There is no way to tell who will get afflicted with cardiovascular problems. We are seeing this in everyone, of all ages, although we tend to see more women affected. No one should let down their guard, no matter your age or health condition. While we are seeing a higher mortality rate in those over 60 or with diabetes, chronic lung disease or chronic heart disease, we’re also seeing this in young healthy patients.”
Follow strict COVID-19 prevention protocols, recommends Dr. Tejpal. Wear a mask in public places and ensure that everyone in your household is doing the same. Practice good hygiene by frequently and thoroughly washing hands with soap and warm water. Maintain a distance of at least 6 feet from anyone not living in your household, even while masked.
In recognition of American Heart Month, Dr. Tejpal stresses remembering that COVID-19-induced heart damage can hit anyone. Physicians are seeing life-changing complications in otherwise healthy athletes and younger adults. “There is no way to identify who will sustain heart damage or experience symptoms."
For more information about Premier Suburban Medical Group, visit PremierSuburban.com or call 815-300-7764 (PSMG).