How does coronavirus affect patients with heart diseases?

Among chronic diseases, cardiovascular diseases are included in risk group regarding coronavirus. So, how does Covid-19 affect these patients and what are the symptoms? All details are in this interview made with Professor Sinan Dağdelen, M.D, Cardiovascular Specialist in Acıbadem Healthcare Group Turkey.

Coronavirus caused Covid-19 disease leading to an outbreak which started from China and spread around the globe. Covid-19 is similar to other known influenza viruses. However, it can be differentiated from influenza based on its effects. Because, coronavirus involves more organs, the symptoms are severer especially in the elderly (with suppressed immune system) while they are milder in young individuals. Briefly, the older the organs are, the harder they protect themselves against the coronavirus. 

Patients with which chronic diseases are most vulnerable to the virus?

Individuals older than 60-65 years of age create the highest risk group in coronavirus. Although the disease can affect children and young adults, death and organ damage are most frequently seen in the elderly. Patients with cardiovascular disease, hypertension and diabetes are under high risk. In a report published in China, it is stated that 40 percent of Covid-19 patients have heart disease and 12 percent of patients are diabetic. According to another published scientific research in China, infection patients are patients with chronic cardiovascular disease, hypertension and diabetes. Deaths are also most frequently seen in patients with cardiovascular diseases (10.5 percent). This is followed by hypertensive patients with a ratio of 6 percent. Covid-19 is more frequently seen and symptoms are severer also in patients with cardiovascular diseases.

Symptoms of Covid-19 in chronic patients

Generally, symptoms of Covid-19 are similar to influenza infections, namely fatigue, tiredness, malaise.  However, the disease is different from influenza with severe cough, high fever and less runny nose and watering in eyes, severer shortness of breath and extreme fatigue. Patients with chronic heart disease can show different symptoms as well. Abnormal hypertension can be seen in those patients. Because, the virus enters into cells by affecting enzyme receptors in body. Therefore, hypertension occurs.  This condition can be severer in patients with heart failure.  As the immune complexes and fever caused by coronavirus worsens the inflammatory condition of body, risk of heart attack is higher in patients with cardiovascular diseases. 

The infection worsens heart disease

Course of Covid-19 is much severer and longer in individuals with chronic heart disease. Heart diseases in those individuals become severer. For instance, class 2 heart failure can progress to class 3 and class 4. Blood pressure may not be controlled and rhythm disorders can develop.

Can antihypertensive drugs be used?

The relation between hypertension and coronavirus should be investigated. Because, coronavirus especially enters into lung cells through angiotensin receptor, this virus starts to maintain its vitality in the cell by this way. This receptor is critical for hypertension. Related drugs are the antihypertensive agents that are most commonly used both in Turkey and around the world. There have been discussions about increase in effect of virus in body due to these drugs. However, according to notices of American Heart Association and European Heart Network, using this group of drugs called angiotensin converting receptor inhibitors and angiotensin receptor blockers has no negative effect on patients. Hypertensive patients can safely use these drugs.

When should heart patients see a doctor?

Patients with chronic diseases should necessarily present to hospital when there is an unexpected change in blood pressure and glucose levels before coronavirus infection is diagnosed. They should also consult a physician without wasting time when they notice abnormal difficulty breathing and tiredness. Shortly, they should see their primary physicians if they say “I would not be this tired normally, I have been extremely tired for the last 3 days”. They should consult their cardiologists, internists or infection diseases physicians to ask “Do I have a viral infection?” in case of fever, cough, recent onset shortness of breath. 

How is their treatment affected?

They should continue their medications especially drugs for heart diseases. Drugs for cholesterol, hypertension and heart diseases can be used. This virus can involve heart, lungs, brain, internal organs and cardiac muscle. When coronavirus affects the cardiac muscle, a heart inflammation called myocarditis is seen. Myocarditis causes complaints like palpitation, poor exercise capacity and fatigue. In other words, quicker and extreme shortness of breath and palpitation are experienced. At this point, whether the coronavirus involves the heart or not is investigated by a cardiologist. Briefly, patients with cardiovascular disease and hypertension should see their primary physicians or a cardiologist in case of abnormal conditions.

How can heart patients protect themselves from coronavirus?

• Especially people older than 60-65 years of age should avoid crowded places.
• They should stay at least 5 meters away from people with influenza.
• They should drink plenty of water.
• They should eat healthily.
• They should avoid physical and psychological tiredness and sleep well.
• Immune system should be supported.
• They should not be in crowded places unless strictly required.
• When they have to be in crowded places, they should use gloves and mask. However, those gloves should immediately be thrown away after using. They should not touch their mobile phones and everyday items like comb and tissue. Gloves should immediately be peeled and thrown away after they are used in public spaces like subway.
• In case of an unexpected problem, they should consult a physician.