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In all my years as a cardiologist, I never expected to see a pandemic like this

February 24, 2021
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By Dr. Aaron Kugelmass, Vice President and Medical Director, Baystate Heart & Vascular Program

In all my years as a cardiologist I never expected to see a once in a century pandemic infecting and killing so many people around the world, and even surpass heart disease as the leading cause of death in the United States.

While it is well-known that this was a virus that primarily affects the lungs, we quickly learned that COVID-19 can also have serious effects on the cardiovascular system. We also identified that people with underlying cardiovascular disease were at increased risk of serious illness with COVID-19 infection – including those with heart failure, coronary artery disease, cardiomyopathies and pulmonary hypertension, and cerebrovascular disease. Also, because of the mechanism by which COVID-19 infects human cells, individuals with high blood pressure are at increased risk. That is also true for people with diabetes, lung problems and a variety of other health conditions.

COVID-19 impacts the heart and blood vessels in many ways. First, patients with severe lung infection have trouble getting enough oxygen into their blood. This limits the amount of oxygen that can be supplied to the heart. As this worsens, the heart is deprived of oxygen and this can cause heart damage, limiting the heart’s ability to pump, and can even cause a heart attack. The COVID-19 virus can directly infect heart cells, causing a viral myocarditis. Also, your body responds to viruses by creating inflammation which helps to fight the infection, but in some patients with COVID-19 it appears to go into overdrive. This exaggerated immune response to the virus is so strong that the response can injure the heart.

We also know that stress alone can impact heart function causing stress induced cardiomyopathy or “broken heart syndrome.” The physical stress of severe COVID-19 infection, resulting in the abundant release of stress hormones, can also cause this problem. Beyond the heart muscle itself, COVID-19 infection can inflame arteries and cause blood clots. Both vascular inflammation and exaggerated blood clotting can result in a heart attack, stroke, embolism to the legs or arms, as well as blood clots in veins and the lungs. Also, heart attacks, cardiac inflammation and many of these other conditions often cause abnormal heart rhythms. An underlying cardiovascular problem makes the risk of these effects even greater. People with high blood pressure, diabetes or obesity are more likely to have problems with their hearts due to COVID-19.

COVID-19 has even impacted heart health in those who are not infected. Heart disease and the risk factors that can cause it are very prevalent in our community. Not getting regular care for these conditions due to fear of the virus increases your risk of cardiovascular problems, including heart attack and stroke. For those with symptoms or signs of heart attack or stroke, fear of catching COVID-19 can delay or prevent seeking emergency care. Studies in the United States and Europe have shown that at least 1 in 5 expected emergency visits for heart attack or stroke did not occur during the initial months of COVID-19 for fear of becoming infected. Every minute counts when someone is having a heart attack because it is vitally important to open that blocked artery to prevent heart muscle from dying. Heart disease has not gone away due to COVID-19. If anything, the pandemic has caused more heart disease.

Be assured that hospitals are prepared to safely treat you when an emergency occurs and are taking appropriate measures to help prevent the spread of the coronavirus.

If you have been infected with COVID-19, it is a good idea after recovery to be able to recognize symptoms such as fatigue, breathing problems, rapid heart rate, unexplained swelling and chest pain. These could be a sign that COVID-19 has affected your heart and you should make an appointment to visit your primary care provider.

Learn More

To learn more about heart disease, its prevention and treatment, as well as how COVID-19 can affect your heart health, I invite you to watch Baystate Health’s free annual Heart & Vascular Health Lecture series.

This op-ed was originally published on MassLive.com.

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