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Coronavirus and Heart Disease

Part 2: Why people with heart disease don't do well with coronavirus.

Read Part 1 of this series here.

What does coronavirus have to do with psychology? Apparently a lot. As awareness is rising, so is anxiety. I am a cardiologist, but I have spent most of my time lately discussing coronavirus with my patients.

I usually use this space to teach people that they can protect their brains from vascular dementia by preventing strokes. That's still good advice—you can prevent a stroke (read my book by the same title)—but today, you need to understand that your underlying heart health is the number one predictor of survival from COVID-19 (the coronavirus).

Here's why. When we are infected with anything, our body has an increased metabolic demand (to fight the infection). That means the body will ask the heart to do more. In the case of coronavirus, a lot more. The metabolic demands when we are infected with this sort of virus are typically four to eight times more than the normal workload on the heart. It's kind of like running upstairs or running upstairs really fast.

Can your heart handle that?

How do you know?

When I talk about preventing strokes, I always emphasize that symptoms do not predict risk. Our heart and vascular health on the inside changes with time, and we do not feel it (until something bad happens). This is why we call heart and vascular disease the "silent killer." You do not have to have any obvious symptoms of anything, but you may have had significant aging of your heart and arteries. You may not be able to handle the stress and work that come with an infection.

How can you know? You can ask.

Ask your doctor, "What's the health of my heart, and how do we know?"

By the age of 60, everyone has started to age on the inside. Arteries are constantly being pounded, which leads to chronic vascular inflammation, which is why everyone grows plaque in their arteries (eventually). It's not a disease—it's part of aging. How much do you have? Is it affecting your heart? How do you know? Everyone, by 60, begins to have stiffer arteries as well. Our blood vessels become less flexible. This leads to higher blood pressure which increases the work on the heart. Increasing the work on the heart will eventually lead to a less healthy heart. Third: As we get older, the heart has a hard time beating regularly. In fact, one-third of 70-year-olds have intermittent atrial fibrillation (an irregular heartbeat) and 90% don't know it (more on that another day).

The point is: You don't know the health of your heart until you check it out. If you are over 65, you likely have Medicare. Medicare is very good at covering a wide array of heart testing (like echocardiograms, stress testing, carotid ultrasounds, cardiac monitoring). Mostly, you need to ask.

No one is immune to aging.

You don't know your health on the inside unless you look. You don't know how well you will be able to withstand the stress of the virus unless you've asked.

Once you know the health of your heart, your arteries, and your heart's rates and rhythms, you can work with your doctor to optimize your heart and vascular health. You do this so that you can increase your cardiac reserve. That means being able to handle the stress of an infection.

Prevent is an active verb. Follow CDC guidelines to avoid infection, and in the meantime, work with your doctor to make your heart as prepared as it can be.