COVID-19 and Heart Disease: Practical Advice

This won't pass quickly. There are things you should know.

Posted Mar 16, 2020

Dragana Gordic/Shutterstock
Woman having chest pain.
Source: Dragana Gordic/Shutterstock

I will never forget my first day on active duty as a Navy doctor. In August 1997, I left Johns Hopkins Hospital and volunteered to serve on Guam. Twelve hours after I landed on the island, a commercial 747 crashed into the jungle. We saved 21 lives. 

Everyone scrambled. It was an "All-Hands-on-Deck" moment. The first 24 hours were critical, but perhaps the hardest part came after. Everyone had pitched in, but the wounded were critically ill for more than the first day. It took weeks of sustained effort to keep everyone alive.

And we were all exhausted after the first day.

The moral of this story: We need to pace ourselves. This pandemic is going to take time. It won't be over quickly.

In the time it took for the first 40 deaths from coronavirus in the United States, an estimated 100,000 people died of heart disease who were not infected. The moral of that story is that it is important that we not neglect our routine health maintenance.

But things are obviously different. What are we to do?

First, remember that being older, or having heart disease, does not make it more likely that you will contract coronavirus. In fact, young people (children especially) are likely carriers of the virus. They just don't get that sick. Having heart disease means that if you get the virus, you won't do as well. 

Worldwide, heart disease is still the biggest predictor of dying should you contract the virus. That means we should listen to the CDC. Socially distance yourself. Stay six feet away from people. Don't shake hands. Wash your hands. Don't play with the grandkids. Time to hunker down and finally read War and Peace.

Next: Understand your heart condition. Here is a helpful truth: There is (almost) no such thing as heart disease. It's just natural aging. Aging alone changes our heart and our arteries. No one is immune to aging. An older heart does not have the reserves to stand up to the stress of this sort of infection. 

Hopefully, you already know the health of your heart. If not—when all this blows over—go see your doctor to find out just how healthy your heart is. When it comes to heart disease and aging, symptoms do not predict risks or tell you how healthy your heart is. That's why we call heart disease the silent killer. Remember, heart disease is a silent killer, but it is not invisible. We can see it if we look.

Don't be intimidated by the term "heart failure." It's not a single diagnosis. It's really just a situation. When the body asks the heart to do more than the heart is capable of doing, the heart "fails" to meet the body's needs. That's heart failure. 

It's like when you drive a car. If you have a Prius, that may be an excellent car, but if you attach a boat trailer to it and ask it to drive up a mountainside at high speed, the car can't do it. It will fail. So it is with the heart. If you ask it to do more than it can, it will fail you.

Having COVID-19 is like asking your car to pull a boat uphill really fast. It's hard work that you may not be ready for.

Everyone, as they age, will have changes that affect the heart. These include the tendency to grow plaque in our arteries (coronary artery disease), stiffer arteries (high blood pressure), and irregular heartbeats (nearly a third of 70-year-olds have atrial fibrillation, but most don't know it). 

Know your health.

Then, perhaps the most important thing: Have a plan. This is where planning ahead makes the greatest difference. We should try to never be caught off-guard by our heart.

Ask your doctor (or cardiologist) what to do "in case."

In case I feel my heart racing, what do I do?

In case I feel breathless, what do I do?

In case I feel faint, what do I do?

In case I have chest discomfort, what do I do?

Depending on your heart's health, you can, and should, have a plan in advance for these situations. That way, you may be able to avoid a trip to the Emergency Room. The hospitals do not want you to go to the ER unless really necessary, and you should have a heart plan in advance. What the plan is depends on your particular situation. Maybe you need a contingency prescription. Ask for it now.

Practical Advice:

1. Follow guidelines on how to avoid infection. Social distancing, hand washing, etc.

2. Know your heart issues. Do you have afib? Are you prone to heart failure? If so, why? Do you have a coronary disease?

3. Have a plan. You need to ask your doctor what to do "in case." Have contingency medication. Know when you have to go to the ER for your heart but have an understanding of what you can manage at home.

This virus will be with us for a while. Be patient, be prudent, and be prepared.