Many who suspect or know they have a heart condition have been hesitant to seek care during the pandemic. COVID fears have led to a 23 percent drop in visits to the emergency department for heart attacks, according to the Centers for Disease Control and Prevention. However, delaying needed care is even more risky.
In this episode of San Diego Health, host Susan Taylor interviews Paul Teirstein, MD, an interventional cardiologist at Scripps Clinic and medical director of the Prebys Cardiovascular Institute. Their discussion covers when, where and why you should seek medical treatment for chest pain or other symptoms of a heart problem, plus the different ways to receive care, such as an emergency room visit via a 911 call or a video visit for a non-emergency.
It’s a really big problem. We have seen patients delaying care or not coming to the emergency room because they’re so afraid of the emergency room and they’re having heart attacks at home. Or they’re having prolonged chest pain, which is weakening their heart to the point where, when we do get to work on them, it’s a much more difficult job.
I highly recommend if you’re having symptoms of chest discomfort, squeezing in your chest, anything that could relate to the heart, you go to the emergency room. Emergency rooms are a safe place to be. Anybody suspected of COVID is isolated. Anyone who comes into the hospital is tested. Everyone is wearing masks.
The biggest issue is heart attacks. And that’s usually a feeling of discomfort in the chest. It’s not always chest pain, actually rarely chest pain. Usually like a squeezing, a heaviness in the chest. It can radiate to the jaw, to the arm. It usually can come on with exertion, but the real heart attacks actually come on when you’re just at rest. So, that is something to worry about.
Patients most at risk for heart disease are patients who are older, over the age of 60, who have high blood pressure, who have diabetes and who are obese. Those patients are the ones that often are subject to heart attacks and heart failure. Interestingly, those are also patients at most risk for having a bad reaction to COVID.
COVID can affect the heart in many ways. The heart is impacted by the inflammatory response to COVID and this can cause heart failure. It can cause shock and loss of blood pressure. When patients really get sick in the hospital because of COVID and are in the intensive care unit, most of the time, in addition to their lungs, it’s their heart that’s involved. We have patients on heart lung machines for this reason. They can get very, very, very sick, very quickly.
The virus can also attack the heart directly and they can get a myocarditis, an inflammation of the heart muscle, and they get blood clotting. There are lots of problems from COVID interacting with the heart.
You should be going to the emergency room if you feel chest discomfort, a squeezing, heaviness in the chest, tightness, chest pain, especially if it lasts more than about three or four minutes. That’s when you want to call 911. If you’re short of breath, significantly short of breath, that’s another time you should go to the emergency room. Don’t hesitate. It’s safe to come to the emergency room.
The obvious good side about televideo is that it’s efficient and you can get to the point with the physician of knowing whether or not you need to come in or whether you need to get some blood tests done or X-rays done. But, by all means, if you’re worried about coming to the hospital or your doctor’s office, do a televideo.
One of the biggest risk factors for heart disease is obesity.
Going to the doctor, controlling your blood pressure are really important, but there’s a lot of obesity out there these days. That means exercise. That means eating properly and making that a big part of your life. Those are the most important things.
Lightly edited for clarity
Watch the San Diego Health video with host Susan Taylor and Dr. Teirstein discussing heart care during COVID-19.