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Scott Webb: Though our hearts are innocent bystanders when it comes to COVID-19 illness and to complications, it appears that some people may suffer lasting heart issues if they've had the virus and this is especially true for those of us with pre-existing heart conditions. And joining me today is Dr. Roger Chaffee. He's a cardiologist and Chairman of Cardiovascular Disease at Summa Health. And he's here today to help us understand how COVID-19 affects our hearts and to encourage anyone with signs and symptoms of heart attack to call 911 immediately.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So doctor, thanks so much for your time today. We're talking about COVID-19 and the heart. So let's start there with a baseline question, how does COVID-19 affect our hearts?

Dr. Roger Chaffee: Well, it can really affect any part of the heart. Now, the heart is not the primary target usually with this virus, but it often is a kind of an innocent bystander. But if you think of the heart in layers, the heart muscle, so the heart muscle can be affected by what we call myocarditis or inflammation in the heart muscle.

And usually, these patients that's asymptomatic. People don't even know that, but it can be severe and it can even be fatal, but that's very uncommon. If you look at the most inner part of the heart muscle called the endocardium, which is the valves that open and close, really doesn't affect the valve, so that's good.

The sac around the hardest called the pericardium and it can be affected. It can get inflamed, which can cause chest pain. It can feel just like you're having a heart attack. And it also can lead to an accumulation of fluid called a pericardial effusion. So that fluid can get around the heart, that can continue to cause pain and it can even compress to the heart to cause heart failure. And that's called pericardial tamponade.

Then, if you go to the outer layer of the heart, the coronary arteries, it can cause inflammation in the arteries and inflammation in the plaque of the artery. So it can cause a heart attack or even some injury to the arteries called aneurysms, we think would be more likely to cause some plaque to become active and to narrow the coronary arteries and cause a heart attack.

And then finally, the electrical system of the heart. It can cause arrhythmias where a most common would be one called atrial fibrillation. But ventricular or lower chamber heart rhythm problems can occur and those can be fatal. But again, usually not. So the heart's probably involved in coronavirus, at least in people hospitalized maybe about one in five. But it's generally not the target so much of the virus, but certainly can be effected.

Scott Webb: That's a really interesting point. I haven't heard it put that way before that the heart is sort of an innocent bystander, but of course the consequences can be dire.

Dr. Roger Chaffee: And it can be fatal.

Scott Webb: Yeah. It can be fatal for sure. So that's one of the things I want to follow up with is, you know, can there be long-term damage to people's hearts even after they recover from COVID-19? And if so, why?

Dr. Roger Chaffee: Really in two ways, one would be if you get inflammation in the muscle called myocarditis, it can actually cause scarring of the muscles. You can actually lose functional muscle and that can lead to what we call cardiomyopathy, meaning heart muscle disease. And that can lead to both heart failure, where the heart muscle is quite weakened and becomes weak, or it can also lead to heart rhythm problems. Any times there's scar tissue in the heart muscle, that can set up the milieu or the environment for heart rhythm problems, and that also can be fatal.

So that's one reason why there's some interest in doing CAT scans or MRI tests, magnetic resonance imaging or computed tomography, those types of tests to look at least some people as they recover from a coronavirus-19 to see how often that happens.

Now, I just read a report recently of I think it was 145 athletes that were mild or minimally symptomatic. And of those, only two were found to have any evidence. They did MRIs on all those young people. And they only found some evidence of some injury to the heart muscle in two of them. So it looks like in general, the risk of that's pretty low.

The other way it can injure the heart is if you developed a blood clot in one of the coronary arteries or intense inflammation in one of the coronary arteries that made the artery close down. And that can just cause what would generally be the run-of-the-mill a heart attack, we call that myocardial infarction, but that can also damage the heart muscle.

And I guess to think about it, I'd say a third even, if you get inflammation around the heart called pericarditis, that sac around the heart called the pericardium. If you get pericarditis, that can occur acutely. So you have it during the initial illness, but with any viral infection that can set up a chronic recurrent pericarditis that can damage the pericardium and either lead to fluid buildup in the pericardial sac or a thickening of the pericardium that can kind of compress the heart. And that's called constrictive pericarditis. We see that with other viral infections and we probably will see that with coronavirus-19.

Scott Webb: You know, I think there's this feeling that despite how much we've learned about COVID-19 in this last year or so that there's still so much that we don't know, but you seem to know a lot about COVID-19 and its effects on the heart and perhaps the longterm ramifications. So I want to specifically ask you about people with heart disease who get COVID-19. Are they at higher risk for more severe COVID-19 complications?

Dr. Roger Chaffee: They are. You know, one of the several risk factors, hypertension, obesity, diabetes, pre-existing lung disease, and certainly then heart disease, they're at higher risk for the life-threatening or fatal complications. It's interesting though, in the studies I've read, in someone say with chronic heart disease, say coronary disease or cardiomyopathy or valvular heart disease, anything that is chronic and stable in a patient. People that come in with coronavirus infection and have evidence of acute damage to the heart and we measure that by a blood test called the troponin. It's a protein that the heart muscle releases when it's damaged.

If people that don't have heart disease or any known heart disease come in and have abnormal troponins, meaning that they have some acute injury to the heart, they're actually at higher risk for fatal or near-fatal complications than people that have stable heart disease and don't have positive troponins, don't have any evidence of acute injury. But what we think is that when we see acute injury to the heart, again, kind of the innocent bystander in this illness, when we see acute injury to the heart, that is just an indication of the severity of the overall disease and just is a marker for more severe disease, more severe pulmonary disease. And people that die from coronavirus infection usually die from the pulmonary, the lung complications more than anything else.

Scott Webb: I've been hearing that people during COVID-19 have been delaying care for symptoms of stroke, symptoms of heart. And of course, we know time is brain, time is muscle, time is heart, but it's kind of alarming to think that people are suffering from the symptoms and not going to the hospital out of fear of COVID-19. So maybe just have you a kind of cardiologist 101, what are the typical or general signs and symptoms of a heart attack?

Dr. Roger Chaffee: Most common is an alarming, unpleasant feeling in the chest. People call that chest pain or chest pressure or it's like an elephant sitting on my chest, but some alarming, unpleasant feeling in the chest and that's usually a feeling of heaviness or tightness or pressure. And I tell people if you feel that way and it doesn't go away within 10 minutes, you know, don't get in the car, don't have someone drive you to the emergency room, don't sit at home because if you're having a heart attack, if you get to the hospital within 15, 20, 30 minutes, we often can prevent any serious damage.

So if you have those symptoms, call 911 and go in by ambulance because when the medical team gets to your home or wherever you are, they start treatment immediately. You know, they'll get an IV in. They'll give you oxygen. They may give you medicine to relieve the pain. They'll send an EKG to the emergency department where they're sending you. And if there is evidence of a heart attack, they'll alert the team to come into the cath lab and be ready for you when you get there. So alarming chest pain. And again, that usually is felt like pressure or heaviness or tightness. Ten minutes of that, you should seek immediate medical attention by 911.

Any alarming shortness of breath. Being from Akron. I tell patients that LeBron James gets short of breath, but he gets short of breath when he's doing something that he knows will cause shortness of breath. But if you get alarming, shortness of breath and it doesn't go away within 10 minutes, short of breath that you shouldn't be having, you should seek immediate medical attention again by 911 and medical transport.

If you feel like your heart's beating really fast and this is unusual. It's not because you're nervous, it's not because you're scared. It's not because you just went for a run, but you're just sitting around and your heart feels like it's racing, again, if that doesn't stop within about 10 minutes, you need to seek immediate medical attention.

And then the other would be if you faint, if you pass out, you should seek immediate medical attention. And I'll add one more would be symptoms of stroke, sudden loss of vision, sudden inability to speak properly, sudden weakness on one side of the body or the other, again, that doesn't go away within about 10 minutes, seek immediate medical attention by calling 911 and getting experts out to your home or wherever you are.

Scott Webb: And doctor, as we get close to wrapping up here, anything else you want to tell people about COVID-19 and what we know at least so far about the short and long-term effects on our hearts?

Dr. Roger Chaffee: No, that's a great question, Scott. Number one, get vaccinated. We've had over 500,000 deaths from coronavirus-19. I don't think we'll have any deaths from immunization. So when you weigh the risks of immunization to the benefits of the immunization, the benefits far exceed the risk, not only you to yourself, but it's the right thing to do for the community because it makes you less likely to get the infection and give it to someone else.

And it appears that all of the vaccines that are available are not only protective of the infection, but as important and maybe even more important, they're protective from the serious disease. It looks like if you're immunized, even if you get the infection, you won't end up in the hospital or dead. And it also makes you less likely to pass it. So number one, get immunized.

Number two, until we get this under control, practice mask-wearing when you're in a group, social distancing and hand-washing. So practice those measures that have been advocated until hopefully within about the next three months, we're going to see a big drop. But practice those until we get this under control.

Don't ignore symptoms, and don't be afraid of the emergency department and the doctor's offices. We're all very used to handling patients now that could have or suspected coronavirus. And most people don't have it, but even if you're asymptomatic and you come in the office, you could have it, but the ERs, the doctor's offices, the testing sites were, you know, really set up for the appropriate personal protective equipment and social distancing. So the medical places are safe places now.

Scott Webb: Yeah, definitely. And a great way to end. And one of my favorite things about hosting these is I get really great advice from the experts. And I appreciate your expertise today, your way of explaining things. This was really great. Thank you so much, doctor. And you stay well.

Dr. Roger Chaffee: Yeah, my privilege. If it helps one person out there, it was worth my time.

Scott Webb: Please consult your primary care physician, if you were concerned about the effects that COVID-19 may have on your heart. And if you found this podcast helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

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