FAQs- The Coronavirus and heart disease and stroke

By June Shannon Coronavirus News   |   9th Apr 2020

Medical Director of the Irish Heart Foundation Dr Angie Brown, answers some questions you may have on coronavirus and cardiovascular disease.

At the Irish Heart Foundation we are acutely aware that the threat of the coronavirus can be particularly worrying for people living with a heart condition or those who have suffered a stroke. It is also an anxious time for their families, loved ones and carers.

In an effort to help provide as much information as possible, the Irish Heart Foundation has a special dedicated coronavirus news section on its website as well as a general information page that is updated regularly.

The Coronavirus is a new disease and is therefore one that we are all still learning about. Information and research studies on the illness are coming out at an impressive rate but this also means that guidelines and advice are also changing rapidly as we learn more about coronavirus.

Below the Medical Director of the Irish Heart Foundation and consultant cardiologist Dr Angie Brown answers some of the questions you may have in relation to your heart condition or past stroke and the coronavirus.

Question: The HSE has issued a list of people who are said to be “medically vulnerable” and these people must cocoon. These groups include, anyone with a heart transplant, pregnant women with heart disease, people with severe heart failure or severe vascular disease. Why are these people considered to be medically vulnerable?

Answer: The patients in the group above are considered to be medically vulnerable because they are immunocompromised. Being immunocompromised means that your immune system is weaker than those without these conditions and you are therefore less likely to be able to fight off infections including those caused by the coronavirus. That is why it is important that you follow the HSE advice to cocoon as your best method of prevention from the coronavirus.

Question: I have heart disease/survived a stroke why am I in the at-risk group for this disease?

Answer: This may be partly because many patients with heart disease or those who have suffered a stroke are older and may also have a less robust immune system. Furthermore people’s immune systems tend to weaken as they age. Many of these patients will also have multiple risk factors for cardiovascular disease including, smoking and diabetes.

It is also possible that the effects of the virus may exacerbate or worsen your underlying condition.

For example, if you have heart failure the heart already struggles to pump blood round the body and deliver oxygen to the body. If you contract the coronavirus your heart may be under even more strain if you develop a severe lung infection, which can further reduce oxygen levels.

Furthermore, the World Health Organisation has said that conditions that increases oxygen needs or reduce the ability of the body to use oxygen properly will put patients at higher risk of the consequences of bilateral viral pneumonia.

Viruses like the coronavirus release things called inflammatory cytokines, which cause inflammation throughout the body. This can increase the risk of heart rhythm disturbances all of which can make the patient very unwell.

 

Question: What is it about cardiovascular disease that means you will get more severe COVID-19 if you contract it?

Answer: While people with cardiovascular disease (heart disease or stroke) are not at an increased risk of contracting coronavirus they are more likely to have poorer outcomes if they get the virus.

As mentioned above a majority of patients with cardiovascular disease tend to be older and the coronavirus has sadly shown to cause more severe disease in older people. People with cardiovascular disease may also have a number of risk factors such as diabetes and hypertension which are also in the at risk groups for coronavirus.

It is also thought that the coronavirus may destabilise fatty plaque in the arteries to cause heart attacks. When plaque (the fatty deposits) clogs your arteries, that’s called atherosclerosis. As plaque builds up, the wall of the blood vessel thickens potentially causing a heart attack/blockage or make heart failure worse and increase the risk of rhythm disorders /arrhythmias etc.

Sadly the majority of patients who die from coronavirus tend to be older (over the age of 70) and have advanced heart and lung conditions.

The majority of older people and people with preexisting conditions have a mild or moderate form of the illness and make a full recovery.

Question: Over half of all adults in Ireland over 45 years of age have high blood pressure. Why therefore are people with high blood pressure in the at-risk group? 

As mentioned above the coronavirus is a very new disease that has only been in existence for a few months. There is still a lot we don’t know about the virus. It is unclear why people with high blood pressure are considered to be in the high-risk group.

Research from China where the coronavirus first originated has shown that high blood pressure was a risk factor for more severe illness in people who contract coronavirus.

High blood pressure is indeed very common in Ireland and it is more common among older people. The risk therefore may be related to older age, higher BMI and decreased immunity in this group of patients. However it is not possible to say this definitively yet.

Question: Is everyone with high blood pressure at increased risk if they contract COVID-19 or just those who do not have their high blood pressure well controlled?

Answer: We simply don’t know the definitive answer to this question due to the fact that the coronavirus is such a new disease.

Research is currently underway but the evidence is limited as studies lack definitive detail on this question.

Again research from China has shown that hypertension was a risk factor for more severe disease in coronavirus patients.

As mentioned above high blood pressure is more common in older people who may also have other underlying conditions and decreased immunity.

Therefore, it is possible that younger patients with no other risk factors and whose blood pressure is well controlled may not be at such a high risk as the older patients.

However, the stress of becoming ill from the coronavirus may be more likely to increase your blood pressure and create an added strain on your heart in patients with high BP. Therefore, it is important that everyone with high blood pressure take rigorous precautions to prevent themselves from contracting coronavirus.

Question: What effect do viruses like covid-19 have on your heart?

Answer: Even if you have no underlying heart conditions the coronavirus can cause a cardiac injury leading to a raised level of troponin in your blood.

Troponin is a complex of three regulatory proteins found in the heart and skeletal muscles and is integral to muscle contraction. If the muscle is damaged in anyway the troponin level in your blood is increased so it can be a marker of a heart attack or myocarditis but can also be increased in other conditions such as sepsis (severe infections) or pulmonary embolism.

With this virus it seems that damage such as myocarditis (damage to the heart muscle) or pericarditis (damage to the sac around the heart) can occur.

The virus can also cause an inflammatory response in the body which shown on an ECG looks like a heart attack but with no blocked arteries, but this inflammatory response could also theoretically cause plaque to rupture leading to a heart attack.

The inflammatory response also means there may be an increased risk of many arrhythmias such as Atrial Fibrillation.

Acute inflammation can negatively impact the way your heart or kidneys work. Therefore, if you have underlying heart disease, the outcome if the virus affects the heart is likely to be worse.

Question: What is the risk to me if I have had a stroke?

Answer: Anyone with cardiovascular disease, which includes someone who has had a stroke, is at higher risk; this may partly be related to the fact that many strokes occur in older people with reduced immunity and other risk factors. But it may also be down to the inflammatory response the virus causes worsening the underlying disease.

There is also some emerging evidence that the coronavirus can affect the brain directly causing confusion, stroke and seizures in a small subset of patients with COVID -19. Some patients present with reduced smell and taste.

Given the severity and speed of the impact of COVID-19 worldwide, the quality of evidence that available is currently very limited. There are a lot of researchers and scientists around the world currently working on coronavirus in an effort to learn more about it so hopefully more information will be available quickly.

Question: Does the flu vaccine/pneumonia vaccine help in the fight against Covid-19?

 Answer: No they don’t protect against COVID19 there is currently no vaccine to prevent the coronavirus.

However, the flu and pneumonia vaccines do help to reduce the risk of flu and pneumonia, which would debilitate you and make you more susceptible to the effects of COVID-19 if you were to catch it.

Question: I am the main carer of someone with heart disease/stroke what precautions should I take?

Answer: There is a range of advice and information for carers on the Irish Heart Foundation and HSE website.

 

We are here for you 

We are living in difficult and uncertain times and here at the Irish Heart Foundation we are very aware of the extra challenges people living with the effects of heart disease and stroke face.

The Irish Heart Foundation has developed a number of services to support you at these difficult times.

Telephone and email support

Our nurses are available on phone and email support Monday to Friday 9 am to 5 pm. Call 01 6685001 or email support@irishheart.ie

Further useful sources of information:

HSE

World Health Organization

European Centre for Disease Prevention and Control

Health Protection Surveillance Centre

Please note the information on this page is for general guidance and comes from national and international guidance. It is not intended to replace the individual support of a medical professional.

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