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COVID-19 and The Heart
Dr. Tommy Lee discusses COVID-19 and its affects on the heart.
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Learn more about Tommy Lee, M.D., F.A.C.C.
Tommy Lee, M.D., F.A.C.C.
Tommy Lee, M.D., F.A.C.C. joins the Dignity Health team from private practice. After completing his undergraduate education in chemistry at Stanford University, he attended the Albert Einstein College of Medicine in New York. He returned to Stanford to for his Internal Medicine residency and Cardiology Fellowship.Learn more about Tommy Lee, M.D., F.A.C.C.
Transcription:
COVID-19 and The Heart
Introduction: This Dignity Health Podcast on COVID-19 was recorded on May 18th, 2020. This is Hello Healthy, a Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: So what are the effects of COVID-19 on the heart, our heart patients and patients with diabetes and hypertension at greater risk? And how can you limit your risk of getting sick? Let's find out with Dr. Tommy Lee, an Interventional Cardiologist at Dignity Health. Dr. Lee, thank you so much for your time. So does having a heart condition increase your risk of contracting COVID-19?
Dr. Lee: No. In fact, the infection occurs in anyone and just having a heart condition itself doesn't make you more susceptible to the infection. But having a heart condition can certainly make you more likely to have complications from an infection. So the higher mortality patients are generally the ones with high blood pressure and diabetes and many heart patients have these other comorbidities as well. So contracting the infection has the same odds as anyone else, but the complication rates and the subsequent mortality from the infection can certainly be greater in heart patients.
Host: Okay. So then the risk of severe illness is greater in patients with heart disease?
Dr. Lee: Absolutely. So infection generally affects the lungs and the lungs takes in oxygen. So the oxygen generally drops in patients with these infections. And a lot of these patients also develop this very severe inflammatory response and inflammation causes a drop in the blood pressure further taxing the heart. So these patients sometimes immunocompromised or elderly or frail, they can really suffer greatly from an infection from this COVID virus. So a lot of other heart conditions that can make the infection even worse. So for instance, some people have rhythm disorders such as Brigade syndrome and patients that have congenital heart disease, they suffer greater because of the drop in the oxygen and the taxing effects of dropping in blood pressure as a result of the infection.
Host: What about patients with AFibs? Speaking of heart rhythm issues, what about people with AFib? Are they at a greater risk?
Dr. Lee: No, they have the same risk but then because they have AFib, their heart rhythm and the heart rates may become less easy to control. And generally patients with AFib are elderly and have other comorbidities. Consequently, these patients also have greater risk of complications from this infection.
Host: So having diabetes and hypertension puts someone at a higher then?
Dr. Lee: Unfortunately, many heart patients have diabetes and high blood pressure as their comorbidities as well. So having all of these conditions together certainly puts that particular patient at a higher risk.
Host: So if I could briefly ask you, what is it about diabetes that puts people at a higher risk? Is it that their immune system is compromised?
Dr. Lee: You know, that's a very good question. I think that there's lots of research that's going into why hypertensive and diabetics seem to have this infection. In theory, and this is only a theory at this time, that the patients who have diabetes and high blood pressure now only sometimes are immunocompromised, but sometimes are taking medications that increases potentially the risk of these infections.
Host: So then are people with heart disease, are they more likely to die from COVID-19 than those without?
Dr. Lee: No, not necessarily. As you know, there are many heart conditions, conditions that has to deal with the lining of the heart, rhythm of the heart, the muscle of the heart. So it really depends on what particular heart condition that you have. But in general, older patients with underlying conditions such as high blood pressure and diabetes would increase their risk. And this diffuse inflammation that I tell you about associated with this viral infection could in theory cause inflammation of the arteries causing plaque that's in the artery to rupture and therefore clotting the heart artery or this systemic infection that you could see with inflammation in the heart muscle, you could see more atrial fibrillation and inflammation of the heart muscle could cause a worsening of the heart muscle. So the heart might begin to show signs of heart failure.
Host: So then should someone seek medical attention if they have a preexisting heart condition?
Dr. Lee: Well, I think that if you are in doubt of what's going on with your body, you should always call your doctor. There are so many avenues to contact your physicians today. We have phone visits, video visits, and of course every doctor is available to see you in their office. And there's lots of measures that are taken to protect you and the staff when you come to the doctor's office. So never hesitate to contact your doctor. And certainly if you have symptoms such as fever, shortness of breath and cough, you should definitely seek some kind of medical attention.
Host: Okay. And then what can someone do to limit their risk of getting sick?
Dr. Lee: Well, obviously if you could avoid sick people, that would be the first thing and the virus is spread by droplets. So if you could avoid some kind of contact with other individuals who you don't know, whether they have the disease with Willy help you. Social distancing by putting distance between you and others, you decrease the chance of being exposed to, potentially exposed to droplets. And of course, as you know, washing your hands is so for at least 20 seconds would be helpful to destroy the virus that you might have come into contact with. Covering your mouth when you're coughing or sneezing or protect others and avoid things such as touching your eyes or your nose or your mouth could decrease your chance of putting this virus into a position where it could be taken into your body. You know, door knobs and handles and night light switches. They could really be a surface that can Harbor the virus for a long period of time. So cleaning these surfaces often will be helpful in avoiding contact with this virus and stay at home as much as possible so that you don't come in contact with sick people. I think those are general rules that everyone should follow even after this infection.
Host: Right. And then as we continue to talk about limiting risk, you were talking about medications earlier. Should someone change their medications to reduce their risk of infection?
Dr. Lee: Absolutely not. I think that when there is any doubt about new medications you should talk to your doctor, your doctor would be the best source for changing your medications, address any concerns that you may have. And of course always bring your doctor up to date regarding what you're taking in terms of your medication.
Host: And then is there anything we should know about medications that are used to treat COVID-19, and as far as other heart issues such as heart arrhythmias?
Dr. Lee: Well there are lots of efforts going into research, into medications that could help with this infection. And as you know, there are a lot of medication, medication interactions. So the first thing is to be sure that you tell your doctor what you're on and be complete with your lists. The medications that could be particularly important in heart patients, is associated with their rhythm. There are lots of rhythm disorders that can be worsened with some of the drugs that may be used for COVID-19, such as hydroxychloroquine. So in instances where this drug needs to be used, monitoring the EKG and rhythm would be very important. So if the doctors don't know about your underlying heart condition and your heart rhythm conditions, it may make it more difficult. And certainly people who are more susceptible to rhythm disorders they will be more careful in taking some of these drugs that we have for our COVID-19.
Host: Right. Now there's been surveys that show people are concerned with going to the hospital or doctor's office because that's where the COVID-19 is. Is it safe going to a doctor's office or hospital?
Dr. Lee: Yes, of course. I think that if you feel sick or if you have symptoms of COVID-19 that you need to get evaluated, you should definitely go to your hospital or to your doctor's office. In fact, there is some data that is coming out that suggests that by sheltering in place and staying away from social situation may actually cause some harm. You know the CDC keeps track of all deaths and it's an effort to detect outbreaks. What they are able to do is project deaths and during this pandemic what we see is an increase in deaths as you would expect and what they have shown so far, at least with the early reporting, that all the increase in deaths cannot be attributed to COVID-19 directly. So this excess stats that we see during the Pandemic, not directly attributed to COVID-19, maybe from maybe people who couldn't make it to the hospital because the hospitals were full when they're treating COVCID-19 patients. Or maybe patients are staying home when they shouldn't and suffering their heart attack at home or their stroke at home. And this lead to the increase in deaths.
Host: And then what steps are doctor's offices taking to ensure that people are safe from infection while in the office?
Dr. Lee: Well, I think most hospitals and doctor's office try to screen patients before they come to their institution. So in our office we texted a patient on the day of their visit and ask about shortness of breath, fever and cough. And if there was a yes to any of those text questions, then they get a phone call to evaluate whether or not they have an active infection that we need to take special precautions about. And by the time they come to our front door, there is a screener at the door that takes her temperature and is able to ask some more screening questions. As far as the appointments, as you know, we try to keep social distancing and we maintain that in our office as well. So we schedule appointments so that patients are not so close together and there's not a whole lot of people in the waiting room. We also limit visitors. We try and protect our patients and our staff by having a universal masking policy to protect our staff and our patients from asymptomatic carriers. And I think most hospitals and offices have similar policies. Finally, we have a enhanced sanitation routine, so all surfaces that are in contact with a patient or a visitor is clean immediately after the patient or guest leaves. So I think these are all very preventative measures that institutions follow and offices follow to minimize the risk of transmission when patients come in.
Host: Right. Well that is really good to know. And then why is continued care important? Why should someone keep their current doctor's appointments?
Dr. Lee: Well for two reasons to maintain your health, especially diabetics with these chronic illnesses, it's fully important to be sure that the medications that you're taking is appropriate for your disease condition at that time. Routine monitoring your blood work and your examination really helps your doctor alter your treatment as they see fit because of your condition. And the second part, especially in those who are symptomatic, having your symptoms addressed early on will help you avoid some catastrophic events such as a heart attack weeks or days down the road. So maintaining your health and addressing your needs in a timely fashion is really important.
Host: And then last question, Dr. Lee and thank you so much for your time. What can someone do for their mental wellbeing?
Dr. Lee: Well, you know, I think this pandemic has really changed society and probably will change for a long period of time, I think that keeping social distancing will help us avoid giving each other this illness, but sometimes fully affects the way we think about our environment. So to maintain a healthy mental attitude's very important and part of it has to deal with your diet, maintain a healthy diet and a regular diet would be helpful in keeping up your immune system, fresh vegetables and fruits like you're supposed to be having would help. And limiting things like sugar and alcohol and your diet can also go a long ways in maintaining your health and also your mental wellbeing. Drink lots of water and stay hydrated. And of course exercise. I don't know how many patients I've seen in my walks around the neighborhood and I don't even know that they live in our neighborhood, but this pandemic has really brought people out to increase their exercise.
A little sunlight would go a long way in keeping you your mental health, socialization internet, zoom, and all these virtual visits that we're having more family will help maintain your mental health as well and staying busy with chores. It's a wonder what it does to your mental health to cross off one of those chores that you've been meaning to do for a long time. So keeping up with these normal things will be helpful in your mental. And finally I got to say that you have to keep up with news, actually understand what's going on in the world, but you know, having too much news, sometimes it's not good for you. So there's oftentimes negative messages on the news. So keep up with the news and understand what's happening, but don't keep it on all day.
Host: Really good advice. Get outside, feel the sunshine, walk around the block and limit your news exposure. This has really been informative. Dr. Lee, thank you so much for your time.
Dr. Lee: Well, thanks for having me. Have a good day.
Host: That's Dr. Tommy Lee. And to learn more, visit dignityhealth.org/bakersfield/heart. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.
COVID-19 and The Heart
Introduction: This Dignity Health Podcast on COVID-19 was recorded on May 18th, 2020. This is Hello Healthy, a Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: So what are the effects of COVID-19 on the heart, our heart patients and patients with diabetes and hypertension at greater risk? And how can you limit your risk of getting sick? Let's find out with Dr. Tommy Lee, an Interventional Cardiologist at Dignity Health. Dr. Lee, thank you so much for your time. So does having a heart condition increase your risk of contracting COVID-19?
Dr. Lee: No. In fact, the infection occurs in anyone and just having a heart condition itself doesn't make you more susceptible to the infection. But having a heart condition can certainly make you more likely to have complications from an infection. So the higher mortality patients are generally the ones with high blood pressure and diabetes and many heart patients have these other comorbidities as well. So contracting the infection has the same odds as anyone else, but the complication rates and the subsequent mortality from the infection can certainly be greater in heart patients.
Host: Okay. So then the risk of severe illness is greater in patients with heart disease?
Dr. Lee: Absolutely. So infection generally affects the lungs and the lungs takes in oxygen. So the oxygen generally drops in patients with these infections. And a lot of these patients also develop this very severe inflammatory response and inflammation causes a drop in the blood pressure further taxing the heart. So these patients sometimes immunocompromised or elderly or frail, they can really suffer greatly from an infection from this COVID virus. So a lot of other heart conditions that can make the infection even worse. So for instance, some people have rhythm disorders such as Brigade syndrome and patients that have congenital heart disease, they suffer greater because of the drop in the oxygen and the taxing effects of dropping in blood pressure as a result of the infection.
Host: What about patients with AFibs? Speaking of heart rhythm issues, what about people with AFib? Are they at a greater risk?
Dr. Lee: No, they have the same risk but then because they have AFib, their heart rhythm and the heart rates may become less easy to control. And generally patients with AFib are elderly and have other comorbidities. Consequently, these patients also have greater risk of complications from this infection.
Host: So having diabetes and hypertension puts someone at a higher then?
Dr. Lee: Unfortunately, many heart patients have diabetes and high blood pressure as their comorbidities as well. So having all of these conditions together certainly puts that particular patient at a higher risk.
Host: So if I could briefly ask you, what is it about diabetes that puts people at a higher risk? Is it that their immune system is compromised?
Dr. Lee: You know, that's a very good question. I think that there's lots of research that's going into why hypertensive and diabetics seem to have this infection. In theory, and this is only a theory at this time, that the patients who have diabetes and high blood pressure now only sometimes are immunocompromised, but sometimes are taking medications that increases potentially the risk of these infections.
Host: So then are people with heart disease, are they more likely to die from COVID-19 than those without?
Dr. Lee: No, not necessarily. As you know, there are many heart conditions, conditions that has to deal with the lining of the heart, rhythm of the heart, the muscle of the heart. So it really depends on what particular heart condition that you have. But in general, older patients with underlying conditions such as high blood pressure and diabetes would increase their risk. And this diffuse inflammation that I tell you about associated with this viral infection could in theory cause inflammation of the arteries causing plaque that's in the artery to rupture and therefore clotting the heart artery or this systemic infection that you could see with inflammation in the heart muscle, you could see more atrial fibrillation and inflammation of the heart muscle could cause a worsening of the heart muscle. So the heart might begin to show signs of heart failure.
Host: So then should someone seek medical attention if they have a preexisting heart condition?
Dr. Lee: Well, I think that if you are in doubt of what's going on with your body, you should always call your doctor. There are so many avenues to contact your physicians today. We have phone visits, video visits, and of course every doctor is available to see you in their office. And there's lots of measures that are taken to protect you and the staff when you come to the doctor's office. So never hesitate to contact your doctor. And certainly if you have symptoms such as fever, shortness of breath and cough, you should definitely seek some kind of medical attention.
Host: Okay. And then what can someone do to limit their risk of getting sick?
Dr. Lee: Well, obviously if you could avoid sick people, that would be the first thing and the virus is spread by droplets. So if you could avoid some kind of contact with other individuals who you don't know, whether they have the disease with Willy help you. Social distancing by putting distance between you and others, you decrease the chance of being exposed to, potentially exposed to droplets. And of course, as you know, washing your hands is so for at least 20 seconds would be helpful to destroy the virus that you might have come into contact with. Covering your mouth when you're coughing or sneezing or protect others and avoid things such as touching your eyes or your nose or your mouth could decrease your chance of putting this virus into a position where it could be taken into your body. You know, door knobs and handles and night light switches. They could really be a surface that can Harbor the virus for a long period of time. So cleaning these surfaces often will be helpful in avoiding contact with this virus and stay at home as much as possible so that you don't come in contact with sick people. I think those are general rules that everyone should follow even after this infection.
Host: Right. And then as we continue to talk about limiting risk, you were talking about medications earlier. Should someone change their medications to reduce their risk of infection?
Dr. Lee: Absolutely not. I think that when there is any doubt about new medications you should talk to your doctor, your doctor would be the best source for changing your medications, address any concerns that you may have. And of course always bring your doctor up to date regarding what you're taking in terms of your medication.
Host: And then is there anything we should know about medications that are used to treat COVID-19, and as far as other heart issues such as heart arrhythmias?
Dr. Lee: Well there are lots of efforts going into research, into medications that could help with this infection. And as you know, there are a lot of medication, medication interactions. So the first thing is to be sure that you tell your doctor what you're on and be complete with your lists. The medications that could be particularly important in heart patients, is associated with their rhythm. There are lots of rhythm disorders that can be worsened with some of the drugs that may be used for COVID-19, such as hydroxychloroquine. So in instances where this drug needs to be used, monitoring the EKG and rhythm would be very important. So if the doctors don't know about your underlying heart condition and your heart rhythm conditions, it may make it more difficult. And certainly people who are more susceptible to rhythm disorders they will be more careful in taking some of these drugs that we have for our COVID-19.
Host: Right. Now there's been surveys that show people are concerned with going to the hospital or doctor's office because that's where the COVID-19 is. Is it safe going to a doctor's office or hospital?
Dr. Lee: Yes, of course. I think that if you feel sick or if you have symptoms of COVID-19 that you need to get evaluated, you should definitely go to your hospital or to your doctor's office. In fact, there is some data that is coming out that suggests that by sheltering in place and staying away from social situation may actually cause some harm. You know the CDC keeps track of all deaths and it's an effort to detect outbreaks. What they are able to do is project deaths and during this pandemic what we see is an increase in deaths as you would expect and what they have shown so far, at least with the early reporting, that all the increase in deaths cannot be attributed to COVID-19 directly. So this excess stats that we see during the Pandemic, not directly attributed to COVID-19, maybe from maybe people who couldn't make it to the hospital because the hospitals were full when they're treating COVCID-19 patients. Or maybe patients are staying home when they shouldn't and suffering their heart attack at home or their stroke at home. And this lead to the increase in deaths.
Host: And then what steps are doctor's offices taking to ensure that people are safe from infection while in the office?
Dr. Lee: Well, I think most hospitals and doctor's office try to screen patients before they come to their institution. So in our office we texted a patient on the day of their visit and ask about shortness of breath, fever and cough. And if there was a yes to any of those text questions, then they get a phone call to evaluate whether or not they have an active infection that we need to take special precautions about. And by the time they come to our front door, there is a screener at the door that takes her temperature and is able to ask some more screening questions. As far as the appointments, as you know, we try to keep social distancing and we maintain that in our office as well. So we schedule appointments so that patients are not so close together and there's not a whole lot of people in the waiting room. We also limit visitors. We try and protect our patients and our staff by having a universal masking policy to protect our staff and our patients from asymptomatic carriers. And I think most hospitals and offices have similar policies. Finally, we have a enhanced sanitation routine, so all surfaces that are in contact with a patient or a visitor is clean immediately after the patient or guest leaves. So I think these are all very preventative measures that institutions follow and offices follow to minimize the risk of transmission when patients come in.
Host: Right. Well that is really good to know. And then why is continued care important? Why should someone keep their current doctor's appointments?
Dr. Lee: Well for two reasons to maintain your health, especially diabetics with these chronic illnesses, it's fully important to be sure that the medications that you're taking is appropriate for your disease condition at that time. Routine monitoring your blood work and your examination really helps your doctor alter your treatment as they see fit because of your condition. And the second part, especially in those who are symptomatic, having your symptoms addressed early on will help you avoid some catastrophic events such as a heart attack weeks or days down the road. So maintaining your health and addressing your needs in a timely fashion is really important.
Host: And then last question, Dr. Lee and thank you so much for your time. What can someone do for their mental wellbeing?
Dr. Lee: Well, you know, I think this pandemic has really changed society and probably will change for a long period of time, I think that keeping social distancing will help us avoid giving each other this illness, but sometimes fully affects the way we think about our environment. So to maintain a healthy mental attitude's very important and part of it has to deal with your diet, maintain a healthy diet and a regular diet would be helpful in keeping up your immune system, fresh vegetables and fruits like you're supposed to be having would help. And limiting things like sugar and alcohol and your diet can also go a long ways in maintaining your health and also your mental wellbeing. Drink lots of water and stay hydrated. And of course exercise. I don't know how many patients I've seen in my walks around the neighborhood and I don't even know that they live in our neighborhood, but this pandemic has really brought people out to increase their exercise.
A little sunlight would go a long way in keeping you your mental health, socialization internet, zoom, and all these virtual visits that we're having more family will help maintain your mental health as well and staying busy with chores. It's a wonder what it does to your mental health to cross off one of those chores that you've been meaning to do for a long time. So keeping up with these normal things will be helpful in your mental. And finally I got to say that you have to keep up with news, actually understand what's going on in the world, but you know, having too much news, sometimes it's not good for you. So there's oftentimes negative messages on the news. So keep up with the news and understand what's happening, but don't keep it on all day.
Host: Really good advice. Get outside, feel the sunshine, walk around the block and limit your news exposure. This has really been informative. Dr. Lee, thank you so much for your time.
Dr. Lee: Well, thanks for having me. Have a good day.
Host: That's Dr. Tommy Lee. And to learn more, visit dignityhealth.org/bakersfield/heart. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.