Released: 5/30/2020 4:05:43 PM
By Scott Scanlon
Published May 29, 2020
Covid-19 surpassed cardiovascular disease last month as the leading cause of death in the United States.
Dr. Vijay Iyer is among heart specialists who believe that probably changed this month, as the novel coronavirus fatality curve flattened in many metro hot spots.
“We have seen an uptick in the number of people showing up with heart attacks,” Iyer said, “when suddenly in the end of March and most of April, it seemed like the heart attacks had disappeared.”
They didn’t. Instead, too many people withstood symptoms, fearful of contracting the virus if they went to an emergency room or doctor’s office, said Iyer, who directs structural heart interventions at Gates Vascular Institute as well as the complex valve clinic next door at Buffalo General Medical Center.
Those who waited included people with chest pains already aware they had uncontrolled blood pressure, clogged arteries, atrial fibrillation and congestive heart failure, Iyer said.
“We're talking to them on the phone and saying, ‘Maybe you should come in, maybe we should plan a procedure,’ but families were saying, ‘No, let's wait another couple of weeks.’ The pushback was not just coming from patients but also families,” said Iyer, also chief of cardiovascular medicine in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
It’s time to stop procrastinating, he said, in part because an unaddressed cardiovascular problem is likely to worsen a case of Covid-19 if you come down with one.
Q: Western New York generally has been on a downward trend. Does that message to avoid the doctor or emergency room need to change?
The message we've been trying to send for at least the last two weeks is that if you have a medical condition that needs attention, or you're not sure you should get attention, don't wait because you have a perception that hospitals are unsafe. Hospitals have gone over and above to make sure that patients who have the coronavirus are not a risk to either health care professionals or to noncoronavirus patients. We're segregating and isolating them. People also should not be scared to go to the doctor's offices or call them. Doctor’s offices (including specialists) also are doing video visits and telephone visits.
Q: Why are patients telling you they are waiting?
Patients are scared. They have symptoms. Sometimes they have symptoms like little discomfort, shortness of breath, and they think they maybe have coronavirus. The message, at least in the beginning part of the epidemic, was stay away from the hospitals and the ERs, talk to your primary doctor. And they're just sitting at home and procrastinating or worried about coming in because they think hospitals are difficult places right now. There's a lot of fears about getting exposed to the virus in the health care system.
Q: Has the coronavirus impacted office visits and your contact with patients as well?
Yeah. Early on we were telling people, “We are really going to be trying to do everything by phone or video visits.” Over the last week to 10 days, we are encouraging those patients that we want to see, that we need to physically examine them, to come in. Everybody coming into an office or into the hospital setting is getting screened at the door for temperatures and they're getting a mask. All health care providers are wearing a mask. There’s lots of hand-washing. The level of care and scrutiny is a lot higher than it normally is. If patients are willing to come in, we're willing to see them and some people that we think are better served with a physical examination, a direct visit, we’re encouraging them to come in. If we have a televisit or phone visit, we’ll say, “That looks like something we need to take a look at.”
Q: Can you still perform angioplasties or cardiac catheterizations?
Even if you come in and have a stress test, and it's moderately abnormal, it's unlikely that we'd say we can sit tight for another six weeks and not do anything. As they continue to have symptoms, deciding on medications they need to be on, at least have a diagnostic procedure. We do want to know what we're dealing with. So we have continued to do urgent semi-urgent cases, taking care of patients, assessing patients for valve disease or heart conditions and not just the emergencies. These are not truly elective cases. They're really more urgent or semi-urgent.
Q: What are some of the symptoms that set off alarm bells for you as a cardiac interventionist?
When people have been having chest discomfort in exertion and it’s getting worse. Initially, maybe they had symptoms walking a mile. Now it's coming on when they’re walking 100 yards of climbing one flight of stairs. That's always a concern, especially when they're still on good medical therapy. Or people who have valvular heart disease and now they're saying, “I was short of breath with a lot of activities and that is getting worse. I'm starting to see some swelling in my feet or I'm getting lightheaded,” things like that. Those are symptoms. As things have progressed – if this is not where we were a couple of weeks ago, a couple of months ago – this is something that they need to get assessed.
Q: Have you been fairly successful with the phone calls and telehealth?
They've been actually pretty good for us, especially the video. That is where we can see the patient. How are they breathing? What do their neck muscles look like? We can have them point a camera at their swollen leg. We can't hear how their heart sounds. Many patients have blood pressure cuffs, so they can tell us what their blood pressures have been, what their heart rate is. There are apps … where they can use their iPhone and send us an EKG strip. The pandemic showed us the power of telehealth and I think we're going to see much more use of that and expansive use of other kinds of technologies.
Q: What can people with high blood pressure, congestive heart failure and other cardiac concerns do to best keep those under control at this time?
All the things that we have told them in the past. Control your diet. Make sure you're not eating a lot of salt. Weigh yourself every day. Check your blood pressure. If they see something that's different, something that has changed – for heart failure patients, for example, have they unexpectedly gained four to five pounds – as they have in the past, they should seek instructions from their doctors. Early intervention is better.