Spotting coronary heart disease in the age of COVID-19
Written by Dr Simon Davies, a consultant interventional cardiologist at Royal Brompton Hospital. He specialises in coronary artery disease and PCI, aortic valve disease and TAVI, and cardio-oncology.
We all know that our lifestyle is likely to have a direct effect on our health. Heart health is one area in particular that is likely to be negatively affected by us smoking, having an unhealthy diet or not getting enough exercise.
The impact of COVID-19
Most of those who test positive for COVID-19 will experience symptoms similar to influenza. These include fever, troublesome dry cough, a sore throat, headaches and feeling fatigued. In some people these symptoms can be relatively mild.
However, in a smaller number of cases, those with COVID-19 will experience more serious complications. Apart from breathing difficulties, some patients showing symptoms resembling that of a heart attack.
Dr Simon Davies, consultant interventional cardiologist at the internationally renowned cardiology department at Royal Brompton and Harefield Hospitals, explains, “In such cases, we have carried out a series of diagnostic tests, including ECG and blood tests, which show the same changes as a typical heart attack. However, X-Ray images have not shown any blockages in the main arteries. Instead, there have been signs of inflammation to the heart in response to the virus.”
He continues, “It is very important for anyone who is showing signs of a heart attack to seek immediate medical attention. At Harefield Hospital green pathways have been developed to ensure patients who have not contracted COVID-19 are kept safe in an isolated area of the hospital. Patients are routed through separate areas of the hospital where they can receive all the necessary treatment required.”
Taking heart health seriously
The COVID-19 pandemic is another major reason for us all to take heart health much more seriously. Cardiovascular health is one of the leading causes of death in many parts of the world. The risk factors of contracting COVID-19, and potentially dying from it, are tied to the leading risk factors associated to cardiovascular health – diabetes, heart disease, obesity and smoking.
It is important to manage cardiovascular health through regular exercise, eating a balanced diet, weight management and avoid smoking. Changes in these behavioural risk factors can greatly improve biological risk factors such as blood pressure, cholesterol and blood sugar levels.
Lifestyle plays a huge impact on likelihood of coronary heart disease
The most common type of heart disease is hereditary, with family links increasing someone’s chances of developing it. Coronary heart disease is the biggest killer of both men and women, killing one-third of men and one-quarter of women. In fact, it is a bigger killer of women than breast cancer.
Dr Davies comments, “Someone may have coronary heart disease in their family, but their lifestyle could either bring forward its development by 20 years or put it off for 20 years. Even during the COVID-19 lockdown it is important to try to keep to a healthy diet. Regular exercise is difficult indoors, but there are many exercise videos and apps which can help to motivate.”
Knowing the symptoms of the disease
Warning signs of coronary heart disease can be breathlessness during exercise, chest pain, or simply the feeling of tightness or having a weight on your chest that feels uncomfortable.
“Knowing your family history of the disease and your own cholesterol level is vital.”
Even now, in an age where education around the effects of poor lifestyle choices is as good as it’s ever been, coronary heart disease continues to affect both those who do the right things and those who do the wrong things to their bodies.
This is why Dr Davies argues that screening is key in spotting problems quickly and ensuring that patients aren’t incorrectly diagnosed with the disease.
Screening involves a variety of tests for your heart health
“If you notice pain or breathlessness, I would always advise going to a primary care doctor first. They’ll know more about your history and they can then refer you on to a cardiologist if your symptoms indicate that you may require some form of cardiac investigation.
Not all chest pain or breathlessness stems from the heart, there can be other causes. If your doctor suspects another condition, such as lung disease, they can refer you to other specialists as appropriate.”
The screening process for coronary heart disease can involve several different types of test. These might include testing a patient’s cholesterol levels, non-invasive tests showing how effectively the heart is pumping blood around the body and new, sophisticated imaging techniques that will give cardiologists incredibly detailed pictures of a patient’s individual arterial health.
The use of non-invasive tests reduce complications
An angiogram, one of the imaging techniques currently used to screen coronary heart disease, involves an invasive element where a fine, flexible tube is threaded along the arteries to reach the heart in order for the pictures to be taken.
Through that same tube, a stent can be fitted to open up a damaged artery to fix the problem as soon as it is seen. However, Dr Davies believes the ‘gold standard’ in terms of screening should involve new non-invasive imaging tests taking place first.
“Putting a tube into the heart does come with a small risk of complications. Through the new non-invasive imaging techniques we are now able to perform at a specialist centre, we as cardiologists can build a picture of someone’s heart health and then decide if they need an invasive angiogram. This helps achieve the best outcomes for the patient.”
A modern CT scan of the coronary arteries:
Left: A 3-dimensional reconstruction of the heart, looking down on the coronary arteries, is now a standard tool. Right: More recently, computers are used to analyse the images to predict the blood flow along each branch of the coronary arteries, and whether it is likely to be normal (blue), slightly restricted (green and yellow), or very reduced (red).
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