Physicians: Don't let COVID-19 resurgence delay medical care

One of Dr. Mark Ricciardi's patients wasn't exactly the Hollywood image of a heart attack victim.

In the movie version, someone having a heart attack clutches the left side of the chest in agony. But Ricciardi's patient felt discomfort, a pressure sensation, in the center of his chest and a bit lower, what doctors call epigastric pain.

The man dismissed his symptoms, a warning sign of serious heart trouble, and put off seeing a doctor until he was in the throes of another major medical emergency.

“He had a full-on stroke,” Ricciardi said.

The cardiologist with NorthShore University HealthSystem points to the case as a cautionary tale about the risks of suffering at home and delaying medical care during the pandemic.

Physicians, researchers and the American Heart Association have expressed alarm over people avoiding the hospital for fear of exposure to the virus or because they don't want to burden the health care system.

In the early spring, NorthShore saw a 50% reduction in heart attack cases during the state's stay-at-home order. While the system, which includes Glenbrook Hospital in Glenview, is not reporting such a decline right now, Ricciardi is worried about another steep drop-off as Illinois faces a renewed surge in COVID-19 infections.

“Facilities certainly like ours are able and ready to take care of patients despite all these spikes we're seeing across the country and the horrific numbers we're reading about,” Ricciardi said. “We're operational. We can certainly take care of patients who are having a heart attack now.”

Don't wait

For patients with the most critical type of heart attack, a medical team has a window of opportunity to perform an angioplasty, a procedure to prop open a completely clogged artery, restore blood flow and lessen the damage to heart muscle deprived of oxygen.

The American Heart Association recommends that the artery be reopened within 90 minutes of “first medical contact.” Put another way, “time is muscle,” cardiologists say.

“One of the points of opening the artery early is that we can salvage heart muscle,” Ricciardi said. “So the longer the artery's closed, the more likely that part of the heart muscle will die and form into scar tissue.”

If that part of the heart muscle doesn't contract because it's now scar tissue, Ricciardi said, a little aneurysm can form.

“And within that aneurysm, there can be stagnant blood flow,” Ricciardi said. “And when there's stagnant blood flow, you can develop a clot.”

The man who felt the chest pain recently went to the emergency room and had an echocardiogram, or ultrasound of his heart. His doctors suspected his symptoms were several days, not hours, old.

“We saw an area of aneurysm and clot in that aneurysm,” Ricciardi said. “And the theory was that a piece of that clot broke off and went north to his brain in one of the blood vessels in his brain and caused a stroke.”

Recognize symptoms

Ricciardi and other physicians are imploring people to take heed of heart attack symptoms. The American Heart Association also launched a “Don't Die of Doubt” campaign last summer to raise awareness about symptoms and to remind people they shouldn't hesitate to call for help even in a pandemic.

“We just have to get everyone through this as best as possible until the vaccine comes and we can get a good handle on this,” said Dr. Ann Davis, a cardiologist at Edward Hospital in Naperville. “But that means, again, masks on everybody, washing your hands, social distancing, doing all the things that we're supposed to do. But that doesn't mean ignore symptoms of cardiovascular problems at the same time.”

If there's any question, get it checked out, Davis said.

Chest discomfort, shortness of breath, or pain radiating to your neck, arm, back or jaw are the more common signs. Sometimes patients have excess fatigue that's out of the ordinary, Davis said.

“I think the atypical ones that we see people miss mostly are sweating, nauseous, lightheadedness,” said Dr. Nauman Mushtaq, medical director of cardiology at the Bluhm Cardiovascular Institute at Northwestern Medicine Central DuPage Hospital in Winfield and Delnor Hospital in Geneva. “And a lot of times they think that they just have some epigastric discomfort or belching or reflex-like symptoms.”

Mushtaq is reassuring patients that hospitals have employed a number of strategies to keep them safe. Employees and patients are screened for virus symptoms. Patients can preregister online so they don't have to wait at a counter.

“We've done a great job at making operational changes to allow for safe care of non-COVID patients,” Mushtaq said.

Heart attack data

A study published this month in the Journal of the American College of Cardiology collected data from 77 medical centers in 18 European countries during the pandemic. Researchers found a 19% drop in what's known as primary percutaneous coronary interventions, the practice of bringing heart attack patients directly to a catheterization lab for procedures that open up blood flow through the heart.

The study's authors suggested factors related to social distancing and lockdowns may have played a role in a drop-off in patients, “including less business-related stress, improved air quality, and a more sedentary lifestyle.”

Ricciardi acknowledged there's still some debate about whether people may be having fewer heart attacks due to lifestyle changes.

“Overall fatality from heart disease seems to have gone up during the pandemic, which would argue for not only a direct effect of COVID on the heart, which we've heard about, but the fact that people are suffering at home and avoiding the hospital.”

Other studies have shown the time from symptom onset to the time doctors open the artery has increased significantly during the pandemic, Ricciardi said.

“The longer people wait, the more likely they're going to have complications from their heart attack,” he said, “whether they be fatal or just cause more heart damage than they otherwise would.”