Stressed by COVID-19 and suffering chest pain? Don't put off visit to emergency

MONTREAL -- Two months into the pandemic, Ron (not his real name) a healthy Montreal man with no history of heart disease began to feel a tightening in his chest that wouldn’t go away. After three days, he called the province’s telephone health line and a nurse told him to go to a hospital emergency room. It was the last place he wanted to go during the height of the pandemic, but he did. Tests revealed he was not having a heart attack and was likely suffering from stress.

He was lucky.

Doctors say, had it been a heart attack, he might have suffered irreversible damage or died by waiting.

That was one of several messages to come out of a Virtual Parlour Meeting open to the public with top doctors at the Jewish General Hospital yesterday.

Dr. Lawrence Rudski, Director of the hospital’s Azrieli Heart Centre said “we measure in minutes the time that it takes from you to get chest pain and call Urgences Santé to get to the hospital. Our goal is to get the artery open, meaning you come with the ambulance to the emergency, you’ve gone through the catheterization lab and your artery is open within less than 90 minutes. We saw many people coming in two days, three days after their symptoms and by then there was a lot of damage already done.”

Across the world there was a 50% reduction in patients who presented to hospital with heart attacks in the early months of the pandemic. A huge drop, said Rudski, not because heart attacks were down but because patients were afraid to come to the hospital.

“The problem with that is there is a doubling in your risk of dying. Not because they came to the hospital and got COVID, but because they came late. We saw many late presentations of heart attack because people were afraid to come and when you present late you end up with more complications”, he said.

When doctors and researchers first began recording symptoms of COVID-19, there were reports that the virus could have a profound effect on the heart. Early reports out of China said up to 25 per cent of patients with COVID-19 had heart damage.

“The evidence for heart disease from COVID is actually quite small," said Rudski.

During his presentation, Rudski explained how there have also only been a few dozen cases of proven inflammation of the heart muscle likely caused by COVID reported worldwide. And while particles of the virus can enter the heart or cause inflammation of the sac around the heart, the frequency and extent are controversial. A lot of the early reports have, in fact, been discredited or retracted, with a term that we know as “COVID-Science”.

Researchers have found that the stress of the COVID-19 pandemic, more than of the virus itself, can cause strong emotions that can cause heart damage. This is known as Takotsubo or Broken Heart Syndrome.

“Because of the stress during this period we’ve actually seen a five-fold increase in very strong emotional stress causing this transient heart damage”, he said.

Still, Rudski says most people who presented to hospitals with COVID-19 and found to have heart damage shown by elevated blood enzyme levels, already had underlying heart conditions or risk factors for heart disease before they were ever infected. So the virus only exacerbated or showed what was already there.

It usually did not cause the heart issue.

“We’ve only had one case of serious heart disease related to COVID at the JGH one patient. About a month ago, a 23-year-old medical student who was coming over from Africa and seems to have caught COVID on the plane and we’ve had two other patients who were hospitalized for COVID for other reasons and had heart attacks while in the hospital”.

The hospital’s Azrieli Heart Centre is now close to running again at full scale. Cath labs and surgeries are back at full operation and their 54 beds , which once had 10 patients are again full.

“There was a lull and then it exploded about six weeks ago with people deciding they needed to care of themselves” he said. Only the out-patient area is still reduced because of social distancing so they can only handle 13 patients instead of 35 in the waiting area. But to make up for it, they are still doing a lot of virtual visits with patients.

For those who do visit the hospital Rudski is reassuring.

“The hospital is one the safest places you can go. I used to get palpitations when I was going to visit the grocery store. But with all the precautions we take, I never felt worried at the hospital. Right now we only have one patent with COVID in the entire hospital,” he said. 

Bottom line- don’t be afraid. If you’re worried about your heart, get it checked out quickly. Don’t be another “late-presenter” because fear of catching COVID-19, not the virus itself, could be more damaging.