Transcript: SCAD and COVID-19
Speakers: Sharonne N. Hayes, M.D., and Marysia S. Tweet, M.D., Mayo Clinic Spontaneous Coronary Artery Dissection (SCAD) Research Program
Dr. Hayes: Greetings from the Mayo Clinic SCAD Clinic! I'm Dr. Sharonne Hayes and I am here with Dr. Marysia Tweet. We wanted to connect with you, via SCAD Research Inc., to speak to a few of your SCAD-related concerns in these uncertain and stressful times.
All of us, and especially those of you who have had a heart attack or have loved ones who have had a SCAD, are concerned about the rapidly evolving pandemic response related to the coronavirus infection, or COVID-19.
The uncertainty of the current pandemic and the experience in other countries and cities can be a real source of concern and for some, fear. This may be particularly true for those with chronic medical conditions and a history of a heart event, such as SCAD.
Dr. Tweet: Dr. Hayes and I wanted to provide an update with facts as we know them as of March 19th. While there's a great deal of uncertainty, our knowledge is rapidly evolving regarding the diagnosis and treatment of COVID-19, with the important proviso that by the time you watch or read this, there will likely be new information and possibly different recommendations on aspects such as social isolation.
Dr. Hayes: Let's start with what we know. What is the coronavirus?
The COVID-19 virus is a respiratory virus that can spread easily with symptoms similar to influenza. While most affected people have mild disease, especially children, some people infected with this virus may become critically ill.
Those who are older and those who have diabetes, heart or lung disease are considered at risk. However, individual risk may vary and be based on factors that we are still working to identify and understand.
What are the symptoms? The most frequent symptoms are
- Shortness of breath
- Muscle aches
- Sometimes diarrhea is an early symptom
Notably, a runny nose or head cold symptoms are not signs of COVID-19 infection.
Dr. Tweet: When should you contact your doctor?
If you think you have been exposed to COVID-19, and you develop symptoms such as a cough, fever and shortness of breath, you should call your health care provider for directions and next steps.
If you think you may have COVID-19, call your health care provider first rather than showing up without warning. Protocols are in place to care for you and to determine whether testing is appropriate, and it is important to avoid infecting others if you are sick.
If you think you have been exposed to COVID-19 and you do not have symptoms, current recommendations are that you do not need to be tested nor seen by a health care provider. You should self-monitor for symptoms that may develop and use good hand hygiene.
If you experience severe symptoms, such as difficulty breathing; new, severe chest pain or pressure; or confusion, then you should seek emergency medical care.
Since the COVID-19 pandemic response is constantly evolving, experts are learning more about the virus every single day. Therefore, recommendations — including those for testing — may change.
Dr. Hayes: What about SCAD patients?
A number of our patients and participants in the Mayo Clinic SCAD Registry have raised questions about COVID-19 in relation to their history of SCAD. And as you might imagine, there isn't a lot of SCAD-specific data.
However, for those SCAD patients who have high blood pressure (hypertension), who had large heart attacks that resulted in reduced heart pumping function (low ejection fraction), or for those who have heart failure, you should take particular care to avoid illness, because those conditions have been associated with a higher risk of complications related to infection.
The absolutely most important thing to do is to take steps to keep yourself physically and mentally healthy. Take your prescribed medications. Consider getting your pharmacy or your health care provider to help you have on hand an extra 30- or 90-day supply of your medications.
Some have heard questions specifically about whether patients should continue taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) as prescribed if they've been exposed to or diagnosed with COVID-19 infection. Misinformation on the subject has caused confusion among some patients.
These medications — often used to treat heart failure, high blood pressure and diabetes — are a pivotal part of the treatment process for many patients with heart disease. We suggest following expert advice from a March 17th collaborative statement from a team of experts from the Heart Failure Society of America, American Heart Association and the American College of Cardiology who advise patients not to stop these medications on their own and only stop treatment if told to do so by their doctor.
Dr. Tweet: What else? And then there is the often repeated but often hard to remember advice: Wash your hands often, avoid touching your face and practice appropriate self-care. In addition, now is the time to practice social distancing and avoid nonessential gatherings or travel, limit close contact with those who are sick, and reduce touching "high-touch" surfaces in public areas, such as elevator buttons, door handles, and so forth.
Dr. Hayes: Some additional thoughts on social distancing: In these stressful times, not having contact with those who love and care about us, being worried about others in our life, not being able to exercise, and other limitations to day-to-day life can make us even more stressed and literally sick. Not to mention the economic impact many are feeling.
Use this time to stay connected and to reconnect with family and friends who are experiencing the same kinds of feelings and isolation that you are. Even though my mother is quite healthy, I am talking to her two or even three times a day, which is more than usual. I am touching base with my sister, who lives far away, on a daily basis. This is through phone or texts and social media. Whatever works for you!
A good resource with tips on how to deal with the psychological effects of social distancing, isolation and quarantines is available from the Substance Abuse and Mental Health Services Administration (SAMHSA) (PDF).
Your regular health care provider or health system may be making changes to when and how they see patients. Mayo Clinic is temporarily holding off on in-person visits for routine checkups and for people who are well.
If you have a routine health care visit planned in the near future, consider calling in advance and seeing if you might be able to cover what needs to be done via a phone call or telemedicine visit or simply delay that routine visit until later in the year when things have settled down. This is probably not the time to be getting your routine screening mammogram or colonoscopy.
Dr. Tweet: What else can you do?
Seek reliable sources of information. That would be information from your local public health department, the CDC website, your local hospital or academic medical center, or websites like MayoClinic.org. You can also visit the Mayo Clinic News Network for current, accurate information.
There is a lot of confusing and sometimes misleading information out there. We want you to remain safe, healthy and informed. If your locality recommends further limitation of social interaction, follow those rules.
It may seem like every hour brings something new about this infection, and so far, that has been true. We are here for you.
Dr. Hayes: On behalf of our entire team at Mayo Clinic, thank you and stay well.