Aside from respiratory symptoms, COVID-19 can also cause chest discomfort, shortness of breath and breathing difficulties which appear to be similar to clinical manifestations of certain types of heart disease. Regardless of the cause, these life-threatening symptoms urge an immediate medical attention and prompt treatment.

Heart disease or COVID-19

When SARS-CoV-2 enters into the body, it comes into contact with the mucous membranes that line the respiratory system. Infection begins to develop in the upper respiratory tract, even though the virus can travel down the airways. Common symptoms include nasal congestion, runny nose, cough and sore throat presented along with low- to high-grade fever, chills, malaise or fatigue, headache and muscle ache. If the infection extensively progresses, the lower respiratory tract including the lungs will be further affected. Once the virus reaches the lungs, the lining can become irritated and inflamed. The inflammation and infection activate our immune system to fight back through several immune mechanisms, resulting in an elevated metabolic rate with lung infection. Pneumonia develops when the lungs are inflamed and filled with an excess fluid, leading to breathing difficulties. The COVID-19 induced pneumonia tends to take hold in both lungs where air sacs in the lungs filling with fluid limit their ability to take in oxygen. Due to impaired oxygen levels in the blood, patients exhibit shortness of breath and palpitation defined as a skipped beat, rapid fluttering in the chest.

Despite the fact that both COVID-19 and heart disease can cause chest pain and breathing difficulties, heart disease does not typically exhibit previous respiratory symptoms that are similar to flu. The chest discomfort, as a result of reduced blood flow to the heart, is triggered by physical exertion or vigorous activity.

Shortness of breath associated with heart failure or pulmonary edema is induced by an excess fluid with the absence of fever or flu-like symptoms. However, breathing difficulties caused by heart failure or pulmonary edema are worsened while lying down. The flatter the patients lie, the more they suffer from shortness of breath. Due to less tolerance for lying flat, some patients need several pillows to lie on. In severe cases, patients can only sleep when they sit upright. It is important to point out that when patients with cardiovascular disease become infected, COVID-19 can exacerbate their symptoms, leading to life-threatening events which urgently require emergency and intensive care.

COVID-19 in patients with cardiovascular disease

Based upon medical evidence currently obtained, patients with cardiovascular diseases are not more susceptible to get infections with COVID-19 than the general populations. However, if they become infected with COVID-19, they are at greater risks of developing serious illness which leads to higher risk of death. Not only in patients with heart disease, but severe manifestations of COVID-19 are also found in elderly people aged over 65 and patients with preexisting conditions, such as hypertension, chronic respiratory disease, diabetes, cancer, chronic kidney disease and chronic liver disease as well as immunocompromised patients. Moreover, mortality rates rise significantly if these conditions are present along with COVID-19 infection. To minimize the risk of infections, all preventive measures advised by healthcare authorities must be strictly complied with.

COVID-19 has been related to various cardiovascular complications, including acute myocardial injury, myocarditis and arrhythmias. In adiditon, COVID-19 can aggravate the symptoms of myocardial infarction or heart failure through systemic inflammatory response. As a result, metabolic rates correlatively increase and eventually provoke preexisting symptoms. Furthermore, hemodynamic balance is abruptly altered, leading to excessive fluid in which kidneys fail to excrete from the body. Fluid overload brings on acute kidney failure and pulmonary edema (excess fluid in the lungs), causing prolonged hospitalization with serious complications and life-threatening conditions.

Essential tips for cardiovascular patients

Preventive measures taken for prevention of COVID-19 include:

• Maintain social distancing by staying at least 2 meters from other people.
• Wear a face mask at all times while in public.
• Wash hands frequently with soap or hand sanitizer.
• Practice good food hygiene.
• Refrain from going to crowded or polluted areas.

During the pandemic, if appointments are made at the hospitals for treatment monitoring or follow-ups, patients need to follow all instructions. Although a large number of patients have rescheduled or postponed their appointments due to being afraid of visiting hospitals, missing appointments in patients whose conditions are medically unstable is not advised. To keep conditions under control, medications should be taken as prescribed. Telemedicine via online consultation can be also considered.

Owing to the similarity in symptoms, patients with cardiovascular diseases must be aware of their abnormal signs. Immediate medical attention must be sought if respiratory symptoms, e.g. nasal congestion, runny nose, cough and sore throat arise present along with fever, malaise and headache. In case that chest discomfort and breathing difficulties exhibit, further diagnosis and investigation is urgently required.