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Advancing Care - February 2022

covid and the heart

 

COVID-19 and your heart

Much has been reported about how COVID-19 affects the lungs, but few may know that the virus can also lead to serious heart problems, according to Erica Spatz, MD, a cardiologist at YNHH and director of the Preventive Cardiovascular Health Program.

How does COVID-19 affect your heart? 
COVID-19 makes the blood clot more easily, which can trigger a heart attack, Dr. Spatz explained. “The virus can enter heart cells and blood vessels through an enzyme called ACE2 and cause disruptions to the cells’ normal function. This can lead to blood clots, inflammation of heart tissue, constriction of blood vessels, and dysregulation of hormones – which can result in hypertension, heart attacks, arrhythmias and congestive heart failure.” 

To fight any virus, including COVID-19, the body reacts by creating inflammation. In some people with COVID-19, however, the inflammation goes into overdrive. Myocarditis, inflammation that causes injury to the heart muscle, can occur with COVID-19. Inflammation can disrupt the electrical signals of the heart, leading to abnormal heart rhythms (called arrhythmia). It can also make an existing arrhythmia worse. 

“In this phase, the body’s immune system begins to attack itself,” she said. “This is why we see people who get worse one or two weeks after they were first infected. In fact, the risk for hospitalization is highest within the first 10 to 14 days of the disease.” 

Multisystem inflammatory syndrome in children (MIS-C) is a high level of inflammation found in children and teens. It can particularly affect the heart.

Am I at risk?  
If you are already at risk for having a heart attack, it is more likely that COVID-19 will affect your heart, Dr. Spatz said. “People with underlying heart disease or who are at risk for heart disease are more vulnerable to the effects of COVID, since the virus and the associated inflammatory response can trigger or destabilize existing disease.”  

Chronic health conditions that may increase the risk for cardiovascular complications from COVID-19 include cardiomyopathy, coronary artery disease, diabetes, heart failure, high blood pressure, obesity, stroke and vasculitis.

What if I don’t have risk factors? 
Even if you do not have the risk factors for heart disease, COVID-19 can still impact your heart. “Long COVID” is a specific concern for young, healthy people who get the virus. Although most people with COVID-19 get better within weeks of illness, some people experience health problems for weeks, months and even years after being infected with the virus. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions, such as shortness of breath, difficulty thinking or concentrating, tiredness or fatigue, heart palpitations and chest pain. 

“The symptoms of long COVID are varied and impact nearly every organ system, including the heart,” Dr. Spatz said. “We see many patients with chest pain, tachycardia and fatigue after exercise who do not have evidence of heart disease, but they have symptoms that are impacting their daily life and ability to work. So there are lots of reasons to avoid being infected with COVID, even if you are young and healthy.” 

When should I call my doctor?
If you’ve had COVID-19 and start to experience symptoms including chest pain, palpitations, shortness of breath or extreme fatigue (especially occurring with physical exertion), you should contact your primary care provider. Dr. Spatz noted that cardiovascular symptoms can occur months after having COVID19, even if you had a mild case. 

What can you do to keep yourself and others safe? 
“Get vaccinated,” said Dr. Spatz. “That means three doses. That is the most important thing a person with heart disease can do to protect themselves.” 

Also wear a good-fitting mask when you are in a high-risk setting (think large crowds or indoor settings) especially when the rates of COVID-19 in the community are high. Protect yourself and others by washing your hands often and staying at least 6 feet apart.

Dr. Spatz also recommends a healthy lifestyle. “Diet and exercise are extremely important. One of the biggest risk factors for having severe COVID and dying from COVID is obesity. Eating whole foods, fresh fruits and vegetables, and getting daily exercise can help,” she said. Taking prescribed medication on a regular basis and keeping up with screenings and check-ins is also important.

And don’t neglect your mental health. “Stay connected. Being kind to oneself and practicing self-care can truly save lives,” she said.

Making sense of scents after COVID-19 

One of the earliest warning signs of COVID-19 disease is a loss of taste and smell. As patients recover, these senses usually return. Some people, however, say that things smell different – and things that should smell nice, such as food, soap, and even their loved ones, smell repulsive. Doctors have been treating more people with this condition, known as parosmia, since the pandemic started. Scientists are not sure why it happens, or how to cure it.

A study published in the Journal of Medical Science (November 2021) reports that up to 85 percent of people who tested positive for COVID-19 have experienced “olfactory dysfunction,” a reduced or distorted ability to smell. Researchers indicate most patients who lost their sense of taste or smell recovered within six months. Approximately 10 percent of patients, however, developed parosmia.

For those with parosmia, smells such as coffee or fruit can smell like garbage, rotten meat or eggs, or ammonia. They struggle with daily tasks such as showering and doing laundry due to distorted smell. 

One theory is that the virus damages specific cells in the nasal cavity that support the smell-detecting neurons, which in turn, translate odors to the brain. Once these support cells are attacked, the body mounts an inflammation response that damages both the smell-detecting neurons and the support cells. During regeneration, the neurons may misfire, thereby distorting smell. Researchers believe that a person can recover their sense of smell once the neurons are fully repaired. The process can take weeks to years.

One treatment that shows promise is olfactory or “smell-retraining:” therapy. This therapy exposes the patient to different strong scents for several minutes at a time over the course of three months, according to Peter Manes, MD, an otolaryngologist at Yale New Haven Hospital. 

“Olfactory retraining has been one of the only treatments where we have some evidence that it improves symptoms. We typically have people start with four scents, using essential oils and ask them to smell each for about 20 seconds, twice daily for three months,” he said. 

Dr. Manes explains that people may also try olfactory retraining on their on their own as it can be effective for many different causes of smell loss, not just COVID-19.

“I recommend starting with rose, lemon, eucalyptus and clove before moving on to a new set of scents as these seem to be the best at stimulating smell receptors,” he said, noting that most people get better within a few weeks. “Researchers are looking into supplements and different ways to stimulate the olfactory nerves, but for right now the most important thing for people to do is not give up. Keep working your sense of smell like a muscle.” 

Scholarships available for local students  

The Yale New Haven Hospital Auxiliary is offering $2,000 scholarships to area high school students planning to pursue a career in a health-related profession. Scholarships are based on academic excellence; financial need; personal statement; and community service, including school and community activities and/or employment. Applicants must be high school seniors who are residents of one of the following towns: Bethany, Branford, Cheshire, East Haven, Guilford, Hamden, Madison, Milford, New Haven, North Branford, North Haven, Orange, Wallingford, West Haven or Woodbridge. 

For an application, email the Auxiliary at [email protected]  or call 203-688-5717. You can also download it from the auxiliary. Submission deadline is March 18. 

YNHHS marks 1 millionth telehealth visit

Yale New Haven Health recently celebrated the its 1 millionth telehealth visit. The beauty of partnering health care with this technology is that telehealth brings patients and providers together when circumstances such as the pandemic discourage in-person visits.

Telehealth  refers to electronic telecommunications technologies that include smartphone apps and video visits. Video visits – sometimes called telemedicine – allow you to receive health care and services from your provider who is in a different location.

In collaboration with Yale Medicine, Yale New Haven Health offers the convenience of telehealth visits with many of our providers, including specialists. You can connect with your clinician via audio or video, through your phone, tablet or computer. On a live telehealth visit, our doctors can access your electronic medical records, examine and prescribe treatments and conduct follow-up visits. Patients can use the secure MyChart app to connect with their provider. Our electronic medical records system, called Epic, helps support these video visits. All video visits are secure and meet the federal government’s HIPAA privacy requirements and consultations. Visits are not recorded.

Pediatricians and specialists at Yale New Haven Health also see young patients through video visits. Before an appointment, a parent downloads the MyChart and Zoom apps  to connect with the child’s provider. During the call, the parent and child must be present on the video. If a child needs to see multiple providers, they can conference in to the same telehealth visit.

Video visits are used for some new patient visits, follow-up visits, post-operation visits, visits to manage your medications, and ongoing health conditions and education. Call your doctor’s office to request a video visit.

Learn more about Telehealth Services at Yale New Haven Health.

A new treatment for sleep apnea 

Continuous positive airway pressure, or CPAP, is considered the “gold standard” for treating sleep apnea, according to sleep medicine doctors. But what if you just can’t tolerate wearing the mask? 

Waking up more than five times an hour is considered abnormal, according to Andrey Zinchuk, MD, a pulmonologist at YNHH and director of the Advanced Apnea Management Program at the Yale School of Medicine. More than 30 times is considered severe sleep apnea, which can cause poor sleep duration or sleep quality. “Both of those things are associated with impaired neurocognitive function, sleepiness during the day, fatigue, loss of productivity, irritability … and higher rates of car accidents,” said Zinchuk.

Patients who suffer from sleep apnea are often encouraged to try CPAP, a machine that works by forcing air through a mask into the respiratory tract. This pressure keeps the tongue, throat or palate from closing. However, CPAP isn’t always the solution for some patients, said Bruno Cardoso, MD, a head and neck surgeon at YNHH who specializes on conditions that affect the ear, nose, and throat. “It’s been pretty well studied that about 40 to 50 percent of patients … don’t tolerate it very well” and stop using the machine, he said.
 
For these patients, a new treatment offered at YNHH may be the solution to their sleep problems. The treatment, called INSPIRE therapy, involves implanting a device that sends a signal to the nerve that controls the forward movement of the tongue. 

Is INSPIRE therapy right for you? Learn more about it in a free webinar on Monday, Feb. 28 at 7 pm. Speakers will include Zinchuk and Cardoso, who will answer questions about the device and how it is used to treat sleep apnea. Register online or email Jennifer Caprio  for more information. 

Find a Doc at YNHH

Are you looking for a physician? Call 888-700-6543 or visit our website’s Find a Doctor feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience.  

Make a lasting impact at YNHH

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Yale New Haven Hospital offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.