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As of this writing, there have been two reported deaths from the coronavirus in Washington, D.C. The virus was almost responsible for at least one more in a patient of mine who wasn't even infected. She had heart disease.
She needed a pacemaker. This was not a mystery. We knew for a long time that she was going to need a pacemaker eventually. The older we get, the less reliable our heart's rhythm will be, and a great many people will eventually benefit from a pacemaker. The goal is to get it before it is an emergency.
Because of the virus, there was a growing sense that no one should do anything. This included people avoiding their doctors, even though they have ongoing health problems (like heart disease). Giving someone a pacemaker is normally a simple outpatient procedure, unless you wait too long and wind up in the emergency room, surrounded by sick people, with everyone suddenly trying desperately to keep your heart beating.
My patient's story ended well. I came to the hospital (at midnight), gave her a pacemaker, and she went home, perfectly well in a few hours.
This was supposed to have been done as a non-emergency but was delayed. The irony is that the main reason for the delay was that no one (the patient or the hospital) wanted to commit hospital resources. But by creating a delay, that is exactly what happened.
Instead of taking the necessary steps to maintain a working heart, a disaster ensued. Instead of a four-hour, scheduled outpatient procedure, there was an emergency room, an intensive care unit, a whole lot of emergency equipment and staff. A huge amount of time and resources.
None of that needed to happen.
Just because something is not immediately life-threatening, that doesn't mean it's optional. Heart disease is not contagious, but it is relentless.
It has been well-established that the strongest predictor of death with a coronavirus infection is heart disease. That makes it all the more important that we do not allow ourselves to "decompensate" from our heart disease.
Don't have a heart attack or a stroke trying to avoid the virus. Avoidance makes everything worse for everybody. Yes—it's bad to have a heart attack, a stroke, uncontrolled afib, or decompensating heart failure. It's even worse to have these things and require hospitalization because you are now using resources that are needed by others. It would be unconscionable to get hospitalized for a heart reason when it could have been entirely avoided.
So: Know who your doctor is. Hopefully, if you have heart issues, you know your doctor already. Again, the heart is not at all mysterious. We can know our heart health in advance. You can, and should, manage your health as you age. You can learn all about that in the patient handbook published by the Foxhall Foundation, "You Can Prevent a Stoke," which I recommend everyone over 50 reads, especially now.
Just because something is already scheduled doesn't make it unnecessary or non-essential. Cardiac patients often require frequent visits to adjust medications and pacemaker settings. This is best done someplace other than the hospital. Before skipping an appointment with your doctor, call ahead and ask your doctor whether you can afford to miss the appointment.
Consider telemedicine. Many questions can be answered remotely, but the heart is something that often needs to be examined to know the best course of action. It's much better to be examined outside the hospital.
There is nothing about your heart's health that is unimportant. You should not wait until you are in critical condition and then go to the hospital. That is never a good idea, and today, when hospitals are being taxed, that's the worst way of taking care of your health.
