When it comes to heart attacks and strokes during the coronavirus pandemic, doctors and hospitals are seeing fewer of them — and that’s not a good thing.
There’s no physical reason for fewer cases of stroke or heart attacks, said Dr. Peter Monteleone, an interventional cardiologist at Ascension Seton. In fact, he said, “viral infections increase the risk and danger of heart attacks.”
And some research points to an increased risk of stroke for people who have COVID-19.
While it’s early in the study of this coronavirus, Dr. Steven Warach, a neurologist and the director of the Seton Dell Medical School Stroke Institute, said one small study in the New England Journal of Medicine found five cases of people younger than 50 with COVID-19 having a large-vessel stroke. Another study found a link to blood clots in blood vessels. Some reports coming out of China also noted an increase in "neurological events,“ or strokes, in people with the coronavirus, he said.
“It's still very early in the course of our understanding this disease,” but the virus seems to cause blood to clot more, Warach said. Doctors are reporting little blood clots in the lungs as well as in other places in the body, such as fingers and toes.
The cases of heart attacks and strokes should be increasing, not decreasing, but one study found that at nine U.S. hospitals the number of cases of STEMI, a serious form of heart attack, was down 38%. That echoed an earlier study in Spain, which found cases were down 40%.
At Ascension Seton hospitals, these STEMI heart attack cases were down 44% from April 2019 to April 2020, although the company declined to say how many patients were treated. “This is despite record high presenting numbers in the months preceding the COVID pandemic,” the hospital system said in a statement.
Warach is seeing similar reductions with strokes.
Why would cases be down when COVID-19 could increase the risk of heart attacks and strokes?
It’s simple: People are afraid to go to the emergency room because of the coronavirus.
They are putting off care, which in the case of a heart attack means permanent damage to the heart muscle. In the case of a stroke, it means that some of the treatments to minimize the effects of the stroke can no longer be done.
"We have effective treatment,“ Warach said, ”and they are waiting to get the treatment.“
Heart attacks and strokes are life-threatening, he said. “Their risk of dying is much greater than that of COVID.”
Strokes kill at a rate of roughly 71 people per 100,000 residents in the Austin area each year, according to the most current CDC data. The toll from heart disease in Travis County is 228 deaths of those 35 and older per 100,000 residents. Hays and Williamson counties post similar numbers, but the death rate for heart disease is higher in Bastrop County, 342 per 100,000 residents.
Monteleone said in cases of STEMI heart attack — the acronym of this serious form stands for ST-elevation myocardial infarction — the death rate is 30% in patients who don’t seek treatment. With treatment innovations, doctors have lowered the death rate to 5%.
People who survive without treatment will have lasting damage to their heart muscles. That might cause congestive heart failure, breathing problems, damage to heart valves, electrical problems in the heart, such as arrhythmia or a ruptured heart muscle.
“They could have a catastrophic problem that was otherwise preventable,” Monteleone said.
Because people have been delaying care, he predicts that doctors will begin to see conditions they haven’t seen in 30 years. With heart attacks, Monteleone said, “time is muscle.” The quicker you can get help, the better the recovery and the less risk of permanent damage.
In some treatments, the goal is to get care within 90 minutes, Monteleone said.
Both doctors say hospitals and emergency medical services have safety procedures to prevent exposing patients to the coronavirus. Those include protective equipment, cleaning protocols and isolating COVID-19 patients to certain wings of the hospital, including which hallways they travel through.
If you think you are having any of symptoms of a heart attack of stroke, call 911 to get immediate help. Emergency workers can start treatment on your way to the hospital to improve your chances. Monteleone said people who try to drive themselves to the hospital could risk passing out, having cardiac arrest on the way or getting into an accident, which endangers other people.