Suspected heart attack? Don’t fear the emergency room due to COVID-19

Even before the pandemic, people with heart attack symptoms sometimes hesitated to seek emergency care. But during the first wave of COVID-19 infections in early 2020, many more people than usual stayed away. From mid-March to late May 2020, emergency room visits for heart attacks fell by 23% compared with the preceding 10 weeks. And 20% fewer people showed up with strokes, according to the CDC.

Fear of leaving home and risking exposure to the coronavirus likely explains this trend, which has abated over time. “The overall volume at emergency rooms is still somewhat below normal, and we’re seeing people who come in many hours or even a day after their heart attack symptoms began,” says Dr. Joshua Kosowsky, assistant professor of emergency medicine at Harvard Medical School. These people sometimes have signs of heart damage that might have been easier to reverse or treat if they had come in right away, he adds.

Low threshold, low risk

If you think you might be having a heart attack (see “Heart attack symptoms”), call 911. If you’re unsure or have misgivings, call your doctor’s office for advice. “In general, you’ll find that primary care providers have a low threshold for sending their patients to the ER if there’s any concern,” says Dr. Kosowsky. Once you’re in the ER, any possible exposure to the coronavirus is likely far lower than at a crowded supermarket or on public transportation. Staff members take the safety precautions — masks, gloves, and distancing — very seriously. “Don’t imagine a crowded waiting room with stretchers in the hallways,” says Dr. Kosowsky.

Receiving a prompt evaluation and treatment for a heart attack can prevent serious heart damage and may save your life. The constant updates about coronavirus fatalities tend to obscure the deadly toll from cardiovascular disease. But on average, about 655,000 Americans die of heart disease each year, which far exceeds the number who died as a result of complications due to COVID-19 over a 12-month period.

Heart attack symptomsDiscomfort, pressure, or a squeezing sensation, usually in the center of your chestPain in one or both arms or shoulders or in your back, neck, or jawA rapid or irregular heartbeatTrouble breathingFeeling lightheaded, dizzy, or weakFeeling “sick to your stomach,” possibly vomiting

Overlapping risks, symptoms

These two serious health conditions are intertwined in other ways. For one, the problems that leave people vulnerable to heart disease — such as high blood pressure, obesity, and diabetes — also put them at greater risk for complications from COVID-19. For another, two classic heart attack symptoms, chest pain and breathlessness, are also common symptoms of COVID-19. “People who show up with those symptoms will be tested for COVID and asked to isolate until testing negative, but their initial workup for a possible heart attack will otherwise be essentially the same as in the past,” says Dr. Kosowsky (see “Diagnosing a heart attack”).

Although your loved ones can’t accompany you into the emergency room, you can stay in close contact with them with a mobile device (cellphone or tablet), now widely used in these settings.

Diagnosing a heart attackThese are the two main tests you’ll receive for a suspected heart attack:Electrocardiogram (ECG): This test measures the heart’s electrical activity through 12 small electrodes placed on your chest, arms, and legs. You’ll get this test in the ambulance if you call 911 (which is highly recommended). If an artery feeding your heart is blocked, that chokes off the blood supply to part of your heart muscle. This usually creates a distinct signature on the ECG.High-sensitivity troponin (hs-troponin) test: This blood test measures a protein that rises in response to heart muscle damage. Because elevated levels don’t show up right away, you may need to stay for several hours to receive repeat measurements.Other possible tests include these:A chest x-ray to check for other possible causes of chest discomfort, such as pneumonia.An echocardiogram (heart ultrasound), which may reveal changes in your heart’s movement resulting from restricted blood flow.Other advanced imaging tests that create detailed pictures of your heart’s arteries or the blood flow to your heart.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11

 “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22

 “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” – Philippians 4:6

 “Above all else, guard your heart, for everything you do flows from it.” – Proverbs 4:23

 “For God has not given us a spirit of fear, but of power and of love and of a sound mind.” – 2 Timothy 1:7

 “Consider it pure joy, my brothers and sisters,[a] whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance.” – James 1:2-3

 “In all your ways acknowledge him, and he will make straight your paths.” – Proverbs 3:6

 “Commit your actions to the LORD, and your plans will succeed.”- Proverbs 16:3

 “Consider the ravens: They do not sow or reap, they have no storeroom or barn; yet God feeds them. And how much more valuable you are than birds!” Luke 12:24 – Luke 12:24

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