Five Questions With: Dr. Herbert Aronow

Dr. Herbert Aronow is an interventional cardiologist with expertise in vascular medicine and endovascular intervention. He is the director of interventional cardiology at the Cardiovascular Institute and director of the cardiac catheterization laboratories at Rhode Island and The Miriam hospitals.

Aronow discusses recent research targeting COVID-19’s effect on patients with cardiovascular disease, the virus’s capability to cause heart problems, and how Rhode Island and The Miriam hospitals are balancing care for cardiovascular patients during the COVID-19 crisis.

PBN: Is there evidence that people with preexisting cardiovascular disease may be more at risk of becoming seriously ill from COVID-19?

ARONOW: We have learned from large population studies, including tens of thousands of patients with COVID-19, that those with cardiovascular risk factors, such as high blood pressure or diabetes, and those with established cardiovascular disease fare worse than those without these conditions.

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Because it is often not possible to rid oneself of cardiovascular risk factors or cardiovascular disease, it is vitally important that individuals with these conditions remain vigilant about social distancing and seek medical care early if they suspect COVID-19 infection.

PBN: Have doctors seen cases of COVID-19 that affect the heart in people with no history of cardiovascular disease?

ARONOW: COVID-19 can affect the heart in multiple ways, in people with and without a history of cardiovascular disease, ultimately resulting in heart muscle damage (“heart attack”), heart muscle weakness (“heart failure”) or life-threatening abnormal heart rhythms (“sudden cardiac death”).

These effects on the heart may occur through multiple mechanisms. First, it is possible for the COVID-19 virus, known as SARS-CoV-2, to directly infect heart tissue. Second, the infection can cause inflammation throughout the body with release of factors that are toxic to the heart. Third, the stress of becoming acutely ill with COVID-19, especially in patients with cardiovascular disease, can be enough to outstrip the heart of its needed supply of oxygen and nutrients. Finally, patients with COVID-19 are more likely to form clots in their blood vessels, including those in the heart.

PBN: Has the COVID-19 response by hospitals in Rhode Island pushed aside care for some heart patients who do not have the virus?

ARONOW: On the contrary, hospitals and health care providers across the state have been very careful to minimize the risk to heart patients who do not have the virus. Routine office visits have been converted from face-to-face to telehealth (audio and/or video) encounters when appropriate, and heart tests and procedures which are not urgent or emergent have been postponed. These changes have been implemented to keep healthier patients away from those with COVID-19 infection.

Now, under Gov. [Gina M.] Raimondo’s direction and in concert with other medical and surgical specialties, hospitals and health care providers across Rhode Island have begun resuming postponed cardiovascular care in a very careful and coordinated fashion.

PBN: Are the cardiology departments at Rhode Island and The Miriam hospitals expecting a flood of patients as hospitals begin to return to normal?

ARONOW: Although we anticipated that patient volumes would decline when we began postponing noncritical outpatient procedures due to COVID-19, we also observed significant reductions in the number of patients presenting with urgent and emergent cardiovascular conditions, such as heart attack and stroke. Some of those patients eventually made their way to the hospital but were much sicker than they would have been had they arrived sooner. Others likely never made it to the hospital.

We suspect there are still many patients who unnecessarily delayed seeking cardiovascular care who will now begin doing so. That said, at Rhode Island and The Miriam hospitals we should have no problem accommodating their health care needs, and it remains critically important that they be evaluated at the earliest sign they are unwell.

PBN: Are there drugs being investigated as treatments for COVID-19 that may cause cardiovascular side effects? For otherwise healthy patients, are the risks the same as for those who already have heart conditions?

ARONOW: Multiple so-called “antimicrobial” drugs are being investigated in clinical trials for treatment of COVID-19. Some of these, like chloroquine and hydroxychloroquine, azithromycin and lopinavir/ritonavir have been shown to impair normal conduction of electricity through the heart, potentially resulting in life-threatening heart rhythms.

While these risks exist for any patient, those with certain inherited or acquired heart rhythm disorders may be particularly susceptible. Until the safety and effectiveness of such agents has been established, they should not be used alone or in combination for treatment of COVID-19 outside of clinical trials. Patients should seek input from their health care provider before initiating such agents.

Elizabeth Graham is a PBN contributing writer.

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