Emergency room visits for conditions other than COVID-19 have decreased significantly across the nation. But serious medical emergencies like heart attacks don’t just postpone themselves during a pandemic. So why are people not calling 911 or going to the ER?
We asked Lorrie Pool, RN, Director of Program Management of Cardiovascular Services at the Heart & Vascular Institute at St. Luke’s Health–The Woodlands Hospital, to share some of her thoughts.
Q: Have you witnessed a decrease in heart attack cases?
Lorrie Pool: Yes, we have seen fewer heart attack patients present to the emergency department (ED). Heart attacks don’t just stop. The speculation is that these patients that are experiencing milder symptoms — which, under normal circumstances, would have sent them to the ER — are seeking treatment from primary care or outpatient clinics, or they are forgoing treatment altogether. There seems to be an overall fear of going to the ED in our current situation, a fear of being exposed to COVID-19 while in the ED.
Q: Are heart attack patients more often calling 911 or taking themselves to the ER?
Lorrie Pool:Our mix here has been about the same as during normal times. The speculation is that many patients live a little further out than just here in The Woodlands. The concern is that people are experiencing life-threatening conditions, like a heart attack, and are delaying seeking emergency care out of fear of contracting COVID-19 at the hospital, or maybe they are concerned about adding additional strain on our healthcare system. We want our community to know that if you are experiencing an emergency, we will always be here for them.
Q: Can you tell whether a patient has been waiting to seek emergency medical treatment during a heart attack?
Lorrie Pool: We can determine this to some degree. Those presenting in the later stages of myocardial infarction are more likely to present with complications that could have potentially been prevented if treatment had been sought earlier — complications such as failure of the left ventricle that could lead to cardiogenic shock. These cases become very complicated to manage and require admission to critical care units for mechanical support.
Presenting early to an ED for care gives patients the greatest opportunity for recovery. If care is delayed, the prognosis for these patients starts to diminish. We are well versed in cardiac care and are capable of treating a myriad of cardiac disorders. It is easier to treat if the issue is detected early.
Q: Have you noticed whether patients are waiting longer to seek emergency medical care for heart attack symptoms?
Lorrie Pool: We are seeing patients that developed serious symptoms hours — even days — prior to presenting for care. By delaying treatment of symptoms that would have prompted them to go to the ER under normal circumstances, these illnesses, like heart attacks, are developing into a more serious situation with long-term damage or even death.
Q: What precautions do patients need to take for non-COVID-19 emergencies like heart attacks?
Lorrie Pool: We want our community to know that under no circumstance should they avoid seeking emergency care, either by coming to our ED or by calling 911, if you feel that your symptoms are truly serious. Every second that you delay, the likelihood of having a worsened outcome increases exponentially.
Q: With the amount of COVID-19 patients in the hospital, is a trip to the ER worth the risk?
Lorrie Pool: Please seek emergency help. Precautions are in place at the ED to help prevent infection. Delaying care for life-threatening conditions is not wise. Early treatment could mean the difference between life and death.
Q: Can COVID-19 harm our heart health?
Lorrie Pool: Lung injury and acute respiratory distress syndrome (ARDS) have taken center stage as the scary complications of COVID-19. However, heart damage has recently emerged as yet another harsh outcome of the virus’s potential complications.
The manner in which this virus prompts cardiac injury is not new or surprising. The question still remains if SARS-CoV-2 is more virulent to the heart than other viruses.
We do know that those with preexisting cardiac disease are at much greater risk for severe cardiovascular and respiratory complications from COVID-19. We know from research that even infection with the influenza virus poses a more significant threat for those with underlying cardiac disease than those without. We also know that heart attacks can actually be brought on by respiratory infections like the flu.
Q: If a patient has COVID-19 and begins to experience symptoms of a heart attack, what should they do?
Lorrie Pool: These patients should call 911 immediately. When speaking with the 911 dispatcher, they should notify them that they are COVID-19 positive so that the appropriate precautions can be put into place prior to arrival of the EMS team and that information can be relayed to the receiving ED so that the staff there can have precautions in place as well.
Q: Do you have any advice for patients who may be experiencing symptoms of a heart attack?
Lorrie Pool: If you are experiencing any symptoms of a heart attack:
- Pressure or tightness in the chest
- Pain in the chest, back, jaw, or other areas of the upper body that lasts more than a few minutes or that goes away and comes back
- Shortness of breath
- A cough
- A fast heart rate