by Carolyn Thomas ♥ @HeartSisters
Barely a month ago – hey, remember a month ago? – my GP ordered a number of routine blood and urine tests following a meds review. So I booked an appointment online at my local testing lab – but within hours, I decided to cancel. All I could think about was this: “Lab waiting rooms are filled with sick people!” There was no way I was going to put myself at further risk during this COVID-19 pandemic.
It turns out that heart patients like me are not only reluctant to walk into lab waiting rooms, but cardiologists are now reporting that many of us are reluctant to seek urgent medical care – even during a heart attack. . .
In his New York Times essay called “Where Have All the Heart Attacks Gone?“, Yale University cardiologist Dr. Harlan Krumholz cited a study from Spain that found a 40 per cent reduction in procedures for heart attacks during the last week of March compared with just before the pandemic hit.
Other countries are reporting similar results. In a new study of nine high-volume cardiac centres across the U.S. published on Friday in the Journal of the American College of Cardiology, procedures to treat serious STEMI heart attacks dropped by 38 per cent after March 1, 2020 compared with the 14 previous months.(1)
These findings don’t seem to make sense. What has happened to all the heart patients?
As Dr. Krumholz explained, he and his colleagues actually expected to see more cardiac procedures – not fewer – during this time, because respiratory infections typically increase heart attack risk. He added:
“The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with the corona virus.
“This theory suggests that COVID-19 has instilled fear of face-to-face medical care. As a result, many people with urgent health problems like cardiovascular disease may be opting to remain at home, rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened.
“We need to combat perceptions that everyone else must stay away from the hospital. The pandemic toll will be much worse if it leads people to avoid care for life-threatening yet treatable conditions like heart attacks and strokes.”
In the U.K., cardiologist Dr. Rohin Francis observed in this video presentation that “everywhere – here, Spain, America, Italy – heart attacks appear to have gone out of fashion.”
He reminds us that, in cardiology, time is muscle:
“In a heart attack, when an artery supplying the heart muscle is blocked, it needs to be unblocked as soon as possible to minimize the amount of permanent damage to that muscle.
“Complications caused by an untreated heart attack are thankfully quite rare these days.
“But this may be changing. Heart patients are now scared of coming to the hospital for fear of catching the COVID-19 virus. Some patients may also be feeling that they don’t want to trouble those hard-working doctors and nurses, who are all so busy treating COVID-19 patients. So they don’t call an ambulance. But 24-48 hours later, they’ve become progressively unwell, and the damage is done.
“Perhaps those of us working in the hospital are not even hearing about the majority suffering in silence, going on to develop heart failure, or even dying at home.”
This is the tragic scenario described by the Fire Department of New York (FDNY). The FDNY runs New York City’s paramedic response through its Emergency Medical Services, and reported this week that on Sunday, April 5, out of 322 cardiac calls to 911 on that day, 241 (almost 75 per cent) ended in sudden cardiac death. That compares with 38 per cent for the same period one year ago. As one senior FDNY officer observed:
“I know crews that go from cardiac arrest to cardiac arrest all day long.”
What this means, he added, is that more heart patients are calling 911 closer to death, and more of them are now dying before they ever reach a hospital.
These findings also reflect what I am hearing from my Heart Sisters blog readers. For example:
♥ “Fear of heart issues was already anxiety-producing, and now fear of COVID-19 is added in. I live in California, one of the worst areas. Extremely scary to think of going to the hospital.”
♥ “Last night, I woke up in the middle of the night with a lot of chest pain. But my biggest fear is having to go to Emergency.”
♥ “I had a STEMI (heart attack) two years ago. Right now, I have been having mid-back pain radiating around to underneath my ribs for two days. But I’m too afraid to go to the E.R.”
♥ “I have to go in for an additional lead for my ICD (Implantable Cardioverter-Defibrillator) and am very nervous to do so. My doctors tell me this is necessary surgery, and assure me that they have safe procedures in place to do it. But this is a very scary time.”
Dr. Rohin Francis warns:
“Just because COVID-19 is dominating the headlines, it doesn’t mean that other medical problems have gone away. Please do NOT ignore serious symptoms, and please do NOT feel you will be adding to our workload. This is what we’re here for!”
Here in Canada, that advice is echoed in the “Emergencies Are Still Emergencies” awareness campaign from the Heart and Stroke Foundation, where Dr. Thalia Field urges people with symptoms of heart attack, cardiac arrest or stroke to seek immediate medical care.
Drs. Amol Verma and Fahad Razak are internal medicine specialists and assistant professors at the University of Toronto, and are also concerned that people who really need hospital care are staying home. They point out in a recent Healthy Debate essay that empty hospital beds for non-virus patients (and the dangerous spikes in serious complications and death caused by associated treatment delays) were similarly problematic during previous viral outbreaks like SARS and Ebola:
“People who have concerning medical issues must not avoid health care. This is an important public health message that has not been communicated widely. People should not confuse ‘social distancing’ and calls to ‘stay home’ as messages to stay away from necessary care.”
And as Philadelphia emergency physician Dr. M. Kit Delgado urged on Twitter:
Our messaging needs to be clear: “Stay home if you are well, come in if you feel sick.”
In short, YOU KNOW YOUR BODY. You know when something is just not right. If you are experiencing symptoms that you suspect are heart-related, please seek immediate medical help.
♥
1. Garcia S, Albaghdadi MS, Meraj PM, et al. “Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.” J Am Coll Cardiol. 2020; e-pub ahead of print.
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Q: Have you hesitated before seeking urgent help for cardiac symptoms? If so, why?
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NOTE FROM CAROLYN: I wrote much more about how heart patients can manage health crises in my book, A Woman’s Guide to Living with Heart Disease. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).
See also:
♥–It’s okay not to feel “normal”
♥-Scary times: living with (but not IN) fear
♥–“Let’s all be palm trees together” in facing COVID-19
♥–COVID-19: Can facts help to minimize fears?’
♥–CardioSmart (a report from the American College of Cardiology on how COVID-19 affects heart patients)
Heart Sisters 
Hello Tracey – I’m sorry that you have gone through 10 months of this uncertainty and suffering – and still with no definitive answers. It’s very frustrating to keep going back repeatedly – yet not getting a clear diagnosis and treatment plan. So far, it sounds like the potential culprits mentioned have been high blood pressure, costochondritis or unstable angina (heart disease).
I’m not a physician so of course cannot offer a guess as to what the answers are. I can tell you generally that ST depression on your ECG could reveal a number of possible causes – ranging from medication side effects to low potassium to heart disease.
My only suggestion right now is: start a Symptom Journal – I wrote more about this here: https://myheartsisters.org/2019/06/30/start-a-symptom-journal/ Simply keep a daily record of each bout of symptoms, time of day and date, description of the symptom, how long it lasted, how severe it was, what you were doing/feeling/eating in the 1-2 hours or so leading up to the symptom. Sometimes a pattern will begin to emerge that can help you and your doctors solve the mystery. Bring the Symptom Journal with you to your next doctor’s appointment. Also, you’ve mentioned Costochondritis, a painful joint inflammation condition that can often mimic a heart attack – I wrote more on this here: https://myheartsisters.org/2013/12/26/chest-pain-costochondritis/ Keep taking the statins and aspirin, which is what your cardiologist would likely be prescribing for you anyway if all of your cardiac test definitely pointed to a heart issue.
Sounds like you’ve been doing a good job standing up for yourself despite the lack of answers to your questions. Hang in there – something is causing your symptoms, but you just don’t quite know yet what that ‘something’ is. This may or may not be heart-related, but you DO need to be your own best advocate in solving this mystery. Your only job now is to become the world expert on your body, and a good DETECTIVE – a special kind of detective that tracks down clues and reports them to your doctors. And if your doctor says anything that isn’t perfectly clear to you when you do meet up, don’t just say “whatever that means” – keep asking the doctor to repeat for a clear and straightforward explanation of ANY detail that seems confusing to you. It’s stressful to keep going back for medical appointments, but you need to know what is going on.
Good luck to you. . . ♥
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Hi Carolyn,
This is such an important reminder. If a person is afraid to seek help when she/he knows something’s not right with her/his body, the result of inaction likely won’t be good.
It’s understandable to fear going to the ER or even to a clinic for a scheduled appointment these days. I just hope a lot of people aren’t dying because they’re too afraid to seek help when they need it.
“Stay home if you are well, come in if you feel sick.” – I agree, that messaging needs to made more clear.
Thank you for helping to do exactly that.
Stay safe. Stay well.
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Thank you so much Nancy for your comment, and also for sharing this post on social media this morning.
I read an interesting observation from Calgary endocrinologist Dr. Doreen Rabi recently:
“The rapid shut down on ambulatory care sent two unfortunate messages to patients:
1) Coming to clinic may be risky
2) Your health issues aren’t as important as COVID-19
We have to address this ASAP & little air time is given to this very important issue.”
I know from personal experience (being misdiagnosed in mid-heart attack and sent home from the ER) and also from what my readers continue to tell me that, once a patient becomes convinced that her/his medical condition isn’t important, they are highly reluctant to seek help (even with debilitating symptoms).
The shocking New York City stats on sudden cardiac death are a good example of how deadly that belief can be.
You stay safe too, Nancy… ♥
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Regarding this, rationale, “stay home if you’re well, come in if you feel sick” — I went to hospital, (first visit) September 2020; had symptoms coming on for about nine days getting more pronounced, breathlessness, hard to breathe, pressure tightness in my upper chest area, choking feeling in my throat-neck area, dizzy, (never had high BP at all in my life)
Short version of this:
I walked to drs office, BP and pulse taken, listen to chest, Rx prescription for antibiotics, dr’s suggestion: if anything was going to happen, it would have happened by now.
Walking home, felt hard to breathe, thought I was going to pass out, rang Healthline, they sent the ambulance.
Ambulance came, Rx no heart attack, but ask GP to check your BP.
Got to hospital, ER dr’s suggestion: yes Cardiac, ECG, cardioversion, Go to ward for watching, discharged next morning, Costochronditris take ibuprofen.
Symptoms didn’t subside or go away. 2021 Feb symptoms more obvious, with a new one, unable to lay on my back, hard to breathe, so had to sleep on my side, this helped a bit, but restless sleep: still does, 5 month later.
March 2021, got to work, feeling unwell: symptoms as above in back, ring for ambulance; BP taken, 195/104, oxygen good, ECG borderline,(whatever that means), get to hospital, wait, 4 1/2hrs in hallway:, I decided to go home, seen by no dr, tell staff-Paramedics “I’m going home”. Dr appears, Dx, “fine”: I say I’m going to work tomorrow, Dr said no, no, here is your medical cert. my Q, “What for, Why I’m so fine? Dr: do you need 5 days off work. me???
By this stage, I start to wonder what’s going on, new symptom appears, full ache between my shoulder blades when breathlessness starts, I contact heart foundation, Australia, they say, go back to GP.
Shorten this story,
Contact Cardiologist via Skype, to be told, you’ve had no cardiac tests, so go back to GP to refer to a Cardiologist.
Do that get Stress test & Echocardiogram, shows ST Depression suspension, diagnosis, Unstable Angina. take Metropol and Aspirin.
Get referred for Angiogram, wait 3mths, June 24 Ambulance call again,
BP, 190/110, same same, ECG, same.
Hospital tests CTAC & Echocardiogram, all normal, no need for pills, I leave hospital, hospital pharmacy telephones to tell me “you forgot you prescription” – me: ?
In-short, I contact Dept of Health, raise concern, next day appt Angiogram, week later done.
Results-normal, take Statin and Aspirin, no Metropol. Hospital telephone checkup, my symptoms still here, they say come in. I feel reluctant, getting nowhere, but I still get all the symptoms, but now having to wear a mask, brings on.
Now, July 2021 – still get symptoms, in a cluster, breathing feels tight, breathlessness, painful ache between my shoulder blades, really pronounced ache now, dizzy, nausea feeling, tight choking feeling around my throat, sweaty, and now unusual fast heartbeats with the missed heart beats – these have been ongoing all along.
Family history, yes, mother, Angina and father Wolf Parkinson White, sister brother same, BP yes, mother/sisters.
Uncles, heart failure, cardiac arrest and heart attack, x 5 died of cardiac arrest, with heart failure.
And I’ve given up, asking.
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I had been wondering how all of this was affecting the Mayo Clinic… they are furloughing about 1/3 of their workers…. Seems like a national effect that people are just not using hospitals as much… much of it of course due to reducing elective surgeries…
I wonder if they are now stacking up…
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I just read about the layoffs at Mayo this morning. Empty hospital beds don’t make any money… Elective procedures are still considered “medically necessary”, which is why I feel so bad for those who did have elective procedures “post-poned” (a charitable way of saying we have no freakin’ clue when we’ll be rebooking this procedure for you because we have something far more important than you to worry about now…)
I have a friend who learned on the morning of his planned hospital procedure that his appointment was not going to happen due to the need to keep all non-urgent beds empty because of the pandemic.
His was considered elective, but to him it’s still an extremely painful issue that is NOT being appropriately taken care of, and nobody can tell him when it will be taken care of. It’s a horrible price to pay, especially given that so many of the beds in some hospitals are still empty.
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Carolyn — Yes, similarly about the last place I would want to go now would be the hospital, or almost anywhere these days…
It would take serious chest pain or other signs of a heart attack to get me out of the bunker…
There is some solace in knowing that I can contact my GP physician by e-mail if something feels serious… Like many local physicians, he has closed down his practice but responds to emails or phone calls… I sent him an email to ask how he was doing, and he appreciated it..
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I know what you’re talking about, Dr. Steve. But I’m wondering…. if you did have that serious chest pain (let’s hope NOT!) and you did email your GP, who told you to go directly to the E.R. as fast as possible to get it checked out, would you immediately follow his recommendation – or might you still be reluctant to leave your safe bunker?
It’s a scenario I’ve thought lots about regarding my own symptoms… I told a bunch of cardiologists on Twitter this morning that what we need to hear from them loud and clear is that hospitals are SAFE, and they need to explain HOW SAFE they are for us. As the doctors quoted in this post admit, “this is an important public health message that has NOT been communicated widely.”
Stay safe in that bunker…
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Yes, it sure hasn’t been communicated that it is safe to go the hospital. This COVID disease has such bad press that getting sick with it and ending up on a ventilator sounds worse than having a heart attack…
I think people are going to go to hospitals less after this, in the same way lots of folks will avoid cruises. The world population has been traumatized, and people don’t trust that it is safe out there….
It takes at least two years to get over a trauma. It is not going to be the same world, not even close. Not so different than having a normal life and then getting a chronic illness; unfortunately now one has both traumas…
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You have hit the nail right on the head Dr. Steve: “Getting sick with COVID-19 and ending up on a ventilator sounds worse than having a heart attack…” This is a crisis of public confidence. While taking extraordinary and necessary measures to prepare for what other countries failed to prepare for (e.g. having enough hospital beds), governments have inadvertently done a bang up job convincing the rest of us who also may need medical attention that hospitals are no longer open for us.
Now a little flurry of concerned cardiologists are suddenly noticing that their cath labs aren’t filled, revascularization procedures are not getting done during heart attacks, and people are steering clear of hospitals, even at our peril! Yoiks…
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Thank you for this, a good reminder for all of us , especially women.
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HI Paula – I was thinking exactly that when I was reading all these studies and news reports this past week: women heart patients have long been known to engage in what researchers call “treatment-seeking delay behaviour“ – and now the men seemed to have joined us!
We need to stop minimizing, denying and talking ourselves out of seeking care when we do need it!
Stay safe, Paula… ♥
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I visited my cardiologist a few days before everything was shut down, and I was very nervous. I wore gloves until I was in the examining room. My next appointment in May will likely be a telephone appointment because it is to check my blood pressure readings and tweak meds.
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Hi Pauline – doesn’t it seem like a lifetime ago when we we just showed up to see our cardiologists without a moment’s nervousness? Remember those days? We do need to take more precautions now and for sure, to take advantage of every opportunity available for phone visits.
I wonder if these kinds of non-urgent telehealth follow up appointments will become the way of the future once the virus scare is long gone? I sure hope so, if only for simple convenience during routine visits (saves time for both doc and patient, gas, parking, waiting in waiting rooms, etc).
Stay safe, Pauline! ♥
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This is such a timely and much-needed article, Carolyn! But it’s not just heart attacks and emergency rooms, it’s all the basic care right now for me.
Because I recently started on insulin, I was anxious a couple weeks ago to get my A1C number and see if it had gone down (which it has). After seeing my endocrinologist and then putting it off about 4 days I finally made the lab appointment.
My endocrinologist also wanted me to have my left ear cultured due to an external infection of some kind that has been raising my blood sugar (turned out to be a staph infection). Talked to the gal at the family medicine office and she scheduled me for a late afternoon lab appointment that day which would normally take about 10 minutes to stick my finger and get the A1C number from the machine. She said she would have to call back about the ear swab. Then she told me that when I came in for the A1C the door would be locked and someone would have to screen me to find out information on my COVID risk before they would let me in; no one was allowed to go in and sit in the waiting room.
A little while later I received a call from the beloved nurse practitioner I usually see, who had treated my ear problem some time earlier and wanted to know what was still going on with it. She told me she didn’t want me to visit ANY medical offices if I could help it — that was kind of sobering.
I told her I was having the A1C done that afternoon and she said she would see if the nursing staff could do the swab when I came in. It all worked out that afternoon, but I tell you, the whole locked-down doctor’s office thing, with nurses all wearing masks and scrubbing down the chairs that nobody was sitting in, coupled with a general sense of high anxiety, was truly scary. It makes me want to avoid all doctors right now and take my NP’s advice.
Which is bad because I am long overdue for a 6-month check with my cardiologist and I’ve been having chest issues, which I really do believe are caused by anxiety this time, but maybe not? I’ve been on my exercise bike almost every day for weeks (one good thing!) and it’s been hard to get back into it after not doing it for so long but I think it’s really helping. I have been experiencing shortness of breath when out in the cold air and wind — dreading the thought that perhaps I might need another stress test (hate those!!!). Have taken nitro a couple of times. I’m sure I don’t need the ER but I should report all this to my cardiologist and I should go in for that long-overdue appointment!
Last week I had four routine appointments scheduled and only did one of them, my foot doctor. I canceled the dietician and the mammogram (I’m at low risk and never had a problem, so feel okay about delaying that a few months), and the dentist office canceled my cleaning because they are only doing emergencies right now.
It’s CRAZY right now to be so afraid to continue my normal health care routines. I don’t want to go out of the house at all! I don’t even live in a high-risk area.
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Hello Meghan – that advice from your NP (avoid ANY medical offices!) is so understandable. You just don’t know if the people around you are contagious, or if YOU are contagious. For a staph infection, for example, I was thinking of the possibility that you could touch that ear, then touch a doorknob in the office, then the next patient opens that same door….
A friend told me this morning after reading this post that she had just been to the same testing lab that I had mentioned at the beginning, and that I’d be happy to know now that the lab staff there are wearing full Personal Protection gear, patients booked 15 minutes apart, chairs/counters/bathrooms being scrubbed, all doors are wide open (including external doors, so that the patient touches nothing from the time they enter the lab until they get back into their cars).
So whenever I hear about medical facilities that are taking these extra safety precautions, however scary-looking, I like to remind myself that this will all help to make my visit SAFER, not SCARIER.
I think it’s reasonable to postpone all non-urgent appointments as you describe, using our discretion. My real concern is for other potentially serious – even deadly – issues that if ignored, might lead to tragic (and preventable) outcomes.
Good work on that exercise bike, Meghan, and good luck with those chest issues. Yes, definitely let your cardiologist know – even if they are anxiety-driven, it’s good for him to keep tabs…
Meanwhile, stay safe! ♥
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Besides the news about NYC’s increase in the number of cardiac arrests they are being called to, they have also experienced an alarming increase in “deaths at home”.
We will never know how many of those deaths were people afraid to call for help during a cardiac event. I have access to almost immediate online assistance in making the decision to go into the ER… but of course, as you have said, whether it is online or ER there is STILL not a true appreciation of how cardiac ischemia manifests in women.
I truly believe, that on 3/8, 1 week after a clean annual cardiac check up, I had some type of ischemic event. I had no chest pain at all but became SOB with all activity and fatigued to my core for 3 days. My cardiologist checked labs, just BMP but was convinced it was not cardiac. (12 lead EKGs are not diagnostic for me because of my Left Bundle Branch Block).
I still sleep a lot and have low energy… but that is something I’ve had before. I guess I will never know for sure.
Blessings to all Heart Sisters in these Crazy Times🙏
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Crazy Times indeed, Jill.
New York City’s death-at-home stats are frightening and unprecedented, so it’s highly probably these are largely preventable deaths – if only the patients had sought urgent care at their first cardiac signs. We already know that an untreated blocked coronary artery leading to a heart attack is the most common cause of sudden cardiac death (up to 80% of all cases).
It can be so challenging for many heart patients like you to tease out which symptoms are signs of real trouble and which may be, as you say, something benign that you’ve experienced before.
For women, having access to online assessment tools to help decide whether to go to Emergency only works if we actually pay attention to what the tool tells us, and if the advice is appropriate for women heart patients (some like the Babylon Health app used in the UK’s NHS (and elsewhere), give two different suggestions depending on if you type in ‘male’ or ‘female: it recommends males with classic cardiac symptoms to seek immediate emergency care, while telling females with identical symptoms and demographics that it’s just a panic attack…)
This is why we really need to ultimately trust our own gut, and then be willing to take action exactly as if those symptoms were happening to somebody we care about.
Stay safe, Jill. ♥
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Absolutely, I continue to feel I don’t want to burden the medical profession.
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That’s understandable, Roz, especially when every day we’re hearing nonstop stories of their lack of adequate personal protection, desperate working conditions, long hours, rising patient death tolls. That’s especially true in Emergency and ICU wards – yet we ‘re also hearing of cardiac floors waiting half-empty. As one nurse tells her patients: “You’re safer in the hospital than you are shopping…”
Re being a burden: if serious symptoms were happening to your sister, mum, or daughter, you would not hesitate to call 911 to get help for that person, right – with no thought given to how burdened the hospital staff might be. We MUST make the same decisions for ourselves, too.
Stay safe, Roz… ♥
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My own widow maker and subsequent issues in 2006 were hard to diagnose and I was dismissed at first. I persisted. During that time and within the week I had an emergency triple bypass.
I have said a small prayer everyday during this pandemic that heart patients like me are not dismissed because we are hard to diagnose. Being a heart patient is scary enough.
Happy Easter.
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Hello Jennifer – I’ve been worrying about this, too. These emerging reports focus on the dramatic drop in cardiac procedures, but no mention so far of pre-admission dismissal as you (and I) faced during our heart attacks.
Happy Easter to you, and stay safe…. ♥
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