Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'm a cardiologist. I'd like to share with you some questions I've been getting from my patients around COVID-19 and in particular for patients who have been suffering or subject to irregular heartbeats or arrhythmia. Well, first of all, COVID-19 seems to be most of a concern when it comes to individuals who have diminished immunity or diminished capacity to fight off the infection. So in simple terms, if the only thing wrong with an individual is a rhythm disturbance and that rhythm disturbance is well controlled and all other aspects of that individual's health are good, then that person is not necessarily at increased risk if they were to contract COVID-19. When we think of rhythm of the heart. We think of rhythm arising from the top chambers or the top chambers being the atria or from the bottom chambers, the bottom chambers being the main pumping chambers called the ventricles. Rhythms from the top chambers certainly can occur and be present in an individual without any other major comorbidities. And these rhythms from the top of the heart, things like atrial fibrillation in isolation, atrial flutter, and supraventricular tachycardia, don't necessarily of their own increase the individual's risk of a poor outcome with COVID-19. But remember, Something like atrial fibrillation is a common association with other comorbidities, such as hypertension, diabetes, people with cardiac failure, people with renal failure. And atrial fibrillation can even occur at times of stress when people are run down and have other illnesses. So atrial fibrillation, for example, of its own, not necessarily a high-risk feature, but atrial fibrillation in conjunction with other... other problems for that individual certainly can be a marker of increased risk for that person. When we talk about rhythms for the lower part of the heart or the ventricles then it's important to understand that more often than not if rhythms are arising from that lower part of the heart that it is not working properly and there is a problem with that. So those individuals would likely carry an increased risk. of a bad outcome if infected with COVID-19. It's important to remember that pacemaker patients, people with a pacemaker in place, aren't necessarily at increased risk at all. And a really sensible thing would be to check if that pacemaker can be checked remotely as many of the modern pacemakers are able to be done. And this means that you don't have to come into hospital or clinics where there are collections of people and particularly hospitals where they may be hotspots for the virus. So if possible, keep away from those collections of people, particularly hospitals. If you can get your pacemaker checked remotely, fantastic. For people who have a defibrillator or a cardiac resynchronisation device these people will generally have left ventricles that are not functioning normally and if you've got a heart that's not functioning normally that is a if you like a comorbidity that's a another problem and those individuals need to be particularly careful because they would carry a higher risk as the heart may well play up during a COVID-19 infection. When it comes to other aspects of heart related issues, there's been a lot of talk about whether you should be on a particular sort of medication or not, if you have high blood pressure, because of a possible increased risk of developing COVID-19. Well, the backstory to that is that a fairly recent paper released in The Lancet by a group of people in China, in Wuhan, looked at a couple of centres where they looked at associations for poor outcomes for COVID-19, and they found a about 24%, 25% of individuals with poor outcomes had hypertension. The authors also found that about 25% had diabetes and the authors wanted to make a theoretical suggestion that people with hypertension on a particular sort of drug called angiotensin converting enzyme inhibitors, you don't need to remember them, but there are a common group of drugs, things like perindipril, lisinopril, enalapril, acupril. These drugs can alter some of the protein receptors within the lungs and theoretically give the COVID-19 virus a place to engage and sit on a receptor and therefore increase likelihood of infection. The paper that was published didn't actually look at all at the medication that the individuals were on. So really we didn't have any data about that whatsoever. The other thing is if you look at the rate of hypertension within the paper of the people who did badly, the rate of hypertension is actually exactly the same as the rate of hypertension in a third world community anyway. So at this stage... current feeling is that the ACE inhibitor type medications, including angiotensin 2 blockers, which is Micartis, Candesatin, Atacand, agents you may be familiar with, at this stage there's no indication to hold those medications. Watch this space. It is an interesting theoretical thought, but certainly not required at the moment. I hope that's an interesting and informative update. for you if you've got any issues with your heart whether it's blood pressure issues or importantly rhythm disturbance last quick note remember the virus can last about 72 hours on a hard surface up to about 24 hour on soft or porous surfaces and it can last in the air a couple of hours. So do be careful. Wash your hands. Soap works because the virus has a fatty or lipid coat on it. Alcohol will work as well. Things like bleach and peroxide. I do wish you all the very best. Please don't get caught up in COVID-19. Take care and bye for now. 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