Coronavirus: what it means for you if you have heart or circulatory disease
This is a Q&A provided by the British Heart Foundation
Updated Tuesday 31 March 2020
Our medical experts explain what we know so far about the Covid-19 coronavirus and how it can affect people with heart disease.
I have a heart or circulatory condition – am I at increased risk of coronavirus?
We know that this is a frightening time for lots of people, especially if you have an existing health problem. Most people with coronavirus (Covid-19) have mild symptoms and make a full recovery. Having a heart and circulatory condition probably doesn’t make you any more likely to catch coronavirus than anyone else. But if you have a heart condition it may mean that you could get more ill if you catch it, which is why it’s really important to protect yourself.
Anyone with a heart condition is considered high risk of more severe complications of Covid-19 coronavirus.
It’s important you keep up to date with the government’s advice.
How do I know if I fall into the "extremely vulnerable" group who need to stay at home for 12 weeks?
Some heart patients are considered at extremely high risk of severe illness from coronavirus. You are classed as extremely vulnerable (most at risk) if:
- you have had a transplant at any time, including a heart transplant.
- you are pregnant and have significant heart disease - defined by experts as any of the following: coronary heart disease (if you have symptoms), hypertrophic cardiomyopathy (if it affects your heart function), thickening of the heart muscle (left ventricular hypertrophy) caused by high blood pressure, pulmonary arterial hypertension, a narrowed or leaking heart valve if this is moderate or severe, heart failure that affects your left ventricular function, significant congenital heart disease.
If you are in one of these groups, you should protect yourself by staying at home, and minimising contact with people you live with, for the next 12 weeks. This is called shielding. If this applies to you, you will be contacted directly by the NHS with further advice. If you think you fall into one of these categories but have not received a letter, email or text by Thursday April 2, you should discuss your concerns with your GP or specialist doctor or nurse.
I don't fall into one of those groups: am I still at high risk from coronavirus?
Even if you are not at extremely high risk, you may still be at particularly high risk because of your heart condition if:
- You have heart disease and you're over 70
- You have heart disease and lung disease or chronic kidney disease
- You have angina that restricts your daily life or means you have to use your GTN frequently
- Heart failure, especially if it restricts your daily life or you’ve been admitted to hospital to treat your heart failure in the past year
- Heart valve disease that is severe and associated with symptoms (such as if you regularly feel breathless, or you have symptoms from your heart valve problem despite medication, or if you are waiting for valve surgery). A heart murmur that does not cause you symptoms doesn't put you at high risk.
- You’re recovering from recent open-heart surgery in the last three months (including heart bypass surgery)
- Cardiomyopathy (any type) if you have symptoms such as breathlessness, or it limits your daily life, or you’ve been told you have problems with your heart function
- Congenital heart disease (any type) if you also have any of the following: lung disease, pulmonary hypertension, heart failure, you’re over 70, you are pregnant, or if you have complex congenital heart disease (such as Fontan, single ventricle or cyanosis). Read our information about coronavirus if you have congenital heart disease.
If you are in one of these groups, the advice is the same as for everyone in the UK (except for the extremely vulnerable, who have to be even more careful to protect themselves): stay at home apart from essential needs.
If you don't fall into one of the groups above, having a heart condition or any of these issues means you are at high risk - again, you should stay at home, apart from essential needs:
- Coronary heart disease, such as a past heart attack, stent, or bypass surgery (at any time)
- Over 70 years old
- High blood pressure (hypertension)
- Pregnancy
- Diabetes
- Lung disease, including asthma
- Chronic kidney disease
- Stroke
- Vascular dementia or small vessel disease in the brain
- Body mass index of 40 or over (severely obese)
- Smoking - because the act of smoking (putting your hand to your mouth) increases risk of catching it, and because it damages your lung health. If you smoke, stop today.
If you have Brugada syndrome or Long QT syndrome and get coronavirus symptoms (especially a high temperature), you should call 111 and tell them about your heart condition, as well as telling the doctor who treats you if you are told to go to hospital. This is because you might need extra ECGs to monitor your heart, and your heart condition may affect what treatment for Covid-19 is right for you.
If you have atrial fibrillation, there isn’t enough information at the moment to tell whether it or other abnormal heart rhythm problems put you at higher risk from coronavirus. It seems likely if you have well controlled atrial fibrillation, that your risk is lower than for the groups mentioned above.
If you have a pacemaker, whether or not this raises your risk from complications may depend on the reason why your pacemaker was inserted.
Covid-19 coronavirus is a new disease and we don’t know everything about who is most at risk of complications. Other heart patients may still be at particularly high risk or high risk. This list is based on the best information available from relevant experts. It's possible that other conditions could put you at risk that we don't know about yet, so it's important that everyone works hard not to catch or spread coronavirus.
- Read the government's list of people who fall into the high-risk category.
Should I still call 999 or go to hospital if I'm worried about my health?
Whether or not you have coronavirus symptoms, it's essential to dial 999 if you have symptoms that could be a heart attack or stroke, or if your heart symptoms get worse. Some recent information from Italy suggests that people are not seeking help for possible heart attack symptoms, or waiting longer to seek help, which means more of them needing intensive care or suffering long-term heart damage.
Despite the pressure that the NHS is under, you should always dial 999 immediately if your chest pain is sudden, spreads to your arms, back, neck or jaw, and feels heavy or tight, or if you become short of breath or start to feel sick.
You should also dial 999 if you have signs of a stroke, such as your face drooping on one side, can’t hold both arms up, difficulty speaking. You should also dial 999 if you are having severe difficulty breathing (such as gasping for breath, choking, lips turning blue, or not being able to get words out.)
I am at high risk from coronavirus - can I still go to work?
If you are in one of the high-risk groups, you should avoid going to work if you can, even if you are a "key worker". You can work from home, if that is possible for you. Speak to your employer about your situation. If your employer is not supportive, ask your GP if they can give you a letter for your employer explaining that you should not be going to work. Your GP may need to consult your cardiologist.
Is it true that my blood pressure medications could cause more severe coronavirus (Covid-19) infection?
We’d strongly advise people to continue taking all their medications unless advised differently by their doctor.
The medical profession has a number of expert groups who have reviewed the scientific information and they are agreed that there is a lack of evidence to support speculation that ACE inhibitors and angiotensin receptor blockers (ARBs) increase the chances of severe Covid-19 infections.
What is clear is that stopping your medication could be dangerous and could make your condition worse. These drugs are very effective for heart failure, and to control high blood pressure to help prevent a heart attack or stroke. It’s really important that you continue to take them as prescribed, unless you're told differently by your doctor.
If you have Covid-19 coronavirus (as with any infection) your doctor may ask you to stop taking some heart medicines such as ACE inhibitors and diuretics for a day or two, if you are feeling dizzy, or not eating or drinking as much as usual while you feel unwell, or you have diarrhoea. Don't stop your medications without your doctor telling you to do so.
What should I do to avoid coronavirus?
Everyone needs to work hard not to catch or spread Covid-19 coronavirus. This applies whoever you are, so that you stay healthy and don’t pass it on to vulnerable people. And it applies especially if you’re in a high or very high risk group, such as the conditions listed above.
You must protect yourself and others by following the latest instructions from the UK government:
- Stay at home
- You can only go out to buy food, for any medical need, for exercise once a day, and for work if this absolutely cannot be done from home
- Wash your hands with soap and water often, including when you return home – do this for at least 20 seconds
- Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
- Put used tissues in the bin immediately and wash your hands afterwards
- It’s still really important to carry on taking any medication you’ve been prescribed, even if you feel unwell. Ask someone to collect your prescriptions from the pharmacy if necessary.
You may be asked not to attend your routine hospital appointments in person and told about alternative arrangements.
The government says this advice is likely to be in place for three weeks initially, and may change, so be sure to check their website.
- Read about the difference between social distancing and self-isolation.
What are the symptoms of coronavirus?
The main symptoms to watch out for are a cough and fever as well as shortness of breath. If you have any of these symptoms, no matter how mild, it’s important that you self-isolate for seven days and follow the Government’s advice. If you live with other people, they should stay at home for 14 days from the day the first person got symptoms. You do not need to contact 111 to tell them you are staying at home.
Read the government's full advice on how and when to stay home.
How is coronavirus treated?
Scientists are working hard to develop treatments and vaccines for Covid-19 but this will take time. At the moment the goal is to treat symptoms and reduce the risk of others becoming infected. It helps to:
• get plenty of rest
• keep hydrated
• take paracetamol to help with symptoms such as a high temperature.
Antibiotics do not help, as they do not work against viruses. If you develop complications from coronavirus, you may need hospital treatment. Do not go straight to hospital - use the NHS 111 online coronavirus service if:
• you feel you cannot cope with your symptoms at home
• your condition gets worse
• your symptoms do not get better after 7 days.
If it's a medical emergency, you should call 999.
What is coronavirus and what is Covid-19?
Coronaviruses are a large group of viruses that are responsible for different illnesses including the common cold so many of us have had a coronavirus before. However, the virus that is causing the current outbreak, called Covid-19, was described as ‘novel’ because it had not been identified previously in humans. This outbreak started in animals (probably bats) and then spread to humans.
Where can I get more information?
The information provided by the government is updated daily. If you live with a heart or circulatory condition and would like to speak with a cardiac nurse, you can call our Heart Helpline on 0300 330 3300, Monday to Friday 9am-5pm, or email [email protected].
The World Health Organization (WHO) regularly updates its website on the global picture as well as providing myth-busters to the unreliable information that is circulating about this condition.
