PROFESSOR DR. ERNST VON SCHWARZ,
ONE OF THE MOST PUBLISHED AND RECOGNIZED
CARDIOLOGISTS IN THE WORLD,
SHARES EXPERT VIEWPOINTS ON THE DECLINE OF
HEART ATTACKS
AMID THE COVID-19 PANDEMIC
FEWER DIVORCES, LIKELY LESS INFIDELITY,
REDUCED DAILY STRESS AND ROAD RAGE
PROFESSOR DR. ERNST VON SCHWARZ–one of the most published and recognized cardiologists in the world and director of the Southern California Hospital Heart Institute, Los Angeles, CA–is sharing his expert viewpoints on the decline of heart attacks amid the Covid-19 pandemic.
“Right now, there are fewer divorces, likely less infidelity, reduced daily stress and road rage,” PROFESSOR DR. ERNST VON SCHWARZ says. “The Covid-19 pandemic has created a new and different reality. There are reports that heart attacks and strokes are being seen less frequently in the hospitals, which I can confirm from my experience in several hospitals in Southern California, and I’ve heard similar stories from across the U.S.”
“In California alone,” he elaborates, “ERs have reported a 40-70% reduction in non COVID-related ER visits. Without any doubt it is true that many patients are just too scared to go to the hospital and might delay their needed care; however, there are many more factors involved including patient-related, healthcare-related and environmental factors.”
In the bullet points below, PROFESSOR DR. ERNST VON SCHWARZ offers explanations for the current reduction in hospital admissions of patients with acute heart attacks during the pandemic.
He explains that “there are three factors to be considered and a few hypothetical pathophysiology mechanisms.
●Patient-derived factors.
●Health Care Provider-derived factors
●Environmental factors
●Pathophysiologic Model of Stress
Patient-derived factors:
Patients are scared and stay at home and try to avoid going out; they don’t want to be in a hospital. If that would be the main cause, then we would expect a much higher number of patients dying at home from heart attacks, which has not been reported, yet. Even though the pandemic and home confinement as well as the economic burden can cause enormous chronic stress for many, the up and downs and daily anxieties from being at work, on the road, running from on appointment to another, stressing out with business associates and customers etc. is off the table for many. It has been replaced by hanging out on the couch and watching ‘Tiger King,’ which in fact, seems to be very relaxing and entertaining for many. The replacement of daily stressors by staying at home might keep the heart calmer.
Another patient-related factor might be a reduction in heavy exercising, since all the gyms are closed, and people might stress their heart out less vigorously. That does not mean exercise would be harmful, but if someone has coronary disease with severe blockages, heavy physical activity requires higher oxygen demands and thus possibly ischemia (lack of oxygen) leading to heart attacks and life threatening arrhythmia.
Furthermore, there is likely less infidelity, simply because of lack of opportunities, i.e., no bars or restaurants are open, not even coffee places anymore. Less infidelity causes less stress at home, which might result in fewer triggers for heart attacks (which often appear after stressful situations at home). Even though sexual activity in general has a low incidence of heart attacks and sudden death, few old studies showed that if people die from a heart attack during sex, it was oftentimes with a partner other than the spouse and oftentimes after heavy eating and drinking. Again, no bars, no restaurants, no parties or corporate meetings, no gyms to hook up, therefore less infidelity, and likely less heart attacks.
Another patient-related factor is a reduction in court cases including divorces during the pandemic. Divorce is an extremely stressful situation and many patients develop chest pains, angina, even heart attacks during the divorce procedures. The courts are closed right now, nobody gets divorced, nobody undergoes the stressful situation being in court trials which might also reduce the number of heart attacks at least among some patients.
Healthcare-derived factors:
Doctors are seeing less patients in their clinic, so they are sending less patients to the hospitals. Telemedicine is done, but even though we do have the technical capabilities to get EKGs in the patients’ homes and to evaluate those via telemedicine media, most doctors do not have this opportunity, so less EKGs are done, less heart attacks are diagnosed, less heart attack patients come to the hospital. Furthermore, doctors and healthcare providers are not performing elective surgeries. If there are no elective surgeries, then there are no periprocedural heart attacks. In other words, even a minor surgery can have a small risk of a cardiovascular event such as a stroke or heart attack if the patient has underlying but often undiagnosed heart disease. Even though these numbers are low, most of heart attacks that occur during hospital admissions for other than cardiac reasons occur during elective surgeries. No elective surgeries, no gall bladder removals, no knee surgeries, no cosmetic surgeries, etc., therefore no periprocedural heart attacks. Furthermore, many doctors do not perform ‘high risk’ procedures during the pandemic since those could occupy hospital beds, ICU beds and ventilators and staff and therefore, are postponed until after the pandemic crisis.
Environmental factors:
The air is cleaner, there is less air pollution, less traffic on the streets and freeways, less motor vehicle accidents, less road rage, all of which reduces the daily stress we all go through during ‘normal’ times.
Pathophysiologic Model of Stress:
One hypothetical explanation for less heart attacks could also be caused by the well- published phenomenon of ‘preconditioning.’ This is an interesting concept from experimental animal research. We among many other groups have published studies demonstrating that some degree of stress makes the heart more tolerant towards subsequent stress. If a coronary artery in an experimental animal model is artificially occluded (for example by putting a surture around an artery in a pig model), then 70-80% of the heart tissue is going to die as a result of lack of oxygen within one hour. If we, however, block that artery for only 10 minutes and then reperfuse the heart and then block that artery thereafter, then only 20% of the heart tissue dies. This is called ‘ischemic preconditioning.’ The temporary lack of oxygen (which is stress for the heart but not enough to cause permanent damage) then renders the heart more tolerant towards subsequent lack of oxygen, and thus, protects the heart. In medicine, however, we cannot stress the heart with lack of oxygen BEFORE a patient has a heart attack. It has been shown that the stress of major disasters–for example the Northridge earthquake in 1994 or the Los Angeles riots–have resulted in more people dying of heart attacks acutely during the disaster but significantly less people died in the weeks thereafter. It has been proposed that the acute stress eliminates the weak patients but also renders the less weak ones more tolerant towards dying from a heart attack. This stress might therefore have some preconditioning protection which represents a ‘survival of the fittest’ in a social Darwinistic sense. Just food for thought.”
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