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Melanie Cole: Welcome to Back to Health, your source for the latest in health, wellness and medical care. Keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and today we're discussing COVID-19 and patients with cardiac conditions. Joining me is Dr. Stephanie Mick. She's a Heart Surgeon who's the Director of Minimally Invasive and Robotic Cardiac Surgery at Weill Cornell Medicine. Dr. Mick, it's a pleasure to have you join us today. Tell us a little bit about COVID-19 and how it's affecting those who have preexisting conditions such as a person who's had cardiac conditions or who has had heart surgery. How is it specifically affecting the heart and those who have heart issues?

Dr. Mick: A lot of what it's causing is a quite a lot of stress and uncertainty. Patients don't know what to make of the information somewhat, don't know whether to take it too seriously or not seriously enough, and so I think it's causing a lot of questions and a lot of anxiety for most of my patients.

Host: Well, I think it certainly is, and thank you for telling us that. Now as far as the continuum of care, should someone stop taking their medications? If they're on ACE inhibitors or ARBs, what do you want them to know about the importance of continuing their care and medications at this time? And please address the need if they are coming in for surgery, to have medications on hand and plan for caregiving, all of that that goes along with continuum of care.

Dr. Mick: One of the things that's really important to remember is that just because COVID is happening doesn't mean that all other health conditions suddenly drop off the map and they're not important anymore. All of that patient's preexisting conditions, high blood pressure, valve problems, all of that still needs to be cared for during this time. And so for instance, regarding the blood pressure medications, the ACE inhibitors and the ARBs, a lot of people have heard about those on the news. And initially in this whole crisis there was concern that maybe taking these medications would place patients at higher risk if they were to contract COVID-19 but this is a very dynamic area and what has been found as scientists all over the world have looked at this, is that although it was a conceptual possibility that these medications may make things worse for COVID patients. Really the jury is still out and there is no strong evidence that these medications harm patients who do indeed contract COVID-19.

And all of the major cardiologic societies, the American Heart Association, every major scientific organization has come out and evaluated the evidence and concluded that there's really no reason to stop those medications. And if a patient is considering stopping those medications, then this gets to the continuum of care. That just because you have hypertension doesn't mean all of a sudden you don't need to take care of it anymore. So that decision would need to be made in consultation with a patient's cardiologist. Just because cardiologists and all Doctors are very busy right now, taking care of patients and reorganizing hospitals and all of those things doesn't mean patient care drops off the list. And so if you're considering stopping a medication, which we are not recommending, but if you want to have that conversation, it's important to have that conversation with your Doctor. That could be over the phone or over a video visit. All of these decisions still need to be made with your Doctor. And that includes someone, for instance, who may need heart surgery, a patient who has been told they need heart surgery. When do I need to get it? How soon do I need to get it? These sorts of decisions about delaying or changing care need to be made with your care team.

Host: What a great point and thank you for letting the listeners know that. So tell us, you mentioned video visits. How are you utilizing telehealth to help people with heart conditions at this time and what do you want them to know if they do have to come in as far as screening patients for symptoms and really what you'd like them to know about the video visits?

Dr. Mick: Well, there's been a lot of great success increasing the use of video visits and the video visits have stepped in to fill the gap when patients, and frankly Doctors don't want people moving around as much, you know, so we're using video visits for sort of routine matters, video visits to talk about the timing of surgery, video visits to talk about how you've done, if you've had surgery, we're using those now. You can't use a video visit for everything. So for instance, say you've had surgery and you need a suture taken out and you don't feel comfortable taking it out at home, then in that case we can still schedule patients to come into the hospital. There are a lot of precautions that are taken. So every patient who wants to schedule a visit is screened for symptoms. When you walk in the door, every single person that enters this hospital who is not a worker gets the screen for symptoms, gets their temperature taken, and everybody is wearing masks at all times inside of the hospital. So a great deal of precautions are being taken here in the hospital if a patient does need to come in. Now, if you don't need to come in a video visit as the perfect thing to do and patients enjoy it, we enjoy it, you know, you don't have to leave, you don't have to arrange for transportation. They're very convenient.

Host: So then for patients that are questioning whether they have to come in or whether they can do this through a video visit, what symptoms you want them to know about as a heart surgeon that would trigger a visit to the ER versus contacting your doctor and doing something via a virtual visit? What would you like them to know about some real important red flags they should pay attention to?

Dr. Mick: So really important red flags whereby you shouldn't be thinking I'm going to take care of this over a video visit. Rather I should be thinking about going and seeing somebody are the ones that we hear about all the time. It doesn't make it any less true chest pain, chest tightness, new concerning shortness of breath like very sudden increase in shortness of breath, certain symptoms of strokes such as weakness on one side of the body, inability to speak. These are the sorts of things that would not trigger a video visit. These would trigger a visit to the emergency room. As far as some symptoms that you might more likely use for a video visit. It would be someone who has a known condition that seems like it may be a little worse. Someone who maybe gets swelling in their feet and it seems worse than it had in the last couple of weeks. Someone who already has a little bit of shortness of breath, feeling like there may be a little bit more things where it doesn't seem like there's going to potentially need to be an immediate action taken. Those would be more appropriate for a video visit.

Host: So Doctor, as you were talking about surgery that's necessary at this time, reinforce the message, encourage patients how safe it is because they might be scared to come in if they need a stent or they need bypass or they need to go to the cath lab. Any of these things, what precautions? You mentioned masks and some screening, but expand a little bit on that and what you're doing to let them know that if they do have to come in for any of these procedures that they are being well looked after.

Dr. Mick: First, I would want to say that that decision of doing a procedure at this time, it's being very carefully done by all of the physicians here at the hospital. And so when we decide and we recommend for a procedure to be done at this time, it means it really needs to be done and we want to do it safely. So what we're doing is every patient who is having a procedure is screened for COVID before the procedure can even take place. We are having patients recover from those procedures in special areas of the hospital that do not contain any patients who do have COVID and those patients are tested regularly to make sure that nobody has developed COVID in those treatment areas and any patient at any time or any healthcare provider for that matter at any time who has a symptom that's consistent with COVID, we are testing them immediately and keeping them away from all of other patients. So remember Doctors whole job is to keep people healthy and so what we do is set up the hospital in such a way that we know that we can deliver the healthcare in a healthy and safe way.

Host: Well, thank you for that encouragement. Before we wrap up the stress that we're all feeling, but specifically the stress that heart patients are probably feeling because stress and heart disease do not go very well together. Put it into perspective for us a little bit and help us to manage the emotional challenges during this pandemic. Some things that they can try, some calming words, things that you want, heart patients of yours to know about why the continuum of care is more important than ever and things that they can do to help stay calm at this time.

Dr. Mick: Well, first thing I would like to give a fact to heart patients and the fact is that just because you have a heart condition doesn't mean that you are more likely to get COVID-19 you have the same risk as everybody else in contracting it. So if you are taking care of yourself and abiding by the social distancing guidelines, washing your hands with soap and water, all of the things we've heard on the news, then you are the same risk as everybody else for getting COVID-19 if you get it, you have a higher risk of having a more serious form of the disease, but you don't have an elevated risk of getting it. So that's one important and calming fact to know that if you're doing what you need to do, taking care of yourself and you have the same risk as everybody else of getting COVID-19. Now the next thing, and I'm a heart surgeon, I'm not a specialist in this, but I do know a little bit about relaxation and some of the things that really help us all in this time would be, one watching the news enough to get the information but turning it off when you find that you're starting to get so anxious that you can't focus any longer, you need to ration your news.

You can't be watching it all day long and wondering how we're all going to get out of this. Get a little bit to get the information cause you do need the information but don't watch so much of it that it starts to crowd your mind with just all negative thoughts. Second thing is to try to keep your eye out for positive things. Look out every single day and you'll see so many stories of hope and survival. And so try to focus on those positive things rather than just the negative and the death counts and all of those things. Another thing is to really maintain your physical health. So eat healthy foods, nourishing foods. Nobody feels good, nobody feels stress-free when they're eating junk food all the time. It actually makes you feel worse even though it tastes good at the time. And getting enough physical exercise within, you know, the social distancing guidelines. Very, very important. Sticking to a routine even though you're inside of the house. Having some sort of routine to do every day helps you to maintain your mental health. And then lastly, when you feel like it's just getting too much and you're feeling stressed out as something as simple as taking a deep breath, counting one through five as you breathe in, holding it, then counting one through five and then letting it out, counting one through five and then just repeating that until you feel relaxed. That's a very simple but very, very helpful technique.

Host: And do you have any final thoughts for heart patients about your services at Weill Cornell Medicine and what you'd like them to know during this pandemic?

Dr. Mick: My final thoughts are that we have basically led the world in the treatment of this disease and COVID-19 and we have at our heart the desire to do the right thing for patients and to keep people safe and so we have your best interests at heart and we just ask you to keep us informed about what's going on with you. Don't make any rash decisions and we're going to all get through it together.

Host: What a great segment this was. Dr. Mick, thank you so much for joining us really and sharing your incredible expertise. For more information on how to manage the emotional challenges of this pandemic, please visit weillcornell.org/news. You can also learn about how Weill Cornell Medicine is taking extra precautions to prioritize your patient experience in office and offering more resources via digital health on weillcornell.org/digital-health-services. Thank you for joining us today. That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate and review back to health on Apple podcast, Spotify, and Google Play Music. For more health tips, go to weillcornell.org and search podcasts. Parents, don't forget to check out Kids HealthCast. I'm Melanie Cole.

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