Alan Helgeson (host): Hello and welcome. You’re listening to the Health and Wellness podcast brought to you by Sanford Health. I’m your host Alan Helgeson with Sanford Health News. Our conversation today is about COVID-19 and the long-term effects on the heart. Our guest today is Dr. Tom Stys with Sanford Heart. Dr. Stys, as we get started today, why don’t you give us a little bit about your role and your background with Sanford Health?
Dr. Tom Stys: I believe it’s almost 20 years since I started at Sanford Health. It was my first job, in fact, after coming out of fellowship training in New York when I remember we came out with my wife, from New York, Long Island. And we came out to South Dakota for the first time ever in January. We did go ahead visit some small towns, USA, South Dakota middle of January, went blowing snow and …
Alan Helgeson (host): Knew you needed a coat.
Dr. Tom Stys: Yes, no question about that. And then, you know, we did see I that that’s, yes, it was an opportunity, opportunity for us to have our family, kids grow up in a Midwestern environment, culture that we very much appreciated, which is awesome. And I personally had an extremely successful career here as an interventional cardiologist, meaning that I found Sanford’s resources, and ambition, completely in pair with mine. We evolved in the Cardiovascular Institute, affiliated ourselves with Sanford School of Medicine, USD. In fact, we hold the chair position for the division of cardiology for USD School of Medicine. Five of our cardiologists are the core faculty. We have introduced anything that was innovative and permissible in the field of interventional cardiology, electrophysiology, and other areas of cardiology and brought it to the region. And I believe I can very confidently say that we have created the leading program in the Dakotas.
Alan Helgeson (host): So now being here 20 years associated and affiliated with Sanford and a big anniversary, a 10-year anniversary for the Sanford Heart hospital. So in that 10 years prior, you had a hand in really helping lay that foundation and what that looks like and building the program, correct, Dr. Stys?
Dr. Tom Stys: That’s correct. That’s correct. We are very blessed and fortunate to be sitting in our new heart hospital. Well, 10 years. So maybe I should not be using that, that term “new.” It’s, we’re so used to it now, but it’s a beautiful facility. I remember planning, designing with administration. I remember doing procedures with visiting interventional cardiologists and heart surgeons from, quite honestly, all over the world and I have not run across a single one of them that would not be most impressed when they came out here and saw our institution.
Alan Helgeson (host): Well, congratulations to you and your team and the program that you’ve built. And we’re talking about something today. There isn’t any part of medicine that over the last year, two years, that has not been touched by COVID-19 or coronavirus, and things that we’ve heard way too much about the last couple of years, and in interventional cardiology, you’re no different. Our topic today, we really wanna talk about the connection between COVID-19 and heart health, as we’re hearing that there are short and long term effects that COVID-19 can have on the heart. Can we just jump in right there and just from your expertise let’s talk about that, Dr. Stys.
Dr. Tom Stys: Yes, of course. It is most important to talk about COVID and how it affects patients with cardiovascular disease in many different ways, in fact. And, very early, in fact, in the pandemic, we realized that the fear among our patients and community was huge and appropriately so. However, there was too much of lack of recognition of cardiovascular disease and the scope of an issue that it carries it with itself, if not addressed, taken care of treated properly. And so statistically speaking, heart disease, cardiovascular disease, heart attacks, stroke are still number one cause of death, period. And that’s talking about last – that’s our COVID year. COVID emerges number three cause of death.
We very quickly learned early in the pandemic that we will have patients that will be failing to come and seek attention. They will be having symptoms, which sometimes I feel patients are a blessing because at least those patients do get early symptoms of heart disease have a warning sign that allows them to identify an issue, seek attention and help, and perhaps prevent a severe disease that otherwise could be growing with, ultimately its consequences, unnoticed until it’s too late.
So very quickly early in the pandemic, we initiated a campaign of advising our patients, not to neglect cardiovascular disease. And I think that’s the first monitoring, which we very quickly recognized that COVID affects cardiovascular disease.
Our patients initially were afraid to come and seek attention that frequently was lifesaving. We started seeing many more patients coming with advanced forms of heart disease, coming in with advanced heart attack situations, where patients have coming in with warning signs of a heart attack. We fix things. They go home next day, all of a sudden show up with cardiac arrest going into cardiogenic shock. And that’s a completely different story.
My colleagues in cardiology, the division at their institutes, we very quickly identified and appropriately addressed where we even worked with departments of health and the state to make sure that we all had the same message. So then there are other ways where there’s no question COVID affected us. And the pure disease of COVID itself includes effects on heart/cardiovascular system.
And so indeed COVID does create circumstances in our body that can lead to increased frequency occurrence of clot formation, increased occurrence of heart attacks, some arrhythmias, inflammation of the heart muscle, and heart failure. So, there is a number of ways that the disease process itself also affects the hearts and results in bad outcomes.
COVID can affect us in many different ways. Too often, we do not link COVID disease syndrome with cardiovascular disease that COVID can cause directly. Not only COVID can affect outcomes of conventional atherosclerotic coronary artery disease, stroke disease syndromes, by, as I mentioned earlier, neglecting to get help, attention in a timely fashion, but also COVID itself affects cardiovascular system and can be a cause of exacerbation in the form of cardiovascular syndromes.
And for instance, yes, we can have an increased incidence of inflammation of heart muscle, myocarditis, heart failure. We can have increased incidence of stroke. We can have increased incidence of arrhythmias. We have a lot of patients that, after they recover from COVID, have long-term symptoms. And, sometimes it’s even tough to say is it’s relating COVID lung disease, it’s related to heart and consequences of the COVID syndrome associated with cardiovascular disease. Sometimes it’s tough to differentiate. Nevertheless, there’s clear association between COVID and cardiovascular disease. So COVID does affect the cardiovascular system directly.
But I believe that it’s, it’s also very important to recognize that COVID will affect our cardiovascular system in different indirect ways and we very well know that cardiovascular disease for instance, is a lifestyle disease. It’s lack of exercise, our extra weight, smoking, poor diet that are responsible perhaps for majority of cardiovascular disease. Interestingly, it’s a very preventable disease with that in mind, because how easy is it to eat less and exercise more and weigh less? Well, it’s easy to say, tough to do nevertheless, at least theoretically, it’s a very, a preventable disease, but it’s tough for us to do.
Now in COVID pandemic, unfortunately with the isolation, with the lack of outdoors activities, with lack of opportunities to socialize, go out and spend time in many diverse ways that would be perhaps healthier from heart’s perspective. Well, we ended up isolating ourselves, not only physically at home but also psychologically, much less interactions with others in the society.
Well, as by not going out for a routine walks to the mall, shopping, theater, movies, restaurants that stripped us from an opportunity that’s extremely important as far as healthy living. Unhealthy lifestyle behaviors that we have actually observed during the pandemic are increasing incidence of bad diet and extra weight, obesity.
I have to say that that just about every other patient comes to see me currently in the clinic, unfortunately when they step on the scale, the weight is in the wrong direction. They gain weight and it is always the same excuse. Well, I don’t go anywhere. I don’t do anything. I sit at home, watch TV. And the only thing to do is grab snack after snack and, which is sad, right? But very true. And that is a way in which COVID affected us last year. That’s not minor.
Another unfortunate, bad habit that we’ve noticed increased, increased incidents is alcohol consumption. You know, alcohol is not heart healthy. And there’s a clear association between the COVID pandemic and increase in the alcohol consumption that then leads to mental issues, more social issues, more problems, and definitely in a less heart healthy lifestyle than otherwise.
Missed medical visits is another way that COVID affected us very objectively. When we study our population here in South Dakota, there’s a big, big noncompliance you could say with otherwise necessary medical follow-ups. You know, whether you call it noncompliance or just, you know, not understanding the situation, definitely not a positive thing from cardiovascular disease. As I mentioned earlier, cardiovascular disease is still number one cause of death. So if I’m afraid of getting COVID and dying. You know what, I should be just as much or even more so afraid of having a heart disease. And so the fear of COVID should not really prevent me from getting attention, from cardiovascular perspective.
There has been an observed fear of hospitals. So no, I will not go to hospital and I’m not feeling well because that’s where I can get COVID more so than anywhere else. Again, the very false assumption, you know, and we very early in the pandemic made a big effort to make sure that it’s very clearly publicized in media across our state that no, it is probably one of the safest places where everybody’s compliance precautions are taken special, units are organized. And if anything, I think that you should feel safer going to see your doctor or be admitted to hospital for other, perhaps not COVID related issues, then going shopping to a grocery store. So, so it’s very interesting, but that fear of hospital was real. And it did I believe impact outcomes as far as our cardiovascular patients.
So as you can see, COVID also affected our patients from heart disease perspective indirectly.
Alan Helgeson (host): Is age impacting some of those effects that you’re seeing?
Dr. Tom Stys: Definitely age is a very pertinent factor, as far as outcomes of COVID. We find that that’s older patients have poor outcomes. Patients with established cardiovascular disease have worse outcomes. Well, our cardiovascular patients are the elderly patients. We very well have observed that younger populations, especially the teenagers, young people when they do get the COVID infection, their illness is not as severe. And again, whether it relates to us to the age itself or other comorbidities, tough to say, but as a cardiologist, I have to say that yes, age is very clearly recognized as a risk for worse disease course and worse outcomes.
And at the same time, yes, it is our elderly patients that have more cardiovascular disease, preexisting cardiovascular disease, such as coronary artery disease, hypertension, diabetes, stroke history, those cardiovascular diseases themselves, if preexisting will make COVID disease worse.
Alan Helgeson (host): As a person that has been vaccinated, can you still be affected with heart health and heart issues through COVID even if you’re vaccinated?
Dr. Tom Stys: Yes, you can. It has been very clearly proven, however, that patients who have been fully vaccinated undergo much milder disease course and are much less likely to be hospitalized, are much less likely to die. Nevertheless, they can still be affected by COVID and have an acute illness. And so that’s where the recommendation has been. That even though you’ve been vaccinated, you still have to be cautious and careful.
Alan Helgeson (host): What kind of lingering symptoms are you seeing for people that already have existing heart issues?
Dr. Tom Stys: So, first of all, I would say that, as I mentioned earlier, you know, the symptoms of COVID too often mimic heart disease. And sometimes it’s tough to tell quite honestly in patients with preexisting cardiovascular disease, once they recover from COVID, are these still the symptoms lingering from COVID or are these symptoms really more relating to worsening of their underlying cardiovascular disease by COVID? So that’s a very challenging issue for us currently.
We see a lot of people coming to get rechecked after they had COVID with one of our cardiologists in the office. And, the reason is that the symptoms are frequently similar. Each time we had a wave of acute infections in the community, a few weeks later, we have a wave of patients who’ve recovered from COVID and coming for cardiovascular checkups. In those instances, we check patients very thoroughly.
I think it’s extremely prudent to be thorough and not miss progression of cardiovascular disease in patients that have recovered from COVID because as I said earlier, still cardiovascular disease is number one cause of death, and if you’re concerned with COVID, you should be concerned just as much or even more so from cardiovascular disease perspective.
Alan Helgeson (host): What advice do you have for someone who may be under a cardiologist’s care or has had heart concerns for some time that is maybe just recovering from COVID-19? Are there some specific things that you would say to this audience?
Dr. Tom Stys: Definitely. It’s a very good and a very important question. Symptoms of COVID frequently mimic symptoms of cardiovascular disease. COVID itself affects cardiovascular system. So not only you could say that in a way it is also a cardiovascular disease, but at the same time, the fact that you have COVID does not mean that nothing else coincidentally might be going on in your body.
So my advice would be to be aware of too easily, assuming that it’s COVID, I don’t need to worry about my cardiovascular health. Have a very low threshold to pick up the phone, call your doctor. There is nothing wrong, even if you’re on isolation, with having a phone conversation with a doctor, cardiologist, especially with preexisting cardiology condition, cardiac conditions. Discuss the symptoms and see if you need to be concerned or not neglecting symptoms that otherwise may be early signs of something bad happening with your heart, may result in your having not only COVID, but also presenting with a heart attack. And then it’s a very challenging situation.
Alan Helgeson (host): What can a person do to help prevent or lessen the possibility of long-term heart effects from COVID-19?
Dr. Tom Stys: I think I would resonate the CDC recommendation of getting vaccinated. That is the best way to, first of all, hopefully avoid the infection and disease altogether, but at the same time avoid the otherwise possibly grave consequences of severe illness and even dying of COVID. So get vaccinated.
Alan Helgeson (host): We’ve talked about, you know, people staying out and not getting routine appointments. Can you just share a little bit from your perspective as a cardiologist, the importance of heart and vascular screenings?
Dr. Tom Stys: Getting early attention in the course of cardiovascular disease is lifesaving. As I always say, it’s a very preventable disease, first of all, so you can prevent it altogether. And even if you start getting some atherosclerotic disease, plaques, mild plaques here, or there at that stage, you can still intervene and treat it very effectively where you might not even have any consequences of that plaque formation process throughout your life.
Cardiovascular diseases are very preventable and very treatable. The worst thing to do is not get attention when you’re affected. And that’s exactly where our community cardiovascular disease screening program fits. We have very effective, accurate, simple ways of identifying patients that’s a high risk of developing severe cardiovascular disease, whether it’s heart attack, whether it’s other forms of cardiovascular disease. So we should be using those tools. And that’s our screening program.
Alan Helgeson (host): Dr. Stys, thank you for taking time to join in this conversation about heart health and COVID 19. This episode is part of the Health and Wellness series by Sanford Health. For additional podcast series and topics, please click the podcast link on Sanford Health News. I’m Alan Helgeson. And thank you for listening.