When Your Heart’s in Quarantine, What Does Anything Else Really Mean?

In an unprecedented time like this, when everything in our lives has turned upside down—so unprecedented that the dizzying drops in the stock market, the number of people who have recently found themselves unemployed, and the number of small businesses who have suddenly been cut off at the knees, all make the Great Depression look like a picnic—but at least then, we could still have picnics. Today, even our picnics have been pulled, and why?

This guy, that’s why!

This underhanded, single-stranded, positive-sense RNA virus.

Yes, the novel coronavirus, SARS-CoV-2, or COVID-19, has wreaked havoc of untold proportions on the world. And because it is “new” to the world (nobody is immune to it), we do not have a sufficiently established understanding of how it acts.

The virus affects different people differently. That’s why some people don’t even know they have it, while others die mercilessly in spite of the most heroic of interventions. It is becoming obvious that one’s genetics play an important role (i.e. two completely healthy people of the same age end up having two different outcomes- one dies and one easily recovers). We are discovering that your underlying genetics as it pertains to your immune system plays the most important role (in my opinion, more important than the underlying condition and age).

The hallmark of a poor outcome in a COVID-19 patient is something called ARDS (acute respiratory distress syndrome), which is often the patient’s ultimate cause of death. On the way to developing ARDS, their immune system mounts a response. While this sounds like a good thing, in COVID-19, something called a “cytokine storm” occurs: the release of pro-inflammatory cytokines, such as interleukin-6. Even though hospitals have intubated and ventilated to breathe for such patients, between the effects of the cytokine storm in terms of inflammation, the damage caused by the ARDS itself, and the multi-organ failure (especially kidney and heart) that has often already begun by this point, the prognosis for recovery is sadly poor, which is why most ventilated patients never get off a ventilator.

We are also learning that the COVID-19 infection can present in very unusual ways such as lower extremity rash or stroke as the only presenting symptoms ( I will discuss these unusual presentations in more detail in my next blog). Let’s now talk about the Virus’ effect on the heart:

The coronavirus affects the HEART —in more ways than one:

Directly:
When reports came in from China and New York that COVID-19 victims had heart disease on autopsy, that was no surprise. Such patients likely were high-risk before they were infected and were thus more likely to succumb once they contracted the virus. Makes sense, right? What did not make sense was the significant number of patients who had healthy hearts prior to the infection. Quite a few of otherwise healthy patients were noted to develop severe, direct heart disease, mainly a condition called myocarditis. Myocarditis means inflammation of the actual heart muscle. In its mild form, it can manifest only as chest tightness or pain that is specifically worse when you take a breath or with certain positions. In its severe form, it can lead to accumulation of fluid around the heart, which if severe enough, can prevent the heart from functioning (a condition called cardiac tamponade). In its severe form, myocarditis can directly weaken the heart function, leading to dangerous changes in the heartbeat (typically, ventricular arrhythmias), which in turn, can stop the heart and cause sudden death. As myocarditis is typically a virally caused disease, it suggests that COVID-19 directly attacks the heart in some patients, making it even a more formidable adversary than we already have known it to be. A major cause of death in the ICU patients with COVID-19 is severe myocarditis. There are reports of patients who, after two weeks of being intubated in the ICU, eventually recovered and were extubated, only to develop myocarditis in the next few days and die of Sudden Cardiac Death. The good news is that some new IV medications have shown to be effective in reducing the inflammation of the heart and have been shown to prevent sudden death in this group of very sick ICU patients.

The second, recently discovered, serious effect of the COVID-19 virus is its ability to provoke a “hypercoagulable response”. The term “hypercoagulable state” refers to the body’s predisposition to form blood clots in the vasculature. In other words, the increased tendency of the blood vessels of the body to cause stroke, heart attack and blood clots in the legs, as well as kidney disease, etc. I will discuss this and other unusual manifestations of the virus in my subsequent blogs.

Indirectly:

Up until recently, I, and probably everyone else you know, have probably been telling you that you need to get out and socialize with your friends and family more. And why? Because studies have consistently shown that being social—getting out and about, as opposed to keeping to oneself—has been shown to have measurable benefits when it comes to heart health: That means people who spend more time being sociable as opposed to being hermits have a lower risk of having a cardiovascular disease (“CVD”) event like a heart attack or stroke. And now, what happens? Sure enough, along comes Covid-19 and ruins it all for everyone, making “social distancing” not only the order of the day, but often city and state law as well! If you do what they always say in medical school, “look at the risk/reward ratio,” you would see there is some reward for your continued cardiac health by staying social in the conventional sense ( going out and seeing your friends and family exactly like you did before), but you would have a greater risk of catching coronavirus by doing that, so the quarantine would win out. What are the effects of quarantine on the heart?

Effects of quarantine on the Heart:

All of the following seven items are results of the COVID-19 pandemic, and as shown, are potential or actual known stressors in terms of elevating cardiovascular disease risk.

1. Loss of Job/Income (Major Life Stressor)
2. Decreased Social Interaction (Known to Increase CVD Risk)
3. Both Spouses at Home, Which May Not Be Typical (Could Create Stress)
4. Kids are Home and You Have to Home-School Them (Could lead to Increased Stress)
5. Lack of Attention to Diet (Poorer Dietary Choices Lead to Increased CVD Risk)
6. Inability to Exercise Due to Lockdown/Quarantine (Increased CVD Risk)
7. Depression (Known to Increase CVD Risk)

“The quarantine itself is causing stress on my heart”

In the words of an old Motown record, “Mama said there’d be days like these.” Oh no she didn’t! Because even at her most well-meaning, I can guarantee you, Mama never could have predicted a quarantine lasting months, her kids having to be home-schooled in one room while Papa tried to conference in to whatever might be left of his job (if he still has one) on Zoom in the other. This is presuming that Mama and Papa have decent, stable, white-collar jobs! What if they don’t? What happens if Mama and Papa owned a restaurant, or were in the food-service business, businesses which have become closed because of the pandemic?)

I have talked to some patients who have had mild cardiac issues before, but these were being well-managed, and therefore, they were at low risk for heart disease in the future. Now, due to the COVID-19 crisis, a number of these patients are, I feel, going through severe anxiety and depression (which itself increases heart-disease risk): Some of them fear contracting the virus, or fear that their friends and family might contract it. And, like most of us, they fear the uncertainty about the future: about when, or even if, this pandemic will ever be over. It is a pervasive feeling that their lives will be permanently in limbo; the sense that no matter what they do, no matter how hard they try, that they will be forever unable to work, unable to go anywhere, unable to make money, or indeed, unable to do anything. Right now, they can only see being in quarantine indefinitely, but they will do it because they feel that is their only option other than death. It is literal purgatory. This is not the “endogenous” type of depression that many of us doctors see that is purely based on genetically low serotonin levels. This is “situational depression”—depression caused by our situation.

There is no doubt about it: We are facing situations that are unprecedented in our lifetime. HOWEVER, you will need to understand that this is going to be a long but a TEMPORARY situation. Life Will get back to normal. The economy WILL fully recover. We WILL get our lives back. The key is to be optimistic and patient. The key is to follow the guidelines, educate ourselves and protect ourselves. If you do that, then “This shall pass”. In order to get you through these tough times I strongly recommend the following:

1. Exercise ( 45 min to one hour a day in any form). There are many exercise apps you can download which guide you through various in-home exercises. Some of my patients work remotely with their trainers through Facetime etc. If you have to go out for a walk, make sure you wear a mask and gloves and stay at least 6 feet away from the others on the street. Exercise releases endorphins and other substances in your brain which help relax you and make you feel good.
2. Resist the temptation to eat junk food. Junk food makes you feel good for a minute but then will make you feel worse. Eating healthy will give you long term energy and make you feel good longer. I know it is easy for me to say but you can do it.
3. Virtual or remote psychotherapy. All therapists I know have virtual sessions with their patients. You don’t need to have a face to face session with your therapist. Phone consultation will do the same thing. I will be glad to refer you to some therapists if you need one.
4. Meditation- This, I believe, is the best and most effective way to reduce your stress, depression and improve your overall mental and emotional well being. SKY Meditation (Sudarshan Kriya) a rhythmic breathing technique which has pretty robust scientific data supporting its efficacy in depression, anxiety and stress. It brings a sustained sense of peace and calm which now, more than ever before, seems to be the need of the hour. Here is a link to “The art of living” site which teaches you this style of meditation: https://tinyurl.com/destressMay2020. The instructor, Michael Fischman, has been teaching this technique around the world for many years.

Prophylaxis Against COVID-19 Infection: Is There Anything Else I Can Do?
There are a number of ongoing research studies worldwide on the use of two IV supplements which are showing significant promise and benefit in both prevention and possible treatment of COVID-19.

1. High dose IV vitamin C- This is based on reports of many clinical research studies (many still ongoing) from around the world, including the widespread employment of high-dose intravenous Vitamin C in New York hospital populations. We have been using high dose IV vitamin C in a select group of our patients for many years with good results and do continue to offer this to our patients for a range of medical conditions.
2. NAD+/MNM- NAD infusion or oral MNM (the precursor of active NAD+) has been shown in many studies to help with COVID-19 infection. A recent study (March 23,2020) showed how NAD+ can reduce the autoimmune and inflammatory effects of COVID-19 infection. Furthermore, a colleague of mine just published a case study of one of his patients who was recently admitted to Cedars-Sinai Hospital with severe COVID-19 infection. His condition quickly deteriorated, but the course quickly turned around and the patient had a complete recovery after administration of MNM.

The supplements above are extremely safe without any significant side effects . We use a customized protocol of high-dose intravenous Vitamin C and NAD+ in our practice. The recent scientific finding that boosting an immune response to coronavirus may be effectuated by boosting NAD+ suggests the potential for this particular strategy. The hope is that this combination therapy may offer some benefit in terms of mitigating the risk of contracting the virus in the event of an accidental exposure.

If you are interested in the above protocol, please contact our office at (310) 550-8000 and ask for Sabrina. As a disclaimer, please remember, these supplements have not yet been approved by the FDA to prevent or treat any diseases including the COVID-19 infection.

To our loyal patients, we dedicate this blog to you today in a spirit of reflection, contemplation, and ultimately, celebration of your strength, for that is what has allowed your hearts to beat on in the face of this insidious virus. So, till I blog at you again next time, don’t be afraid to sing along while you’re home in quarantine to this smooth classic:

Author

Arash Bereliani, M.D., M.S., F.A.C.C. Beverly Hills Institute For Cardiology & Preventive Medicine