key: cord-0901287-zvo60882 authors: Rosman, Lindsey; Gehi, Anil; Sears, Samuel F. title: How to Stay Healthy and Manage Stress If You Have a Heart Rhythm Disorder: A Guide for Patients and Their Families During the COVID-19 Outbreak date: 2020-12-16 journal: Circ Arrhythm Electrophysiol DOI: 10.1161/circep.120.009064 sha: 7b4d8c9ad31922968175d78dc6ed87d34bc8be36 doc_id: 901287 cord_uid: zvo60882 nan C oronavirus disease 2019 (COVID-19) is a respiratory illness that is caused by a new type of Coronavirus. 1 The spread of COVID-19 has been stressful, and patients with heart rhythm disorder may face additional challenges during a pandemic or public health emergency. This guide was developed to help patients, their families, and caregivers better understand the impact of COVID-19 on those with heart rhythm disorders. COVID-19 is spread from person to person through droplets in the air (eg, when someone coughs or sneezes) or by touching a surface contaminated with the virus. COVID-19 can cause symptoms such as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion, nausea or vomiting, and diarrhea. 1 Symptoms occur on average about 5 days after exposure, however, not all people infected with the virus will have symptoms (asymptomatic). Having a heart rhythm disorder does not increase your risk of catching the virus. 2 If you test positive for COVID-19, talk to your cardiologist about how the virus may impact your heart condition. Steps you can take to protect yourself from the virus: • The best way to prevent illness is to avoid being exposed to this virus. • Frequently wash your hands with soap and use hand sanitizer. • Practice social distancing by maintaining a 6-foot distance from others. • Clean and disinfect surfaces, like your desk, phone, and countertops. • Avoid large crowds of people and travel. • Wear a mask or cloth face covering in public. Virtual appointments are a great way to connect with your cardiology providers from the comfort and safety of your own home. Prepare for these visits by keeping a log of your weight, blood pressure, heart rate, and any symptoms you have experienced since your last appointment. If you have a defibrillator, pacemaker, or implanted cardiac monitor, you may have a remote monitoring system in your home. A remote monitor collects information from your cardiac device (eg, heart rate, heart rhythm, device function) and sends it to your cardiac care team at regularly scheduled times. This allows your health care team to continuously monitor your device and heart rhythm during the pandemic from the comfort of your home. Remote monitoring does not turn your cardiac device on/off and it is not an emergency medical alert system-it will not call 911 during a health emergency. Everyone reacts differently to stressful situations, and it is normal to feel anxious, angry, or sad about COVID-19. Other people may experience intense worry, grief, hopelessness, loneliness, changes in eating and sleeping habits, and trouble focusing or making decisions. It is important to recognize these changes and get help when needed. If symptoms last for 2 or more weeks or lead to problems at home, work, and in relationships, ask your care team for a referral to speak with a psychologist or a licensed mental health professional. Below is a list of strategies to help you maintain a healthy lifestyle and manage stress during the outbreak of COVID-19. Additional resources and a list of frequently asked questions and responses are provided in the Table. 1. Get the facts. Knowledge is power! Get information from reliable sources-not social media. 2. Information control. Constant news about the pandemic can cause fear and anxiety. Take breaks from social media or listening to news stories. 3. Know the symptoms of your heart condition and when to contact your medical team. If you have new or worsening heart symptoms, your provider may want you to be seen in person. Hospitals and clinics are taking extra steps to protect your health during in-person visits, such as scheduling additional time between appointments to limit contact with other patients, requiring masks, and allowing you to stay in your car until they are ready to take you directly to an exam room. • Call 911 immediately if you think you are having a heart attack or stroke. • Symptoms of a heart attack may include the following: chest pain, difficulty breathing, discomfort in your back, jaw, or chest. Symptoms of a stroke may include the following: numbness, weakness, or loss of movement in your face, arm or leg, loss of balance, and difficulty with speaking or understanding others. 4. Manage your medications. In times of stress, it can be easy to forget to take your medications. Write out a medication schedule or use a smartphone app or pillbox. 5. Take care of your body. Get plenty of sleep and avoid alcohol and drugs. Try to limit caffeine, The COVID-19 outbreak and the resulting changes in the daily lives of everyone have been stressful. This patient page provides strategies and guidance for maintaining your physical and emotional wellness. Remember that you are not alone-this pandemic will pass, and we will get through this together. This manuscript was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health to Dr Rosman (K23HL141644). None. Circ Arrhythm Electrophysiol. 2020;13:e009064. DOI: 10.1161/CIRCEP.120.009064 December 2020 Are patients with heart rhythm disorders more likely to be infected by the virus? No. Patients with heart rhythm disorders are not more likely to get COVID-19. 2 Will taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, increase my risk of becoming sick or having worse symptoms of CO-VID-19? Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications can help reduce inflammation, pain, and fever but they should be used as infrequently as possible. There is no evidence linking the use of NSAIDs to worse symptoms of COVID-19. There are a number of over the counter medications for pain and fever available for patients who wish to avoid NSAIDs, such as acetaminophen. If I receive a shock from my ICD should I go to the hospital? If you receive a single shock and do not have any other concerning symptoms, then you can call your doctor/ clinic. You can also send a remote transmission to the clinic from your home with your remote monitoring system. If you receive a second shock within 24 hours or have rapidly worsening or severe symptoms, please seek immediate medical attention. Should I stop taking certain heart medications (ACE inhibitors or ARB) if I test positive for COVID-19? Right now, there is no evidence that ACE inhibitors or ARBs are harmful to patients with COVID-19 and heart disease. 3 Stopping or changing your medication could be dangerous and could make your heart condition worse. Do not change your medications or treatment without first talking to your health care professional. What do I do if I need to refill prescriptions for my heart medications? Pharmacies are continuing to fill prescriptions. Contact your care team if you need medication refills. Some pharmacies also offer home delivery-contact your local pharmacy to learn more about your options. Also, if you need a refill on a prescription, ask for refills 7-10 days before you run out. It may be helpful to get a 90 day supply rather than your usual 30 day supply. If you are self-isolating, see if family, friends, or neighbors can pick up your medication for you. My cardiac rehabilitation program is closed because of the virus-what should I do to stay active and eat healthy at home? If you are staying home, you may be less physically active than usual. Find ways to be more active around the house by combining exercise with other activities, like watching TV, cleaning, or cooking. Put the screens down and turn off your television/streaming device! Take a walk in your neighborhood while maintaining a safe distance from others. Try to be active as a family by playing a game of hide-and-seek. Get out the exercise equipmentcanned goods are great for strength straining. It can also be difficult to eat healthy during a public health emergency because grocery stores can quickly run out of items. Do the best you can. Try to eat fruits and vegetables, whole grains, low-fat dairy products, skinless poultry, and fish. Try to limit caffeine, sweets, and sugar-sweetened beverages. Should I take medications, such as chloroquine and hydroxychloroquine, to prevent or treat symptoms of COVID-19? Research is under way to better understand whether certain medications are a safe and effective treatment. Please remember to only take medications prescribed by your doctor, as some of these medications can be harmful or even deadly without proper monitoring. Can I get COVID-19 from food purchased at a grocery store? Currently, there is no evidence of COVID-19 transmission via food. Wash fruits and vegetables thoroughly with water before eating. Sealed containers of food are unlikely to be contaminated. Wash your hands after unpacking your groceries. Do not eat, drink, or inject household cleaning products, harsh chemicals, or disinfectants. Cleaning products are designed for external objects-not our insides. Online resources for health information and support Rumors and false information spread very easily during a crisis, especially on the internet and social media. Center for Disease Control and Prevention Symptoms of Coronavirus. Accessed Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality