 is fear of the coronavirus harming people with other medical conditions. Joining us for our Your Health segment tonight are Mark Vesely, an interventional cardiologist with the University of Maryland Medical Center and an associate professor of medicine at the University of Maryland School of Medicine, and Jeremy Pollock, a cardiologist at the University of Maryland, St. Joseph Medical Center. Doctors, thanks to both of you for being with us. Dr. Pollock, if I can begin with you, it's been reported around the country. There are people with symptoms of other medical conditions. Say it's your appendix, appendicitis, who are delaying seeking treatment because of fear that if they go to the hospital, they're gonna catch the coronavirus. In your practice, are you seeing anything like that? Now, Jeff, first and foremost, thanks for having me on and it's a pleasure to be on with Dr. Vesely. And sorry, we have to do this afar like this. So thanks for having us. And your question is a really good one, an apropos one. Something we've seen as collateral damage from COVID is patients not seeking timely and appropriate care. I'm covering the hospital wards at St. Joseph's right behind me, and every day, I've seen patients presenting days, hours, weeks, later than they should for heart attacks. And we have a saying in cardiology that time is muscle. So every minute, every hour you delay, you lessen your chance of a good outcome of leaving the hospital with a good outcome. And it's important you're having us on, Jeff, because both Mark and I are here to report back to you guys and to Marylanders across the state that St. Joseph's University of Maryland as a system is here, we're ready, willing and able to take care of you with or without COVID. Dr. Vesely, you run a cath lab where heart attack patients are treated initially. Have you seen anything in your work along those lines? Absolutely, Jeff. I agree with what Dr. Pollock has said tremendously. We've had patients, and as you mentioned, across the state and across the country, coming in with delayed presentations, having had symptoms for a while, that fear is something that's very important to get over. I think it's important that we recognize as patients that our systems have had weeks and weeks to prepare and continue to prepare to receive patients, both with COVID-19 and with the same medical issues that we had six months ago, heart attacks and strokes, appendicitis, all of these things are critically important that people reach out and you hear over and over again of patients coming in and talking about delaying because of this fear. So what are the safeguards that are in place in either of your hospitals? Somebody walking in the door at the emergency department, how is that handled? So we've had time to, okay, so we've had plenty of time now to develop both infrastructure and our physical plan to ways that the patients are handled and kind of taken through an emergency room visit, as well as throughout the hospital to really make it as safe as possible, both for the patients as well as our healthcare provider team to limit the chances of exposure of people with COVID-19 to people without COVID-19 and to do very rapid screening and try to separate those people. So walking into the emergency room, you should expect to very quickly be screened for potential symptoms related to COVID-19 and then taken down pathways both physically and structurally within the healthcare teams to manage each person's individual problems as best we can. Always good idea to review what those symptoms are, whether it's a stroke or a heart attack of some kind and especially because the symptoms can differ between individuals, between men and women. Dr. Pollack, what sort of symptoms do you not want somebody waiting on? You know, the classic heart attack symptoms that we teach patients are sudden onset chest pain. Now, not everyone says chest pain. It's a discomfort that can be in the middle of your chest. It's a tugging, it's a pressure. It can be associated with shortness of breath, with nausea, with sweating, with just not feeling right. Sometimes it can be an impending sense of doom. Things that you normally don't feel that come on suddenly, these are all things that you have to recognize and call and seek help right away. Let me remind our viewers, if you have a question about the heart, about the coronavirus and the intersection of those, give us a call. We'll have the number up on the screen. You can also send your questions to our email address, which is livequestionsatmpt.org. So, Dr. Vesely, the coronavirus itself, the intersection of that and people who have heart issues, maybe somebody you've placed a stent. We know there's a clotting issue in some people with the coronavirus. What should they be alert to? Well, a couple of different reasons to be concerned about the blood clots. And again, you see blood clot issues in manifesting in heart attacks, as well as in stroke patients as well. And we know that people who have a predisposed or prior history of heart disease have an increased risk of getting very sick with COVID-19. So we are very careful as we approach these patients. If someone comes in with a heart attack, some of the EKG changes that we're finding are a little bit different than what they were, say six months ago when COVID-19 wasn't around and some patients look like they're very much having a heart attack, but they may not be. Their heart is still affected by that and we need to see those patients very quickly. So it's a little bit of a challenge for us at times, but we're getting through that as best we can in figuring out things as we go with cath lab tests and other things to take patients through. Let's take a phone call. This is Anita. Anita is calling from West Virginia. Anita, thanks for the call. Go ahead. Yes, hello. I know there's still so much that needs to be learned about the coronavirus and how it spreads. My concern is if you're around people who are smoking, either track of cigarettes or those e-cigarettes, can the virus, if that person has the virus, can the virus be transmitted by breathing that secondhand smoke or the vapors from those e-cigarettes? Great topic. Thank you very much for the phone call. Doctors, either of you. I mean, I think that's the first thing you have to say with that. It's a great question. Thanks for calling in from West Virginia is you shouldn't be smoking to begin with, regardless of COVID. So there's seven traditional risk factors for the development of coronary disease and smoking is one of the biggest ones. So please, please, please don't smoke. And then your question, I think, is regarding the aerosolization of COVID. Now, I am not an infectious disease specialist. I'm a cardiologist, but I would say that we just all have to abide by the CDC recommendations, the state and country recommendations of staying six feet apart. And I do think it is prudent to stay away from people that are smoking. I would add on to that, these masks that we're wearing. I'm sorry. I would just add on that the masks that we're wearing at this point are to help prevent that aerosolization. And if you're close enough to be worried about secondhand smoke that people have floating around them, then you're probably too close to also be potentially exposed to the virus. So keep wearing the mask and keep that distance. I was gonna ask about some of the maybe longer range factors at the moment. One is just everybody's stress level. You know, even if you don't think you're affected by this, everybody's life has been changed, whether you work in a hospital, you're a first responder, you have nothing to do with it. The level of stress is there. The second point I was gonna make is when you go to the grocery store, if you go out shopping, there's this feeling of maybe it's part of the stress that you're lucky to find stuff. You know, there's toilet paper, yay. So when it comes to food, you're maybe grabbing the Twinkies and forgetting about the things that you had been meaning to do with your diet. So Dr. Pollack, how do you think about all that? Yeah, I mean, it started out as a holiday without any of the fun for the first week or two. And now we're in week nine or 10 and we're all finding that we're violating the first three risk factors for heart disease, which are the fountain of youth, with diet, exercise, and weight loss. So we're all having the COVID-19 turn into the COVID-20. So it's as important as it to recognize signs of a heart attack, it's also important to recognize the things that can cause it long term. So this is the time sun's coming out, it's warm to get moving again, to eat better, to try to lose that weight that you gained over the last eight to 10 weeks, because it's really, really important. And that's how you avoid having to come to the hospital and have to meet Dr. Vessely and I. Let's take a call from Prince George's County. This is Diane. Diane, thanks for calling, go ahead. Good afternoon, I have a question. If someone's been diagnosed as having fluid around the heart, does that make the person more at risk for serious complications if they contract the virus? Let's ask Dr. Vessely, thank you for the phone call. So there hasn't been any direct correlation of fluid around the heart with a particular more severe case of COVID-19 or an increased risk of picking it up. I would say anecdotally, not with any kind of published randomized trials or other observational studies, but I do feel like there are a fair number of people coming in with COVID-19 who have that fluid collecting around the heart. Sometimes that fluid, if it accumulates very rapidly, can lead to pressures on the heart. We need to drain that quickly with a needle. It's actually not that invasive of a procedure as much as it sounds pretty ugly, but it's something that we'll be watched for very carefully in the hospital and fluid around the heart particularly is not something that should chase you off the other messages here of paying attention to other symptoms like chest discomfort and shortness of breath. Let's take a call from Fairfax County. This is Paul. Paul, thanks for calling. Go ahead. Yes, thank you for being there. Is there something we can do from home when we start to have symptoms to be proactive, to try to get as much treatment as possible from home so that we can avoid having to go to the hospital and have all of those difficult treatments? Some providers may not be that proactive if you have somebody with lung susceptibility, maybe early use of steroids, maybe early use of some oxygen. What can we do from home to give us the best chance of not needing to go to the hospital? Paul, before you go, you're talking coronavirus symptoms, not cardiac symptoms, right? Absolutely, coronavirus, start to get symptoms, but you don't wanna just wait and you don't wanna just go to the hospital. Should you push for steroids? Should you push for a inhaler? Should you push for oxygen? What can you do from a home setting? Thanks for the phone call. We have two cardiologists with us. So either of you wanna add anything to that? I think it's important to go ahead, Jeremy. All right, Mark, thanks. Yeah, to address both COVID and non-COVID symptoms, Paul, so it's a great question and we wanna keep patients at home as much as possible. And so now if there was waiver 1135, which CMS and the payers just enacted about seven weeks ago that allow us as physicians to provide care virtually. So we all have, for the most part, cell phones that have video cameras on it. So now when I'm in the outpatient setting, I'm seeing my patients via FaceTime or via video conferencing application. So if you're having symptoms, whether or not it's COVID symptoms or you think it's cardiac symptoms, you can access me. You can access our primary care doctors at St. Joe's at University of Maryland. You can access our specialists via virtual visits where we can help you assess the risks and benefits. Listen to your symptoms and decide, hey, what are the tests that you need? Do you need to come to the hospital or is this something that we can delay and see you in a few weeks? Dr. Vesely, did you wanna add to that? I think Dr. Pollock hit the nail on the head there. There are hotlines and they're established through both of our centers that if you struggle to reach out to your other established doctors or you just need help, you should reach out to us. So you can find us through our websites and things to reach out. So rather than sitting on things and just waiting, call out for help. Yeah, Dr. Pollock, on the subject of being in your profession and having to do an appointment virtually, you can't take their blood pressure, you can't look at them. How much of a handicap is that for the doctor? You can't take vitals. Yeah, I mean, it's a paradigm shift for all of us, but you can do 95% of the visit virtually. Most patients have a blood pressure cuff that gives you what their blood pressure is in the moment, what their pulse is. A lot of patients have pulse oximeters at home. You can actually visually see a patient. I can get a lot of the physical exam just by having them move the video camera. And then listening to the patient. Dr. Vesely is one of my mentors and it's something that we're taught as we're in training is the history, actually hearing what the patient has to say is 90 to 95% of the battle. So we can do a lot of this without physically having you present in front of us. So it's very important to recognize this that you don't always have to access the emergency room. You can access us from the primary care specialist setting in a virtual sense. All right, I just have half a minute. Dr. Vesely, let's end with some bottom line advice here from cardiologist standpoint. What are the things that you don't want somebody ignoring today because they're afraid of coming to a hospital? So the classic symptoms again for a heart attack are chest discomfort, whether it being pressure or a squeezing sensation or other type of pain associated with shortness of breath, sometimes very heavy sweating, or being nauseated or being dizzy. Those are the main symptoms to look out for a heart attack, for a stroke, a nice acronym to kind of point to is called FAST. F is for a facial droop. A would be for arm weakness. S would be for any kind of new slurred speech. And T for time. Remember that time is muscle and time is brain and reach out for that help. Very good, Dr. Mark Vesely, Dr. Jeremy Pollock of the University of Maryland Medical System. Gentlemen, thank you very much. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.