Baptist HealthTalk

Emergency Care During COVID-19: Holiday Uptick in Strokes and Heart Attacks

December 09, 2020 Baptist Health South Florida, Dr. Jonathan Fialkow, Dr. Felipe De Los Rios, Dr. Leo Huynh
Baptist HealthTalk
Emergency Care During COVID-19: Holiday Uptick in Strokes and Heart Attacks
Show Notes Transcript

 The holiday season is known for celebrations and cheer. It’s also recognized as a peak time of year for strokes and heart attacks -- and not just for older people. What’s behind this potentially deadly phenomenon and how can we reduce our risk?  

 Host, Jonathan Fialkow, M,D., chief population health office at Baptist Health looks into this “holiday phenomenon” with guest experts Felipe De Los Rios, M.D., medical director of the stroke program at Miami Neuroscience Institute and Leo Huynh, D.O., chief of emergency medicine at Baptist Hospital.

 This podcast contains excerpts from a recent episode of Baptist Health’s Resource Live program, which also focused on the importance of never delaying care for symptoms of a heart attack or stroke. Emergency rooms are open and safe, with strict protocols in place to protect patients, staff and visitors from exposure to the novel coronavirus.

For more information about COVID-19 please visit BaptistHealth-coronavirus.com

Announcer:

At Baptist Health South Florida. It's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk Podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.

Dr. Jonathan Fialkow:

Welcome back, Baptist HealthTalk podcast listeners.  I’m your host, Dr. Jonathan Fialkow. I’m a practicing preventative cardiologist and lipidologist at the Miami Cardiac & Vascular Institute at Baptist Health South Florida, as well as chief population health officer at Baptist Health.

 

The holiday season is here, and while it brings celebrations and cheer, it also brings an increase in the numbers of strokes and heart attacks. 

 

Health experts are particularly concerned this year, because hospital visits for strokes and heart attacks have decreased significantly since the beginning of the COVID-19 pandemic. Why? Because people are making dangerous decisions to ignore symptoms or delay seeking care, for fear of exposure to the coronavirus. 

 

In a recent episode of Baptist Health’s Resource Live program, we explored the holiday stroke and heart attack phenomenon: the factors behind it, ways to avoid it and the reasons to ALWAYS seek emergency care when symptoms arise.

 

I had the pleasure of hosting the program with guests, Dr. Felipe De Los Rios, medical director of the stroke program at Miami Neuroscience Institute, and Dr. Leo Huynh, chief of emergency medicine at Baptist Hospital.

 

Let’s listen in….

 

  Dr. Jonathan Fialkow:

Felipe, let's start with a little level set. I do want to get into specifically what happens in the holidays, what symptoms we should look out for. I think we can bring in a little bit of heart attack as well, and then certainly we'll address the efforts that Baptist health and we have put into place to eliminate the risk of exposure to COVID for people with strokes and heart attacks. But first, can you just speak a little bit about what is a stroke?

Dr Felipe de Los Rios:

Yeah, absolutely. So stroke is a very common condition. Actually one out of six people will have it throughout our lifetime. It's the fifth leading cause of death. And what happens is the brain receives, needs oxygen and nutrients that come through the blood to survive. And when you, whenever you have a stroke, there's a interruption of blood flow to an area of the brain. So that area essentially gets deprived of oxygen nutrients, and doesn't survive very long. The brain doesn't store energy like some other organs do. So as soon as blood supply is cut, then that organ starts to malfunction and you can get permanent brain injury by that lack of blood flow. So that essentially is a ischemic stroke where there's a lack of blood flow to the brain.

Dr. Jonathan Fialkow:

So I appreciate that level set. So, if that's something that happens mechanically where something obstructs a blood vessel in the brain, doesn't get blood. Why do we think this might increase in frequency during the holidays?

Dr Felipe de Los Rios:

Yeah, there's many reasons. And one of them is very common. People travel, might forget their medications as well, there's interruptions of things that they need to take. Be that medications for blood pressure or diabetes or aspirin, things like that. That puts you at increased risk if they're stopped suddenly. Blocked the nerves for example. Prolonged travel as well. If you're laying still in an airplane, for example or smaller seats, now everything is about volume.

Dr Felipe de Los Rios:

And if you are, it has been shown that if you have longer flights, eight hours or more, you have higher risk of getting complications than smaller or shorter flight durations. But that applies to any prolonged car ride, it would be the same. Then there's things that change to your day-to-day. So there's that situation where people don't generally exercise and they're quite sedimentary maybe and then now they have time and then they start doing a lot of exercise all of a sudden, and then your body's not used to that. So that puts an extra strain on your body as well. Or the opposite, where normally you do some exercise or relatively active. And then all of a sudden you're lying down or sitting on the couch or watching TV for prolonged periods of time. And that lack of movement can also predispose to clot formation.

Dr Jonathan Fialkow :

Right, yeah I mean it's very interesting when you think about the holidays is a celebratory time, which they are, but then the physical stresses of traveling, having to buy gifts, family dynamics we could [crosstalk 00:07:09]

Dr Felipe de Los Rios:

Emotional stress has been linked to our arrhythmias, heart problems and stroke as well. There's some, your body goes through a lot of changes during that time, and it's a very stressful period of the year for sure.

Dr Jonathan Fialkow :

Leo, speak a little bit about if you would, we talked about cardiovascular disease, so I'd assume cerebrovascular disease of the brain, but also cardiac disease. Do we see the same statistics and experiences with heart attacks around the holiday season?

Dr. Leo Huynh:

Yeah, we do. It's actually been studied for quite a while for both stroke and heart attack, the increased incidents. And it does occur during a holiday. And as fully been mentioned, a lot of it is preventable as far as overindulgence of food, alcohol, as well as salt intake, it will put a big stress on the cardiovascular system.

Dr. Leo Huynh:

So, and additionally,(5:16) I think the most important thing regarding strokes as well as heart attacks is timely care. Certainly with COVID everyone's a little more tentative in their daily life, but it's really important to distinguish a medical event and they have to get immediate attention. So a lot of what we do is very time dependent. So regarding stroke and heart attacks, time plays a very critical role. It's very important for everyone to realize with themselves and also people around them. Pay attention to the people around you around the holidays. And if you see something, then certainly act upon it.

Dr Jonathan Fialkow :  

I do want to get into symptoms and things people should recognize a little bit, but those comments are well received Leo. So Felipe why could, can you explain why getting medical attention at the first sign of a stroke for example, is so critical?

Dr Felipe de Los Rios:

Yeah, so the brain cells are really required that oxygen and nutrients from the blood in order to preserve their function, their integrity, the structure. And like I mentioned earlier, those brain cells don't store energy. So as soon as that interruption of blood flow happens, the clock starts ticking. And it has been shown that brain cells don't survive too much, mostly in the range of hours, for the most part, and when that, when there is a complete lack of blood flow.

Dr Felipe de Los Rios:

So the longer that time goes by the more injury those brain cells endure, and there's a point where it's, you can't recover. Those brain cells will die, even if blood flow is restored, but if it's restored too late. So then that's irreversible injury and you don't recover. Brain cells don't regenerate like hair or skin though. So whatever injury there is, it's permanent. But people do improve because other brain cells train and get better at doing things that they weren't doing before. But you don't really regenerate brain cells like that. So being able to restore blood flow before they have irreversible injury is key.

Dr Jonathan Fialkow :

And the same is true for heart attacks as well. The quicker one gets taken care of and able to restore blood flow, the less damage and the better they'll do. So to that end Leo, in your role as head of the ER, what specific roles are played by people? What do we do when someone comes in with what we think is an acute stroke or heart attack? How do we preserve those brain cells? How do we work to open up the blood flow as quickly as possible?

Dr. Leo Huynh:

It's a simple question, complicated answer. So, there's a lot of work that both of our teams collaborate on with the neuro team and the cardiology team. Essentially we have protocols that really fast track because we understand that it's very time sensitive. So really getting the patient to the diagnostic study and an EKG or getting a brain CT and reacting upon what those show. And we have a really good system obviously as you know since you've been integral in setting that up. And we have great outcomes, the Baptist, just from all the hard work that we've done in the past, so.

Dr Jonathan Fialkow :

And arguably to your credit and the team's credit. When we have a person who presents with a stroke or heart attack, we're able to get those arteries open in minutes. And we measure it in minutes, not in hours. And also it's 24/7 right? Three in the morning on a Sunday night, it's the same response as you're going to get otherwise. So I thank you both for helping build that and support that. Get a little clinical Felipe, what are, and again, to the best of your ability in this context, what are the warning signs of a stroke, or what are the symptoms that should make someone say to themselves or to a family member get to the emergency room right away, or call, basically call fire rescue right away?

Dr Felipe de Los Rios:

Yeah, I think more people are familiar with the signs and symptoms of heart attacks. We see it in movies within a lot of other places, but for stroke is not that common. But what we focus is lack of function. So people are able to do something. And then all of a sudden, suddenly they can't do something. They can't speak, they can't understand, they can't move, feel. The acronym FAST, F-A-S-T captures about 70 to 85% of all stroke symptoms. And what it stands for is F is for face.

Dr Felipe de Los Rios:

So you can have facial weakness, on one side of the face looks droopy than the other. A is for arm. So there's arm weakness, arm or leg weakness. Usually one side. So it's not in both arms, but it's usually one side being weak. The S is for speech changes, any speech change, meaning it's a little slurred or the person doesn't understand language or can't speak normally.

Dr Felipe de Los Rios:

And then the T is for time. So because time is so important. And sometimes people say, well but I'm really close to the hospital. I'll drive myself. I can get there faster than 911. But the thing is that not all hospitals can treat stroke, so it's important that you go to the right hospital at the beginning, otherwise you will incur delays of treatment. And then the other thing is 911, lets us know before the person arrives. So the whole team is much more ready to really streamline the process. So 911 is the way to go. But with FAST you capture about 85% or so of all stroke symptoms

Dr Jonathan Fialkow :

Is pain a part of stroke. If someone's arm hurts and, or neck hurts or something is, you didn't mention pain, is that a component of a stroke?

Dr Felipe de Los Rios:

It can be, so most strokes don't hurt but ischemic strokes, we're talking where there's a lack of blood flow, but some can. So if there's the opposite phenomenon where a blood vessel bursts inside the head, which can happen, that's about 10 to 15% of all strokes, then that is painful. Especially if its by an aneurysm or so on the outer part of the brain, that can be very painful and people describe the worst headache of life. 

Dr Felipe de Los Rios:

So if you do have a sudden onset worst headache of life, then yes. However, I will say that most people that experience that type of headache go to the emergency room because it's very very very painful. So you wouldn't stay at home for, would you had that.

Dr Jonathan Fialkow : 

And Leo, similarly chest tightness, chest pressure, we know most people having a chest symptom are not having a heart attack. But what recommendations would you give to the viewers in terms of differentiating about, I'm not playing around with this, I'm going to call fire rescue, because this is concerning. And by the way, it's totally okay for people who might be thinking they're having heart attacks or strokes to get it checked out and find out it's not. So we don't want to make it like the individual has to decide. 

Dr. Leo Huynh:

Absolutely. So it's a common set up as far as eating a lot. And then you feel like heartburn or indigestion. That's the most common symptom that gets mistaken for not being a heart attack. We also have a little indigestion or heartburn and they sit on it and wait on, and then it doesn't go away. And then the next day, they come to the ED were they lost valuable time. So the atypical presentations are actually very common.

Dr. Leo Huynh:

So certainly the classical presentation of chest pain, shortness of breath, and certainly [inaudible 00:15:18] to the arm or the jaw. Not everybody presents like that, and I think we all know that. So pay attention. The key is pay attention to your body, listen to your body. Don't sweep under the rug and hopefully it'll go away. Seeking medical attention, great. If you come to the emergency department or any of our points of care and it's deemed not a heart attack or something fantastic. But sometimes you got to get that workup to, to ensure that's not occurring.

Dr Jonathan Fialkow :

So, let's bring this conversation a little bit to the COVID scenario. We mentioned early on that across the country where COVID was hitting hard, we saw decreased ER visits for strokes and heart attacks. Are you still seeing that? If so what do you expect? If not, why do you think that's the case? And do you expect that to continue? I'll start with you Felipe.

Dr Felipe de Los Rios:

We have not being seeing that as of late. In April when we had the first wave, we did see that there was a significant decrease in ER visits. People were very scared to come to the hospital and they were not coming with life-threatening emergency conditions, which is a very bad decision because these conditions have a higher risk of death and disability by far than COVID does.

 More than two, three times of what COVID could do to you. This heart attack and strokes will damage permanently someone's life. But this time around, we haven't, we are definitely seeing the COVID numbers go up. The hospital is busier. We see that second wave, but the, I think from the hospital side, people are still coming, at least now when they have concerns.

Dr Jonathan Fialkow :

And I think you made the important point, which is that assessments one has to make, which is my risk of getting COVID. And even if I get COVID my risk of a serious case, which we don't want to ignore is less than the risk of having a stroke and staying home and not getting proper treatment. So we really want to encourage people to seek emergency room care, call fire rescue, call 911 for both cardiac and stroke related symptoms.

Dr Jonathan Fialkow :

But we've also, spent great effort, time, thought in protecting people from COVID in the emergency room. So Leo, can you speak a little bit to the viewers regarding what that experience would be like, whether it's for stroke or a heart attack, which of course a critical issue is for. But for other emergency room related visits, what have we done to decrease the exposure to COVID for someone who needs emergency care?

Dr. Leo Huynh:

Great, great. So this has been a very large hospital collaborative right from the beginning. And it's really separating the COVID patients versus the non-COVID patients, right from the point where they enter the door. So we have a screener and then we have separate processes for those patients to ensure that the COVID patients or the person under investigation are treated for appropriately, as well as a non-COVID patient.

Dr. Leo Huynh:

So it's from the point you enter the ED, it's a separate process, separate waiting room. And we really worked hard to protect all the patients and all of our staff. Obviously we, the proper use of PPE is critical and thankfully at Baptist, we've never had any shortage. And we're always really on top of our supply of PPE. So take a lot of pride, because it took a lot of work. A lot of collaborators. Our executive team did an amazing job really to keep our patients safe, so.

Dr Jonathan Fialkow :

And what we found to the, to yours and others credit is the documented exposure to COVID or people have gotten COVID from the hospital. This includes our employees is really rare and certainly much less than the risk of getting COVID from the community. So in a sense, it is safe to get your medical care in the Baptist Health systems and you're not going to be exposed to COVID in any extraordinary way.

Dr Jonathan Fialkow :

Leo,  --elaborate a little bit more. And I know this is something that I deal with quite often. People have a sensitivity to getting their care because they're afraid of if they're admitted, they can't have their family around them and visitors. And arguably those policies really are to protect the patient and the employees. It's not just to be punitive, but where do we stand now at Baptist regarding visitor policies?

Dr. Leo Huynh:

It's good question. So, number one is that we really understand the importance of having the family involved in the patient care. So that's number one, and there's always a balance of making sure we do it safely. So in the ED, we do have a visitor policy to have the patient at bedside. And we also promote, if you're going to wait in the car, which will be certainly a that's completely fine, we'll communicate via phone or FaceTime, but we do have a visitor policy in the ED, as well as the hospital.

Dr. Leo Huynh:

We do adapt it to the current wave and currently there are visiting hours. And again, we do everything we can to make sure that the family is involved with the care because that's very important for the emotional wellbeing of the patient and the family, as well as even actually the care giver to the patient. So yeah, it's something that we take very seriously and we've walked over it to make sure that the family is involved.

Dr Jonathan Fialkow :

I mean we have incredibly friendly, skilled, caring nurses and caregivers at the facilities. Very sensitive to those family needs using iPads, iPhones where appropriate. But I think you made an important point, which is, this is viewed daily, hourly and policies sometimes change based on the needs of the hospital. How busy we are, how full we are and stuff. But right now there is a visitor policy at the hospitals.

Dr Jonathan Fialkow :

Let's talk a little bit about what people can do to be a little proactive maybe with the holidays coming. What general things and specific to the holidays can be done to avoid strokes and heart attacks? Let's start with Felipe. What kind of recommendations would you make regarding this holiday season and COVID to keeping people healthy?

Dr Felipe de Los Rios:

Yeah, I think one of the important ones that Leo mentioned as well is alcohol and binge drinking really increases the risk of stroke and heart attack as well as accidents and all other sorts of things. But people sometimes go a little crazy and drink more than they should during the holidays. And that is, the alcoholic is associated with all of these. It's a big part of why the risk goes up.

Dr Felipe de Los Rios:

So just drink in moderation, take it  calmly. Don't get over anxious with traveling and plan ahead, make sure you have enough medication supplies to last the whole trip. Make sure you take them with you, keep through your usual schedule as well. I think that those will help. Be aware of the protections that you need during this COVID times, because it's not just COVID. I mean, stroke risk goes up with all sorts of infections. Any other  respiratory infection also increases the risk of stroke. We've seen it with other illnesses as well. So I think those things can help.

Dr Jonathan Fialkow :

I love the advice of making sure you continue your medications because we do see quite a bit people run out of medications. They don't want to be bothered to get them refilled. Maybe they have problems getting them refilled, and that's a contributor. So as much as possible, maintain your regular healthy lifestyle and medical care. Leo, anything to add. I mean, it's a, some of these are obviously universal and common sensical, but they're worthwhile being pointed out.

Dr. Leo Huynh:

So again, everything in moderation, listen to your body, pay attention to those around you, I think will keep everyone a little safer. And again, in this day and age, there's a lot of access to medical care. So certainly do not be afraid to seek medical care because it could save you or your family’s life.

Dr Jonathan Fialkow:
If you’d like to watch the full episode of Resource Live, there’s a link in the notes for this podcast.

As always, if you have any comments, questions or suggestions for topics for the podcast, email us at [email protected]

Thank you for listening.  Stay safe and mask up!

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