Coronavirus cases continue to increase both in the United States and around the world, and as we learn more about the effects of COVID-19, it becomes clearer who is at higher risk for contracting the virus and for developing serious complications. Those who have heart disease and related complications may be asking if you are at increased risk and, if so, what you should do. Here's what we know.

What are the risks for those with heart disease?

A bulletin released by the American College of Cardiology argues that it is reasonable to suspect that people with heart disease and related factors are at higher risk for contracting COVID-19. This may be because those with underlying heart issues often have weakened immune systems and thus show less resistance to the virus. This effect is exacerbated by age, particularly for those over 65.

More concerning is that those with heart problems are more likely to develop serious complications if they contract coronavirus. Evidence coming out of Wuhan, China, ground zero for the disease, indicates that among fatalities, 59% showed evidence of heart disease in comparison with only 1% amongst survivors. Here, in America, reports show that 40% of hospitalized patients showed some form of cardiovascular or cerebrovascular disease.

According to Orly Vardeny, Associate Professor of Medicine at the Minneapolis VA Health Care System and University of Minnesota, because the virus initially attacks the lungs, extra pressure is placed on the heart to pump oxygen to the body. Evidence also indicates that for those with plaques in their arteries, the virus destabilizes these plaques causing increased risk of artery blockages.

We also do know that previous coronaviruses, such as SARS and MERS, were linked to heart muscle inflammation, heart attack, and rapid onset failure. While this hasn't clearly been proven for COVID-19, it is becoming clearer among researchers that fatality results less from lung failure and more from heart failure.

"A few of the patients we've had have also developed pretty profound cardiogenic shock, and those are the ones who have passed away so far," reports Seattle intensive care doctor, James Town. "[This cardiogenic shock] was more dramatic than just the respiratory failure that we kind of expected to see."

Which heart patients are highest risk?

While recommendations are that anyone with heart-related disease or complications and cerebrovascular disease practice caution and shelter in place, there are those who are at higher risk for serious complications.

• Extremely High Risk: Anyone who has had a transplant, especially heart transplant, or anyone who is pregnant and has significant heart disease (including congenital). Recommendations are to shelter in place for at least 12 weeks.
• Significant Risk: Those who are 70 years or older and have heart, lung, or chronic kidney disease; patients with angina that restricts daily life; those who have suffered heart failure, particularly if you were hospitalized and treated within the past year; anyone with severe heart-valve disease; patients recovering from open-heart surgery within the last three months; anyone who has congenital heart disease in combination with lung disease, pulmonary hypertension, heart failure, is over 70, is pregnant, or has complex congenital heart disease; or individuals with cardiomyopathy of any type who show shortness of breath or other limitations to daily life.
• High Risk: Those with coronary heart disease who've had a past heart attack or stent or by-pass surgery; sufferers of high blood pressure, diabetes, lung disease, including asthma, chronic kidney disease, or vascular dementia; women who are pregnant; patients who've suffered stroke; and those over 70 years old.

What should I do if I have a heart condition?

The most important step is to practice prevention. Doctors recommend that those at high-risk act as if they have the virus and are trying not to transmit it. They should wash hands regularly, try not to unnecessarily contact surfaces, decontaminate surfaces with approved cleaning products, stay at home, avoid crowds, and make as little contact with others as possible.

It is also recommended that you keep vaccinations up-to-date, particularly the pneumococcal vaccine. And while there is no evidence of flu vaccines having any effect on COVID-19, doctors still recommend receiving them to prevent other infections that compromise your immunity.

Additionally, it is a good idea to prepare for sheltering in place by stocking up on prescription and over-the-counter medications; to have plenty of food, beverages, and cleaning supplies in stock; and to keep emergency contacts handy. You may have heard concerns about the use of ACE inhibitors in conjunction with coronavirus, but there is no evidence of harm in COVID-19 patients. There is, on the other hand, much proof of their life-saving benefits in heart patients. It is thus recommended that if you are prescribed ACE inhibitors, you continue their use.

If you are a lower-risk patient who contracts the virus and are exhibiting basic symptoms, such as fever over 100 degrees fahrenheit, a cough, or flu-like symptoms, it is recommended that you shelter in place; treat the fever, aches, and cough; and drink plenty of fluids and get rest. If you show serious signs, such as shortness of breath, chest pain, or difficulty breathing; or if you are a high-risk patient contact your doctor or call 911.