In Part I of her conversation via Zoom with Dr. David Fulton (left), Charlotte Lawrence (right) asks—perhaps appropriately—how Zoom has changed cardiac care and the long-term implications of heart health from COVID-19.
As the health ambassador for ME Regional High School, sophomore Charlotte Lawrence is focused on raising awareness about issues that may impact the health. This year, not surprisingly, understanding COVID-19’s impact on all aspects of health has become “the” challenge, and opportunity. In this, the first in a series of articles on health and medicine for The Cricket, Lawrence interviewed Dr. David Fulton, head of Cardiology at Boston Children’s Hospital to learn how the pandemic has impacted the heart health of his patients.
A: It was interesting. I have not actually been back in the hospital since March 13th; we scheduled only surgeries that were urgent, minimized our testing because we wanted to minimize contact, both for the patients as well as the providers. And then, because of limitations with in-person connections, changed our in-person clinic visits to virtual visits.
A: The medicine is easy, but this [Zoom] technology is challenging. What I think has been a positive of these virtual visits is that really, nobody's late for their appointments. They don't have to worry about finding the clinic, parking, costs, time spent in travel. All of those things are really positive.
The challenge is that while I can still speak to lots of families face-to-face virtually, I can't do an actual physical examination, and for cardiology, that means I can’t listen to the patient’s heart. For the last two years, I've been using an electronic stethoscope that captures the heart’s sounds on recordings, and I thought this might be a great tool to use for virtual visits. [Once we confirm the data is valid], I’d like to explore sending devices to families, so that while we're seeing the patients in a virtual visit, they can actually record the sounds. And, [now that patients have experienced virtual visits], I don’t know how many people are going to be willing to come in to see us in person when the pandemic ends. So, we have to keep the lines of technology open.
In adults, if somebody has chest pain, it's pretty easy to convince yourself that it's not heart-related if you don't want to seek medical attention. And so, people, theoretically, with serious health issues that might've been signaled by symptoms, have been in some cases reluctant to seek help; I think that that's a problem. I can't quantify it for you, but I know by talking to adult providers that they've been concerned about people delaying the need for medical attention.
We've found in a proportion of cases, specifically adults, the organ effects of COVID have been in multiple areas. Some of those involve the lung, the blood vessels, and the heart tissue itself, and in a number of cases, you can find inflammatory changes in the heart muscle, by virtually either looking at some blood tests that suggest it or by specific imaging tests that can show abnormal heart function. That has led, in a number of cases in adults, to mortality, and certainly, that's a concern, not only for the near term, but assuming if people respond to their therapy and improve, there are long-term consequences that may be the heart muscle has been partially damage to the extent that they may have limitations in the future. Inflammation in the heart is not trivial, even in children.
A: The American Heart Association recommends for anybody, child or adult, 60 minutes of vigorous activity, seven days a week. It doesn't necessarily have to be 60 minutes of sustained activity at a time; one could divide it on a daily basis between 30 minutes in the morning, 30 minutes in the afternoon. What I've told people for years is that based on that need for that 60 minutes, it's not important in terms of what type of exercise to do, as long as you're doing something. It can be anything: jogging, walking fast, a treadmill, swimming. It doesn't really matter, as long as, number one, you push yourself and try to get tired by the end of exercise, sweaty, really push your heart. That's important for all children, whether they've got a heart condition or not, at least push yourself to the extent that you can. Not only is it good for fitness heart-wise, it's great for mental fitness as well.
So, I realize there are limitations in this time of COVID, but you can do home exercise. What I worry about is if people sit at home and say, "Well, I can't go out and play with friends or ride a bike for various reasons, therefore, I'm not going to do anything." And that coupled with doing nothing, and perhaps eating more of some of the things they shouldn't be eating, only leads to other health problems. Everything's linked here, and I think that's why anything that we can do, including to encourage young people to keep exercising, is really critical. It's an important part of heart health for your life.
A: The most important thing is a balanced diet, including the various types of nutritional aspects that we identify as, grains, protein, carbohydrates, some fat and some dairy products, all of which should be considered in the context of healthy choices. So, low fat milk, for example, protein that is relatively low in fat, like animal protein, even though some is fine, but emphasize more chicken, fish, more vegetables and fruits. Fresh fruits are best, but even canned fruits are acceptable. Try to avoid soft drinks and other bottled drinks or juices with high sugar content, those are not necessarily heart-healthy, or body-healthy for that matter.
Now, there are also some people who are overweight; in the US there is a high number of people who fit into an overweight or obese population. I recommend that people are aware of their body mass index (BMI), a measure of body fat. If someone decides they need to diet, it should be done in consultation with professional guidance - especially for young people, so they don’t get into the habit of restricting their intake inappropriately. We know there are a lot of people who do have issues with abnormal food intake, whether that's anorexia or bulimia, so we have to proceed responsibly, with the help of professionals.
A: First, it is important to measure blood pressure. For children who have high blood pressure, it doesn't necessarily mean they have true hypertension like we see in older individuals, but there are a variety of reasons that people actually can have elevated blood pressure and It's important not to ignore it. In many cases, when people come to see us, they're anxious, blood pressure's a little high, you can understand why. It’s important in individuals where the measurements are higher to repeat those measurements in various ways, at home or in somebody else's office setting, or a place where you're more comfortable to make sure that those are just values that were spur of the moment values, not persistent high blood pressure. But for those who do have high blood pressure, then being treated for them by people skilled in managing hypertension is important.
The second, as I mentioned previously, is maintaining a good BMI, and addressing it if your BMI is high. The American Academy of Pediatrics has suggested a screening tool between ages nine and 11 for cholesterol measurements, as well as for children at the age of 17. So, people should have single cholesterol measurements at those two age categories to make certain we're not missing people with underlying abnormalities of cholesterol and lipids.
Finally, it's also important to note that if you have a family history of early onset of heart disease, you may need some screening. There are many things that you can do, even though you feel well, to make sure that your heart is optimized going forward. And then, of course, exercise. If you couple all of those various areas together, you've done the most to address your future heart health. Pretty important.
A: First, getting the vaccine. If Dr. Fauci says it's okay, I believe him. And seeing my young grandson on the west coast, since the last time we saw him was January. Also, I'd like to get back to a gym one day. And then travel. I’d like to do things that we took for granted.
