Swine flu, heart disease may be deadly mix

Experts are concerned about the impact the swine flu epidemic will have on people with heart disease, with some doctors warning it could be a deadly mix leading to a worldwide spike in heart patient fatalities.

For that reason, some doctors warned on the sidelines of a European cardiology meeting this week that patients with heart disease - the world's top killer - should be among the first to receive a swine flu vaccine when it is available. They also should make sure they take all the usual precautions to avoid viruses, like regular hand-washing.

There could be a silver lining in all this: Most heart patients are 60 or older, the only age group that appears somewhat less susceptible to swine flu, a new virus that no one is immune to.

Still, while heart patients may be less likely to catch the virus, if they do, there could be major complications.

"It's almost a given that any influenza exposure is going to cause more mortality in heart patients," said Alfred Bove, president of the American College of Cardiology.

In people with weak hearts, the swine flu virus could prove lethal. Patients with heart failure, a condition where the heart can't pump enough blood around the body, are especially vulnerable.

"For people with severe heart failure, H1N1 influenza (swine flu) might be the last thing that pushes them over the edge," said Joep Perk, a professor of health sciences at Sweden's Kalmar University and spokesman for the European Society of Cardiology.

In many heart failure patients, fluid builds up in the lungs because blood isn't pumped efficiently enough. Patients can take drugs to get rid of this excess fluid, but if they catch the flu, the drugs don't work as well.

In addition, if heart failure patients develop a fever, a common swine flu symptom, the stress of trying to fight that off could put a potentially fatal strain on their hearts. Doctors also worry that inflammation - which happens when the body is struggling with an infection - could worsen heart and vascular problems.

The swine flu virus also may exact a more deadly toll on heart patients than some of the century's last pandemics.

The Asian flu pandemic of 1957, for example, mainly caused infections in the upper respiratory tract. Swine flu, however, seems to infect many people in the lower respiratory tract. That can cause severe respiratory illnesses, which stress the heart as well as the lungs.

In its recent guidelines on who should get the swine flu drug Tamiflu, the World Health Organization named heart patients, HIV patients and pregnant women as "at-risk" groups that should get it as soon as they are suspected of catching swine flu.

But before heart patients start taking Tamiflu, their doctors should ensure the antiviral won't interfere with any other drugs they may be taking. Heart patients often take a cocktail of various drugs to lower their cholesterol and blood pressure or prevent bleeding.

Some of those drugs, like the blood thinner warfarin or cholesterol-lowering statins, must be monitored carefully for potentially dangerous interactions.

WHO has previously estimated that one out of three people might get swine flu by the time the pandemic ends in a year or two. Experts say unless heart patients take precautions to avoid catching the virus, such as getting vaccinated and practicing good hygiene, there could be lethal results.

"If peoples' behavior remains as usual, we will see increased deaths," said Rose Marie Robertson, chief science officer of the American Heart Association. "There will be a lot of this virus around, so people should do everything possible to avoid it."

That may even include avoiding any sneezing grandchildren.

"The classic example is a heart patient who sees their grandkids who don't look sick, but have a little sniffle," Bove said. "Two days later, the grandparents are deathly ill."

Since children are notorious flu spreaders, Bove said heart patients should be cautious.

"They don't need to avoid their grandchildren entirely," he said. "But if they have any flu symptoms, grandparents should stay away."