Although COVID-19 is primarily a virus that effects the respiratory system, healthcare professionals (HCPs) suspect that before long, secondary cardiac effects of the pandemic will start to surface. As TIME magazine puts it in a recent article:

“Take a nation that already eats too much, drinks too much, exercises too little and fails too often to show up for regular checkups, put them in lockdown… and those behaviors – all of which are drivers of cardiovascular disease – will only get worse.”

COVID-19’s Impact on the Heart

SARS-CoV-2, the virus that causes COVID-19, does on occasion directly damage heart tissue. The Journal of the American Medical Association (JAMA) Cardiology cites two studies showing COVID-19 in heart tissue.

• One study shows 78 out of 100 people who had survived COVID-19 had myocardial tissue damage, including inflammation and scarring.
• A second study reported SARS-CoV-2 in the heart tissue of 61.5% of 39 patients who had died of COVID-19.

The sample size in both these studies is small, and heart failure is not a proximate cause in the vast number of cases of coronavirus death. However, the pandemic does appear to be leading to lifestyle changes that underlie cardiovascular disease.

Causes of Cardiac Disease

The risk factors of heart disease are well known, both by HCPs and the general public. They include overweight or obesity, excessive alcohol consumption, a sedentary lifestyle, as well as stress that leads to impaired mental health.

Unfortunately, the COVID-19 pandemic is creating the perfect storm for cardiovascular disease to develop, especially over the long term. Numerous studies are showing the following effects of pandemic living:

• Alcohol consumption increased by 14% in a sample group of 1,540 adults
• Physical activity decreased by 32.3% in a group of 3,052 adults who had been physically active prior to the pandemic
• 31% of adults report snacking more during lockdowns

In addition, stress due to factors like economic hardship and depression caused by feelings of isolation has a negative impact on heart health. People are afraid to go to doctors’ offices for routine checkups and monitoring of chronic conditions. One official from the American Heart Association (AHA) says, “We know people have delayed getting care for heart attacks and strokes, which can lead to poorer outcomes.”

As the saying goes, the best defense is a strong offense. Educating healthcare students in the basics of diagnostic assessment including auscultation of heart sounds is one way to fight back against COVID-19’s negative impact on the heart.

Choosing the Right Stethoscope

The first line of diagnostic assessment is the simple practice of listening to heart sounds.

The stethoscope was invented inadvertently by French physician Rene Laennac in 1816 when he decided to roll a piece of paper into a tube in order to listen better to a patient’s heartbeat. The name for the device is a combination of Greek words: stethos (chest) and skopien (to view or see). Two and a half decades later, George P. Camman of New York created a scope with an earpiece for both ears. Finally, in the 1960s, Dr. David Littmann patented further improvements on the stethoscope that most of us recognize today.

A stethoscope consists of a headset with ear tips to fit in the user’s ears; tubing to carry the sound from the chest piece to the ears; a chest piece or head; and a diaphragm. The tubing is usually one tube that divides into two pieces at the headset. Educators, students, and HCP professionals choose from a number of configurations that suit their needs.

• A single-head stethoscope has one flat surface for listening to heart sounds, with a sealed diaphragm on the other side.
• A double-head stethoscope has a large diaphragm on one side and a smaller bell on the other. The large surface is flatter and works well to hear higher frequency sounds; the bell, which looks like a small cup, works better to hear lower frequency sounds.
•  A teaching stethoscope can be single- or dual-head; its defining characteristic is that is has two sets of ear tips, one for a student and one for a teacher.
• Cardiology stethoscopes are designed specifically to hear heart sounds best.
• Pediatric stethoscopes often have a smaller chest piece, making it more proportional for listening to a child’s heart. Doctors who see patients of all ages will often use the bell side of a double-head stethoscope for their pediatric patients.
• Electronic stethoscopes: Most stethoscopes are acoustic, meaning the tubing delivers sound waves to the user’s ears without any extra amplification. Electronic, or digital, stethoscopes translate the sound waves into an electronic signal for amplification, improving listening and diagnosis.
• Finally, a Sprague Rappaport stethoscope features two tubes that go all the way from the chest piece to the ear tips. The tubes are held together with metal clips until they split at the headpiece, and the design is intended to boost sound quality.

Instructors can teach and demonstrate auscultation with any of these stethoscopes. Using simulation and task trainers to teach heart, lung, and organ sounds in the classroom is a viable option. Dedicated instruction and repetition are necessary to learn the sounds that can be identified with a stethoscope.  

Sources:

Kluger, J. “COVID-19 may lead to a heart disease-surge,” TIME Magazine, Feb.15-Feb.22, 2021. https://time.com/5936029/covid-19-heart-disease-rise/

“The Ultimate Guide to Types of Stethoscopes,” allheart.com. https://www.allheart.com/blog/sa/b-ultimate-stethoscope-guide/