A Heart Patient’s Guide to Surviving Flu Season

by Rita Colorito Health Writer

If you’re one of the more than 126.9 million Americans with heart disease, flu season is more than a nuisance—it’s a legit medical concern.

Flu season is dangerous for those with heart disease because these seasonal bouts of sickness can make underlying heart issues worse. “Having the flu gives you kind of a one-two punch of having respiratory troubles that can spur on other infections, even bacterial pneumonia, that can put additional hardship on the heart, and also lead to systemic body inflammation,” says Nicholas Ruthmann, M.D., M.P.H., a cardiologist at the Cleveland Clinic in Cleveland, OH.


The Scary Flu-Heart Connection

In a large-scale study that spanned eight flu seasons, the Centers for Disease Control and Prevention (CDC) found that one in eight people hospitalized for flu developed sudden heart complications, called acute cardiac events. Of these, one-third were admitted to intensive care and 7% died. What’s more: the CDC study found approximately 50% of those hospitalized during recent flu seasons had underlying heart conditions. So how do you make sure the flu doesn’t make your heart disease worse? Start here.


Give Your Heart a Head Start

“Make the necessary lifestyle changes now, even before flu season, to be as heart-healthy as possible,” Dr. Ruthmann says. “The healthier that patients are, the more likely they’re able to get through flu seasons without significant or serious heart problems.” Lifestyle changes include maintaining a heart-healthy weight, keeping blood pressure under control, engaging in moderate-intensity activity or exercising most days of the week, and following a heart-healthy diet, such as the Mediterranean diet.


Get the Flu Shot

No matter how mild, moderate, or severe your heart condition, getting a flu vaccine decreases your risk of sickness and death, says Dr. Ruthmann. In the CDC study, researchers found that people who had been vaccinated against the flu were at a lower risk of experiencing acute heart failure and acute ischemic heart disease.

The flu vaccine you get matters. There are two different versions of the flu vaccine, the shot—which contains parts of a killed virus, and the nasal spray—which contains a weakened live virus. “In the cardiology community, the thought is if you have underlying significant heart disease, then you should receive an inactivated vaccine (the flu shot) and not a live vaccine (nasal spray),” Dr. Ruthmann says.


Get These Shots, Too

Talk to you doctor about getting two other vaccines that prevent serious respiratory illness: the pneumonia vaccine and the COVID-19 vaccine. If you do get the flu, it increases your risk of pneumococcal pneumonia, a serious bacterial lung infection. “Patients with cardiovascular disease are more likely to have complications if they’re hospitalized with bacterial pneumonia than those patients who don’t have underlying cardiovascular disease,” says Elizabeth Juneman, M.D., associate professor of medicine at the University of Arizona School of Medicine, in Tucson, AZ. In addition, respiratory infections can put strain on the heart, which could lead to heart attack or heart failure, Dr. Ruthmann says.

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Keep COVID-19 Precautions in Place

Like COVID-19, flu is a respiratory virus. “We learned a lot from COVID that will really be applicable to flu seasons going forward,” Dr. Juneman says. “I think wearing masks in very densely populated areas may be what we are doing in the future to try and prevent respiratory-acquired diseases…. Many patients have told us they had far fewer upper respiratory infections this past year because they wore masks.” During the pandemic, the flu season was insignificant. “That’s probably because practicing good hand washing, social distancing, staying home when you’re sick, and wearing masks in public, work,” Dr. Juneman says.


Watch for Symptoms

Flu symptoms come on suddenly. Though flu and the common cold share similar symptoms, flu is more intense and tends to come with a fever. If you have flu, you’ll often experience body and muscle aches, chills, cough, fatigue, headache, sore throat, and a stuffy or runny nose.

Any symptoms should be followed up quickly with your healthcare provider. In particular, patients with heart failure should contact their doctor immediately if they experience trouble breathing, says Dr. Juneman, who is also medical director, Advanced Heart Failure and Transplantation at Banner Health in Tucson, Arizona.

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Get Tested if You Suspect Flu

Confirming early that you have flu can help your doctor treat you and monitor you during your flu bout to make sure it doesn’t impact on your heart, says Dr. Ruthmann. Depending on which flu test your doctor uses, you can get your results in 10 minutes or in several hours. If flu is diagnosed within the first 48 hours of getting ill, your doctor can prescribe one of four antiviral medications. Antivirals aren’t a cure for flu, but they do help reduce the severity of symptoms, keeping you out of the hospital.


Use OTC Meds With Caution

If it’s too late to start antiviral medications, over-the-counter (OTC) medications can help relieve some flu symptoms, such as fever and body aches. To reduce fever, opt for acetaminophen (Tylenol). Take non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Advil) or naproxene sodium (Aleve), in moderation. “Taken in excess, these can cause fluid retention in heart failure patients and worsening high blood pressure,” Dr. Juneman says. Also, avoid taking cold and flu medications containing pseudoephedrine, which can act as a stimulant making heart rhythm problems worse, Dr. Ruthmann says. Whatever you do, make sure to talk with your doctor about any OTC medications that could affect your heart health or interact with your prescription medications.

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Keep Taking Your Heart Medications

It’s important to continue your heart health treatment during the flu, Dr. Juneman says. During flu season, make sure you have at least a two-week supply of all your heart medications. That way you don’t have to worry about running out of your medications or running out to pick them up when you should be home resting.

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Stay Hydrated

“Influenza tends to cause people to become dehydrated,” says Dr. Juneman. If you’re feeling lethargic and unable to do basic activities like getting dressed or walking around the house, it could be a sign that you’re dehydrated. The easy fix? Drink plenty of water, soups, broth, and teas to replenish fluids lost during sweat, urination, and vomiting. But skip the alcohol. “[It] decreases the quality of sleep as well as dehydrates you. So, if you’re trying to get good sleep or stay hydrated, alcohol can counteract those,” Dr. Juneman says.

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Pay Attention to Emergency Signs

The flu can trigger heart issues even among healthy people. Consider this: The risk of heart attack can be six times higher within a week of getting the flu, according to a 2018 study. This is just another reason not to blow off flu symptoms and act if you are experiencing a fever or cough that improves then suddenly worsens, ongoing dizziness or confusion, persistent pressure or pain in your chest or abdomen, or severe muscle pain, weakness or unsteadiness.

Dr. Juneman also recommends contacting your doctor if you develop symptoms of low blood pressure (such as blurred vision, dizziness, light-headedness, nausea, or more noticeable heartbeat) or fevers over 103 that don’t respond to OTC medications.

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Follow Up

After the worst of the flu is over and you experience any chest pain or limited ability to function normally, Dr. Ruthmann recommends following up with your doctor or cardiologist. “We call that exertional intolerance, and it includes shortness of breath with activity,” he says. “If you’re having significant changes from a breathing or general functioning standpoint, it’s worthwhile to follow up with your doctor.”

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Rita Colorito