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DEAR DR. ROACH: I recently brought myself to the hospital because my electrocardiogram (EKG) result showed "possible ischemia." I went to a bigger hospital, and they immediately gave me numerous medications, had me chew three pieces of 100-mg aspirin, and gave me another EKG and an echocardiogram.

They concluded that I had a mild heart attack called a non-ST-elevation myocardial infarction (NSTEMI) due to COVID. How is this possible? I only had GERD-like symptoms and chest discomfort when I brought myself to ER.

Can you enlighten me as to what happened to my heart? They gave me an initial dose of remdesivir, steroids and omeprazole. I feel like there's always gas stuck in my abdomen, and it feels like a heart attack. -- K.T.

ANSWER: COVID, unfortunately, is still out there, and at the time that I write this, it is at high levels across much of North America. Your doctors must have been very worried about your COVID infection, since you were treated with a regimen for moderate to severe COVID that usually goes hand in hand with low oxygen levels. This kind of COVID infection can absolutely damage the heart.

The exact mechanism of heart damage in a severe COVID infection isn't always known. Any time a person is very ill, the heart has to work hard to provide energy to the body to fight off the infection. Especially when body oxygen levels are low, the oxygen requirement of the heart exceeds the ability of the blood vessels that supply the oxygen. If this goes on long enough, heart muscle cells will begin to die. COVID can also cause large and small blood clots that can clog arteries and cause a heart attack.

Large heart attacks usually have a finding on the EKG called "ST elevation." Sometimes we find damage to the heart muscle cells through very sensitive blood tests, but if there isn't any ST elevation, the heart attack is considered an NSTEMI.

Heart attack symptoms are highly variable. Some people develop crushing chest pain, which radiates to the left arm or jaw and is generally associated with trouble breathing, sweating or palpitations. But both men and women can have much more subtle presentations. Stomach trouble, especially heartburn (GERD), is a common symptom. Chest discomfort is as common as chest pain. Sometimes the pain is in the jaw, back or shoulder.

Heart damage due to COVID is more common in people with severe COVID and people who already have some form of heart disease. It is absolutely imperative that you see a cardiologist soon to look carefully at your heart and see whether you are at risk for further damage.

DEAR DR. ROACH: I have had a nodule observed in the left lobe of my thyroid for many years. It has been stable in size since at least 2016, at about 2.4 centimeters. Each year, my doctor discusses the options of continued observation with an ultrasound or a biopsy. I have repeatedly elected for continued observation. But are there material risks associated with a biopsy? Do you have any thoughts on how I should think about these options? -- N.R.

ANSWER: The benefit of a biopsy is that you'll get a pretty definitive answer on whether you need to worry about this nodule. Most thyroid nodules are benign, and if the ultrasound doesn't show any worrisome signs, a biopsy is not needed. The size is less important than the appearance on an ultrasound.

If a nodule doesn't have suspicious characteristics on the ultrasound, it's very unlikely to turn cancerous, especially after all this time.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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