Can I have an elective cardiac catheterization while experiencing flu-like symptoms such as fever, chills, sore throat, cough, and fatigue?

Elective Cardiac Catheterization Should Be Postponed When You Have Flu-Like Symptoms

You should not proceed with elective cardiac catheterization while experiencing flu-like symptoms such as fever, chills, sore throat, cough, and fatigue. The procedure should be rescheduled until you have recovered and tested negative for infectious causes, particularly influenza and COVID-19.

Primary Reasoning

Risk of Cardiac Complications from Active Viral Illness

• Influenza and other respiratory viruses can directly cause acute cardiac complications including myocarditis, pericarditis with effusion, and cardiogenic shock, which would significantly increase procedural risk 1, 2
• Acute influenza infection has been documented to cause severe cardiac tamponade requiring emergent pericardiocentesis, demonstrating that seemingly mild flu symptoms can mask serious cardiac involvement 2
• A 41-year-old patient with flu-like symptoms developed severe cardiogenic shock from acute perimyocarditis due to influenza B, requiring intensive cardiac monitoring 1

Infection Control and Healthcare Worker Safety

• The presence of respiratory symptoms mandates enhanced infection control protocols that are specifically designed for urgent/emergent procedures, not elective cases 3
• Cardiac catheterization labs require dedicated COVID-19 protocols including full PPE (FFP2 masks, impermeable gowns, double gloves, splash goggles, shoe covers) when treating patients with respiratory symptoms, which depletes limited resources 3
• Healthcare workers must be monitored for 14 days following exposure to patients with respiratory viral infections, potentially removing multiple staff members from service 3

Procedural Risk Assessment

• Elective procedures should only be performed when they provide clear clinical benefit without added transmission risk 3
• The appropriate use criteria for cardiac procedures emphasize avoiding "rarely appropriate" examinations, and performing elective catheterization during active illness falls into this category 3
• Only 0.6% mortality and 1.4% major adverse cardiac event rates occur in patients waiting for catheterization over median 27-60 days, suggesting brief delays for illness recovery pose minimal additional risk 4

Clinical Algorithm for Decision-Making

Step 1: Symptom Assessment

• If you have ANY of the following, postpone the procedure: fever >38°C, cough, sore throat, shortness of breath, fatigue, myalgias, chills 5
• Loss of taste or smell strongly suggests COVID-19 (present in 85-88% of cases) and mandates testing and delay 5

Step 2: Testing Requirements Before Rescheduling

• Obtain nasopharyngeal swab for COVID-19 RT-PCR (gold standard, 60-78% sensitivity) 5
• Consider rapid influenza testing if presenting during flu season 2
• Wait for negative test results AND complete symptom resolution before rescheduling 5

Step 3: Timing of Rescheduling

• Allow at least 5-7 days after complete symptom resolution before proceeding 5
• For COVID-19, follow current CDC isolation guidelines (typically 5-10 days from symptom onset plus 24 hours fever-free) 5
• Ensure repeat testing if symptoms were severe or prolonged 5

Important Caveats and Exceptions

When to Proceed Despite Symptoms (Urgent/Emergent Indications Only)

The above recommendations apply only to elective procedures. You should proceed immediately with appropriate infection control measures if you have:

• Acute coronary syndrome with ongoing chest pain or hemodynamic instability 3
• ST-elevation myocardial infarction requiring primary PCI 3
• Cardiogenic shock (regardless of infectious symptoms) 3
• Life-threatening arrhythmias requiring urgent intervention 3

In these emergent scenarios, dedicated catheterization labs with full PPE protocols must be utilized 3

Common Pitfalls to Avoid

• Do not assume mild symptoms are "just a cold" - influenza can cause acute cardiac tamponade or myocarditis even with initially mild presentation 2, 1
• Do not proceed based on negative rapid antigen testing alone - these tests have lower sensitivity than PCR, particularly in the first few days of symptoms 5
• Do not ignore isolated gastrointestinal symptoms (nausea, vomiting, diarrhea) as these can be the presenting symptoms of COVID-19 without respiratory complaints 5
• Avoid NSAIDs for symptom management until COVID-19 is ruled out due to early concerns about potential adverse outcomes 5

Risk Stratification for Rescheduling Priority

Once recovered, prioritize rescheduling based on:

• Highest priority: Age >65, left ventricular ejection fraction <35%, aortic stenosis, New York Heart Association class III/IV symptoms 4
• These patients have 2-4 times higher risk of adverse events while waiting and should be rescheduled within 1-2 weeks of symptom resolution 4

Healthcare System Considerations

• The overall complication rate for elective cardiac catheterization is only 3.6% in stable patients, with 0.1% mortality 6
• Delaying 1-2 weeks for viral illness recovery poses far less risk than proceeding with active infection 1, 2, 4
• Sustainable cardiac services during endemic respiratory viral seasons require selective postponement of truly elective cases to preserve capacity and protect healthcare workers 7