Dr Lin Weiqin, Consultant, Department of Cardiology, National University Heart Centre, Singapore, contributed an article about managing heart failure. Pointing out it is a growing epidemic, he noted that it is one of the most common causes of hospital admissions in Singapore and added that there is no single test to allow doctors to make the diagnosis of heart failure in insolation. He referenced a patient with severe heart failure who is managing his condition with medical therapy and the help of a multi-disciplinary heart failure team.
According to the Singapore Myocardial Infarction Registry Annual Report 2017 released by the National Registry of Diseases Office, the number of acute myocardial infarction (AMI) episodes increased by more than 60 per cent from 7,246 episodes in 2008 to 11,877 episodes in 2017. With advancements in emergency care, the number of deaths has fallen by 20 per cent over the same period, from 1,242 in 2008 to 1,004 in 2017. Professor Tan Huay Cheem, Director, National University Heart Centre, Singapore said the decrease in mortality rate was due to improvement in treatment and hospitals’ procedures which helped to reduce consultation time.
Dr Wang Mingchang, Associate Consultant, Division of Sports Medicine & Surgery, NUH, and Dr Yeo Tee Joo, Consultant, Cardiac Department, National University Heart Centre, Singapore, provided comment on the kind of exercises suitable for those with chronic diseases. Dr Wang noted that regardless of the type of chronic diseases (one has), patients are encouraged to do aerobic exercise, strength training and stretching exercises. Dr Yeo pointed out that if they have heart problems, they must first check with their doctors before exercising. The tests that the doctors may arrange include electrocardiogram (ECG), echocardiogram, and exercise testing. Dr Yeo also shared that people who do not exercise regularly or have not exercised in a long time, should start with low-intensity workouts.
Prof Tan Huay Cheem Director, NUHCS, a key contributor of “The Healthy Hearts, Healthy Ageing Asia Pacific Report” commented on the findings and provided tips for cardiovascular health.
An article on how Asia-Pacific countries should move away from an acute care model to a preventive one in order to reduce the incidence of cardiovascular diseases. Professor Tan Huay Cheem, Director, NUHCS, said that governments across the world have important roles to play in cardiovascular disease prevention. He also said the first step is to provide evidence-based, cost-effective care. Second step is to put in place legislative measures and finally, government should work towards improving the general economic health of the population.
A contributed article by Professor Tan Huay Cheem, Director, NUHCS, and Professor Terrance Chua, Medical Director, NHCS, on how to choose the right test for heart disease. While there are many tests for heart disease, each does have its own strengths and limitations while different tests are also recommended for different situations. Ultimately, choosing a test should depend on whether it can lead to better recovery outcomes.
Professor Tan Huay Cheem, Director and Senior Consultant, National University Heart Centre, Singapore commented on the cardiovascular risks of regularly consuming fried foods (which contain trans fats) and saturated fats like palm oil. Notwithstanding the data, he qualified that a person’s cardiovascular risk is ultimately dependent on multiple factors, with diet being one aspect. Pointing out that people may not realise they are consuming far larger amounts of saturated fats and trans fat than the recommended daily allowances, he mentioned that heart patients (in particular) should be consuming less trans and saturated fats.
A large-scale international clinical trial has found that alirocumab, a cholesterol-lowering drug sold here, is effective in reducing heart attack and stroke risk. The trial involved about 19,000 patients from 58 countries including Singapore, who had experienced a heart attack or unstable angina that required hospitalisation. Though the drug was approved by the Health Science Authority in 2017, Associate Professor Poh Kian Keong from the National University Heart Centre, Singapore (NUHCS) remarked that the take-up rate has been low alluding it to two reasons – (1) effects on cardiovascular morbidity and mortality had not been determined and (2) expensive cost of drug.
Mr Koh Chye Choon, 65, a patient of the NUHCS suffered a heart attack in February this year. He was diagnosed with severe dyslipidaemia and coronary artery disease. Mr Koh could not be on statins therapy due to his intolerance to statins. He was referred to A/Prof Poh Kian Keong who prescribed him alicumorab to reduce his LDL-C levels and cholesterol. Over six weeks, his blood cholesterol fell from 190mg/dL to 70mg/dL.
In recent years, aspirin has been found to prevent myocardial infarction and stroke. Prof Tan Huay Cheem, Centre Director of National University Heart Centre, Singapore, gave advice on primary and secondary prevention. Those with diabetes, high blood fat or high blood pressure, or those who smokes or have a family history of early heart attack, should consider taking aspirin for primary prevention. If you do not have the risk factors listed above, it is not recommended to take aspirin. Secondary prevention of cardiovascular disease refers to preventive measures for patients who have had myocardial infarction, ischemic stroke, bypass surgery, angina pectoris or peripheral vascular disease. Aspirin benefits these patients and is used to prevent recurrence and progression of the disease, improve prognosis, and reduce the rate of death and disability.
An article which reports that excessive caffeine can increases the risk of cardiovascular diseases. A survey done by the University of South Australia showed that drinking six or more cups of coffee a day would increase the risk of heart disease.
Professor Tan Huey Cheem, Director, NUHCS, mentions that while caffeine gives a refreshing effect, it also causes an increase in blood pressure and rapid heartbeat. Prof Tan also mentions that some caffeine drinks do negatively affect health such as energy drinks that are high in sugar and calories.
Professor Tan Huay Cheem, Director of National University Heart Centre, Singapore provided his expert opinion on push-ups and heart health. He shared that all forms of exercise are associated with improved cardiovascular health. The recommendations for improved heart health should be a mix of aerobic exercise and resistance weight training. Push-ups should be viewed as part of an overall balanced exercise programme.
Assistant Professor Chan Wan Xian, Senior Consultant, National University Heart Centre, Singapore (NUHCS) spoke at the Go Red for Women Luncheon 2019 organised by the Singapore Heart Foundation. She shared that while heart disease is commonly the result of an obstruction in the blood vessels, women are twice as likely as men to suffer from non-obstructive heart disease. She cited an example of takotsubo cardiomyopathy also known as “broken-heart syndrome” which is related to acute stress or emotional shock, possibly due to a surge in adrenaline, leading to heart failure.
A contributed article by
Professor Tan Huey Cheem, Director, NUHCS, on out-of-hospital cardiac arrest
(OHCA) being a worldwide public health problem, the function and effectiveness
of the automated external defibrillator (AED), when and how to use the AED and
the locations of AED.
A contributed article by Prof Tan Huay Cheem, Director, NUHCS, shared that asymptomatic premature beats are common and usually not harmful. It mainly occurs in two forms – premature atrial contractions (PAC) and premature ventricular contractions (PVC), with the latter happening more frequently. While it is normal for PVC to occur during daily activities, PVC may lead to cardiomyopathy if it occurs often. Early diagnosis can be made using electrocardiograms or other medical technology. One does not need medication if there is no heart disease linked to the contractions.
An article on NUHCS working to reduce the number of people in Singapore with serious heart problems by catching and treating patients before their condition blow up. NUHCS are working with polyclinics to identify patients that doctors think may be at risk of cardiovascular diseases.