Cardiology

Awards

You can trust our expert team to diagnose, manage and treat your condition. We were privileged to be awarded with the 2019 Global Health and Travel Cardiology Service Provider of the Year in Asia Pacific.

We bring together the recent advances in medicine for the prevention, early diagnosis and treatment of the 3 main causes of death in Singapore; Heart disease, Cancer and Stroke.

Cardiovascular Conditions

Blockage of heart artery is commonly called coronary artery disease. In coronary artery disease, the blockage is caused by the gradual accumulation of cholesterol deposits and / or calcium on the artery wall. As the plaque gets larger, the lining of the plaque becomes thinner and more vulnerable to rupture. When the rupture happens, it triggers a process where the body repairs itself by forming a clot. If this clot is large enough to occlude the artery, it will cause a heart attack. Hence, the key to preventing a heart attack is to ensure that plaque rupture will not occur.

With the advancement in technology and medicine, it is now possible to prevent a heart attack with certainty.

If you suspect that you have heart disease or have risk factors such as high cholesterol, high blood pressure, diabetes mellitus, smoking or a family history of heart disease, you can check the condition of your heart arteries by using the latest MRI heart scanner in Asia at our medical centre.

With a clear diagnosis, doctors can start you on treatment and make lifestyle modifications to prevent the possibility of you getting a heart attack. With medication, the plaque could regress, without the need for placement of stents.

Heart attack is usually caused by blockage of a major heart artery resulting in insufficient blood flow to the heart muscle causing damage to the heart muscle. The mechanism of a heart attack is not a sudden blockage of the heart artery due to accumulation of the plaque as it is commonly thought. In most heart attacks, the cholesterol deposits build up within the wall of the artery and causes a bulge in the wall of artery called a plaque. As the plaque gets bigger, it will obstruct the channel of the heart artery. When the lining covering this plaque is damaged as a result of stress to the heart, the lining can rupture and tear. The body attempts to repair the tear by forming a clot, it can form within minutes and completely obstruct the channel of the heart artery, blocking the flow of oxygen rich blood to the heart muscle, resulting in a heart attack.

More than 90% of heart attack is due to a sudden rupture to the lining of the plaque resulting in the clot formation and sudden occlusion of a heart artery. This can happen even in arteries where the plaque does not cause significant blockage of the heart artery. One of the best ways to prevent a heart attack is to ensure that the plaque is reduced and stabilize the condition with lifestyle changes and medications so that the plaque rupture does not occur.

Some patients have recurrent chest pain with no significant blockage of heart artery. This can be due to conditions such as spasm of heart artery, where the heart artery restricts blood flow to the heart muscle, causing chest pain. It can also be due to abnormal position of heart artery or it could be compressed by other larger blood vessels or the heart artery is embedded into the heart muscle being squeezed by the opening heart muscle, the condition known as artery myocardial bridging.

When the spasm occurs, your arteries narrow and prevent blood from flowing to your heart. They are brief and temporary and may lead a heart attack. One is more likely to have these spasms with conditions like high cholesterol or high blood pressure.

Further investigations can be done to find out the cause so that doctors are able to recommend appropriate treatment.

Those who complain of palpitations may feel that the heart skips a beat and sudden run of fast heartbeat or pulse rate may be irregular. This is due to an abnormality of heart rhythm. This condition can be benign and it does not have an impact on their health. There are certain types of abnormal heart rhythm that predisposes one to a stroke such as atrial fibrillation can lead to sudden deaths such as ventricular tachycardia. One should seek medical advice and evaluation if they have such symptoms.

Such conditions are less common in the more developed cities whereas the prevalence of rheumatic heart disease is more common. This can lead to damage to heart valve. Other common causes of the heart valve condition mitral valve prolapse which is commonly seen in women and can cause chest pain and palpitations. There’s also congenital condition called Bicuspid aortic valve will lead to deterioration of the valve over time. It is associated with increased risk of blockage of heart artery. Most valve problems are due to age related degeneration. If you start to feel progressively short of breath on exertion, it can be due to heart valves causing heart chambers to be swollen.

The heart can be damaged by viral infection or heart attack or other causes resulting in swelling of the heart and decreased in the ability of the heart to pump blood out of the heart to the body. This can lead to heart failure which means that there’s water accumulation in the lungs causing shortness of breath. Heart failure is a serious condition.

Heart failure is a serious condition that needs to be managed carefully. There are better drugs available now and also many options available now for the treatment of heart failure.

There are various types of high blood pressure. There are different criteria used by national bodies to diagnose high blood pressure. Generally, most of them use 140 / 90. About 90% of the patients has no underlying specific causes. In about 10% there may be an underlying cause, such as narrowing of kidney arteries, kidney failure, abnormal narrowing of heart aorta, etc.

Cholesterol is a waxy substance that is made in our liver and comes from certain foods. It is an essential component of cell membranes and is an important part of many hormones. Too much LDL cholesterol can build up in the inner layers of the blood vessels, cause clogging up of the arteries, reduce blood flow and cause heart and stroke disease.

Cholesterol has two main forms. LDL (low density lipoprotein) cholesterol is often called the bad cholesterol and HDL (high density lipoprotein) is often called the good cholesterol. It is important that you know the levels of both the good and bad cholesterol.

LDL is bad because it supplies cholesterol from liver to elsewhere in the body for essential functions, but the excessive fat accumulates and causes furring up in the vessels. As far as LDL is concerned, the lower the better. Reducing LDL by 1 mmol reduces heart disease risk by 55%. HDL removes excessive fat from the rest of the body to the liver where it is removed and therefore acts in a protective manner.

What is good cholesterol – HDL? Why is it called “good” cholesterol?

HDL is a good cholesterol because it works to remove the bad cholesterol from the body and helps to protect against heart disease by preventing the blood vessels in the heart from furring up with cholesterol. This furring up causes blockages and can cause narrowing in the blood vessel reducing the flow of blood and can cause sudden blockages called heart attacks.

The usual level should be more than 40mg/dl.

How can I increase my good cholesterol i.e HDL?

  1. Having a healthy mediterranean diet. Use more olive, rapeseed, sunflower and nut oils, along with a diet rich in whole grains, fruits and vegetables, pulses, nuts, and seeds. Avoid meat intake in every meal and include oily fish such as salmon, herring, mackerel, and sardines up to 4 times a week. Avoid deep fried and industrially processed food.
  2. Activity like walking, jogging, swimming, or cycling for at least 30 minutes for five or more days of the week helps.
  3. Reducing one’s waistline helps to increase HDL and can be as little as few inches even if total weight is unaltered. Excess fat around the waistline, indicates high levels of fat in the liver and pancreas. Stopping smoking also helps significantly.
  4. Medical treatment can include fibrates and newer medicines on the horizon such as CETP inhibitors which can help

In addition to the above plan, certain foods can help reduce bad cholesterol.  Soya is naturally low in saturated fat and has special proteins that help to reduce cholesterol. Nuts are nutrient rich, and a handful of nuts a day can reduce cholesterol by about 5%. Oats and barley are rich in a fibre called beta glucan which binds cholesterol in the intestines and stops it being absorbed. Foods fortified with plant sterols and stanols, vegetable oils, whole grains, fruits, and vegetables are also good to help reduce LDL.

Abnormal thickening of heart muscle is also called hypertrophic cardiomyopathy. It is one of the most common causes of sudden death under the age of 35 years old. This condition is generally genetic and can present during teenage years or in middle life. Because of the genetic condition, the heart muscle thickens abnormally. It results in stiffness of the heart, abnormal heart rhythm, heart failure, chest pain, shortness of breath and even sudden death. This can be detected on the 12 lead ECG and confirmed with 2D ultrasound study of the heart.

More commonly detected in young children. However, some patients may be undiagnosed until adulthood. The more commonly seen congenital heart disease seen in adult hood includes atrial septal defect which is the hole in heart in the upper heart chambers or ventricular septal defect involving the lower heart chambers. There are also complicated congenital heart conditions. This would require multi-modality assessment to get a clear picture of the condition.

A stroke happens when blood flow to the brain is stopped, leading to brain cells death. There are two types of stroke. Ischemic strokes happen due to blood clot or plaque buildup, thus blocking a blood vessel in the brain. Hemorrhagic strokes happen due to blood vessels breaking and leaking into or around the brain.

Causes of stroke:

  • High Blood Pressure
  • Atrial Fibrillation
  • Carotid Artery Disease
  • Other Risk Factors
  • Lipid Panel (Cholesterol)
  • Glucose (sugar, an important marker for Diabetes)
  • C-Reactive Protein

Most of the time, there are no warning signs for stroke, but if you do experience any of the following symptoms, you should seek medical assistance immediately:

  • Sudden weakness or numbness of the face, arms or legs, particularly on one side of the body
  • Sudden loss of speech or trouble understanding speech
  • Sudden unexplained memory loss
  • Sudden dimness or loss of vision in one eye
  • Sudden onset of double vision
  • Sudden severe, acute headache
  • Sudden dizziness or loss of balance

How to lower the risk of having a stroke attack:

  1. Lower your blood pressure
  • Reduce your salt intake
  • Avoid high cholesterol food
  • Eat more fruits and vegetables
  • Exercise more
  • Quit smoking
  1. Lose Weight
  • Reduce your calories intake
  • Increase your exercises
  1. Exercise More
  • Take the stairs instead of the lift
  • Spend at least 30 mins each day to exercise
  1. Reduce your sugar intake
  1. Control your diet
  • Eat more fruits and vegetables
  • Choose poultry, fish and lean meat
  • Buy only whole-grain bread, cereal, rice and pasta
  • Consume low-fat or fat-free products

Investigations for the heart

Using the latest ultrasound technology, we take the image of the heart in a safe and painless manner. This allows us to assess the heart size, blood flow in the heart, the heart’s pumping function and the condition of the heart valves (stenosis, regurgitation etc), and changes due to high blood pressure.

For those with abnormal heart rhythms, this continuous recorder allows the nature of the heart problem to be diagnosed. We use the latest monitoring devices which are small and convenient

If you are unsure if you really have high blood pressure, or if your blood pressure is optimally controlled, our accurate and convenient ambulatory blood pressure monitor will provide the answer

We use the latest scanner that can be customized to your individual needs. Highest resolution with clearer pictures (Highest Spatial resolution and highest isotropic resolution) Elimination of unnecessary radiation dosage. Reduction of radiation dose used by up to 68%

Comprehensive Treatment Options

Using a new angioplasty and stenting technique, our doctors are able to open blocked heart arteries, including complex and difficult blockage, through a small 2 mm skin opening. This new technique delivers excellent results.

The procedure uses the latest imaging technology, enabling our doctors to study the nature and extent of the blocked arteries in great detail before the procedure. The procedure is done under local anaesthesia and fasting is not required. On average, the patient only needs to stay in the hospital for one night.

This new angioplasty and stenting technique is safe and effective. It is even suitable for patients with complex and severe disease of the heart arteries. Our doctors are the first to publish the results of this new technique in a major scientific medical journal.

  • World first clinically certified resorbable Magnesium Stent
  • Easily implantable
  • Strong radial support offering better stability in opening diseased blood vessels, reducing potential complications
  • The stent can be completely absorbed by the body in about 12 months
  • Patients will not have to be on blood thinners for life
  • Patient’s vasomotor function restores 6 months after the operation with positive effects

  • Reduces the bad cholesterol LDL-C in the blood
  • Dosage administered fortnightly
  • Suitable for patients with high cholesterol, strong family history, and serves as adjunctive therapy for patients on high dosage of statins
  • Actual case of reduction of heart artery blockage from 80% to 20% after 1-year treatment seen in a 40-year-old female patient, eliminating the need for surgery
  • In 2018, the American Heart Association published “Odyssey Outcome”. Patients’ bad cholesterol (LDL-C) were reduced from 87mg / dl to 53.3mg / dl, acute myocardial infarction rate decreased by 14%, the incidence of ischemic stroke decreased 27%, the incidence of unstable angina decreased by 39%, and the total mortality rate also decreased by 15%.
  • The most effective treatment for patients with abnormally low cholesterol (LDL-C) above 100 mg/dl is that their major cardiovascular recurrence rate can be reduced by 24% and the mortality rate can be reduced by 30%.