Heart disease is a leading cause of death worldwide. An international study has found that with good control of risk factors, 90 per cent of heart attacks can be prevented. The risk factors include hypertension, high cholesterol, diabetes, smoking, obesity, a sedentary lifestyle, unhealthy eating habits and stress. As World Heart Day takes place on 29 September, let’s take a proactive step to reduce our risk of heart disease and keep ourselves fit and healthy.

Dr Ho Kay Woon, Senior Consultant from the Department of Cardiology at National Heart Centre Singapore, gives detailed answers to your questions.

Question by Claudia

Hi,

I had pneumothorax 12 years ago on my left lung. In the last few years, I get chest pain (left) when I get stressed or tired out. At times, the pain do get quite bad, although only short intervals.

I am worried if it might be early signs of heart attack (but my yearly health checks says I am in good shape)... I also read that it could be due to the pneumothorax I had 12years ago even though I have healed from it.

Can you advice? I am currently 31, married with a kid.

Rgds,
Claudia

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

Chest pain due to heart attack is usually severe and for a prolonged duration (usually lasts for hours) whereas chest pain due to coronary artery narrowing is generally worse on exertion and better with rest. From the description, the pain does not sound like either condition. It is unlikely that previous pneumothorax is the cause of the chest pain since it was quite remote from the current occurrence of chest pain and the pneumothorax has been resolved. If the chest pain is persistent, you should seek medical evaluation and advice.

Question by AKANKSHA

Helo my partners name is kashif khan. HIs age is 21 yaers..He has been experincing pain in the left side of chest near heart for last 2 or 3 yaers. He went for an ECG which was normal but still he has been experincing the severe heart pain which lasts for 5 -10 mints followed by breathelessness , sweating. What can be the possible reasons for dis?. should we again go for another ECG and further tests .. WHAT TESTS WILL YOU RECOMMEND

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

Although on ECG done at rest which is normal is generally reassuring, in cases of coronary artery narrowing, ECG done during stress testing (like treadmilll stress testing) would be more diagnostic. It is unlikely that your partner will develop coronary artery disease at such a young age but this should be further evaluated with tests like chest x-ray and treadmill ECG stress testing if the chest pain is persistent.

Question by fareethamajid

Hi Doctor I have a family history of heart disease. my father passed away due to heart attack. one of my brothers has a heart condition too. what are the early signs and symptoms of heart disease to look out for?Are male family members more susceptible to hereditary heart condition as opposed to females? thank you

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

Early signs of coronary artery disease include chest discomfort that occurs during periods of exertion that resolves with rest. Both male gender and family history of early heart attack are risk factors of coronary artery disease. Family members of affected relatives with heart attacks have higher risks of heart attacks themselves, both male and female. Females are relatively protected from developing coronary artery disease due to the protective effects oestrogen and generally develop coronary artery disease 10 years later compared to males. Of course having both risk factors of family history of heart attack and the male gender increases the risk of developing coronary artery disease compared to just having one of the two risk factors alone.

Question by catherinetiah

Dear Doctor Ho,

My mum has high blood pressure and had been taking HB pressure medication for many years. Recently, the doctor suspected myocardial ischaemia- which is complication of HB pressure, but the doctor's appointment is still 2 months away from now. But I am worried and concerned.

For now, my mum is still taking HB pressure medication, but she feels cold and gets tired easily.

Can I ask if I can let her take multi-vitamins for supplements, glucosamine and calcium tablets for joints- together with her HB pressure medication.

Can we also take Cordyceps as a general tonic- which is widely mentioned to relieve tiredness in old people and high blood pressure.

What are the dietary requirements for her- what food can/ cannot she take, or the changes to lifestyle? Can myocardial ischaemia be cured/ controlled by medicine?

Pls advise. Thank you very much for your patience.

Catherine

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

The suspicion of coronary artery disease seems to be made on the ECG with your mum not having any symptoms of chest pain. These ECG changes could be due to high blood pressure itself rather than ischemia. If there is no symptoms at the moment, treatment for ischemia can be started after testing confirms this. Supplements mentioned can be taken with the blood pressure medication. As mentioned, tests have to be conducted to confirm the presence of ischemia after which further testing or therapy such as coronary angiogram or medications will be discussed.

Question by liz_soh

Hi Dr Ho, Thanks for taking time to answer our questions. Recently I did a body checkup and my ECG results revealed that I have first degree heart (AV) block. The GP told me there is not much of a concern regarding my condition and there is no treatment for it. Actually the GP don't even recommend any follow-up actions. However, I came across some articles on the internet stating in some rare instances, cases of 1st degree heart block can progress to more severe forms of heart block. I also read somewhere that this condition increases the risk of atrial fibrillation (irregular heartbeat), which in turn increases the risk of stroke. It is rather disconcerting to know that one has a heart-related condition but nothing much can be done. Hence, I would like to take this opportunity to clarify some doubts:

1. Is 1st degree heart block considered a heart disease?
2. Since this condition is related to the heart's electrical system. Will this electrical system be affected/weaken as we age? Could it progress to a more severe from of heartblock, especially in old-age?
3. Is it necessary to do some form of monitoring (e.g annual ECG checks)?
4. Is it true that 1st degree heart block increases the risk of atrial fibrillation?
5. Will it increase the risk of heart attacks/failures?
6. Is there a possibility for recovery i.e. the heart's electrical system may "right" itself?

Many thanks!

Regards
Liz

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

First degree heart block generally does not cause symptoms and does not need to be treated unless it is severe and associated with symptoms. Common causes of first degree heart block include medication such as beta blockers or physiological especially in the fit and young population. It can however be an early sign of slowing of the conduction system of the heart especially in the elderly patients which may progress to higher degrees of heart block that may necessitate a pacemaker implantation. The heart’s conduction system may degenerate as we age but this generally occurs beyond 60 years of age. There is no need for annual ECG testing if a clear cause of the first degree heart block is identified e.g. physiological first degree heart block. First degree heart block is generally not a cause of atrial fibrillation unless it is very severe and causes uncoordinated contraction of the atrium and ventricle with enlargement of the atrium over time. This is extremely rare. Atrial fibrillation is generally related to conditions like hypertension, hyperthyroidism and valvular heart disease. First degree heart block does not increase the risk of heart attack. If the first degree heart block is due to medications or physiological, it is generally reversed with withdrawal of the responsible medication or cessation of exercise training.

Question by helene

Hi Dr Ho, 3 years ago, I was recommended to see a heart specialist because my treadmill result was not ideal during an annual health screening. The heart specialist prescribed 10mg statin for the cholesterol and sent me for calcium score and echo cardio test. The result is 0 for calcium score and the echo cardio test shows no blockage. (Note: This echo test involves injecting some substance and the dosage is increased gradually till the heart rate reached the optimum level.) I was discharged but asked to continue the 10mg statin. My blood pressure was and is still normal. There seems to be no real threat and so I stopped taking the statin because I fear that the statin might eventually lead to kidney and liver failure. My questions are:

1. What are the chances of me developing a blockage within the next ten 10 years of the tests?
2. Is it true that heart disease is more likely to occur in those with both high cholesterol and high blood pressure than those with either one of the symptoms?
3. How often should one go for the calcium score test and echo cardio test to determine health of the heart?

Appreciate your valuable advice.

Thanks.

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

There is no coronary artery disease based on the test results and the treadmill test was false positive.

1. Risk of coronary artery disease and hence whether statin treatment is needed depends on how high is the cholesterol level especially the low density lipoprotein (LDL) or the “bad” cholesterol. Having high LDL levels with coronary risk factors might necessitate treatment even with no current evidence of coronary artery disease to reduce future risks.
2. Hypertension and high cholesterol are coronary artery risk factors. The more risk factors present especially when they are not controlled will increase one’s risk of coronary artery disease.
3. Calcium score and stress testing are investigations to determine presence of coronary artery disease and atherosclerosis. Routine, regular testing of population without symptoms has not been established to reduce future cardiac events. Calcium score gives additional information on how aggressive risk factor lowering like controlling cholesterol should be but again there is no data to tell us how often calcium score should be done.

Question by jamesgoh2012

Hi Dr Ho, I understand that many symptoms of Heart Attack resemble those of anxiety related attack. For example, shortness of breath and tightness around the chest, etc. And more over, I also understand that the onset of a Heart Attack also cause pain or tightness on the jaw or neck area and left arm. The question is how do we really tell the difference? I have both TMJ (a jaw problem that cause pain and tightness on my jaw and neck usually and on any other occasion) as well as anxiety attack which I am undergoing treatment. How would I be able to tell since I have other symptoms that are similar and could cause undue concerns. Please advise.

Regards,
James.

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

The relationship to exertion is the key in differentiating coronary artery disease from other condition. Coronary artery narrowing generally cause symptoms when someone is exerting himself and relieved in period of rest. Seeking expert medical evaluation and functional testing such as treadmill stress ECG can be useful to help differentiate these causes.

Question by rsim

Hi Dr Ho,

We often read about healthy fit runner having a silent heart failure during their marathon run.

How can we detect heart disease earlier? Will annual ECG test or treadmill ECG able to do so?

Thank you.

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

This is a controversial issue. There are many causes of sudden death during exercise for which sudden cardiac deaths is one of the commonest causes. Some of the cardiac conditions can be picked up during physical examination, ECG and echocardiogram testing. However the pick-up rate for these conditions in the general population is very low and sudden death can still occur even if all these testing were normal. Usefulness and cost effectiveness of screening prior to say a marathon have not been established.

Question by pocoyosky

Hi Dr Ho,

I read with concern that stress is also one of the risk factors of heart disease, with today fast pace, stressful working environment, this risk seems unavoidable.

What are the tell-tale signs of heart disease then that we should watch out for? What are the exercises that are good for the heart?

Thank you for your time.

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

Early signs of coronary artery disease include chest discomfort that occurs during periods of exertion that resolves with rest. Exercise increases our fitness and general well-being although there is a very very low increased risk of cardiac event during exercise itself. Overall regular exercises are helpful and recommended.

Question by esim

Dear Dr Ho,

Is heart disease mainly more common for elderly?

What are the symptoms of heart disease that we should look out for?

Is it true that doing over strenuous exercise can stress our heart?

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

1. Yes
2. Early signs of coronary artery disease include chest discomfort that occurs during periods of exertion that resolves with rest.
3. Exercise increases our fitness and general well-being although there is a very very low increased risk of cardiac event during exercise itself. Overall regular exercises are helpful and recommended.

Question by labbit87

Dear Dr. Ho, I am told by doctors to have mild heart murmurs and I read online to find that it is common and may either mean nothing or it may be a symptom to heart diseases especially heart attacks. Is this true? After 2 doctors confirmed my heart murmurs, I began to feel my heartbeat strongly occasionally, strongly but not irregular, I don't know if it's my hallucinations or worries making me feel my heartbeats. I have never being consciously aware of my heartbeat before this. I read online that heart murmurs may be linked to irregular heartbeats so I was quite afraid. Can you help me on this? Thank you very much.

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

Having sensation of stronger heart beat that is not fast or irregular can be normal and not associated with heart condition. Heart murmurs are due to flow turbulence in the heart and can be innocent or can be associated with pathological conditions like valve problems or holes in the heart. This should be evaluated by a medical professional and for an echocardiogram to evaluate if deemed by the medical professional to be necessary.

Question by mosmos

Hi Dr Ho, May I know butter or margarine, which is more gentle to the heart artillery? We know that margarine contains trans fat which will cause heart diseses. But butter contains saturated fats which also causes the same heart problems. Thanks.

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

Both butter and margarine contains transfat and saturated fat and both should be taken in moderation.

Question by kengy223

Hi! Dr Ho

I have done treadmill stress test. Though i was told that I had normal stress test. But what worries me is that my BP raise to 190/88 at stage 2 and stage 3 it went up to 234/98. What does this implies?. Do I have the potental risk of having stroke during stress test or cardiac failure in future?

Answered by Dr. Ho Kay Woon Consultant Department of Cardiology National Heart Centre Singapore

It is physiological that blood pressure increases during exercise especially when we are a little excited during the exercise testing. So long as the baseline blood pressure is normal before exercising, there is no need for treatment.

Ref: T12