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Cardiovascular disease, commonly known as heart disease, is the leading cause of death worldwide, with one in three deaths in Singapore due to heart diseases and stroke.
While certain types of cardiovascular disease cannot be prevented, such as congenital heart disease, adopting a healthy lifestyle can help reduce the risk of developing heart disease.
In this "Ask the Specialist" forum, Clinical Assistant Professor Koh Choong Hou, Consultant from the Department of Cardiology, and the Director of SAF Cardiac Fitness Centre at National Heart Centre Singapore (NHCS), answers your questions about heart disease. NHCS is a member of the SingHealth group.
Don't miss this chance for you to:
This Q&A forum is open from 1 Sep to 28 Sep 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
Hi Dr,
I did a transthoracic echocardiogram @ 35yrs old and the result was mildly dilated left atrium LAVI 34ml/m2. I was given High BP medication. May I check is the mildly dilated left atrium a serious condition based on the readings? is it reversible? How long does it take to recover if reversible? What other tests should I undergo to eliminate further risks? I need to consume Visanne on a long term basis.
Answered by Clin Asst Prof Koh Choong Hou, Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS)
Thanks for the question. Your left atrium dimension is considered top normal based on the measurement you provided. There are many causes for a dilated left atrium, such as a stiff heart (usually age-related), poorly controlled high blood pressure, mitral valve related conditions, athletic remodelling due to high exercise intensity, or certain abnormal heart rhythms.
Progesterone containing pills are not known to cause left atrium enlargement. If you have no cardiac symptoms such as unusual palpitations or breathlessness, there is no cause for concerns for this incidental finding at the moment. However, if you are experiencing cardiac symptoms (e.g. persistent palpitations/ breathlessness), it may be best to seek consultation with a cardiac specialist to discuss whether more investigations are necessary.
Hi I am a 50 yr old male vegetarian with no smoking or drinking record and a healthy BMI and normal BP. I check my blood cholesterol yearly and have also started doing threadmil stress test last year just as a routine heart health checkup. However I do not exercise at all. How do I ensure that these test are adequate to ensure there is no clogged blood vessels? Can I do an angiogram or any other blood vessel scan test periodically to ensure that there are no clogged blood vessels although I have no symptoms of heart disease? And if I can how often should it be done?
That’s a great question that many people have on their minds. Firstly, exercise has many beneficial effects on overall health and you are encouraged to engage in some form of exercise to reduce long term cardiovascular risk.
A coronary angiogram is an invasive test to assess for artery blockages in selected individuals. Like in any other tests, angiogram does come with some risks, therefore it is recommended for those with high risk factors or high probability of significant coronary artery disease.
If you do not have symptoms, and would like to screen for underlying coronary plaques and estimate cardiovascular risk to guide your lifestyle changes, you may consider computerised tomography (CT) coronary calcium score scan. It is a non-invasive procedure and a useful screening tool that provides a good gauge of coronary artery plaque status. Based on the score and the overall risk profile, it also provides recommendations on lifestyle interventions such as initiation or intensification of cholesterol medications.
For Heart problem, does the pain or discomfort always happens at a single location or it can be at different location at different times?
Thanks for the question. The initial occurrence of cardiac conditions varies depending on the type of heart-related disease (e.g. artery blockage, heart rhythm problem, valve issues, etc.), and is affected by the presence of other non-cardiac conditions such as lung, nerve, bone or muscle conditions. It would be useful to check-in with your family physician if you have persistent symptoms to let them perform an initial assessment, and they can advise whether specialist evaluation may be necessary after that.
Based on the Mayoclinic.org and some other websites, Omeprazole may increase the risk of having frctures of the hip, wrist, and spine and damage to kidney especially for patients of 50 years of age or older. To reduce the risk is it ok for patients on Omeprazole and Aspirin to take Omeprazole on alternate days or are there alternative medicine for the purpose of protecting the stomach? Thank you.
Thanks for the question. Cardiologists usually combine a blood thinner (such as aspirin) with a stomach lining protecting medication (such as omeprazole), to reduce the risk of stomach bleeding due to the blood thinner.
Depending on your risk profile (such as previous stomach bleeding episodes or previous healed stomach ulcers), the benefit of maintaining daily omeprazole may outweigh the nominal long term risk of fractures (which is very rare).
Further discussion with your primary physician will be useful to evaluate your overall bleeding risk to assess suitability to continue long term omeprazole. There is insufficient medical evidence that alternate day dosing provides adequate protection.
Is clopidogrel better than Ticlopidine in preventing heart attack and stroke? If a patient who was on Ticlopidine has a stroke, will changing the blood thinner to Clopidogrel prevent the stroke from worsening?
Thanks for the question. Both clopidogrel and ticlopidine are blood thinning medications that reduce the clotting effect of blood and reduce future events in individuals who had prior stroke/ heart attacks. In recent years, ticlopidine is less used due to its side effects, with clopidogrel (as well as ticagrelor/ prasugrel) replacing it as the preferred blood thinning medication in populations with heart artery blockages. You may want to consult a neurologist to discuss the risk benefits of clopidogrel versus ticlopidine for stroke prevention.
Dear Dr,
I'm 60 yrs old now and I have been trying to keep myself fit by engaging in various sports & exercises regularly and by clocking at least 10000 steps and 30 MVPA every day. What types of health screening do you recommend for people who are 60 & above and who are healthy without any medical conditions. Eg. should they go for treadmill test, colonoscopy, or eye examination on a regular basis, like every 5 yrs? Thank you.
Dear Chris, thanks for the great question. Cardiovascular screening is indeed important as we age. Recommended baseline assessments for heart health include:
Dear Dr. Koh,
Just a brief summary of my family's medical history. Both my uncles had a pacemaker implanted for many years due to irregular heart rhythm. I also understand my cousin is also having the same issue of irregular heart rhythm but he did not go for any pacemaker. My late father was also having weak hearts when he was young but he did not consult any specialist.
About myself, I am at age 58 having thalassemia Alpha and fainting spells when seeing blood or being too emotional. I have chest pain on the left side occasionally but goes off after a few seconds and do feel at times my heart beating fast when resting without a reason. I also feel tired easily. I do not have diabetes, high blood pressure or high cholesterol but borderline.
Should I consult a specialist to do a proper check up for my heart?
Regards,Eugene
Dear Eugene, thanks for the question. Fainting spells related to specific triggers such as seeing blood or extreme emotions are usually not due to an underlying cardiac condition. The chest discomfort you are describing is not typical for angina, which is chest pain due to significant heart artery blockages. It may be useful to consult your primary care physician to review your symptoms and perform a standard 12-lead electrocardiogram, who may then refer you for specialist assessment if there are abnormal findings.
Question posted by Mr Goh
I am Mr Goh, 63 years old. I am interested to do a heart check-up/scan as a private patient. Should I get a letter of referral from my GP or can call direct to make appointment?
Dear Mr Goh, thanks for the enquiry. For general screening of the cardiovascular system (heart and lungs), it may be useful to check-in with your family physician first to perform first line screening and basic tests. They can then advise whether specialist review is necessary based on their initial evaluation, and make the referral as required.
Question posted by Mohsin
How does high cholesterol (LDL?) affect one's heart and brain? Should we refrain ourselves from taking animal fat, oily food, etc?
[By the way, I am in my late sixties and used to visit National Heart Centre regularly to get treatment there. Currently I am living in North America.]
Thanks for the great question. Our diet indeed plays a big role in our overall health, including cardiovascular (heart) and cerebrovascular (brain) health. High levels of LDL is known to increase the risk of heart attacks and strokes, and there are great reliable dietary guidelines and resources provided by our own Health Promotion Board, and American Heart Association, that can be readily accessed online. You can also read our articles on diet and heart health here and here.
Question posted by Anggie
I am 44+ year old. Lately I've been have chest discomfort. My GP did a NT-ProBNP test which shows a result of 400pg/ml. However all ECG & Heart scans done seems normal. Had a CT Coronary Angiogram done recently & my appointment with the doctor to review the results is only next year. But as there's no calls from the clinic, I would just assume that the results are normal. what are the chances of having a false-positive NT-ProBNP result? Thanks.
Dear Anggie, thanks for the question. NT-proBNP, otherwise known as N-terminal pro B-type natriuretic peptide, is a biomarker used to detect cardiac injury or stress, such as in heart failure. However, there are also other non-heart-related factors that can cause the biomarker to be elevated, such as kidney failure, sleep apnoea, high lung pressures, advancing age, etc. It would be best to consult with your doctor to discuss whether any further evaluation is required, as well as to review the CT coronary angiogram result.
