Our heart is a critical organ, responsible for pumping blood throughout our body, sustaining the functions of vital organs. 

The heart itself is supplied by coronary arteries which provides oxygen-rich blood to the heart muscle. 

A heart attack, also known as acute myocardial infarction (AMI) or acute coronary syndrome (ACS), occurs when one of the coronary arteries becomes abruptly blocked, cutting off blood flow to a region of the heart muscle. 

Without prompt restoration of blood flow, the affect muscle can suffer irreversible damage.

A heart attack is a medical emergency requiring immediate treatment. Knowing the signs and symptoms of a heart attack will help you recognise a heart attack and obtain timely help.

Understanding the underlying cardiovascular risk factors can help you to reduce the risk of having a heart attack as well.

Don't miss this chance to ask Dr James Cai and Assistant Nurse Clinician Joan Nurjono on what causes increased risk of a heart attack, and what you can do to avoid an attack.

About Dr James Cai

Dr James Cai is a Consultant from the Department of Cardiology at National Heart Centre Singapore. His special interest is in non-invasive cardiac imaging, specifically echocardiography and nuclear cardiology. 

He set up and has been running the post-acute coronary syndrome (Post-ACS) clinic with Assistant Nurse Clinician Joan Kirana Nurjono in NHCS Cardiology @ SKH since 2022 and has a strong interest in improving care for patients after their myocardial infarction.

About Assistant Nurse Clinician Joan Nurjono

Assistant Nurse Clinician (ANC) Joan Nurjono has been a nurse for 21 years and is a cardiac specialty nurse at Sengkang General Hospital (SKH). She has vast experience in caring for patients with various cardiac conditions and has been educating and supporting patients in their rehabilitation journey after a myocardial infarction. ANC Joan has been working with Dr James Cai to manage the NHCS Cardiology @SKH since it began in 2022.

Questions and answers on heart attack prevention

1. Question by HT Tan

Dear Dr Cai,

Is it advisable or even necessary for a person to do a CT heart scan in order to establish a baseline of our coronary condition, e.g. presence / degree of blockage? I recently did my annual health screening and my ECG result is normal.

I'm 63 years' old male who is on 10mg Simvastatin medication due to borderline high cholesterol level (216 mmol/dl). Your advice is much appreciated.

Answer by Dr James Cai

Dear Mr Tan,

For patients who are asymptomatic, there is currently no strong evidence for routine screening with advanced cardiac tests such as CT coronary angiography or stress testing. What can be done is to calculate your 10 year risk for heart disease (Framingham risk score) which is locally validated and available on HealthBuddy app under “Heart Disease Risk” (tap the link to access "Heart Care" directly on Health Buddy app).

Overall, control of traditional risk factors such as hypertension, hyperlipidaemia, diabetes mellitus, as well as lifestyle modifications with good exercise and diet habits will help you reduce your risk of future cardiac disease. Not smoking and having moderate alcohol consumption is advisable as well.

Answer by Assistant Nurse Clinician Joan

Specifically, aerobic exercises such as brisk walking, jogging, or swimming have been proven to improve heart health.

In general, it is recommended for healthy adults to aim for 150 minutes of moderate exercise per week. However, if you have not been exercising for a while, it is best to begin with light or moderate intensity exercise of shorter duration (under 10 minutes). Walking is the safest form of exercise and can be easily incorporated into your lifestyle. You can increase both the duration and intensity of the exercise gradually over time. It is important to spread your physical activity throughout the week to achieve optimal results.

If you are interested to read more about exercises to improve your heart health, you can read this article on HealthXchange by tapping the link (Best Exercises for Your Heart - HealthXchange.sg).

2. Question by LH

Dear Doctor,

I had my angioplasty procedure done with two stents about 12 years ago. I have been going for my regular check-ups with a cardiologist ever since, including blood tests and treadmill runs. I diligently take my medication daily prescribed by the cardiologist. I exercise regularly and I am aged 79. So far, I have not experienced any discomfort all these years.

My question is whether it is necessary for me to undergo another angioplasty procedure since my last one was done about 12 years ago. Thank you.

Answer by Dr James Cai

Dear LH,

In patients with prior stenting who have no symptoms, there is no indication for routine repeat angiography to “check” on the stents. 

All procedures have risk so the benefits would have to outweigh the risks for such a procedure to be offered.

If you do have any cardiac symptoms such as chest pain or breathlessness, I would advise you to seek consultation with your doctor.

3. Question by Kuldip

Dear Dr,

Due to artery blockage, I received 2 stents in 2010. Will these stents last forever and when should I get an angioplasty done?

Save for some breathlessness after walking, I feel ok. I am a 69 years old Indian male. Appreciate your advice.

Answer by Dr James Cai

Dear Kuldip,

In patients with prior stenting who have no symptoms, there is no indication for routine repeat angiography to “check” on the stents. 

All procedures have risk so the benefits would have to outweigh the risks for such a procedure to be offered.

If you do have any cardiac symptoms such as chest pain or breathlessness, I would advise you to seek consultation with your doctor.

4. Question by Jean

Dear Dr Cai,

I have experienced this pain, more like an ache about a handful of times in 3 years or so. It’s not a sharp pain. When I feel the pain coming on, I will lie down for 10 or 15mins and it gradually dissipates.

I’m a 68-year-old female. Non-smoker. High cholesterol LDL 4.18.  HDL is 1.12.  Weight 48.6, height 150cm. My FRS assessment shows 5% risk. Am not taking statins but am careful in choosing low fat foods. 

Hopefully I’m not a candidate for heart problems. Thanks for your attention.

Answer by Dr James Cai

Dear Jean,

I would advise you to seek consultation with your doctor for your symptom of chest pain, as it requires clinical evaluation. As for your risk, you have astutely calculated your 10-year cardiovascular risk using the Framingham Risk Score. A result of 5% places you at low risk. 

I would encourage you to monitor your risk factors such as your cholesterol levels closely. In addition to a healthy diet, exercise would be a cornerstone to good cardiac health.

5. Question by Peiyan

Hello Doctor,

My dad suffered a heart attack 4 years ago and has been on medication since. He is Chinese and is living an active lifestyle by cycling daily.

Aside from being disciplined in taking his medication and eating well, what else can be done to prevent a second heat attack from occurring?

Due to his previous admission to the ICU, he developed a fear of traveling overseas, despite he very much would like to. How can we encourage him to travel abroad?

My dad is 73 and mom is 72.

Answer by Dr James Cai

Dear Peiyan,

Adherence to medications and a healthy lifestyle is the backbone to preventing a second heart attack. You can also encourage him to continue his exercise on top of having a healthy diet. Having his cholesterol, in particular, LDL, under tight control is important.

Travel advice is best tailored to individual needs. I would suggest he consults with his doctor if he would like to explore travelling.

6. Question by Jeffrey

Hi Dr James Cai,

I am now aged 68 years and would like to build up my stamina in jogging.

However, I am apprehensive about jogging as I have come across cases of peoples (including an MP with clean bill of health from standard checkup) who got sudden heart attacks while jogging & passed on.

Most of my exercise sessions are just strolling/brisk walking & very little short distance (<200m) jogging.

What kind of medical checkup is 100% sure that a person of my age can safely go for jogging without worrying about sudden fatal heart?

Is a CT scan the only way to ensure that there are no heart blood vessel blockages for a senior would-be jogger?

I understand that in a CT scan, the blood carrying the dyes passing through the heart will be able to show whether or not a person heart blood vessels have been partially blocked or badly blocked and therefore it is not advisable for such a person to go for jogging. 

However, CT scan is expensive for retiree like me. If so, is there a cheaper way & equally accurate & dependable to safely screen a person for potential heart attacks before he goes for jogging.

What type of checkups should I go for before I start my regular jogging exercise? Appreciate your advice.

Answer by Dr James Cai

Dear Jeffrey,

If you are well and do not have any cardiac symptoms such as chest pain or breathlessness, and you intend to embark on light to moderate exercise, there is no indication for advanced cardiac tests such as a CT scan. 

If you do experience any such symptoms while exercising, please seek a consultation with your doctor.

7. Question by Jimmy

Dear Dr Cai,

Is it true that numbness on the left side of the body, whether on the face or arm, is an indication of an impending heart attack?

Answer by Dr James Cai

Numbness on one side of the body is not a classical symptom of a heart attack and is more suggestive of a stroke. Central crushing chest discomfort radiating to the left arm or neck, shortness of breath and heavy sweating are more classical symptoms of a heart attack.

If you experience symptoms of numbness or weakness on one side of your body, please seek medical attention.

8. Question by Alvin

Hi Doctor,

I had a heart attack (MI) on September last year, with 2 stents placed due to 2 blocked arteries.

2 months ago, I had another NSTEMI / ACS while overseas and had 3 stents placed due to 2 blocked arteries, with 1 of the blockage being inside the stent that was placed last year.

I had been on a plant-based diet for the past year and my LDL is below 1.0 (average 0.7). However, I noticed that my HDL is also on the low side (1.0 average). I also exercise regularly and swim 1-2 times a week prior to my last MI.

I'm struggling to keep my HDL on a higher value despite taking in fish oil supplements with EPA of above 400.

Appreciate any advice as I want to get out of this MI cycle. Thank you.

Answer by Dr James Cai

Dear Alvin,

It’s gratifying to see that you have good control of your LDL levels through your diligent efforts with diet. You are doing a good job! If you were recently admitted for a heart attack, you can consider cardiac rehabilitation. Check with your doctor if this is available to you.

For any further steps to take with your treatment, I would defer to your primary doctor who will know the details of your case better.

Answer by Assistant Nurse Clinician Joan

A cardiac rehabilitation programme consists of both education and exercise components, bringing patients through a supervised exercise plan. It empowers individuals to make healthy lifestyle changes to improve their health. It can help with recovery and reduce the risk of future heart problems. 

Additionally, we recommend individuals who have had a heart attack to receive vaccinations for influenza and pneumococcal infections. These help to prevent respiratory infections which can strain the heart and hinder recovery.

9. Question by Audi

Dear Doctor,

Thanks for your time conducting this Q&A.

Is it an accepted fact that with age, plague build up is inevitable? At what stage of build-up, would it be considered a health risk and can the built-up plague be cleared through lifestyle changes? Thank you.

Answer by Dr James Cai

Dear Audi,

Coronary atherosclerosis is common but is not inevitable. I cannot emphasise enough on the importance of primary prevention through a healthy lifestyle and risk factor control. Coronary atherosclerosis at any stage puts a patient at risk of heart attacks. 

Once detected, patients would be advised to have strict control of common risk factors such as blood pressure and cholesterol levels. They can also be started on medications such as statins that will help reduce the risk of heart attack. 

Unfortunately, plaque build-up has not been shown to be “cleared” by lifestyle changes, so it’s better to prevent it from happening before build-up occurs.

Answer by Assistant Nurse Clinician Joan

To prevent heart disease, you can incorporate these 5 lifestyle changes to reduce your risk of heart diseases.

• Adopt a healthy diet consisting of food that is low in fat, cholesterol, salt and sugar, but high in fibre.

• Exercise regularly, aiming for 150 minutes of moderate-intensity exercise every week.

• Maintain a healthy weight, with body mass index (BMI) between 18.5 to 22.9kg/m2.

• Learn to cope with stress and ensure adequate sleep.

• Stop smoking (if you are a smoker).

Smoking is a major risk factor for heart diseases. It contributes to atherosclerosis and significantly increases the risk of a heart attack. Hence quitting smoking is one of the most effective ways to improve heart health. There are many resources and stop-smoking aids that can increase chances of success and we encourage individuals who is keen to quit to speak with their doctor. 

The Health Promotion Board I Quit Programme at http://www.healthhub.sg/programmes/iquit is a good resource for individuals who are looking to quit smoking.

10. Question by Serene

Hi Dr, 

I am a lady aged 57.  I have just menopaused.  My LDL is 3.04 mmol and my HDL is 1.95 mmol. My triglyceride level is 0.88.  My blood pressure is normal.  My weight is 57 kg. My height is 164 cm. 

My father died of heart failure at 76. My mum died of stoke at 51 years old.  My father suffered from diabetes and had high cholesterol since his 40s.  My mum did not go for checkups before her death but her siblings had diabetes.

May I know if I am at increased risk of heart attack or stroke? Is my LDL level ok or should it be lowered? Do I have additional risk because of my parents’ history? Thank you for your advice.

Answer by Dr James Cai

Dear Serene,

Family history of cardiac disease such as coronary artery disease and stroke is a risk factor and can contribute to one’s risk for cardiac disease.

For your query regarding cholesterol and medications, you should seek advice from your primary physician. A Framingham Risk Score to assess your 10-year risk for cardiac disease will be useful in helping guide your treatment choice.

11. Question by Glad

Dear Dr,

Is there a first aid measure to do or first aid medication to give when a suspected heart attack is happening?

Answer by Dr James Cai

Dear Glad,

If you suspect a person is having a heart attack such as having severe crushing chest pain, the most important thing to do is to seek urgent medical attention and call 995.

If the patient has a history of coronary artery disease and is already prescribed sublingual glyceryl trinitrate (SL GTN) as required for chest pain, the patient can take it to relieve his chest pain. If the chest pain persists, please seek medical attention.

12. Question by Chee Tsing

Dear Dr,

I would like to know if palpitations would lead to heart attack? Thank you.

Answer by Dr James Cai

Dear Chee Tsing,

Palpitations is a symptom by itself and should be evaluated. It doesn’t necessarily lead to a heart attack.

If the symptom persists, please seek medical attention.

13. Question by HJ

Hi Dr James Cai,

Does taking long term high dosage fish oil supplement (triple strength, once a day) helps to prevent heart attack for someone (age 60-65, male, 83kg, 174cm) with mostly sedentary lifestyle, with some swimming, cycling and brisk walking once in a while?

At the moment, from the blood test taken yearly, result for total cholesterol is at moderate range 200 - 239 (5.45, HDL Ratio : 3.61.) However, reviewing doctor said, it’s normal/acceptable.

Blood pressure and blood sugar are within normal range.

Thank you and looking forward to your advice.

Answer by Dr James Cai

Although there were promising studies looking into fish oil supplements, the combined evidence does not show that such supplements will improve cardiovascular outcomes or prevent heart attacks. 

I would recommend that you focus on what has been shown to be beneficial – regular exercise. It is recommended to have 150 to 300 minutes of moderate-intensity exercise a week.

Your BMI is also elevated at 27.7, so you should aim to lose some weight through exercise and diet. Lastly, if you are concerned about your cholesterol, it might be helpful to discuss with your doctor whether medications are necessary.

13. Question by Amin

Dear Dr James Cai,

There are times when the area above my right ribs (below the nipple and on the side of the chest) has a light poking pain. This is not a regular occurrence and the pain is neither severe nor lasts long. Beyond this, the other day, my heart started racing when I was having a nightmare and I forced myself to wake up to calm myself down.

Based on what I mentioned above, can the above be considered warning signs of heart disease or an impending heart attack? At what point do I start seeking medical assistance or get myself checked?

Some background info:
I go for regular health check-ups and have even done the threadmill test for heart but nothing was identified through these. My cholesterol is on the higher side which I have been reducing with a good diet and exercise as well.

Thank you for your attention to this matter.

Answer by Dr James Cai

From your description of your chest pain, it sounds atypical in nature as it occurs on the right side of the chest and is poking in nature. However, I would still advise you to seek a consultation with a doctor for your recurrent symptoms.

Chest discomfort that is suggestive of cardiac disease typically involves pain in the centre or on the left side of the chest, sometimes radiating to the left arm or neck. Some patients describe this sensation as “heaviness”, “squeezing” or “pressure”.

Another sign of heart disease is chest pain that worsens with physical exertion, such as climbing stairs or jogging, and improves with rest. Pain triggered by emotional distress is also a concerning symptom.

14. Question by Linda

Dear Dr James and Nurse Joan,

I understand reflux can have the result of heartburn at times. If frequent occurrence of reflux causing heartburn, will it affect our heart functions in long term and increase the possibility of a heart attack happening? Thank you.

Answer by Dr James Cai

The term “heartburn” is just a descriptive name but it is not due to any disease of the heart. 

It is due to reflux of the gastric contents from your stomach into your swallowing tube (oesophagus), causing a burning sensation in a patient’s chest, therefore the term “heartburn”. It is not related to the heart and does not increase your risk of heart attack.

However, if the discomfort is due to gastric condition, it can often be managed with lifestyle changes. This includes avoiding certain food triggers such as oily, spicy, or fried foods, avoiding having large meals late at night, and opting for smaller, more frequent meals throughout the day. Medications may help as well. 

I would ask that you discuss this matter with your primary care physician (polyclinic or GP).

14. Question by Mardiah

Dear Dr James,

Does taking health supplements for heart disease affect the medicine that we are taking for the same disease (heart disease)? Thank you for your advice.

Answer by Dr James Cai

This would depend on what supplements you are referring to. 

If you are taking traditional Chinese medications, I would advise you to stop and check with your doctor before proceeding as there may be some interactions with your heart medications.

Ref: H24