The heart is probably the most important organ of the body as it’s vitally responsible for just about everything that gives your body life. Get the facts about heart disease, including its symptoms, available treatment and advice on prevention.

Dr Yeo Khung Keong, Senior Consultant from the Department of Cardiology at National Heart Centre Singapore, gives detailed answers to your questions.

Question by jlow1944

Hi Dr Yeo, for heart screening for middle aged individuals, is it enough to get cholesterol, blood pressure, ekg tests done regularly? Thank you.

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

In general, benefits of screening depends on your risk profile (eg. presence of diabetes, high blood pressure etc). For most middle-aged individuals, the tests you mentioned are probably reasonable.

Question by lifeartsg

How much exercise is optimal for heart health? Is it true that too much vigorous exercise over many years can wear out the heart in old age?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Yes, it is possible. However, there are many causes for shortness of breath. It is probably advisable that you see your doctor for a check-up to see what the likely causes are.

Question by chansy24

How much exercise is optimal for heart health? Is it true that too much vigorous exercise over many years can wear out the heart in old age?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Like everything else, moderation is the key. We like the American Heart Association recommendation of

At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes

OR

At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of the two

AND

Moderate to high intensity muscle-strengthening activity at least 2 or more days per week for additional health benefits.

Question by Afiskha Sweet

Doctor...how do i handle my weakness. ive been suspecting that.I got heart weak. everytime if i have high emotion my heart beating so fast, feel no energi, my whole body cold. especially my hand n my leg. thanks...

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

When stressed or anxious or excited, it is not uncommon to feel your heart beat fast and may be associated with some of the symptoms you describe. However, if your heart beats fast for no good reason, then you should see a doctor for a check-up.

Question by suzannesoon

Dear Dr Yeo, if there are no existing symptoms of any heart problem, what is the recommended age group to go for a heart health screening? What are the recommended tests involved to check the health of our heart?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Heart health screening begins with the identification of risk factors for heart attacks. These include high blood pressure, diabetes mellitus, obesity, high cholesterol and other risk factor such as a smoking history. In general, we recommend that you undergo regular visits with your doctor for health check on your weight, blood pressure and cholesterol levels. After age 45, you should also have a check to see if you have diabetes. If you are in good health and your work does have any special requirements, additional tests in the absence of symptoms or risk factors are not necessary.

Question by ireneneo

Dear Dr Yeo,

Am a Type 2 diabetic patient whom is slightly overweight. At times I experience slight chest pain for a min or two ,even without doing any vigorous exercise. Is this consider a pre-condition of heart disease?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

It is possible that this may represent heart disease but as there are many causes of chest pain, it is probably a good idea to see your doctor.

Question by Salim Dear

Sir, Recently I went for medical checkup at Sata, after checking my ECG, the Dr told me that I had first degree block. Pls clarify what she meant by that?

Thanking u in advance

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

The heart is a pump that is controlled by electrical signals. For the heart to pump in a coordinated manner, electrical signals need to travel from one part of the heart to another. If the signal is too fast or too slow, it may result in heart problems.

First degree heart block is a mild problem that occurs when the signal traveling from the atrium takes slightly longer than usual to travel to the ventricles. It is usually not dangerous and we tend to leave it alone.

Question by mosmos

Dear Dr Yeo, If a person have a sudden cardiac arrest in the public area, what should we do to help before the ambulance arrive?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

You should shout for help, make sure that the surrounding is safe and start chest compressions. If you know Basic Cardiopulmonary Life Support (BCLS), you should do so immediately. There are organisations (most hospitals and some polyclinics) in the community that teach BCLs.

Question by octane

Hi Dr Yeo, How does smoking linked to heart diseases? Does breathing in "Second hand smoke" also in danger of contracting heart diseases?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Smoking is a major risk factor for heart disease. It promotes the development of cholesterol ‘plaques’, also known as atherosclerosis in blood vessels, and cause heart attacks. Yes, second hand smoke can also contribute to heart disease.

Question by brenlsloh

Hi, 1.What is Atrial Septal Aneurysm and it is serious? 2. What should one do if one has the above? Appreciate greatly for information on the above. Thank you. Brenda

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

An atrial septal aneurysm refers to a very floppy septum (or wall) that separates the right from the left atrium. In general, it is not dangerous although some research suggest that there are uncommon situations that may cause problems. In general, no treatment is required.

Question by Sandra

Dear doctor I am a 54 yrs old Chinese female. Sometimes in February I had experienced some dull ache/ pain right below the ribs. The pain will sometimes go away and return. It had been on/off till today. I had been to the doctor and they said maybe reflux or gastric pain. The doctor prescribed esomeprazole & to take the medication twice a day. I had been taking this medication for the last few days but seem there is no improvement.

I do not have nausea and my stool color is not black. What should I do to get rid of this pain. It is affecting my work & daily lifestyle. By the way I do not smoke or drink alcohol.

Thank you

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

If it does not improve, you should see your doctor again. There are many possible causes for your symptoms and your doctor will need to take a careful history and perform a careful examination to decide what to do next.

Question by rsim

Dear Dr Yeo, I am not an active runner, when I do 5km run, I feel slight tightness of my heart and I will stop to take a rest. Is the tightness due to over stretching my heart?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

If you get chest tightness with running, you should probably see a doctor as it may represent heart disease. Your doctor will ask more detailed questions that will help decide if further testing is necessary.

Question by pocoyosky

Hi Dr Yeo, What are the causes of heart disease? Is stress one of the causes?

There are many causes of heart disease. They include diabetes, high blood pressure, high cholesterol, a sedentary lifestyle, smoking and many others. Yes, stress can contribute to heart disease.

Question by chai

Hello Doc, I went for annual ECG check and was told my heart beat is normal. However sometimes I could not catch my breath and I was not exercising when this happen. Is this a sign of heart disease?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

This is difficult to say without more information. The ECG is a very basic test that may appear normal even when heart disease is present. You should see your doctor if you have frequent symptoms.

Question by labbit87

Hi Dr Yeo, I have a friend, aged 25, who is recently being diagnosed Mitral Valve Prolapse as doctors heard murmurs from her heart and she went for an ECG for an examination. The doctor said that her prolapse is mild, and her check-up is in 2 years time. He also said that if it worsens as time goes by, she may have to undergo heart valve repair surgery when she is in her 50s or 60s. The doctor said that symptoms of worsening may be shortness of breath or chest pain. She is quite worried about her condition but online information and doctor's advice do not seem to provide a lot of information, it seems like there is nothing she can do about her condition.

1. May I ask if there is anything she can do to prevent the prolapse from worsening, or to strengthen the valve?
2. Is there any more information Dr Yeo can provide us with on Mitral Valve Prolapse?
3. Is she able to do vigorous exercise or strenuous activities, or should she do more exercise?
4. The result of her ECG also shows the possibility of a Bicuspid Aortic Valve, though that cannot be confirmed as the ECG is not very clear. Can Dr Yeo answer the above 3 three questions on Bicuspid Aortic Valve as well?
5. How is chest pain like? Do you feel pain or tightness, only in the chest area or whole body?

Thank you so much for your time and reply! We look forward to your kind reply!

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Mitral Valve Prolapse (MVP) is not uncommon and in general is of concern primarily if it results in leakage of the mitral valve (mitral regurgitation or MR). To answer your questions:

1. Not really.
2. The main concern is that MVP can lead to MR which when severe can weaken the heart and will require surgery. However, the majority of MVP patients have no symptoms and do not develop severe MR. Hence if a MVP patient has mild MR, we only see them once every year or two. We do advise that they seek medical attention if there is worsening shortness of breath.
3. Unless she has significant MR, she should be able to do vigorous exercise. However, I would advise that for specific exercise prescription, she should speak with her cardiologist.

For bicuspid aortic valve, it would be picked up on an echo and not on an ECG.

To answer

1. Not really;
2. Bicuspid aortic valve is associated with multiple cardiac abnormalities and will require some monitoring and explanation of the potential risks. It is probably best to see your doctor in person.

Question by synergy

Dear Doctor

I am age 31 and have been diagnosed with small ventricular septal defect (VSD) since young. During my follow up at NHC last year, my doctor told me that she detected a "prolapse". Is the condition considered serious? My doctor didnt mention that a surgery is necessary and put me on follow up every 2 years.

May I enquire, what will be the symptoms to look out for if my condition worsens? Any preventive measures to take?

I am thinking to buy a critical illness insurance. Do you think my condition will result in exclusion of coverage for any condition related to heart?

Thank you.

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

The main symptoms to watch out for are shortness of breath, or decreasing effort tolerance. If you have persistent high fevers, you should also see your doctor. Antibiotics are generally not required.

It is likely but will depend on the insurance company.

Question by simly6

Dear Dr Yeo, I am on the plump side and my body fats level is on the high side, I am inactive in exercising, is this a trigger for heart disease?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Yes, being overweight and sedentary can predispose one to heart disease. Do watch your weight and consider starting some exercise. If you are uncertain about your fitness to exercise, please see your doctor.

Question by dsim

Hi Dr Yeo, What are other alternative prevention to heart disease if I am not fit to do running? I assume running is best to exercise the heart? Thanks!

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Running is a good exercise. However, there are many other excellent exercises. Walking, swimming, and cycling are also good exercises. For walking, try to walk briskly for at least 45 minutes every day. You can break this up within a day.

Question by mrina

Hi Dr Yeo, Are there any natural food or fruits that can help to prevent heart disease?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Many fruits are beneficial to your health when taken in moderate quantities. There are none with a clear-cut benefit specific to the heart.

Question by esim

Hi Dr Yeo, What are the screen tests available to detect heart disease? Is ECG one of them?

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Yes, an ECG is one of them. However, tests used to perform screening depends a lot on your age, risk factors etc. If in good health, probably the only tests you need are a blood pressure check, weight (or BMI) check, cholesterol blood tests and a screen for diabetes. More tests may be required depending on your risk profile.

Question by beisaikong

Hi

I am 37. health screening 2 weeks back shown my hdl is 66 and ldl is 157 and triglycerides is 67. I do not smoke and no other found concerns in the report. I exercise about twice a weeek, 30 mins each time.

I have some questions on lowering LDL:

1. Will strict daily diet alone help to lower LDL in 3 months ? Diet of more fruits, vegetables, less saturated fats, high fibre.
2. Is hypocol red yeast rice consider a cholesterol drug as I believe it contains similar substance use in cholesterol drug?
3. Marigold HL milk that contains plant sterols. it claims it will contains 0.65g of plant sterols in one glass and will be able to reduce LDL if consume 2 glass daily.
4. The supplement "esstential forte N", is it something which will lower LDL? Should I take this as an supplement?

Regards na

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

1. Yes, it will help although the degree of reduction is variable.
2. I​t does contain similar substances but hypocol is considered a health supplement and is not regulated like standard medications.
3. The ability and extent of LDL reduction is not well established.
4. I’m not familiar with the over-the-counter health supplements. For you, at your age, given your exercise and good HDL levels, I would not recommend any LDL lowering agent at this time.

If you get chest tightness with running, you should probably see a doctor as it may represent heart disease. Your doctor will ask more detailed questions that will help decide if further testing is necessary.

Question by Mrs Goh

My spouse is a army regular in his late 30s, fit & exercises regularly, high cholesterol (referred to see a endocrinologist soon to check for familial hyperlipedemia), blood pressure normal, BMI 23. A GP has referred him for arrythmia 7 years ago, but the specialist cleared him after a series of tests. He has a history of blackout spells which recurs every 2 years or so, latest just this week. How often should he be reviewed by a heart specialist and what would be the sign of deterioration to look out for?

Many thanks for taking time to answer this!

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

He should see his cardiologist again. In general, if he has multiple frequent blackout spells, he should see a doctor as soon as possible.

Question by Yong Ling

Hi, My father who is in his early 70s, complained of breathlessness, and he suspected that there is a blockage in his heart. We have seen the polyclinic doctor who did an ECG and Xray. The X ray is normal and he said the ECG seems fine though there were some abnormalities.

So eventually he referred us to a specialist at SGH. In this case, the waiting time for SGH is quite long so my father's appointment is only in July but Im concerned if his symptom of breathlessness warrants something serious.

In your professional experience, would you recommend that I have my dad to go as private patient to Heart Centre to get a thorough check just to be on the safe side? Thank you for your advice! Cheers,

Answered by Dr Yeo Khung Keong Senior Consultant Department of Cardiology National Heart Centre Singapore

Apologies for the long waiting time. It may be worthwhile to visit the polyclinic doctor again for a re-assessment. There is a mechanism to get him to see a specialist at NHCS earlier if the polycl​inic doctor feels that he requires urgent attention. Of course, one can also arrange to be seen as a private patient.

Ref: S13