Do you have high cholesterol, high blood pressure or high lipid (fat) count ? These are all risk factors for heart disease.

Dr Felix Keng, Senior Consultant and Dr Jack Tan, Senior Consultant and Deputy Head from the Department of Cardiology ​at National Heart Centre Singapore, give detailed answers to your questions.

Question by jass

Dear Doctors,

Here are something encounters we heard and read from people, and on the web. They are usually touted to be symptoms of heart disease. I think we all lively in a time where issues concerning health, are easily mis-interpreted. It is good for us hear perspective from a medical professional standpoint. And learn to take charge for our health and that of our loved ones in more holistic manner.

Doctor kindly edify us the following symptomatic signs. Is slight twitch( squeezing sensation) near left armpit and pinning on wist vein symptoms of heart attack,valve disorder and anxiety attack? How could one who has no history of heart disease spot for any indicative of the diseases know when is suitable period that one should seek medical attention?

While early sign of heart disease could be less vivid. How are heartburn related to heart disease? Does pain below chest bone a mist of inhalation suggest an indication for heart disease too? On the diagnosis front, is ECG the accurate test for heart disease? Is a person with a perfect ECG result completely free from heart disease? Thanks.

Answered by Dr Jack Tan, Consultant, Department of Cardiology, National Heart Centre Singapore

Classic angina pectoris is a form of referred pain from heart ischemia. The typical symptoms are that of central chest discomfort, usually described as tight, heavy, pressing or squeezing. This symptom tends to get worse on exertion and is relieved by rest. Occasionally, atypical symptoms of heart attacks can include cold sweating, nausea, vomiting and pain localised to the epigastric region. These symptoms can mimic heart burn and panic attacks and is difficult to tell.

An ECG is crucial to detect an ongoing heart attack and can be life-saving. However, the ECG test is not sensitive enough to pick up stable and chronic blockages in coronary arteries and other non-invasive tests may be more appropriate after consulting your GP or cardiologist. Some form of stress testing is often then performed to clarify the symptoms.

Question by lee

Is there any way I can "guarantee" myself from not getting a heart attack? What should I do ? I am getting very worried reading in the news now and then that some men just collapse on the threadmill and drop dead, even though they seemed to look very fit... Pls advise. Thanks

Answered by Dr Jack Tan, Consultant, Department of Cardiology, National Heart Centre Singapore

Two things can’t be avoided. These include death and taxes. Heart attack risk increases with age and tends to be higher for men. Exercise increases the risk of an event but over the long run decreases the overall risk for a heart attack. Most cases of sudden deaths are still secondary to coronary heart disease with a small proportion related to hereditary heart disorders.

Before embarking on a regime of aggressive exercise, it is wise to check with your physician.

Question by ninerniner

I'm 52,male,non smoker,just casual drinker,weigh 66kg. High cholesterol but last test from GP back to normal though asked to take Fenosup 160mg alternate days & to re test again.

I'm suffering from anxiety problem & currently under psychiatrist & psychologist treatment. Recently till now my anxiety is getting bad,I'll have fast palpitation & aftermath develop into breathlessness,tight chest,pain at the center of chest. With this prolong for long period of months into years,will I have a heart attack or stroke down the road?

Though at times,I'll pop in a pill from GP like Propanolol for the anxiety or Anarex for pain & muscles relaxation.

Answered by Dr Jack Tan, Consultant, Department of Cardiology, National Heart Centre Singapore

Your symptoms are very suggestive of a panic attack and your ten-year risk of a heart attack is low.

I’m glad that you are receiving help from the psychiatrist on behavior modification and possibly some anxiolytics may be helpful. If you are still very worried, a stress ECG can be performed for reassurance. Speak to your psychiatrist.

Question by kitkat1015

websites on health give differing opinions on arterial plaque. is arterial plaque reversible if one takes good care of one's health by monitoring on food intake and exercise regularly?

Answered by Dr Jack Tan, Consultant, Department of Cardiology, National Heart Centre Singapore

Arterial plaque buildup is reversible but very aggressive lifestyle modification is required.

Your cholesterol levels should also be <2.0mmol/dL before that occurs, usually with taking cholesterol medications like statins.

Question by magoqs

Hi, I'm a 49yr old female, with symptoms of familial hypercholesterolemia - a genetic disorder, likely passed down by my father who died of a heart attack at age 57.

My cholesterol has always been in the range of 250mg - 290mg/dL with LDL being the main culprit. I also have a bit of fatty liver plus other physical symptoms - a white ring around my iris (both eyes) and some xantholomas around my Achilles tendons which I understand are also due to the high cholesterol.

I'm not on any medication as I'm afraid of the side effects, so I've only resorted to regular exercise and strict diet (no red meat, processed food, etc). However, my last cholesterol reading in Dec 2009 was 278mg/dl.

What would you advise to help bring down my cholesterol level? is medication the only solution?Thank you.

Madeline Ong

Answered by Dr Jack Tan, Consultant, Department of Cardiology, NHCS

I’m glad that you are very faithful to a strict diet but in your case, a statin (cholesterol medications) is mandatory to reduce the risk of a heart attack.

Question by arturus78

Dear Doctors, I am 54+ years old and am relatively active. I cycle twice a week for about 45mins each and trek around Bukit Timah once or twice a week with an 8-10 kg load. I am 72 kg and at a height of 1.72m. Recently, I bought a home kit for reading my blood pressure and heart rates. The readings are on an average 130/88 and HR @ 58bpm. I am concern with my resting blood pressure as I understand it's a bit on the high side. Occasionally, my bp drops to 118/78 and at times it reads 135/90. My heart rates are on average 58bpm for both high and low readings of my BPs.

My question is should I be on medication to control or lower my blood pressure?

Thank you both for your kind attention. Best regards, Adam Ang KH

Answered by Dr Jack Tan, Consultant, Department of Cardiology, NHCS

You should check that the machine is a validated one. Bring it down to your GP and check the readings against a manually taken reading. Your blood pressure is in the pre-hypertension phase.

Continue your active lifestyle and decrease your salt intake. Some weight loss would also be helpful. I would observe the blood pressure for the time being for at least a further 6 months and start only if the blood pressures goes above 140/90mmHG.

Question by narkke

Hi, My parents are in their mid 60s and both are on medications for high cholesterol. I'm concerned that their heart arteries might be blocked and this is a "time bomb" waiting to be happened. Are there any health checkup designed specifically to identify potential heart attacks? Thanks.

Answered by Dr Felix Keng, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Hypercholesterolemia is rather common is Singapore.

You are rightly justified in worrying about heart artery blockage as this is an increasingly common disease in Singapore due to our affluence.

Although there are many tests that can be done to detect such problems, it is not recommended that all people with high lipids undergo them. Perhaps it would be best to consult the physician looking after your parents as he is probably in the best position to decide whether further assessment is required.

We would further assess patients who have symptoms suggestive of ischemic heart disease such as chest discomforts or reduced effort tolerance, in patients with abnormal electrocardiograms etc.

Tests that are useful for detecting coronary artery disease and ischemic heart disease can include treadmill testing, myocardial perfusion imaging, cardiac CT and stress echocardiography. The best everyone can do is to commit to a healthy lifestyle (exercise, healthy diet etc) in an effort to reduce the chance of developing this dreaded disease.

Question by eonggk

hi doctors, my husband of age 41 was being diagnosed of arteries blocked few months ago. One of the arteries was 70% blocked. 2 months ago, his eye sight is getting poorer. After investigation at the eye centre, doctor mentioned that veins and muscle to the eyes were lack of oxygen which cause the eye ball to be swollen. Is there a possibilty that it was caused by the blocked arteries? Pls advice. thanks.

Answered by Dr Felix Keng, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

Atherosclerosis is a generalised disease process that can affect any artery in the body. The fact that your husband already has coronary artery blockage points to a more generalised problem of artery disease. It is certainly possible that there may also be significant arterial disease affecting the eyes. As this is a generalised problem, the important things to do would be to control these risk factors associated with this disease. These include diabetes, hypertension, high cholesterol, smoking etc. If your husband has any of these other medical conditions, it is highly recommended that he consults with his physician and get treatment with a view to control all these risk factors. These could include lifestyle modifications and medications, or even surgery if deemed necessary.

Question by bridge362509

I do suffer from highblood pressure and my cholestrol is above the normal count. I take half tablet stamlo and 1 tablet Ezetrol. I am diabetic and cancer survivor. I would like to know what exercise would be suitable for me (age 65) I am currently working and am active person.

Currently I do once a week gym- treadmill or cross trainer. Is this sufficient? Thanks Bridget

Answered by Dr Felix Keng, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

The usual recommendation would be that of aerobic exercise (treadmill or cross-trainer is fine) for at least 3 times a week for at least 30 minutes each. One should also aim to increase heart rate during exercise to about 60-70% predicted for age (maximum heart rate = 220 - age).

Since you are active and have controlled your blood pressure adequately, I would recommend that you increase the frequency to 2-3 times a week. Recent reports have suggested that one session of very vigorous exercise a week may suffice. I would not recommend that yet as the data has not been verified.

Question by baozhen

Hi Doc,

I lately had an extra heart beat confirmed by a GP. I had been exercising regularly except lately more frequent.

During the check it heart beat rate is normal but additional beat. At that point I can feel the discomfort. No pain though. This happens most at rest and its continuous for more than 20 mins.

Understand that this is known as Arrythmia and its no cause for alarm.

In that case, can I still continue with my gym workout? Please advice. Thanks Tina

Answered by Dr Felix Keng, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

If your doctor has detected an arrhythmia, he would decide whether this is benign or would deserve further evaluation. Extra heart beats (ectopic beats) are a frequent occurrence, and the majority of these are benign.

However, if symptoms are increasing in frequency or duration, you should have yourself re-evaluated by your doctor. I would still advise that you can continue to exercise provided the symptoms do not occur or worsen during exercise.

Question by dave

There are so many types of scans for the heart and body in the market. Can you tell which ones a person would need and when? I want to go for a preventive check, but don't want unnecessary tests, radiation nor costs. Appreciate your professional advice.

How often should a man or woman go, and from what age please.

Answered by​ Dr Felix Keng, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

​There are numerous tests that can be done, too many to enumerate here. The best option would be to consult your doctor as to what kind of test you should go for, based on your risk profile and medical problems.

If you are relatively healthy and have no problems, you could consider a health screening package for a generalised health screen. Be reminded that there are many different packages available in the market, catering for a wide range of people. The most basic package would include and history and physical examination, ECG, chest X Ray, and simple blood and urine investigations.

Basic health screening is recommended for all above 40 years of age. Following the screening, further tests may be required as determined by the doctor.

Question by rachel

My dad had a heart attack when he was just past 60 years. He is now 75 years, and so far, so good. He has been reading about 'the latest scans' for heart and arteries, so he wants to know which he should go for to check on his latest condition, so as to be careful about any relapse. He is already on regular medication. Would that be enough, as long he eats properly and exercises as well, which he is doing regularly? Anything else he should do or watch out for?

Answered by Dr Felix Keng, Senior Consultant, Department of Cardiology, National Heart Centre Singapore

It is imperative that your father looks after himself well. I suppose he is taking many medications presently and is on regular follow-up by a doctor. Keeping healthy and controlling all the risk factors are extremely important in this respect, as it is well known that heart artery disease is a progressive disease that can worsen despite the best treatment.

There are a lot of tests that can be done for people with heart attacks, but it would be best to consult your regular doctor who can best advise on such matters.

Regular consultation with clinical examination, blood pressure, sugar and cholesterol checks would be recommended for your father. If he does not have any symptoms suggesting further heart artery trouble like chest discomforts or reduce effort tolerance, I would not recommend doing the ‘latest scans’ for the heart & arteries, as this would probably not change the management of your father.

If he does get the symptoms, the best thing to do would be to consult your doctor, who will then decide which test to do, or to refer him to a specialist if necessary for further evaluation. Please keep in mind that all tests have their pros and cons and should only be done when medically necessary.

Question by health3888

I am keen to kow how to reduce the LDL levels besides taking medication. I think even exercise is tough -- it does not help to reduce LDL, although exercise helps to increase HDL. My HDL is 93 and LDL is around 110. I usually exercise 3-5 times a week, doing yoga, pilates, and cardio like treadmill and cross trainer. I am female, coming to 41 years. Please advise how to reduce LDL. Thank you.

Answered by Dr Jack Tan, Consultant, Department of Cardiology, National Heart Centre Singapore

You are right, the majority of cholesterol especially LDL output from the body is genetically predetermined. If your LDL level is 110 and you do not have any coronary artery disease or diabetes, I would not worry about it. Please continue your current active life style. Cut down on red meat and increase whole grain produce and fruit intake. A balanced diet helps.

Question by James See

Dear Doctors, Is it useful to take a blood test for homocysteine for an overweight adult? If yes, can this test be done at a polyclinic or specialist outpatient clinic of hospital? If the result is high, what should be done to reduce the homocysteine level? Thanks, James See

Answered by Dr Felix Keng, Senior Consultant, Department of Cardiology, NHCS

Homocysteine is an amino acid in blood that can be detected by simple blood tests even at the polyclinic. Its significance is that it is associated with atherosclerosis and subsequent coronary artery disease and heart attacks.

High homocysteine levels have been associated with an increased incidence of heart attacks, strokes, and possibly increased ease of blood clotting leading to other deleterious effects.

There are actually no good ways of lowering this level apart from taking folic acid, Vitamin B6 and B12. However, large studies on the effects of these interventions have been equivocal. As such, we do not do homocysteine levels as a routine for cardiac patients.

Ref: V10​