Listen to your HEART

Early treatment can arrest permanent damage to the heart muscle but prevention is still better than cure.

Early treatment can arrest permanent damage to the heart muscle but prevention is still better than cure.A greying population and an increasingly affluent lifestyle are a deadly combination that can swell the pool of people with heart ailments. And for Singapore, the two are coming together at a time when unhealthy living is, perhaps, at its worst.’The accumulation of all the adverse lifestyle effects are now peaking with economic growth,’ says Richard Ng, consultant cardiologist, Parkway Group Healthcare.Over-eating, lack of exercise, stress and smoking are doing damage to the hearts of an increasing number of Singaporeans. At the same time, ageing is also playing its part in contributing to the problem. Hypertension, diabetes and high cholesterol – three medical conditions of the elderly that can lead to heart illness – are on the rise.Dr Ng doesn’t have precise figures but says there are definitely more people coming to him complaining of heart problems. And most heart specialists agree with him.Teo Wee Siong, a consultant cardiologist and electrophysiologist, also with Parkway Group Healthcare, says 80 per million Singaporeans now require a pacemaker to help regulate their heartbeats, up from 50 per million 15 years ago.Lifestyle killer diseases like heart attacks and cancer have overtaken infectious illnesses as the biggest health threat in Singapore. One in four Singaporeans die yearly of heart problems, the second biggest killer after cancer.The twin developments of a greying population and an unhealthy lifestyle inevitably raise the number of people with ailing hearts.On the one hand, as more Singaporeans grow old they are likely to fall prey to heart ailments because the elderly – those in their 50s and older – are prone to have weaker hearts, and their blood vessels tend to harden and become less elastic.On the other hand, a lifestyle that emphasises fatty food and ignores exercise is spreading heart disorders increasingly to younger Singaporeans. Heart specialists here report they are treating patients still in their twenties.Of course, there are also patients born with heart abnormalities which may surface only in their teens. If not treated, this may lead to complications and heart failure. Irregular heartbeats or arrhythmia, for instance, is one common congenital abnormality. A teenager born with it may experience sudden and very fast beating of the heart that lasts as long as 20 minutes each time.Congenital arrhythmia, which occurs in less than 1 per cent of the population, can be rectified through a procedure known as electrophysiology study, says Dr Teo. Wires are inserted into the heart through blood vessels to see what is wrong with its electrical short circuit. The problem is taken care of – most of the time, for good – by destroying the short circuit.Dr Teo, who started electrophysiology study in Singapore in 1991, says the procedure takes one to two hours and costs $8,000. Some 2,000 patients have undergone it so far.The Merck Manual of Medical Information has a long list of heart disorders. Among them: congestive heart failure, a serious condition where the amount of blood pumped by the heart every minute is insufficient to meet the body’s normal requirements; cardiomyopathy, a progressive disorder that impairs the wall of the heart’s lower chambers; malfunctioning of heart valves from leaking or failing to open adequately, which affects the heart’s ability to pump blood; and endocarditis, an inflammation of the smooth interior lining of the heart, often resulting from a bacterial infection.But the most common heart disorder in Singapore – and in most affluent societies – is coronary heart disease, which is a clogging of arteries supplying blood to the heart. Plaque forms out of cholesterol, fatty compounds, calcium and a tough fibrous material build up in the heart-vessel walls and then bursts, blocking blood flow. When the heart muscle is robbed of its blood supply, the heart either pumps erratically or simply stops beating, resulting in a heart attack.The longer a coronary artery stays blocked, the more likely it is that the heart muscle will be permanently damaged. So it is crucial to get to a hospital fast. It helps to take aspirin – a blood thinner – before you go. Clot-dissolving drugs like streptokinase can often be used to clear an artery blockage and restore blood flow to the heart. Otherwise, surgery like balloon angioplasty may be necessary to open a closed artery.But prevention is still better than cure – and Dr Ng says this has to be targeted at two groups of people: the general population, especially those at high risk like smokers and people with a family history of heart ailments; and former heart patients.According to heart specialists, sticking to a healthy lifestyle is the simplest, cheapest and most efficient way of keeping the heart pumping evenly. ‘The long and short of it is we still have to go back to basics,’ Dr Ng says. ‘It may be difficult and unpleasant but it’s still the most rewarding for day-to-day living.’This means not smoking, keeping your weight under control, exercising regularly and eating more vegetables, fruits and fibre while cutting down on red meat, fats and sugar.’My guiding principle for exercise is the word ‘fit’,’ says Dr Ng. ”F’ is for frequency – and that means you should exercise no less than three times a week; ‘I’ is for intensity, which suggests the exercise you do must be strenuous enough to work up a sweat; and ‘T’ is for time, that is each exercise session should last at least half an hour.’No single symptom can point definitely to heart disease, but certain symptoms indicate a possibility. And several symptoms together may make a diagnosis almost certain. Symptoms – and these are more obvious for men than for women – include chest pains, shortness of breath, fatigue, palpitations, light-headedness and fainting.While chest pain may not necessarily indicate heart disease, Dr Ng says it is often simply dismissed as a sign of indigestion. ‘It may well be the heart, you never know. So don’t ignore it. The next time, it may be a full-blown heart attack.’He recommends a yearly heart screening for people who have reached 45. For those with a high risk of heart disease, the check-up should start early – perhaps at 40 or younger. A full screening typically involves a review of your medical history, physical examination, chest X-ray, urinalyses, blood test, electrocardiogram (ECG), body fat analysis, heart risk assessment, treadmill test and calcium scoring.The X-ray is done to ensure your heart is not enlarged. If it is, you have a heart problem. The blood test will tell your cholesterol level. High cholesterol may be lowered by medication with a drug called statin. The ECG does an electrical tracing of the heart muscle – and it will reveal any abnormalities if the muscle suffers from a lack of blood flow, or oxygen.But Dr Ng says an ECG by itself is insufficient. ‘ECG is good when it shows abnormalities. When it doesn’t show, it doesn’t say anything.’The treadmill test, which requires running for 12 minutes covering half a kilometre, is the most telling, according to him. ‘Very often, if a person has silent heart disease, the resting ECG (alone) will not show any abnormality. But if you let the person stress the heart by exercising gradually, you can expose hidden heart trouble, where the coronaries are narrow. And these will be shown on the ECG.'(Source: Asia Business Times: June 2004)