Heart Conditions | Centre of Excellence | Mount Elizabeth Hospitals

Heart Conditions
The heart is one of the most important organs in the body. It is in charge of receiving oxygen-filled blood from the lungs, pumping this blood throughout the body so that every organ receives the oxygen it requires, and recirculating the oxygen-depleted blood back into the lungs where it receives a fresh supply of oxygen.

The importance of the heart means that all diseases and conditions involving this organ have to be treated with great care. Heart diseases can be a result of many causes, such as congenital disorders where the heart muscles failed to develop normally, or blockages in the arteries connected to the heart.

Understanding your heart condition is the first step to better health. Below is a list of some heart diseases.

Aortic aneurysm & aortic dissection

Carotid artery disease

Congenital heart disease

Coronary artery disease

Heart arrhythmia

Heart attack

Heart failure

Valvular heart disease

Other conditions we treat
Aortic Aneurysm & Aortic Dissection
The aorta is the biggest artery in the body. It originates from the heart and supplies blood to the whole body via branches of arteries. Diseases of the aorta can lead to abnormal narrowing and dilation of the arteries. These diseases include aortic aneurysm and aortic dissection.

Aortic aneurysm refers to the abnormal dilation (swelling) of the aorta. The dilation of the aorta’s wall may lead to the aorta being ruptured, which can lead to massive internal bleeding and severe pain.

Aortic dissection refers to a tearing in the wall of the aorta. The dissection causes the layers of the wall of the aorta to come apart as blood is flowing between the layers. Rapid blood loss can occur if the aorta is completely torn apart by the dissection. This is considered a medical emergency.

An aortic dissection can affect the blood supply to various parts of the body, leading to:

Damage to the aortic valve (aortic regurgitation)

Organ damage (including kidneys, intestines, heart, brain)

Stroke, which may lead to paralysis

Death

Causes

These conditions are commonly associated with uncontrolled high blood pressure or any of the following conditions that lead to the weakening of the blood vessels wall:

Chronic high blood pressure, which affects the aortic tissue, making it more susceptible to tearing

Congenital conditions (conditions that you are born with) that weaken and dilate the aorta’s wall (including Marfan’s syndrome and bicuspid aortic valve)

In rare instances, motor vehicle accidents might lead to aortic dissections due to traumatic injury to the chest

Other potential causes include:

Ageing

Drug use

Pregnancy

Symptoms

Most aortic aneurysms result in no symptoms

Symptoms of aortic dissection include:

Abdominal pain

Fainting

Intense ripping pain in your chest or upper back

Numb or cold extremities

Stroke

Sweating

Treatment

Aortic aneurysm:

If you have no symptoms and your aneurysm is small, the doctor can suggest a ‘watch-and-wait’ approach with regular monitoring of the size of your aneurysm

If your aneurysm is big enough or if it is growing more than 1 cm a year, the doctor may recommend aortic surgery

Aortic dissection:

Oral and intravenous medications can help control your blood pressure and heart rate while the aorta is healing

The diameter of the aorta can be monitored to help prevent enlargement or rupture

If the dissection affects the initial part of the aorta, the doctor may suggest surgery because there may be risk to your heart and brain arteries
Carotid Artery Disease
Your carotid arteries are a pair of blood vessels located inside the neck that deliver blood to your brain and head. Carotid artery disease results from the build-up of waxy deposits, called plaque, over the inner surface of the arteries. Plaque can gradually decrease or block the blood supply to the brain and may lead to stroke or transient ischemic attack (TIA), also known as ‘mini-stroke’, which occurs when a blood clot temporarily obstructs an artery that supplies blood to the brain.

Carotid artery disease is responsible for 20% − 30% of all strokes. The treatment of carotid artery disease may include a combination of lifestyle changes, medication and in some cases, surgery.

Stroke is the most common complication of carotid artery disease. A stroke can lead to:

Muscle weakness and paralysis

Permanent brain damage

Death

Causes

The causes of carotid artery disease include:

Modifiable causes

Obesity, diabetes, high blood pressure, and high cholesterol can increase the risk of carotid artery disease

Smoking, lack of exercise and an unhealthy diet

Non-modifiable causes

Women who are over 75 years old have a greater risk than men in the same age group. Men younger than 75 years old are more prone to developing carotid artery disease than women in the same age group

Family history of the disease

Those who suffer from coronary artery disease (hardening of the arteries supplying blood to the heart) are more prone to developing carotid artery disease

Treatment

Your doctor will evaluate your condition and discuss with you the range of treatment options suitable for you. These may include a combination of:

Lifestyle changes:

Limit alcohol consumption

Maintain a healthy diet

Maintain control of your blood pressure, diabetes and other heart diseases

Quit smoking

Regular exercise

Medication to reduce the risk of stroke and other heart disease complications, as well as clot-dissolving medications

Surgery to unblock the artery and prevent future strokes
Congenital Heart Disease
Congenital heart disease refers to heart defects that you are born with. The severity of the disease ranges from mild defects to severe and life-threatening conditions. In Singapore, according to the birth defect registry, congenital heart disease was a factor in 0.81% of total live births from 1994 − 2000.

The incidence of this disease in Singapore is on the rise and there are approximately 12,000 adults living with congenital heart disease. With around 37,000 − 40,000 newborns per year, it is estimated that 300 − 320 adult cases will be added annually. There are numerous types of congenital heart disease such as:

Atrial septal defect (hole in the wall separating the two upper, right and left, atriums of the heart)

Coarctation of the aorta

Tetralogy of Fallot

Hole in the heart

Mitral valve prolapse

Patent ductus arteriosus

Pulmonary atresia

Pulmonary/aortic stenosis

Transposition of the great vessels

Ventricular septal defect (hole in the wall separating the right and left ventricles)

Complications

Complications related to pregnancies, use of contraception and risk to offspring

Inflammation of the inner layers of the heart (endocarditis)

Managing of resulting non-cardiac medical problems

Social, emotional, financial, employment and education issues

Life-long follow-up

Causes

The causes of congenital heart disease are not very well known, though they may include:

Chromosomal or genetic conditions, which can be inherited or might occur (rarely) in early pregnancy:

Down syndrome, DiGeorge syndrome, Marfan’s syndrome and Turner syndrome

Environmental factors can lead to congenital heart disease:

Excessive drug or alcohol consumption during pregnancy, acne medications, exposure to chemicals, viral infections (eg. rubella), and other diseases including diabetes

Symptoms

Depending on the type and severity, many congenital heart defects may present with no symptoms. When the heart defects are severe or if multiple heart defects are present, especially in newborns, the following symptoms may occur:

Blue skin, lips and fingernails

Chest pain

Fainting

Heart murmur

Palpitation

Poor blood circulation

Rapid breathing

Tiredness

Treatment

Transcatheter procedures may be used to treat congenital heart defects. These are minimally invasive procedures performed using a catheter (small tube). This includes the delivery of an intravascular device such as a balloon, a coil or a stent to help dilate or close existing cardiovascular defects.

Transcatheter procedures include:

Balloon angioplasty or balloon dilation is a procedure that expands narrowed blood vessels to improve blood flow to the heart

Balloon atrial septostomy is used to treat some congenital heart defects and can be performed on fetuses or infants. This technique expands the hole between the right and left upper chamber of the heart.

Balloon valvuloplasty is recommended for patients whose valves are narrowed. A tiny balloon catheter is directed to the target valve, then inflated until the valve opening is widened sufficiently.

Device closure of a condition called patent ductus arteriosus (PDA) is performed when a baby’s ductus arteriosus (blood vessel normally present and closed a few days after birth) is not completely closed after birth. A device is inserted through the blood vessels in the groin to close this gap.

Device closure of atrial septal defect (ASD), a congenital heart defect between the upper two chambers of the heart. An occluder (separator) can be inserted to divide the two chambers of the heart when atrial septic defect is present. This will help the heart resume its normal function.

Surgery

Cavo-pulmonary shunt (CPS)

Fontan procedure

Ligation of patent ductus arteriosus

Modified blalock taussig shunt (BTS)

Norwood procedure

Pulmonary artery band (PAB)

Rastelli operation

Ross procedure
Coronary Artery Disease
Coronary artery disease is one of the most common heart diseases in Singapore. It refers to the narrowing or obstruction of the arteries that supply blood to the heart. The narrowing of the arteries occurs due to the build-up of fatty deposits in the wall of the arteries. These fatty deposits, called plaque, accumulate over the years and can eventually block blood flow to the heart. Coronary artery disease can lead to chest pain and shortness of breath (angina) during exertion or stress, as well as heart attack and heart failure.

There are many complications associated with coronary artery disease including:

Arrhythmia (irregular heartbeat)

Heart attack

Heart failure

Symptoms

Coronary Artery Disease can manifest in different symptoms and severity:

Chest pain, known as angina, during exertion and stress

Cold sweaty hands

Heart Attack

Nausea

Palpitation

Shortness of breath

You may not experience any symptoms, even though there is restricted blood flow to your heart (this is known as silent ischaemia)

Treatment

Your doctor will evaluate your condition and discuss with you a range of treatment options suitable for you. These may include a combination of:

Lifestyle changes to improve the health of your heart:

Control your blood pressure, blood cholesterol and diabetes with regular exercise and weight control

Maintaining a healthy diet

Quit smoking

Medications to dissolve blood clots, regulate heart rate, and prevent other heart disease complications

Surgery may be recommended by your doctor in severe cases of coronary artery disease in order to improve the coronary blood flow:

Coronary artery bypass surgery: Open heart surgery, during which coronary blood supply is restored by creating a route for the blood to go around the blocked part of the coronary artery.

Percutaneous coronary intervention (also known as coronary angioplasty): A small balloon is inserted into the blocked artery to help re-open the blocked artery and allow blood to flow again. A stent (a tiny expandable metal coil) may be used to help keep the artery open.
Heart Arrhythmia
Heart arrhythmia refers to an irregular heartbeat. Some arrhythmia may have no significant consequences, though other types can be life-threatening. The severity of the consequences depends on how long the arrhythmia lasts for, how irregular it is and how it affects blood flow and blood pressure.

Arrhythmia can cause the heart to beat too slowly (below 50 beats per minute), too quickly (greater than 100 beats per minute), or irregularly.

There are different types of heart arrhythmia including:

Premature (extra) beats

Supraventricular arrhythmia

Ventricular arrhythmia

Ventricular fibrillation

Ventricular tachycardia

Most heart arrhythmia are manageable and do not lead to severe complications. However, in cases where they are not treated correctly, they can lead to fainting, stroke, and heart failure.

Causes

The risk of developing heart arrhythmia increases with age, and the condition can occur in someone with a healthy heart. In some instances the cause may remain unknown. However, the condition is known to be strongly associated with cardiovascular conditions including:

Coronary artery disease

Heart failure

Heart valve diseases

High blood pressure

There are also non-heart-related causes that lead to heart arrhythmia. These include:

Overactive thyroid gland

Stress, excessive consumption of alcohol, tobacco, and caffeine, as well as diet pills, decongestants and cough medicines

Symptoms

The symptoms of heart arrhythmia can include any of the following:

Chest pain

Dizziness

Fainting

Palpitations (missed beats, fast heartbeat, pounding or fluttering chest sensations)

Shortness of breath

Treatment

Some arrhythmia may not require treatment. Your doctor will evaluate your condition and discuss with you the range of treatment options suitable for you. These may include a combination of:

Lifestyle changes:

Quit smoking

Avoid activities that trigger irregular heart beat

Limit consumption of caffeine

Avoid stimulants used in cough and cold medications

Medications:

Anti-arrhythmic drugs to control heart rate

Anticoagulant therapy (blood thinners) to reduce blood clot formation

Electrophysiology studies (EP): This procedure is performed under a local anaesthetic, allowing your doctor to stimulate the heart with controlled electrical pulses to locate the source of the block or irregular beat.

Catheter ablation: This procedure usually cures arrhythmia and is primarily done post-EP studies and when medication is not effective or is not convenient. It works as follows:

Several thin tubes (catheters) with electrodes are inserted into the blood vessels and directed into the heart

A burst of radiofrequency energy (the same as microwave heat) ablates (removes) the area of the heart muscle causing the irregular beats

Surgery to control arrhythmia and restore a regular heart rate:

Devices such as a pacemaker, cardiac implant, or defibrillator can be implanted in the chest. These devices deliver electrical energy and fill in the missing beats to help restore the heart function close to normal. These devices can be temporary or permanent.
Heart Attack
A heart attack (medically known as myocardial infarction) occurs when the blood flow to the heart is reduced or blocked. This blockage occurs due to the build-up of fatty deposits in the walls of the arteries supplying blood to the heart and results in a poor oxygen supply to the heart muscle. If the blood flow is not restored promptly, the affected heart tissue dies.

Some patients experience chest pains when a heart attack occurs, but others present with no evident symptoms at all. It is crucial to recognise the warning signs of a heart attack so that it can be treated early. Heart attack is the third leading cause of death in Singapore after cancer and is the leading cause of death in some parts of the world.

Causes

The most common cause of a heart attack is the narrowing of one or more of the arteries that supply blood to the heart. This results from the build-up of cholesterol deposits in the wall of these arteries (a process known as atherosclerosis). This restricts blood flow to the heart muscle, compromising the supply of oxygen.

There are modifiable and non-modifiable risk factors associated with a heart attack.

Modifiable risk factors:

Lifestyle factors like smoking, lack of exercise and an unhealthy diet

Treatable conditions including high blood pressure, high cholesterol, and diabetes

Non-modifiable risk factors:

Age, a strong family history of the disease, ethnicity, gender (men are 3 to 5 times more prone to having a heart attack than women)

Menopause (loss of natural oestrogen increases a woman’s risk of heart disease)

Symptoms

If you are experiencing a heart attack, you may experience the following symptoms:

Chills and sweating

Cold and sweaty skin

Dizziness

Nausea

Pain that spreads from the chest to the neck, arms, shoulders or jaw

Prolonged and severe central chest pain (heavy and crushing sensation)

Shortness of breath

Weak pulse

Treatment

The aim of the treatment is to unblock the affected artery promptly to minimise damage to the heart muscles. The doctor will evaluate the severity of your condition and perform the most effective way to unblock the artery. This may include:

Performing a coronary angioplasty, where a small balloon or stent is inserted into the blocked artery to help re-open it and restore blood flow.

Cardiac rehabilitation: A programme that aims to help you achieve a healthier heart after your heart attack by reducing risk factors.

Medicines:

Anticoagulants to dissolve blood clots

To reduce the risk of another heart attack

To relieve chest pain

To control diabetes, high blood pressure and high cholesterol

Complications and related diseases

Arrhythmia, or abnormal heart beat

Cardiogenic shock, which is similar to heart rupture, but more serious

Damage to the heart valves

Heart failure, resulting in the inability of the heart to pump blood effectively around the body

Heart rupture, where the heart’s muscles, valves and walls split apart
Heart Failure
Heart failure describes the condition in which the heart is unable to pump an adequate supply of blood to the body’s tissues. The organs and muscles are therefore deprived from oxygen and nutrients, and, as a result, do not function properly. Heart failure leads to oedema, which refers to the build-up of fluids in the tissues.

Heart failure is a chronic condition with serious consequences. It can affect your general well-being including your mental and physical state, and its prevalence increases with age. There is no cure for heart failure, but a combination of lifestyle changes, medications and sometimes surgery can help in the management and the treatment of this condition.

Causes

There are numerous causes that lead to heart failure and the most common risk factors are:

Cardiomyopathy – A disease of the heart muscle that causes the muscle to weaken. Coronary heart disease and other heart diseases can lead to cardiomyopathy.

Coronary heart disease – One of the most common causes of heart failure as it restricts the ability of the heart to pump blood adequately. It refers to the hardening of the arteries supplying blood to the heart due to the build-up of fatty deposits in the walls of the arteries.

Excessive consumption of alcohol and drug abuse

High blood pressure – The heart has to work harder to supply blood to the body. If the heart is unable to keep up with the pressure, heart failure can develop.

Others – Defects of the heart valves, and congenital heart disease (heart defects present at birth)

Symptoms

If you are suffering from heart failure, you may experience the following:

Shortness of breath resulting from fluid build-up in the lungs

Swollen feet, ankles and legs resulting from fluid build-up in the veins and body tissues

Chest pain (angina)

Fainting and dizziness due to inadequate blood and oxygen supply to organs and muscles

Fatigue due to inadequate blood and oxygen supply to organs and muscles

Sudden death

Treatment

Your doctor may recommend a combination of lifestyle changes, medication, and sometimes surgery to treat heart failure.

Lifestyle changes include:

Limit salt intake to help reduce swelling

Maintain a healthy diet

Quit smoking

Reduce or eliminate consumption of alcohol

Regular exercise (your doctor can recommend a specific exercise programme)

Medication:

To help eliminate excess fluid in the tissues

To help stimulate the heart’s pump action

To lower blood pressure

To correct arrhythmia

Surgery may be recommended by your doctor to correct heart abnormalities that cause heart failure. In cases of end-stage heart failure, your doctor might consider:

Ventricular Assist Device (VAD) – A mechanical heart device that helps the heart to pump oxygen-rich blood into the body. This device is placed into the patient’s chest but does not replace the heart.

Mechanical heart device or total artificial heart – This is a man-made pump that takes over the pumping action of the heart

Heart Transplantation
Valvular Heart Disease
Valvular heart disease refers to the disease of the heart valves. Heart valves act like doors to control the blood flow between the different parts of the heart. Valvular heart disease affects one or more heart valves, which then become damaged and do not function properly. Different valvular heart diseases involve different valves, and certain diseases can affect more than one valve.

Valve diseases can consist of congenital abnormalities (present at birth), or can be acquired later in life as a result of infection or degeneration.

There are 2 major types of valvular heart disease:

Valvular insufficiency, which occurs when the valve does not close tightly enough and causes backflow

Valvular stenosis, which occurs when the opening of the valve is smaller than normal, reducing the amount of blood that flows through

Causes

There are many causes that can lead to valvular heart disease:

Congenital (present at birth)

Degeneration of valve tissues with age

Drugs (migraine medication, diet pills) and radiation therapy (cancer treatment)

Heart attack, atherosclerosis (build-up of fatty deposits in arteries), and high blood pressure

Infections including rheumatic fever and infective endocarditis

Symptoms

Initially, you may not present with any symptoms even if the damage to your affected valve is severe. However, the symptoms can progress to include:

Fainting

Fatigue

Irregular heart beats

Shortness of breath on exertion

Swollen ankles

Treatment

Different treatments are available for different valvular heart diseases, depending on the valves involved and the severity of the damage. The treatments include:

Medication – it is important that regular follow-up is maintained to prevent recurrence

Balloon valvuloplasty is recommended for patients whose valves are narrowed. A tiny balloon catheter is directed to the target valve, which is inflated and deflated several times, until the valve opening is widened sufficiently.

Surgery may be needed when multiple valves are severely damaged and you may be referred to one of our interventional cardiologists or a cardiac surgeon:

Valve repairs can result in fast recovery from surgery, very good survival rates and may not need life-long medical therapy, whilst maintaining your original valves

Valve replacement is usually performed for more complex cases and where the valves are severely damaged. This can be a minimally invasive approach where the old valve is replaced with a new one.
Other Conditions We Treat
- Peripheral Arterial Disease
- Pregnancy related Cardiac Conditions
- Pulmonary Arterial Hypertension