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Conditions We Treat

  • Heart Conditions

    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

    abdominal aortic aneurysm infographic

    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)
    • Death
    • Organ damage (including kidneys, intestines, heart, brain)
    • Stroke, which may lead to paralysis

    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:
      1. Ageing
      2. Drug use
      3. 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

    carotid arteries x-ray

    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

    • Death
    • Muscle weakness and paralysis
    • Permanent brain damage

    Causes

    The causes of carotid artery disease include:

    • Modifiable causes
      1. Obesity, diabetes, high blood pressure, and high cholesterol can increase the risk of carotid artery disease
      2. Smoking, lack of exercise and an unhealthy diet
    • Non-modifiable causes
      1. 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
      2. Family history of the disease
      3. 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:
      1. Limit alcohol consumption
      2. Maintain a healthy diet
      3. Maintain control of your blood pressure, diabetes and other heart diseases
      4. Quit smoking
      5. 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

    complex congenital heart disease fallot's tetralogy infographic

    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
    • Fallot's tetralogy
    • 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:
      1. Down syndrome, DiGeorge syndrome, Marfan’s syndrome and Turner syndrome
    • Environmental factors can lead to congenital heart disease:
      1. 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

    fatty deposit build up in coronary artery disease infographic

    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:

    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:
      1. Control your blood pressure, blood cholesterol and diabetes with regular exercise and weight control
      2. Maintaining a healthy diet
      3. 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:
      1. 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
      2. 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

    how arrhythmia causes irregular heartbeat infographic

    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:

    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:
      1. Quit smoking
      2. Avoid activities that trigger irregular heart beat
      3. Limit consumption of caffeine
      4. Avoid stimulants used in cough and cold medications
    • Medications:
      1. Anti-arrhythmic drugs to control heart rate
      2. Anticoagulant therapy (blood thinners) to reduce blood clot formation
    • Electrophysiology studies (EP). Performed under a local anaesthetic, this procedure allows your doctor to stimulate the heart with controlled electrical pulses, which locate the source of the block or irregular beat
    • Catheter ablation usually cures arrhythmia and is primarily done post-EP studies and when medication is not effective or is not convenient. It works as follows:
      1. Several thin tubes (catheters) with electrodes are inserted into the blood vessels and directed into the heart
      2. 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:
      1. 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

    what happens during heart attack infographic

    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:
      1. Lifestyle factors like smoking, lack of exercise and an unhealthy diet
      2. Treatable conditions including high blood pressure, high cholesterol and diabetes
    • Non-modifiable risk factors:
      1. 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)
      2. 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:
      1. Anticoagulants to dissolve blood clots
      2. To reduce the risk of another heart attack
      3. To relieve chest pain
      4. 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:
      1. A healthy diet (limit salt intake to help reduce swelling)
      2. Maintain a healthy diet
      3. Quit smoking
      4. Reduce or eliminate consumption of alcohol
      5. Regular exercise (your doctor can recommend a specific exercise programme)
    • Medication:
      1. To help eliminate excess fluid in the tissues
      2. To help stimulate the heart’s pump action
      3. To lower blood pressure
      4. 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:
      1. 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.
      2. Mechanical heart device or total artificial heart – This is a man-made pump that takes over the pumping action of the heart
      3. Heart Transplantation
  • Valvular Heart Disease

    healthy heart valves and diseased heart valves infographic

    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:
      1. 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
      2. 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

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