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Dr. Tan Yong Seng , Consultant Heart, Lung and Vascular Surgeon


Heart Attacks! What You Should Know


Do you know heart attack and stroke together is the number one killer in Singapore?

One in five people has coronary heart disease and one in 24 suffers from stroke.

Are you at risk of getting coronary heart disease/Heart attack? The risks are higher if you are older age, male gender/ postmenopausal woman or have a bad family history.

For heart health assessment, we evaluate your global risks which include your weight, BMI, waist circumference, blood pressure, blood lipids, blood glucose, smoking and stress level.

Unhealthy lifestyle (dietary imbalance and lack of exercise) is the root cause of coronary heart disease.

Signs and Symptoms

Chest pain/ arm pain/jaw pain/ breathing difficulty/irregular heart beat/leg swelling/poor appetite /lethargy/ weakness are the usual complaints in heart patients.

For women, the symptoms are often quite different and more subtle. They are likely to experience symptoms like: unexplained weakness or fatigue, anxiety or unusual nervousness, indigestion or gas-like pain between the breasts or beneath the breast bone, discomfort/pain between the shoulder blades, neck, jaw or stomach.

People who have diabetes do not “feel” heart pain in the same way and, consequently, have a greater risk of experiencing a “silent” or unrecognized heart attack.

Impending heart attack symptoms include prolonged duration of chest pain, sweatiness, cold hands/feet, and giddiness, shortness of breath; irregular heart beat or even loss of consciousness/collapse.

If you suspect you are having a heart attack, go to the hospital immediately. Time is muscle!!!


Many different tests are available to assess one’s heart status. Each test has its own sensitivity/specificity.

It is important to have a complete heart assessment if you are > 40 years old or have one or more risk factors for coronary heart disease.

Treatment for Coronary Heart Disease

A patient's life depends on successful treatment of coronary artery disease. For some people, careful lifestyle changes and medications can control the disease. In more serious cases, balloon angioplasty, stenting or bypass surgery may be required. In any case, the disease requires lifelong aggressive risk factors management.

Types of Therapy

1. Lifestyle changes

One of the best ways to treat coronary artery disease is to change one's habits.

These include:

a. Diet change

Foods that taste good are not necessarily good for the body, especially in patients predisposed to developing atherosclerosis. Fats, particularly saturated fats, cause high levels of blood cholesterol, a primary ingredient of the deposits that clog arteries.

Being overweight also leads to high blood cholesterol. Therefore, losing weight is a major step to a healthier heart and blood vessels. Patients should concentrate on adding fruits and vegetables to their diet. One or two servings of fish per week are also beneficial.

b. Exercise
Exercise helps a body remove excess weight and build a stronger circulatory system, thus decreasing the risk of death from coronary artery disease. Patients with advanced forms of the disease may need to limit their exercise, and should check with their doctor for special advice.

2. Medications

Medications can also help prevent the progression of coronary heart disease. Other drugs can improve blood flow to the heart if the disease is already present. Some of the more common medications include:

a. Cholesterol-lowering drugs
By decreasing the amount of cholesterol, especially LDL (low-density lipoproteins, the "bad" form of cholesterol), these drugs decrease the primary material that make up deposits that narrow or plug coronary arteries. Examples of these drugs are niacin, statins, fibrates and bile acid sequestrants. Some foods and margarines are now available with special cholesterol-lowering ingredients.

b. Aspirin
This common medication and other blood thinners can reduce the tendency of blood to clot, reducing the likelihood that a coronary artery will be blocked, causing a heart attack. Other antiplatelets agents or anticoagulants may be prescribed as well.

c. Beta-blockers
These drugs help slow heart rates and decrease blood pressure, which lowers the heart's demand for oxygen.

d. Nitroglycerin
This medication, as a tablet, spray or skin patch, controls chest pain (angina) by opening coronary arteries and improving blood flow to the heart muscle.

e. Calcium channel blockers
These drugs also help open coronary arteries to increase blood flow to the heart muscle. They also control high blood pressure and lower the heart rate.

f. Angiotensin-converting enzyme (ACE)
These drugs widen the arteries in the body, allowing blood to flow from the heart to the body more easily and decreasing the workload on the heart.

3. Coronary angioplasty

Angioplasty involves moving a balloon-tipped catheter to the coronary artery obstruction, then inflating the balloon to widen the artery opening.

In patients where drugs or lifestyle adjustments cannot relieve the chest pain, heart catheterization and coronary angioplasty may be done to open up the blocked coronary artery. A thin, flexible tube (catheter) that carries a small inflatable balloon at its tip is threaded through an artery from the groin or arm into the blocked coronary artery. When the balloon reaches the obstruction, it is expanded to push the vessel wall out. In some cases, a small wire tube (stent) is placed in the artery to keep it from growing closed again. If a re-blockage occurs, it can often be opened up again with the same procedure. Currently, there are 2 types of heart stents: bare metal or drug coated stents.

4. Coronary artery bypass grafting (CABG)

Coronary artery bypass grafts create a detour to reroute the blood around blockages (in yellow).

In patients where angioplasty cannot be done because it is too risky (especially when more than one or two blockages are present or the heart's pumping function is low), coronary artery bypass grafting may be necessary to correct the problem.

This treatment works by creating a detour for the blood to go around the blockage. In this procedure, a short piece of blood vessel is taken from some other location in the body (usually a vein from a leg) and is connected to the aorta on one end and to the heart muscle downstream of a blockage on the other. Blood flows through this "bypass" to nourish the heart. If more than one artery is blocked, a bypass can be performed on each. This type of operation was first done in 1969 in United States; doctors now perform about 800,000 bypass operations every year world wide. The risk of surgery for patient with normal heart function is less than 1-2 %. Length of stay in hospital for open heart surgery is between 6-8 days.

There are many newer techniques available in heart surgery such as less invasive vein harvesting and beating heart surgery.


Prevention is always better than cure. Early prevention requires early diagnosis, so that early therapy can be given.

Make an appointment to see a heart specialist for thorough assessment. Most things can wait but not your health.

Date Posted : 2009-07-15 11:45:15