Heart disease and stroke are the leading causes of death in Singapore; it is estimated that 17 people die from cardiovascular disease each day. This means that around 1 in every 3 deaths in Singapore is related to heart disease in some way, and while this statistic is startling, it is also unnecessary and preventable. Early detection and treatment significantly reduce the risk of death due to heart disease or stroke.
What is Heart Disease, and Who Gets it?
Heart disease is an umbrella term for a range of cardiovascular diseases and conditions which have varying symptoms but one key thing in common; they primarily affect the functioning of your heart. There are many different forms of heart disease, but the most common are:
- Coronary Artery Disease (CAD): CAD is a result of plague build-up in the arteries which feed the heart and is often called ischemic heart disease. Symptoms include chest discomfort, fatigue dizziness and fainting.
- Atherosclerosis: Atherosclerosis occurs when the arteries harden and become inflexible causing coronary artery disease, stroke and high blood pressure.
- Cardiomyopathy: Cardiomyopathy is a disease which causes a weakening or hardening of the heart muscles, resulting in heart failure.
- Arrhythmia: Arrhythmia is a disease which causes the heart to beat abnormally or in an irregular manner and leads to dizziness or fainting or increased risk of stroke.
- Congenital Heart Defects: Congenital heart defects are irregularities or deformities in the heart which are present at birth and can cause a number of symptoms including swelling, cyanosis, and tachycardia (a rapid heartbeat).
There is a common misconception that only elderly people are likely to suffer from heart diseases but the reality is that while older people are most at risk, anyone can suffer from heart disease. Some people are born with it, others face it as a result of other co-occurring conditions. However, for most people, heart disease is preventable and treatable when detected early.
The Leading Causes of Heart Disease
Though they fall under the same category, heart diseases are not all the same. Congenital heart defects, for example, are a result of what happens in the womb and can be hereditary while CAD is often caused by poor lifestyle and unhealthy habits. Other forms of heart disease can occur as a result of diabetes or as a side-effect of medication for pre-existing conditions unrelated to the cardiovascular system (e.g. cancer treatment). Some heart diseases are therefore, not preventable but the leading cause of preventable heart diseases are:
- Sedentary lifestyle or Physical inactivity
- Poor diet choices such as a consistently high-sodium diet, or high trans-fat diet
Leading a healthy, active life will reduce your chances of developing preventable heart disease, but regular screening can increase your chances of detecting and treating heart diseases before they become a major problem.
How Regular Heart Screening Could Save Your Life
Being diagnosed with heart disease does not necessarily translate to a death sentence. Regular heart screening helps against the most serious complications which are associated with heart disease. With the right treatment, it can be managed or even resolved effectively.
The Risks of Untreated Heart Disease
Undiagnosed, ignored, untreated or under-treated heart diseases poses a number of risks to health and wellbeing. The potential side effects and consequences of untreated heart diseases vary in severity. Short-term, lower severity symptoms of undiagnosed heart disease include, but are not limited to:
- Chest discomfort
- Dizziness, in more serious situations, fainting
- Reduced exercise effort tolerance
Consequences of undiagnosed, ignored, untreated or under-treated heart diseases include:
- Sudden death
- Cardiac arrest
- Heart attack
- Heart failure
- Peripheral artery disease (PAD), including sexual dysfunction (erectile dysfunction)
Each of these consequences pose a greater risk of long-term damage to your health and the possibility of premature death. However, the early detection of heart disease can reduce the likelihood of these consequences.
Cardiac Screening and Early Detection
While it used to be difficult for doctors to tell who was at risk of developing heart disease in later life, modern medical science has made it possible for cardiologists to identify those who are at higher risk before they develop serious symptoms or consequences of heart diseases. The primary goal is to identify conditions such as atherosclerosis while they are still potentially reversible and therefore prevent its progression.
Identifying heart disease early and beginning treatment before onset of symptoms and consequences can reduce risk of more severe symptoms and premature death.
Types of Cardiac Screening
Cardiac screening tests can take many forms and may include blood or urine tests, as well as non-invasive imaging tests which show the inside of the body.
The most common types of cardiovascular tests which may be employed by your cardiologist include:
Electrocardiography (EKG or ECG): An ECG or EKG measures electrical activity in the heart to reveal information on the beats per minute and rhythm of beats.
Ankle-Brachial index (ABI): ABI is the ratio of the blood pressure at the ankle to the blood pressure in the upper arm (brachium). Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease
It is recommended that the ankle brachial index (ABI) be considered as a screening test for individuals with high risk for peripheral artery disease. The risk factors for peripheral artery disease are similar to those for coronary artery disease.
Cardiac Stress Test: A cardiac stress test, also known as a cardiac exercise stress test, measures blood pressures and the electrical activity of the heart as well as its rhythm during exercise of increasing intensity. This most commonly takes place on a treadmill. It can be used for assessing heart fitness and prescribing exercise as treatment for common conditions like high blood pressure, high cholesterol and diabetes mellitus. It can be used to assess severity of heart blockages.
Echocardiography: Echocardiography uses ultrasounds to create a moving picture of the beating heart. It is used for analysis of heart size, shape and function.
Cardiac CT (for Calcium Scoring): A cardiac CT examines the coronary arteries to test for abnormally elevated levels of calcium, which is a surrogate indicator of the amount of plaque in the arteries. This test can be used as a preliminary assessment for coronary artery disease. However, a cardiac CT cannot indicate the severity of artery narrowing, called stenosis.
CT Coronary Angiography (CTCA): A CTCA creates 3D images of the coronary arteries and heart via the external imaging of an injection of intravenous contrast material or dye. It is very useful in cardiac evaluation, as it will reveal the coronary anatomy, and the presence or absence of coronary artery plaques, including its severity.
With the above investigations, there will be an assessment to see if there is a need to progress to invasive coronary angiography (ICA).
Invasive Coronary Angiography (ICA): This involves arterial puncture and injection of a contrast dye followed by X-ray of the dye flow. It allows for a more detailed identification of blockages and plague build-ups. With the advent of CTCA, ICA is usually a prelude assessment for the need of percutaneous coronary intervention (PCI), commonly known as stenting or coronary artery bypass (CABG).
Who Should Go For Heart Screening?
It is recommended that everyone should begin screening for risk factors for heart disease, and counselled on good heart health habits like abstinence from tobacco use, safe regular physical activities, and heart healthy diet from the age of 18 years old.
Blood checks for lipid status and presence of diabetes mellitus should be checked from aged 40 years old. It should be checked from 18 years old if the individual has risk factors for heart disease.
Routine ultrasonographic screening of men 65 years and older for abdominal aortic aneurysm may be considered, particularly in those who have ever smoked (current and former smokers)
Subsequent types and frequency of evaluation will depend on the initial evaluation assessment.
Conventional management strategies usually involve more evaluations if initial tests are not within normal risk ranges, and more frequent follow-up visits for individuals with more medical issues, be it risk factors or actual medical conditions.
Preventative Treatments for Early Stage Heart Disease
Regular and comprehensive screening at clinics is important in identifying the onset of heart disease or risk factors for heart disease. When screening highlights a developing issue or shows that a patient is in the early stages of heart disease, there are a number of treatment options open to a physician and their patient. The most obvious of these preventative treatments is a change in lifestyle. Drinking less alcohol, quitting smoking, eating moderately, and being more physically active are some of the best preventative treatment options for those in the early stages of heart diseases such as CAD or high blood pressure. However, it may not be enough to hold off or treat other forms of heart disease. But of course, a healthy lifestyle is good for your overall cardiovascular health.
When lifestyle modification won’t do, medication is often the next step. The type of medication prescribed depends on the type and severity of the condition in question. You will need to discuss with your cardiologist on the reasons for your medications, weighing the benefits and any potential side effects or risks.
In situations where a condition has progressed beyond the help of medicine, more invasive strategies like putting in stents, or pacemakers or cardiac surgery may be indicated.
Regular Heart Screening Could Save Your Life!
Taking care of your heart is so important to your overall health and wellbeing, and while no-one likes to spend too much time at the doctors, a simple screening with a heart specialist could be instrumental in saving your life!
Take steps to protect your future by protecting your heart. Make a booking for a heart evaluation today!
Gerard Leong Cardiology Clinic
Thomson Medical Centre
339 Thomson Road #05-05
Phone : 6717 0008