Wednesday, December 13, 2006

What you should know about Cardiovascular Disease

Today's big health news is that Singaporeans only have a vague idea about how to prevent heart disease. So I have decided to write a series of blogs on the factors that affect the health of your heart and what you should do. Let me first start by giving you a real life scenario:

Mr M was a 42 year old patient of mine who has a history of high blood pressure and cholesterol. When I first saw him about a year ago, he was perfectly well, aside from high blood pressure and high cholesterol. He suffered no symptoms at all. He told me that he previously had an excercise stress test that showed some minor irregularities but he has not followed up on it. My advice to him was that he should go for a repeat excercise stress test and referred him to a cardiologist for follow up.

The months went by, and Mr M delayed going to the cardiologist because he felt he had no symptoms and did not want to do another stress test. I don't blame him, because in an excercise stress test, you go on a thread mill and have to run for a period of time. (How many of us like to do that?)

I finally suggested an alternative which was to do a 3D CT scan of the heart to look at the blood vessels of the heart which he finally agreed to do. An example of the 3D CT scan is shown above.

The 3D CT showed that his main artery was critically blocked and that his other 2 arteries have also narrowed. This means that at any time, he might suffer a massive heart attack. Within a week he had open heart surgery and had a 6 vessel bypass! The 3D CT scan had saved his life.

How you get a Heart Attack and Stroke

Cardiovascular problems (Cardio - heart, Vascular - blood vessels) are one of the biggest killers in Singapore. They occur when because of certain factors the blood vessels to the heart and brain narrow and eventually blood supply to these vital organs are cut off. The result is a heart attack or a stroke.

What are the Risk Factors for Heart Disease?

Below are the risk factors for Heart Disease, I like to divide them into 3 groups.

Group 1: Those things you can't do much about.

1. Male - if you are a man your risk goes up
2. Age - Men above 45 and women above 55 have higher risk
3. Genetics - If your parents have heart disease, you are at higher risk

Group 2: Those things you can do for yourself

1. Smoking - Stop smoking! Smoking dramatically increases risk of cardiovascular diseases
2. Alcohol - Too much drinking will also increase risk.
3. Obesity - Diet and Excercise and keep your weight to below a BMI of 23!

Group 3: The things you should consult your Doctor:

1. Hypertension - The silent killer, you may not feel any symptoms and the damage is gradual
2. Diabetes
3. Cholesterol levels

The bottomline is this: Prevention is better than cure and you should visit your doctor to discuss with him about how to prevent heart disease!

In the meantime, if you know your cholesterol and blood pressure readings, you may wish to calculate your 10 year risk of getting a heart attack by clicking this.

More information about Cardiovascular Risk Factors are found here

My next Blog in the Cardiovascular Health Series will touch on Cholesterol and how to read your cholesterol report.


Anonymous said...

Hi Leslie, whats the difference between a 3D CT, CT Coros and a Calcium Score?
I see more CT coros being done nowadays though Coronary Angiogram is still the preferred test by the cardiologists.

Anonymous said...

hi leslie..can u explain this statement to me..thks

the thoracic aorta is unfolded . the right superior mediastinal shadow is attributed to the innominate artery


Anonymous said...

What's the best test to have to see if my arteries are in good shape? Will a simple blood pressure test do or must it be something more advanced like a exercise stress test?

Dr Leslie said...

A blood pressure test does not tell you whether your arteries are in good shape. Whether you should do an excercise stress test will depend on individual risk factors and history. This is something you need to discuss with your doctor. What can be done in the clinic is an ECG but this won't give you as much info as an excercise stress test or a 3D CT scan

Anonymous said...

Thanks Leslie. Can I get an exercise stress test at any hospital or must I visit a cardiologist? I'm 32, 1.75m and 72.5kg. I exercise regularly and have quit smoking for 2.5 months. Is it a good time to go for a exercise stress test?

Dr Leslie said...

Perhaps you can write to I am sure you don't feel comfortable with publishing your figures in public! The excercise stress test can be organized by your Family Doctor.

Anonymous said...

Hi Dr Tay,

I've recently been diagnosed to have hypertension, but im not very sure if my diagnosis is right. My BP whenever measured at the clinic is consistantly around 160/80. At home, when i monitor my blood pressure it seems to fluctuate a great deal. In the day after running around the house and doing chores it would be about 140-150/70 but when i take it at night before bed it drops to a normal range of 100-110/70. But during the day when my BP is elevated, I do experience some fatigue. I hope you could give me some advice on whether i should start on atenalol or not. Thank you!

Dr Leslie said...

Perhaps you should consider doing a 24 hour BP monitoring. Your doctor should be able to arrange it for you.

Anonymous said...

So even if i do a 24hr BP monitoring, what would warrent me to take medication to lower my blood pressure? does my blood pressure have to be persistantly elevated even when i sleep to start medication? or so as long as it is elevated for most of the day i should start taking medication? Thanks so much for your advice!