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Doctor On Call (DOC): Dr Julian Tan – Ischemic Heart Disease (Part 1)

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Doctor On Call, or DOC for short, is a brand new series brought to you by Medical Channel Asia. This series aims to bring doctors and specialists from various fields to give you an introduction to common health and medical topics that you and the Asian population are interested in. In our 7th DOC, held on 19 Oct (Tuesday), from 8pm to 9pm (GMT+8), we have Dr Julian Tan, Interventional Cardiologist at The Cardiology Practice, to talk to us about Ischemic Heart Disease and how COVID-19 affects the heart.

This 3-part cardiology webinar series aims to educate the Asian population on the different aspects of cardiac conditions, ranging from the risk factors of heart diseases, to the most current updates on CPR, and the types of treatment options available after a heart attack.

For Part 1 of the forum, we have Dr Julian give us a short presentation on one of the most common heart disease: ischemic heart disease, and the treatment options available. In Part 2, Dr Julian answers some of the questions posted by our audience, both collated from the registration process, and also posted LIVE. Read below to find out what more about ischemic heart disease, and find out how COVID-19 can actually affect our hearts!

Presentation by Dr Julian Tan

Atherosclerosis – precursor to ischemic heart disease

Your blood vessels of the heart are clean and clear during birth. Overtime, there is a build up of plaque in the walls of the blood vessels. As these plaque accumulates, it can rupture and cause blood to clot, leading to heart attacks, due to the lack of oxygen flow to the area of the heart. This is the end results that we want to avoid eventually.

Symptoms to look out for heart attack

Chest pain is the most common. The chest pain associated with the heart is usually described as heavy, congestion feeling behind the chest/sternum. Usually you will be unable to pinpoint the spot.

It is also often associated with cold sweats and jaw or arm aching.

Men and women may differ in terms of presentation. Men usually will have the classical symptoms as mentioned above. Women may sometimes present with more vague symptoms, such as anxiety, back pain or nausea. But of course whenever in doubt and symptoms do not go away, it is best to seek medical attention.

Case report of a 29 years old Briton who passed away after collapsing during a marathon. Key message: preparation before the marathon is key. How do we prepare: a proper heart health screen is warranted, especially if you have been sedentary for the most of your life. There are 3 basic tests:

  • Electrocardiogram (ECG): a 2 second snapshot of your heart rhythm. It is safe and fast to do, but does not pick up all the heart diseases
  • Treadmill test: a continuous ECG monitoring as you are exercising on the treadmill machine. This gives cardiologists further information on whether there are narrowing of the arteries due to build up of plaque.
  • Echocardiogram: an ultrasound of the heart. This gives information in terms of heart structure and pumping strength, and also valvular problems (if any).

I would advice men above age of 40, and women above the age of 50, to do a proper heart health screen before embarking on such strenuous activity. Females are protected by the female hormones, before menopause occurs. Once menopause sets in, their risk of heart diseases equal that of men.

Real life example and case report of Dr Julian’s patient

Treadmill test was abnormal, but he did not know of the results before entering a marathon. An invasive coronary angiogram needs to be done to see where the blockage is at.

You can imagine the coronary arteries as a ‘water pipe’. Blood flows in this ‘pipe’ – turns out as black in the angiogram. The narrowing can then be seen on the angiogram, which happens due to the buildup of plaque. Flow of the blood is impeded.

Coronary angioplasty is done. It is basically putting in a stent into the arteries to open up the passageway to allow for the blood to flow freely.

Tips to prevent ischemic heart disease

Key ingredients of a healthy diet: fruits and vegetables. Basically a balanced diet to reduce the risks of ischemic heart disease. My advice to all my patients is that all food classes (proteins, carbohydrates, fats) are all essential for body’s building blocks, and hence all are necessary for body’s nutrition. The key is moderation, take them in small amounts, and in balanced way.

In addition, there are other risk factors that you need to be concerned of:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Smoking
  • Obesity
  • Sedentary
  • Genetics / family history – if your male first degree relative (i.e. father or brother) had a heart attack before the age of 50, and if its your female first degree relative having a heart attack before the age of 60.

Percutaneous Coronary Intervention (PCI) for ischemic heart disease

Also known as coronary angioplasty or coronary heart-stenting. This involves putting a small tube to the heart through your wrist, and we can then check the heart from there. The tube will have tiny balloons or a tiny wire mesh tube, that will prop open the plaques and widen the arteries.

COVID-19 and the heart

COVID-19 enhances and exaggerates the heart diseases. Patients with pre-existing heart diseases have an increased risk of worsening heart diseases when they catch the COVID-19 infection. The mechanism is still in debate, but generally speaking heart attacks are due to blood clots forming in the arteries, as a result of the rupture of the plaque. This can also be due to inflammation.

COVID-19 enhances inflammation. This can also lead to inflammation of the plaque and causing them to rupture more easily. Hence, people with pre-existing heart disease will have worse outcomes if they get COVID-19 at the same time.

What’s next in store?

  • See Part 2 for the Question and Answer (Q&A) segment with Dr Julian!
  • If you have missed our previous DOC webinars, visit our Medical Channel Asia’s YouTube page, or you can also read the articles in our cardiology series:
    • Doctor On Call (DOC): Dr Michael MacDonald – The Silent Killer Part 1, Part 2
    • Doctor On Call (DOC): Dr Jade Kua – DARE to Save a Heart Part 1, Part 2

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