Article contributed by Dr Woo Jia Wei, Consultant Cardiologist from Sunrise General Medical and Heart Service. In this interview with Dr Woo, we learn important facts about heart and cardiovascular diseases such as heart attacks and cardiac arrests.
Cardiovascular diseases rank as the top few biggest killers locally, coming in second after cancer and as a top killer among women in Singapore. According to statistics by Singapore Heart Foundation, almost 1 in 3 deaths is due to heart diseases or stroke. Cardiovascular diseases are also the top disease burden in Singapore, responsible for ~20% of the total disease and injury burden. The risks for cardiovascular disease increases markedly with age. Thus, awareness of cardiovascular diseases for risk and disease management purpose among seniors is highly important.
We approached Dr. Woo Jia Wei – Consultant Cardiologist at Sunrise General Medical and Heart Services to learn more about cardiovascular and heart diseases, especially among elderlies in Singapore. Aside from helming Sunrise General Medical and Heart Services, Dr. Woo is also a Visiting Consultant Cardiologist to National University Heart Centre Singapore. Trained in Melbourne and having worked in Australia and Singapore, Dr. Woo specialises in advanced cardiac imaging using echocardiography, adult general medicine, community, and preventive cardiology.
1. What are Heart Disease and Cardiovascular Disease? Are they the same?
“Cardio” means heart and “vascular” means blood vessels. Cardiovascular diseases refer to diseases of the heart as well as blood vessels. All heart diseases therefore are cardiovascular diseases; but not all cardiovascular diseases are heart diseases, though they can be highly related. For example, atherosclerosis – a condition of the blood vessel in which the arteries harden due to accumulation of plaque, commonly referred to as coronary artery disease – can make it difficult for the heart to get sufficient blood supply, which in turn may cause heart attack.
2. What are the Most Common Heart Diseases in the Elderly?
Common heart diseases in the elderly would include degeneration of the aortic valve, the conducting system in the heart leading to low heart rates, as well as coronary artery disease.
The aortic valve is a part of the heart which controls blood flow through and from the heart. Degeneration of the aortic valve can manifest as shortness of breath, dizziness, and fainting. This can either be treated by open heart surgery or via a minimally invasive procedure that involves making a small puncture in the groin. Untreated aortic valve diseases can lead to heart failure or severe infection.
The conduction system is a sophisticated system in the heart responsible for regulating the heart’s blood pumping activity. Degeneration of the conduction system most commonly leads to low heart rates, making the heart unable to generate enough blood flow to the brain. As a result, patients feel faint and dizzy and should avoid medications that further slow down the heart rate. In some circumstances, a pacemaker insertion may be considered to help the heart pump faster.
Elderly individuals also have a heightened risk of having a heart attack. As humans age, more calcium deposits tend to accumulate on the walls of the blood vessels. Calcium deposits, together with cholesterol deposits make the blood vessels more vulnerable to a sudden blood clot formation which can cause either a stroke or heart attack.
3. Talking about Stroke and Heart Attack, How are they Similar and Different?
A stroke can be thought of a “brain attack”. Stroke and heart attack both happen when there is a lack of blood flow to the brain or the heart, respectively. They are similar in the sense that they both affect critical parts of the body.
Most heart attacks and one type of stroke called ischemic stroke share the same cause, which is blockage in an artery. Both heart attack and stroke are emergencies, requiring prompt medical intervention to save lives and preserve heart and brain function.
Their symptoms however are different. Most common early symptoms of a heart attack may include chest pain and difficulty breathing. A heart attack can sometimes produce subtle symptoms and the patient may simply feel that “something is not right”. It may or may not be sudden. Stroke often presents itself with symptoms such as sudden weakness or numbness in the area of the face or limb, often in one side of the body, slurred speech, trouble understanding speech, lack of coordination. (More about stroke signs and symptoms in our in-depth article here.)
Treatments are also different of course.
4. What Causes a Heart Attack? How does a Heart Attack Happen?
A heart attack occurs when there is a sudden lack of oxygen to the heart due to sudden occlusion of the blood vessels to the heart leading to a lack of oxygen supplied to the heart. A heart attack can also occur when certain processes such as an infection demands an increase in oxygen supply in the heart which far exceeds the amount of oxygen that can be supplied.
Sudden blockages of the blood vessels are most often due to a formation of a blood clot which obstructs the flow in the blood vessel. This is most commonly due to a ruptured cholesterol plaque on the vessel wall which leads to the rapid formation of a blood clot in the area. Less commonly, they can be due to a clot migration from another part of the vasculature to the coronary artery.
5. What are the Common Symptoms of a Heart Attack?
A heart attack can cause several symptoms including pain in the center of the chest and shortness of breath. Patients may also feel faint or dizzy. Symptoms of a heart attack may be gradual or sudden. Chest pain may persist for days before the patient realizes they may have a heart attack and visit a Cardiologist or the hospital.
6. Are a Heart Attack and a Cardiac Arrest Related or Different?
A cardiac arrest happens when the heart beats irregularly, causing irregular blood supply to the heart and other parts of the body, whereas a heart attack happens when blood cannot be transported to the heart due to blockage. Cardiac arrests can happen because of a heart attack. In severe cases of heart attack, the pump function of the heart may be impaired leading to low blood pressure and poor oxygen supply to the whole body.
Both heart attacks and cardiac arrests are emergency situations.
7. You mentioned earlier that Senior Adults are at Greater Risk of Heart Diseases. Aside from Age, What are the Other Risk Factors?
The risk of heart attacks would depend on individual risk profiles which are dependent on traditional cardiovascular risk factors such as smoking, high cholesterol, high blood pressure and diabetes. Other risk factors would include having end stage kidney disease and peripheral vascular disease.
8. How are Heart Attacks Treated?
A heart attack can be treated promptly with medications and a medical procedure called Percutaneous Coronary Intervention (PCI) or Coronary Angioplasty. The procedure involves accessing the heart arteries either via a small incision in the wrist or groin. After accessing the heart arteries, the area of blockage can be identified and can be opened up with a balloon. A stent can then be deployed at the area to further stabilize the blood vessel.
Patients often need to follow up with medication and cardiac rehabilitation after a heart attack is treated, to restore their heart functions and get them back to full life. Self-monitoring and risk factor management are important to prevent recurrence.
9. What are the Consequences of a Heart Attack being Left Untreated for Elderly?
The consequences of a heart attack being left untreated for the elderly would depend on other medical conditions that they may have existing.
For stronger elderly patients with stronger reserves, the consequence of a heart attack being left untreated may increase the risk of sudden cardiac death within the first few hours after a heart attack. It may also lead to irreversible damage to the heart muscle which can cause issues such as heart failure and dangerous heart rhythms down the track. The extent of treatment suitable for the elderly would depend on their reserves.
However, for elderly who are more frail with other medical conditions, the risks of heart attack treatment itself may potentially cause harm to the elderly. An example is an elderly patient with a high bleeding risk. Treating them with blood thinning agents for their heart attack may lead to massive life-threatening bleeding in these individuals.
Hence, medical treatments for heart attacks must be tailored to each elderly individual depending on their risk profile.
10. What should we Do when Someone is Suspected to have a Heart Attack or Cardiac Arrest?
If someone is suspected to have a heart attack, it is very important for medical assistance to be rendered as soon as possible. If there is a cardiac arrest, immediate bystander CPR has to be performed immediately while arranging for an ambulance. Thus, it is very important to be equipped with basic life saving skills such as CPR.
11. How can we Prevent Ourselves and Loved Ones from Heart and Other Cardiovascular Diseases?
Cardiovascular diseases can be prevented through long term good lifestyle habits which should ideally start from a young age. However, it is never too late to start these habits. Regular exercise for at least 150 minutes of aerobic activity a week is highly recommended. This approximately translates to exercising for around 50 mins each time at least 3 times a week. A healthy diet of at least 4 to 6 servings of fruits and vegetables can be helpful. Long term consumption of good oils such as olive oils and canola oils can also help prevent cardiovascular diseases.
Senior adults with known related conditions such as high cholesterol, high blood pressure or diabetes, as well as those with personal and family history of cardiovascular diseases should conduct screening for cardiovascular diseases to manage their risks. At home, self-monitoring and in certain cases, lifelong medication is necessary to keep our heart and cardiovascular system healthy.
Thank you for your valuable sharing, Dr. Woo Jia Wei!
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After initial assessments by Ninkatec’s Cardiologist, eligible patients will be monitored with suitable systems with 24/7 support from the Cardiology specialist team. Depending on severity of the patient’s condition, a combination of the following services might be recommended:
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