Reviewed by Dr Woo Jia Wei, Sunrise General Medical and Heart Service
According to the latest statistics, there were 4,031 deaths caused by ischemic heart disease (loosely understood as heart attack) in Singapore in 2019. Total number of mortality related to cardiovascular disease reached 6,291 deaths in the same year. Across the island emergency departments received estimatedly 33 heart attacks and 21 strokes every day.
The numbers do not show signs of slowing down. As the population ages, we see a concerning rise in the prevalence of cardiovascular risk factors, including diabetes, high blood pressure, and dyslipidemia (e.g., high cholesterol, high triglycerides). Overall, cardiovascular diseases including heart diseases are the third-leading cause of death in Singapore, preceded only by cancer and pneumonia.
In this article, we cover the different types of heart diseases, their signs and symptoms as well as major risk factors, particularly the role of cholesterol in your risk profiles. Having knowledge of common heart diseases is the first step you can take to prevent yourself and elderly loved ones from the diseases. If you find the terminology for heart and cardiovascular diseases complex, fret not! This article will also demystify and clarify some of the common terms for you.
I) The different types of heart and cardiovascular diseases among elderlies
Heart and cardiovascular conditions are sometimes used interchangeably by the general public; but they are not the same. Cardiovascular diseases is an umbrella term that encompasses a whole range of ailments that affect the heart and blood vessels. Heart conditions only refers to diseases of the heart. Heart diseases however are highly related to cardiovascular conditions, due to the susceptibility of blood vessels to many types of heart conditions.
Senior adults are vulnerable to cardiovascular diseases due to accumulation of damage to the heart from exposure to risk factors over a lifetime, and degeneration in parts of the heart as part of the aging process.
In this article, we discuss the 5 heart conditions that are common among elderly individuals in Singapore, including heart attack, cardiac arrest, congestive heart failure, cardiac arrhythmias, and valvular heart disease. Two cardiovascular conditions commonly observed among seniors are degeneration of the aortic valve and degeneration of the conducting system in the heart leading to low heart rate have been covered in our earlier article here.
1. Heart Attack
A heart attack, medically known as myocardial infarction (MI), often happens suddenly, causing irreversible impact to the heart and even death.
How does a heart attack happen?
The heart needs oxygenated blood to function. The coronary arteries are responsible for delivering oxygenated blood to the heart muscle. In some individuals, the artery is blocked, due to a fatty structure known as the atheroma or atheromatous plaque which has over time formed inside the vessels of the coronary arteries. When a coronary artery gets completely obstructed, blood can not reach some parts of the heart. As a result, the area in the heart without any blood supply will starve and die. This is called a heart attack.
Early signs of a heart attack
When the heart doesn’t receive sufficient blood supply, the heart muscle is usually strong enough to withhold the lack of oxygen and nutrients for some time. However, there could be early signs. By recognising these signs and symptoms of a heart attack, you can act quickly to receive timely medical attention. Here are the early signs and symptoms of a heart attack:
- Chest pain or discomfort
- Stomach pain
- Pain in your arm
- Difficulty breathing
- Getting tired quickly
Treatment of a heart attack
A heart without blood supply may be damaged quickly; thus people having a heart attack or suspected to have a heart attack need immediate medical treatment. The treatment of heart attack primarily focuses on alleviating the obstruction in the blood vessel. Depending on the severity of the cases, we can achieve this by drug to break down the clot obstructing the blood vessel, or procedure called Percutaneous Coronary Intervention (PCI) or Coronary Angioplasty (also called heart cath, cardiac cath, or cardio angiogram) to destroy the clot and restore normal blood flow to the heart muscle.
2. Congestive heart failure (CHF)
Congestive heart failure often referred to as heart failure, is a chronic condition involving the malfunction of ventricles of the heart – the compartments responsible for pumping blood out of the heart. CHF is often the result of decades of unhealthy lifestyle choices that gradually wreaks havoc on the heart’s chambers.
How does a congestive heart failure happen?
The heart has 2 ventricles. The left ventricle is responsible for pumping oxygenated blood to the body while the right one is responsible for pumping deoxygenated blood to the lung. The most commonly affected compartment in CHF is the left ventricle, leading to a dilated heart chamber that is unable to properly pump blood. As a result, blood and fluid quickly build up in parts of the body such as limbs, abdomen, lung or liver and medical intervention is required urgently.
Early signs of a congestive heart failure
Signs and symptoms of this chronic condition manifest differently through stages of the disease. Early warning signs of a heart failure may include shortness of breath, fatigue, loss of appetite, swelling, persistent coughing when fluid builds up in the lung, chest pain, and temporary loss of consciousness. Individuals suffering from chronic blood hypertension, valve diseases (e.g., stenosis, regurgitation), and genetic conditions (e.g., Marfan syndrome) are more likely to develop CHF.
Treatment of congestive heart failure
Depending on the stage of the disease, the severity of the symptoms and therapeutic approach will vary. At an early stage, depending on how CHF affects the individuals, doctors can prescribe lifestyle modifications and pharmacological drugs such as drugs to slow down the heart rhythm, or drugs to improve blood flow, or diuretics to reduce fluid retention in the body. However, as the disease progresses, patients may require cardiac transplantation to replace the defective heart.
3. Heart rhythm problem (Cardiac arrhythmias)
Arrhythmias are sometimes simplified and referred to among the general public as irregular heartbeat. This umbrella term covers a diverse range of more than a dozen categories of conditions, involving too fast or too slow heartbeat, presenting with palpitations, syncope, and other general symptoms.
How does a heart rhythm problem happen?
It is a common condition among elderly adults, resulting from an irregular electrical activity in the heart muscle and may cause a heart failure or stroke down the road. Atrial fibrillation is the most common type of heart rhythm problem among adults over 65 years old.
Signs and symptoms of heart rhythm problem
Heart rhythm problems sometimes do not show any signs and symptoms. Patients often find out they have heart rhythm problem from ECG test. Other times, they just feel their heartbeats are irregular, or their chest tightening, or a dizzy, light-headed sensation. In a few cases, heart rhythm problem is discovered when a complication such as stroke or heart failure happens.
Treatment for heart rhythm problem
Treatment for cardiac arrhythmias aims to manage heart rate and prevent complications. It often involves the prescriptions of antiarrhythmic medications, the implantation of pacemakers, and in some cases, surgical procedures.
4. Valvular heart diseases
This group of diseases involve the malfunctioning of the heart valves. There are 4 valves inside the heart that get affected in two ways:
- Restricted valves that do not open properly (valvular stenosis)
- ‘Floppy’ valves that do not close properly (valvular regurgitation)
How does a valvular heart disease happen?
As the body and the heart ages, the heart valves may be less efficient, causing valvular heart diseases. They can happen as a result of an infection or other heart diseases that damages the heart valves. Other cases are congenital.
When the valves are affected in either of the two ways above, the heart can’t pump blood properly, leading to an overworked heart. Blood may also leak during the process, leading to other heart conditions such as heart failure, cardiac arrest (more about this in the next part), and even death. The most commonly affected valves are the mitral and aortic valves – the 2 valves connected to the left ventricle which is responsible for receiving and pumping oxygenated blood.
Common signs and symptoms of valvular diseases:
- Heart murmur
- Cardiac arrhythmias
- Shortness of breath
- Swollen ankles
- Signs and symptoms of CHF in the case of severe forms
Treatment for valvular heart diseases
Treatment’s objective is to manage the symptoms with medicines. Surgery may be required if the affected valve is severely affected, to improve the functioning of the valve or replace it, depending on the causes of the disease and the condition of the valve.
5. Cardiac arrest
Cardiac arrest is an umbrella term used to describe an electrical dysfunction of the heart, which halts the function of pumping blood to the body, including to critical body parts such as the brain and the lung.
How does a cardiac arrest happen?
The heart relies on an ‘electrical system’ to beat regularly. Cardiac arrest happens when this ‘electrical system’ malfunctions – similar to an electricity blackout at your home. This causes the heart to stop pumping blood to the rest of the body. Patient quickly stops breathing, falls into unconsciousness, and without immediate medical attention, may die.
Cardiac arrest may happen as a result of heart rhythm problems, including ventricular fibrillation (VF). It often happens suddenly and quickly, and is not to be mistaken with a heart attack. Cardiac arrest can be thought of as an ‘electrical problem’ where the electrical system of the heart itself malfunctions, while heart attack is a ‘pumping problem’ where the pumping power of the coronary artery malfunctions, leading to lack of blood supply to the heart. They are however related. Patients suffering from heart attack are at higher risk of cardiac arrest.
Common signs and symptoms of cardiac arrest
- Gasping, abnormal breathing or no breathing
- Loss of pulse
- Sudden collapse
Treatment for cardiac arrest
Cardiac arrest victims need to receive CPR (Cardiopulmonary Resuscitation) immediately while waiting for professional medical care.
At hospital, to rescue patients with cardiac arrest, doctors shock the heart with electrical pads in an attempt to reset the electrical current inside the muscle. The scene of rescuing a patient suffering from cardiac arrest is often depicted in movies and TV shows. Subsequent treatment involves pharmaceutical drugs and surgeries to treat the damage to the heart during cardiac arrest and the underlying causes if any.
II) The risk factors of heart diseases
The pathogenesis of a heart attack is complex. However, most researchers think of it as a combination of non-modifiable risk factors which we can not control, such as genetic predisposition, gender, and age; and modifiable risk factors such as smoking, uncontrolled diabetes, uncontrolled blood hypertension, high LDL (i.e., bad cholesterol) levels, obesity, and sedentary lifestyle (more on that later).
Non-modifiable risk factors
1. Advanced age
The vast majority of people who die from myocardial infarction are above the age of 65.
2. Family history
Having a family history of heart disease increases the risk of this condition for their children. Asians, in particular, seem to have a higher risk of developing heart disease relative to Caucasians. However, this is only true for American-Asians, who tend to live an unhealthy lifestyle in the United States.
Generally speaking, men have a higher risk of myocardial infarction compared to women. Additionally, men tend to experience heart attacks earlier in life. Note that there is a risk increase of cardiovascular disease after menopause, where the levels of protective hormones (e.g., estrogen, progesterone) drop.
4. Previous history of heart diseases
If you experienced any heart problems before, your risk of future episodes inadvertently increases.
Modifiable risk factors:
Smokers have a significantly higher risk of heart disease relative to nonsmokers. It is an independent risk factor that also interferes with other elements. Note that second-hand smoking also elevates the risk of dying from a cardiovascular event.
People who have excess body fat, especially in the abdomen and waist, are prone to heart disease and stroke. Conversely, losing weight can tremendously lower your risk of these conditions.
7. Sedentary lifestyle
Living a sedentary lifestyle predisposes people to myocardial infarction. Experts recommend getting regular physical activity for at least 150 minutes a week to lower your risk.
8. High cholesterol
High blood cholesterol, along with the other risk factors listed above, makes up the perfect recipe for cardiovascular disease.
Here are the items to keep in mind:
To calculate your total cholesterol score, follow this equation:
Total cholesterol = HDL + LDL + 20% of your triglyceride level
As a general rule of thumb, you need to keep your high-density-lipoprotein (HDL) cholesterol high since it protects your blood vessels and your low-density-lipoprotein (LDL) low.
A blood test can reveal your cholesterol level at the time of testing. If you carry many of the risk factors, it is vital to screen your cholesterol levels to take measures early on.
9. High blood pressure
High blood pressure, or hypertension, increases the workload of your heart, which negatively impacts the muscle fibers and blood vessels. Make sure to measure your blood pressure regularly in order to lower your risk of heart disease.
10. High blood sugar
High blood sugar seen in diabetes increases your risk of cardiovascular disease. Controlling your glucose levels should be your number one priority to reduce the risk of a myriad of diseases. If you have diabetes, be sure to work with your doctor to find the best ways to manage this condition.
Preventing heart and cardiovascular diseases for yourself and elderly loved ones
The early identification of cardiovascular risk factors is vital to lower the rates of fatal complications. We hope that this article helps you appreciate the risk factors of heart diseases and how you can prevent many of the modifiable risk factors. Awareness of cardiovascular conditions is the best way to lower the incidence and mortality of this condition for yourself and your senior family members.
For this reason, Singaporeans are recommended to get regular screenings of their modifiable risk factors. Eligible Singaporeans can participate in the Screen For Life program to benefit from subsidised or free of charge screening for heart diseases.
Managing cardiovascular conditions at home with Ninkatec
Ninkatec provides cardiology care solutions for those who are healing from heart conditions at home. Our cardiology care process starts with consultation with Ninkatec Care team and assessments by Ninkatec’s Cardiologist. After that, eligible patients will be recommended with suitable cardiology care plan, which includes remote monitoring of vital signals and 24/7 support from the Cardiology specialist team. Depending on the patient’s needs, the following services might also be recommended:
- Urosheath/urine output monitoring
- BP monitoring
- Continuous ECG monitoring
- Telehealth BP monitoring
- Cardiologist home visit
- Nursing visit
- Cardiology support at home
With Ninkatec’s curated cardiology care solutions, seniors having cardiovascular conditions can be assured of utmost care right in the comfort of your home.