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"My Heart Can Go On"
- Cardiac Rehabilitation Forum

Changi General Hospital conducted a Cardiac Rehabilitation forum on 18 October 2003 at the CGH Auditorium. This forum had been eagerly anticipated by many of our cardiac patients as it had been postponed from its earlier date in March 2003 due to SARS.

Matters of the Heart
Dr Goh Ping Ping
Senior Consultant Cardiologist

According to Senior Consultant Cardiologist Dr Goh Ping Ping, heart disease is the leading cause of death worldwide and the second commonest cause of death in Singapore.

A heart attack occurs when the blood flow to the heart is critically reduced or completely blocked, causing the person to feel varying degrees of chest pain. Prior to a heart attack, most victims experience episodes of angina (chest pain) that, like a heart attack, is provoked by blockage of blood flow to the heart (ischaemia). With angina, blood flow is quickly restored, pain recedes within minutes, and the heart is not permanently damaged.

The risk of coronary heart disease increases with age and affects more men than women. If a family member (father, mother, brother, sister) has a history of early heart disease (before age 55 for men and before age 65 for women), you are at a higher risk for heart disease than someone with no family history of early heart disease.

Smoking, diabetes, hypertension, high blood cholesterol, obesity, lack of exercise and stress are risk factors in coronary heart disease.

"My Heart Can Go On"
Medical Intervention After A Heart Attack
Dr Tan Kok Soon
Visiting Consultant, Cardiology, CGH

So what are the symptoms of a heart attack? According to Dr Tan Kok Soon, Visiting Senior Consultant Cardiologist, patients have described a heart attack as "a chest pain that comes and goes. The pain penetrates the chest, and spreads to the lower jaw, down the inside of the left arm to the ring and little finger. The pain took 10 minutes to build to maximum intensity."

Heart attacks often occur "out of the blue" at rest, asleep, during or after exertion and often early in the morning.
Mr Justin Monteiro, a heart patient, sharing with Ms Soh Xin Yi, physiotherapist, on how he changed his lifestyle after his heart attack.

 

 

 

 

 

 

 

 

Treatment for a heart attack starts immediately, as time is critical. The aim of the treatment is to clear the clot and unclog the artery. The two treatment options available are:
a. Dissolve the clot - use of "clot busters"
b. Mechanically remove the clot - PTCA

"Clot Busters" such as Streptokinase work to dissolve the blood clots. Statistics show that the effectiveness of clot busters is time dependent, i.e. more patients survive if treatment is administered quickly.

An alternative to Clot Busters is to manually remove the clot. This is done through a procedure called Percutaneous Transluminal Coronary Angioplasty, also known as PTCA, coronary artery balloon dilation or balloon angioplasty.

PTCA is used to dilate (widen) narrowed arteries. A doctor inserts and advances a catheter with a deflated balloon at its tip into the narrowed part of an artery. Then the balloon is inflated, compressing the plaque and enlarging the inner diameter of the blood vessel so blood can flow more easily. Then the balloon is deflated and the catheter removed.

Cardiovascular rehabilitation that will begin after the procedure takes place in phases. It benefits patients by improving exercise tolerance, symptoms and blood lipid levels. It also helps in the patient's psychological well being and reduces their stress level. Most importantly, cardiovascular rehabilitation has shown to reduce the mortality rate in cardiac patients.

Hearty Meal
Ms Ling Ping Sing
Dietitian, CGH

So then what steps can be taken to prevent heart disease? Dietitian, Ms Ling Ping Sing says that a healthy diet or "hearty" diet as she puts it, can significantly reduce your risk of heart disease.

A diet that is high in cholesterol, salt, fat and alcohol intake will have an adverse effect on your heart. Thus, a hearty meal would be one that is low in fat, cholesterol and salt, while high in fiber and taste.

While it is not easy to completely eliminate salt and cholesterol from your diet, Ping Sing says that there are ways to keep the intake under control.

Seafood, eggs and red meat are sources of high cholesterol. So try to limit your intake to two eggs a week, and seafood to only 1 type a week. Lean red meat can be consumed and add as variety in your diet. Salt can be taken, but moderate it to a teaspoon of table salt a day.

When dining out, you can control your fat intake by choosing alternatives. Instead of dining on fried noodles, choose soup noodles instead. For desserts, choose a clear dessert, instead of one filled with coconut milk.

In the end Ping Sing says that what is most important is "balance and moderation". Just remember to eat smartly.

"Surviving My Heart Attack"
- A Patient's Experience
Ms Soh Xin Yi
Physiotherapist

So how can a cardiac patient exercise safely and effectively?

Physiotherapist Ms Soh Xin Yi advises patients to begin their exercise routine with walking at least 10 minutes for the first week. This should be done at least twice a day and 4-5 times a week. The length of time should be extended by 5 minutes with every week. However, Xin Yi stressed that if you feel symptoms such as giddiness, breathing difficulties, chest pains or excessive cold sweat, you should stop your exercise immediately and consult your doctor before continuing.

Patients with diabetes should check their glucose levels before and after exercise and look for signs of hypoglycaemia, e.g. feeling faint, pale, with palpitations or trembling.

To emphasise the importance of a healthy lifestyle, Mr Justin Christopher Monteiro, 59, a heart disease survivor, spoke about his experience with heart disease. He admitted that he used to lead a "very unhealthy" lifestyle.

"I smoked about 60 cigarettes a day, I drank and ate whatever I liked. I also did not exercise regularly." He said.

It was no surprise then given his lifestyle and the fact that he had a family history of heart disease, Mr Monteiro suffered a heart attack six years ago. As a result, Mr Monteiro had to undergo a triple bypass surgery.

Today, Mr Monteiro is a changed man. He has stopped smoking and drinking. He exercises daily and has even stopped eating red meat. If there is one message that Mr Monteiro wanted to put across, it would be "be honest with your doctors. Listen to them and follow their advice or one day you will regret it."