With our heart beating an average of 100,000 times a day and pumping about five litres of blood per minute around our body, taking care of this organ is essential to our overall health. We look at two common heart conditions and related issues seen by the Department of Cardiology at Changi General Hospital (CGH).
Atrial fibrillation (AF) is one of the most common forms of arrhythmia — also known as irregular heartbeat or heart rhythm disorder — that affects about 1.2 per cent of people aged 65 to 79, and 5.8 per cent of those aged 80 and above in Singapore. The prevalence of AF has increased in the older population over the years.
In patients with AF, the upper chambers of their heart (atria) are not pumping effectively, and blood does not flow properly to the lower chambers of the heart (ventricles). This lack of coordination between the atria and ventricles causes the heart to beat irregularly.
Common symptoms of AF include palpitations, heart flutters, shortness of breath, chest discomfort, near-fainting or fainting spells, dizziness, and fatigue. However, there are cases where some patients with AF might not experience such symptoms.
Factors that can increase the risk of developing AF include age, high blood pressure, excessive alcohol intake, obstructive sleep apnoea and coronary artery disease. One may reduce the risk of AF by taking medication and making lifestyle changes to manage the associated risk factors, including exercising regularly and adopting a healthy diet.
If left untreated, AF can result in further complications. With the heart not pumping effectively, blood flow becomes slow or stagnant, which may cause blood clots to form, especially in the upper left chamber of the heart. A stroke can occur if the clots dislodge, move into the bloodstream, and block the arteries in the brain. AF with a prolonged rapid heart rate can potentially lead to heart failure.
In patients with atrial fibrillation, abnormalities in the heart’s electrical impulses cause blood to be pumped improperly.
Managing atrial fibrillation
To better manage patients’ AF conditions and lower the risk of death due to stroke or major bleeding, CGH adopts the AF Better Care
ABC pathway — a decision-making strategy that helps the care team provide integrated and holistic care, which has shown to improve survival rates and reduce hospitalisation rates.
Anticoagulation/Avoid stroke: to optimise stroke prevention, individuals with high stroke risk are identified and started on oral anticoagulation (medicines that prevent blood clots). The care team follows up with them for regular reviews.
Better symptom management: the care team treats symptoms through symptom-directed decisions on rate or rhythm control.
Cardiovascular and comorbidity optimisation: to manage a patient’s risk factors, the care team makes recommendations for lifestyle changes, which include regular physical activity, quitting smoking, maintaining a healthy weight and having a healthy heart diet that is low in salt and cholesterol in order to help reduce the risk of developing AF.
There are also procedures for patients with AF if required. In electrical cardioversion, a machine sends an electric shock to the heart to convert AF to a normal heart rhythm. Another procedure is catheter ablation, which uses radiofrequency energy through heating or cryo-ablation through freezing to isolate the pulmonary veins, which can harbour the electrical triggers for AF.
Heart failure is a condition where the heart is weak or stiffened and unable to efficiently pump and circulate blood around the body. This leads to fluid retention in the lungs, kidneys and other organs, giving rise to shortness of breath and swelling in the legs.
The common signs and symptoms of heart failure include breathlessness (on exertion and/or at rest), which leads to the inability to lie flat to sleep, abdominal and lower limb swelling, a reduction in effort tolerance and increased feelings of fatigue. Common causes of heart failure include coronary artery disease, hypertension (high blood pressure), disease of the heart muscles, as well as excessive alcohol consumption.
While CGH’s Department of Cardiology sees about 1,100 cases of heart failure a year, with an ageing population, the prevalence of heart failure is increasing. The reason for this upward trend is likely multi-factorial, due to the increasing complexity and occurrence of more than one disease or condition present in patients at the same time.
CGH’s approach to managing the condition
A multi-disciplinary team at CGH manages and cares for patients with heart failure. Guided by a robust heart failure pathway, the care team members look into each aspect of the patient journey from the initial contact at the emergency department, throughout the inpatient stay in the wards, to the discharge planning.
“The heart failure pathway we developed incorporates the best practices distilled from international heart failure guidelines so that our patients can receive the best outcomes and care,” says Clinical Assistant Professor Sheldon Lee, Senior Consultant, Department of Cardiology, CGH.
Depending on the severity of the heart condition, the care team will prescribe a variety of treatment methods to manage and prevent deterioration. These include lifestyle changes, such as appropriate exercise, a healthier diet, stopping smoking and reducing alcohol consumption. Medications can help to lower patients’ blood pressure, reduce the heart rate and strengthen the heart. If needed, interventional procedures may be required to correct electrical abnormalities or clear blocked coronary arteries. In cases where there is irreparable severe damage to the heart, mechanical assist devices may be required.
With treatment and lifestyle adjustments,
Mdm Lau now leads an active and
65-year-old Mdm Lau Sui Lang was out shopping with her husband when she suddenly blacked out and fell, leading to her admission to Changi General Hospital (CGH). The CGH care team traced her blackout to a post-conversion pause, where her heart had stopped beating for several seconds when her sudden irregular heart rhythm returned to a normal rhythm.
In the weeks after, Mdm Lau experienced irregular heartbeats again and was warded at CGH. Through an electrocardiogram (electrical tracing of the heart rhythm), the CGH care team found that the reason for these episodes was atrial fibrillation (AF). “Mdm Lau was offered a choice of having a permanent pacemaker (PPM), or ablation — a procedure where localised and specific burns are applied to the heart to prevent the triggering of AF. A PPM is a device implanted in the body that prevents the heart from beating too slowly, while ablation could remove the symptoms of AF and reduce the risk of passing out by maintaining a normal heart rhythm,” shares Clinical Assistant Professor Colin Yeo, Senior Consultant, Department of Cardiology, CGH. “Recent studies have also showed that rhythm control from ablation can reduce stroke, hospitalisation and even death from cardiovascular conditions.”
Mdm Lau eventually opted for ablation. Following the successful operation, she carried a portable cardiac monitoring device over two days, which showed that her heart rhythm remained normal without any evidence of AF. She also underwent a follow-up review by the CGH transition care team and has been recovering well.
“The CGH care team was very professional. During my stay at the hospital, I could feel their exceptional level of care,” says Mdm Lau. “The physiotherapists guided me on the exercises I should be doing, while the dietitians advised me on balanced eating choices that would be better for me.”
Mdm Lau used to do a lot of brisk walking, but stopped during the months when she experienced the heart issues. After the ablation procedure, she has resumed her brisk walking and made some additional changes to her lifestyle by reducing her caffeine intake. To Mdm Lau, this harrowing experience strengthened her acknowledgement of the importance of good health.
“Our health is very important. Take care of yourself, make appropriate adjustments to your lifestyle, and choose the healthier options in life,” she says.
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