China Press Article: Datuk Dr Rosli & Dr Choo: “Heart valve replacement without opening the chest. A new option for non-operable patients”

[Kuala Lumpur]

Does the heart also have a door? That’s right! The human heart valve is like the door and window of the heart. Each valve must operate smoothly to make blood run smoothly, while the aortic valve is like the “gate” of the heart. Only when the gate opens and closes smoothly, the heart can supply blood effectively.  Once the valve is narrow or unable to close, the heart will be underpowered, and in severe cases, it may even lead to heart failure.

In recent years, the incidence of heart valve disease has been significantly increasing among the elderly, especially those at high risk after the age of 70. Aortic valve stenosis is a common type of valvular disease in the elderly age.

Many people may be unfamiliar with the term “aortic valve stenosis”, but do you still remember Serena Liu, the queen of Taiwan’s national standard dance, who passed away not long ago? The culprit that took her precious life was aortic valve stenosis. How dangerous is aortic valve stenosis? Let the CVSKL Cardiologist tell you the truth!

Dr Choo Gim Hooi, a cardiologist at the Cardiac Vascular Sentral of Kuala Lumpur (CVSKL), believes that aging should not be a reason for patients to refuse treatment. With correct treatment measures, elderly patients can also maintain the quality of life and live a wonderful life.

Dr Choo Gim Hooi: There are two types of aortic valve stenosis

Dr. Choo Gim Hooi, a cardiologist at Cardiac Vascular Sentral Kuala Lumpur (CVSKL), pointed out that aortic valve stenosis can be divided into two categories. One is caused by degenerative, calcified or infection. Elderly people are prone to valve calcification, valve thickening and hardening, deformation of calcium salt deposition, etc. Such lesions generally lead to valve stenosis or incomplete atresia, causing blood backflow problems.

Congenital valve disease is another type of causes: “Once aortic valve stenosis is diagnosed, treatment should be taken as soon as possible to avoid affecting the quality of life, and it also improve the survival rate of the patients.”

Cardiologist at the Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Datuk Dr Rosli is the Malaysia’s first transcatheter aortic valve implantation supervisor (Proctor). He emphasized that not all patients with aortic valve stenosis need immediate surgery. Doctor will first assess the patient’s valve damage and then formulate a best appropriate treatment plan to the patient.

Datuk Dr Rosli: Degenerative diseases are major affected by the age.

Cardiac Vascular Sentral Kuala Lumpur (CVSKL) cardiologist Datuk Dr. Rosli Mohd Ali said that aortic valve stenosis is a degenerative disease that will change over time. The patient may not have any obvious symptoms in the early stage of aortic valve stenosis. Once symptoms appear, the aortic valve stenosis is considering a serious condition. This condition usually will worsen within 2 – 3 years period. Repair and replaced aortic valve are the best option treatment for the aortic valve stenosis patient.

Of course, not all aortic valve stenosis requires immediate surgery. The doctor will assess the patient’s valve damage and the nature of the disease before deciding whether to repair or replace the valve: “Patients with mild symptoms generally do not need surgery, but they need regular follow-up visits. In order to monitor whether the heart valve is further narrowed and determine the appropriate time for surgery. Patients with severe aortic stenosis must undergo surgery. Adult and elderly people should also receive regular heart-related examinations every year to get as early as possible find out heart problems and treat them promptly.”

The incidence of aortic valve stenosis is more common in the elderly, but young people may also suffer from aortic valve stenosis (Serena Liu is an example), but the incidence of young people is much lower than that of elderly people over 65.

Morbidity is more common in the elderly

Dr. Datuk Rosli and Dr. Choo Gim Hooi said that the incidence of aortic valve stenosis is more common in the elderly (especially those over 65). Therefore, it is often seen in outpatient clinics that the elderly do not want to spend money to treat the aortic valve. If you are narrow, or worry that the medical expenses may not be effectively treated, you would rather give up treatment. In addition, there are also many patients who give up treatment mainly because they are too old to undergo traditional open-heart surgery and cannot wait for a heart transplant. However, if aortic valve stenosis is not treated, these elderly patients with aortic valve stenosis will often suffer various symptoms, such as chest tightness, asthma, poor mobility, inability to lie down, painful, with poor quality of life.

Actually, you may not know? With the advancement and development of medicine, in addition to traditional open heart-surgery for aortic valve stenosis, Transcatheter Aortic Valve Implantation/Replacement (TAVI or TAVR) can also be used for Minimally Invasive Aortic Valve Replacement Surgery. This type of surgery is usually can performed by a cardiologist.

Dr. Datuk Rosli said that the emergence of this micro-innovative technology has brought new hope to eldery patient which not suitable for open heart surgery to replacement the aortic valve: “Even the elderly can recover as long as they receive treatment by extend their life, and regain a normal life. Therefore, we should get rid of the inertial thinking that elderly patients do not need treatment, especially today with the continuous development of medical technology, the emergence of transcatheter aortic valve implantation makes many patients do not need surgery A thoracotomy can also replace the main valve.”

Dr. Datuk Rosli is also Malaysia’s first Transcatheter Aortic Valve Implantation (TAVI) Supervising Doctor (Proctor). He is responsible for training and supervising the application and operation of the TAVI program to others doctor, and help to train the doctors to be fully prepared for any form of operation.

Transcatheter Aortic Valve Implantation (TAVI)

Since there is no medicine to treat aortic valve stenosis, through valve repair or replacement surgery is the only way to relieve symptoms and prolong life. Generally, the traditional open-heart surgery aortic valve replacement (Surgical Aortic Valve Replacement, SAVR) requires opening the heart to remove the damaged valve and then implanting it into a new artificial aortic valve (biological valve or mechanical valve can be used), but open-heart surgical operation is a risky surgery and It may not be suitable for all patients. This is because most patients with severe aortic stenosis are elderly age, and often have other disease at the same time (for example: heart, lung & kidney function is weak).

TAVI is a new minimally invasive technique in which a biological valve is implanted in the diseased valve by a percutaneous catheter. Suitable for elderly patients which suffering from severe aortic stenosis. The doctor will pierce the skin in the groin, upper leg arteries, carotid arteries, the space between the ribs and other suitable “channels”, insert the catheter into the artery, pass the blood vessel directly into the heart, and then directly replace the aortic valve in the heart by the catheter valve. The difference between TAVI and open-heart surgery is that no need to open the patient’s chest and avoid stop the heartbeat to implant the artificial valve. The artificial valve is directly implanted/replaced while the patient’s heart is still beating. This procedure can be done under local anaesthesia or sedatives.

This new technology has the characteristics of less trauma and quick recovery, it is an ideal treatment plan for certain patient populations (for example: patients with severe aortic stenosis but unable to accept surgery, high-risk groups of surgery, etc.). Of course, TAVI is not zero risk, but it is relatively lower than open heart surgery. It is recommended to discuss with your attending doctor to customize a suitable treatment plan.

Warning Signs of Aortic Valve Problems

■ Feel Chest pain and pressure

■ Feel weak.

■ Dizziness

■ Feeling tired

■Shortness of breath

■Heart palpitations or feeling the heart beating irregularly

■Heart murmur

Understanding Aortic Stenosis

The artery is located in the left ventricle of the heart. It is a conduit for blood from the heart to the body. The aortic valve is the door that opens the passage. With age, the opening of the aortic valve may gradually narrow. Aortic valve stenosis refers to the obstruction of blood flow through the aortic valve. This is a progressive disease. Common clinical symptoms include decreased exercise capacity, exertional chest pain (angina), syncope, and heart failure. Patients suffering from aortic stenosis may die within a few years if they don’t receive the correct treatment.

Cardiologists can understand and master the health of the aortic valve through various examinations, including: cardiac ultrasound/echocardiogram (measures the thickness, relaxation, and prolapse of the valve, and can also assess the contractile function of the left ventricular muscle, whether the atria and ventricles are enlarged, etc.), electrocardiogram (such as checking whether the left atrium and left ventricle are hypertrophy), physical examination (such as: the doctor finds that the patient’s heart has a murmur during auscultation), carotid ultrasound examination, CT Scan and etc. The doctor will decide which tests are needed based on the individual patient’s condition.

 

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CVSKL Primary Care Summit – GP Doctor Conference

It was a lovely Saturday afternoon as we held our first physical event since the RMCO was implemented. Our consultant cardiologists spoke at the first of five Heart Failure series in Majestic Hotel and the session was chaired by Dr. Surendran Thuraisingam, followed by case presentations by Dato’ Dr. David Chew Soon Ping and Dr. Lawrence Chan Hon Wah.

Our cardiologists collectively agreed that co-management of heart failure patients together with general practitioners is extremely crucial for the benefit of the patient. It was a lively session as our consultants shared their knowledge of heart failure and the types of cases they see in CVSKL while the attending general practitioners took the opportunity to raise their questions in an open Q&A session.

The session was held with strict compliance to the SOPs. Regular reminders were given throughout the day to sanitise their hands and to maintain a strict 2m distance at all times.

It was great to catch up with our key GP partners after so long and we’d like to thank those who attended. See you all at the next one!

   

China Press Article: Dato’ Dr David Chew & Dr Lawrence Chan say: “Difficulty Breathing, Chest Pain is an Early Signs of Heart Failure”

[Kuala Lumpur]

It turns out that symptoms such as dyspnea or shortness of breath, wheezing, and tiredness are all symptoms commonly described by the most heart patients. Cardiac Vascular Sentral Kuala Lumpur (referred to as CVSKL) cardiologist, Dr. Lawrence Chan pointed out that when the heart has problems, patients often have symptoms of chest tightness and dyspnea: “Shortness of breath or dyspnea is a common symptom. Although asthma, lung disease, anemia, severe liver and kidney problems, and even coronary pneumonia may cause the above symptoms, it may also be attributed to heart function problems or even one of the early warning signs of heart failure.”

CVSKL Cardiologist Dr. Lawrence Chan pointed out that dyspnea is not necessarily a lung problem. In many cases, it may also be a heart problem or even one of the early warning signs of heart failure.

Dr. Lawrence Chan: Patients with chronic diseases are at high risk of having heart failure

Under normal circumstances, the heart pumps blood from the arteries to the whole body. Oxygenated blood is transported to the rest of the body and deoxygenated bloody will be pumped back to the heart through the veins. Therefore, the heart must contract and relax to ensure that blood circulation continues in an orderly manner.

Heart failure does not mean that the heart has stopped beating or has completely lost its function, but it means that the state of the heart is not as good as it used to be, and it can no longer do its job as efficiently. Generally speaking, heart failure usually refers to the failure of the heart to fill up with enough blood, or the inability to transport blood to all parts of the body. Heart failure is due to various causes of malfunction of the heart. In this case, the cardiac output will be reduced and is unable to meet the needs of various tissues and organs of the body, causing a series of clinical symptoms. Difficulty in breathing is one of them.

The so-called dyspnea or shortness of breath is simply a symptom of not being able to breathe in air and working harder than usual to breathe.

Of course, sometimes people may have difficulty breathing when exercising. How do we know when we need to see a doctor? According to Dr. Lawrence’s analysis, if you belong to a high-risk group (such as smoking, hypertension, diabetes and other chronic illness diseases) or dyspnea is accompanied by the following symptoms, it is best to consult a general practitioner or a cardiologist as soon as possible for further evaluation and diagnosis of:

  • Worsening symptoms of breathing difficulty
  • Chest tightness, chest pain, fainting, or nausea
  • Swollen ankles
CVSKL Cardiologist Dato’ Dr David Chew emphasized that heart failure can be treated. The correct treatment plan will help patients improve heart failure symptoms and heart function.

Dato’ Dr David Chew: Chronic high blood pressure can increase heart load.

Heart failure refers to the inability of the heart to pump enough blood to meet the needs of the body. It is also the final stage of the development of various cardiovascular diseases. Epidemiological data shows that more than 26 million people worldwide suffer from heart failure, and it can affect any age group. It is a disease with high morbidity and mortality.

According to the European Heart Journal in 2016, the onset of heart failure in European and American countries ranges from 70 to 75 years old. The average age of heart failure patients in Asian countries is 60 years old, and the condition is more severe than that in European and American countries. Coupled with high blood pressure, obesity (Malaysia is the country with the most obese population in Asia) and diabetes, these are common risk factors that lead to heart failure. Heart failure has become a health issue that you and I need urgent attention and prevention.

According to CVSKL Cardiologist Dato’ Dr David Chew, the main cause of heart failure is diseases that damage the heart, such as: dilated cardiomyopathy, hypertension, coronary heart disease and so on. “Dilated cardiomyopathy is a very common type of cardiomyopathy. Patients will present with symptoms as heart failure and enlarged heart. Once the heart is enlarged, the heart function will reduce. Genetics, and the presence of viral infection and inflammation are all possible causes to dilated cardiomyopathy. In addition, hypertension is also one of the main risk factors for heart failure.”

 

Good Control Blood Pressure Can Reduce Half of The Risk.

The cause of heart failure due to high blood pressure which will increase the load on the heart. The heart must contract more forcefully than normal to pump blood into the aorta to combat the elevated blood pressure. Eventually, the heart walls will thicken (hypertrophy) or become stiff, causing only less blood to be pumped out than normal with each contraction, which eventually leads to heart failure. Studies have shown that poor blood pressure control can lead to heart failure, and good blood pressure control and treatment can reduce the risk of heart failure by 50%!

During a consultation with cardiologist for breathing difficulties or any suspected symptoms, the doctor will usually first perform some tests to diagnose whether you have heart failure or other heart disease. In addition to the most basic enquiry about the patient’s medical history, physical examination, heart murmur examination, etc other examinations will also be carried out according to individual patient needs, including blood examination, chest X-ray examination, cardiac ultrasound examination, electrocardiogram examination, angiogram and so on.

In medicine, heart failure is mainly based on its development (acute and chronic), location (for example: left heart failure, right heart failure, and total heart failure), and basic principles (for example: systolic insufficiency and diastolic insufficiency) ) And the manifestations of heart failure (for example, there are no symptoms in the early stage, but the heart is enlarged and the heart function is reduced during the examination). Doctors will classify heart failure according to the patient’s symptoms, severity and various examination results, and different heart failure problems require different treatments.

Heart Failure Is Not the End of Life

In any case, even if the heart fails, life is not the end! Medically, heart failure can be divided into left heart failure, right heart failure and congestive heart failure. Left heart failure can be further divided into systolic heart failure with abnormal myocardial contraction and diastolic heart failure with abnormal myocardial relaxation. Different heart failure problems require different treatments.

Dato’ Dr David Chew emphasized that heart failure is a chronic disease. Various treatment options can be combined according to the different conditions of the patient to improve the symptoms of heart failure and heart function to help patients improve their quality of life: “Drugs are usually the main treatment for heart failure. Clinically applicable drugs include angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists (ACEI/ARB), β-receptor blockers and aldosterone receptor antagonists (MRA), according to different patient conditions Combination treatments prescribe drugs to help improve patients’ symptoms and maintain heart function.”

Follow the Doctor’s Advice to Control Heart Failure.

The main goal of drug treatment is to relieve symptoms, delay the deterioration of the disease and reduce the risk of death. To achieve the above-mentioned treatment goals, a variety of heart failure-related drugs are generally required. In some cases, as many as 5 drugs may be required. In the past, patients with heart failure often need to take multiple drugs at the same time. In recent years, more and more combination drugs with multiple effects have been developed to help improve patients’ compliance with medication.

In any case, heart failure requires long-term medication to control the disease. Therefore, it is extremely important to follow the instructions to take the medication as prescribed. Dr. Lawrence said that patients must not reduce or stop medication by themselves, nor can they change the dosage or frequency of medication without prior consultation. Adhering to medical advice and treatment can prolong and maintain their quality of life. Additionally, patients with heart failure must also change their bad habits and adjust their diet to avoid aggravating the heart load and worsening the problem.

It Is Treatable, Don’t Give Up

“Prevention is always better than cure! If you are a healthy person, please maintain good habits and exercise regularly, and don’t let heart disease creep up on you. If you are already a patient with chronic diseases such as diabetes, hypertension, etc., be sure to follow your doctor’s advice to treat and control your condition, reduce the risk of heart failure. If you suspect that you have been diagnosed with heart disease, don’t delay treatment!”

Dato’ Dr David Chew emphasized that heart failure is a treatable disease. Even if the disease progresses to a severe stage and the drugs cannot work effectively, it is possible to consider whether to implant a ventricular assist device (such as a pacemaker) or surgical treatment according to the patient’s condition (Such as heart transplantation) to extend the life of the patient.

Medical Dictionary

Echocardiograms Examination and Cardiac Ejection Fraction

The percentage of stroke volume to ventricular diastolic volume is called ejection fraction. 50% or more is the normal range, which is also one of the important indicators for judging the type of heart failure.

Cardiac ejection fraction can be determined by echocardiograms. This test can assess the structure and function of the heart, understand the size and contraction of the heart, determine the activity of the heart valves, and allow the doctor to measure the thickness and stiffness of the ventricular wall The degree and ejection fraction are used to determine whether there is heart failure.

The ejection fraction is related to the contractility of the heart muscle. The stronger the heart muscle contractility, the greater the output of the heart per stroke, and the greater the ejection fraction. Once heart failure occurs, the myocardial contractility is weakened, and the ejection fraction will decrease. The more severe the heart failure, the lower the ejection fraction.

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