With heart health-related issues on the rise, cardiology experts share the treatment options available and why early detection can save lives.

Heart diseases have increased drastically in the past decades, accounting for a third of deaths in 2019, according to a new study published last year in the Journal of the American College of Cardiology. The study also found a significant increase in the years of life lost as well as number of years lived in disability related to heart disease.

Dr Suren Thuraisingham, the consultant cardiologist at Cardiac Vascular Sentral Kuala Lumpur (CVSKL), pointed out that worldwide, more people die annually from cardiovascular diseases than from any other cause, and of these deaths, 85 per cent are due to heart attack and stroke.

In Singapore, almost 30 per cent of deaths in 2019 were due to cardiovascular disease, which includes heart diseases and stroke, based on figures from the Ministry of Health.

TYPES OF HEART DISEASES

There are many types of heart diseases. According to Dr Beni Isman Rusani, consultant cardiologist at Institut Jantung Negara (IJN) in Kuala Lumpur, acquired heart conditions typically affect the adult population and are associated with certain risk factors.

For example, coronary artery disease, which may lead to a heart attack, is linked to risk factors such as diabetes, high blood pressure, high cholesterol, smoking and obesity, Dr Beni said.

Other common acquired heart conditions include heart failure, rhythm problems (with the most common being atrial fibrillation that could lead to a stroke) and valvular heart disease like aortic stenosis, he added.

Dr Suren said the “obesity epidemic” and its associated risks of diabetes and hypertension is the major reason for the current uptick in acquired cardiovascular diseases.  

“The fast food explosion, especially in underdeveloped nations, and the increasingly sedentary lives of urban dwellers, have been key contributors,” he said.

As childhood obesity becomes more prevalent, Dr Marhisham Che Mood, senior consultant paediatric cardiologist and head of the Paediatric and Congenital Heart Centre at IJN, said hypertension and coronary artery disease have been observed in the younger population, too.

An expectant mother’s health issues and lifestyle habits such as uncontrolled diabetes, smoking and alcohol consumption during pregnancy, may also increase the risk of having babies with abnormal heart structures leading to congenital heart diseases, he added.

Congenital heart diseases are heart defects present since birth. They occur in about 1 to 2 per cent of births, and about a quarter will require surgery in the first year of life, Dr Suren said.

There are different types of congenital heart defects that can disrupt normal blood flow through the heart. These may involve the walls, valves or blood vessels of the heart.

Children born with normal heart structures may also acquire heart disease due to infections, such as rheumatic heart disease, said Dr Marhisham.

CARDIAC SCREENING: WHY IT MATTERS

For many patients, heart disease is treatable when detected early. Although a majority of patients may experience symptoms such as chest pains, breathlessness and palpitations, Dr Beni warned that heart diseases may occur “silently”, and patients may not experience obvious symptoms. This is why regular screenings are important for at-risk groups, such as those who are obese or those with a family history of premature heart disease.

Dr Syed Mohd Adeeb Bin Syed Jalaludin, a cardiothoracic surgeon at KPJ Johor Specialist Hospital, said the American Heart Association recommends regular heart screenings from age 20 onwards.

According to Dr Suren, cardiac screening usually involves an assessment of a patient’s risk profile for cardiovascular diseases using the risk factor background screen to evaluate family history, propensity for hypertension, diabetes, high cholesterol and smoking habits. It is usually followed by guided diagnostic tests, done under the advice and guidance of a physician.

Dr Syed Adeeb explained: “For asymptomatic patients (those with no symptoms), this would include mainly a detailed history, blood indices, electrocardiography and a treadmill test. Patients with risk factors and are symptomatic would require further detailed investigations such as coronary angiography.”

Dr Marhisham added that pregnant women who are at risk of having babies with congenital heart disease are advised to undergo a fetal echocardiogram during pregnancy. The procedure, which uses sound waves to check an unborn baby’s heart, requires trained fetal imaging specialists and paediatric cardiologists to interpret the results accurately.

TREATMENT OPTIONS AT A GLANCE

When it comes to managing heart diseases, early detection, diagnosis and adherence to treatment are key.

According to the cardiac experts, tests commonly used to diagnose heart diseases include electrocardiograms (ECG) to detect abnormal heart rhythm, chest X-rays, exercise stress tests as well as imaging such as ultrasound and computerised tomography (CT) scans to assess heart arteries for signs of narrowing.

Echocardiography and cardiac MRIs may be used to assess heart pump function, cardiac muscles and valvular disorders, Dr Beni said.

He added that the cornerstone treatment for the majority of heart diseases typically involves medication, which varies according to each patient’s condition. For example, a person might need a combination of blood thinning and anti-cholesterol medication to manage coronary artery disease.

Surgical intervention may be required in certain situations. In the case of severe coronary heart disease, for instance, treatment may include coronary artery bypass grafting, a type of heart surgery that redirects blood around a blocked or partially blocked artery to improve blood flow to the heart.

Minimally invasive procedures are also available for some heart diseases, such as percutaneous coronary intervention (also known as angioplasty with stent), which is used to treat blood vessels in the heart that are narrowed by plaque build-up.

Other cardiac treatments include using a stent to treat coronary artery blockages, pacemakers to regulate slow heart rates and implantable cardiac resynchronisation therapy to assist some patients with heart failure, Dr Beni said. 

ACCREDITED CARDIAC SPECIALITY CENTRES

In Malaysia, cardiac specialists offer a spectrum of advanced treatments for various heart diseases.

Mr Mohd Daud Mohd Arif, chief executive officer of Malaysia Healthcare Travel Council (MHTC), said that 48 out of its 75 members are cardiac speciality centres equipped to take patients through screenings, diagnostics and treatments related to cardiovascular conditions. They are monitored by the Ministry of Health Malaysia under the Private Healthcare and Facilities Service Act (1998).

An initiative under the Ministry of Health Malaysia, MHTC coordinates industry collaborations and public-private partnerships within the country and abroad to facilitate and grow the healthcare travel industry in Malaysia.

Mr Daud shared that the centres carry accreditations from the Malaysian Society for Quality in Health, the Joint Commission International and other agencies under the International Society for Quality in Healthcare.

Some of the centres, he said, are using new cardiology technologies, such as the Micra AV pacemaker, an implantable device for the treatment of a slow heart rate via pacing. IJN is the first hospital outside of the United States to implant the Micra AV pacemaker.

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