About 30% of cholesterol produced by the body is due to one’s lifestyle, a cardiologist says.
Cardiac Vascular Sentral Kuala Lumpur (CVSKL) consultant cardiologist Dr Suren Thuraisingham said the rest was influenced by genetics.
“When you have high bad cholesterol, which is low-density lipoprotein (LDL), it has to be treated,” he said, adding that exercise alone had minimal effect on bad cholesterol.
Dr Suren, who has decades of experience in interventional cardiology, was one of three speakers at the “StarLIVE: Take Charge of Your Heart” event at Menara Star in Petaling Jaya, Selangor, in conjunction with World Heart Day.
The Saturday event was a collaboration between Star Media Group and CVSKL.
In his talk titled “Living Life #Unblocked: Cholesterol Explained”, Dr Suren advised the public to avoid trans fats and encouraged individuals with family history of heart conditions to undergo cardiovascular risk profiling.
“Adopt a sensible diet,” he said, also remarking that the majority of medical-related information on social media – sometimes by self-proclaimed experts − was inaccurate.
“These pieces of medical advice are not backed by proper medical studies,” he said, urging the public to be cautious when consuming unverified healthcare information.
On the topic “Heart Failure Has No Age: Why More Young Adults Are Affected”, Dr Chew said patients who suffered from heart failure conditions should only engage in mild forms of exercise, with walking being a recommended option.
“Three to four hours of mild exercise weekly, such as walking, is encouraged,” he said.
“Managing blood pressure, diabetes and weight is also crucial for heart patients,” he added.
Dr Chew explained that not all heart attacks were fatal, but some resulted in heart failure and atrial fibrillation which could lead to shortness of breath.
Meanwhile, Dr Razali discussed the benefits of smartwatches and mobile electrocardiogram (ECG) devices in detecting irregular heartbeats.
“These devices can help people monitor and record irregular heart rate episodes and alert them when needed.
“This information can then be brought to doctors for further assessment.
“They are also useful for post-procedure monitoring,” he said during his talk on “A Fluttering Heart and the Hidden Stroke Risk”.
He added that some smartwatches were capable of detecting atrial fibrillation, an irregular and often rapid heart rhythm which could increase the risk of stroke.
About 200 people attended the talk.
Attendee Selvakumaran Muthusamy, 52, shared that some of his peers who were active in sports had died from heart attacks.
“This event was insightful. We learned that genetics play a large role, while lifestyle has a lesser impact on cholesterol levels,” he said.
Margret Lim, 87, said she attended the talk to stay updated on cardiovascular health.
“I was a nurse and used to run full marathons up to the age of 60.
“I make time to attend talks like this to stay informed,” she said.
Ng Leong, 74, gave the event a thumbs-up, calling it eye-opening.
“I have learned that I need to monitor my bad cholesterol and take action to prevent cardiovascular diseases,” he said.
Adriene Teh, who cares for her 90-year-old mother, also found the session valuable, saying: “What’s important is being aware of early warning signs like irregular heartbeat.”
All attendees received RM50 health scan vouchers, while a lucky draw gave away two RM799 health screening vouchers from HealthScan Malaysia, CVSKL’s dedicated screening centre.
YOUR heart can flutter, figuratively, when you set eyes on someone or something that stirs excitement, desire or longing.
But when it literally flutters for no apparent reason, it could signal trouble ahead.
According to Cardiac Vascular Sentral Kuala Lumpur (CVSKL) consultant cardiologist Datuk Dr Razali Omar, abnormal rhythms of the heart (arrhythmias) come in many forms, and one of the most common is called atrial fibrillation (AF).
“It’s the oldest arrhythmia known to man.
“It was described in ancient Chinese texts some 5,000 years ago as a ‘weak and irregular pulse’,” observes Dr Razali.
Affecting millions worldwide, AF is linked to serious complications if left untreated.
“It used to be associated with advancing age, but we now see a new pattern emerging,” he says.
“AF now affects younger individuals as well.
“The incidence is increasing, not only in older population groups, but also younger ones.
“No one knows why the incidence is increasing, or why the ages of those affected are getting younger.
“Part of it may be due to lifestyle disorders such as obesity, diabetes, hypertension. It may be due to alcohol, as it was recently found that alcohol consumption increases risk as well.
“Obstructive sleep apnoea is also linked to AF.
“But more than that, no one knows for certain the exact cause,” adds Dr Razali.
All these have implications for treatment, requiring the need for AF to be treated holistically, which means addressing possible sources of the problem in addition to direct treatment targeted at the heart.
Understanding AF
AF is an irregular and often rapid heart rhythm originating from the upper chambers of the heart known as the atria.
Normally, the heart’s electrical system ensures the four chambers of the heart contract in a coordinated way.
But in AF, the electrical signals become chaotic, leading to a fast and irregular heartbeat.
The condition can be occasional (paroxysmal), persistent or long-standing persistent, with symptoms ranging from palpitations, fatigue and shortness of breath to dizziness and chest discomfort.
Some individuals might not experience symptoms at all (up to 50%, according to Dr Razali) and discover they have AF only through a routine medical exam, or when they are struck by the consequences of the condition.
AF can lead to serious complications like stroke, heart failure and cognitive decline if not properly managed.
“In a person with AF, the risk for stroke is increased by five to six times compared to someone who doesn’t have it.
“And stroke from AF is worse than from other causes. AF- related strokes often lead to death, and among those who survive, a significant number are left with long-term disabilities,” stresses Dr Razali.
Diagnosis of AF typically begins with a physical examination and an electrocardiogram (ECG) to detect abnormal rhythms.
In some cases, wearable or implantable monitors may be used to track heart activity over longer periods, especially when symptoms are intermittent.
These are called Holter monitors and they are essentially ambulatory ECG devices that monitor the heart.
Such monitors can track between seven and 14 days, unlike the bulkier monitors of the past that usually track for a day only.
“These days, I also see patients who come to me after their smart watches alert them that they have heart rhythm disturbances.
“Of course, we have to confirm that it truly is AF, but there have been confirmed cases from these,” notes Dr Razali.
Traditional treatment options
According to Dr Razali, managing AF involves the primary goals of reducing the risk of stroke, preventing heart failure and restoring normal rhythm to the heart.
“After thorough assessment, treatment will be instituted based on our primary goals.
“Anti-coagulants are given to prevent blood clots that can cause stroke.
“Oral anti-arrhythmic medications are given to try and control heart rate and attempt to restore normal heart rhythm to prevent heart failure, although there haven’t been any new discoveries for the past 30 to 40 years on this front,” he notes.
When medications aren’t effective or suitable, catheter ablation – a procedure that targets and destroys the areas of heart tissue causing the erratic signals – is recommended.
Dr Razali observes that catheter ablation, traditionally using radiofrequency or cryotherapy, has been a game-changer for many patients, provided it is carried out in the early stages of AF.
“It’s much more difficult to treat chronic AF,” he stresses.
According to Dr Razali, catheter ablation for heart arrhyth- mias have been available in Malaysia since 1992.
“AF ablation started in Malay-sia in December 1999, at the National Heart Insitute (IJN), Kuala Lumpur.
“Although it’s the oldest known arrhythmia, it’s the ‘last’ to be ablated since it was relatively late before the source of the arrhythmia was found – in the pulmonary veins.
“Radiofrequency and cryotherapy are thermal energy, and ablation with such energy is not without its challenges, including risk of collateral damage to nearby tissues of the heart, oesophagus, nerves, and even blood vessels.
“In expert hands, such risks are minimal, although the consequences could be catastrophic if it were to occur depending on the affected tissues,” warns Dr Razali.
A new frontier: pulse field ablation
In recent years, a new treatment – pulse field ablation (PFA) – has emerged.
PFA represents an exciting advancement in the treatment of AF because, unlike conventional ablation methods that rely on thermal energy (either heat or extreme cold), PFA uses high-voltage, short-duration electrical pulses to create tiny pores in heart cells – a process known as electroporation.
This approach selectively targets heart muscle cells without damaging surrounding structures like the oesophagus, nerves or blood vessels.
“This selectivity is one of the standout advantages of PFA as it significantly reduces the risk of collateral damage,” emphasises Dr Razali.
The procedure itself is typically done under general anaesthesia, with the patient anti-coagulated to prevent blood clots, which could lead to stroke.
A transoesophageal echocar- diogram (TOE) is carried out beforehand to assess the heart’s anatomy and rule out any existing clots. Catheters are threaded through blood vessels to the heart, guided by imaging.
A 3D electroanatomical map is created, and once the catheters are in position, the PFA system delivers a series of controlled electrical pulses to isolate the areas triggering AF, usually around the pulmonary veins.
After ablation, the heart is challenged with isoprenaline to check for any remaining or additional AF triggers.
Once over, the patient is monitored – in the intensive care unit if required. But most patients can expect to go home the next day.
As with any medical procedure, risks still exist, though they are significantly lower with PFA.
The procedure represents a significant leap forward in the treatment of AF, offering patients a safer, quicker and potentially more effective solution.
As the technology continues to evolve and long-term data emerges, it could well become the new gold standard in arrhythmia management.
“I believe PFA is the way of the future. It’s essentially the same technique as traditional ablations, it’s just the energy source is different,” opines Dr Razali.
Access to PFA may also depend on availability, as the technology is still being adopted in many parts of the world, and even in many parts of Malaysia.
For patients currently living with AF, Dr Razali emphasises the importance of early detection, lifestyle modification and regular follow-up.
“Don’t ignore the signs: palpitations, fatigue, or even mild breathlessness. Talk to your doctor.
“With the right treatment, including innovative options like PFA, you can regain control of your heart rhythm and your quality of life.”
THE heart is essentially a pump with four chambers and various “pipes” that connect it to all the organs and tissues in the body.
Within the chambers of the heart are valves that serve as conduits through which blood flows through.
One of these valves is called the aortic valve, which is responsible for regulating blood flow from the heart’s left ventricle to the rest of the body.
In the condition called aortic stenosis (AS), this valve becomes narrowed or partially blocked, which obstructs the smooth flow of blood – forcing the heart to work harder to pump blood.
Over time, this increased workload can lead to significant heart problems.
According to consultant cardiologist Dr Jayakhanthan Kolanthaivelu at Cardiac Vascular Sentral Kuala Lumpur (CVSKL), several factors contribute to the development of AS. The most common is age-related wear and tear on the valve.
“Generally, those who are elderly, as in 75 years and above, experience degenerative issues of the valve.
“And because the valve is so important as a ‘gate’ through which blood flows to the whole body, narrowing of the valve results in the heart working harder to push blood out into the body.
“As a consequence, the heart may swell and eventually develop some form of heart failure.
“One of the biggest problems with AS is that you can have sudden collapses because there’s not enough blood flowing out to the body, especially the brain.
“This may lead to sudden death in certain circumstances,” warns Dr Jayakhanthan.
Other risk factors include congenital heart defects, rheumatic fever, and certain genetic conditions. High blood pressure and cholesterol levels, diabetes and smoking also increase the risk of AS.
Symptoms
“Generally, when it comes to valve problems of the heart, one of the key symptoms is breathlessness,” says Dr Jayakhanthan.
“Patients may also feel more tired than usual.
“Other symptoms may include chest pain or discomfort, dizziness, and fainting. It’s essential to pay attention to these signs, especially if they occur during physical activity or exertion.”
Early detection
One of the challenges with AS is that it often progresses slowly, and individuals may not experience noticeable symptoms in the early stages.
Hence, early detection of AS is crucial for effective management and improved outcomes.
Routine check-ups and cardiovascular assessments can help identify the condition in its initial stages.
Diagnostics tests such as echocardiogram, electrocardiography (ECG), or cardiac catheterization may be recommended to assess the severity of the valve narrowing and its impact on heart function, says Dr Jayakhanthan.
“The echocardiogram is like a ‘baby scan’ of the heart. It’s an ultrasound of the heart that is painless and easily carried out.
“Depending on the severity of the AS, other tests may be also be required,” he says.
Treatment
The treatment approach for AS depends on the severity of the condition.
Dr Jayakhanthan reveals that in mild cases, regular monitoring and lifestyle modifications may be sufficient.
“It is recommended that patients get an echocardiogram every year, unless the symptoms progress or something happens.
“For moderate to severe conditions, we monitor every six months and manage accordingly.
“Some patients may even have more severe stenosis without any symptoms. We have to consider all factors before deciding on treatment options, looking at the risks and benefits of any intervention.
“For some, medical intervention to control symptoms may be the answer. For others, surgical options include aortic valve replacement or repair, which can significantly improve blood flow and alleviate symptoms.”
Less invasive procedures, such as transcatheter aortic valve replacement (TAVR), have become increasingly common, offering alternative options for eligible patients.
“Aortic valve replacement involves open heart surgery to replace the valve. It has been the traditional way to treat heart valve problems over the years,” Dr Jayakhanthan says.
“TAVRs have been around for about only 12 to 15 years, and it’s becoming more prevalent. Initially, it was meant for high risk patients who could not risk aortic valve replacement surgery.
“Over the years, long term data has emerged about TAVRs, and these indicate that such procedures can be very effective to treat valve problems, even in less severe AS.
“These days, there are quite a few options available, and the technology has kept on improving.”
Both surgical options have their own unique advantages and possible side effects, and which option to decide on will depend on the individual patient and the treating doctor, says Dr Jayakhanthan.
The important thing is to monitor patients closely so that a decision can be made according to the patient’s condition.
“We should optimise treatment based on their health parameters such as blood pressure, heart rate, symptoms, other illnesses and so on.
“Based on these, we can then make an informed decision about treatment and management,” notes Dr Jayakhanthan.
Lifestyle changes
While some risk factors for AS such as age and genetics, are beyond our control, adopting a heart-healthy lifestyle can play a crucial role in prevention and management.
A balanced diet, regular physical activity and managing comorbidities are key factors in promoting overall cardiovascular health.
Regular check-ups depending on your age and situation, timely medical intervention, and leading a heart-friendly lifestyle are essential to maintaining good heart health and ensuring a fulfilling and active life.
COVID-19 ravaged humanity in a way that’s rarely seen in the history of mankind.
Throughout the whole episode, however, other diseases continued to exact a toll on human lives – upstaged, but not outdone by the pandemic.
One such group of disorders is cardiovascular (heart) disease, which still remains the leading cause of death worldwide.
According to Cardiac Vascular Sentral Kuala Lumpur consultant cardiothoracic surgeon Dr John Chan, cardiovascular disease encompasses a group of illnesses that affect various parts of the heart.
The common ones include coronary artery disease, heart valve disease, diseases that affect the aorta of the heart, and heart rhythm disorders.
“In coronary artery disease, the blood vessels that supply the heart are narrowed or blocked.
“As for heart valve disease, there are four (valves). The valves are important to ensure smooth flow of blood from one heart chamber to the other. These valves can get diseased and narrowed, and they may leak.
“Diseases of the aorta (the main artery that carries blood away from the heart to the rest of the body) usually come in the form of aortic aneurysms, whereby areas of weakness in the aorta start to balloon and increase in size. If these become big enough, the artery will tear and rupture – a medical emergency.
“The heart also has its own electrical source and supply, which acts to regulate heartbeat. There can be problems with the electrical conduction of the heart, leading to irregular heartbeats (heart rhythm disorders),” he says.
Who is at risk
Risk factors for heart disease include high cholesterol (which narrows and eventually blocks off coronary arteries), diabetes (especially uncontrolled diabetes), unhealthy diet (with high fat), and smoking, among others.
“Genetic factors also play a part,” says Dr Chan. “Obviously this is a bit more difficult to control.
According to consultant cardiothoracic surgeon Dr John Chan, it is not uncommon to see younger patients (in their 30s) with coronary artery disease. There are multiple reasons for this, including a sedentary lifestyle, obesity, diabetes and smoking.
“The other factor is ageing.
“For example, take the heart valves. A lot of times, the valves get diseased because of the natural process of wear and tear as we get older.
“Infections may also affect the heart valves. If you have an infection in another part of the body that is not treated properly, this can spread to the heart valves and start ‘eating away’ at the valves. This is called endocarditis.
“In Malaysia, we still have rheumatic heart disease – an inflammatory condition whereby patients get an infection (usually of the throat) that is not treated adequately, which triggers inflammation in the heart valves.
In later years, the valves thicken in response to this inflammation, and this precipitates heart valve disease.“In the aorta, uncontrolled hypertension can lead to tears in the aorta, leading to aortic dissection, which is commonly fatal.
“Electrical rhythm problems in the heart are often due to ageing.
“Excessive alcohol consumption is also a risk factor for such problems.
“Furthermore, long-standing coronary artery disease and heart valve disease can lead to heart rhythm problems.”
There are many possible symptoms of heart disease, and these include:
> Chest discomfort and pain
> Uncomfortable feeling in the chest
> Discomfort in the neck radiating down to the arms
> Shortness of breath for coronary artery disease.
Heart valve disease can lead to shortness of breath, as well as dizziness. Patients may also sometimes lose consciousness.
As for diseases of the aorta, Dr Chan warns that the typical symptom is very severe pain in the chest or back.
Treatment options
Getting diagnosed is the first step towards treatment.
Depending on what the problem is, tests may include getting an ECG (electrocardiography), stress ECG, CT scan, coronary angiogram, echocardiography (for heart valve disease), and Holter monitor for heart rhythm disorders.
Treatment depends on the disease.
“First, we control risk factors such as cholesterol, diabetes, hypertension and so on.
“For coronary artery disease, options include putting a stent in the affected artery.
“If the disease is extensive, and involves multiple coronary arteries, then a bypass is recommended. This gives the best survival rate for such patients.
“For heart valve disease, if the leak is a minor one, we usually control with medication.
“In severe leakage, the only way to treat is surgery to repair the valve or replace the valve.
“There’s also the option of replacing heart valves via transcatheter valve procedures, which is a minimally-invasive procedure to replace diseased valves. This procedure is usually carried out in older patients who are not fit for surgery.
“In the early stages of an aortic aneurysm, we can ‘wrap’ the aneurysm to stop it from getting bigger. This is called a personalised external aortic root support,” says Dr Chan.
If the aorta is already dissecting or torn, the risk of surgery is very high, so it is better to treat it in the very early stages to prevent the progression of the disease.
Ultimately, he advises that a healthy lifestyle is the best deterrent against cardiovascular disease.
“Eat in moderation, don’t smoke, try to exercise, and find out if you are at risk for heart disease by going for a physical and blood test.
“You should maybe get the physical when you are in your 30s, especially if you have a history of heart disease in the family,” he says.
Dr John Chan is a consultant cardiothoracic surgeon at Cardiac Vascular Sentral Kuala Lumpur (CVSKL).
The phrase “heart skipped a beat” is often used to describe excitement, fear, anxiety or any other strong emotion.
In real life, the heart skipping a beat or two can occur, and it could be a warning that we need to take heed of.
According to Cardiac Vascular Sentral Kuala Lumpur (CVSKL consultant cardiologist Dr Zulkeflee Muhammad, we don’t usually feel our “normal” heartbeat. It is regular, constant and doesn’t intrude into our consciousness.
However, it can change depending on what we are doing.
When we exercise, the heart can go up to 180 beats a minute. When we are resting, it can beat at a leisurely pace of 60-plus a minute, and we are oblivious to it.
Occasionally, we do feel our heartbeat, but not on a regular basis. If we do keep feeling our heart beating, it could be a sign that there’s something wrong.
Electrophysiology
Electrophysiology is the study of the electrical systems of the heart. So, a consultant electrophysiologist is a cardiologist who specialises in diagnosing and treating issues with the heart’s electrical system.
“Imagine the heart as an engine. It has its own electrical system, mechanical components (heart muscle), plus other components. All have different properties and functions.
“In a nutshell, the heart contracts at the prompting of its electrical system.
“When this electrical system is compromised, problems arise,” explains Dr Zulkeflee.
An electrophysiologist can carry out an electrophysiology (EP) study to diagnose electrical anomalies in the heart.
This study can look at the electrical properties of the heart, stimulate the heart to trigger any abnormal electrical circuit, as well as be treat those with abnormal electrical rhythms.
“The EP study evaluates the electrical condition of the heart, diagnoses the problem, and guides treatment according to the abnormality,” he adds.
Arrhythmia
Heart rhythm problems are called arrhythmias. We often describe them as palpitations.
It can mean anything from a fast heart rate (tachycardia) to a slow heart rate (bradycardia) and an irregular heartbeat or extra heartbeats.
It can affect all age groups, but some types are more common in the elderly.
Common triggers include viral illnesses, alcohol, medications, illegal drugs, and even exercise.
Some types occur in people with coronary heart disease, and these can lead to sudden death.
Others can accompany illness such as hypertension, thyroid problems, and even after severe Covid-19.
Some people might not feel the abnormal rhythm at all and only find out about it after a stroke due to the abnormality.
Others may not experience symptoms involving abnormal heartbeats.
Some may feel as if there’s something “stuck” in the chest which is relieved by taking a deep sigh.
“This could be a sign of extra heartbeats,” says Dr Zulkeflee.
'Imagine the heart as an engine. It has its own electrical system. The heart contracts at the prompting of its electrical system. When its electrical system is compromised, problems arise,' says Dr Zulkeflee.
When to see a doctor
According to him, those who feel palpitations should seek clarification.
“It doesn’t have to be an electrophysiologist. It could be a simple assessment by a cardiologist to differentiate whether it could be life-threatening or a simple extra beat (benign).”
However, the EP study should be carried out urgently if the palpitations are followed by fainting episodes, dizziness, breathlessness or chest pains.
“We need to increase awareness of arrhythmias and electrophysiology, not only amongst the public, but also among doctors,” says Dr Zulkeflee.
Treatment
But it has to be said that an electrophysiologist will have a wider range of options to investigate and pick up what’s happening.
Advances in technology means that the diagnostic and treatment arsenal available to an electrophysiologist is becoming ever more sophisticated.
“The EP procedure is minimally invasive. We thread a small catheter through the blood vessel in the groin to the heart.
A catheter is placed inside the right ventricle of the heart for an EP study and radiofrequency ablation.
“There’s no pain, though you might feel discomfort as if there’s something moving around in the chest, or you could feel the heart beating faster.
“But there’s sedation to make the whole experience more comfortable for the patient.
“There are risks, but these are minimal, less than undergoing an angiogram. There could be bleeding, infection or perforation,” says Dr Zulkeflee.
In terms of treatment, there’s a wide variety available to the electrophysiologist. Besides medications, treatment includes ablation therapies such as radiofrequency therapy, cryoablation, pulsed-field ablation, and devices such as pacemakers and implantable cardioverter defibrillators.
Dr Zulkeflee has this advice for everyone: “If you have an issue with heart rhythm, best to see an electrophysiologist.
“If you are not able to, please at least see a cardiologist.”
When the heart is stiff and doesn’t relax properly between heartbeats
An elderly woman can no longer walk as far as she could before.
She often feels tired and breathless no matter how much rest she has had.
Her legs are swollen.
This senior citizen in her 70s has problems lying down flat to sleep because she ends up coughing.
Her weight has gone up above what is normal.
“If a person experiences such symptoms, he or she may be having diastolic heart failure.
“It’s best to see a doctor – to rule out kidney, liver and other problems,” explains consultant cardiologist Dr Lee Li Ching.
Diastolic heart failure (DHF) is a type of heart problem somewhat different from the popular image of heart attacks – a person clutching his chest as he feels pain, tightness or pressure there.
6% to 10% of hospital admissions in the country are due to heart failure,’ says Dr Lee Li Ching consultant cardiologist at CVSKL
This is potentially a cause of systolic heart failure – when the heart is not strong enough to pump sufficient blood to the rest of the body (a heart attack causes pump failure, in other words, systolic heart failure).
You may have heard of the terms “systolic” and “diastolic” before when taking your blood pressure. The systolic is the top number of the reading. It measures the force of blood against your artery walls while the main heart chambers (ventricles) squeeze to push blood out of the rest of the body.
Whereas the diastolic is the bottom number of your blood pressure reading. It measures the force of blood against the artery walls as the ventricles relax and is allowed to refill with blood.
DHF occurs when the heart is stiff and doesn’t relax properly between heartbeats. So it doesn’t fill up with as much blood as it should and thus pumps out less blood to the rest of your body than a healthy heart would.
This decreased blood flow leads to the symptoms described above – fatigue and shortness of breath.
Moreover, when the heart is not able to pump efficiently, blood can back up into the veins from the lungs.
This eventually leads to fluid building up inside the lungs, a condition made worse when the person lies down flat.
Is DHF common?
“Diastolic heart failure is harder to diagnose, so it’s harder to collect data on it.
“Some of the symptoms could overlap with other problems such as kidney disease and blocked arteries,” explains Dr Lee, who is a consultant cardiologist at the specialist heart hospital Cardiac Vascular Sentral Kuala Lumpur (CVSKL).
“In Malaysia, we don’t have specific data. But 6% to 10% of hospital admissions in the country are due to heart failure.”
How much is a person at risk of dying from this disease?
“Different studies show different mortality rates,” says Dr Lee.
“However, the five-year mortality from heart failure could be higher than some forms of cancer.”
Other conditions such as high blood pressure, diabetes, sleep apnea, heart valve problems, blocked arteries and atrial fibrillation (irregular heartbeat) are commonly linked to DHF.
This can also indicate an increased risk for the disease.
Still, it doesn’t mean that every elderly person who feels breathless has this condition. So how is DHF diagnosed?
Even an electrocardiogram (ECG) may not pinpoint this disease.
The best way to find out is to do an echocardiogram, which is an ultrasound scan of the heart.
“This is the definitive test,” says Dr Lee.
“It will show any anatomical problems such as thickening of the heart walls. It will also show how stiff the heart walls are, and whether they are relaxing properly (between beats).
“Echocardiograms are best done at a hospital. GP (general practitioner) clinic usually only do a normal ultrasound for other organs.”
Treatment, lifestyle changes
Dr Lee says there is no “cure” as such for DHF, but heart function
a be improved and the symptoms managed.
Various drugs are used to reduce the heart’s stiffness.
These include ACE (angiotensin-converting enzyme) inhibitors, and angiotensin receptor blockers (ARBs), which are also used to treat high blood pressure.
“The aim is to soften the heart, so that we increase the time in which blood can flow in to fill the heart chambers,” she says.
“We also use beta blockers to slow down the heart, so that the patient feels better.
“This is a mechanical approach to remodel the heart and deal with the disease.”
When a heart becomes more stiff and hard, there is a tendency to have more fibrous tissue.
“Anti-fibrotic medicines are used to prevent further build-up of such tissue.
Symptoms are also treated by doctors. “For example, we use diuretics to get rid of extra fluids in swollen legs,” she says.
The next step is to deal with other underlying problems, such as high blood pressure, diabetes and irregular heart rhythms (atrial fibrillation).
Those with sleep apnoea (a sleep disorder in which breathing repeatedly stops and starts, often characterised by loud snoring) are advised to use a CPAP (continuous positive airway pressure) machine. This maintains a mild pressure to ensure the airways are kept open.
“A CPAP machine also helps those with diastolic heart failure as it pushes out fluid from the lungs,” adds Dr Lee.
Doctors will also recommend a change in diet.
“A low-salt diet is better for diastolic heart failure. This is because salt encourages more absorption of water, and thus more fluid retention. This then raises blood pressure.
However, this can be a challenge as “Malaysian food tends to be salty, especially ‘outside’ food,” she adds.
Other recommended lifestyle changes include:
> Maintaining a healthy weight.
> Eating a heart-healthy diet.
> Regular, moderate exercise.
> Quitting smoking (or vaping).
> Limiting alcohol intake.
“Sometimes, patients have been having symptoms of diastolic heart failure for weeks or even months
“While it’s not (immediately) life-threatening, the longer-term prognosis could be worse than certain cancers. So it’s best to get it treated,” concludes Dr Lee.
KTM Bhd and healthcare provider CVSKL have launched a partnership to provide free rides to patients across Peninsular Malaysia. The initiative aims to enhance the healthcare industry by providing hassle-free transportation for patients who need critical cardiac and vascular treatments. CVSKL is located in the nation’s transportation hub, KL Sentral, where most passenger rail networks converge.
Patients from all over Malaysia are often referred by their primary doctor to CVSKL.
The KTMB-CVSKL partnership was piloted in 2022 to encourage response. With the official launch, both parties hope to improve healthcare tourism by providing a more seamless access to patients.
Present at the launch were CVSKL chairman Tan Sri Dr Yahya Awang, its chief executive officer Tan Eng Ghee and KTM Bhd Group chief executive officer Datuk Mohd Rani Hisham Samsudin, as well as representatives from both parties.
Mohd Rani said they wanted to encourage medical tourism as well as remind people to take heart health seriously.
“We are proud of this partnership with CVSKL that aligns with the mission of KTMB to provide safe, reliable, comfortable and sustainable rail services on time, every time.”
Dr Yahya said CVSKL was recognised as a centre of excellence for cardiac and vascular matters.
“The patients that we treat not only come from the Klang Valley but as far as Butterworth and Ipoh.
“We hope that this initiative will provide convenience to our patients.
“We’d also like to thank KTMB for supporting this wholeheartedly,” he added.
Tan said the collaboration allowed CVSKL to address patients’ needs, including transportation.
“We envision the patient’s journey even before they get to the hospital and we want to make it easier for them,” he said. CVSKL said it was mulling working with other rail lines to further serve the community.
Small mesh tubes to open blocked or narrowed arteries of the heart.
DESPITE the fact that coronary (heart) stents have been increasingly widely used for the better part of three decades, there is still much about this technology that is not well understood by both the layman and sometimes, even medical professionals.
Stents are broadly defined as small mesh tubes that are used to hold open narrowed or diseased passages in the body.
They come in an array of sizes and materials to accommodate the varying uses in the human body.
Stents are made from a variety of different non-corrosive materials like metals, metal alloys as well as plastic polymers, and modern devices can be bonded with therapeutic drugs tailored for specific healing purposes.
Although stents are used in various locations in the body – for example, the biliary and urinary system – they are most commonly used to treat blocked or narrowed arteries of the heart, aorta and peripheral (limb) circulation, according to Dr Goh Khiam Yan, consultant cardiologist at CVSKL.
Stent only the first step
Dr Goh shares that while stents help to treat coronary heart disease, they are only part of the treatment.
“Stents do not cure heart disease per se, although they are frequently but not always, the first step in the treatment process.
“This is because while a stent restores blood flow and therefore functionality at the site where it is delivered, the disease process causing the problem is an ongoing one.
“It is probably more appropriate to regard coronary stents as a symptom alleviator than a cure.
“Once you put a coronary stent in, your symptoms disappear almost immediately because blood flow is restored. Chest pains, shortness of breath, and lethargy – stents can rapidly alleviate these symptoms very effectively if used appropriately, which is why it can be a bit deceptive.
“The patient can literally go running the next day and feel fine, but technically they are not ‘cured of heart disease.’ The vessel has just been reshaped to function better. You still have to prevent the other areas in the circulation from narrowing again over time.
“One of the frustrating things about coronary stents is that although the rationale of restoring flow in abnormal arteries is easy to understand, there remains the longstanding paradox that stents, despite relieving symptoms effectively, do not always prolong lives in patients with stable heart disease when compared with optimal drug treatment. This apparent conceptual paradox is another long discussion in itself.
“Having said that, in acute emergencies like heart attacks which are caused by acute abrupt occlusions of coronary arteries, and in situations where a patient’s symptoms are escalating typically from imminent closure of a diseased vessel, stents are a crucial and often lifesaving treatment.”
Healthy lifestyle first
A stent (right image) restores blood flow and therefore functionality at the site where it is delivered.
Patients have to look at their well-being holistically after implanting a stent, as treatment of the disease requires addressing issues on a panvascular level, or pertaining to the entire circulation system of the heart and body.
Crucial to this is adherence to medications prescribed, especially blood thinners, and drugs to control cholesterol and blood pressure levels.
“Stents are only a part of the treatment process. Patients will still have to change their lifestyles – as mundane as this sounds.
“The repeated but necessary calls for dietary changes, regular exercise and stopping smoking are so easy to ignore because these issues are repeated so often it feels almost like background noise in every health talk.
“Sometimes I feel mildly embarrassed to talk about changing lifestyles to my patients because it feels a lot like nagging about things they already know (but don’t always do!).
“I appreciate that a person’s diet and exercise activities are deeply personal and, in many ways, cultural – which are hard things to change.
“For example, our meals with our families are almost unique to each household. The choice of dishes, the amount of food served, what is regarded as healthy or otherwise – these are things and beliefs that are not easy to change overnight.
“Diets that are overly restrictive (such as the zero carbohydrate fad) or culturally alien (how do you even pronounce quinoa?) are difficult to sustain in the long term for most people.
“Likewise, overambitious exercise regimes and weight loss targets will be discarded after the initial scare is over.”
Dr Goh usually advises his patients to shift their diet to more plant-based food and to abstain from any form of meat (and yes, chicken is meat, he says) for at least two days a week, as cholesterol originates from animal products like meat, milk and eggs plus downstream products from milk and eggs, pastries and baked goods, sauces, cheese etc.
“Get out of the habit of needing meat with every meal. Learn to cook a little – it is the best way to understand what goes into a meal and will enable you to make better food choices when you dine out.
“As for exercise, find something that you can enjoy whether it is a particular sport, running, dancing or swimming so that you will return to it on a regular basis.
“Aim for modest weight reduction over a few months rather than an intimidating target weight.
“Many people are unnecessarily self-conscious about starting on exercising especially if they do not feel they are physically fit, but the truth is no one else is really looking at you when you exercise and if they do, it’s none of their business anyway.”
He says that taking the prescribed blood thinners after implanting a stent is crucial to avoid early complications, as the body will treat the stent as a foreign object in the initial phase.
“When you put a stent within a blood vessel, the body will cover it with a layer of cells called the endothelium over a period of weeks and months.
“Once that happens, it becomes incorporated into the vessel wall and the blood flowing through the stent will no longer be in contact with the metal.”
Low maintenance, not maintenance-free
Although there is a little bit of “maintenance” required to prevent clots and/or new blockages, Dr Goh shares that stents do not require to be removed at any point after implantation, and they can remain in the body indefinitely.
But taking the prescribed medication is a must to prevent early complications.
“The stents are not replaced. If there is a new disease forming around the stent, we can conduct procedures such as balloon angioplasty or use small blades on special cutting balloons to cut open and reshape the narrowed areas.
“But the stents that are implanted, stay inside. Our primary interest is to allow adequate blood flow to allow the heart muscle to function properly.”
He says although there is no set limit to the number of stents that can be implanted in a person, it is not encouraged to have too many stents in the body, as it is still a foreign metal object in the body.
He adds that the decision of “when not to stent” is as important as “when to stent,” as it should not be considered a universal solution to all “heart narrowings”.
An open discussion between patients and cardiologists on the risks and benefits of the treatment should take place before the procedure.
Outside of an emergency, you do not always have to make an immediate decision and if in doubt, a second opinion is often beneficial in protecting the interests of both the patient and physician.
In conclusion
Dr Goh says living a healthy active life should still be the foundation strategy to keeping a healthy heart.
“Things like hypertension and hypercholesterolaemia have a long latent phase before it declares itself as a problem.
“So, the best time to start looking after yourselves is in your 20s or early 30s.
“By the time that patients come into our clinics in their 40s and 50s, the condition has already been brewing for a very long time.”
He advises men and women over the age of 40 to get routine health checks every year.
Find a doctor that you trust and stay on their follow-up, this is often preferable to changing doctors frequently as a timeline of test results and symptoms is often more informative than a “snapshot” assessment by different doctors.
“Above all, take the same commitment that you give your job or business and apply it to your own well-being – in the end your mind and body are your only true assets in this life.
“And one last thing, Google is not The Lancet!” stresses Dr Goh.
Dr Goh is a KL native. He has recently located to Kuala Lumpur and works at CVSKL.
KUALA LUMPUR: Cardiac Vascular Sentral Kuala Lumpur (CVSKL) commemorated its fifth anniversary this year with its annual Charity Day.
This time, it was held with the support from CVSKL Foundation, a charitable non–profit organisation founded by prominent healthcare professionals and governed by a distinguished Board of Trustees who are industry leaders in various sectors.
CVSKL Charity Day is spearheaded by its chairman, Tan Sri Dr Yahya Awang who believes that private hospitals should always contribute back to society, especially the underprivileged segment who may not be able to afford medical treatment.
This campaign has benefitted many low-income B40 patients and now with the CVSKL Foundation as its’ charity partner, they can increase the assistance to a greater pool of cardiac and vascular patients.
Among the cases that were done were angioplasties, atriovenous fistula (AVF) creation, and Coronary Artery Bypass Graft (CABG).
This initiative was also strongly supported by its long-term partners in the medical industry such as Boston Scientific, Medtronic, Biosense Webster, Orbus Neich, Alvi Medica, Bard, B. Braun, Mitsu Scientific, Terumo, MK Trimedic, Medisense, Stellar Medical, BKS Medik, HNA Medical, Biosensers, Cook Medical and Gaia Medical.
Under this initiative, the participating doctors waived their professional fees and the hospital complemented these efforts by waiving all charges.
Tan Sri Rashpal Singh Randhay, chairman of CVSKL Foundation shared that “One of the missions of CVSKL Foundation is to provide support for low-income group patients suffering from cardiothoracic and vascular diseases.
“On behalf of the trustees, we’d like to thank CVSKL for extending a helping hand to these patients.”
Dr Yahya also commented on the philanthropic effort, “I am proud that we can make this an annual occasion to highlight our core belief as a private heart centre in giving back to the society as much as we can.
“I am proud that this continuous effort has made an impact on our underprivileged patients and thankful that we were given such a meaningful chance to aspire others to do the same to improve the quality of healthcare to ensure the B40 patients are not being neglected.” Being the first private cardiac hospital in the region, CVSKL is looking forward to many more future charitable contributions via CVSKL Foundation, non-profit body to strengthen their CSR presence in Malaysia.
The foundation is currently open for donations where no amount of contribution is too small or too big.
For more information, call 03 2276 7002 or email info@cvskl.com.
‘The average age when a heart attack occurs is 58, so anyone below 40 years is considered young,’ says Dr Al Fazir.
Knowing your risk factors is key to managing heart disease that is increasingly affecting younger people. ONLY in her early 30s, Lina (not her real name) booked an appointment with her doctor after experiencing shortness of breath. She gets tired especially from exertion and climbing up the stairs.
Exercise stress test showed ECG changes and her doctor proceeded to conduct further examination. That’s when a heart CT scan found Lina had several heart blockages. Lina is among many younger people who have what used to be seen as a disease of the elderly. For cardiologist Dr Al Fazir Omar, the youngest patient he has treated in recent years was in his early 20s.
“Noticeable now is that younger patients are coming in with heart disease,” says the consultant at Cardiac Vascular Sentral Kuala Lumpur. It scares me that patients in their early to late 30s are coming in with heart blockage. “We see a trend of younger people presenting themselves with heart disease,” he says, adding that the average age when a heart attack in Malaysia occurs is 58, so anyone below 40 years is considered young.
What to look out for
Also known as cardiovascular diseases (CVDs), heart disease is a disorder of the heart and blood vessels leading to coronary artery disease, heart valve disease or an impairment in the heart’s electrical system. Like in Lina’s case, heart disease may present itself in unassuming ways.
Dr Al Fazir says that symptoms may take many forms such as chest discomfort, difficulty in performing physical tasks, breathlessness, swelling of the leg and palpitation. “A classic symptom is chest pain or discomfort in your chest walls. You get this uncomfortable, heavy and pressing feeling in your chest – the centre or to the left of your chest.
“It can also radiate to your arm, back and jaw.” As for breathlessness and difficulty in performing physical tasks, Dr Al Fazir shares: “Patients would say they were able to climb two or three flights of stairs without stopping but now needed to stop after half a flight of stairs. “Another patient once said that he could cycle fast on an incline but started to experience difficulties. When he came in, we found that he had 90% blockage in his artery.
“Some complained of swelling of the leg. “Make sure you go for a check up to find out what is causing this – it could either be the heart or issues with other organs such as the kidney disease that is causing the leg swelling,” he says. Dr Al Fazir says he has also come across a common symptom, especially since the covid pandemic: palpitations. “Patients come in saying there is an extra beat or a missed beat. While this is normally quite benign, it warrants further tests such as checking the patient’s clinical history or conducting an ECG and echocardiogram. “Sometimes, it is recommended to use a Holter ECG to monitor at home for a few days. Some smartwatches are able to pick up irregular heartbeats, too,” he says.
Early screening important
As the saying goes, prevention is better than cure. In this case, Dr Al Fazir extols the importance of early screening. “Malaysians tend to have a lot of risk factors. It is important to know your risk profile and heart screening enables you to be more aware of your health.
“Heart screening is recommended after you are in your 30s. If you have a very strong family history of premature heart disease, you may want to check up even before your 30s. “I treated a patient in her 40s who was a triathlete and her only risk factor was a slightly raised cholesterol level. When we did the stress test and followed by CT cardiac, unfortunately, it showed a high grade of artery narrowing of the main artery,” he says.
Health screening not only screens for persons with coronary artery disease. Many young patients that come for assessment are worried if they are suffering from heart disease or that their friend just suffered from heart disease and it is causing them some distress. So it is nice to inform them that after all the checks that they are well and should continue and resume their daily activities and physical exertions without too much worry. Recently I have been seeing some patients as they are preparing for their Ironman (Ironman is known for their triathlon event).
Know your risk profile
Understanding your risk profile is important to manage your lifestyle and if you have risk factors to manage – which can be divided into modifiable and non-modifiable risks.
“Modifiable risk factors are obesity, blood pressure, sugar, cholesterol levels and lifestyle as well. Lifestyle means the amount of exercise you do if you lead a sedentary life, smoking, and consume excessive amounts of alcohol.”
The non-modifiable risk factors, he says, are those of genetics, sex and age.“Stress is another risk factor that is difficult to measure but can have an indirect effect on your modifiable risk factors. “If the parent has heart disease, the patient may inherit risk factors like diabetes and high cholesterol.”
Simple tasks such as climbing a flight of stairs which now makes you breathless can be an indication of heart disease.
Lifestyle for better heart
If you are diagnosed with coronary artery disease, there are actions you can and should embrace. “The first is to adopt a healthier lifestyle. This means exercising for at least 150 minutes a week, reducing dietary cholesterol and salt intake, and cutting out sugar completely if you can.
“It is a good trend that people are exercising regularly but you have to be careful as well because some people have not exercised for a while but they go and sign up for a marathon run. “While exercising is good, you should know what your target heart rate is and know how much to push your body,” says Dr Al Fazir.
He says that your personal physician will advise on these and may advocate important pillar medications if you suffer from diseases such as hypertension, high cholesterol and diabetes. He adds that with the ease of current social media, this can lead to misinformation on side effects and patients sometimes stop taking their medicine.
“Some patients with heart disease just stopped taking their medications because they received a message (from well-meaning friends and family or online). “Please be discerning about the information you received and check with your doctor if you have any concerns about your medication or treatments”
#BreakTheHeartAche is a public education campaign that focuses on driving awareness on heart diseases in Malaysia. Jointly organised by Cardiac Vascular Sentral Kuala Lumpur and Viatris Malaysia, this campaign highlights the importance of early detection of heart problems, and to seek relevant treatment.
