Mah Sing Group Bhd founder and group managing director Tan Sri Leong Hoy Kum (second from right) presenting a mock cheque for RM50,000 to Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Foundation chairman Tan Sri Rashpal Singh Randhay, witnessed by CVSKL consultant cardiologist, Datuk Dr Rosli Mohd Ali (left) and CVSKL chief executive officer Tan Eng Ghee.
References:
CARDIAC Vascular Sentral Kuala Lumpur (CVSKL) has established the hospital’s first foundation for the benefit of underprivileged Malaysian patients, especially those seeking critical medical care.
CVSKL Foundation, founded by the team of CVSKL doctors, is governed by a board of trustees consisting of industry leaders.
Its objectives are to support medical advancement and research initiatives, increase awareness of cardiac and vascular diseases and provide financial support to the low-income group through management of funds received and raised.
Present to officially launch the foundation was its patron, Yang Dipertuan Besar of Negri Sembilan Tuanku Muhriz Tuanku Munawir, together with Tunku Ali Redhauddin Tuanku Muhriz and the board of trustees.
CVSKL Foundation chairman Tan Sri Rashpal Singh, in his speech, said the launch came at a most opportune time when the government was shifting its priorities from managing the Covid-19 pandemic to restarting the nation’s economy and recovery.
“The high utilisation of public healthcare services has led to overcrowded facilities that result in a longer wait, thus initiatives such as medical research funding and reducing the burden of public hospitals can be looked into.
“We are ready to work with the Health Ministry to complement the government’s hard work in improving the social well-being and health of fellow Malaysians.”
During the event, CVSKL consultant cardiologist Datuk Dr Rosli Mohd Ali handed over a donation of RM1mil to CVSKL Foundation.
Dr Rosli said the establishment of the foundation was an essential piece of the puzzle that would amplify CVSKL as a centre of excellence.
“In 2021 alone, our corporate social responsibility (CSR) efforts totalled RM4.15mil, which benefitted 545 patients.
“With CVSKL Foundation unifying and intensifying this, I am certain we will be able to help more people,” he added.
References
Pay attention if your veins are enlarged, swollen, lumpy, twisted, blueish or dark purple – they are probably varicosed and need medical attention.
Patients seldom consult a doctor as the initial symptoms may be mild and do not always lead to major health complications.
These unsightly veins can appear anywhere in the body, but most of the time, they show up in the legs because standing and walking increases the pressure in the veins of the lower body.
Our circulatory system is made up of blood vessels that carry blood from and towards the heart.
Arteries are blood vessels responsible for carrying oxygen-rich blood from the heart to the body.
Veins are blood vessels that carry blood low in oxygen from the body back to the heart (and to the lungs) for reoxygenation.
There are tiny one-way valves inside our veins that open to let the blood through, and then close to prevent it from flowing backwards.
If the walls of our veins become stretched and lose their elasticity, it causes the valves to weaken.
When the valves malfunction, the blood then leaks and flows backwards in a condition called venous reflux or chronic venous insufficiency (CVI).
This results in blood pooling in the veins.
For blood to return from the legs to the heart, the veins in the leg must work against gravity and as they are unable to do so, they become swollen or enlarged.
Other CVI symptoms include restless or heavy legs, fatigue, leg or ankle swelling, pain, aching, cramping, burning or itching skin, and ulcers.
CVI is two times more common than coronary artery disease and five times more common than peripheral arterial disease, yet there is poor awareness among Malaysians of the possible complications resulting from untreated varicose veins.
From cosmetic to pain
There are six stages of varicose veins:
As the disease progresses, the skin above the affected vein becomes pigmented, hardened and itchy, and eventually develops non-healing ulcers.
Occasionally, veins close to the skin’s surface can also burst and cause bleeding.
Varicose veins may start off as light spider veins (telangiectasis).
For many, this presents a simple cosmetic concern until pain and discomfort sets in.
Consultant vascular and endovascular surgeon Dr Tan Kia Lean says: “A lot of people live with varicose veins and think it is nothing because it doesn’t cause much pain in the early stages.
“I won’t say this is the wrong attitude as people are scared of operations and being cut up, but modern treatment is different.
“When it gets to the last stage (ulcer), varicose veins become very difficult to treat and may take months or years to heal.
“One of my patients had a non-healing ulcer for 20 years!
“Even with treatment, he was only able to go back to stage 5 and that’s why early treatment is vital.”
While in stage 3, the symptoms can still be reversed, but at stage 4 when there is skin damage, the symptoms cannot be completely reversed.
Dr Tan explains: “The pigmentation around the ankle area is like rusted iron.
“Our red blood cells carry iron and this iron has oxygen-binding capacity.
“But in varicose veins, when the vein is dilated and turns tortuous (i.e. twisted), the red blood cells cannot pass through and remain outside the veins.
“The iron within those cells will be oxidised and this oxidisation gradually leads to stage 4b, changing the colour of the skin and damaging it.
“The drying and hardening of the skin results in it stretching, and causes micro-oxidisation that cannot be seen with our eyes.
“But we can feel it because when it is exposed to air, it turns itchy; when we scratch, it gets infected and inflamed.”
Women more prone
While genetics can play a role, women below the age of 60 are more commonly afflicted with varicose veins.
This is due to the presence of oestrogen and progesterone in their bodies.
Dr Tan says: “These hormones make the vein walls more relaxed, especially during pregnancy, so the neck area of the vein gets dilated easily.
“In addition, the enlarging uterus in the pelvic cavity compresses the venous system and speeds up the formation of varicose veins.”
Being overweight and having jobs that require one to be on their feet for long hours also contribute to the problem, e.g. barbers or hairstylists; hawkers, cooks or chefs; teachers, etc.
“Sometimes, when you wear your shoe in the morning, it will fit well, but as the day passes on, it becomes tight as the blood is gushing down to the leg.
“With sitting, you can also get CVI, but it may not lead to varicose veins,” he adds.
Lifestyle management, leg rest and skin care are important interventions to delay disease progression.
Often, patients only consult a medical practitioner when there is pain, and when the doctor asks them when they started seeing their varicose veins, they will say since childhood!
“Varicose veins can be there for two or three decades without causing symptoms.
“When a patient turns up with symptoms, we have to find out where the problem is.
“Usually, it’s through diagnostic tests via an ultrasound as it provides real-time information on whether blood flow is one direction or bi-directional.
“Varicose veins can also reflect something in the heart – it can be quite difficult to tell what is causing the leg swelling.
“If we suspect something else, then we do a CT (computed tomography) scan,” says Dr Tan.
Evolving treatment
The earliest record of varicose veins is in the papyrus of Ebers, written 1550 BCE, where the author described them as “tortuous and solid, with many knots, as if blown up by air”, and recommended people leave their veins in place.
Later, the ancient Greek physician Hippocrates, widely touted as the father of modern medicine, suggested that people do something about their varicose veins as he noticed a correlation between veins and leg ulcers.
This marked the introduction of vein punctures, cautery (using a hot or caustic agent) and compression bandages as a treatment for varicose veins.
“Now we have compression stockings that prevent the reflux – you might have to use it for a lifetime, but it provides very good control.
“When doctors started understanding the disease better, they used the stripping method where they cut the skin near the top and bottom of the damaged vein, put a thin wire through the top (usually the groin), tie the vein over with wire and then pull it out through the cut in the lower leg,” Dr Tan explains.
Since 1990, endovenous treatment such as thermal ablation, i.e. radiofrequency ablation and laser therapy; sclerotherapy; and mechanochemical ablation; have been available.
Of late, these treatment modalities have become less invasive and less painful, without the need for general anaesthesia to carry them out.
Gluing it shut
In the last five years, cyanoacrylate glue – a special type of “super glue” – has become a popular form of treatment for varicose veins.
In this treatment, medical grade glue is placed in a catheter and inserted into the affected vein at the thigh to close it off.
Once the affected vein is glued shut, blood will immediately be rerouted through other healthy veins in the leg.
The closed vein will undergo a process of hardening (sclerosis) and will gradually be absorbed by the body.
“The therapy is quick and effective, takes around 30 minutes and is done as a daycare procedure – the patients don’t feel anything and there is no need for compression stocking afterwards either,” says Dr Tan.
There are also no pre-procedure drugs involved and patients can return to their normal activities right after the treatment.
There is no risk of skin burns or nerve damage, and immediate post-treatment pain medication is not necessary.
There are no guaranteed methods of preventing varicose veins, but the condition can be managed by getting diagnosed early, making lifestyle adjustments via diet and light to moderate physical activity, and symptom control.
The latter can consist of putting on compression stockings, taking intermittent breaks to sit if you have a job that requires long periods of standing, and resting the legs by elevating them above heart level before sleeping.
On the use of compression stockings, the surgeon says to use them only while standing, walking or exercising.
“When you lie down, there is no venous reflux, so why do you need compression stockings at night?” he notes.
“If you’re travelling, then the worry is not so much about varicose veins, but deep vein thrombosis (DVT, blood clots that form in the deep veins of the leg and travel to the lungs).
“The stockings that you wear for DVT are different from the ones used for varicose veins.
“If you’re on a long haul flight, it is good to put on a DVT stocking, but be sure to maintain hydration throughout so that your blood does not become concentrated.
“Also, walk around to get the blood circulation going,” he advises.
A common myth is that massage is good for varicose veins.
Dr Tan points out: “A massage does not prevent varicose veins from returning; in fact, it will rupture the veins.
“You can massage the legs, but not the affected vein.”
References 
It’s no longer surprising when someone says he has a stent placed in his coronary artery, or that she has gone for a bypass surgery.
After all, coronary artery disease (CAD), also known as ischaemic heart disease, is the biggest killer in the world, as well as in Malaysia.
According to the Statistics Department, 15% of medically-certified deaths in 2019 were due to CAD.
The casualties were 11,330 (69.4%) males and 4,995 (30.6%) females, with the states of Selangor, Johor and Perak topping the chart.
Like a number of other non-communicable diseases, the patients being struck down by CAD are getting younger.
In 2019, 18% of CAD deaths occurred in the 41-59 age group and 16% in the above-60 age group.
However, the good news is that medical technology is also advancing to help save patients’ lives.
Since the first coronary angioplasty to unclog blocked arteries was performed in 1977, the field of interventional cardiology has progressed in leaps and bounds, giving CAD patients another shot at life.
Angioplasty uses a tiny balloon catheter that is inserted into a blocked blood vessel to help widen it and improve blood flow to the heart.
It’s often combined with the placement of a small wire mesh tube called a stent, which helps prop the artery open, thus decreasing its chance of narrowing again.
Most stents are also coated with medication to help keep the artery open.
These are known as drug-eluting stents.
Angioplasty is also often performed during a heart attack to quickly open a blocked artery and reduce the amount of damage to the heart.
Angiograms are an essential part of an angioplasty.
An angiogram is a procedure that utilises a contrast agent to look at the blood vessels via X-ray.
It shows a two-dimensional silhouette of the interior of the coronary arteries that allows the cardiologist to see how much the vessel has narrowed.
Now, however, there is an imaging tool that allows the doctor to see a cross-section of not only the interior of the blood vessel, but also the layers of the artery wall itself.
This tool, known as intravascular ultrasound (IVUS), uses sound waves (ultrasound) to generate detailed imaging of the heart’s blood vessels.
This makes it possible to evaluate the amount of disease present, how it is distributed, and in some cases, what it is made of.
Explains consultant cardiologist Datuk Dr Tamil Selvan Muthusamy: “It’s a finer version where a camera-like device is attached to the tip of a catheter so that we can further evaluate the coronary arteries.
“With an angiogram, yes, we can tell that the artery is narrowed, but with IVUS, we can also assess the severity and nature of the blockage as we can see the artery inside out.
“Normally, we will balloon and put in a stent in many situations, but if you have IVUS knowledge, your techniques of angioplasty may differ, particularly if you have a severely calcified (hardened) artery.
“Then a normal balloon or stent may not work, and we have to decide what is the most appropriate device to tackle the blockage.”
Improved outlook
In 2018, a three-year study was conducted on 1,448 patients to determine the percentage of patients who had recurring blockages after undergoing a stenting procedure, also known as target vessel failure (TVF).
It was found that only 6.6% of patients who underwent IVUS-guided procedures had TVF.
This was significantly lower than the 10.7% of patients who did not undergo IVUS and had TVF.
Published in the Journal of the American College of Cardiology, the results of the study emphasise IVUS’s ability to help reduce the chances of TVF by almost half.
This is important as a main risk of angioplasty, compared to bypass surgery, is renarrowing of the affected artery.
Thus, the use of IVUS could help improve the long-term results of angioplasty with stent implantation.
Says consultant cardiologist Datuk Dr Rosli Mohd Ali: “With IVUS, doctors can get a clear look at the final stent expansion and reduce the chances of post-procedure complications, thus achieving better long-term outcomes as shown in numerous studies.
“At the same time, we can also see the edges of the stent and if there is any tear in the vessel that may cause a blood clot.
“If this happens, a patient can get a heart attack after the procedure – sometimes within one to two hours.
“In certain areas, it is almost compulsory to use IVUS, e.g. in the left main trunk, which supplies two-thirds of blood to the heart.
“If anything happens there, it can be catastrophic, and sometimes, we can lose a patient there and then.”
Although IVUS technology has been around for more than 20 years, it has only recently made inroads in Malaysia.
Last year, IVUS was used in 8.7% of angioplasties in Malaysia.
In Japan, it was used in 80% of such procedures; in Singapore, 25%; in the United States, 6%; in Europe, 4%; and in India, 3%.
While the long-term outcome is more promising, not all cardiologists are using IVUS.
Cost and experience
It’s probably due to financial issues, Dr Tamil Selvan says, as the overall cost may be 10-15% higher.
In Japan, almost every patient has insurance, so IVUS is widely used.
Dr Rosli opines: “Another reason besides cost is because some cardiologists are not comfortable interpreting what they see.
“When you don’t have the confidence, the chances of picking up the device and using it is probably lower.
“You don’t need special skills, but you need to know how to interpret findings and act on it – this comes with education and experience.
“It does take a bit more time and not all cardiologists have the patience.
“In teaching institutions, the young ones are quick to pick it up, provided they are given the go- ahead by the senior consultants.”
Both consultants have each performed more than 100 IVUS-guided procedures to date.
“Very often, we are faced with patients who return and we see the stents have narrowed – not be- cause of cholesterol plaque, but due to the healing process and scar tissues forming inside.
“In these cases, we prefer to use IVUS.
“We usually find that the stents are underdeployed to start with, so not only are we are treating the scar tissue, but we also have to create enough lumen (space in the artery) so that the renarrowing doesn’t occur,” says Dr Tamil Selvan.
Basically, the concept is: the bigger the lumen, the better.
Dr Rosli elaborates: “Angiographically, you can sort of gauge, but you cannot know what it is like inside the vessel.
“You deploy the stents at a certain point and you think the results will be good, but it may not be because you only see two dimensions, whereas with IVUS, you can see three.
“For me, if the patient comes in with typical symptoms of angina or chest pain due to lack of blood flow to the heart, and he’s got a typical profile – elderly, high cholesterol, diabetic – I will advise an angiogram.
“There are certain patients who say they want other tests instead of an angiogram.
“If the pain is not severe, then it’s okay, but if the symptoms are severe, the blockage is probably significant and they need an angiogram.”
Dr Tamil Selvan adds: “The investigation you do is dependent on the individual.
“If I see an 87-year-old with a typical angina – obviously, the heart is diseased and we try our best to give medications to subside the symptoms.
“We don’t do any procedures (as the patient is elderly) unless the symptoms are really bad, then we take the risk.”
Achieve your targets
How long can one live after stenting?
Says Dr Rosli: “One must remember that treatment via stenting or bypass surgery is not a cure.
“I’ve seen bypasses get blocked again within a couple of months; the same thing with angioplasty.
“What is important is to take care of yourself and address all your risk factors, e.g. diabetes, hypertension, smoking, obesity, etc.
“Be on proper medication, but you must achieve the right target.
“There is no point taking cholesterol medications and the level goes down, but it still doesn’t achieve the target.
“That means the disease will still progress on, so you have to do something to halt this progression.”
When a coronary artery gets blocked again, it doesn’t necessarily mean it is from the previously-treated site.
He continues: “Data shows that 50% can be at a different site, so this tells us the progression of disease is what drives lesions at the same or new sites.
“That’s why it is important for people be on proper treatment and achieve targets consistently.”
The other aspect is the procedure itself – the correct technique must be used.
“You have to look at the blood vessels – if the vessel is small, has lesions or is calcified, then whatever the method we use, the results may not be good,” says Dr Rosli.
The blockages are likely to return, although it can vary from being very quick to years.
The upside, as Dr Rosli adds, is that: “Technology is always expanding and devices are only going to get better.”
Not total freedom
A lot of patients feel that once they have a stent, they’re “free” forever.
“That is wrong!
“It is common for patients to ask if they can stop taking cholesterol tablets once their levels are normal and I always tell them no.
“They’ll ask how long more and I tell them they have to take it until they are 90, then we push them off the cliff!” jokes Dr Tamil Selvan.
Another common question patients ask is if they need a bypass surgery if they have more than three blocked vessels.
“It depends on the location of the narrowing,” he says.
“If I put seven or eight stents and I can get very good results, so be it.
“But if I can only put in two stents and get bad results, then a bypass is best.
“Data has shown that the longer the stents and the more we use, the risk of recurrence is higher.
“So we try to use shorter stents instead of longer ones unless there is a valid reason.”
There are also other devices available in the market that can be utilised.
Dr Rosli says: “There are special drug-coated balloons where the drug goes into the tissue and there is a reduction in the risk of renarrowing.
“This drug is similar to the one placed on the drug-eluting stent.
“If the results are good, we don’t have to stent that area.”
Do note that if you’re diabetic – like one in five Malaysian adults – you’re twice as likely to have CAD as high blood glucose levels can damage blood vessels and nerves that control the heart.
Dr Tamil Selvan stresses that CAD will probably strike at an even younger age group in a decade’s time, so the “fight should begin in schools now”.
“Be aware that CAD is a chronic disease and a burden to the country.
“We need to take care of ourselves for ourselves and for our families,” concludes Dr Rosli.
Reference
THE World Health Organisation says non-communicable diseases (NCD), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70% of all deaths worldwide.
NCDs, also known as chronic diseases, are the leading cause of death and morbidity among Malaysian adults.
This has resulted in the formulation of a National Strategic Plan for Non-Communicable Diseases 2016-2025 to address the threats posed by NCDs in Malaysia.
To combat this Covid comorbidity crisis, Switzerland-based pharmaceutical company Novartis hosted a Zoom event entitled “Non-communicable diseases in the new normal”.
Novartis Corporation patient access and government affairs country head Azwar Kamarudin, in her welcoming remarks, said they had roped in three doctors to share their experience and knowledge of three diseases.
Kicking off the session was Pantai Hospital Kuala Lumpur consultant pulmonologist Dr Helmy Haja Mydin, who discussed asthma as a heterogeneous disease, and explained various conditions of asthma patients.
“What you see in an asthmatic patient is inflamed or swollen airways, ” he said, elaborating that some people would experience difficulty in breathing, chest tightness, wheezing and coughing.
Citing scenarios, he said that there was exercise-induced asthma as well as attacks triggered by changes in temperature. Allergy-induced asthma, he highlighted, was “very specific to an individual”.
Pointing to the situation in Malaysia, he said only 41% of patients had their asthma under control.
“This means they don’t need an excessive amount of reliever inhaler and their asthma does not affect their day-to-day activities, ” said Dr Helmy Haja, who is also head of the private hospital’s lung centre.
While talking on “Asthma in the New Normal”, he said inability to control asthma symptoms with the available treatment options was one of the main risk factors for exacerbated and uncontrolled asthma.
Citing findings on productivity loss, he said 48% of Malaysian patients had missed work or school due to asthma, with an average of 11.2 days away in 2010.
“Malaysians reported an average productivity drop by 21% when their asthma was at its worst, ” he said.
He stressed that correct use of reliever inhaler was important, saying that its overuse could cause death.
“Patients with asthma must take the right inhaler regularly with the right technique. Use a controller inhaler if necessary. Don’t depend on a reliever.”
On the indirect impact of the Covid-19 pandemic on asthma, Dr Helmy Haja said it caused less interaction with doctors.
He said that sometimes the use of masks and sanitiser as well as an unconducive work-from-home environment, increased indoor exposure and stress or anxiety, among others, affected asthmatic patients.
To a question from a participant at the event, he said there was no cure for asthma but it was very controllable.
“Asthma affects many people. Poorly-controlled asthma can lead to poorer health outcomes, impaired quality of life and even death.
“The risk of complications from Covid-19 is less if the asthma is well-controlled, ” he added.
Dr Helmy Haja said it could be difficult to differentiate between an asthma attack and Covid-19 symptoms.
“If you have fever, cough and sore throat, get a swab test done to find out (the cause), ” he advised.
Cardiac Vascular Sentral Kuala Lumpur consultant cardiologist Dr Choo Gim Hooi shared his insights on the topic, “Hypertension in the New Normal.”
Dr Choo said hypertension was a silent killer if untreated, and that it caused various complications.
“Hypertension is the main contributor to cardiovascular (CV) disease burden worldwide.”
He advised patients to measure their blood pressure and said that in general, hypertension was when clinic measurement was consistently above 140/90mmHg.
“Risks associated with blood pressure is a continuum. Controlling hypertension prevents and improves outcomes and saves lives, ” said Dr Choo, who is also board member of the Asian-Pacific Society of Interventional Cardiology and National Heart Association of Malaysia and Interventional Cardiac Society of Malaysia council member.
“During the Covid-19 pandemic, CV disease patients, including hypertensives, continue to be a high risk for adverse events.
“In addition, they are at higher risk of getting a more serious manifestation of Covid-19 and dying from Covid-19 infection.”
Among others, he said that fear of Covid-19 and access barriers to medical care resulted in failure or delayed attention to CV disease and risk factors.
He added that defaulted medical follow-up and prescription refills had resulted in excess deaths.
Dr Choo advised all hypertension patients to wear a face mask, sanitise their hands regularly, maintain physical distancing, boost their immunity and rest well. “Adopt a healthy lifestyle and diet, and ensure your blood pressure is well controlled. See your doctor regularly. Make sure to take your medication, ” he said.
Meanwhile, Gleneagles Hospital Kuala Lumpur consultant dermatologist Dr Peter Ch’ng Wee Beng spoke on “Psoriasis in the New Normal.”
“Talk to your dermatologist if you get psoriasis during this Covid-19 period. Don’t stress too much as it will become worse, ” he pointed out.
He said those with the skin condition should not smoke or drink alcohol excessively.
“Remember to exercise. Take up a new hobby and enjoy time with your family, ” advised Dr Ch’ng, who is also Cosmetic Dermatology and Laser Medicine Board of Malaysia chairperson.
He shared that some of his patients abroad and from other states in Malaysia could not seek treatment during the initial movement control order period.
“Some had financial difficulties and had to cut down their medication and because of this, their psoriasis became more severe.”
Asked if moisturiser could aggravate psoriasis, he said ideally, it should not contain fragrance, preservative and colouring.
“The most important thing is that the patient finds the moisturiser soothing.”
Asked if psoriasis would worsen with age, he said although there was no evidence to back this up, on a personal level his father’s condition improved as he got older.
KUALA LUMPUR, 30 September 2020: Living with heart failure can be terrifying. But people need to know that the condition is preventable, treatable and manageable. People living with heart failure need treatment for the rest of their lives, according to a cardiologist.
“There is effective medication to treat people with heart failure. Treatment improves heart failure symptoms and quality of life, reduces hospitalisation and helps patients to live longer, ” says Datuk Dr David Chew Soon Ping, consultant cardiologist at Cardiac Vascular Sentral Kuala Lumpur.
“Heart failure is a chronic condition whereby the heart can’t pump enough blood to meet the body’s needs. The older you are, the more likely that you may get heart failure. However, this does not mean that heart failure does not affect younger people.”
Up to 10% of those above 65 years of age may develop heart failure. It is also the most common cause of hospitalisation among this group.
Some of the common causes of heart failure include coronary artery disease and heart attack, hypertension, heart muscle disease or valve disease.
Dr Chew points out that medications need to be continued long-term and the challenge with some heart failure patients is medication compliance – they don’t take their medication as directed by their doctors. In some cases, patients stopped their medication without consulting their doctors. This usually results in worsening of their condition and may lead to hospitalisations and death.
Besides medication, other treatment options include implantation of electrical devices or surgery – if patients have severe coronary artery disease or valve conditions, and in extreme cases, heart transplant.
For people in risk groups (high blood pressure, diabetes, high cholesterol and obesity), Dr Chew recommends: “Treat these conditions appropriately to prevent the development of heart disease that can later on lead to heart failure. Watch your salt and sugar consumption. You should exercise too but always discuss with your doctor before you start.”
For healthy people, Dr Chew says: “Maintain a healthy lifestyle that involves watching your diet, maintaining an ideal body weight, exercising regularly and don’t smoke.”
“If you practise healthy habits and lifestyle, the chances of developing high blood pressure, diabetes, and even heart diseases are lower. This helps to prevent heart failure too.”
If heart disease like coronary artery disease develops, Dr Chew advises: “Appropriate treatment and management of your condition can prevent the heart disease from getting worse, reduce heart attacks and prevent the heart from getting damaged and avoid heart failure.”
Some of the signs and symptoms of heart failure include shortness of breath or trouble breathing, fatigue and weakness, swelling (in the ankles, feet, legs, and abdomen), rapid or irregular heartbeat and persistent cough or wheezing.
“Heart failure symptoms are not distinct and some of them are pretty common. That’s why it can be challenging to diagnose heart failure. For some heart failure patients, they think they are short of breath because they are not fit. But if you feel unwell, don’t dismiss it as ageing. Go get it checked, ” he says.
