Cardiovascular disease (CVD) is said to be one of the leading causes of death in the world and atleast half of these cases are said to occur in Asia. When compared with the west, most Asian countries are estimated to have higher age-adjusted mortality from CVD. To know more about the heart and heart disease, we spoke to Dr Eric Chong, cardiologist from ESC Cardiovascular & Medicine Clinic, Singapore.
We are grateful to Dr Chong, for giving us this interview and enlightening us about the various aspects of the heart and heart disease.
GetDoc: Dr Chong, can you start by telling us a bit about the heart and its functions?
Dr Chong: The heart functions as a central pump of body that maintains blood circulation. The left heart chamber pumps blood to the body and brain; the right heart chamber pumps blood to the lungs. The left ventricle is the largest chamber. Its contractility and function can be measured using echocardiography. The effective contraction of left ventricle helps to pump blood and supply oxygen to the body and brain. Weakening of heart occurs in heart attack when the heart fails to contract properly.
GetDoc: Tell us about the heart of a child, how different is it from that of an adult?
Dr Chong: Besides the heart chamber size, the structures of the heart are essentially the same between a child and an adult. There are 4 chambers in the heart, 4 cardiac valves and 2 main arteries connecting the heart to the lungs and body respectively.
GetDoc: What is the ECG/EKG? Can you tell us about it?
Dr Chong: ECG or Electrocardiogram (Local version) or EKG (U.S version) is a simple test to assess the electrical pattern of the heart. It also assesses the heart rhythm and heart rate. It shows the electrical pattern of the heart from 12 different directions. ECG can be very useful to evaluate diseases such as heart attack when electrical pattern changes dynamically or heart rhythm disorders such as atrial fibrillation and heart conduction block.
GetDoc: What are some of the common heart ailments that affect Malaysians/Singaporeans?
Dr Chong: The most common heart diseases include heart failure, heart attack and atrial fibrillation. From the Ministry of Health Singapore data, heart diseases account for more than 6% of all hospitalisations and 1 in 5 of all deaths.
GetDoc: What is a silent attack? How can it be recognised? What are the signs/symptoms?
Dr Chong: Silent heart attack is more common in people with diabetes. Diabetes and abnormal sugar level can affect nerve sensation and therefore mask the typical chest pain sensation during heart attack. The diabetic patients may not feel much of chest pain during heart attack, instead, they present with less obvious symptoms such as breathlessness, sensation of choking, cold sweating, left arm numbness and giddiness. Sometimes, patients may not recognise that they are having heart attack and therefore present to doctor late with more dangerous heart failure symptoms.
GetDoc: Is heart burn same as heart attack? How can we differentiate between the two?
Dr Chong: Heart burn is caused by gastric acid reflux when gastric juice refluxes from stomach into food tube. It causes a burning sensation. Heartburn is common in GERD (gastro-esophageal reflux disease). It occurs typically after eating spicy, sour and oily food and after drinking alcohol. It does not get worse with exertion like climbing stairs. Heart attack symptoms usually get worse during physical exertion. It also has other associated symptoms such as breathlessness and cold sweating. Sometimes, heart disease and GERD can co-exist as smoking, obesity, alcohol drinking are common risk factors of both conditions. Therefore, if heartburn symptoms persist or does not get better after treatment, a heart check should be carried out too.
GetDoc: Is heart attack mostly caused by high cholesterol?
Dr Chong: Heart attack is most commonly caused by high cholesterol. Among my heart attack patients, nearly all have high level of bad cholesterol (LDL). In addition, low level of good cholesterol (HDL) and high sugar level increase the risk of heart attack further. In my daily practice, the “high-five” risk factors for heart attack are commonly seen in Singapore patients which are high cholesterol, high blood pressure, high sugar, high body weight and high stress level.
GetDoc: How can diet affect the functioning of the heart? Does diet play a role in the development of heart disease?
Dr Chong: High salt diet causes hypertension, high sugar diet leads to diabetes and high fat diet leads to high cholesterol. Over consumption of food particularly those contain refined carbohydrate and trans fat contribute to weight gain and metabolic syndrome. Diet control plays a major role is preventing the ‘triple high’ condition. A diet with moderated quantity which contains less salt, less sugar and less fried food is good for heart. Certain heart friendly food includes blueberries, pomegranate, walnut and omega rich fish.
GetDoc: How does physical activity/body weight affect the functioning of the heart?
Dr Chong: Moderate intensity aerobic exercise and relaxation exercise like Yoga can improve function of heart. Cardiac Rehabilitation exercise has shown to reduce mortality in heart attack patients. However, we should avoid over intensified exercise that can be harmful to heart muscle and nerves. A normal body weight prevents overworking of heart. A non-obese person is more likely to have normal blood pressure than an obese person. Normal blood pressure reduces work demand from the heart and is good for longevity of heart.
Thank you very much Dr Chong for those quick answers.