Frequently AskedQuestions
Do I really need to take medicine for high blood pressure?
My friends tell me once I have started on medicine, I can never stop
I have high blood pressure. Is there anything I shouldn’t eat?
My friend and I have the same cholesterol readings. Why is it that my doctor asked me to take medicine but not my friend?
I have been experiencing some chest pain. Am I having a heart attack?
What is the difference between Heart Attack and Angina?
Do I really need to have stents in my artery?
Do I really need to have a by-pass operation?
I have blocked arteries. Can I still play golf or exercise?
Can I take Viagra? I have blocked arteries
I am feeling breathless when I walk. Is there something wrong with my heart?
When should I start going for health screening?
I have heard of Chelation Therapy for unblocking artery. Is there evidence to suggest that it works?
I have heard of arthrectomy device. They remove the cholesterol deposit from the artery without stents. Are they better?
Frequently Asked Questions Cardiac Specialist Centre
These are questions which are commonly asked. We hope we can provide you with satisfactory and honest answers. We would be more than happy to have a face-to-face chat with you and your relatives.
Do I really need to take medicine for high blood pressure?
Once you have been properly diagnosed with high blood pressure (Hypertension), you will need to take medicine. High blood pressure produces no symptoms for many years. In fact, in the 1st few years of high blood pressure, there is not much organ damage especially if the blood pressure is not very high. The damage comes over years of exposing yourself to this high pressure.

The aim of taking medicine is to prevent the long-term ill effects of this high blood pressure. It will prevent stroke, heart attack, heart failure, kidney failure and other organ failure. Therefore, you may feel well today without any medicine, in years to come, your organs will be damaged and this will lead to unnecessary sufferings.

My friends tell me once I have started on medicine, I can never stop

This is one the most common misconception that patients have. To go straight to the point, there is no law against stopping your medicines. You can stop taking your medicines or stop seeing your doctor any time you chose to.

Taking your medicines is like paying for insurance premium. As long as you pay your premium, you are covered against accidents. Taking your medicine for high blood pressure, high cholesterol or even diabetes is like paying your insurance premium. As long as you are taking them, they protect you against getting serious disease like stroke or heart attack. You may stop them anytime. But the risk of getting stroke or heart attack returns to the same level as before you started treatment. Therefore while you can stop your medicine, it is really not advisable. Compliance with your medication will greatly reduce your chances of getting serious complications and lets you live a full life.

I have high blood pressure. Is there anything I shouldn’t eat?
In general, one has to eat healthily for good health. That means high fiber, low fat and low sugar. In the setting of hypertension, one should aim for a low salt diet. Salt is found in many foods such as Luncheon meat, sausages (both Western and preserved Chinese ‘Lup Cheong’), Salted vegetables and various processed and preserved food. These should be avoided. Salt is also found naturally in fresh food. Therefore, if your pressure is already elevated, you should attempt not to add any salt to your cooking. However, in our local setting where we all enjoy good food, this is sometimes very difficult. Therefore, if eating out is a necessity, you may ask the hawker or kitchen to reduce the salt in your food. You may also visit dashdiet.org for more information on ‘Dietary Approach to Stop Hypertension’.
My friend and I have the same cholesterol readings. Why is it that my doctor asked me to take medicine but not my friend?

Like high blood pressure, high cholesterol also produces no symptoms. The damage done is slow and over the years. Arteries slowly become blocked. Eventually, it will lead to stroke and heart attack. This is why cholesterol has to be lowered.

The level to which cholesterol is lowered is dependent on the person’s risk profile. Those who have had a heart attack, blocked artery, stroke or diabetes will need to have lower levels than those who don’t. Therefore, while 2 people’s cholesterol levels may be the same, their risk profile may be different, thus requiring slightly different target for treatment.

I have been experiencing some chest pain. Am I having a heart attack?

Thankfully, not all chest pains are due to heart attack. In fact, statistically, around 80% of people who turn up to the clinic with chest pain, have nothing wrong with their heart. But it is the other 20% we are most concerned with. The only way to be sure that you do not fall into the other 20% is to see a doctor when you get chest pain.

The doctor will need to assess your symptoms carefully. He will have to know where is the pain, what is the character of the pain and what might set the pain off. He will also have to assess your risk factors for heart attack such as presence of high blood pressure, diabetes or family history of heart disease.

After which, tests may need to be performed to make sure your chest pain is not originating from your heart. These may include some form of stress test, CT angiogram or even coronary angiogram.

What is the difference between Heart Attack and Angina?
When an artery becomes narrowed, it impedes or slows down the blood flow in that artery. When you start to do something physical, like climbing up stairs or walking fast, the area down stream from that blockage will start to experience a lack of blood and thus oxygen. You will experience this lack of oxygen as a tightness or crushing chest pain. This may radiate to your jaw or your arm. As you stop your activities and rest, the unpleasant pain slowly subsides. No permanent damage has been done to your heart yet. This is Angina.

As the artery becomes more narrowed by the collection of cholesterol, the wall over the cholesterol pool becomes thinned and fragile. This compromised wall may sometime crack open, exposing the cholesterol underneath. Once this cholesterol is in contact with the blood, a chain reaction takes place resulting in the rapid and total blockage of the artery. You will then experience a severe chest pain like that described above. However, this pain will last much longer and will not ease with rest. This usually results in permanent damage to your heart muscle if treatment is not started immediately. This is a Heart Attack.

Do I really need to have stents in my artery?
The simple answer is that, ‘Not all blocked artery needs to be stented’. However, life is never that simple. There are 2 broad categories where stenting is considered.

The 1st is in the setting of heart attack. The 2nd is in the setting of stable ischaemic heart disease.

In the 1st scenario, it is well proven that stenting of the affect artery saves lives and lowers the probability of having repeated heart attack. The use of stents here is absolutely necessary.

In the 2nd scenario, more factors have to be taken into account. These will include your symptoms, such as if you are experiencing any angina and how severe they are, if your stress tests were abnormal, how severely blocked are the arteries and how many blocked. Therefore, this is a more complicated issue. You would want a doctor whom you feel is able to give you a balanced opinion and who can explore with you the alternatives. There are cases where a by-pass operation is best suited to you and some times just medication would be better for you.

Do I really need to have a by-pass operation?
This is a big decision that your doctor has come to with you. There are certain settings where a bypass is better than stenting. In certain settings, you may require so many stents that a bypass would work out to be less expensive. However, an operator’s experience and skill are also factors to consider. Not all operators are comfortable performing stenting of Left Main artery or Chronic Total Occlusion. Therefore, if you are very averse to having an open-heart surgery, you may wish to seek second opinion.
I have blocked arteries. Can I still play golf or exercise?
You will need a proper consultation with your doctor before starting exercise. It depends on the severity of the blockages and the symptoms it produces. If the blockage is mild, not causing symptoms and there is no need to have it stented, it us usually perfectly fine to exercise. If the symptoms only comes with severe exertion but is controllable with sublingual GTN, you may still be able to continue some form of exercise. However, if you experience chest tightness at rest or on minimal exertion, or your stress tests showed strong positive results, you may need to have angioplasty or by-pass operation before resuming your activities. Your doctor may have already prescribed you with medications. It is very important that you should be compliant with them.
Can I take Viagra? I have blocked arteries
You will need proper assessment before you start on erectile dysfunction therapy. These medicines can interact with nitrates (the medicine to be place under the tongue). It has the potential of dropping your blood pressure to dangerously low levels and may cause death. Therefore, you should not be taking any form of nitrates at all should you be considering the use of these medicines. Furthermore, you should inform any doctors treating you who are not familiar with your case, that you are taking these medicines. This will prevent them starting a nitrate for you.
I am feeling breathless when I walk. Is there something wrong with my heart?

Breathlessness can originate from the heart or the lungs, sometimes a combination of both. You will need to see a doctor to be properly assessed. He will need to ask you questions about the character of your breathlessness. When does it come, what makes it worse and if there are other symptoms associated with it.

For the heart doctor, an echocardiogram will be a useful tool to assess the function of your heart. This will check your heart muscles and the valves’ function. Sometimes, a stress test may also be useful.

If your symptoms sound more like it has originated from the lungs, then your doctor will refer you to an appropriate specialist.

When should I start going for health screening?
The Health Promotion Board advises all above the age of 40 years old to start screening for Diabetes, Hypertension (High Blood Pressure), Hyperlipidaemia (High Cholesterol), Breast and Cervical Cancer. Early detection and treatment prevents complications. It allows you to enjoy a full and productive life.

However, if you or your family members already have any one of these conditions, you should start and continue regular screening at an even earlier age such as 30 years old.

I have heard of Chelation Therapy for unblocking artery. Is there evidence to suggest that it works?

Sadly, the answer is ‘No’. At best – ‘Not yet’. Chelation therapy involves injection of a substance called ‘EDTA’ into the blood stream. The idea is that it will remove the calcium deposited in the blocked artery. Thereby improve the artery’s function and relieve the blockage.

There are very few well-conducted studies. One notable study called ‘Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health’ (PATCH) trial showed no benefit what so ever between placebo and active therapy. On the other hand, there have been cases of adverse reaction reported from its use. Therefore, until there is evidence for the use of this alternative therapy, it is best avoided for now.

I have heard of arthrectomy device. They remove the cholesterol deposit from the artery without stents. Are they better?

These devices are not new. They have been around for the last 10 years or so. There are 2 main types. One that bites off the cholesterol plaque and one that drills through the plaque. But as experience and data in these devices accumulates, it is found that they don’t perform better than stents. In fact, the device that takes bite out of the plaque has stopped production. The drill called ‘Rotablator’ has a niche market in treating heavily calcified plaques. Therefore, they are still in use, but only in specific circumstances. Stents are still the best therapeutic option.

Consultation
Know Your Cardiologists

I feel breathless when walking.

I feel a tightness over my chest.

Do I need to take my medicine for my blood pressure?

Do I need to take my medicine for my cholesterol?

Do I really need stents for my artery?

Do I really need to have a bypass operation?

When should I go for health screening?

I have heart problem, can I take Viagra?

I have heart problem, should I exercise?

Heart Disease
Learn about your heart Conditions

You may need an ultra sound scan of your heart to assess its function.

You may need a treadmill stress test.

You may need closer monitoring.

You may need a more thorough risk assessment and life style change.

You may only need to take your medicine.

You may get away with just stenting.

This generally should start at 40 years old.

Yes, but there are certain strict conditions to fulfill.

Yes, but you will need to find out the appropriate intensity.

Clinical Services
Know what tests are needed for you
  • Health Screening
  • Treadmill stress test
  • 2D Echocardiography
  • and more ...
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