Latest / Health Matters / Implantable device to help deal with Coronary Artery Disease

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Implantable device to help deal with Coronary Artery Disease · Health Matters

• 0:00
  Speaker 1: If it's a matter of health, it matters. Health Matters
• 0:04
  Speaker 1: with Daniel Martin. Welcome into Health Matters, everybody. Thank you
• 0:07
  Speaker 1: so much for joining me on today's edition. We've often
• 0:10
  Speaker 1: heard those terrifying stories. It's so tragic when it does
• 0:13
  Speaker 1: happen of people in mass sports events and sporting events
• 0:17
  Speaker 1: succumbing to an unknown heart condition.
• 0:21
  Speaker 1: We've heard about people launching New Year's resolutions and jumping
• 0:25
  Speaker 1: into fitness routines and then finding out that perhaps there
• 0:29
  Speaker 1: was an unknown cardiac or coronary artery disease issue behind
• 0:33
  Speaker 1: the scenes lurking, and they, it, it's always bewildering.
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  Speaker 1: Because this is a younger person, this is somebody who's
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  Speaker 1: generally been fitter, had no signs or symptoms. What can
• 0:45
  Speaker 1: be done about it in terms of picking up early
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  Speaker 1: and potentially treating early as well, so you can continue
• 0:50
  Speaker 1: with your healthy lifestyle well into your later years. We're
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  Speaker 1: joined on today's edition by Doctor Leslie Tay, who's an
• 0:55
  Speaker 1: interventional cardiologist based at Mount Elizabeth Novena. Doctor Tay, it's
• 0:59
  Speaker 1: good to talk to you. Welcome aboard.
• 1:01
  Speaker 1: Thank you, thank you, Daniel, for having me. What are
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  Speaker 1: some of these conditions like? Because obviously when it comes
• 1:05
  Speaker 1: to cardiac conditions, we talk about the big ones on
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  Speaker 1: my show all the time, we talk about the heart disease,
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  Speaker 1: we talk about the stroke, we talk about the coronary
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  Speaker 1: artery disease, but when it comes to the lesser considered
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  Speaker 1: risk factors or known conditions, what are we talking about?
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  Speaker 2: Uh, well, in terms of um.
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  Speaker 2: Say for example if we if we're gonna if if
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  Speaker 2: if uh patients are going to uh start to.
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  Speaker 2: Um,
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  Speaker 1: Begin that fitness routine?
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  Speaker 2: Yeah, breaking that fitness fitness routine. Uh, I think it's important,
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  Speaker 2: number one, to identify whether you have any problems or not. Uh,
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  Speaker 2: is there any underlying uh heart disease? And, uh, before
• 1:48
  Speaker 2: you embark onto a um an exercise program.
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  Speaker 2: Um, and, and it's important to go to your doctor's
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  Speaker 2: and have it evaluated first.
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  Speaker 1: Other names for some of these lesser known conditions, like
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  Speaker 1: I said, we all know, we all know like, oh,
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  Speaker 1: heart attack, stroke, we know the terminology, for example, these
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  Speaker 1: lesser known conditions or things that might be lurking behind
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  Speaker 1: the scenes, even for young, fit person. What are some
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  Speaker 1: of these things known as?
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  Speaker 2: Yeah, so essentially we want to look for all forms
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  Speaker 2: of heart disease that can potentially cause problems when someone
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  Speaker 2: exercises or exerts themselves.
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  Speaker 2: So for the common conditions we know, coronary artery disease, uh,
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  Speaker 2: blockages in heart arteries, uh, these are, these are fairly common,
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  Speaker 2: they're more common in the elder population. In the younger population,
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  Speaker 2: then we look for uh things like uh genetic uh
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  Speaker 2: heart conditions like cardiomyopathy or structural problems in the heart.
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  Speaker 2: These are more common in the younger population.
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  Speaker 1: And it's possible that even though they've had this for
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  Speaker 1: most of their life, there have been no signs, no symptoms,
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  Speaker 1: no impact, they've been going to the gym and being
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  Speaker 1: fit regularly and no issue.
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  Speaker 2: Yes, absolutely. So it's, it's usually, uh, when, when a
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  Speaker 2: person goes and stresses beyond their fitness level, so they,
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  Speaker 2: they've exercised, uh, normally, but when you say, for example,
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  Speaker 2: at the end of someone trains for a marathon and
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  Speaker 2: and starts running a marathon, but you're 500 m to
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  Speaker 2: the end, you start running and sprinting at the end,
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  Speaker 2: and this is when you're exhausted, you're lethargic, you're dehydrated,
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  Speaker 2: and that's when you're.
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  Speaker 2: Your body uh decompensates and, and, and, and your arrhythmia,
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  Speaker 2: a deadly arrhythmia can, can happen.
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  Speaker 1: My gosh, so it means in some cases, really, we
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  Speaker 1: can actually say if that person had never run a marathon,
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  Speaker 1: they could have lived their whole life without succumbing to
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  Speaker 1: this condition if they had never really stressed their body
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  Speaker 1: beyond that exertion level.
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  Speaker 1: Yes, exactly. That is tragic. That is absolutely tragic. But
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  Speaker 1: at the same time, I can understand why that person
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  Speaker 1: would never think to even check for this because every
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  Speaker 1: time they go for their annual health check, or every
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  Speaker 1: time they, they, they see their doctor or something, and
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  Speaker 1: the doctor asks them, how are you feeling? Any signs symptoms? No,
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  Speaker 1: everything's fine. No palpitations, no sign of breathlessness or lethargy.
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  Speaker 1: Why would you even want to check?
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  Speaker 2: But that's, that's the more uncommon one. So these are, so, uh, the, the,
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  Speaker 2: the patients I'm the, the people I'm talking about are
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  Speaker 2: those who have never evaluated, they've never had a heart
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  Speaker 2: screening done, they've never seen a doctor, and then they
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  Speaker 2: decided one day to wake up and, uh, lead a
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  Speaker 2: healthy life, uh, as they say, and start exercising.
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  Speaker 1: Yeah, the irony is that they can go too far, right?
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  Speaker 2: Yes, exactly.
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  Speaker 1: So for example, you just, you went from 0 to
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  Speaker 1: hero in the span of a month, that's when the
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  Speaker 1: stress is happening.
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  Speaker 2: Yes, uh, and it's the weekend warriors, uh, that pushes
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  Speaker 2: themselves beyond their limits.
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  Speaker 1: So the, you know, I've been doing a whole bunch
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  Speaker 1: of fitness related shows over the years as well, and
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  Speaker 1: there is always that concern when somebody jumps into the spinning,
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  Speaker 1: and that can be a big problem for them as
• 4:55
  Speaker 1: well when they jump into the, uh, the weightlifting, which
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  Speaker 1: seems so popular right now as well. We learned a
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  Speaker 1: lot about that post-COVID as well when it comes to
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  Speaker 1: cardiomyopathy concerns. And of course, the long endurance races and
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  Speaker 1: things like that.
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  Speaker 1: So what is the recommended course of action? What should
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  Speaker 1: you do medically speaking before embarking on something like this?
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  Speaker 2: Uh, I think everyone who is who has decided to
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  Speaker 2: start an exercise program. So, uh, you know, if you're
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  Speaker 2: 35 years old and and over or even if you're
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  Speaker 2: under 35 years old and you decide to embark on
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  Speaker 2: an endurance program.
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  Speaker 2: Should have uh their checkup with the doctors and that
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  Speaker 2: will include simple things like blood tests to identify risk
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  Speaker 2: factors like high cholesterol, uh, diabetes they'll have their blood
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  Speaker 2: pressure checked they'll do a simple ECG or electrocardiogram and
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  Speaker 2: that's able to, uh, we're able to evaluate the electrical
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  Speaker 2: uh um um function of the heart uh simple things
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  Speaker 2: like that, um, and, and, uh, we'll be able to
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  Speaker 2: identify the vast majority of, uh, conditions.
• 6:03
  Speaker 1: I want to go to our WhatsApp, where a lot
• 6:04
  Speaker 1: of listeners has WhatsApped across. Interesting question. 963-11938, Dr. Tay,
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  Speaker 1: this person asks, I was recently discovered to have a
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  Speaker 1: hole in the heart, but I was also of the
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  Speaker 1: opinion that this is something that would have been picked
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  Speaker 1: up at a much younger age, even at birth as well.
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  Speaker 1: This has made me think twice and I'm working with
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  Speaker 1: my doctor in terms of the physical activity that I'm
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  Speaker 1: taking part in.
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  Speaker 1: I've been advised that, you know, I may have to
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  Speaker 1: change certain physical activities, but my question is, why wasn't
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  Speaker 1: this picked up at birth? Thanks very much for your question.
• 6:32
  Speaker 1: at 963-11938. Hole in the heart, is that one of
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  Speaker 1: the conditions that, that we could be talking about as
• 6:36
  Speaker 1: well here?
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  Speaker 2: Uh, unlikely, uh, for a hole in the heart to
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  Speaker 2: be a cause of sudden death during endurance activities, uh,
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  Speaker 2: so the, the, the, the major or the, the holes
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  Speaker 2: in the heart that, uh, that cause issues are those
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  Speaker 2: that are in the bottom chamber of the heart, the ventricles,
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  Speaker 2: and these are almost invariably picked up.
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  Speaker 2: Uh, at, at, at birth or or um very early on,
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  Speaker 2: especially when, when infants and babies are examined by the doctors,
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  Speaker 2: I think the hole in the heart that this, uh,
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  Speaker 2: listener is alluding to would be, uh, either a, a
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  Speaker 2: flap that is, that exists within the left and right chambers,
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  Speaker 2: and this is actually present in about 30% of the
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  Speaker 2: population really, uh, yes, yes, uh uh uh something called
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  Speaker 2: a foramen of valley.
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  Speaker 2: Uh, and this can potentially be a cause of strokes
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  Speaker 2: in the younger patient.
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  Speaker 1: Does it develop over time or has it always been there?
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  Speaker 2: No, it's,
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  Speaker 2: it's, it's there to provide communication or provide blood flow
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  Speaker 2: when the baby is still in the in the womb,
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  Speaker 2: when a baby doesn't need to breathe. So once a
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  Speaker 2: baby is delivered and it starts breathing, then this, this whole,
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  Speaker 2: this flap.
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  Speaker 2: Uh, closes within the first few days of life, and
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  Speaker 2: about 30% of patients, they, it, it actually, uh, stays open.
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  Speaker 1: That is fascinating. I need to do a whole show
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  Speaker 1: on that now. That's it's up to 30%. And if
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  Speaker 1: it does remain open, can it become stressed and a possible? No,
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  Speaker 2: I mean, vast majority of the time, it doesn't cause
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  Speaker 2: any problem, and that's why we don't, we don't really
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  Speaker 2: look for it. It's only when someone say has a
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  Speaker 2: stroke and we worry about blood clots which can travel
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  Speaker 2: across this flat becomes a
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  Speaker 1: pathway.
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  Speaker 2: A cause for the stroke and that's when we think, oh, OK,
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  Speaker 2: you know, someone who's 30 years old had a stroke
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  Speaker 2: and he's got this flat, then perhaps this may be
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  Speaker 2: a cause for it and we should close it. But
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  Speaker 2: apart from that, we don't do, uh, we, we don't
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  Speaker 2: close these uh holes, uh, um, with in asymptomatic uh
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  Speaker 2: uh individuals.
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  Speaker 1: Thank you very much for that WhatsApp at 963-1193. Doctor
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  Speaker 1: Lesliete is an interventional cardiologist, Mount Elizabeth Novena joining me
• 8:50
  Speaker 1: on today's edition.
• 8:51
  Speaker 1: So we've talked about some of the lesser consider risk
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  Speaker 1: factors of cardiovascular disease amongst the middle-aged person, even the
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  Speaker 1: healthier individual as well.
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  Speaker 1: And we've talked about how, yes, heart failure can strike
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  Speaker 1: even those who are very health conscious, who are younger,
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  Speaker 1: and who exercise regularly as well. You could have lived
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  Speaker 1: with it your whole life and had no symptoms emerge
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  Speaker 1: as well. So let's say you go for one of
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  Speaker 1: these pre-event screenings. Um, and I know a lot of
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  Speaker 1: hospitals and heart centers are running these now, thankfully as well.
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  Speaker 1: Maybe before your first marathon, 12 months before your first marathon,
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  Speaker 1: you go for this before you start your training and
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  Speaker 1: so on and so forth. If things are picked up,
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  Speaker 1: what kind of things can be picked up?
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  Speaker 2: Um, OK, so, uh, you, you mentioned heart failure, um, so, uh,
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  Speaker 2: a a person's heart strength, uh, is, uh, measured by
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  Speaker 2: something called the ejection fraction, and that is, uh, the
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  Speaker 2: percentage of blood that is pumped out of the heart, uh,
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  Speaker 2: with each heartbeat. Uh, now, and this number is, uh,
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  Speaker 2: a normal heartbeat, a normal ejection fraction is anything above 55%.
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  Speaker 2: And uh it doesn't matter whether you're 20 years old
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  Speaker 2: or 90 years old, the heart strength is always above 55%
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  Speaker 2: unless there's underlying conditions, uh, which can be either blockages
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  Speaker 2: in artery or uh any, any number of genetic conditions
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  Speaker 2: uh that can cause this. So, um, you know, prior to, uh.
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  Speaker 2: A and an exercise program, a part of the screening
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  Speaker 2: may include an echocardiogram, which is what we use it's
• 10:27
  Speaker 2: an ultrasound scan of the heart, which is what we
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  Speaker 2: use to assess the uh heart structure and functions.
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  Speaker 1: And if those things are found, what can be done
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  Speaker 1: about it? Do you change your entire life or can
• 10:40
  Speaker 1: there be procedures or implantable devices that can help with this?
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  Speaker 2: Yeah, so it reminds me of one of a patient
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  Speaker 2: that I had a couple of years ago. Uh, he
• 10:52
  Speaker 2: was training for a marathon, in fact, it's 2022, he
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  Speaker 2: was training for the Standard Charter marathon, and he started
• 10:59
  Speaker 2: having severe chest pains and breathlessness during his runs. Now
• 11:03
  Speaker 2: he's been running for over 10 years, and he's never
• 11:07
  Speaker 2: experienced this, and his wife pushed him to have it
• 11:10
  Speaker 2: checked out with the doctor.
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  Speaker 2: So when he, when he came to me, I did
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  Speaker 2: two things to check his heart, one is an echocardiogram,
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  Speaker 2: and we found that he had severe heart failure. His
• 11:20
  Speaker 2: heart strength was 24%.
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  Speaker 2: So the question would be what has caused his heart failure,
• 11:28
  Speaker 2: and in his case, uh we evaluated his heart using
• 11:32
  Speaker 2: a CT scan to to do something called a CT
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  Speaker 2: coronary angiogram, and this, you know, identified that he has
• 11:39
  Speaker 2: severe blockages in all the arteries of his heart. Oh my.
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  Speaker 2: So the cause of his heart failure is something called
• 11:47
  Speaker 2: ischemic cardiomyopathy, so uh we can't because of uh blockages
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  Speaker 2: in the arteries uh and so the, the discussion moving
• 11:55
  Speaker 2: forward from that was that.
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  Speaker 2: We should, I, um, you know, start to think about
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  Speaker 2: clearing the blockages, um, and that's through procedures, uh, minimally
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  Speaker 2: invasive procedures called an angioplasty where we can balloon the
• 12:10
  Speaker 2: arteries and deploy stents or if it's appropriate, open heart
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  Speaker 2: bypass surgery.
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  Speaker 1: Yeah. And when, when those options come up for a
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  Speaker 1: younger person, obviously I can imagine how it can be
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  Speaker 1: very concerning.
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  Speaker 2: Yeah, so the discussion with him, uh, um, you know,
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  Speaker 2: we both agree that angioplasty was the was the best, uh,
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  Speaker 2: procedure to move forward, um, and, uh, you know, angioplasty, uh, uh, to,
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  Speaker 2: to fix a blocked artery is something that we do
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  Speaker 2: very regularly in Singapore and worldwide, uh, but to do
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  Speaker 2: an angioplasty on someone who has severe heart failure increases
• 12:51
  Speaker 2: the risk tremendously.
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  Speaker 1: Right, whether or not the heart can take the procedure
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  Speaker 2: exactly and and so there are a lot of tools
• 13:00
  Speaker 2: in our armamentarium that will be able to support the
• 13:04
  Speaker 2: procedure to ensure that it becomes safer and it runs
• 13:09
  Speaker 2: smoothly uh and and so for his, for his procedure
• 13:14
  Speaker 2: we implanted the world's smallest heart pump that acts as.
• 13:19
  Speaker 2: Uh, a mini heart to provide cardio cardiac output while
• 13:24
  Speaker 2: we are doing the angioplasty procedure.
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  Speaker 1: So, so it takes over the function of the heart
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  Speaker 1: pumping so that it can, it supports
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  Speaker 2: it supports it. So I mean, if you can imagine
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  Speaker 2: if the, you know, your heart is, if we think
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  Speaker 2: about the heart as the engine, uh, and the arteries
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  Speaker 2: of the heart that are blocked, these are the fuel supply,
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  Speaker 2: petrol to the engine, the blood supply to the engine.
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  Speaker 2: And your engines already weak. You need to clear up
• 13:49
  Speaker 2: the blockages. If you clear up as you're working to
• 13:52
  Speaker 2: clear up blockages, the heart can potentially be weaker while
• 13:55
  Speaker 2: you're doing it and so that can potentially compromise blood
• 13:59
  Speaker 2: supply to the brain, to the kidneys and other vital organs.
• 14:03
  Speaker 1: But does that mean you have to go for a
• 14:04
  Speaker 1: procedure first to implant the heart pump?
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  Speaker 2: No, it's all doing all
• 14:07
  Speaker 2: at the same time.
• 14:09
  Speaker 1: So we
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  Speaker 2: start, start to finish is about, uh, you know, depending
• 14:13
  Speaker 2: on how complex the procedure is, it takes about, you know,
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  Speaker 2: 4 to 6 hours.
• 14:19
  Speaker 1: Got it. OK, so the first thing we do is
• 14:21
  Speaker 1: support the heart with the heart pump, and then we
• 14:23
  Speaker 1: can go about clearing the blockages with the angioplasty.
• 14:26
  Speaker 2: Exactly. And, and you know, during the procedure, at one point,
• 14:30
  Speaker 2: his blood pressure was almost unrecordable, but because there was
• 14:33
  Speaker 2: a heart pump there.
• 14:34
  Speaker 2: Uh, we were able to proceed and, and know that
• 14:38
  Speaker 2: he is well supported.
• 14:39
  Speaker 1: After the angioplasties are completed, does the heart part remain?
• 14:45
  Speaker 2: No, we, uh, well, OK, it depends if we feel
• 14:48
  Speaker 2: that the the heart requires it, but in, in his case,
• 14:51
  Speaker 2: we removed it immediately after the procedure.
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  Speaker 2: Uh, 8 hours later, he was, uh, you know, walking
• 14:58
  Speaker 2: around in his room and he was discharged 2 days after.
• 15:01
  Speaker 1: That's so good to hear. Bearing in mind what, as
• 15:03
  Speaker 1: you said earlier on, his, his, um, heart uh uh performance,
• 15:07
  Speaker 1: it was 24% or something like that.
• 15:09
  Speaker 2: Yes, yes. Exactly.
• 15:11
  Speaker 1: Were there options in the past before the advent of
• 15:13
  Speaker 1: things like small heart pumps? Were there options in the
• 15:16
  Speaker 1: past for individuals like this to even go through an angioplasty?
• 15:20
  Speaker 2: Uh, well, the, the, this, this, I mean, in long
• 15:24
  Speaker 2: time ago, uh, in, in very complex procedures when, when
• 15:28
  Speaker 2: angioplasty was not, uh, so mature, then a a vast
• 15:32
  Speaker 2: majority of these patients underwent uh bypass surgery and that's when, uh,
• 15:37
  Speaker 2: you know, the surgeon would, uh, actually put.
• 15:42
  Speaker 2: The the the patient in a, in a heart lung
• 15:45
  Speaker 2: machine and bypass uh while they do the procedure and
• 15:49
  Speaker 2: so while they recreate new blood vessels for the heart, that's,
• 15:53
  Speaker 2: that's what's traditionally done and is still done in some
• 15:57
  Speaker 2: cases where it's appropriate.
• 15:59
  Speaker 1: Gosh, but still, I mean the.
• 16:01
  Speaker 1: The option that we have here that's fascinating, what a
• 16:03
  Speaker 1: unique option and opportunity. I would imagine it's a lot
• 16:05
  Speaker 1: easier than a heart lung machine in that sense, right,
• 16:07
  Speaker 1: to have something like this. I'm gonna end off with
• 16:10
  Speaker 1: one final question, doc, that has come in at 963-11938.
• 16:13
  Speaker 1: This is interesting because it ties into the idea of
• 16:15
  Speaker 1: the blocked arteries that we were discussing. This person says
• 16:17
  Speaker 1: they've had a seat, I'm gonna paraphrase.
• 16:20
  Speaker 1: They've had a CT angiogram, they've worked with their cardiologist.
• 16:23
  Speaker 1: They have very high cholesterol, but they've found out that
• 16:26
  Speaker 1: the cholesterol is not laying down in the arteries even
• 16:29
  Speaker 1: though they've got a very high cholesterol. It's suspected familial hyperlipidemia,
• 16:34
  Speaker 1: and doctors suggested either we go on a high dose
• 16:37
  Speaker 1: statin or we continue monitoring if you're not on a
• 16:40
  Speaker 1: high dose statin because your cholesterol is so high anyway,
• 16:44
  Speaker 1: it can't bring it down that much.
• 16:46
  Speaker 1: So this person is wondering, regular monitoring, is that enough
• 16:50
  Speaker 1: to see whether or not cholesterol is laying down in
• 16:53
  Speaker 1: the arteries?
• 16:55
  Speaker 2: Uh, it's a good question. Uh, my immediate, my first
• 17:00
  Speaker 2: response would be, do you want to wait for cholesterol
• 17:03
  Speaker 2: to start laying down your arteries and to you for
• 17:06
  Speaker 2: you to have blockages before you start treatment?
• 17:11
  Speaker 2: We know that high cholesterol from many decades of research
• 17:15
  Speaker 2: is associated with heart attacks, with strokes with blockages, and
• 17:20
  Speaker 2: that's why worldwide, um, the recommendation has to be has
• 17:24
  Speaker 2: been to control the the the cholesterol to uh to
• 17:27
  Speaker 2: the desired levels. Now having familial or genetically uh uh
• 17:33
  Speaker 2: family history of high cholesterol makes a person more genetically vulnerable.
• 17:39
  Speaker 2: To high cholesterol and all the more reason to make
• 17:43
  Speaker 2: sure that it is well controlled so I mean my
• 17:46
  Speaker 2: my recommendation would be to listen to your doctor, start
• 17:50
  Speaker 2: the medication, try to head towards a healthier level and
• 17:53
  Speaker 2: maintain it lifelong.
• 17:55
  Speaker 1: Remind us what's a healthy level of cholesterol just as
• 17:58
  Speaker 1: a key takeaway.
• 17:59
  Speaker 2: It
• 17:59
  Speaker 2: really depends on the patient's condition. You cannot treat someone
• 18:04
  Speaker 2: who has had a history of heart attack, the same
• 18:07
  Speaker 2: as I would treat someone who has no heart disease whatsoever. Uh,
• 18:10
  Speaker 2: but look at the LDL levels, the lower the LDL levels,
• 18:14
  Speaker 2: the better. Uh, someone who's had a heart attack needs
• 18:17
  Speaker 2: to be really low, some, you know, in the region
• 18:19
  Speaker 2: of less than 1.4 or 70.
• 18:22
  Speaker 2: Uh, but most people, uh, you know, around about 2.6,
• 18:26
  Speaker 2: 3.0 if they have no heart disease, that is a
• 18:29
  Speaker 2: somewhat acceptable level. A very Singaporean level is about 3.2
• 18:33
  Speaker 2: because of our hawker center, uh, and our lifestyle.
• 18:36
  Speaker 1: That is the truth unfortunately because of the dietary relation,
• 18:39
  Speaker 1: the lifestyle factors as well. Doctor Tay, this has been
• 18:41
  Speaker 1: absolutely fascinating. Thank you for your time today.
• 18:44
  Speaker 1: Thank you so much for having me. Here is Doctor Leslite,
• 18:47
  Speaker 1: an interventional cardiologist based at Mount Elizabeth Novena. This has
• 18:51
  Speaker 1: been Health Matters with me, Daniel Martin.
• 18:58
  Speaker 1: Before making any decisions based on the information in our program,
• 19:02
  Speaker 1: please consult a medical professional.