Dr Teck Kee Ang

Well, it depends on the type of medication you are taking. In general, most medication is ok with heart medications but there are some specific ones we look out for. For example, if you are taking nitrates, isosorbide dinitrate, or even a Glyceryl trinitrate spray, then try not to take things like Viagra, because they enhance the vasodilation effect and can cause your blood pressure to rise to a life-threatening level. Other things could be dependant on whether you are taking blood thinners. Let's say you have a stent implanted then you have two blood thinners already.

Health or heart screening is generally done in asymptomatic individuals who may or may not have pre-existing cardiovascular risk factors (examples include but are not limited to): diabetes, hypertension high cholesterol, sedentary lifestyle, smoking and a significant family history of heart disease. Electrocardiogram (ECG) is a safe, non-invasive and quick test. It is a 10 seconds snapshot of the electrical activity of your heart.

As with any vital equipment which is needed on a daily basis, our heart too requires regular servicing and maintenance to keep if functioning well. The average life expectancy in Singapore is close to 84yrs old. At 50yrs old, one would have 34 more years of life ahead of them. Our aim is to keep patients healthy and be able to enjoy more years of healthy living. Regular screening allows patients to detect diseases early, hence allowing early intervention and treatment. Having a heart screening once a year can help pick up potential diseases sooner and hence treatment can be initiated earlier.

Patients may complain of chest pain to their family physician, who may then refer you to a cardiologist depending how his/her initial assessment of you. A good and detailed history followed by a focused physical examination by your doctor is the first step in the initial assessment of chest pain. This not only allows the physician to assess your pre-test probability that the chest pain is due to coronary artery disease, it also allows the physician to determine the next course of relevant investigations that is appropriate for the individual patient.

So, as the name suggests, SCAD (Spontaneous coronary artery dissection) is spontaneous. It happens suddenly, so if we are talking about whether it shows up on ECG, then yes, only if you happen to do the ECG at the moment of symptom. Spontaneous Coronary Artery Dissection depends on when or where it occurs. If it occurs in a certain territory in the heart that the ECG can reflect on, then it can show up as an ECG sign. Because it is acute, it's almost like an acute heart attack because the dissection can potentially occlude the artery, but otherwise, it can't be seen. You can go for a CT scan.

There are a lot of things that can affect your resting heart rate. Let us break it up into physiological and pathological factors. So if you exercise a lot, your resting heart rate can be quite low. The normal heart rate is 60 to 100. Less than 60 is a low heart rate, above 100 is a fast heart rate. Again, it depends if you are a very active person. Your heart rate tends to be on a lower range if you are those really active people; your heart rate can go as low as 40. So when we look at the heart rate, we got to look in terms of the context of the patient.

Our body generally is not very smart when it comes to pain referred to the front. A lot of things can cause chest pain. For example, the most worrying to people is whether its a cardiac event or just chest pain but naturally a lot of pain can be referred to the front, for example, musculoskeletal pain, referred pain from a spine condition, or even pain from infection. For example, I remember a patient complained about chest pain and nobody opened up the clothes to look at the patient's chest wall, who was having shingles, so having pain on the chest wall resulted from that.

For this question, I will split coronary heart disease patients into two groups. The first group will be those patients with coronary heart disease but have not had an event yet. For example, when you come for health screening, then we do some checks like the CT Scan like an Angiography before finding out if you have some coronary artery disease. Essentially, this happens when you've never had an event yet, never had a heart attack, never had a stroke, essentially have no Ischemia event as we call it.

So coronary artery disease is the cause of angina. Basically, you are talking about pressure on the left side of the chest due to coronary artery issues. Number one, it can be caused by what we call a heart attack, that means it's due to blood rupture and then there is a sudden occlusion of your coronary artery then you present with cold sweat, breathless, nausea, vomiting, etc. Then there is a second group where there is a narrowing of your artery but it hasn't completely occluded that means patients with 70% narrowing.

There are several causes actually. When talking about hypertension, there are various types of causes. Basically, postural hypertension is a general category or a broad heading. Under postural hypertension, there are various types of things like Vasovagal, things like POTS (Postural orthostatic tachycardia syndrome), which has a few types, Type I and Type II, then there is also those that are related due to medication, and those due to dehydration. In cardiac terms, usually for patients with postural hypertension, we first try to rule out the reversible causes.