Comprehensive Guide to Cardiology

Cardiology is a branch of internal medicine that focuses on the study, diagnosis, treatment, and prevention of conditions related to the cardiovascular system, including the heart and blood vessels. In this comprehensive guide, we will discuss everything you need to know about cardiology in Singapore, including common heart conditions and treatment options.

Main Types Of Cardiology

Cardiology can be divided into three main types:

• Invasive Cardiology: This type of cardiology uses open or minimally invasive procedures to diagnose and address structural or electrical abnormalities within the heart, including angioplasty and stenting.
• Non-invasive Cardiology: This concentrates on diagnosing heart conditions without incisions or inserting needles, fluids, or any other objects into the body. Instead, it uses non-invasive procedures such as an electrocardiogram (ECG), stress tests, and heart ultrasound imaging.
• Interventional Cardiology: This is a branch of cardiology that deals with minimally invasive, catheter-based diagnosis and management of various structural heart diseases, such as coronary artery disease, heart valve disease, and acquired structural heart disease, eliminating the need for open-heart surgery.

What are the Different Types of Cardiologists?

The field of cardiology encompasses several subspecialties. Some types of cardiologists include:

• Interventional Cardiologist: These doctors are skilled in performing catheter-based procedures (most notably angioplasties) to diagnose and treat cardiovascular diseases, such as coronary artery disease.
• Heart Failure Specialist: A heart failure specialist focuses on managing symptoms and delaying the progression of heart failure. They develop treatment plans for each patient, which may include lifestyle modifications, medications, special devices, or surgery.
• Preventive Cardiologist: This type of cardiologist provides strategies to prevent or lower the risk of heart disease, such as lifestyle adjustments, medications, preventive screenings, and risk factor management.
• Paediatric Cardiologist: Paediatric cardiologists focus on identifying and treating cardiovascular conditions that affect children. They have undergone additional training to understand the unique physiology and development of a child’s heart.
• Imaging Cardiologist: This doctor performs various imaging procedures, such as echocardiography, cardiac MRI, and nuclear cardiac stress testing, to obtain detailed images of the heart’s structure and function and detect abnormalities or progression of heart diseases.
• Electrophysiologists: An electrophysiologist employs specialised techniques and tools, such as electrophysiology studies, to evaluate the heart's electrical system and treat complex disorders like arrhythmias, palpitations, and fibrillation.

Who is at Risk of Developing Heart Disease?

People with the following factors are at increased risk of heart disease:

• Age and Gender: Male individuals aged 45 and above and women past menopause are at a higher risk of developing heart disease.
• Blood Pressure: Hypertension or high blood pressure adds stress to the arteries, putting the individual at a higher risk of heart attack or stroke.
• Cholesterol Levels: Individuals with high LDL cholesterol (bad cholesterol) or low HDL cholesterol (good cholesterol) are more likely to develop heart disease.
• Excess Weight: Being obese or overweight is linked to other risk factors for coronary artery disease. Inactive lifestyles can also increase the risk of heart conditions.
• Smoking and Alcohol: Smoking reduces the oxygen in the heart and lungs, causing and exacerbating the symptoms of heart conditions. Excessive alcohol consumption can increase other risk factors for high blood pressure, stroke, and heart failure.
• Diabetes: High blood sugar can damage the arteries, blood vessels and nerves controlling the heart, putting people with diabetes at higher risk of developing heart disease.

What are Some Common Heart Conditions?

Some of the most common heart conditions include:

• Coronary Artery Disease: This occurs when the blood vessels supplying oxygen-rich blood to the heart become narrow or blocked due to the accumulation of fatty deposits or plaque. It can result in chest pain (angina), shortness of breath, a heart attack, and more.
• Heart Failure: This condition arises when the heart muscle is unable to pump blood effectively and normally, resulting in inadequate oxygen supply to the body’s tissues. It can lead to fluid retention in the tissue (oedema) and impaired function.
• Heart Muscle Disorder (Cardiomyopathy): This condition affects the heart muscle, resulting in structural and functional abnormalities. This can include arrythmias, heart failure, or other complications.
• Congenital Heart Disease: These are structural abnormalities or malformations in the heart walls, valves, or vessels present at birth. The severity of the disease or defect can vary substantially.
• Chest Pain (Angina): This is characterised as a burning or squeezing sensation or pressure in the chest area, which can radiate into the neck and the jaw. Chest pain can be a symptom of various heart conditions, such as coronary artery disease or a heart attack.
• Heart Arrhythmia: This condition occurs when the electrical impulses, which regulate the heartbeat, fail to function properly. As a result, the heart may beat too fast, too slow, or irregularly.

Common Types of Heart Screenings

Heart screenings help to detect, prevent, and monitor heart conditions. Common ones include:

• Treadmill ECG: During the test, the patient walks or runs on a treadmill with several electrodes attached to the chest to measure their heart’s response to physical stress. The ECG machine records the heart’s electrical signal to assess its function and detect irregular heart rhythms or other abnormalities that may not be present when the heart is at rest.
• Echocardiography (Heart Ultrasound): This diagnostic test uses high-frequency sound waves to generate real-time images of the heart’s structure and function. It also helps measure the size and function of the heart’s chamber, examine the heart valve motion, and assess the heart muscle contraction and blood flow pattern.
• 24-Hour Holter ECG Monitoring: A Holter monitor is a portable electrocardiogram (ECG) device that records the heart’s electrical activity for 24 hours or longer. This helps to identify and determine the risk of irregular heartbeats or arrhythmias.
• 24-Hour Ambulatory Blood Pressure Monitoring: During this test, a patient wears a portable device and a blood pressure cuff that automatically inflates and measures blood pressure at regular intervals.
• Left & Right Heart Study: This procedure involves inserting a specialised catheter to determine the pressures within the left and right heart chambers, as well as the pulmonary artery bed. It also measures the cardiac output—how well or poorly the heart pumps blood out at each beat.

Treatment Options for Heart Disease

The treatment options for heart diseases vary depending on the specific condition and its severity. They can be broadly classified into medications, minor procedures, and cardiac surgery.

Non-Invasive Treatments

• Medications: The doctor may prescribe certain medications to improve heart function, alleviate symptoms, and reduce complications. These include:
  • Anticoagulants or blood thinners, which help prevent blood clot formation
  • Angiotensin-converting enzyme (ACE) inhibitors, which treats heart failure and hypertension by expanding the blood vessel
  • Anti-anginal drugs, which relax the muscles in the heart and blood vessels and provide relief from chest pain
  • Anti-arrhythmic drugs, which help control heart rhythm disturbances
  • Diuretics, which are prescribed for patients with congestive heart failure and excessive amounts of water and salt in their bodies
• Pericardiocentesis: This procedure removes excess fluid from the pericardial sac, the protective lining surrounding the heart. The doctor will insert a needle and catheter into the pericardial sac to drain the fluid.

Invasive Treatments

• Coronary Angioplasty: This procedure widens narrowed or clogged coronary arteries by using a tiny balloon and a stent to help keep the narrowing open and maintain proper blood flow to the heart.
• Coronary Angiogram: This procedure involves injecting a contrast dye into the coronary arteries through a small catheter to detect any blockages. If necessary, the specialist can perform an angioplasty during the procedure.
• Valve Repair or Replacement: In this procedure, the cardiac surgeon repairs or replaces the damaged heart valves with artificial valves to correct problems due to diseased heart valves. This helps restore normal blood flow in the heart and improve heart function.
• Heart Transplant Surgery: This involves removing the diseased heart and replacing it with a healthy donor heart. A heart transplant is reserved for patients with end-stage heart failure who have not experienced adequate improvement from medications or other surgeries.

When Should You See A Cardiologist?

If you are experiencing any symptoms associated with heart health or have a pre-existing heart condition, it is crucial to consult with a cardiologist. Some common indications that may warrant a visit to a cardiologist include:

• Heart palpitations
• Fainting
• Shortness of breath
• Persistent chest discomfort
• Swelling in the legs
• Noticeable weight gain
• A family history of heart disease
• Other risk factors, such as high blood pressure, high cholesterol levels, or diabetes

Choosing a Cardiologist in Singapore

When selecting a cardiologist in Singapore, consider the following factors:

• Qualifications and Credentials: Ensure that the cardiologist you choose is Ministry of Health-certified and holds relevant qualifications and credentials.
• Experience and Expertise: Look for specialists with an extensive background in treating general and/or subspecialised cardiovascular conditions.
• Hospital Affiliations: Consider the hospital where the cardiologist practices. Look for reputable institutions with a wide network of specialists, advanced facilities and technologies.
• Partnership with Insurance Providers: Choose a cardiologist who has partnerships with insurance providers to help minimise out-of-pocket expenses and facilitate smooth coordination of care.

Preparing for a Cardiologist Consultation in Singapore

Preparing for a cardiologist consultation is key to maximising your appointment. Here are some tips:

• Bring Personal and Family Health History Documents: Compile relevant documents, such as your personal and family health history, previous medical records, results of any previous heart tests or procedures, and a list of medications you are currently taking.
• Compile a List of Questions You Want to Ask Your Doctor: It is essential to prepare a list of questions to ask your doctor during the consultation; so that you can address all your concerns and gain a better understanding of your condition and treatment.

What to Expect When Visiting a Cardiologist

During your first visit, your cardiologist will review your individual and family health history documents and inquire about your symptoms, lifestyle, and any factors that may increase the risk of heart disease.

They can also conduct a physical examination that involves measuring your blood pressure, examining your heart and lungs, and checking your pulse. The doctor may also recommend additional diagnostic tests, such as an electrocardiogram (ECG), echocardiogram, or stress test, to obtain more detailed information about your heart health.

Once the evaluation is complete, your doctor will discuss the findings and explain the diagnosis. If a heart condition is detected, your cardiologist will outline available treatment options, including lifestyle modifications, medications, or further procedures.

Regular check-ups, personalised medical treatment and lifestyle changes are essential for individuals manage heart diseases at an early stage.