March - April 2006, New Breath

The Truth Behind Heart Attacks
- A Community Service from the Singpaore Heart, Stroke and Cancer Centre

Another key ingredient to a healthy lifestyle is to have regular medical check-ups

Atherothrombosis occurs in 3 main steps. Firstly, arteries narrow due to plaque forming on the artery walls. Secondly, these plagues may tear when aggravated by increased blood flow from vigorous exercise - a condition called "plaque rupture". Lastly, the body forms a blood clot to repair the tear.

Sometimes, the clot breaks loose or is jolted free by strenuous exercise, before being lodged in various arteries throughout the vascular system. It is when the clot restricts or stops blood flow to the heart that a heart attack occurs.

"Smokers and people who have high blood pressure, high cholesterol, diabetes or weight problems are particularly at risk," said Dr Lim.

In order to control the above risk factors, it is important to lead a healthy lifestyle, and an important part of a healthy lifestyle is to have a healthy diet and control your weight. Some basic guidelines are:

1. Choose a nutritious diet: choose from a variety of food.
2. Reduce the size of the services.
3. Eat less fat: select fish, poultry and lean meats; trim excess fats and remove the skin
4. Eat less sugar: reduce the amount of sweet food such as cakes, soft drinks, biscuits. Reduce the sugar in recipes. Use fresh fruit instead of canned ones
5. Increase the intake of complex carbohydrates such as rice, potatoes, and whole grain bread
6. Eat more bread and cereals, fruit and vegetables
7. Drink less alcohol
8. Use less salt as this may increase your blood pressure
9. Drink more water

Regular exercise is also beneficial to one's health. However, Dr Lim cautioned against overly strenuous exercise as this may exert too much strain on the heart and lead to a heart attack, especially in patients who have underlying silent significant atherosclerosis (narrowing of the arteries supplying the heart muscle).

Another key ingredient to a healthy lifestyle is to have regular medical check-ups. Some simple checks include checking your blood pressure and cholesterol levels. While check-ups may be able to pick up serious blockages, detecting minor blockages is often trickier. In fact, not all conventional medical diagnostic equipment can pick up minor blockages, and some may even return negative or inconclusive readings, lulling people into a false sense of security. According to a recent Straits Times article, the Academy of Medicine recommends using computed tomography (CT) scans if conventional tests like the treadmill test cannot yield conclusive results despite the patient having telling symptoms like chest pains.

A CT scanner detects X-rays that pass through the heart and send the information to a computer, which then construct a 4-dimensional image of the heart and surrounding arteries. By using CT scans, doctors are able to capture clearer and more detailed images, thus allowing earlier and more accurate diagnosis and treatment. In addition, a CT scanner has another advantage that many will appreciate - it is non-invasive and painless. Previously, coronary angiogram involved having a thin tube threaded through the blood vessel, which is uncomfortable and may require hospitalisation. With the CT scanner, patients simply have to lie still as they are put through the scanner. The process is over in a matter of seconds, and the patient need not be hospitalised.

As with all other things in life, prevention is better than cure. Dr Lim foresees that by making disease diagnosis more accurate, painless and fast, the latest technology in medical imaging can help bring about the "paradigm shift in medicine from treatment to prevention". Regular medical check-ups will be able to pick up ailments before it gets too serious and treatment gets too complicated. This will in turn result in a decrease in healthcare costs and also eventually prolong the lifespan of the population.

For further queries on screening and detection of heart diseases and stroke, please contact the Singapore Heart, Stroke and Cancer Centre at enquiry@shsccentre.com or call: 6881 8811.