Heart Attack and Cardiac Arrest – Are You at Risk?
He was at the peak of his career. He has a loving wife and lovely children. But his work was demanding, he smoked to relieve stress and he had little time to exercise.
We aim to be a Cardiology Practice that provides Holistic Care for All our Patients, guided by our Core Values of Trust, Compassion and Competence.
He was at the peak of his career. He has a loving wife and lovely children. But his work was demanding, he smoked to relieve stress and he had little time to exercise.
Atrial Fibrillation or AF is the most common heart rhythm problem people have, especially in the elderly. The condition puts you at risk of stroke, heart failure, and other problems.
A Coronary Angiogram is one of the commonest procedures in Cardiology, used to diagnose blockages in the heart arteries.
Patients with symptoms suspicious of heart disease will undergo a specialist consultation with a full and detailed history obtained by our Cardiologist. Thereafter, a full physical examination will be performed including measurements of vital signs, weight, height and body mass index. Our Cardiologist will make an initial diagnosis and suggest further evaluation and treatment options.
Our hearts serve us every moment of the day and for the average person in Singapore, it would have pumped more than 3 billion times at the end of our lives. It is hence prudent that some patients at some stage may benefit from screening evaluation to assess their heart health. Patients who might benefit from screening include those with pre-existing diseases e.g. hypertension, diabetes or high cholesterol as well as patients with family history of heart disease or who are smokers. Our Heart Doctor will give an expert opinion of which test(s) are required and suitable for the specific patient.
We provide general health screening services which includes a detailed history, physical examination, blood test screening and other relevant tests or investigations.
Receive expert care in the treatment of your high cholesterol or high blood pressure. Some patients may developed complex forms of high cholesterol and/or high blood pressure that is not of the garden variety. Our Cardiologist can make a specialist assessment of these conditions and provide an advanced level of care, in partnership with your family physician.
We are able to provide access to a full and comprehensive range of blood tests and at the same time, tailor these tests to your needs.
ECG stands for an “electrocardiogram”. This is a tracing of the electrical activity within your heart. The resting ECG is a valuable initial test in revealing various disorders of the heart and is required in all patients with suspected heart disease.
A treadmill stress ECG is performed to screen patients for suspected significant blockage of their heart arteries. It is also useful in assessing exercise tolerance and stability of heart rhythm during exercise. This test however is not able to detect minor narrowing of your heart arteries.
An echocardiogram is an ultrasound scan of your heart. Among other things, it assesses the structure, size, and strength of your. In addition, it is the gold standard test in assessing the valves of the heart. This test is extremely useful and importantly, without risk. It takes about 20 minutes to perform. It cannot however, see the arteries of the heart.
This is an assessment of every beat of your heart within 24 hours. It is a simple and safe test whereby ECG leads are taped to your chest and are attached to a small recording device about the size of a small mobile phone. The device is aimed at assessing your heart rhythm during your usual daily activity. You do not need to be admitted in the hospital.
Similar to the 24 hour Holter ECG, the ambulatory blood pressure device is carried for a whole day. It automatically measures your blood pressure throughout the day at regular intervals. This test is meant to assess your blood pressure during your usual activity and in your usual environment. It will provide useful information about your blood pressure pattern and average readings.
A CT calcium score is a plain CT scan that does not require an injection of contrast. It calculates the amount of calcium in your heart arteries as an indirect indication of blockages. It cannot visualize the heart arteries or the narrowing within these arteries. A CT coronary angiogram is a non-invasive way to assess the heart arteries for blockages. This test usually incorporates a CT calcium score as well. It requires a contrast injection via a venous cannula in your arm. Medications to reduce your heart rate and dilate your heart arteries may be injected as well. This test is able to visualize the heart arteries and give a rough indication of the severity of blockages if seen. It is very accurate if no blockage is seen but can sometimes be inaccurate if moderate or severe narrowing is seen.
This is a form of stress test of your heart. It uses a small and safe amount of nuclear material that is injected into your blood stream and picked up on a scan of your heart. You may be required to walk on the treadmill or receive a medication to dilate the arteries of your heart or speed up your heart rate. This test assesses the amount of blood flow to your heart and does not directly look at your heart arteries. It is very useful in deciding whether you need to unblock arteries in your heart, and especially useful for patients who cannot run on the treadmill stress test.
A coronary angiogram is the gold standard TEST to assess the heart arteries for blockages. However, it is not performed in all patients presenting with chest pain because of the very small risk involved in this test. It is a minimally invasive procedure. A catheter (small but long tube) is inserted via an injection usually through a blood vessel in your wrist but sometimes in your groin if your wrist artery is not suitable. The catheter is advanced through your blood vessel all the way to your heart arteries under x-ray guidance. Thereafter, a contrast (dye) is injected the through this catheter into your heart arteries so that the arteries can light up under x-ray. This enables our Cardiologist to visualize the heart arteries and assess for blockages. Coronary angioplasty (ballooning) and stenting are parts of the same procedure to TREAT the heart artery blockages. It is also performed using a catheter that enters through the same puncture site for the coronary angiogram, hence also minimally invasive. No surgery is performed. It can be performed during the same procedure after a coronary angiogram has been performed. During this treatment, a tiny wire is inserted into the heart artery across the blockage. Thereafter a small balloon fixed on the tip of a smaller catheter is thread over the wire and inflated at the site of the blockage. Almost always, a stent is then placed at the site of the blockage and inflated. A stent is a cylindrical wire mesh the shape of a tube. A non expanded stent is mounted on a small deflated balloon on the tip of another small catheter. It is also advanced over the wire to the site of blockage. The balloon is inflated causing the stent to inflate and anchor on the inside of the artery wall. Everything is removed at the end of the procedure except the stent which is left in the artery permanently as it acts as a scaffold to keep the artery patent. Not all blockages need to be unblocked and not all patients with blockages are suitable for stenting. Our Cardiologist will discuss the most appropriate treatment after the coronary angiogram test. Sometimes, patients only need medications but a small proportion of patients may require bypass surgery which is an open heart surgery.
Transcatheter Aortic Valve Implantation, in short TAVI, is a relatively new technology to implant an artificial heart valve in the position of a diseased original valve. It is to treat Aortic Stenosis which is a condition whereby the aortic valve is severely narrowed usually due to aging. A valve is a “door” in the heart that allows blood to flow in one direction. Patients with this condition experience breathlessness on exertion and sometimes chest pain and dizziness or fainting. Without treatment, the risk of death is very high. Previously, the only treatment option is open heart surgery to replace the valve. However, because this condition usually occurs in the elderly, many patients do not receive surgery because they are at high risk for surgery. But today, there is an effective and relatively safe alternative to treat these patients using TAVI. Briefly, TAVI is performed using an artificial animal skin valve that is mounted on a tube/catheter. This tube is inserted usually through an injection in the groin and advanced through the blood vessel all the way to the heart where it is deployed over the original heart valve.
Pericardiocentesis is an emergency procedure to remove fluid from around the heart. It is used to treat Cardiac Tamponade which is a condition whereby fluid or blood collects between the small space outside of the heart muscle but within the pericardium which is a layer of covering outside of the heart. The accumulated fluid can press on the heart muscle and cause reduced blood being pumped out of a “squeezed” heart. Without treatment, the risk of death is high. Pericardiocentesis is performed using a needle that is inserted in the lower central chest or left lower chest. Usually a small tube is left inside to drain residual fluid for a few days.
A temporary pacemaker is a wire that is inserted into the heart chamber via an injection in the groin of neck. The function of the wire is to cause the heart to beat faster if the heart rate is too slow. It is a temporary measure to treat patients with electrical heart blocks or severe slowing of their hearts.
A permanent pacemaker is a treatment for patients with electrical heart blocks or severe slowing of their hearts. It is a minor surgery procedure whereby a small pacemaker device is implanted below the skin in the left or right upper chest. One or two wires are inserted into the heart chamber(s) via an injection in these areas. The wire(s) are then connected to the above pacemaker device called a pulse generator. The pacemaker will cause the heart to beat faster whenever it slows down.
A permanent pacemaker is a treatment for patients with electrical heart blocks or severe slowing of their hearts. It is a minor surgery procedure whereby a small pacemaker device is implanted below the skin in the left or right upper chest. One or two wires are inserted into the heart chamber(s) via an injection in these areas. The wire(s) are then connected to the above pacemaker device called a pulse generator. The pacemaker will cause the heart to beat faster whenever it slows down.
An electrophysiological study is a minimally invasive procedure whereby wires are inserted into the heart via injections in the groin and neck to assess the electrical activity in the heart. When there are abnormalities in the electrical pathways found, sometimes treatment to disrupt these abnormal pathways are performed using radiofrequency heat called an ablation procedure, also performed using wires. Radiofrequency ablation is a useful treatment for conditions such as supraventricular tachycardia, Wolff-Parkinson-White syndrome, atrial fibrillation, atrial flutter and ventricular tachycardia.
The implantable cardioverter defibrillator (ICD) is a device somewhat like a pacemaker that is implanted under the skin in the left or right upper chest. One or two wires are inserted into the heart chamber(s) via an injection in these areas. The wire(s) are then connected to the above ICD. The function of the ICD is to detect abnormal life-threatening rhythms in the heart and if necessary automatically “shock” the heart in an attempt to save the patient. It is implanted in patients with a weak heart and high risk of sudden cardiac death. The cardiac resynchronization therapy with or without a defibrillator (CRT/D) is implanted in a similar fashion as an ICD. However this device requires 3 wires to be inserted. It has an additional function of synchronizing the timing of the right and left heart contraction. In selected patients, it can help to strengthen weak hearts. Our Cardiologist will discuss with you if you are likely to benefit from a CRT. It can also “shock” the heart like an ICD when needed.
A small proportion of patients have blockages of their heart arteries that may have better long term results if they are treated with coronary artery bypass surgery (open heart surgery). This decision can only be made after a coronary angiogram is performed by a cardiologist. Thereafter, our Cardiologist will discuss with the patient regarding the benefits and risk of surgery vs angioplasty and stenting. If the patient is agreeable to consider surgery, our Cardiologist will refer the patient to a Cardiothoracic Surgeon to perform the surgery. Other heart conditions that may require referral to a Cardiothoracic Surgeon are heart valve abnormalities such as severe leakage or narrowing of the mitral or aortic valves. To determine if surgery is needed, the patient will need to be assessed by a Cardiologist. An echocardiogram is essential and in many patients, a coronary angiogram is required to exclude heart artery blockages. This is because if blockages are also present, it can be treated with a bypass during the same valve surgery. In patients who are at high risk for surgery, there are new minimally invasive procedures that may potentially be suitable treatments as an alternative to surgery. Examples are transcatheter aortic valve implantation (TAVI) for aortic valve disease and the Mitra-clip procedure for patients with leaking mitral valves.
THE CARDIO CLINIC is a private cardiology practice in Singapore that began when Dr Ong Sea Hing was invited to join Dr Baldev Singh in his private practice in the year 2015. Dr Singh has been in private practice for more than 30 years and is a household name in the east. With the wealth of clinical experience of Dr Singh and the cutting edge technical training and experience that Dr Ong brings, this partnership has been one that is synergistic, providing the best care possible to our patients. Most recently in January 2023, Dr Jason See, a highly trained consultant cardiologist subspecialising in imaging, is the newest member of this team. He complements the various subspecialties in this team and brings with him the latest knowledge and skills.
We have 3 fully equipped clinics at 3 locations:
1. THE CARDIO CLINIC @ FARRER based in Farrer Park Hospital, the latest private hospital in Singapore equipped with state-of-the-art cardiology facilities for comprehensive cardiology procedures
2. THE CARDIO CLINIC @ EAST based in Parkway East Hospital, a homely environment and convenient location for patients living in the east.
3. THE CARDIO CLINIC @ ORCHARD based in Mount Elizabeth Orchard Hospital, our latest clinic, in operation since January 2024
Our patient database is linked hence patients can opt to be seen at either locations with full access to their medical data and with the same price assurance.
We are on numerous corporate insurances including Parkway Shenton, Cigna, Fullerton Health, Adept, Alliance, IHP, MHC, Whitecoat, ManaDr etc.
Dr Ong Sea Hing is on the Integrated Shield Plan Insurance Panel for AIA, NTUC Income, Great Eastern, Singlife, and HSBC Life (AXA)
Dr Baldev Singh is on the Integrated Shield Plan Insurance Panel for Great Eastern, Singlife and HSBC Life (AXA)
Dr Jason See is on the Integrated Shield Plan Insurance Panel for Great Eastern and HSBC Life (AXA)
Consultant Cardiologist and Physician MBBS, MRCP (UK), M. Med. (Int Med), FACC (USA), FRCP (Glasg), FRCP (Edin), FAMS (Internal Medicine and Cardiology)
Consultant Cardiologist and Physician MBBS, MRCP (UK), M. Med. (Int Med), FAMS (Cardiology)
Consultant Cardiologist and Physician MBBS (NUS), MRCP (UK), FAMS (Cardiology)
Dr See is a doctor with more than 15 years of experience. He was a Senior Consultant Cardiologist prior to entering private practice. His area of subspecialty is in multi-modality imaging and he has board certifications in echocardiography, cardiac computed tomography and nuclear cardiology. He graduated from the National University of Singapore in 2005 and obtained his Royal College of Physicians (UK) membership in 2010. He continued to train in Cardiology at Changi General Hospital (CGH) and National Heart Centre Singapore and obtained his specialist accreditation in Cardiology in 2014. He was subsequently awarded the Human Manpower Development Program scholarship to pursue fellowship training in advanced cardiac imaging at the Royal Brompton Hospital, London, United Kingdom from 2016 to 2017. Dr See believes in holistic patient care and has a keen interest in preventive cardiology and public health. He is an advocate for exercise and smoking cessation, having completed the Exercise Prescription Course for Primary Care Physicians and is also a Certified Cardiac Rehab Practitioner. On the academic front, Dr See was an Adjunct Assistant Professor of both Yong Loo Lin School of Medicine as well as Duke-NUS Medical School. He has published in multiple journals and presented in numerous conferences. He is an instructor in Advanced Cardiac Life Support and continues to teach medical ethics as a Teaching Faculty with the Singapore Medical Association Centre for Medical Ethics and Professionalism.
He was at the peak of his career. He has a loving wife and lovely children. But his work was demanding, he smoked to relieve stress and he had little time to exercise. One day, he felt chest pain at work and was rushed to the hospital but unfortunately suffered a cardiac arrest en-route. His life was saved but he suffered severe brain injury resulting in being permanently bed-ridden in a vegetative state. This is the story of one of the thousands of heart attack patients in Singapore each year, some of whom suffer similar cardiac arrests (heart stops beating). Only 5% of out-of-hospital cardiac arrest victims survive. Even for survivors, brain damage occurs as early as 3 minutes after their heart stops.
It's therefore important to detect this disease early in order to be started on treatment to prevent such a tragedy.
What is a heart attack?
A “heart attack” happens when an artery (blood vessel) that supplies blood to the heart muscle becomes suddenly blocked causing part of the heart muscle to die. A heart attack carries a high risk of death.
What are the symptoms of a heart attack?
Heavy, squeezing chest discomfort, breathlessness and a cold sweat are the typical symptoms of a heart attack. Some elderly patients or diabetics may only feel breathless or upper abdominal discomfort.
Who is at risk of a heart attack?
People with the following conditions are at a high risk of getting a heart attack:
1. High Blood Pressure
2. High cholesterol
3. Diabetes mellitus
4. Family members with heart disease
5. Smoking
6. Obstructive Sleep Apnoea, Obesity and Stress
How do I reduce my risk?
1. A heart healthy diet, exercising regularly, keeping to a good weight and managing stress can go a long way in reducing your risk.
2. If you have diabetes, high blood pressure or high cholesterol ensure that these conditions are well controlled.
3. If you are over 40 years of age, periodic screening for high blood pressure, cholesterol and diabetes is advised.
4. Smoking is a cause of many health conditions and should be stopped. Young people should never take up smoking as it is addictive.
5. Obstructive Sleep Apnoea is a frequently under-diagnosed condition in our community. Ask your doctor about this condition and its potential treatments
What if I have suspicious symptoms or I think I am at high risk?
Visit your family doctor or a cardiologist directly. Your doctor will do a detailed evaluation and may perform some tests, which may include:
1. Electrocardiogram (ECG)
2. Echocardiogram or heart scan
3. Exercise stress ECG or scan
4. CT calcium score or CT coronary angiogram
5. A conventional coronary angiogram
How is this disease treated?
1. Lifestyle changes such as healthy dietary habits, regular exercise and reducing weight. Smoking should be stopped.
2. Medication is extremely important and is required for all patients. The most important of these are blood thinning and cholesterol lowering medications. Other medications may be required to control diabetes and high blood pressure.
3. Severely blocked arteries can very often be successfully opened up by minimally invasive angioplasty (balloon) and stenting
4. A small proportion with multiple blocked arteries may require open heart surgery (coronary bypass).
If you suspect that you are having a heart attack, get immediate medical attention. Certain types of heart attack require emergency angioplasty and stenting to unblock a totally occluded artery. “Time is Heart”. Every minute counts!
What is atrial fibrillation?
• AF is the most common heart rhythm problem people have, especially in the elderly. The condition puts you at risk of stroke, heart failure, and other problems.
• In people with AF, the electrical signals that control the heartbeat become abnormal. As a result, the top 2 chambers of the heart called the atria stop pumping effectively, and blood pooling occurs in these chambers. As the blood pools, it can start to form clots. These clots can travel to the brain through the blood vessels, and cause strokes.
• People with AF have an irregular heart beat that is usually fast. If the heart is fast for a long time, it can become weak and therefore cause breathlessness and heart failure.
• In a small proportion of people with AF, their heart rate may be fast at times but also too slow at other times causing dizziness or fainting spells.
• In some people, AF never goes away meaning it is permanently there. In others, AF can come and go.
What causes atrial fibrillation?
• Hypertension (high blodd pressure) is the commenest cause
• Aging is also an important cause
• Blockage of heart arteries
• Heart valve disorders (leakage or narrowing)
• Thyroid disorders in particular high thyroid hormone
• Severe infection
• For some patients, no particular cause is found
What are the symptoms of atrial fibrillation?
Some people with AF have no symptoms. When symptoms do occur, they can include:
• Feeling as though your heart is racing, skipping beats, or beating out of sync
• Mild chest “tightness” or pain
• Feeling lightheaded, dizzy, or like you might pass out
• Having trouble breathing, especially with exercise
Are there tests for atrial fibrillation?
Yes. If your doctor suspects you have AF, he or she will do a test called an electrocardiogram (ECG) that measures the electrical activity in your heart. Other tests that are frequently required are
• Blood tests in particular your thyroid function, hemoglobin level and kidney function
• Echocardiogram to assess your heart’s strength and valves
• Stress testing or imaging tests to assess for heart artery blockages
• 24-hour ECG monitoring
How is atrial fibrillation treated? — Treatment can include one or more of these:
• Medicines to control the speed or rhythm of the heartbeat
• Medicines to keep clots from forming
• A treatment called “cardioversion” that involves applying a mild electrical current to the heart to fix its rhythm
• Treatments called “ablation,” which use heat (“radiofrequency ablation”) or cold (“cryoablation”) to destroy the small part of the heart that is sending abnormal electrical signals
• A device called a pacemaker that is implanted in your body and sends electrical signals to the heart to control the heartbeat
What will my life be like?
Many people with AF are able to live normal lives. Still, it is important that you take the medicines your doctor prescribes every day. Taking your medicines as directed can help reduce the chances that your A-fib will cause a stroke. It’s also a good idea to learn what the signs and symptoms of a stroke are.
A Coronary Angiogram is one of the commonest procedures in Cardiology, used to diagnose blockages in the heart arteries. This is performed using a catheter (tube) that is inserted into the opening of the heart arteries in order to inject dye into the arteries so that they can be visualised and assessed. The catheter can be inserted via the wrist or the groin.
Radial artery access for coronary angiogram and intervention.
Radial artery access for coronary angiogram and/or intervention is performed when a cardiac catheter (a long and narrow tube) is inserted through the radial artery in the wrist instead of the conventional femoral artery route in the groin. It has become the preferred route of access because of reduced access site complications such as bleeding and swelling compared to the conventional femoral access. Patients are also able to get out of bed and ambulate earlier. This is the routine route of access in our practice at The Cardio Clinic.
However, in a small proportion of patients (approx. 10%), the radial access may not the best route in all patients. The femoral access may be preferable in patients who require complex coronary procedures especially with larger catheters or in those whose radial access route is too small or tortuous.
All patients who are to undergo radial artery procedures should be examined to ensure adequate blood supply to their hands through the radial artery and ulnar artery both of which are in the wrist.
In patients with suitable radial arteries, a special needle will be used to access the radial artery after local anaesthesia has been given. A short sheath is then inserted in the radial artery. A longer catheter (tube) is then placed into the radial artery sheath and will be gently threaded through the arteries in the arm until it reaches the heart. A special dye can now be injected through the catheter into the coronary arteries of the heart and with x-ray imaging, the coronary arteries can be visualised and abnormalities detected. In patients with significant narrowing of their coronary arteries, coronary intervention which includes angioplasty and stenting may be required to unblock the narrowing.
Angioplasty and Coronary Stenting
This procedure is done to improve blood flow in the body’s arteries. In the heart or coronary arteries, it is used to treat significant narrowing of the arteries due to cholesterol plaque build-up within the artery walls, Such narrowing causes reduced blood flow of nutrients and oxygen to the heart muscle. The decision of whether a patient requires angioplasty or stenting is only made after a coronary angiogram is performed.
Imaging techniques are used to guide an angioplasty catheter to the origin of the coronary artery. A special wire is then inserted into this catheter and placed across the area of narrowing. When performing angioplasty, a smaller balloon-tipped catheter is inserted through the larger catheter, guided by the wire. It is placed at the area of narrowing in an artery. The balloon is inflated for a few seconds to expand the narrowed area. As balloon angioplasty alone results in a high re-narrowing rate, a stent which is a cylindrical wire mesh is almost always placed at the narrowed area to keep the artery open and reduce the risk of future re-narrowing. The aim is to improve blood flow to the heart muscle. At the end of the procedure, the stent remains in the artery but all other equipment are removed from the body.