Cardiology Care for Heart Health

What are the general symptoms of heart diseases?

• Heaviness, pressure, squeezing, or painful feeling in the chest
• Pain may also be felt in the shoulders, arms, neck, throat, jaw, or back
• Coldness in arms and legs due to narrowed blood vessels
• Shortness of breath
• Palpitations
• Fatigue or dizziness
• Nausea
• Weakness
• Fainting/syncope
• Changes in speed of heart rate (tachycardia or bradycardia)
• Bluish-greyish skin colour (cyanosis)
• Swelling in legs, ankles, hands, feet

If you experience any of these symptoms, regardless of the intensity, it is important to schedule a consultation with your medical professional. Your doctor will monitor your symptoms and advise you on the most appropriate care and treatment.

For specific symptoms for each cardiovascular or heart disease, please refer to the diagram here.

What are some possible complications of heart disease?

If you or a loved one are experiencing any symptoms of heart disease, it is advisable to consult your doctor as soon as possible. Without treatment, heart disease can cause consequences such as:

• Stroke
• Heart failure
• Recurrent heart attack
• Aneurysm
• Peripheral artery disease
• Sudden cardiac arrest

What are the risk factors of heart diseases?

• Older age
• Male gender
• Family history of heart disease
• Smoking
• Obesity
• Diabetes / Hypertension
• High cholesterol
• Physical inactivity
• Stress
• Poor diet
• Excessive alcohol or caffeine consumption

In many situations, heart disease can be prevented by making healthy lifestyle choices. However, some conditions, such as congenital heart defects, are present at birth.

Is heart disease common among women?

Heart disease is the leading cause of death for women over 40 years old. The risk of heart disease increases significantly around the time a woman reaches menopause (menses stop permanently), which is 50 years old and above. The risk is also higher among younger women who have undergone early or surgical menopause, especially when combined with other unhealthy lifestyle habits and risk factors such as:

• Diabetes
• Smoking
• High blood pressure
• High blood cholesterol, especially high LDL, or "bad" cholesterol
• Obesity
• Lack of exercise
• Family history of heart disease
• Problems during pregnancy, such as preeclampsia, high blood pressure, gestational diabetes, or elevated sugars
• Rheumatologic and inflammatory diseases

How is heart disease diagnosed? What medical tests are commonly performed to diagnose heart conditions?

Your doctor will examine you and inquire about both your personal and family medical history. The tests required to diagnose your heart illness are determined by your doctor's judgement.

Your doctor may perform a variety of medical tests to determine the nature of your cardiac disease and the best treatment options. These may include:

• Blood tests: Blood tests are performed to analyse the level of substances, such as cholesterol, triglyceride, vitamins, and minerals in the blood.
• Electrocardiogram (ECG): An ECG measures the electrical impulses in the heart. It provides an indication of how well the heart is beating.
• Cardiac stress test: A stress test, otherwise known as a "treadmill" or "exercise", is an ECG that is performed while exercising. It assists doctors in determining how well the heart functions when a patient is physically active.
• Coronary angiogram: A coronary angiogram may be performed if a patient experienced a heart attack or angina. It helps doctors determine the amount and location of the clogged coronary arteries.
• Magnetic resonance imaging (MRI): An MRI creates comprehensive images of the heart on a computer using strong magnets and radio waves. This test reveals the structure of the heart and how effectively it functions, allowing doctors to determine the most suitable treatment.

Learn more about Cardiovascular Assessments and Diagnostic Tools here.

What happens after I have been diagnosed with cardiovascular disease?

Following a diagnosis, you will start seeing your cardiologist on a regular basis. You would also have to make some long-term lifestyle changes. Making dietary adjustments and frequently exercising can help you minimise the risk of getting more serious cardiac problems in the future.

When should I see a cardiologist? What are the warning signs that should I look out for?

If you have concerns about your cardiovascular health, the initial step is to speak with your general practitioner, who will assess whether you require to be referred to a cardiologist. Symptoms that may require you to be referred to a cardiologist include:

• Shortness of breath
• Chest discomfort
• Presence of swelling in the legs
• A heart rate that is unusually slow or quick
• High blood pressure
• Fainting or dizziness
• Aching or ulceration of the legs caused by blood vessel condition

How do I pick the right cardiologist for me?

Communication is one of the most critical elements of the healthcare provider-patient relationship. You should feel at ease with your doctor. Checking the qualifications is another step in the initial screening procedure.

Preferably, you should be referred to a cardiologist by a general practitioner who is familiar with your medical history or concerns.

Here are a few possible reasons you might want to look elsewhere or seek a second opinion:

• Your doctor's style of communication does not match your own.
• You have trouble connecting with your doctor.
• The doctor's recommendation involves a costly or risky intervention, which you are unsure of.

However, it is important to note that even good doctors may not always provide the same suggestions. Therefore, it is often helpful to get different perspectives.

What happens after a patient survives a sudden cardiac arrest (SCA)?

After surviving a sudden cardiac arrest (SCA) you would likely be required to be admitted to a hospital for further treatment and care, where the medical team will keep a watchful eye on your heart. Medication may be provided to help avoid another SCA.

The medical team will also try to determine the cause of your SCA. Angioplasty or coronary artery bypass surgery may be required if you have been diagnosed with coronary artery disease.

Patients who experience an SCA are often fitted with an implantable cardioverter-defibrillator (ICD). This little device is inserted under the skin in the chest or abdomen. An ICD employs electric pulses to help manage dangerous arrhythmias (irregular heartbeats).

What happens after I have had an open-heart surgery?

You might spend a day or more in the intensive care unit (ICU) depending on the surgery. You will be transferred to a regular hospital room when you are ready.

You should anticipate being in the hospital for several days. Your heart care team will walk you through how to look after your incision.

How long does it take for me to recover from an open-heart surgery?

The duration of your recovery depends on the type of surgery, complications, and your overall health prior to cardiothoracic surgery. An open-heart procedure can take 6 to 12 weeks (or even more in certain cases) to recover from.

What is cardiac rehabilitation?

Cardiac rehabilitation is a programme that is supervised by medical personnel designed to assist the recovery from heart attacks, heart failures or heart surgeries. Cardiac rehabilitation comprises three essential parts:

• Exercise training and counselling: Exercise works the heart and cardiovascular system. Patients will learn methods to move the body in ways that will benefit the heart.
• Education on healthy living to promote cardiac health: This may include practising a healthy diet, giving up smoking and taking medications as prescribed.
• Counselling: Stress is bad for the heart. This aspect of cardiac rehab assists patients in identifying and addressing common sources of stress.

Who should get screened for cardiovascular risk factors?

Adults aged 18 and above should be screened for cardiovascular risk factors. Individuals suffering from conditions such as high blood pressure, diabetes and long-term kidney disease are at a higher risk of developing cardiovascular disease. Therefore, they should be screened frequently as advised by their doctor.

What can I do to reduce my chances of developing heart diseases?

There are several measures you can take to lower your risk of developing heart disease and to better control the symptoms and progression of many cardiovascular conditions. You will need to make some important lifestyle changes, including:

• Maintain a healthy weight
• Eat a balanced, healthy diet
• Exercise or engage in a healthy amount of physical activities regularly
• Avoid or stop smoking
• Get sufficient sleep
• Limit alcohol consumption
• Control your medical conditions e.g., high blood pressure, high cholesterol, and diabetes
• Reduce and manage stress

What dietary adjustments do I need to make to lower my risk of heart disease?

The practice of a healthy diet can help reduce the risk of developing heart disease. Here are some adjustments you can implement into your diet to help lower your heart disease risk:

• Consume more fruits and vegetables
• Consume less refined carbohydrates and processed meat
• Consume fibre-rich foods that are low in trans fats, saturated fat and cholesterol
• Control your intake of salt and sugar

How does a lack of regular physical activity increase the risk of getting heart disease?

A lack of regular physical activity has been proven to be directly linked with heart disease. In fact, exercise cuts the risk of heart disease by:

• Lowering blood pressure
• Keeping a healthy weight
• Increasing good cholesterol
• Improving blood circulation and preventing blood clots
• Potentially reducing levels of bad cholesterol and triglycerides, major contributing factors to heart disease
• Stopping or lowering the development of diabetes
• Reducing stress

According to the American Heart Association, adults should do at least 150 minutes of moderate exercise per week. By taking care of your heart, you will also reduce your stress levels and boost your mood. Get moving and improve your heart health today!

How does smoking cause heart disease?

The heart is supplied with nutrients and oxygen through the coronary arteries.Fatty deposits (plaque) may form within the coronary arteries, which may restrict the blood flow to the heart and increase the risk of a heart attack.

Smoking accelerates the narrowing and blockage of the coronary arteries.Cigarette smoke also contains chemicals such as nicotine and carbon monoxide that cause the swelling and inflammation of the cells lining the blood vessels.Without nutrients and oxygen, the cardiac muscles will start to die.

How do I be an effective caregiver someone with heart failure?

Caregivers of patients with heart failure have a wide range of jobs and obligations, depending on the patient's symptoms and comorbidities, the patient-caregiver relationship, and the treatment regimen's complexity.

While the role of a caregiver involves assisting the patient with their daily activities and helping them with their treatment regimen, it is also important for a caregiver to provide psychosocial support.

Myth 1: "I can't do much to prevent heart disease because it runs in my family."

Fact: Even if you have a family history of heart disease, there are steps you can take to significantly lower your risk. The practice of a healthy and active lifestyle can help you maintain a healthy heart.

Myth 2: "I'm too young to get any heart disease. I only need to go for health screening when I'm middle-aged."

Fact: Heart disease does not only affect the elderly. It is becoming more common among young adults. This is partly due to the fact that the circumstances that contribute to heart disease occur at a younger age.

Your current lifestyle will impact your risk of developing a cardiovascular disease later in life. Plaques may begin to build up in the arteries as early as childhood, which may eventually lead to clogged arteries.

It's a good idea to go for regular health screening to take charge of your cardiovascular health earlier.

Myth 3: "Diabetes will not harm my heart if I take my medication."

Fact: Diabetes treatment can help you avoid or prolong the onset of cardiovascular disease. However, you are still at risk for heart disease and stroke even if your level of blood sugar is under control.

The same risk factors that cause diabetes such as smoking, obesity, lack of exercise, and high blood pressure also increase the chances of developing a cardiovascular disease.

Myth 4: "A heart failure occurs when the heart stops beating."

Fact: A heart may cease beating during a cardiac arrest. However, this is not termed as a heart failure. A heart failure refers to the inability of the heart to effectively pump blood to other parts of the body. This typically occurs if the heart gets overly stiff or weak. Therefore, heart failure does not mean the heart has ceased functioning.

Myth 5: "All forms of cholesterol are harmful."

Fact: Certain forms of cholesterol are required to support the health of the body. Cholesterol is required by the body for critical functions such as hormone production and cell synthesis. Cholesterol is carried by lipoproteins through the bloodstream.

There are two types of lipoproteins that transport cholesterol across the body:

• Low-density lipoprotein (LDL): The majority of your body's cholesterol is made up of LDL, otherwise known as "bad" cholesterol. High LDL cholesterol levels increase the risk for stroke and heart disease.
• High-density lipoprotein (HDL): HDL, the "good" cholesterol, transports cholesterol back to the liver to be flushed out of the body. High HDL cholesterol levels can lower the risk for stroke and heart disease.

LDL cholesterol can accumulate in the walls of the blood vessels if there is an excess amount present in the body. This accumulation is often referred to as a plaque, which may cause the insides of the blood vessels to narrow. Blood flow between the heart and other organs may then be restricted and may lead to a heart attack or angina if blood flow to the heart is obstructed.

Myth 6: "I don't have warning signs for high cholesterol and / or high blood pressure. I'm very healthy!"

Fact: High blood pressure is known as the "silent killer" because you may not be experiencing symptoms, making you think you don't have it. However, it's always better to go for regular medical examinations to be safe and before you start to develop symptoms that lead to heart disease.

It's also a good idea to start going for regular cholesterol level screening even earlier if your family has a history of heart disease. Children in these families may have high cholesterol levels, putting them at increased risk for developing heart disease in their adulthood.

According to the National Health and Morbidity Survey (2019) by the Ministry of Health, 8 million or 40% of adults in Malaysia has high cholesterol, which is a major risk factor for heart diseases.

Myth 7: "I will know when I am having a heart attack because I will have chest pain!"

Fact: Although it is common to have chest pain or discomfort, a heart attack may also cause subtle symptoms including shortness of breath, nausea, feeling lightheaded, and pain or discomfort in one or both arms, the jaw, neck or back.

Myth 8: "I should lead a sedentary lifestyle and avoid exercising after recuperating from a heart attack."

Fact: Research shows that heart attack patients who are regularly physically active and make other heart-healthy changes live longer than those who do not adopt healthy lifestyle changes. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial for their health in the long run.

Myth 9: "This numbness and pain in my leg has nothing to do with my heart."

Fact: Leg pain felt in the muscles could be a sign of peripheral vascular disease (PVD). PVD is caused by the build-up of plaque in arteries, called atherosclerosis. The risk for heart attack or stroke increases for people with this disease.

Myth 10:"My heart is beating so fast. Am I having a heart attack?"

Fact: Some variation in your heart rate is normal. Your heart rate speeds up during exercise or when you get excited and slows down when you're sleeping. Most of the time, a change in your heartbeat is nothing to worry about. But sometimes, it can be a sign of arrhythmia, an abnormal or irregular heartbeat. Most arrhythmias are harmless, but some can last long enough to impact how well the heart works and require treatment.

What is atherosclerosis?

Atherosclerosis is a condition, which occurs when plaque, a sticky substance, accumulates inside the arteries. Atherosclerosis develops gradually as substances such as fat, cholesterol deposits, and blood cells form a plaque.

A plaque can cause the blood vessels to narrow as it accumulates over time. This lowers the delivery of oxygenated blood to the essential organs.

Is there a link between brain and heart health?

The health of the brain and the heart are intertwined because the heart pumps blood to every part of the body, including the brain via blood vessels.

Blood vessel damage may lead to major health problems. These health problems are known as cerebrovascular disease, which refers to the disease of the blood vessels that are supplying blood supply to the brain.

Cerebrovascular diseases develop when there is a restriction of blood flow to the brain due to the narrowing of arteries (atherosclerosis), formation of blood clot (thrombosis), blockage (embolism), or rupturing of blood vessel (haemorrhage). Stroke is the most common cerebrovascular disease.

What is a stroke? Is it the same as aneurysm?

The aorta, the largest artery in your body, is the main artery take transports oxygenated blood from your heart to the rest of your body.

Aortic diseases that affect the aorta include aortic aneurysm and aortic dissection.

• Aortic aneurysm happens when there is a bulging or swelling in the aorta due to damaged or weakened aorta wall. It can cause a tear in the aorta or worse, it can rupture or burst (aortic rupture).
• Aortic dissection is a tear in the aorta caused by aortic aneurysm. This condition is a medical emergency.

What are aortic diseases?

The aorta, the largest artery in your body, is the main artery take transports oxygenated blood from your heart to the rest of your body.

Aortic diseases that affect the aorta include aortic aneurysm and aortic dissection.

What is venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE)? How are they related to cardiovascular disease?

Venous thromboembolism (VTE) refers to a blood clot that starts in a vein. There are two types of VTE:

• Deep vein thrombosis (DVT) happens when a blood clot forms in a deep vein, usually in the leg, thigh, pelvis, and sometimes in the arm or other veins.
• A pulmonary embolism (PE) occurs when a DVT clot breaks loose from the vein wall and travels through the bloodstream to the heart and lungs.

The risk of developing VTE is high after certain surgeries such as coronary artery bypass surgery and certain medical conditions such as post-stroke and having pre-existing heart conditions e.g., heart attack and heart failure.