Listen to your heart


A healthy lifestyle is the best deterrent against cardiovascular disease. Do the simple things daily like taking the stairs instead of the lift, or walking to the stores instead of driving.

COVID-19 ravaged humanity in a way that’s rarely seen in the history of mankind.

Throughout the whole episode however, other diseases continued to exact a toll on human lives – upstaged, but not outdone by the pandemic.

One such group of disorders is cardiovascular (heart) disease, which still remains the leading cause of death worldwide.

According to Cardiac Vascular Sentral Kuala Lumpur consultant cardiothoracic surgeon Dr John Chan, cardiovascular disease encompasses a group of illnesses that affect various parts of the heart.

The common ones include coronary artery disease, heart valve disease, diseases that affect the aorta of the heart, and heart rhythm disorders.

“In coronary artery disease, the blood vessels that supply the heart are narrowed or blocked.

“As for heart valve disease, there are four (valves). The valves are important to ensure smooth flow of blood from one heart chamber to the other. These valves can get diseased and narrowed, and they may leak.

“Diseases of the aorta (the main artery that carries blood away from the heart to the rest of the body) usually come in the form of aortic aneurysms, whereby areas of weakness in the aorta start to balloon and increase in size. If these become big enough, the artery will tear and rupture – a medical emergency.

“The heart also has its own electrical source and supply, which acts to regulate heartbeat. There can be problems with the electrical conduction of the heart, leading to irregular heartbeats (heart rhythm disorders),” he says.

‘Eat in moderation, don’t smoke, try to exercise, and find out if you are at risk for heart disease by going for a physical and blood test,’ is consultant cardiothoracic surgeon Dr John Chan’s advice for a healthy and longer life.‘Eat in moderation, don’t smoke, try to exercise, and find out if you are at risk for heart disease by going for a physical and blood test,’ is consultant cardiothoracic surgeon Dr John Chan’s advice for a healthy and longer life.

Who is at risk

Risk factors for heart disease include high cholesterol (which narrows and eventually blocks off coronary arteries), diabetes (especially uncontrolled diabetes), unhealthy diet (with high fat), and smoking, among others.

“Genetic factors also play a part,” says Dr Chan. “Obviously this is a bit more difficult to control.

According to consultant cardiothoracic surgeon Dr John Chan, it is not uncommon to see younger patients (in their 30s) with coronary artery disease. There are multiple reasons for this, including sedentary lifestyle, obesity, diabetes and smoking.According to consultant cardiothoracic surgeon Dr John Chan, it is not uncommon to see younger patients (in their 30s) with coronary artery disease. There are multiple reasons for this, including sedentary lifestyle, obesity, diabetes and smoking.

“The other factor is ageing.

“For example, take the heart valves. A lot of times, the valves get diseased because of the natural process of wear and tear as we get older.

“Infections may also affect the heart valves. If you have an infection in another part of the body that is not treated properly, this can spread to the heart valves and start ‘eating away’ at the valves. This is called endocarditis.

“In Malaysia, we still have rheumatic heart disease – an inflammatory condition whereby patients get an infection (usually of the throat) that is not treated adequately, which triggers inflammation in the heart valves. In later years, the valves thicken in response to this inflammation, and this precipitates heart valve disease.

“In the aorta, uncontrolled hypertension can lead to tears in the aorta, leading to aortic dissection, which is commonly fatal.

“Electrical rhythm problems in the heart are often due to ageing.

“Excessive alcohol consumption is also a risk factor for such problems.

“Furthermore, long-standing coronary artery disease and heart valve disease can lead to heart rhythm problems.”

There are many possible symptoms of heart disease, and these include:

> Chest discomfort and pain

> Uncomfortable feeling in the chest

> Discomfort in the neck radiating down to the arms

> Shortness of breath for coronary artery disease.

Heart valve disease can lead to shortness of breath, as well as dizziness. Patients may also sometimes lose consciousness.

As for diseases of the aorta, Dr Chan warns that the typical symptom is very severe pain in the chest or back.

Treatment options

Getting diagnosed is the first step towards treatment.

Depending on what the problem is, tests may include getting an ECG (electrocardiography), stress ECG, CT scan, coronary angiogram, echocardiography (for heart valve disease), and Holter monitor for heart rhythm disorders.

Treatment depends on the disease.

“First, we control risk factors such as cholesterol, diabetes, hypertension and so on.

“For coronary artery disease, options include putting a stent in the affected artery.

“If the disease is extensive, and involves multiple coronary arteries, then a bypass is recommended. This gives the best survival rate for such patients.

“For heart valve disease, if the leak is a minor one, we usually control with medication.

“In severe leakage, the only way to treat is surgery to repair the valve or replace the valve.

“There’s also the option of replacing heart valves via transcatheter valve procedures, which is a minimally-invasive procedure to replace diseased valves. This procedure is usually carried out in older patients who are not fit for surgery.

“In the early stages of an aortic aneurysm, we can ‘wrap’ the aneurysm to stop it from getting bigger. This is called a personalised external aortic root support,” says Dr Chan.

If the aorta is already dissecting or torn, the risk of surgery is very high, so it is better to treat in the very early stages to prevent progression of the disease.

Ultimately, he advises that a healthy lifestyle is the best deterrent against cardiovascular disease.

“Eat in moderation, don’t smoke, try to exercise, and find out if you are at risk for heart disease by going for a physical and blood test.

“You should maybe get the physical when you are in your 30s, especially if you have a history of heart disease in the family,” he says.

Dr John Chan is a consultant cardiothoracic surgeon at Cardiac Vascular Sentral Kuala Lumpur (CVSKL).

KKLIU: 2657/ Expiry Date: Dec 31,2025

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