1. Chest Pain What it is Chest pain (angina pectoris) is due to imbalance in the heart’s muscle mass oxygen supply and demand. This oxygen supply may be decreased by hypoxia (lack of oxygen in the tissues) and the narrowing of one or more coronary arteries. It can be precipitated by physical exertion, large meals, emotional stress, increased metabolic demands or cold weather. Chest pain patients commonly complain of breastbone discomfort, shortness of breath, perspiration, nausea, heaviness or weight-like sensations from the chest to the left arm, neck or jaw. Who gets it Women who are obese, diabetic, smokers, lead sedentary lifestyles, and have hypertension, high cholesterol and a family history of the disease are at risk of coronary heart disease. Solution The most effective treatment is stenting and/or balloon angioplasty. Adjunctive medical therapy includes antiplatelet therapy like aspirin, antithrombotic therapy, nitrates, beta-blocker, calcium channel blocker, angiotensin converting enzyme inhibitor and lipid lowering therapy.

Tips to Maintain a Healthy Heart Add more physical activity to your life by exercising at least 30 minutes a day on most days of the week. Eat right to control your cholesterol levels. Avoid food that is high in saturated fats and take food like lean chicken as well as 2 helpings of fruits and vegetables a day. Reduce your risk of high blood pressure by shaking off the salt habit. If you are a smoker, make a concerted effort to stop smoking. Reduce any excess weight. This helps to decrease the risk of heart disease and diabetes.

2. Coronary Heart Disease What it is Coronary heart disease is where there is a narrowing of the blood vessels that supply blood to the heart. The buildup of cells, cholesterol and fat within the blood vessels lead to formation of plaque. When the plaque bursts, it forms a blood clot, which ultimately results in a heart attack. Patients with angina will experience chest discomfort with exertion and/ or emotional stress, shortness of breath, tiredness with mild exertion, jaw ache and discomfort in the upper middle area of the abdomen. Heart attack patients (where there is sudden occlusion of the blood vessel by a clot), on the other hand, will get prolonged chest discomfort for more than 20 minutes with profuse perspiration and/or shortness of breath, and gripping chest pain. Who gets it Men in their 50s, women in their 60s. However, patients with multiple risk factors such as obesity, diabetes, smokers and sedentary lifestyles may develop coronary artery disease at a younger age. Risk factors include smoking, high blood cholesterol, high blood pressure, physical inactivity, obesity or being overweight, diabetes, family history of the condition and race. In Singapore, Indians are more prone to heart attacks than other races. Solution Treatment options include medical therapy, stenting and/or balloon angioplasty. The latter 2 treatments are usually used for heart attack. For patients with extensive coronary heart disease, coronary bypass surgery may be recommended. 3. Arrhythmias What it is Arrhythmias are problems that affect the electrical system of the heart, producing abnormal heart rhythms that can cause the heart to pump less effectively. The normal heart beats at 60 to 80 times a minute when at rest and 60 to 100 times a minute normally or when doing physical activity. Tachycardia refers to a heart rate of more than 100, while bradycardia describes a rate of less than 60. The most common is atrial fibrillation, where the atria (the upper chambers of the heart) quivers instead of beating effectively. When this happens, blood isn’t completely pumped out in the atria, so it pools and clots. Many arrhythmias have no known cause, but there are a number of risk factors such as coronary heart disease, high blood pressure, diabetes, smoking, excessive use of alcohol, drug abuse and stress. Certain medications, dietary supplements and herbal remedies are also known to cause arrhythmias. Tachycardia can produce palpitations, rapid heart action, chest pain, dizziness, lightheadedness and fainting or near fainting. Bradycardia on the other hand, is usually accompanied by fatigue, dizziness, lightheadedness and fainting or near fainting. Who gets it Women with the following risk associations: coronary heart disease, high blood pressure, diabetes, smoking, high cholesterol, obesity, a high fat diet, excessive use of alcohol, drug abuse, stress, advancing age and a family history of heart disease. Solution Bradycardia can be corrected with an electronic pacemaker while tachycardia can be helped with electrical shock treatment, drugs and an implantable cardioverter defibrillator (ICD). Patients with atrial fibrillation are recommended blood thinners. Radiofrequency ablation can be used to treat atrial fibrillation and tachycardia. 4. Palpitations What it is Palpitations are defined as sensations of a rapidly beating heart. The affected person may feel lightheaded, short of breath or a slight chest discomfort. These episodes usually last for a few seconds to a few minutes. Palpitations may also be symptoms of arrhythmias. Palpitations are caused by the same factors as arrhythmias including coronary heart disease, hypertension, diseased heart muscle, heart valve disorders, a previous heart attack, post-cardiac surgery and medical conditions such as thyroid problems and anaemia. Who gets it Women with similar risk associations as arrhythmias. Solution Treatment includes medication, electrical shock, catheter ablation, ICD and heart surgery. 5. Heart Valve Disease What it is Heart valve disease occurs when the valves leak or get blocked. When this happens, the pumping action of the heart becomes impaired. Heart valve disease patients are likely to experience breathlessness during exertion (and even when lying down), palpitations, fatigue and occasionally chest pains. There is also a possibility of swollen ankles, prominent veins in the neck and an irregular heart beat. There are a variety of causes of heart valve disease ranging from infection and rheumatic fever to degeneration (wear and tear). Who gets it Rheumatic heart disease and infection can afflict women at all ages, while degeneration is more common for women above 60. Solution If there are no symptoms, the treatment is usually medication. When symptoms are present, or when the heart starts to swell, percutaneous balloon treatment or surgery are the solutions.

WHEN TO SCREEN Coronary Heart Disease: Women with existing heart disease symptoms should see their doctors for further stress testing. Women with an intermediate risk of heart disease should subject themselves to a coronary CT angiogram. Women above 45 should consider doing a yearly checkup of their blood pressure and cholesterol and glucose levels. Arrhythmias/Palpitations/Chest Pain: Women with one or more risk associations of these disorders should do a routine medical check-up or electrocardiogram (ECG). Heart Valve Disease: Women above 60 should have a check-up once every 2 years even if they have no symptoms. Women who suspect a heart valve abnormality should request for a heart ultrasound.

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