Heart of the matter - conversation with an interventional cardiologist

You are an interventional cardiologist. For people who are not in the know, what is that?

An interventional cardiologist is a doctor who specialises in invasive treatment of heart diseases, including unblocking coronary artery disease ("blockages"), and implanting heart stents - the scaffolding to pop up and prop up the heart's blood vessels.

Do you treat only heart issues?

Heart diseases are rarely isolated health problems. Multiple factors often predispose different heart diseases.

They can include high blood pressure and high cholesterol, psychological factors such as stress and anxiety, and unhealthy lifestyles.

My job involves addressing all these risk factors and ensuring that they are tackled promptly.

What symptoms do people have when they consult you?

The best part of my job is that you never know what to expect.

Common problems include chest discomfort, palpitation and fainting.

What is the most difficult thing to treat in your field?

Medicine is both an art and a science.

Patients do not write their diagnoses on their faces.

So, diagnosing diseases and decisions to treat them can be challenging.

Things are not clearcut.

Medical judgments can be difficult at times as most treatments are benefits versus risks.

As a general rule, most of us usually follow the principle of "first do no harm". However, this is not always possible.

What is in your bag to treat the conditions you see? Any cool gadgets or drugs?

Most of my work involves a host of high-tech medical equipment.

But the most powerful tools I use daily are a pen, my stethoscope, and my mobile phone - not only can I look up any information that I need, it is also the most important communication tool with colleagues and patients.

Over the past few years, we have had medical innovations such as bioabsorbable stents, meaning that your body can eventually absorb the device when it is no longer needed to pop up the blood vessel, and new medication.

For instance, to prevent stroke in patients with irregular heartbeats, they need to be treated with blood thinning medication to make it hard for blood clots to form.

But the danger is that the use of blood thinners may cause patients to bleed non-stop when there is a cut.

Previously, these patients would require close monitoring and frequent blood tests to make sure all is okay.

Newer blood thinning medication, for example Eliquis, which is safer and does not require blood tests, is now available to help these patients.

How do you know how healthy your heart is? Any tests?

The basic one you should do for heart health includes regular heart rate, rhythm and blood pressure measurements.

Yearly electrocardiography (ECG) is useful, but you should not get complacent just because your ECG is normal.

There are many heart problems that cannot be diagnosed by a simple ECG.

If clinically indicated, more detailed examination may be required, such as an echocardiography, a treadmill stress test, or a CT heart scan.

Does stress play a part in blood pressure? How do you know when you are too stressed?

Unfortunately, when stress becomes excessive, body parameters that are associated with stress reactions such as heart rate and blood pressure can become erratic.

It may manifest as symptoms such as palpitation, headache, dizziness and insomnia.

What is the worst thing you can do to your heart?

The worst thing you can do is ignore cardiovascular risk factors such as high cholesterol, high blood pressure, diabetes and continue to smoke heavily.

With time, these factors will invariably clot up our blood vessels, leading to a heart attack and stroke.

Do you have an anecdote about an unforgettable case?

A man collapsed in his son's car on the way to hospital after experiencing chest pain for two hours.

He arrived without any signs of life at the emergency department. We managed to bring him back to life but by then, he had suffered multi-organ failures.

With the diligent care of a multi-disciplinary team of doctors, nurses and allied healthcare workers (such as physiotherapists, speech language therapists), he managed to walk out of the hospital independently and is currently back at work.

It was indeed a miracle.


This article was first published on June 19, 2016.
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