Distress is a combined measure of stress, depression, negativity and dissatisfaction with life. A Danish population-based study showed that distress can affect cardiovascular health, increasing the risk of heart disease.

According to Anders Borglykke, MSc, PhD of the Research Center for Prevention and Health at Denmark’s Glostrup University Hospital, people who score high for “mental vulnerability” were 37 per cent more likely to develop cardiovascular disease.

Mental vulnerability, in this instance, is measured based on 12 questions asking about physical and psychological symptoms, such as frequent loss of appetite, sleeplessness, tiredness, as well as hands that shake easily, being easily irritated, feeling misunderstood, and being troubled by thoughts.

Individuals who are easily frustrated and angered, are likely to possess a “distressed” personality, also known as Type D personality. Type D people are typically characterised by negativity and often exhibit low self-esteem and a tendency towards depression. They may display common characteristics such as stress, anger, worry, hostility and tension.

Distressed individuals also tend to do poorly after invasive surgeries, according to Johan Denollet, a professor of medical psychology at Tilburg University in the Netherlands.

Stress and depression increases the possibility of cardiovascular deaths. Acute stress can alter cardiovascular physiology, which may result in heart attacks even in those who do not suffer from cardiovascular diseases.

Similarly, another study in the US has found that being distressed from as young as age seven significantly increases cardiovascular disease in later life. The study, which recruited 377 participants – who took part in the research since seven, concluded that high levels of distress in childhood increases the risk of cardiovascular disease by 31 per cent in woman, and 17 per cent in men.

Researchers suggest that screening could be done on heart patients to determine if they have characteristics of “distressed” personalities. Once identified, patients should receive psychological counselling, which can potentially improve heart health and future outcomes.

During this treatment, an unconscious patient’s body is rapidly cooled from 37°C to between 32°C and 34°C, where the temperature is maintained for 12 to 24 hours. This is done either by wrapping large cooling gel pads around the torso or by pumping cool saline into a catheter that is inserted into the body. The idea is to bring brain temperature down, helping to save barely alive cells. This is because when oxygen is cut off during a cardiac arrest, it starts a chain reaction that ultimately leads to cell death. When the cells are cooled down, they do not need as much oxygen, which in turn reduces damage, offering surgeons extra precious hours to help patients. Patients are given muscle relaxants during this process to prevent shivering.

In a clinical study involving 40 cardiac arrest patients that took place in Singapore between 2008 and 2012, most patients who were given conventional intensive care ended up in a coma or vegetative state. On the other hand, more than half of patients who participated in Hypothermia Treatment woke up with minimal brain damage.

However, not everyone is suitable for this treatment. Firstly, patients need to have a stable pulse and blood pressure. They also need to be unresponsive after being revived. Finally, the cause of cardiac arrest should not be by a traumatic event such as a car accident, as the person may suffer other injuries.

This treatment is still at its clinical trial stage in Singapore.

The chest pain a person feels 24 hours before a heart attack may actually save his/her life. Up to 40 per cent of heart attack patients experience chest pain, which is also known as pre-infraction angina. According to the Minneapolis Heart Institute Foundation (MHIF), knowing the early warning signs of a heart attack can help to prompt identification and treatment.

In a study done by MHIF, researchers here looked at data from 245 patients who suffered a heart attack. It was found that patients who experienced chest pain prior to a heart attack had a 50 per cent smaller occurrence as compared to those without chest pain. The “chest pain group” also had better heart function after they were discharged from hospital.

Dr. Jay Traverse, a research cardiologist at MHIF, mentioned that pre-heart attack chest pain activates the protective mechanisms in the heart before an attack.

Chest pain usually involves discomfort in the centre or left side of the chest, often lasting for more than a few minutes before going away and returning. This discomfort can be likened to uncomfortable pressure, fullness, squeezing, or pain – mild or severe.

Although chest pain is one of the most common signs of a heart attack, the symptoms may very among male and female individuals. For males, it is a crushing sensation while for females, it may be more subtle as they experience persistent pain around the neck, shoulder and upper back.

Other symptoms of an impending heart attack could include stomach upset, nausea, vomiting, light-headedness, dizziness, shortness of breath and excessive perspiring. It can develop suddenly, or even progressively within hours, days, or even weeks.

Know the symptoms of a heart attack and seek medical help immediately if you suspect anything. Early detection can lessen the damage sustained and save your life.

The history of yoga dates back as far as 5,000 years ago in ancient India. Today, it is practised by many around the world to help with relaxation, improving flexibility and health. From hatha yoga to astanga, yoga offers numerous benefits for your heart.

A study by Ohio State University found that women who did not practise yoga regularly had 41 per cent higher levels of pro-inflammatory cytokine IL -6, a substance that increases inflammation in our body and causes heart disease.

The Indian Institute of Technology also found that yoga increases heart rate variability (HRV). A high HRV indicates a healthy heart. (People who regularly practiced yoga showed a strengthening of parasympathetic control – affecting heart rate.)

Yoga can be beneficial to patients who are recovering from Atrial Fibrillation (AF) too. AF is a heart condition where chaotic beating – sometimes several hundred times per minute – takes place at the two upper chambers of the heart. This irregular rhythm causes the heart to pump less efficiently, which may result in a blood pool or clot in the heart, raising the risk of stroke and heart attack. A study led by the University of Kansas revealed that as little as two one-hour yoga sessions per week can help significantly reduce instances of AF by about 30 to 40 per cent.

According to MindBodyGreen, a health and wellness website, yoga is an activity equivalent to running and cycling. It has been proven to be a lifelong healer for individuals with high blood pressure as well as those who have suffered a mild heart attack along with other types of cardiovascular diseases.

Stress is one of the main contributing factors to a surge in cortisol and blockages in our arteries. Out of 17,415 women – mostly Caucasian health professionals in their 40s and 50s – surveyed by researchers at the Brigham & Women’s Hospital in Boston, MA, 60 per cent of those who displayed stress and anxiety shared that yoga helped to offer them an immediate calming effect.

The aforementioned are just some of the benefits yoga has for your heart. You may want to consider taking this up as a viable alternative to other strenuous forms of exercise like long distance running if they aren’t your cup of tea. At the end of the day, it’s still your heart that wins!

1)     Avoid an empty stomach when going for house visits

When we are hungry, we tend to eat more. Fill up your stomachs with healthy fibre-rich food such as fruits, vegetables, whole grains and calcium-rich low-fat milk before each house visit. By doing so, we are not only eating healthily. We help ourselves contain any urges to pick up excess goodies.

2)     Know your trigger foods, eat lesser of them, or even avoid them altogether

The reason why we crave for foods that are high in fat and calories is because they release chemicals named Opioids. Opioids bind to receptors in our brain to produce feelings of pleasure and even mild euphoria. This may explain why we can’t stop eating once we begin. If you find any goodies too hard to resist, it would be best to totally avoid them rather than risk potentially overeating.

3)     Practise eating and drinking consciously, slowly and wisely

In a study conducted by Kathleen Melanson, Associate Professor of Nutrition and Food Sciences at the University of Rhode Island, 30 women were given a large plate of pasta on two separate visits. When they were told to eat quickly, they consumed 646 calories in nine minutes. However, when they were encouraged to pause between bites and chew each mouthful 15 to 20 times, they consumed only 579 calories in 29 minutes.

Chewing our food and eating slowly not only allows us to savour them but offers our stomachs the time it needs to digest and feel full, which in turn prevents overeating.

What is it?

A heart screening a.k.a. cardiac screening is a diagnostic test that is used to detect and evaluate any underlying heart diseases or conditions. It is often deployed as a preventive measure to easily counter any complications before it worsens and causes further complications.

Many different types of heart screenings are available, and the ones that the patient undergoes may differ depending on the individual. A normal screening for a healthy person would take about an hour or two, whereas someone already displaying heart-related symptoms may need to return for frequent screenings to keep track of progress.

Should I go for a heart screening?

Those aged 18 years are recommended to go for a screening at least every five years. Those with a background of diabetes, high blood pressure and kidney disease should seek their doctor’s advice on how often they should be screened.

What should I expect?

Prior to the medical screening, the patient may be required to undergo a fasting period of 10 hours before the examination to obtain accurate results.

Like every other medical test, a heart screening requires you to disclose any previous medical history before proceeding, including your own medical history as well as your family members. This will determine whether you are at greater risk of any heart complications.

The screening will begin with a full physical examination, including taking blood pressure, height, weight, and a basic eye test.

This will be followed up with an electrocardiogram (ECG), a common test which records the electrical activity of the heart by attaching electrodes to the skin of the patient. It shows doctors how well the heart is beating and points out any heartbeat irregularities, such as arrhythmia.

Another common test would be the treadmill stress test, where a patient is connected to an ECG terminal and made to walk on the treadmill. This evaluates the heart’s ability to cope with stress levels, which will be progressively altered by adjusting the slope gradient or the speed of the treadmill.

A blood test may be conducted to provide doctors a complete overview of your blood count. By fasting, the blood taken will not be influenced by a recent meal, giving the doctors a proper analysis. This can determine whether a patient is diabetic or not.

Depending on your results, your doctor may call you back for a 2D echocardiogram, using ultrasound technology to show doctors a clear and detailed image of your heart. From this test, doctors can examine and evaluate how well the heart is pumping blood and spot any outstanding abnormalities.

Good for the Heart

Baked Turkey is one of the dishes that cannot be missed during Christmas. It is actually healthier as compared to other meat choices like beef and ham, containing less cholesterol and saturated fat. Not only that; it is also rich in tryptophan, an essential amino acid that helps your body to produce vitamin B. Reducing the amount of sauce to go with it helps to cut down cholesterol and saturated fat intake, lowering the possibility of getting heart related diseases.

Next in line would be the Pumpkin Pie. Pumpkin itself contains a high level of beta-carotene – gets converted into vitamin A in the body, along with vitamin C and Potassium. Potassium helps in maintaining a balanced level of sodium within your body, and reduces the effect of sodium if you have high blood pressure.

A bowl of nuts would be ideal to accompany you and your friends during your chat sessions. Out of the many varieties to choose from, walnuts would be our recommendation. Containing unsaturated fats that help to lower cholesterol, it also possesses the highest amount of omega-3 among all nuts. On top of that, they are rich in fibre, vitamin B, magnesium, and vitamin E (anti-oxidant). Walnuts generally help to strengthen our blood vessels’ elasticity and reduce plaque accumulation – culprits of heart related dieases. Nevertheless, whichever the types of nuts consumed, moderation is the key, as the high fat content can do significant harm to the cholesterol profile if taken in large quantities.

Not so Good for the Heart

We understand the need to drink during Christmas. However, if you go overboard, it not only affects your liver but also your heart, with effects like stiff arteries and rigid heart muscles (see How Alcohol Gives Your Heart a Beating). You may consider alternatives like green tea, containing L-theanine, which calms the brain, reduces stress and helps in boosting immunity.

Fruit Cake, a traditional delicacy during Christmas, should be taken in bite-sized amounts . Know that it contains a heavy load of sugar, with its stuffed sweet candies soaked in high sugar content syrup. It will not only increase your Low-density Lipoprotein (LDL) and Triglyceride (TG) levels a.k.a. bad cholesterol, but also decrease your High-density Lipoprotein (HDL). (HDL helps to remove cholesterol within your arteries, transporting it back to the liver to be excreted or reused.) Alternatively, you could try cakes that include fresh fruits like berries, peach or even banana that are not soaked in any form of sugary syrup.

Keep in Mind

While enjoying this festive season, do not forget that everything should still be consumed in moderation. It might seem insignificant but a small step like this helps to contribute to a bigger better future; not just for your sake but your loved ones who want only the best for you in life.

Who is it for?

MitraClip Therapy is a form of minimally invasive surgery/procedure which is used to treat patients suffering from Mitral Valve Prolapse (MVP) with Severe Mitral Regurgitation (MR).

What is Mitral Valve Prolapse (MVP)?

The mitral valve is one of four valves located at the heart, namely between the left atrium and left ventricle. The mitral valve has two flaps or ‘leaflets’ which opens and closes to control the blood flow between these two chambers. When this valve does not close completely, backflow of blood in the left ventricle may occur resulting in Mitral Regurgitation (MR). In severe cases, reduced blood flow is pumped out of the heart. This creates excessive workload on the heart, leading to dilation of the heart chambers.

What are the symptoms?

Very often, the symptoms appear to be very mild. Patients can experience symptoms such as shortness of breath, fatigue, heart palpitations and chest pain. A very small percentage of patients, when the condition is untreated, could suffer from heart failure, heart attack and even death.

How are symptoms of MVP with MR detected?

Normal means such as using a stethoscope are capable of diagnosing MVP. While using a stethoscope, a clicking sound can sometimes be heard after the ventricle begins to contract. The clicking sound reveals tightening of the abnormal valve leaflets against the pressure load of the left ventricle. A whooshing sound can be heard immediately after the clicking sound if there is regurgitation of blood through the abnormal valve.

Echocardiography is the most accurate test to detect MVP. It can measure the severity of the prolapse and the amount of MR. Other tests may sometimes be necessary, including the 24-hour Holter Monitor, which records the patient’s heart rhythm over a period of time as the patient goes about his usual daily activities.

How is MitraClip Therapy done?

In the past, open heart surgery was the only option. MitraClip Therapy is a minimally invasive catheter-based procedure intended to reduce MR. The patient would be put under general anaesthesia, with the entire procedure taking approximately two to four hours. A MitraClip device is attached to the catheter, guided along the femoral vein (around the upper thigh area) to reach the heart, at which point, the clip delivery system delivers and deploys the MitraClip device. The entire procedure is done without opening the patient’s chest.

Risk and Recovery

Different patients undergoing MitraClip Therapy will encounter different risks depending on their condition. Patients are encouraged to discuss the risks of MitraClip Therapy with their doctor and compare it with other options available.. Once the procedure has concluded, you will be transferred to the cardiac monitoring unit for a day. Upon reviewing the results, you may be transferred to the regular ward for another two more days before being discharged.

Other tests conducted after the surgery include a repeat transthoracic echocardiogram, blood tests and chest X-ray. You may also be given blood thinners such as aspirin or clopidogrel for six months. Other medicines you have been taking before the procedure may be continued or modified. Most patients who have gone through MitraClip Therapy do not require special assistance at home.

Who is it for?
Bioabsorbable Vascular Scaffolds (BVS) are made from synthetic polymers that have been specifically produced for safe use in the human body. Many patients who are eligible for the regular cardiac stent are also eligible for the new BVS technology.

Until more experience with this technology is obtained, certain subsets of patients are currently deemed unsuitable for this new breakthrough in treating coronary artery disease. These include those with extensive calcified blockages and blockages at the side of branches that come off the main vessels.

What are the benefits?

Despite being very successful alternatives to coronary surgery, coronary stenting still carries small risks. When balloon angioplasty (without stents) was initially introduced in the 1980s, doctors began to realise how treated blood vessels were likely to become narrowed again as an inflammatory response to the procedure (restenosis). This occurred in 50 per cent of treated vessels.

In the 1990s, with the introduction of bare metal stents at the treated area (cardiac stenting) to provide a permanent scaffold to hold the artery open, things began to look better as the number of patients experiencing restenosis or re-narrowing after the procedure began to decline. This occurred initially in up to 30 per cent of treated vessels and reduced to less than 20 per cent as the technology improved.

However, the stents were not a sure-fire solution, as the medical world has found out today. Metal stents can be prone to blood clotting due to the presence of a foreign object in the body. These patients will always be at risk of the stents suddenly closing if they stop their blood thinning medication (e.g. Aspirin, Plavix) for prolonged periods of time, as might be needed prior to major surgery. In addition, the stents made the arteries permanently less flexible.

Open heart surgery, or Coronary Artery Bypass Grafts (CABG), usually involves a cut in the central chest bone to address blocks in multiple arteries and where stenting is not advisable. The blockages are “bypassed” by creating an alternative route for flow by utilising veins from the legs or arteries from the inside of the chest, i.e. the Left Internal Mammary Artery (LIMA) or other arteries from the forearm. No permanent metal stent is left inside the body, but studies have shown that 50 per cent of vein grafts taken from the legs are blocked at 10 years. The best results are seen with the LIMA grafts, but 10 per cent of these are also blocked at 10 years and there is only one of these available for use in the human body. Therefore, the other arteries will always have a higher risk of restenosis and this is not the perfect solution either.

Doctors and scientists responded with drug-eluting stents (DES) in the new millennium, addressing the issue of restenosis with a drug that inhibits cell growth on the implant. DES were effective in further decreasing the chances of restenosis and blood clotting to 5 to 10 per cent. The number of CABG world-wide were reduced with the widespread use of these stents, as this was considered a very low risk, even in cases where there were multiple “blockages”. Nevertheless, the issue of the permanent implant remained.

But now, there might be a possibility to finally overcome some of these barriers with the introduction of BVS. The synthetic material, which BVS is made of, happens to be biodegradable; meaning it will slowly dissolve into natural chemicals, leaving nothing behind in the treated area after two years. This allows full healing of the affected area in time, allowing the vessel to revert to its natural state, removing some of the risks associated with a permanent implant.

With that said, this technology is still in its infancy, and cannot be used for all patients. To date, we only have follow-up data up to four years. Nevertheless, it provides a viable alternative for those who are not comfortable with the idea of a permanent metal implant in their heart. DES, on the other hand, have been proven and tested for more than ten years with restenosis rates for the newer stents generally quoted at less than 5 per cent for one’s lifetime, and are therefore here to stay unless the new BVS technology proves itself over time.

Important Pre-treatment Screening
Similar to cardiac stenting, patients have to undergo a strict regime of tests to review their overall body and heart condition. This will also allow the doctor to determine which approach is best for each individual patient. These tests may include:

• Physical examination
• Electrocardiography (ECG)
• Chest X-ray
• Blood Tests
• Echocardiogram
• Cardiac Catheterisation: includes Coronary Angiogram, Aortogram and other studies
• Computed Tomography (CT) Scan
• Other tests at the doctor’s discretion

What risks does it bring?

The risks are similar to ordinary cardiac stenting, as the procedure is carried out akin to a normal percutaneous coronary intervention. This may include:

• Discomfort and bleeding at the catheter insertion site
• Blood vessel damage from catheters
• Arrhythmia (irregular heartbeat)
• Restenosis (tissue growth within treated portion narrows and blocks the artery again)
• Blood clot
• Heart attack
• Stroke

Who is it for?
Cardiac stenting, or percutaneous coronary intervention (PCI), is recommended for people who suffer from narrow or blocked coronary arteries as a result of coronary artery disease (CAD). It is also used as an emergency treatment for heart attack cases by quickly opening the blockage and reducing heart muscle damage.

What is percutaneous coronary intervention?
PCI, also known as coronary angioplasty, is a non-surgical method used to open narrowed coronary arteries that supply the heart muscle with blood. It is performed by inserting a flexible catheter (tube) with a balloon at its tip through an artery at the groin or arm. (Heart Matters favours the arm approach where the catheter is inserted through the radial artery at the wrist. It allows early mobilisation as compared to the groin approach which requires patients to keep still for six hours at a go.)

The catheter is then threaded through the inside of the artery back into an area of narrowing or blockage, where the balloon is inflated to compress the plaque against the artery wall to restore blood flow through the blood vessel.

Cardiac Stents in PCI
A cardiac stent is a small hollow mesh that is used to widen arteries supplying the heart that have significant narrowings. It is often used in angioplasty to prevent arteries from becoming narrowed or blocked again in the months or years after angioplasty.

Cardiac stents are also used to repair torn arteries including the aorta – large blood vessel that carries blood out of the heart – or bulges in arteries (aneurysms).

Important Pre-treatment Screening
Prior to PCI, patients have to undergo a strict regime of tests to review their overall body and heart condition. This will also allow the doctor to determine which approach is best for each individual patient. These tests may include:

• Physical examination
• Electrocardiography (ECG)
• Chest X-ray
• Blood Tests
• Echocardiogram
• Cardiac Catheterisation: includes Coronary Angiogram, Aortogram and other studies
• Computed Tomography (CT) Scan
• Other tests at the doctor’s discretion

What risks do PCI bring?
PCI is a common medical procedure. It is usually performed by an interventional cardiologist: a medical doctor with special training in the treatment of the heart using invasive catheter-based procedures. Major complications are rare but possible. This can include:

• Discomfort and bleeding at the catheter insertion site
• Blood vessel damage from catheters
• An arrhythmia (irregular heartbeat)
• Restenosis (tissue growth within treated portion narrows and blocks the artery again)
• Blood clot
• Heart attack
• Stroke

Although chest pain can occur during PCI, this is often transient because the balloon briefly blocks off the blood supply to the heart. Bleeding from the insertion point in the groin or arm is common, in part due to the use of anti-platelet clotting drugs. Some bruising is therefore to be expected.

The risk of complications is higher in:

• People aged 75 and older
• People who have kidney disease or diabetes
• Women
• People who have poor pumping function in their hearts
• People who have extensive heart disease and blockages

What are the benefits?
PCI is used to widen narrowed blood vessels and increase the blood flow to the heart. This decreases the risk of a heart attack, while reducing the discomfort and progress of coronary artery disease. It is minimally-invasive, as the procedure only requires a very small puncture for the catheter to be threaded into the coronary arteries.

What is the recovery period like?
Patients are kept at least overnight for observation after the procedure and discharged within 24 hours after PCI. They are cautioned not to do any vigorous activity or lift heavy items or weights for about one to two weeks. Some patients may be referred to a rehabilitation centre but most patients are able to continue working (not physically intensive) in about three days after PCI.