Related Articles

“Leveraging ChatGPT to aid patient education on coronary angiogram”: Correspondence

Dear Editor, “Leveraging ChatGPT to aid patient education on coronary angiogram”1  is an interesting article. The study assessed ChatGPT’s ability to conversely provide information regarding the coronary angiography process, pointing out its advantages and disadvantages. Although ChatGPT provided information in an exhaustive and methodical manner, it also had flaws, including...

Impact of risk stratification on cardiovascular outcomes in patients with stable chest pain

Dear Editor, Chest pain is a common presenting complaint among patients visiting primary care1 and is a frequent reason for referral to the outpatient cardiology clinic. The European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines advocate estimating pre-test probability (PTP) of obstructive coronary artery...

Tele-ECG collaboration between tertiary and primary care in Singapore: Outcomes and learning over a 6-year period

Dear Editor, An electrocardiogram (ECG) is the mainstay of cardiac evaluation available in primary care, after which assessment in relation to clinical symptoms and signs is made by family physicians to assess the patients holistically. Subsequently, based on this clinical evaluation, patients may then be referred for tertiary review at...

Optimising percutaneous valve-in-valve TAVI with bioprosthetic valve fracture

Dear Editor, Percutaneous transcatheter aortic valve implantation (TAVI) has become an established therapy for inoperable patients, for high, intermediate and low surgical-risk patients over 65 years old with severe aortic valve stenosis (AS).1,2 Valve-in-valve (ViV) TAVI is an approved indication for patients with degenerated aortic surgical bioprostheses. Several ViV TAVI registries...

Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience

Dear Editor, Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan Tock Seng Hospital (TTSH), the TELE ACC service was established to enrol patients who (1) perform self-testing using a loaned point-of-care (POC) international normalised ratio...

Direct oral anticoagulant: Looking beyond convenience

Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it is now more commonly referred to, there has been much development in the field with increasing availability of different DOACs and an expansion in indications...

Strategies to prevent cardiovascular disease in Singapore: A call to action from Singapore Heart Foundation, Singapore Cardiac Society and Chapter of Cardiologists of the Academy of Medicine, Singapore

Despite the success of Singapore’s public health systems in providing medical care through the country, there is still much to be achieved in terms of optimising the cardiovascular (CV) health of its 6 million residents. According to the 2019 Global Burden of Disease report, while the incidence rate of...

Cardiovascular effects of COVID-19 in children

The global coronavirus disease 2019 (COVID-19) pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the respiratory system is  the primary infectious target of SARS-CoV-2, systemic symptoms are fairly common and organ systems throughout the body can be affected with multisystem organ failure in the...

COVID-19: The virus, vaccine and paediatric heart

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality around the world. The development of vaccines has cushioned the effect of the virus and thus, provided hope in the fight against the disease.1 Yet, there are still small battles with COVID-19, at the bench and...

Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests

Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2 While earlier studies in developed countries reported an overall CHD birth prevalence of 3.7–5.54 per 1000 live births,3,4 more recent studies report a global and...

Leveraging ChatGPT to aid patient education on coronary angiogram

Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...

Effects of sex on clinical outcomes of hypertrophic cardiomyopathy in Singapore

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiomyopathy.1 The phenotypic expression of HCM is highly diversified with varying extents of myocardial hypertrophy, which can affect different parts of the heart and result in varying extents of left ventricular outflow tract (LVOT) obstruction, diastolic dysfunction and arrhythmic potential. The large...

Promise and pitfalls of ChatGPT for patient education on coronary angiogram

The past decade has seen extraordinary and rapid progress in the field of artificial intelligence (AI), which produces computer systems capable of performing tasks that typically require human intelligence. These advancements have yielded wide-ranging applications across various domains that are revolutionising industries and transforming the way humans live and...

Preferences for oral anticoagulant medications for managing atrial fibrillation

Dear Editor, Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of serious bleeding events.3 Warfarin and direct oral anticoagulants (DOACs) are the available oral anticoagulants for this indication. We developed a discrete choice experiment (DCE) survey4...

Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes

Sudden cardiac death in athletes during exercise is rare, with an estimated incidence of 1–2 per 100,000 people per year in young athletes,1 and approximately 1 per 7,000 per year in adult athletes.2 The predominant aetiology of these cases is cardiovascular in nature, with conditions such as hypertrophic cardiomyopathy...

Improving electrocardiogram interpretation in Asian athletes: A call to action

The field of sports cardiology has evolved substantially over the past 2 decades due to improved understanding of the athlete’s heart, causes of sudden cardiac death (SCD) in athletes, as well as differentiation between physiological cardiac remodelling and pathological cardiac conditions in athletic individuals. Application of this knowledge forms...

Outcomes of selexipag for treatment of pulmonary arterial hypertension in an Asian population

Dear Editor, Pulmonary arterial hypertension (PAH) is a progressive condition characterised by increased pulmonary arterial pressure and pulmonary vascular resistance, resulting in right ventricular dysfunction and eventually cardiac failure. In the early days, this was an often a fatal disease with significant morbidity. In recent years, there has been increasing...

Suboptimal adherence to medical therapy in patients undergoing lower limb angioplasty in Singapore

Dear Editor, Chronic limb-threatening ischaemia (CLTI) is the advanced stage of peripheral arterial disease (PAD) and patients with this condition face a very high risk of major adverse cardiovascular events and mortality. Several guidelines strongly recommend evidence-based medical therapy (EBMT) to reduce cardiovascular risk.1-3 Specifically, all CLTI patients should be...

Approach to bradyarrhythmias: A proposed algorithm

Bradyarrhythmias are common and occur in both physiological and pathological states. Bradycardia is defined as a heart rate of fewer than 60 beats per minute, and bradyarrhythmias can be caused by sinus node dysfunction or atrioventricular (AV) conduction blocks.1,2 Atrial fibrillation (AF) with a slow ventricular response may also...

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

Atrial fibrillation (AF) is a pertinent health condition that is seeing a sustained rise in global incidence and prevalence.1 In particular, paroxysmal AF (PAF), despite its transient nature, is associated with a slow but steady progression to persistent AF2 and increased mortality compared to patients without AF.3 Furthermore, patients...

Catheter ablation as first-line treatment for paroxysmal atrial fibrillation

Pharmacotherapy has been the mainstay of atrial fibrillation (AF) treatment. As AF progresses from paroxysmal to persistent, electrical and structural remodelling of the atria may become irreversible, rendering future rhythm-control therapies less effective. Results of earlier trials on rhythm control were disappointing and failed to establish the superiority of...

Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation

The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and major adverse cardiac events (MACE) seen in this group of patients even after surgical aortic valve replacement (SAVR).1,2 In recent times, the role of transcatheter aortic...

Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation

Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with increased risks of stroke, dementia, heart failure (HF) and death.1 Globally, 33.5 million people were reported to have AF in 2010,2 with numbers expected to increase exponentially by 2050.3-7 While in part due to ageing...

Different strokes for different folks

Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven first documented ECG tracing of AF in 1906. Fast forward several hundred years since its first observation, AF remains a mystery from its pathogenesis and...

Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction

Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...

Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction

With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction (HFmrEF), much has yet to be fully understood with regard to patient demographic, clinical presentation, response to guideline-directed heart failure therapies, and outcome across the...

Iatrogenic atrial septal defect after catheter ablation—to close or not to close?

Dear Editor, Transseptal access to the left heart is increasingly performed for electrophysiological procedures and for structural heart disease interventions such as balloon mitral valvuloplasty (BMV), left atrial appendage closure (LAAC) and transcatheter mitral valve repair (TMVr). Most of the iatrogenic atrial septal defects (iASDs) close spontaneously, and for those...

Cardiac sarcoidosis: Difficulties in diagnosis and treatment

Sarcoidosis is a multisystem, granulomatous disorder of unknown aetiology. It affects the lungs in 90% of cases, but is also known to affect other organs including the skin, liver, spleen, kidneys and heart.1 Cardiac sarcoidosis (CS) is thought to clinically affect 5% of those with sarcoidosis, manifesting as conduction...

Out-of-hospital cardiac arrest in Singapore: Can we do better?

Cardiac arrests are unpredictable events that frequently result in death or significant residual morbidity among survivors. These sudden events affect not only the individual, but are understandably also significant life events and stressors for the family and friends. As such, the impact of cardiac arrests is felt on a...

Sepsis and cardiovascular events: The story so far

Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that leads to admission to the intensive care unit (ICU). Although advances have been made in the management of sepsis, mortality from sepsis remains high.2 Among...

Previous history of hyperthyroidism in emergency department patients with atrial fibrillation does not increase the risk of thromboembolism and death

Dear Editor, Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision for anticoagulation is guided by risk scoring systems that include factors such as age, sex and comorbidities.1,2 AF can sometimes occur in patients with active...

Pressures, indexes and peripheral arterial disease: Time to rethink our approach?

Most patients with peripheral arterial disease (PAD) are asymptomatic. Despite the absence of symptoms, these patients have a significantly increased risk of death and adverse vascular events.1 Early detection of individuals with asymptomatic PAD facilitates prompt introduction of secondary prevention (lifestyle modification, smoking cessation, anti-platelet medications and lipid management)....

Drug Treatment of Hypercholesterolaemia

Serum cholesterol has been established as a major risk factor for coronary heart disease (CHD). There is a linear association between serum cholesterol level and CHD mortality and morbidity. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Goldberger’s Triad in Dilated Cardiomyopathy—Can it Predict the Severity of Left Ventricular Dysfunction?

In 1982, Goldberger described a novel electrocardiogram (ECG) triad that was highly specific for patients with dilated cardiomyopathy and congestive heart failure (attributable to various aetiologic factors), with a sensitivity of 70%, a specificity of 99%, and a positive predictive value of 91%. For unknown reasons, ventricular dilation causes...

Thyroid Storm Presenting as Jaundice and Complete Heart Block

Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered mental status. With the “apathetic” variant of hyperthyroidism, the classical features may not be evident. This article is available only as a PDF. Please click on...

Simultaneous Transcatheter Valvuloplasty and Amplatzer Septal Occlusion for Pulmonary Valvar Stenosis and Secundum Atrial Septal Defect

Congenital pulmonary valvar stenosis (PVS) and secundum atrial septal defect (ASD) are relatively common forms of congenital heart disease (CHD). Since the first successful clinical application of transcatheter balloon dilation of PVS in 1982, the latter has become the treatment of choice for children with PVS who have significant...

Electrocardiographic Abnormalities in Combined Hypercalcaemia and Hypokalaemia—Case Report

The electrocardiographic abnormalities in isolated hypercalcaemia and hypokalaemia have been well documented in the literature. However, electrocardiogram (ECG) findings in combined hypercalcaemia and hypokalaemia have rarely been described. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...

Interventional Electrophysiology and its Role in the Treatment of Cardiac Arrhythmia

Cardiac arrhythmias are disorders of the electrical system of the heart which can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac death. Clinical cardiac electrophysiology is a sub-specialty in cardiology dealing specifically with the study of the electrophysiology of the heart and all aspects of management...

Incessant Ectopic Atrial Tachycardia and Tachycardia-related Cardiomyopathy: Therapeutic Options and Potential for Cure

Incessant ectopic atria tachycardia (IEAT) is a rare and insidious arrhythmia which is frequently misdiagnosed and if untreated, leads to ‘exhaustion’ of the myocardium and result in tachycardia-related cardiomyopathy. Early strategies to manage this problem such as pharmacological therapy to either block the atrioventricular node or suppress the ectopic...

Intracoronary Brachytherapy: The Beginning of the End of Restenosis?

Restenosis remains a major clinical problem 20 years after the introduction of coronary angioplasty by Andreas Gruentzig in the treatment of coronary artery disease. Recent randomised studies showed a persistent 32% to 57% incidence of angiographic restenosis following successful balloon angioplasty, usually within the first 6 months, despite increased...

Homocysteine and Atherosclerotic Disease: The Epidemiologic Evidence

Homocysteine is a thiol-containing amino acid formed during the metabolism of methionine. The metabolic fate of homocysteine may be influenced by the alterations in the activities of serum folate, pyridoxine and cobalamin. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T wave during sinus rhythm without any changes in the QRS complex, is an uncommonly recorded rhythm. We report here an unusual case of T wave...

Trends in Mortality, Incidence, Hospitalisation, Cardiac Procedures and Outcomes of Care for Coronary Heart Disease in Singapore, 1991-1996

In line with trends in many high-income countries, Singapore has experienced some declines in mortality from coronary heart disease (CHD) since the 1980s. Whether this can be attributed to reduced population levels of risk factors for CHD, declining incidence and severity of disease, changes in medical care, or even...

Initial Experience With an Autocapture Pacemaker System

The longevity of a pacemaker generator varies directly with the total deliverable amount of electrical charge (Q, in coulombs) and inversely with the rate of consumption of charge. The rate of consumption is dependent in turn on the total number of electrical pulses per unit time, and the strength...

The Differential Diagnosis of Supraventricular Tachycardia Using Clinical and Electrocardiographic Features

Noninvasive evaluation of the mechanism of the arrhythmia is important in the management of supraventricular tachycardia (SVT). It guides one in the choice of therapy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cardiac Marker Point-of-care Testing: Evaluation of Rapid On-site Biochemical Marker Analysis for Diagnosis of Acute Myocardial Infarction

In the present era of revascularisation therapy, rapid and accurate diagnosis of acute myocardial infarction (AMI) is important, as these patients may benefit from early intervention in the form of primary angioplasty, fibrinolysis or anti-thrombotic therapy. The most widely accepted criteria for diagnosis of AMI, laid down by WHO,...

Cardiovascular Disease: Genes and Public Health

The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is assumed that the identification of mutations that confer susceptibility will provide the basis for new means of detection, prevention and treatment. This article is available only...

Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study

Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental or lifestyle factors that may be involved. This is aided when the ethnic groups live in the same country, so that differences in completeness and...

Technetium-99m Sestamibi for the Assessment of Myocardial Salvage Following Reperfusion Therapy in Acute Myocardial Infarction

Reperfusion therapy for acute myocardial infarction is feasible with thrombolytic therapy as well as acute percutaneous transluminal coronary angioplasty (PTCA). Both modalities of treatment have been proven to improve long-term survival. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations, or some other less specific complaints such as nausea, pallor and sweatiness. This article is available only as a PDF. Please click on “Download PDF” on...

Diagnosis of Pacemaker Lead Infection Using Transoesophageal Echocardiography: A Case Report

The expanding indications for permanent cardiac pacing mandate an awareness of the potential complications associated with device implantation. After failure of pacing and sensing, infection is the most frequent pacemaker-related complication, with reported rates of between 1% to 7% in older studies1 and <1% in more recent series. This article...

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...

Isolated Non-compaction of Ventricular Myocardium: A Report of Three Cases

Non-compaction of ventricular myocardium is a rare morphogenic arrest of compaction of the ventricular myocardial fibres during intrauterine life. Usually, the left ventricle is more compact and less trabeculated than the right ventricle. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Impairment of Endothelial Function—A Possible Mechanism for Atherosclerosis of a High-fat Meal Intake

The impairment of endothelial vasodilatory function has been considered an early event in atherogenesis. This has been studied in association with various cardiovascular risk factors such as diabetes mellitus, hyperhomocystinuria, smoking, hypertension and hypercholesterolaemia. This article is available only as a PDF. Please click on “Download PDF” on top to...

A Preliminary Study of the Utility of Combined Cardiac Markers in the Evaluation of Patients Presenting Early with Suspected Acute Coronary Syndrome

The management of patients presenting with chest pain of recent onset can prove to be a diagnostic challenge. These patients vary from having atypical musculoskeletal pain, unstable angina pectoris (UAP), non-ST elevation myocardial infarction (NSTEMI), to early ST-elevation myocardial infarction (STEMI). This article is available only as a PDF. Please...

Homocysteine, Folate and Vitamin B12 as Risk Factors for Acute Myocardial Infarction in a Southeast Asian Population

Since the beginning of the last decade, hyperhomocysteinaemia has been identified as a risk factor for acute coronary syndromes. A few large prospective studies have shown a clear increase in relative risk, especially for those populations with plasma homocysteine levels above 15 µmol/L. This article is available only as a...

Myocardial Infarction in Singapore: A Nationwide 10-year Study of Multiethnic Differences in Incidence and Mortality

Rapid urbanisation and increasing affluence have improved the socioeconomic status of Asians. This, however, has brought with it new socioeconomic and medical problems resulting from the urbanised lifestyles entrenched in these newly industrialised economies. This article is available only as a PDF. Please click on “Download PDF” on top to...

Acute Coronary Syndrome—Factors Causing Delayed Presentation at the Emergency Department

Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from acute myocardial infarction (AMI) have seen a worldwide decline in recent years. This article is available only as a PDF. Please click on “Download PDF” on...

Rheumatic Heart Diseases in Pregnancy

Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis causing chronic valvular lesions. Severe myocardial and pericardial involvements are much less common. This article is available only as a PDF. Please click on “Download PDF”...

Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports

Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up to 3 months) after starting allopurinol. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Two Case Reports on Incessant Left Ventricular Tachycardia: Curative Therapy with Radiofrequency Ablation

Left ventricular tachycardia is a recognisable condition in patients with otherwise structurally normal heart. It may arise from various foci in the left ventricle. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Prevention of Restenosis after Percutaneous Coronary Intervention: The Continuing Challenge

Since Andreas Gruntzig first demonstrated its use in humans in 1977, the utilisation of percutaneous transluminal coronary angioplasty (PTCA) has grown tremendously throughout the world today. The ability to treat coronary artery stenosis with this minimally invasive alternative to coronary artery bypass surgery is attractive to both cardiologists and...

A Case Series of Sotalol-induced Torsade de Pointes in Patients with Atrial Fibrillation – A Tale with a Twist

In the light of the Cardiac Arrhythmia Suppression Trial (CAST) which suggested that class I antiarrhythmics may be linked to an increase in mortality, attention has been turned towards the use of class III drugs for the management of both atrial and ventricular arrhythmias. While the adverse effects of...

Immediate and Mid-Term Safety and Efficacy of Single Lead VDD Pacemakers for Patients with Atrioventricular Block and Normal Sinus Node Function—A Single Centre Experience

In patients requiring a cardiac pacemaker for any indication, the ideal goal of therapy is to achieve atrioventricular (AV) synchrony. This replicates the normal cardiac contraction sequence and is better tolerated with fewer associated complications in the long term. This article is available only as a PDF. Please click on...

Torsades de pointes in a woman presenting with syncope

A 57-year-old woman presented with first onset syncope, which was witnessed by her family members. It occurred in the middle of a conversation and lasted for 30 seconds, followed by spontaneous and prompt recovery. There was upward rolling of eyeballs with no witnessed tongue biting, jerking of limbs or...

Spironolactone Does Not Prevent Restenosis After Coronary Stenting in Humans

High restenosis rate, which has been documented to occur in approximately 30% to 50% of cases, still remains a major concern, although percutaneous transluminal coronary angioplasty can be performed with a high initial success rate and good immediate angiographic results. Early elastic recoil, late vessel remodelling, and neointimal proliferation...

Nuclear Cardiology in Singapore: A Review

The past decade has witnessed significant advances and rapid growth in the field of nuclear cardiology. In Singapore, our experience has been similar to the United States, with a 10% to 15% yearly growth in volume of cardiac nuclear studies now performed at many institutions since its introduction in...

Stem Cell Cardiomyoplasty: State-of-the-Art

Congestive heart failure (CHF) remains the most common diagnosis made in cardiology wards today. At present, no long-term therapeutic option for end-stage CHF is available except for orthotopic heart transplant. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Medical Therapy in Heart Failure – Is Polypharmacy Necessary?

The clinical syndrome of heart failure is recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses. Heart failure is the end-stage of all heart diseases. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging

Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there has been a dramatic increase in the survival rate of patients. This article is available only as a PDF. Please click on “Download PDF” on top...

Drug-eluting Stents: The End of Restenosis?

Percutaneous coronary intervention (PCI) is the preferred revascularisation approach for most patients with coronary artery disease because, with comparable clinical outcomes in selected patients, PCI is less invasive and offers shorter hospital stay and faster recovery as compared to coronary artery bypass grafting (CABG). The acceptance of PCI as...

Coronary Artery Ectasia: A Ten-year Experience in a Tertiary Hospital in Singapore

Coronary artery ectasia (CAE) is the abnormal dilatation of a segment of the coronary artery to a diameter of at least 1.5 times that of normal adjacent segments1 (Fig. 1). It is a well-recognised, albeit uncommon, finding at cardiac catheterisation. This article is available only as a PDF. Please click...

Pilot Survey of the Diagnosis and Management of Heart Failure in Primary Care: A Singaporean Perspective

Congestive heart failure is an increasingly common disorder and a major cause of morbidity and mortality in developed countries around the world. It is a clinical syndrome that represents the end point of a myriad of heart conditions. This article is available only as a PDF. Please click on “Download...

High-sensitivity C-reactive Protein is Predictive of Medium-term Cardiac Outcome in High-risk Asian Patients Presenting With Chest Pain Syndrome Without Myocardial Infarction

Patients with chest pain often pose a diagnostic conundrum to the attending physician especially when symptoms are not typical of angina and the electrocardiogram nondiagnostic. Troponin levels are frequently measured at presentation to prognosticate the patient. This article is available only as a PDF. Please click on “Download PDF” on...

Cardiovascular Medicine and Surgery in Singapore: The Next Lap

Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial were the impact of changing demographics and disease patterns, the importance of optimising resources, and the need for structured training and sub-specialisation. This article is available...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications. This article is available...

Clinical Applications of Positron Emission Tomography in Cardiology: A Review

Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a poor prognosis when treated medically. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...

16th Seah Cheng Siang Memorial Lecture – The Changing Face of Cardiology Practice, Training and Research in Singapore

Professor Seah Cheng Siang was one of the most illustrious physicians of his era. During his professional career, he held the following positions: Head, Department of Medicine, Thomson Road General Hospital (1960-71); Head, Department of Medicine III at the Singapore General Hospital (1971-87); Master of the Academy of Medicine...

Building Collaboration in Cardiac Imaging

Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery disease (CAD) detection has captured the imagination of the public appears exceptional. This article is available only as a PDF. Please click on “Download PDF” on...

Guidelines on Cardiac CT in Singapore (2006)

The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice computed tomography (CT) technology such as thin detector collimation and fast gantry rotation allow the heart to be scanned in a single breath-hold. This article is...

The Association of Smoking with Components of the Metabolic Syndrome in Non-diabetic Patients

Metabolic syndrome (MS) is conceptualised as a constellation of physiologic or anthropometric abnormalities. Typically, it includes excess weight, hyperglycaemia, elevated blood pressure, low concentration of high-density lipoprotein cholesterol (HDL-C), and hypertriglyceridaemia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused by atherosclerosis. Atherosclerosis (the hardening of the arteries) is the most common form of arteriosclerosis, in which the walls of arteries become thicker and less...

Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients

Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately 2.2%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative

Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms of its ability to achieve higher patency rates, minimise infarct size, improve left ventricular function and improve long-term survival, as well as lower rates of...

Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry

Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Case of Myopericarditis in a Patient with Methicillin-resistant Staphylococcus aureus Community-acquired Pneumonia

We described a healthy and physically active 41-year-old man who presented to a private practitioner with right axillary pain and fever. Physical examination revealed a right axillary fluctuant lump consistent with an abscess that was subsequently drained. This article is available only as a PDF. Please click on “Download PDF”...

The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow

Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram. Many aetiological factors, such as microvascular and endothelial dysfunction, have been implicated. This article is available only as a PDF. Please click on “Download PDF” on...

Improving Access to Outpatient Cardiac Care at the National Heart Centre – A Partnership Between Specialists and Primary Care

There is evidence that shows that the use of healthcare delivered by private providers, particularly procedures and hospital care, depends on supply. For example, in a population-based study of patients with pain that might signal arthritis of the knee, the number of patients in need of surgery (physicians determined...

Pattern and Outcome of Subsidised Referrals to Cardiology Specialist Outpatient Clinics

Singapore faces an increasing demand for public healthcare from an ageing population in need of chronic care. At our cardiology specialist outpatient clinics, the volume of new cardiology subsidised outpatients has increased at an average of 12.8% per annum for the past 10 years. This article is available only as...

Phaeochromocytoma the Great Mimicker: A Case Report

Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule of 10” where 10% are extra-adrenal, of which 10% are extra-abdominal, 10% are malignant, 10% occurs in normotensive patients and 10% are hereditary. This article is...

The Angiographic Aspects of Myocardial Bridges in Turkish Patients who have Undergone Coronary Angiography

Myocardial bridge, intramural coronary artery, coronary artery over bridging and myocardial loop are essentially the different terms used to designate the same phenomenon. Myocardial bridge was first described by Reyman in 1737 as an anatomical curiosity – the overlaying of the left anterior descending coronary artery by a myocardial...

Management of Acute ST-Elevation Myocardial Infarction: Reperfusion Options

Cardiovascular disease is a leading cause of death globally. More than 920,000 myocardial infarctions (MI) are diagnosed annually in the United States. Of these, about 500,000 ST-elevation myocardial infarctions (STEMI) are estimated to occur each year. This article is available only as a PDF. Please click on “Download PDF” on...

A Case of Acute Myocardial Infarction 24 hours after Acute Ischaemic Stroke

It is well known that thrombolysis for acute myocardial infarction (AMI) may lead to disintegration of pre-existing intracardiac thrombi with subsequent cerebral embolisation. It appears plausible that the same mechanism could apply to patients with cardiac or arterial thrombi who are undergoing intravenous thrombolysis for acute ischaemic stroke. This article...

The Growing Burden of Cardiovascular Disease: Role of the Arterial-Cardiac Interaction

World Heart Day was inaugurated to increase global awareness that cardiovascular disease (CVD) is the world’s leading cause of death, claiming, according to the World Heart Federation website, 17.1 million lives each year. Control of risk factors such as hypertension, diabetes mellitus, dyslipidemia, tobacco use, and physical inactivity, are...

Comparison of Cardiac Output Measurement by Arterial Waveform Analysis and Pulmonary Artery Catheter in Mitral Stenosis

Cardiac output (CO) is a vital measurement that influences clinical decision-making. Although thermodilution via a pulmonary artery catheter (PAC) is considered the gold standard for CO monitoring, the use of the PAC is no longer routine given its associated complications and lack of efficacy data. This article is available only...

Unusual Pacemaker Lead Placement in an Unsuspecting Heart

A 51-year-old man, with a negative cardiac medical history, presented with symptomatic 2:1 atrioventricular block. A permanent pacemaker was implanted. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Embolised Injection Needle Fragment to the Heart, Mimicking a Subcutaneous Charm Needle

Embolisation of a fragmented injection needle to the heart is rare, even in intravenous drug abusers. The presence of an embolised needle fragment to the heart can serve as a nidus for infective endocarditis. This article is available only as a PDF. Please click on “Download PDF” on top to...

Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?

Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of devices has been developed for use over the years, with significant advances achieved in terms of profile and safety. This article is available only as a...

Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients

The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in which there are pathologies in the vessels nourishing the brain. Besides being a serious health problem due to its high mortality and morbidity, stroke is...

Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis

Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the more diffuse and accelerated form of atherosclerosis and endothelial dysfunction which lead to diffuse coronary lesions, small vessel disease, multi-vessel involvement, larger plaque burden as...

Risk Factors and Clinical Outcomes for Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients with Normal Serum Creatinine

Contrast-induced nephropathy (CIN) is a common complication post-percutaneous coronary intervention (PCI). CINis associated with increased morbidity, mortality, prolonged hospitalisation and long-term renal impairment. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?

The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and even direct puncture of the aorta from a translumbar approach, have been utilised in the past. This article is available only as a PDF. Please click...

Angioplasty on an Infarct-related Anomalous Right Coronary Artery Arising from Posterior Coronary Sinus

A 60-year-old chronic smoker had delayed presentation (>18 hours) of acute inferior myocardial infarction with electrocardiogram showing 1.0 mm ST-segment elevation in leads II, II, and aVF on admission to hospital. Subsequently, he developed sustained complete atrioventricular block with no ventricular escape which necessitated temporary pacing. This article is available...

Complete Atrioventricular Block Complicating Acute Anterior Myocardial Infarction can be Reversed with Acute Coronary Angioplasty

Complete atrioventricular block (AVB) develops in more than 5% of patients with myocardial infarction (MI). These patients have poorer outcomes compared to those without complete AVB. Thrombolysis has been demonstrated to improve the prognosis of such patients, especially those with inferior MI. This article is available only as a PDF....

Acute Myocardial Infarction in Pregnant Women

Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. It typically occurs in middle-aged or elderly people with cardiovascular risk factors, such as cigarette smoking and diabetes mellitus. Although uncommon, AMI does occur in pregnant women. From the physiological perspective, pregnancy has been shown to...

Risk Stratification for Sudden Cardiac Death after Acute Myocardial Infarction

In today’s modern era of evidence-based medicine and interventional cardiology, most patients who suffer an acute myocardial infarction (AMI) are started on medication with proven prognostic benefit and undergo coronary angiography with revascularisation as dictated by their presentation and symptoms. This article is available only as a PDF. Please...

Adjunctive Pharmacologic Agents and Mechanical Devices in Primary Percutaneous Coronary Intervention

Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI), with regard to reduction of death, stroke and re-infarction. However, bleeding and thrombotic complications can occur despite successful PPCI and slow flow/no-reflow or poor microvascular reperfusion...

Management of Antiplatelet Therapy During Acute Percutaneous Coronary Intervention: New Strategies and Therapeutics

Platelet adhesion, activation, and aggregation are stimulated during an acute coronary syndrome (ACS), the result of intimal injury due to rupture of an atherosclerotic plaque. This triggers a cascade of events leading to the catastrophic formation of an occlusive clot. Antiplatelet agents assume the cornerstone role in modern pharmacotherapy...

Risk Assessment Models in Acute Coronary Syndromes and Their Applicability in Singapore

Strategies for managing cardiovascular disease are evolving rapidly. This evolution and improvement in care is responsible for reducing mortality especially in patients presenting with acute coronary syndromes (ACS). Nevertheless, there is room for further improvement in outcomes, particularly amongst high-risk patient subgroups in this population. This article is available only...

Current Trends in Diagnostic Biomarkers of Acute Coronary Syndrome

Advances in our understanding of the pathophysiology of acute coronary syndrome (ACS) have led to the marked increase in development of biomarkers for diagnosis, risk stratification, therapeutic decision-making, and assessment of clinical outcomes. Patients with ACS are subdivided into the following 2 major categories based on the 12-lead electrocardiogram...

Update on Clinical Imaging of Coronary Plaque in Acute Coronary Syndrome

Acute coronary syndrome (ACS) encompasses the clinical spectrum of unstable angina (UA) and acute myocardial infarction (AMI). Most ACS are precipitated by luminal thrombi within coronary arteries, which may arise from 3 different atherosclerotic plaque morphologies: plaque rupture, plaque erosion or calcified nodules. This article is available only as a...

Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion

Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for a physician not to consider it as a possible diagnosis in any patient presenting with acute symptoms of chest tightness or discomfort, palpitations, dyspnoea, diaphoresis,...

Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?

In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence suggests the presence of interactions between the immune system, the central nervous system (CNS) and the endocrine system, where these systems can be influenced by...

Clinical and Angiographic Findings of Complete Atrioventricular Block in Acute Inferior Myocardial Infarction

Complete atrioventricular block (AVB) complicates inferior wall myocardial infarction (MI) in 11% to 15% of cases. It usually clusters with conditions indicative of poor clinical status, such as right ventricular infarction, cardiogenic shock, and atrial fibrillation, probably related to its association with a larger infarct size. This article is available...

Reperfusion Strategy and Mortality in ST-Elevation Myocardial Infarction among Patients with and without Impaired Renal Function

Randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fi brinolytic therapy in the treatment of ST-segment elevation myocardial infarction (STEMI) patients with normal renal function. Practice guidelines consider primary PCI as the preferred reperfusion strategy for patients presenting with STEMI, conditional upon timely...

Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes – Does it Still Exist in Contemporary Practice?

Globally, cardiovascular disease (CVD) is the single most common cause of death among women; and in parallel with an increasing life expectancy, the proportion of women who have CVD is also rising. Registry data demonstrate that women tend to be 10 years older than men at the time of...

The Impact of Gender on the Outcomes of Invasive versus Conservative Management of Patients with Non-ST-Segment Elevation Myocardial Infarction

Recent studies have suggested differences in clinical outcomes between men and women following acute myocardial infarction (AMI). Some studies have indicated poorer survival of female AMI patients on admission and short-term follow-up, whilst others have shown no difference in outcome. Poorer outcome was often attributed to less aggressive management...

Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study (FHS) cohort and was designed to predict 10-year risk of hard coronary events, including mortality due to coronary heart disease and non-fatal myocardial infarction (MI)...

Acute Coronary Syndrome: from Epidemiology to Treatment

The term “acute coronary syndrome” (ACS) was introduced a decade ago to describe a spectrum of conditions resulting in acute myocardial ischaemia. It comprises unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment myocardial infarction (STEMI). This article is available only as a PDF. Please click on “Download PDF”...

Off-Pump versus On-Pump Coronary Artery Bypass Procedures: Postoperative Renal Complications in an Asian Population

To date, the major part of routine cardiac surgery is performed using extracorporeal circulation with cardioplegic arrest. Regardless the technique of cardioplegia, temporary renal dysfunction can be observed frequently. Renal dysfunction requiring dialysis occurs in less than 5% of the patient undergoing cardiac surgery with cardiopulmonary bypass. This article is...

Catheter Entrapment During Cardiac Electrophysiology Study

A 50-year-old man underwent cardiac electrophysiology study for palpitations. Under fluoroscopic guidance, 1 deflectable decapolar and 2 quadripolar diagnostic catheters were introduced smoothly into the right femoral vein and up the inferior vena cava (IVC) till the level of the right diaphragm. Using biplane fluoroscopic views at left anterior oblique 30...

Treatment of Coronary In-stent Restenosis with Drug-eluting Balloon Catheter: Real-world Outcome and Literature Review

Dear Editor, Currently, coronary stent implantation is employed in approximately 90% of percutaneous coronary intervention (PCI) cases. Despite the use of drug-eluting stents (DES), coronary in-stent restenosis (ISR) remains an Achilles’ heel of PCI and can occur in about 10% of patients in the real-world population. We explored the efficacy...

Electrocardiograph Changes, Troponin Levels and Cardiac Complications After Orthopaedic Surgery

Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is as high as 10% to 26% at 6 months and cardiac-related death are common. Cardiac injury is potentially treatable and therefore early detection of myocardial...

Long-term Outcomes of Medical Therapy Versus Coronary Revascularisation in Patients with Intermediate Stenoses Guided by Pressure Wire

Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram that offers no information on the functional significance of a coronary lesion. It is difficult to define the haemodynamic significance of a stenosis from the...

Chest Pain, Something is Not Right…Or Left

A 46-year-old female was referred for evaluation of central chest pain unrelated to exertion. She was known to have diabetes mellitus, hypertension, and dyslipidaemia. Physical examination, routine blood investigations, electrocardiogram and chest radiograph were unremarkable. Stress myocardial perfusion imaging demonstrated normal perfusion of the left ventricle (LV) with no...

A Novel “Box Lesion” Minimally Invasive Totally Thoracoscopic Surgical Ablation for Atrial Fibrillation

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of AF,1 which increases with age, is 8% in people aged over 80. About three-quarters of the cases are non-valvular AF. The risk for stroke in...

Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service

Early reperfusion of ST-segment elevation myocardial infarction (STEMI) has been shown to result in better outcomes,1-3 and guidelines for treatment of STEMI recommend a rapid and coordinated response.4 The American Heart Association guidelines released in 2014 recommend a door-to-balloon (DTB) time of less than 90 minutes,5 and timings of...

Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging

Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit into various tissues and organs, the process invariably leads to organ dysfunction. Deposition of amyloid fibrils into the heart results in cardiac amyloidosis (CA). Manifestations...

New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore

Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown. Ascites and gastrointestinal dysmotility in advanced cirrhosis, compounded by the need for dietary restrictions, often result in early satiety and anorexia. Inevitably, liver transplant wait-list...

ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series

Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well as abnormal platelet activation, impaired fibrinolysis, and endothelial dysfunction in COVID-19 patients, resulting in thrombosis. The lungs are thought to be the epicentre of thrombosis,...

Medical management of PAD: Expand or consolidate?

In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management of patients with peripheral arterial disease (PAD). It is easy, upon meeting a patient, to prescribe appropriate medication in an outpatient setting and believe that...

Dynamic mitral regurgitation treated with MitraClip

The dynamic nature of mitral regurgitation (MR) has been well appreciated but clinically under-recognised. In addition, evidence on therapeutic options for dynamic MR has been lacking. We report the case of a 48-year-old woman who underwent coronary revascularisation and extra-corporeal membrane oxygenation support after post-operative cardiac collapse from left...

Percutaneous paravalvular leak repair for severe aortic regurgitation after transcatheter aortic valve implantation (TAVI)

Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous PVL closure has become increasingly performed and is an alternative to surgery.1 PVLs occur more frequently after transcatheter aortic valve implantation (TAVI), as the transcatheter...

Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there are variations in the reported survival-to-hospital discharge rates among different regions in the world. In Singapore, OHCA incidence rate was 27.2 per 100,000 person-years, with...

Cerebral venous thrombosis in a patient with mild COVID-19 infection

Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular coagulation, especially in patients with severe COVID-19 infection. Nauka et al. provided vital insight that thrombotic complications can happen in a patient with non-critically ill...

The Effect of Fenofibrate on Insulin Sensitivity and Plasma Lipid Profile in Non diabetic Males with Low High Density Lipoprotein/Dyslipidaemic Syndrome

Hyperinsulinaemia and insulin resistance have been postulated to relate directly to both hypertension and coronary artery disease in type II diabetes and possibly also in those with the dyslipidaemic syndrome as first described by Reaven. This syndrome (also known as Syndrome X in endocrinology) comprises of some or all...