Original Article
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...
Editorial
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...
Letter to the Editor
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...
Letter to the Editor
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...
Commentary
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...
Review Article
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),...
Editorial
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...
Original Article
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...
Original Article
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...
Editorial
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...
Commentary
Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore
Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED)...
Original Article
Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns
Emergency department (ED) overcrowding is a growing issue that threatens public health in various parts of the world,1 including the US,2 UK,3 Australia,4 Japan5...
Original Article
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...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its...
Editorial
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...
Letter to the Editor
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...
Commentary
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...
Original Article
Epidemiological trends and outcomes of children with aural foreign bodies in Singapore
Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to...
Editorial
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,...
Editorial
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...
Letter to the Editor
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...
Review Article
Determinants of emergency department utilisation by older adults in Singapore: A systematic review
Older adults in Singapore contribute to a disproportionately higher number of visits to the emergency department (ED), mirroring trends around the world.1,2 For instance,...
Original Article
Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial
Critically ill patients in the emergency department (ED) have shorter safe apnoea times due to physiological distress from decreased cardiac output, increased shunting and...
Editorial
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...
Original Article
A Review of Pedestrian Fatalities in Singapore from 1990 to 1994
Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by...
Original Article
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...
Original 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...
Others
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...
Others
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...
Others
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...
Original 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...
Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed...
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...
Review Article
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...
Others
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...
Review Article
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....
Original Article
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...
Review Article
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...
Others
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...
Original Article
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...
Original Article
Extent and Appropriateness of Emergency Department Services Usage by Foreign Workers in Singapore
Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it...
Original Article
Drowning and Near-drowning—Some Lessons Learnt
Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at...
Original Article
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...
Others
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...
Original 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...
Others
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...
Original Article
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...
Original Article
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...
Original Article
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,...
Others
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,...
Commentary
Preparing for the silver boom: A falls prevention tool for older adults in the emergency department
Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls...
Original 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...
Others
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...
Original Article
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...
Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...
Original Article
Intravenous Adrenaline or Vasopressin in Sudden Cardiac Arrest: A Literature Review
Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur...
Original Article
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...
Original Article
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...
Original Article
Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care
Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to...
Original Article
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...
Original Article
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...
Original Article
The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint
Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition...
Review Article
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...
Others
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...
Others
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...
Review 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...
Others
Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations
It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in...
Others
Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital
Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly...
Others
Public Disclosure of Healthcare Performance Information and Its Application to the Singapore Context
It has been said that apart from the prevention of diseases, the best chance of improving health is through improving the quality of care...
Others
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,...
Original Article
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...
Images in Medicine
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...
Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of...
Original Article
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...
Review Article
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...
Review Article
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...
Review 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...
Review 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...
Review Article
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,...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Original Article
Work-related Injury Sustained by Foreign Workers in Singapore
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders,...
Others
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...
Review Article
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...
Editorial
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...
Others
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,...
Editorial
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...
Others
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...
Others
Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report
Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in...
Commentary
Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective
Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health...
Original Article
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...
Original Article
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...
Original Article
Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department
Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in...
Original Article
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...
Letter to the Editor
Renal Artery Embolism in a Patient with Vague Abdominal Pain
Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with cardiac dysrhythmias. However, renal artery embolism is a disease that...
Others
Clinical Characteristics of Renal Infarction in an Asian Population
Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months.
This article...
Original Article
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...
Letter to the Editor
Non-compaction Cardiomyopathy Presenting with Classical Angina Pectoris
Non-compaction cardiomyopathy (NCC) is an unclassified cardiomyopathy, previously known as “spongy left ventricular myocardium”. It is characterised by prominent myocardial trabeculations and deep intertrabecular...
Letter to the Editor
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...
Others
Angioplasty in Critical Limb Ischaemia: One-year Limb Salvage Results
Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain...
Original Article
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....
Commentary
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,...
Original Article
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...
Letter to the Editor
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...
Original Article
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...
Original Article
Characteristics of unplanned hospitalisations among cancer patients in Singapore
Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...
Editorial
The case for better hospitalisation selection in cancer patients
Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...
Review Article
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,...
Letter to the Editor
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...
Letter to the Editor
Reply from Author: Putting the Wedge under Pressure
We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous...
Letter to the Editor
Putting the Wedge under Pressure
We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler...
Editorial
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...
Letter to the Editor
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...
Original Article
Epidemiology of Snakebites from A General Hospital in Singapore: A 5-year Retrospective Review (2004-2008)
Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can...
Images in Medicine
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...
Original Article
Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital
Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have...
Original Article
An Eight Year Review of Exercise-related Cardiac Arrests
Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac...
Letter to the Editor
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original 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...
Original Article
A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore
Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has...
Others
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,...
Others
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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...
Review Article
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,...
Review Article
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...
Review Article
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...
Review Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Original Article
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...
Editorial
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...
Original Article
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...
Images in Medicine
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...
Original Article
Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study
Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world,...
Letter to the Editor
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...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were...
Original Article
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...
Letter to the Editor
Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...
Original Article
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...
Images in Medicine
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....
Editorial
Emergency Medicine Residency Programme in Singapore—Where Are We at Since Inception?
It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July...
Original Article
Pharmacomechanical Thrombolysis versus Surgical Thrombectomy for the Treatment of Thrombosed Haemodialysis Grafts
Permanent dialysis vascular access is the primary route for haemodialysis in patients with chronic renal failure, usually through an arteriovenous fistula (AVF) or an...
Original Article
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...
Original Article
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...
Commentary
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...
Original Article
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....
Original Article
A review of child sexual abuse cases presenting to a paediatric emergency department
Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for...
Commentary
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...
Editorial
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...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work...
Letter to the Editor
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...
Letter to the Editor
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...
Original Article
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...
Editorial
Community-level interventions for out-of-hospital cardiac arrests in Singapore: Yay or nay?
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and a significant public health problem globally. In Singapore, OHCA affected 11,061 adults between...
Letter to the Editor
Circulatory collapse from rupture of splenic artery aneurysm: A case study
Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to...
Letter to the Editor
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...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with...
Original Article
Virtual reality mobile application to improve videoscopic airway training: A randomised trial
Emergency airway management is a keystone of emergency medicine practice and critical skill in residency training. An accredited emergency attending is expected to handle...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports...