Original Article
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...
Commentary
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...
Original Article
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...
Editorial
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...
Editorial
Incorporating assessment of fibrinogen gene polymorphisms and bleeding risk in patients treated with direct oral anticoagulants
Direct oral anticoagulants (DOACs) have become entrenched as the dominant anticoagulant over the last decade for patients with venous thrombosis and atrial fibrillation.1 Compared...
Letter to the Editor
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...
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...
Letter to the Editor
Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations
Dear Editor,
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations....
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...
Letter to the Editor
Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series
Dear Editor,
Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin...
Letter to the Editor
Safety and efficacy of combined antiplatelet and low-dose rivaroxaban in patients with chronic limb threatening ischaemia in Singapore
Dear Editor,
Peripheral artery disease (PAD) is characterised by the debilitating atherosclerotic occlusion of arteries in the lower extremities, with chronic limb threatening ischaemia (CLTI)...
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...
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
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...
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...
Letter to the Editor
Haemoglobin H disease and outcomes in Singapore
Dear Editor,
Haemoglobin H (HbH) disease is a haemoglobinopathy affecting 3 of 4 α-globin genes on chromosome 16. It results from the deletion of 2...
Original Article
Diagnostic thresholds for absolute systolic toe pressure and toe-brachial index in diabetic foot screening
Diabetes mellitus is a global healthcare problem. In Singapore, the rising disease burden of this metabolic condition places considerable strain on the healthcare system,...
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...
Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
This...
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
A Study of Idiopathic Thrombocytopenic Purpura (ITP) Patients over a Ten-year Period
Idiopathic thrombocytopenic purpura (ITP) is an immunoregulatory disorder in which antibodies damage platelets leading to their removal by cells of the reticuloendothelial system (RES)....
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
Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore
In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has...
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...
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...
Others
A Case Report of Adult T-Cell Leukaemia/Lymphoma (ATLL)
Our patient was a 71-year-old Chinese man who presented with a 6-year history of recurrent papular erythematous eruptions to the dermatologist.
This article is available...
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...
Review Article
Newer Thrombolytic Agents
First-generation fibrinolytic agents (streptokinase and urokinase) are effective thrombolytic drugs, but are not fibrin specific as they also have the property to convert circulating...
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...
Others
8th Seah Cheng Siang Memorial Lecture: New Antithrombotic Agents
The tremendous interest in finding new anti-aggregating agents stems from the preeminent role that platelets play, not only in haemostasis and thrombosis, but also...
Original Article
Activated Protein C Resistance: A Study Among 60 Thromboembolic Patients in the Singapore Population
In 1993, Dahlback and colleagues described a new hereditary thrombophilia state-activated protein C resistance (AK-R). Further studies showed this to be the commonest genetic...
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...
Others
Pseudomembranous Tracheobronchitis Caused by Aspergillus in a Patient after Peripheral Blood Stem Cell Transplantation
Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised...
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,...
Original Article
Philadelphia Positive Acute Lymphoblastic Leukaemia (ALL): Clinico-Haematologic Characteristics, Molecular Analyses and 3-year Follow Up—A Single Institution Study
A number of specific chromosome abnormalities are associated with acute lymphoblastic leukaemia (ALL). The commonest in adults with B lineage ALL is the Philadelphia...
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,...
Original Article
Thrombotic and Haemorrhagic Complications in Patients with Mechanical Heart Valve Prostheses Attending the Singapore General Hospital Anticoagulation Clinic
Patients with mechanical heart-valve prosthesis receive lifelong anticoagulation. The management of these patients taking oral anticoagulants is aimed at achieving and maintaining adequate levels...
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...
Original Article
Treatment of Acute Promyelocytic Leukaemia Using a Combination of All-trans Retinoic Acid and Chemotherapy
Acute promyelocytic leukaemia (APL), or acute myeloid leukaemia (AML)-M3 under the French-American-British (FAB) classification, is characterised by the following: a distinct expansion of promyelocytes...
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
CD4 Lymphocyte Enumeration in Patients with Human Immunodeficiency Virus Infection Using Three-Colour and Four-Colour Dual-Platform Flow Cytometry: An Inter-Laboratory Comparative Evaluation
Clinical flow cytometry provides a precise technology for the multiparameter analysis of the morphological (scatter) and immunofluorescence properties of stained leukocyte populations, as well...
Original Article
Deep Vein Thrombosis is Not Rare in Asia—The Singapore General Hospital Experience
Deep vein thrombosis (DVT), pulmonary embolism (PE), the postphlebitic syndrome and recurrent venous thromboembolism (VTE) are important and often preventable causes of early morbidity...
Original Article
High-dose Therapy followed by Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma
Multiple myeloma (MM) is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or...
Review Article
New Aspects of the Blood Coagulation Cascade, Anticoagulants and Vein Thrombosis in Asia
Injury to blood vessels triggers haemostasis, a process that has evolved to achieve two superficially incompatible outcomes: arresting blood loss while protecting vessel patency...
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
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...
Others
Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report
Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly...
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...
Review Article
Idiopathic Thrombocytopenia in Pregnancy
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1...
Review Article
Thrombophilia in Pregnancy
A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there...
Review Article
Management of Haematologic Malignancies in Pregnancy
Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The...
Original Article
Pregnancy in Women with Idiopathic Thrombocytopaenic Purpura
Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated...
Others
Clinical Update on Deep Vein Thrombosis in Singapore
Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It...
Others
Case Report on Recombinant Coagulation Factor VIIa in the Treatment of Three Haemophilia A Patients with Inhibitors in Singapore
Development of inhibitors against factor VIII is one of the main complications in the treatment of haemophiliacs. Inhibitors block the procoagulant effects of factor...
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...
Original Article
Evaluation on the Use of a Portable Unit Versus the Laboratory for the Monitoring of International Normalized Ratio (INR) in Orally Anticoagulated Patients
Oral anticoagulation therapy is used for a number of conditions, namely deep venous thrombosis, pulmonary embolism, mechanical heart valves, embolic stroke as well as...
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
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...
Review Article
Trauma-induced coagulopathy: Mechanisms and clinical management
Globally, trauma accounts for the highest number of mortalities in adolescents and young adults up to 49 years old.1 Of these deaths, a large...
Editorial
Coagulopathy related to trauma: Is it time for a goal-directed approach?
Trauma represents a leading cause of death globally, and post-traumatic haemorrhage accounts for 40% of early mortality in spite of recent improvements in modern...
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...
Original Article
Clinico-pathological Analysis of Myelodysplastic Syndromes According to French-American-British Classification and International Prognostic Scoring System
Myelodysplastic syndromes (MDS) are a heterogeneous group of acquired clonal haemopoietic stem cell disorders characterised by ineffective haematopoiesis and peripheral cytopenia. The natural history...
Original Article
In vitro Biological Characteristics of Human Cord Blood-derived Megakaryocytes
Haematopoietic stem cell transplantation (HSCT) is now a well-established therapeutic modality for a broadening spectrum of medical problems. Umbilical cord blood (CB) has emerged...
Review Article
Unrelated Umbilical Cord Blood Transplantation in Children and Adults
Allogeneic haematopoietic stem cell transplantation (HSCT) is an established form of treatment for many high-risk haematological malignancies and marrow failure syndromes. The use of...
Review Article
Haematopoietic Graft Engineering
Haematopoietic stem cell transplantation (HSCT) has become an established modality for the treatment of cancer and diseases of the bone marrow and immunological system....
Editorial
Stem Cells: Current Usage and Future Potentials
In recent years, the term “haematopoeitic stem cell transplantation” has replaced “bone marrow transplantation”. It is more precise and emphasises the “haematopoeitic stem cell”...
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...
Others
A Rare Case of Porphyria
Porphyrias are a rare and intriguing group of metabolic disorders. We report a case of congenital erythropoietic porphyria, one of the infrequent forms of...
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
Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia
Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal...
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...
Original Article
Clinical Experience with Three Combination Regimens for the Treatment of High-risk Febrile Neutropenia
Cancer patients who become severely neutropenic as a result of intensive myelosuppressive chemotherapy are at high risk for developing life-threatening infections, and unless they...
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
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...
Original 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...
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...
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
Use of Antibiotics in a Haematology Ward – An Audit
Rising rates of antibiotic resistance prompted a review of antibiotic use policies hospitalwide. The Department of Haematology established a new set of consensus guidelines...
Images in Medicine
An Unusual Cause of Lymphadenopathy and Rash
A 38-year-old Chinese man who was previously well, presented with one month of fever and a non-pruritic rash involving the face, trunk and upper...
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...
Original Article
Bone Marrow Cytogenetics Workup: Application of Lean Management System to Determine if Additional Cell Workup is Helpful and Necessary to Analysis
Cytogenetic studies are important to the diagnosis and monitoring of various haematopoietic disorders such as myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), acute lymphoblastic...
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...
Images in Medicine
A Case of Congenital Haemolytic Anaemia and Thrombocytopenia
A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to...
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...
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...
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
Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore
Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A...
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...
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...
Original Article
Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China
Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and...
Original Article
Non-haem Iron-mediated Oxidative Stress in Haemoglobin E Beta-thalassaemia
Thalassaemia is a genetic haemoglobinopathy in which the production of normal haemoglobin is partly or completely suppressed because of a defective synthesis of 1...
Original Article
Thrombocytopenia and its Related Factors: A Hospital-based, Cross-sectional Study
Thrombocytopenia is a common clinical problem found in laboratory results during health examinations. Blood platelets play an essential role in haemostasis, thrombosis and coagulation...
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...
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...
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...
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....
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....
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...
Review Article
Severe COVID-19 and coagulopathy: A systematic review and meta-analysis
Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications....
Editorial
Estimating the impact of COVID-19-induced coagulopathy
The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is...
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...
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...