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CT – Scan

Provided by Escorts Heart Institute
Brought to you by Healthbase

CT (Computed Tomography) is a diagnostic test that combines the use of x-rays with computer technology. A series of x-rays beams from different angles around the body are used to show cross sectional images of the patient’s body. The images so obtained are assembled in a computer into a three- dimensional picture that can display organs, bones & tissues in great detail.

In spiral CT the examination table advances at a constant rate through the scanner gantry. While the x-ray tube rotates continuously around the patient, tracing a spiral path through the patient. This spiral path gathers continuous data with no gaps between images.

CT Angiography (CTA) is an examination that is used to visualize blood vessels in many areas of the body including the brain, kidneys, pelvis and the arteries serving the lungs. Compared to catheter angiography, which involves injecting contrast medium into an artery CTA is much less invasive & a more patient friendly procedure; contrast medium is injected into a vein rather than an artery.

Why is it done?
CT imaging offers detailed views of different types of tissue, including the lung, bones, soft tissues and blood vessels Using specialized equipment & expert technician to create CT scans of the body , radiologists can more easily diagnose problems such as cancers, cardiovascular diseases ,infectious diseases, trauma & musculoskeletal disorders.

How is it done?
Patient is asked to change into a gown before the examination & to remove jewellery, eyeglasses and metal objects depending on the part of the body that is being scanned.

The CT technician begins by positioning the patient on the CT table. The patient’s body is supported by the safety straps & is asked to lie very still and follow the instructions of the technician while the scanning is being performed. During the scanning, the technician can see, hear & speak to the patient at all times.

A CT examination often requires the use of different contrast agents to enhance the visibility of certain tissues or blood vessels. The contrast agent may be injected directly into the blood stream, swallowed or administered by enema, depending on the type of examination. Before administering the contrast agent the radiologist or technician will ask whether the patient has any allergies, especially to medications, iodine and whether the patient has a history of diabetes, asthma, a heart condition, kidney problem or thyroid conditions as these conditions indicate a higher risk of reaction to the contrast agent. Fortunately with the safety of the newest contrast agents the adverse effects are very rare.

The department of Radiodiagnosis & Imaging at EHIRC is well equipped to deal any emergency. A CT examination usually takes from 15 minutes to half an hour. When the exam is over, the patient may be asked to wait until the images are examined to determine if more images are needed.

For the CT Angiography contrast medium is injected into a vein with an automatic injector machine that controls the timing & rate of injection, which may continue during part of the time images are recorded. Afterwards the images are reviewed & some will be repeated, if necessary. The real work of CT angiography comes after the images are acquired, when powerful computer programs process the images & make it possible to display them in different ways.

When it is done/advised ?
It is done when clinicians prescribe it after examining patient and going through his/her records. The radiologists also advise for CT scan when routine x-rays and ultrasonography fail to provide adequate information. It is better device for interventional procedures.


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Eat Smart

By Ms Melissa Aiyathurai-Johnston
Dietitian, Raffles Hospital

Brought to you by Healthbase

 

Food, food, glorious food! Food makes up a big part of our life. Besides providing nutritional benefits, food is also a source of enjoyment, an adventure and it tastes great!

Despite huge and beneficial gains in knowledge about nutrition over recent years, healthy eating has become harder because of the way we live and eat today. There is less reliance on home cooked meals and if we are not mindful, our meals may not be necessarily healthy. They may not be complete (e.g. not being served with enough vegetables) or the portion sizes may be too large.

In addition, the modern diet is usually overloaded with calories for energy compared to the amount we expend, has too much fat (especially saturated fat), sugar and salt and lacking in fruits, vegetables, fibre and dairy products.

This state of “over nutrition” has seen an alarming rise in the incidence of chronic lifestyle diseases. Today 1 out of 3 Singaporeans are overweight or obese which sets the scene for other conditions such as diabetes and heart disease. Excessive fat or salt and the lack of fibre have also been linked with an increase risk of certain cancers (e.g. breast, bowel, stomach), diabetes, stroke, hypertension and osteoporosis to name a few.

There is no secret to healthy eating. You just need to “eat smart”!

Enjoy a wide variety of foods
Add the grains and legumes
Trim the fat

Shake the habit – reduce your salt intake
Munch those fruits and vegetables
Alcohol – enjoy in moderation
Reduce your sugar intake
Track your weight

Enjoy a wide variety of foods
Variety is the spice of life! Everyday your body needs nutrients and other healthful substances (such as antioxidants) that only a wide variety of foods can provide. Most foods and beverages are made up of more than one nutrient, however no one food or food category has them all.

Add grains and legumes
These low fat foods should make up a large proportion of your meals. This group including bread, cereals, rice, pasta and other foods made from grains provides you with carbohydrate (your body’s fuel), B vitamins, fibre and a number of minerals. Legumes (e.g. peas, beans and lentils) provide you with good amounts of protein (important for vegetarians), B vitamins and fibre.

Having more soluble fibre in your diet, such as the type found in legumes will help to lower your cholesterol. The slow digesting carbohydrate they contain will also help those trying to control their weight or diabetics with their blood sugar control.

Trim the fat
Reducing your fat intake will lower your risk of becoming overweight which reduces your chance of certain conditions such as diabetes, heart disease, hypertension and certain cancers. Reducing your saturated fat intake will also go a long way to help keep your cholesterol in check.

Removing the skin from poultry and limit your intake of fatty meat such as pork belly, luncheon meat. When dining away from home choose more soup based dishes which are low in fat and limit those dishes made with coconut milk.

Shake the habit – reduce your salt intake
Too much salt has been linked to the development of high blood pressure or hypertension. The average diet contains more sodium than actually required.

One way to reduce your sodium intake is by tasting your food before adding salt. Also limit or avoid high sodium condiments such as soy sauce, oyster sauce, tomato ketchup. Opt for herbs, spices, chili or lime juice to add flavour instead.

Munch those fruit and vegetables
Besides being an excellent source of fibre, this low calorie, nutrient dense group provides you with essential vitamins and minerals, antioxidants, and phytochemicals that may not be present in other groups of food. Studies have shown that those people with a high intake of fruits and vegetables have a low rate of heart disease and cancer. Aim for 2 servings of fruit and vegetables daily.

Alcohol – enjoy in moderation
A moderate to heavy intake of alcohol has been associated with high blood pressure and certain cancers. An excessive intake can also lead to weight gain as gram for gram alcohol has almost twice the calories of carbohydrate or protein.

A safe intake would be no more than 2 standard drinks a day for women and no more than 4 for men with 2 alcohol free days per week.

Reduce the sugar intake
Food high in sugar tend to be “empty calories” as they have no essential fibre, vitamins or minerals and can sometimes displace more nutritious food. Most foods high in sugar also tend to also be high in fat, which if taken in excess can lead to weight gain. It is best to enjoy these foods in moderation.

Track your weight
A balance between the right food and regular exercise will ensure that your weight is healthy. Choosing low fat meals with ample carbohydrates, vegetables, fruit and protein will help you lose excessive weight, if you need to and help you to stay slim if you do not.

Be careful of fad diets or diets that offer fast weight loss as they more often do not change your eating habits and are nutritionally unbalanced. Once you go off them, the weight tends to come back straight away.

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The contents or materials provided in this website are for general information only and are not intended as medical advice.

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Preventing a Heart Attack

(Source: Raffles Hospital)

Heart attacks come without warning and strike with deadly force. Whilst the spectrum of treatment modalities has improved over the years, they can sometimes be available too late. Prevention is the greatest cure for heart attacks and you should start today.

 

  1. Be mindful of your diet and your weight
  2. Watch what you eat. You should cut down on the fatty, cholesterol enriched foods and sugar. Eat balanced meals with lots of fruit and vegetables. Drink water instead of sugared drinks. Start on an exercise routine that is easy to maintain. Control your weight through proper nutrition and exercise. Spare your heart the extra load.

  3. Don’t smoke.
  4. If you are a non-smoker, don’t start. If you are a smoker, try to kick this habit. You will do better without it.

  5. Be more active
  6. Put more zest into your life and more spring into your steps. Walk more. Use the stairs instead of taking the lifts. Try going to work on public transport and walking instead of driving once in a while.

  7. Manage your stress; don’t let stress manage you
  8. There are many ways to cope with stress in your life. Learn to manage your time more efficiently and take control of stress instead of letting stress take control of you.

  9. Keep blood pressure, blood cholesterol and diabetes under control
  10. If you are already suffering from hypertension, high cholesterol or diabetes, follow the advice of your doctors and take your medications as prescribed. Go for your regular check-ups and follow your doctor’s recommendations faithfully.

  11. Check Early to Save Your Life
    • Don’t put yourself at unnecessary risks. The following tests are conditions that are risk factors for coronary heart disease. You should consider doing these tests on a regular basis. They are simple to do and may save your life.
    • Have your blood pressure checked by your doctor at least once a year.
    • Do a blood cholesterol test at least once in every 5 years, or more frequently if you have a high cholesterol level. Review the results with your doctor and listen to his advice.
    • Have your blood glucose checked at least once a year for diabetes. Diabetes can also be screened for by doing a simple urine dipstick test.
    • If you are particularly at risk of coronary heart disease, you should follow-up with your doctor regularly. Your doctor may advise you to do an ECG (electro-cardiogram) to assess the status of your heart. In some instances, you may need to do an exercise treadmill test to determine the fitness of your cardio-respiratory system.

Remember, early detection of heart disease allows for early treatment, and early treatment could well prolong your life.


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The contents or materials provided in this website are for general information only and are not intended as medical advice.

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Coronary artery bypass graft surgery (CABG)

Provided by Escorts Heart Institute
Brought to you by Healthbase

Coronary artery bypass graft surgery (CABG) involves sewing one end an artery or vein above a blocked coronary artery and the other end below the blockage, thereby allowing blood an alternative means to get to the heart. The arteries or veins used for the bypass (which are known as “grafts”) are usually obtained from the leg or the chest wall. Bypass surgery may not be possible if the coronary artery is heavily calcified or if the disease is very widespread. CABG can be done with or without connecting the patient to heart-lung machine, depending on the kind of blockages and surgeon’s decision.

Several new surgical approaches are being developed, which can potentially reduce the discomfort and complications associated with traditional bypass surgery. These are collectively referred to as being “minimally invasive.” In general, these approaches focus on performing bypass surgery though a very small chest incision and performing bypass surgery while the heart is still beating (ie, without the need for a heart/lung bypass machine).

OPCAB (Off Pump Coronary Artery Bypass)
The bypass surgery done without connecting the patient to of heart-lung machine or pump is called OPCAB.

MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
is bypass surgery done through a small cut (incision) in the lower part of the sternum (chest bone) only, rather than full cut across it. This type of surgery, which is possible in selected cases only, is associated with a small scar, lesser pain and faster recovery. Alternatively, this surgery can also be done through a small cut on the left side of the chest.

The location and degree of coronary artery blockages are determined before surgery by using a procedure called heart catheterization, or coronary angiogram. This procedure provides an outline, like a road map, of the arteries of the heart.

Factors favoring bypass surgery
Bypass surgery is often recommended over angioplasty when the left main coronary artery is narrowed by more than 50 percent, when angioplasty does not relieve angina, when many arteries are narrowed, or when the heart’s left ventricular pumping function is substantially impaired. Bypass surgery is also preferred over angioplasty in diabetic patients who have two or three vessels involved.

Benefits
Bypass surgery can very effectively relieve angina and can even prolong life in people with severe coronary heart disease, such as those with three-vessel involvement associated with impaired left ventricular pumping function. However, the success of bypass surgery on symptoms and on survival depends upon several factors, including the pattern and extent of arterial narrowing, the general progression of coronary heart disease over time, and the blood vessels used for bypass. In general, bypass surgery is more likely than angioplasty to provide complete revascularisation.

About 95 percent of people who have narrowing of several arteries have improvement or complete relief of their angina immediately after surgery. About 85 to 90 percent of people remain angina-free at one to three years after surgery, and about 75 percent of people remain angina-free or free of major coronary events at five years after surgery. By 10 years, about one-half of all grafted vessels become narrowed or occluded, and by 15 years, about 85 percent of grafted vessels become narrowed or occluded. These late events usually require a second surgery

Recovery from bypass surgery
It usually takes a while to recover from even routine bypass surgery. However, about 70 to 80 percent of people who have this surgery are eventually able to return to work; this is about the same as the percentage of people who are treated medically and are able to return to work. Factors that appear to have a role in a person’s ability to return to work are the presence or absence of angina after surgery, employment status before surgery and income, the function of the heart’s left ventricle, and age.


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The contents or materials provided in this website are for general information only and are not intended as medical advice

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Catheter Ablation (RFA)

Provided by Escorts Heart Institute
Brought to you by Healthbase

Catheter ablation has revolutionized the management of patients with certain heart rhythm disorders. Having evolved from arrhythmia surgery, catheter ablation was initially performed using high voltage direct current (DC); however, over the last decade, radio frequency current has supplanted DC as the energy source of choice and has made catheter ablation a first-line therapy for many rhythm disorders. It is an alternative to life-long drug therapy or surgery.

The procedure is done in a special room, called an electrophysiology (EP) lab, by doctors trained in the study and treatment of heart rhythms. Long, flexible wires, called catheters, are inserted into the veins of the leg, arm, and neck (and possibly into arteries in the leg) and positioned in the heart. Through these catheters, the doctor can record electrical signals that come from different parts of the heart. This is similar to an ECG, which records electrical activity from the body’s surface.

With, a special catheter, the area of the abnormality is located inside the heart. The catheter is placed at this area and, by delivering either electrical current or heat from radio frequency waves; the defective heart tissue is destroyed. This eliminates the source of the abnormal heart rhythm or extra pathways.

A catheter ablation can take several hours and does involve some risks. However, the doctor recommending this procedure believes these risks are small compared to the potential benefit for you. Your doctor will discuss this with you and answer any questions you have.


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Aortic Aneurysms & Dissections

Provided by Escorts Heart Institute
Brought to you by Healthbase

An aneurysm is an abnormal swelling in a weakened blood vessel while dissection is said to have occurred when blood enters through a lengthwise tear between layers of the wall of aorta or an artery (a blood vessel carrying blood from the heart to the body). These layers then separate and swell, making a thin walled balloon-like formation that causes severe pain. This condition can be a birth defect, a complication of disease like atherosclerosis or injury. High blood pressure also contributes to this disease.The patient may experience pain in chest, abdomen, or back, and may affect the hips and legs, coughing up blood, shortness of breath, nausea, vomiting, blood in stools, fainting, difficulty in swallowing, or just headache.

The diagnosis can usually be arrived at following review of history, chest x-ray, electrocardiogram (ECG), CT scan (computerized x-rays), Angiogram (x-rays after a dye has been injected into an artery), Echocardiogram, and blood tests.

How is it done?
The preferred treatment is immediate surgery. The doctor will replace the weakened part of the artery with a graft made of artificial material, and is carried out with the help of heart lung machine on many occasions. Depending on the location of the aneurysm/dissection, aortic valve may have to be replaced in some situations. The coronary arteries may also have to be implanted on the new graft for continued blood supply to heart. After surgery, blood pressure and other vital signs will be monitored in the recovery room set up.

After Care
It is important to strictly follow certain guidelines as listed:

  • Stop smoking.

  • Maintain your ideal weight.

  • Eat a healthy diet that includes:

    • Low salt food.

    • Avoiding foods high in fat and cholesterol.

    • Increasing fiber in your diet.

    • Adequate precautions against constipation.

  • Exercise daily; walking is recommended.

  • Get enough rest and learn to use relaxation techniques to help reduce stress.

  • Keep blood pressure under control.


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The contents or materials provided in this website are for general information only and are not intended as medical advice.