Services Cardiac Specialist Centre
We provide comprehensive cardiovascular investigations and treatment at superlative quality. You can have full confidence in our skills and training with a personal touch. Click on the services to see detailed explanation of the tests.
Cardiac Health Screening
If you are above 40 years of age, you should start going for regular screening for Diabetes, High-cholesterol and High Blood Pressure. If you or your family has any of these conditions, you should start at an even earlier age. Here at the clinic, we will screen for all these conditions with emphasis on heart health. In our package, we will do a full blood count, renal and liver panel, thyroid panel, full lipid panel and tumor markers.

We also work closely with other specialist who can provide adjunct services such as gastroscopy, colonoscopy or other urological and gyneacological support. We can also tailor our screening to your needs depending on your risk factors.

Comprehensive Blood/Urine Test
These are standard blood tests performed for general screening. It will include liver function, kidney function and blood count. Depending on your risk profile and needs, we will tailor the tests needed.
12-Lead Electrocardiogram (ECG)
Electrodes are attached to your body. The electrical activities of the heart are then recorded. This can reveal any abnormal rhythm or function of your heart. It is able to detect if you have had a previous heart attack or if your heart is lacking oxygen due to blocked artery.
Treadmill stress test
This is the commonest test done to screen for heart problem. It involves placing electrodes on your body and a blood pressure cuff on your arm. You will then have to walk on a treadmill. This starts at a very slow speed and a slight incline. At interval of 3 minutes, the treadmill will get quicker and steeper. This is to make your heart work hard so that any blockage in your artery will show up as an abnormality in your ECG.

In order to have a valid test, your heart rate should go above 85% of your maximal predicted. This is calculated as (220-age) x 85%.

You will need to come in your exercise gear. That is, a pair of comfortable shorts and sneakers. You don’t need to have any period of training before coming for this test.

This is an example of treadmill stress ECG. The top panel below shows the ECG at rest. The arrows denote the portion of the ECG called ‘ST segment’. The bottom panel shows a positive test. The ‘ST segment’ is depressed compared to baseline (Pink arrow). This indicates the presence of blocked arteries.

2D Echocardiography
This is also known variously as Echocardiogram, Trans-thoracic echocardiogram, 2DE, 2D echo or just Echo. It is an ultrasound examination of the heart. This is also a very common examination done by the cardiologist. It enables the function of the heart muscle to be assessed. It also examines the valves of the heart and measures some internal pressures of the heart.

Essentially, you will lie on your left side for about 15 to 20 minutes while this test is being performed. A probe is placed on your chest to obtain a view of the heart from different angles. This is totally painless process.

In Cardiac Specialist Centre, all echoes are reviewed by specialists who have undergone advance training in echocardiography, and are accredited echo-cardiologists. This ensures that the quality of the examination is of high standard.

The following images are typical example of a normal heart. The still picture has the various structures labeled. This is a 4 chambers view where all 4 chambers of the heart can be see.

This moving image below shows the heart pumping. You can appreciate the muscle of the heart contracting and the valves opening and closing with each beat.

Trans-oesophageal echocardiogram
This is also known as TOE or TEE for short. This is a specialized echo. A normal echo is done from the body surface. The ultrasound beam has to pass through many layers of tissue (skin, fat, muscles etc) before arriving at the heart. Therefore, while it already gives a very clear picture of the heart, there are certain parts of the heart that still cannot be very clearly seen. The heart sits just in front of the oesophagus (gutlet). You will need to swallow a fine tube which is the ultra-sound probe. In the oesophagus, there is very little tissue between the heart and the ultra-sound probe. Therefore, the heart and all the internal structures can be very clearly visible.

The picture below shows a blood clot in the part of the left atrium called ‘left atrial appendage’. This blood clot may form in a patient whose heart is pumping in irregular rhythm called ‘atrial fibrillation’. This view can only be seen in the trans-oesophageal echocardiogram.

Treadmill Stress Echocardiography
This is a treadmill stress test where the use of echocardiography is added. A baseline scan of your heart in various angles are 1st obtained. You will then run on the treadmill. At the limit of your effort tolerance, the treadmill is stopped the scan of your heart is repeated immediately. The baseline scan will be compared with the exercise scan. If there is any portion of your heart that is supplied by a blocked artery, that portion will not function as well at peak stress. This will be seen on the echocardiogram. This form of stress test is more sophisticated and more accurate than a normal treadmill test as it has the addition of imaging. This form of stress test is not done in the majority of clinics as it requires specialized training and years of experience. In Cardiac Specialist Centre, this is our preferred form of stress test as our doctors are trained echo-cardiologists.

Dobutamine stress echo
This is like the treadmill stress echo. It looks at the heart at rest and during stress. However, some patients are unable to perform on the treadmill due to a variety of reasons. In order to stress the heart, a medicine is given through the veins. This medicine is called ‘Dobutamine’. Its function is to raise the heartbeat and make the heart contract more vigorously. The patient needs only to lie on the examination couch during the examination period.

The setting up time for this test may take a fraction longer as a small plastic needle (cannular) needs to be inserted into the vein. During the test, some patient may experience some nausea and strong heart beat. But all these will subside once the medicine is stopped. This test is also useful of certain other conditions such as assessment of viability of the heart muscle or valve function.

Angiography
Your doctor has suggested that you should have an angiography/angiogram done. What is an angiogram?

"Angio" means "Blood Vessel". "Gram" or "Graphy" means picture. Therefore, angiogram or angiography means to take a picture of your blood vessels. In this case, the blood vessels of your heart or coronary angiography.

Normal X-ray does not show up any blood vessels. Only when a dye is injected into the vessel can the vessel be seen.

In order to inject the dye into the arteries, a tube or ‘catheter’ has to be placed just outside the arteries of the heart. This tube has to enter your body from the groin or the wrist and follow your body’s artery up to the heart.

The whole procedure may only take 10 minutes to perform. There will be slight pain when some local anaesthetic is injected into the groin or wrist. After which, there will be no more pain.

This is done as a day-surgery. Another words, you will stay on the ward for a few hours after the procedure for observation. You will be discharged on the same day.

You may follow the link to see what an angiogram looks like. The 1st movie shows the left coronary arteries. You may see the tube (Catheter) in the left upper corner. As the dye is injected, you can see the arterial tree come into view.



The 2nd movie shows the right coronary artery. This is a roughly 'C' shaped artery.

Angioplasty
"Angio" means blood vessel and "Plasty" means to make something big. Therefore "angioplasty" means to make a blocked vessel bigger. Another words, to unblock the artery. This is now done with catheter (tube), which is inserted into the artery (see section on angiogram). Once the catheter is in place, a wire the width of a human hair is slowly maneuvered across the blockage (plaque). Once it is through, a balloon is placed over the wire and pushed into the blockage. The balloon is then inflated. This pushes the plaque aside and the artery is made bigger. To prevent the recoil of the muscular artery, a stent (metal mesh) is placed in the area of the plaque to hold the arterial wall in place. After this, the balloon, wire and catheter are all removed. The stent will remain in your artery and becomes part of you.

The 1st picture shows an artery that is completely blocked.



The 2nd picture shows the blood flowing down the artery after the wire is passed across the blockage.



The 3rd picture shows the stent in place.



The final picture shows the presence of the blocked artery after it has been stented. In simple cases with only 1 blocked artery, the whole procedure may take as little as 20 minutes as in this case. Sometimes, with multiple arteries blocked or where a single artery has been totally blocked for a long time, the procedure make take several hours.

Trans-radial angiography and Trans-radial Angioplasty. What is the difference between the normal groin approach and wrist approach?


In order to place a catheter (tube) in the artery, we have to enter it as it comes close to your body surface. There are 2 common areas where an artery can be felt as a pulse. These are at the wrist and groin. The size of the artery at the groin may be akin to a ballpoint pen. And the size of the radial artery is like the ink tube within the ballpoint pen. Therefore, it is technically more difficult to access the smaller artery at the wrist. However, after the angiogram, pressure has to be applied to the arteries to prevent bleeding. It is more uncomfortable to have pressure applied to the groin than to the wrist. Furthermore, after the procedure from the groin, you have to rest in bed for about 6 hours without moving your leg. This means for a gentleman, passing urine is a little more uncomfortable.

When the procedure is done from the wrist, the tube is removed immediately after the procedure. Since the groin is not affected, you can walk about immediately. The only precaution is to not do strenuous activities with your hand for next 3 days.

Most patients prefer this method of approach. However, since this is technically more challenging, most doctors use the groin for angiogram and angioplasty. We at Cardiac Specialist Centre use the wrist as 1st choice. The groin is used only in complex cases or if the wrist cannot be used for whatever reasons.

The picture shows the set up for a wrist approach angiogram/angioplasty. The patient has the arm by the side of the body. This is a comfortable position. The whole procedure takes only 10 minutes with minimal pain.

Consultation
Know Your Cardiologists

I feel breathless when walking.

I feel a tightness over my chest.

Do I need to take my medicine for my blood pressure?

Do I need to take my medicine for my cholesterol?

Do I really need stents for my artery?

Do I really need to have a bypass operation?

When should I go for health screening?

I have heart problem, can I take Viagra?

I have heart problem, should I exercise?

Heart Disease
Learn about your heart Conditions

You may need an ultra sound scan of your heart to assess its function.

You may need a treadmill stress test.

You may need closer monitoring.

You may need a more thorough risk assessment and life style change.

You may only need to take your medicine.

You may get away with just stenting.

This generally should start at 40 years old.

Yes, but there are certain strict conditions to fulfill.

Yes, but you will need to find out the appropriate intensity.