June 2019 - August 2019

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Official Publication of the Singapore Heart Foundation

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眼睛和心脏疾病

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Resistance Training -A guide for heart patients

Cardiology for the Layman #8Fainting Spells - When Is It

Cardiovascular Related?

PATRONESM Goh Chok Tong

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 48TH

BOARD OF DIRECTORS

CHAIRMANProf Terrance Chua

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee Chew

HONORARY SECRETARYProf Tan Huay Cheem

ASSISTANT HONORARYSECRETARYMr Goh Chiew Seng

HONORARY TREASURERMrs Elsie Foh

MEMBERSDr Chee Tek SiongMr Chong Chou YuenDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeProf May LwinDr Mak Koon HouMr Peter SimDr C SivathasanAdj Asst Prof Jack Tan

HONORARY ADVISORSProf Koh Tian HaiMr Liak Teng LitMr Lim Soon HockA/Prof Lim Yean TengDr Lily NeoMr Tan Kin LianMr Wong Yew Meng

EDITORIAL COMMITTEE

EDITORMr Patrick Deroose

MEMBERSProf Terrance ChuaDr Chee Tek SiongDr C Sivathasan

SECRETARIATMr Vernon KangMs Stephanie HoMs Samantha Chan

2 Editor’s Note

heartline is a quarterly publication of the Singapore Heart Foundation.9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg

The information provided in heartline is for educational purposes only. It should not be used for diagnosingor treating a heart problem or a disease, and should not be substituted for professional health care. Opinions expressed by contributors and advertisers do not necessarily reflect those of the SHF.The SHF does not endorse any products or services in heartline advertisements.

All rights reserved. Copyright is held by SHF.No portion of this publication can be reproduced without the permission of SHF.To advertise in heartline, please email info@heart.org.sg or call 6354 9340.Terms and conditions apply.

Want a copy of heartline delivered to your doorstep or emailed to you?Register on myheart.org.sg, via the QR code or call 6354 9360.Designed by: Vacain Design Pte Ltd • Printed by: A&D Printhub Pte. Ltd.

DEAR READERS,

What do earthquakes, tsunamis, nuclear meltdowns and heart attacks have in common? All of them are catastrophic events, but they are usually preceded by small deviations from the normal.

In 2003, small seismologic recorded tremors preceded the 6.6 magnitude earthquake in Bam, Southeastern Iran. As we saw on 26 December 2004, the retreating sea was the precursor to a devastating tsunami. Small deviations on the dials in a nuclear power station in Chernobyl in 1986, signalled the beginning of a nuclear meltdown. Similarly, minor symptoms such as chest discomfort or fainting spells could be precursors to a major catastrophic cardiovascular event. Small transient ischaemic attacks (TIA or mini stroke) often precede a major stroke. We should be alert to these small changes as Dr Teo Wee Siong explains in his contribution to this issue of heartline, as ignoring these warning signs will be at our own peril. It is not our intention to create panic or turn us all into hypochondriacs like in Moliere’s “Le Malade Imaginaire” (The Imaginary Invalid), but our mission at the Singapore Heart Foundation is to empower you to make informed and educated decisions.

Education based on scientific evidence is key to making well-informed decisions. That is why the recent study published in the Journal of the American Board of Family Medicine [January 2019] which did a meta-analysis of research on exercise, is so important to share. Under the umbrella “Exercise is Medicine”, the researchers provide new scientific evidence which underscores the importance of muscle strengthening in addition to aerobic (cardiorespiratory) fitness. Both aerobic fitness and muscle strength have synergistic effects on these outcomes, regardless of body weight and should begin early in life and continue across the life course. On the role of general practitioners, nurses, paramedics, and the entire healthcare system, researchers state, “A substantial body of research has underscored the pressing need to promote physical fitness more protectively and consistently throughout the healthcare system. Physical exercise is an essential first-line treatment for most chronic diseases and plays a key role in reducing healthcare expenditures. Prescribed interventions should include not only weight control and aerobic fitness but also muscle strengthening, which is independently linked with lower disease risks and improved outcomes and longevity.”

The Singapore Heart Foundation is at the forefront of promoting these heart health objectives through behavioural changes and we aim to educate all Singaporeans on the early warning signs

of cardiovascular diseases, so as to prevent catastrophic events. Exercise is medicine, hence in a similar manner as we take our daily medication - religiously, on the dot and without skipping a dose - we should add a daily dose of exercise, both aerobic and muscle strengthening.

Patrick Deroose

When Is ItCardiovascular Related?

—Fainting Spells

3Feature

By Dr Teo Wee Siong, Consultant Cardiologist and Electrophysiologist at Mount Elizabeth Hospital

Is it a fainting spell?It is important to differentiate a fainting spell from vertigo,

which is more of a spinning sensation with no loss of consciousness and is usually related to the position of the head. Fits and other neurological disorders may also be excluded.

Is it a fainting spell if it’s associated with transient loss of consciousness?For most people, fainting spells may mean a near loss of consciousness or a near blackout. When there is a complete loss of consciousness, albeit transient, the person is often described as having fainted or having syncope. It is important to differentiate if the patient has a fainting spell associated with syncope or not, as the outcome is worse in those who have fainting spells associated with loss of consciousness.

How common are fainting spells?Fainting spells are not uncommon and occur frequently. As much as 10-20% of the general population will have had some fainting spells and they occur more commonly in females.

What are the causes of fainting spells?Fainting spells related to cardiovascular disease may be related to reflex syncope, orthostatic hypotension (fall in blood pressure on standing up), cardiac related heart disease or arrhythmias (abnormal heart rhythm). Reflex syncope is also commonly referred to as simple faint or vasovagal syncope.

Are there any other associated symptoms?When the fainting spell is preceded by exercise or rapid palpitations, care should be taken for further examination.

How does it happen and what are the common causes?It is not uncommon to have fainting spells during severe emotional stress or after prolonged squatting or sitting, and getting up suddenly after that. In fact, this is common especially in young women who already have a relatively low resting blood pressure or older patients who are on drugs for their high blood pressure or prostate problem.

Reflex syncope patients often have a long history of recurrent fainting occurring before the age of 40 and is associated with unpleasant sights, sounds, smells or pain. They are often triggered by prolonged standing especially in crowded and/or hot places or during school assemblies. They recover very quickly and are

usually not associated with any head injuries. These patients (other than their fainting spells) do not have any underlying heart disease. Sometimes, there may be a history of other family members also having had fainting spells. In some reflex syncope, certain situations such as micturition (passing urine) and prolonged coughing can trigger a fainting attack.

A less common cause of fainting episodes occurs in patients with arrhythmias, due to supraventricular (abnormal rhythm arising from the upper chambers of the heart) or ventricular arrhythmias (abnormal rhythm arising from the lower chambers of the heart). These may occur in young or old patients who may or may not have underlying structural heart disease. Patients with ventricular arrhythmias and underlying heart disease are at risk for sudden cardiac death, if they have associated fainting spells.

Near fainting episodes in older patients may be associated with the sick sinus syndrome (see figure below). Classically, these patients have palpitations due to atrial fibrillation (type of rapid irregular rhythm) with a rapid ventricular response which on termination, is followed by a pause lasting for a few seconds. Occasionally, fainting episodes are due to underlying heart disease such as valvular heart disease (e.g. aortic stenosis (narrowing of the valve) in elderly patients) or cardiomyopathies (disorders of the muscles of the heart). Fainting episodes are rarely related to underlying ischemic heart disease, due to blockages of the arteries of the heart.

Fainting due to orthostatic hypotension is usually because of drugs or dehydration, but rarely due to neurological disorders affecting the autonomic nervous system such as Parkinson’s disease.

Cardiology for the Layman #8

4 Feature

How to diagnose the cause of fainting spells?The difficulty in patients with fainting episodes is the diagnosis of the cause of these symptoms. They are usually so transient and unwitnessed that it is difficult to determine the exact cause. Regular blood pressure (both lying down and standing), ambulatory blood pressure monitoring, pulse and Electrocardiogram (ECG) monitoring may be helpful. A 24 to 48 hours Holter ECG monitoring can also be helpful. More prolonged event recording ECGs or the new wearable smartwatch devices (such as ECG watches) can help to monitor any associated arrhythmia.

In some patients with recurrent vasovagal syncope especially those associated with injuries, an upright tilt test may be useful.

Finally, when it is vital to monitor the cause, an insertable loop recorder which is injected just under the skin over the left chest region provides monitoring for 2-3 years.

It is also important to determine if there is any underlying heart disease on the ECG and echocardiogram if needed. Any fainting spells associated with an underlying heart disease needs further investigations.

What are the possible treatments available?Once the diagnosis is obtained, appropriate treatment can be done. For the majority who have slightly low blood pressure (BP) with or without vasovagal syncope, reassurance that it is benign is very helpful to allay fears that it may be more sinister. Increased salt intake and hydration is very important. Patients who are taking blood pressure medication may need to monitor their BP regularly and if there is a demonstration of low blood pressure, they should have a discussion with their doctors to reduce the dose of their medication.

In patients who have rapid arrhythmias, drug treatment or catheter ablation can be considered. Patients with underlying heart disease need treatment of the disease and if there is an arrhythmia associated with fainting spells, an implantable cardioverter defibrillator may be needed. In older patients with sick sinus syndrome, a permanent pacemaker may be needed.

Can it be prevented?Patients who tend to have low blood pressure should avoid getting up suddenly after prolonged sitting or lying down. When fainting spells are associated with near vasovagal syncope, physical manoeuvers such as crossing one’s legs and arms may help. If not, lying down immediately with the legs up may abort the full fainting episode.

Maintaining a healthy lifestyle and prevention of heart disease and heart failure is very important, as failure to do so can often lead to arrhythmias later on in life which can result in fainting spells.

“The eyes are the windows to our soul”, William Shakespeare once said. And truly, our eyes are able to tell us so much about

the health of the rest of our body. In fact, our eyes may offer a peek into the state of our heart affairs.

How exactly? When we look into our eyes, through the pupil, we can see the retina (the innermost lining of the eyeball) and all of its retinal blood vessels. These retinal blood vessels are closely connected to the health of our heart, which means that abnormalities we detect in the retina can be linked to problems with our heart and blood vessels in our body.

High Blood Pressure

High blood pressure, also known as hypertension, is a condition that happens when the force of our blood against the wall of our arteries is too high. This is usually made worse by the fact that our arteries can get hardened as we age, due to the build-up of cholesterol plaques in our arteries, termed as atherosclerosis. High blood pressure over a long period of time can bring about stroke, heart disease and kidney disease.

Eye doctors can look at the state of the retinal blood vessels and determine whether we have high blood pressure without the need for a blood pressure cuff.

Kinking of retinal blood vessels or very tortuous blood vessels can be clues that there is underlying hypertension. The size, calibre and wall of the blood vessels are also indicative signs of the presence of high blood pressure. In severe cases of high blood pressure, there may be swelling of the optic nerve (also termed papilloedema) with widespread hemorrhages (bleeding) and cotton-wool spots (signifying oxygen-deprivation) in the retina. These changes are reversible if blood pressure can be lowered to ideal levels.

EyesHeart

&Disease

Article contributed by Dr Claudine Pang, Medical Director and Consultant Ophthalmologist at Asia Retina Eye Surgery Centre

5Feature

High Cholesterol

With high cholesterol in the blood, it is not surprising that some of these cholesterol plaques can find its way to the retinal blood vessels. Sometimes, eye doctors are able to find cholesterol crystals stuck within the retinal vasculature. These appear as a small white or yellow clot within the blood vessels.

Cholesterol may also appear in other forms in other parts of the eyes. It may appear as drusen (yellow deposits under the retina) in those with age-related macular degeneration, as asteroid hyalosis (cholesterol crystals floating within the eyeball that manifest as floaters), as greyish-white rings around the black of the eyes (called arcus senilis), and as xanthelasma which appear at the corners of the eyelids. All these signs are hints that cholesterol levels in our body are high and signal a need to cut down on a fatty diet!

Cholesterol plaque

Xanthelasma

Drusen

Asteroid Hyalosis

Carotid Artery Disease and Stroke

Carotid arteries are the main blood vessels in our neck that supply blood to our entire head and brain. Fatty deposits or plaques can clog up these vessels and give off emboli (blood clots) which eventually lead to a stroke. Stroke occurs when there is oxygen deprivation to a part of the brain. It is one of the leading causes of death and permanent disability in Singapore.

One of the first signs before a full-blown stroke is the sudden blurring or blackening of vision, which occurs episodically and lasts transiently. Often the vision returns to normal after each episode. This condition is called “amaurosis fugax”. When the eye doctor takes a closer look into the eyes, a blood clot blocking a branch of the retinal artery can often be found. Further tests may reveal narrowing or blockage of the carotid arteries as well. If steps can be taken early to unblock these carotid arteries, stroke can be very much prevented.

Anemia

Anemia is a state of low red blood cell count and can occur in cases of iron deficiency, chronic blood loss, chronic illness or blood disorders like thalassemia. In severe anemia, there can be blood vessel changes that are seen in the eyes. The eye doctor will be able to find blood spots (called Roth spots) and abnormal blood vessels (telangiectasia) growing at various parts of the retina.

This is important because anemia that is present for a prolonged time can result in heart disease and may even lead to a heart attack. Moreover, anemia usually has little to mild symptoms such as light-headedness, tiredness and breathlessness. If detected early by your eye doctor, you can seek treatment to rectify the underlying cause and prevent heart disease.

Diabetes Mellitus and Metabolic Syndrome

Diabetes is another condition that could be left undetected for a long time, because of its slow onset and minimal symptoms. Frequently, the eye doctor may be the first to spot some clues after an eye examination. When sugar levels in the blood are too high, the small blood capillaries in our retina can be damaged resulting in blood spots (hemorrhages) and abnormal new vessel growth within the retina. If left uncontrolled, these abnormal vessel growth leads to internal eye bleeding and eventual blindness.

We know that diabetes not only promotes heart disease, but it can also lead to kidney failure, loss of nerve endings and loss of limbs. Protecting your heart definitely starts with the prevention of diabetes, insulin resistance and the onslaught of metabolic syndrome - which is the cluster of risk factors that eventually lead to heart disease, stroke and diabetes. It includes signs like obesity, high cholesterol and high blood pressure. Stay active and maintain a healthy weight to keep metabolic syndrome at bay.

Conclusion

As you can see, the retina is very revealing of many ailments that can affect our body. As a retinal specialist, I find it intriguing and amazing that the eye is so connected to our heart and the rest of our body. Hence, it is particularly important for everyone to have a detailed check of their eyes and retina to detect and treat early diseases.

Roth Spots

Diabetic Retinopathy

6 Feature

7Health Bites

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HealtH Bites

Evening workouts may reduce men’s blood pressure Hypertension affects roughly one billion people worldwide and is responsible for 8 million deaths a year, mostly from cardiovascular causes like heart attacks and strokes. A recent study has found that evening workouts for men are associated with a meaningful reduction in blood pressure. The research was based on a 10-week experiment with hypertensive men who cycled three times a week for 45 minutes either in the morning (7am to 9am) or in the evening (6pm to 8pm).

Findings revealed an average decrease in systolic and diastolic pressure of 8 mmHg (millimeter of mercury) and 3 mmHg respectively for those who worked out in the evenings.

Although exercise cannot replace medication to manage high blood pressure, these results suggest that men who do work out should try to do so at night. However, if one only has time in the morning, then a workout is still better than no exercise at all.

Sunlight is actually good for your heartIn Singapore, as much as many of us like to hide indoors away from the sun, did you know that getting some sunshine can actually do you more good than harm? However, before you step out, remember to apply a generous slab of sunscreen.

The sun increases Vitamin D in the body, which is essential for bone health and regulation of our immune system. Although this can be achieved through food sources like fatty fish, cheese and cereal, getting Vitamin D directly from the sun is an easier way.

Secondly, based on a study published in the Journal of Investigative Dermatology in 2013, with an increase in sun exposure, the measured rates of high blood pressure and heart disease fall. This is due to the release of nitric oxide which helps to lower blood pressure.

Vitamin D has also been shown to improve weight loss, in conjunction with a low-calorie diet. Hence, insufficient Vitamin D inhibits maximum weight loss and leads to obesity. So what are you waiting for? Get out there and bask in some sunlight for a healthier heart!

Higher risk of heart problems when you are bullied at workAccording to a recent study, people who are bullied or exposed to violence on their job are

at a higher risk of developing cardiovascular disease, as compared to individuals who do have to deal with such challenges at work.

Workers who were bullied on the job were 59% more likely to be diagnosed with heart disease or hospitalised for heart attacks or strokes as compared to those who were not bullied. Likewise, those who were exposed to violence also had a 25% higher likelihood of

developing heart disease or being hospitalised for related events.

These stressors like bullying and violence, might contribute to mood disorders such as anxiety or depression and trigger unhealthy behaviours like smoking or eating and drinking too

much. Severe stress may also contribute to high blood pressure, which in turn increases the risk of heart disease.

“If we can eliminate workplace bullying and workplace violence, the impact of cardiovascular disease prevention would be similar to if we prevent diabetes and risky alcohol drinking,” said lead study author Xu Tianwei.

Editorial8

Protein is an essential source of nutrient, which is needed for our bodily functions and to repair, maintain and generate body

cells. A complete protein is a type of protein that contains all the 9 essential amino acids that the body cannot produce, and is needed for the physiological functions. These complete proteins are mainly found in animal sources like meat, poultry, fish and egg; and plant-based protein like soybean.

It is advisable to consume a combination of animal and plant-based protein, to have a better nutrient profile. However, for vegetarians or those who want to have lower saturated fat protein, soybean products such as tofu or soymilk would be a better option.

Soybean may also help in weight management, as its fibre content increases satiety time. With its low glycaemic index, it can be served as a diabetic-friendly option. With the fortification of soymilk, its nutrient level (in terms of protein and calcium) is similar to milk or even higher, thus making it a healthier choice.

To achieve your daily requirements of protein and calcium, remember to have a glass or two of soymilk a day!

Have You BeanDrinking Soymilk?

Resistance Training (also called strength or weight training) is the term used to describe a type of

exercise where you lift an external load or use your bodyweight as a resistance to improve the strength, size or endurance of your skeletal muscles.

Many people enjoy resistance training, which includes using your own bodyweight, free-weights, weight machines, medicine balls or resistance bands. It is a good way to improve health and fitness in addition to the recommended 150 minutes of weekly aerobic activity, but it is important that strength training is performed safely and correctly.

What are the benefits of resistance training?

• Improvesandmaintainsmuscletone,strengthandendurance– stronger muscles reduce strain on the heart during physical activity and exercise

• Makeseverydayactivitieseasiertoperform• Helpsmaintainahealthybodyweightandshape• Helpstoreducetheriskoffalls,especiallyinolderpeople• Improveswell-beingandqualityoflife• Improves/maintainsbonedensity• Helps to manage long-term health conditions such as

reducing high blood pressure and preventing or controlling diabetes

When is it safe to start?

It is recommended that you have an assessment with a cardiac exercise professional who will provide advice, guidance and design with you an individual resistance training programme. Your start date will vary, depending on your own circumstances and specific cardiac condition.

For example: Angina or an Arrhythmia

You should be able to start as soon as your condition has stabilised.

Heart Attack or Coronary Angioplasty/Stents

You should be able to start in the first few weeks, depending on your diagnosis and treatment.

Pacemaker or Implantable Cardioverter Device (ICD)

In the first six weeks, caution is needed with certain upper body movements used in resistance training (e.g. use of a chest press) and also in the longer term to minimise damage to the device wires.

Open Heart Surgery

During the first 12 weeks, you should be cautious before upper body strength training in order to minimise problems with breastbone healing.

How fit do I need to be?

There is no minimum fitness level required. Strength training may be the most appropriate initial type of exercise for people with low fitness or limited mobility, allowing them to progress to other types of exercise once they have improved muscle strength.

How do I start?

You need to establish the correct choice of exercises and weight to be lifted for each individual muscle group you plan to train. Your cardiac exercise professional will help you to do this.

How often should I do strength training?

At least twice a week, no more than four times a week. It is recommended to wait 48 hours between each resistance training session.

Resistance Training

Resistance Training10

A guide for heart patients

11Resistance Training

How much should I do?

1 set of 10-15 repetitions (reps) for each muscle group. If you cannot perform at least 10 reps one after the other, it means that the weight is too heavy.

How do I progress?

• Increasethenumberofsetsupto3,withaminuterestinbetween

• Increasetheweight(bandstrengthifusingresistancebands)• Forspecificmuscleendurancetraining,keeptheweightthe

same and increase the number of reps to 20

When should I perform strength training?

You can either do resistance training in the same session as your aerobic exercise, after a partial cool down, or in a ‘stand-alone’ session.

Should I warm up/cool down?

Yes, if you are doing strength training as a ‘stand-alone’, you should warm up the muscles by performing the exercise 10 times without a weight. Cooling down should be done by stretching the muscles used.

How should I feel?

The fatigue in your muscles should increase gradually, as you increase the number of reps performed. By your last repetition, the muscle group you are exercising should feel tired to the

point that you are unable to continue. It is normal to feel some muscle soreness up to 48 hours after performing these exercises. If muscle soreness is excessive, you have probably overdone it and should reduce either the weight or the number of sets performed at your next session.

What about technique?

Strength training should be performed:

• Withagoodposture• Inarhythmicalmanner• Atacontrolledslowtomoderatespeed• Throughacomfortablerangeofmovement• Withalternationbetweenlowerandupperbodywork,to

allow muscles to rest between exercises if working both areas

• With avoidance of gripping the weights/bands excessivelyand holding your breath, because both these actions may cause a rapid increase in your blood pressure

• By counting out loudwith each rep to help you breathenaturally

Other considerations:

• Onlyexercisewhenyouarefeelinggenerallywell• Keephydratedwhenyouareexercising• Stopexercisingifyouexperienceanychestpain,palpitations

or light-headedness. If the symptoms do not go away promptly with rest and/or prescribed GTN spray use, seek medical advice as soon as possible.

This guide is based on available evidence and expert opinion and is produced by the Association of Chartered Physiotherapists in Cardiac Rehabilitation.

Note: The information provided in this article is not intended to replace the advice that your doctor or cardiac rehabilitation team has given you, based on their expert knowledge of your condition.

Editorial12

Food can affect one’s mood and well-being. It can make you feel lethargic, easily irritated, alert or energetic.

Hence, consuming the right food matters to better manage your mood, well-being, as well as health.

Having healthy, well-balanced meals at all times will provide constant energy and the adequate amount of nutrients the body needs. Also, replacing refined grains with whole grains will help to promote more health benefits such as reducing the risk of cardiovascular disease and diabetes.

There are a few common types of whole grains which are widely available in all supermarkets, e.g. oats, brown rice, quinoa and wholewheat pasta. If you are new to whole grains and/or have difficulty chewing/swallowing, start with oats which have a more subtle taste and are easier to chew. Begin by replacing a portion of refined grains with whole grains, and increase the portion gradually. With this increment in exposure, you will grow to accept whole grains over a period of time.

So swap out some refined grains with whole grains as part of your healthy and well-balanced meal today, and savour every spoonful of oat goodness!

Oat

In celebration of International Women’s Day on Friday 8th March 2019, Singapore Heart Foundation (SHF) held the 2nd

edition of the Go Red for Women Luncheon at the Singapore Chinese Cultural Centre, SCCCI Multi-Purpose Hall, as part of its Go Red for Women (GRFW) campaign. Themed “Celebrate Women, Celebrate Life”, apart from celebrating the success and progress of women, the event served as an important reminder for women to make their heart health a top priority. GRFW aims to empower women with the knowledge and tools that can help reduce their risk of cardiovascular disease (CVD).

220 women from all walks of life came together for the luncheon, where they were treated to a healthy four-course lunch, and attended talks by healthcare experts from the National University Heart Centre Singapore (NUHCS). Assistant Professor Chan Wan Xian (who is also a GRFW committee member), Senior Consultant, Department of Cardiology at NUHCS shared with attendees on the relations between heart disease and women. In addition, Ms Janice Chen, Senior Occupational Therapist, provided useful tips on leading a heart healthy lifestyle through nutrition, physical activities and stress management.

In collaboration with SHF, Manulife Singapore launched the “Stop the Drama” campaign during the event. The video featured veteran Singapore actor, Lim Kay Tong teaching young actors how to portray heart attack symptoms more realistically. The campaign aims to debunk the common misconception that heart attack symptoms are as dramatic as what we see in TV shows and movies, so as to raise awareness about what a real heart attack looks like.

Another special highlight for the event was a mini fashion show, organised together with fashion brand and main sponsor, SaturdayClub. The fashion show showcased a selection of 10 specially curated red dresses, designed by SaturdayClub. Attendees witnessed a spectacular display of fiery red outfits accompanied with a series of heart health messages. A red dress serves as a warning, a red alert that it is important NOT to ignore the warning signs and symptoms of CVD in women.

SaturdayClub also pledged to donate 2% of its net proceeds for every apparel purchased in the month of March.

Exhibitor booths at the luncheon featured health-related information and all guests walked away with a heart health gift bag worth more than $100! Special thanks and appreciation to Manulife, Captain Oats, Marigold, F&N NutriSoy, Omron, SaturdayClub, Philips, GSK, GoodSalt, Blackmores and alche{me}, for making this event a great success. Lastly, a big thank you to all of you who turned up for the event!

Luncheon 2019Go Red for Women

13Event Review

在哪些情况下与心血管问题相关？

—

如何判断晕厥？区分晕厥和眩晕是很重要的，眩晕更像是一种没有丧失意识的晕厥，通常与头部所处的位置有关。也需要排除类似的其他神经疾病。

如果出现了短暂的意识丧失，就是晕厥吗？对于大多数人来说，晕厥可能会出现意识丧失或近乎昏迷。当完全丧失意识时，虽然发生时间较短，但经常会被描述为晕倒或昏厥。重要的是区分患者是否患有与昏迷相关的症状，因为丧失意识的患者的病情往往更严重。

晕厥有多常见？晕厥并不罕见，而且会频繁发生。多达10-20％的人群会出现晕厥，且在女性中更为常见。

导致晕厥的原因是什么？与心血管疾病相关的晕厥可能与反射性晕厥、直立性低血压(站立时血压下降)、心脏相关的心脏病或心律失常(心律异常)有关。反射性晕厥通常也被称为单纯晕厥或血管迷走性晕厥。

是否还有其他相关症状？如果晕厥前有运动或快速心悸，应当进一步检查。

晕厥是如何发生的以及常见原因是什么？在严重的情绪压力期间或长时间蹲坐后突然起立时，容易出现晕厥。实际上，这种情况在静息血压相对较低的年轻女性或因高血压或前列腺问题服用药物的老年患者中很常见。

反射性晕厥患者通常在40岁之前有复发性晕厥的长期病史，并且伴随令人不适的景

象、声音、气味或疼痛。通常由长时间站立引起，特别是在拥挤和／或炎热的地方或学校集会期间。通常恢复得非常快，与头部受伤无关。这些患者(除晕厥之外)没有任何潜在的心脏疾病。有时患者的其他家庭成员可能也有晕厥史。在某些反射性晕厥中，排尿(通过尿液)和长时间咳嗽等情况可能引发晕厥。

室上性(由心脏上腔引起的异常节律)或室性心律失常(由心脏下腔引起的异常节律)是较少导致心律失常患者发生晕厥的现象。这可能发生在可能患有或可能没有潜在结构性心脏病的年轻或老年患者中。患有室性心律失常和潜在心脏病的患者如果出现晕厥则会有心脏猝死的风险。

老年患者出现近乎昏厥的情况可能与病态窦房结综合征有关(见下图)。一般来说，这些患者由于心房颤动(快速不规则节律的类型)而出现心悸，具有快速的心室反应，随后会出现持续几秒钟的暂停现象。部分情况下，潜在的心脏病可能导致晕厥发作，例如瓣膜性心脏病(例如老年患者的主动脉瓣狭窄(瓣膜狭窄)或心肌病)心脏肌肉紊乱)。晕厥发作很少与潜在的缺血性心脏病有关。

由直立性低血压引起的晕厥通常是由于药物或脱水导致，只有少数与影响自主神经系统的神经系统疾病相关，例如帕金森病。

15特写

外行人的心脏病学(八)

晕厥 文章由新加坡伊丽莎白医院心脏病专家和电生理学顾问张维祥医生提供

如何诊断导致晕厥的原因？对患者来说昏厥发作原因的诊断往往是最困难的。症状往往只短暂出现且无法察觉到，因此难以确定确切的原因。定期血压(卧位和站立)监测，动态血压监测，脉搏和心电图(ECG)监测可能会有所帮助。24小时至48小时的动态心电监护也很有帮助。更长时间的记录心电图或新型可穿戴智慧手表设备(例如心电图手表)可以帮助监测任何相关的心律失常。

在部分复发性血管迷走性晕厥患者中，特别是在与损伤相关的情况下，直立倾斜试验可能会有所帮助。

最后，如果监测病因至关重要，那么在左胸部区域的皮下埋入一个环形记录器，能够进行 2 - 3年的监测。

如有需要，确定心电图和超声心动图结果是否表明存在任何潜在的心脏疾病也很重要。任何与潜在心脏疾病相关的晕厥都需要进一步检查。

有哪些可用的治疗方法？经过诊断后就可以进行适当的治疗。对于轻微低血压(BP)者有或无血管迷走性晕厥的人群来说，良性结果有助于减轻患者对自身状况的担忧。增加盐的摄入量和水合作用非常重要。服用降压药物的患者可能需要定期监测血压，如果出现低血压，患者应该与医生讨论是否需要减少药物的剂量。

对于有快速心律失常的患者，可以考虑进行药物治疗或导管消融。患有潜在心脏病的患者需要接受治疗，如果出现与晕厥相关的心律失常，则可能需要植入心脏复律除颤器。在患有病态窦房结综合征的老年患者中，可能需要使用永久心脏起搏器。

可以预防晕厥吗？伴有低血压的患者应避免长时间坐着或躺下后突然起身。当晕厥与近血管迷走性晕厥相关时，交叉腿和手臂等身体动作可能会有所帮助。如果没有作用，则需要立即躺下并将腿部抬高，可能有助于中止晕厥。

保持健康的生活方式，预防心脏病和心力衰竭是非常重要的，如果不这样做，往往会导致心律失常，这可能导致晕厥。

16 特写

威廉莎士比亚曾经说过，【眼睛是通往心灵的窗口】。事实的确如此，眼睛能够透露人们很多身体部位的健康状况，眼睛也可能窥探到我们的心灵深处。

这是为什么呢？当人们通过瞳孔观察眼睛时，可以看到视网膜(眼球的最深处的衬里)和所有的视网膜血管。这些视网膜血管与人们心脏的健康状况密切相关，这意味着人们在视网膜中检测到的异常可能与自身体内心脏和血管的问题有关。

高血压

高血压是当人们的血液对动脉壁的压力过大时发生的一种情况。随着年龄的增长，由于动脉中胆固醇斑块的积聚，动脉会变硬，通常会使病情恶化，而被称为动脉粥样硬化。长期患有高血压会导致中风、心脏病和肾脏疾病。

眼科医生可以查看视网膜血管的状态并确定人们是否患有高血压，而无需使用血压袖带。

曲折的视网膜血管或十分弯曲的血管扭结可能表明具有潜在的高血压。血管的大小、口经和壁也会出现高血压的指示性迹象。在严重的高血压病例中，视网膜可能会出现视神经肿胀(也称为视神经乳头水肿)，伴有广泛的出血(流血)和棉绒斑(表示缺氧)。如果血压能够降低到理想水平，这些变化是可逆转的。

文章由亚洲视网膜手术中心的医学主任兼眼科医生潘晶晶医生提供

高胆固醇

由于血液中的胆固醇含量高，因此部分胆固醇斑块能够进入视网膜血管。有时，眼科医生会发现黏在视网膜脉管系统内的胆固醇晶体。即在血管内出现的白色或黄色小凝块。

胆固醇也可能以其他形式出现在眼睛的其他部位。在年龄相关的黄斑变性患者中可能表现为玻璃疣(视网膜下的黄色沉积物)、星状玻璃体病变(眼球内漂浮的胆固醇晶体表现为漂浮物)、眼睛黑色周围出现灰白色环(称为角膜老年环)，以及出现在眼睑角落的黄斑瘤。所有这些迹象都表明人们体内的胆固醇水平很高，并表明需要减少脂肪摄入！

胆固醇斑块

黄斑瘤

玻璃疣

星状玻璃体病变

17特写

眼睛和心脏疾病

颈动脉疾病和中风

颈动脉是人们颈部的主要血管，为人们的整个头部和大脑提供血液。脂肪沉积物或斑块会阻塞这些血管并释放栓块(血凝块)，最终导致中风。当大脑的一部分缺氧时会发生中风。这是新加坡死亡和永久性残疾的主要原因之一。

在完全中风之前的首个迹象之一是视力突然模糊或变黑，不定期发生并且短暂持续。通常每次发作后视力会恢复正常。这种情况称为「一过性黑蒙」。当眼科医生仔细检查眼睛时，通常可以发现阻塞视网膜动脉分支的血凝块。进一步的检查也可能显示颈动脉狭窄或阻塞。如果可以尽早采取措施解除这些颈动脉阻塞，可以有效预防中风。

贫血

贫血是一种红细胞计数低的状态，可能发生在缺铁、慢性失血、慢性疾病或地中海贫血等血液疾病种。在严重的贫血症中，眼睛中的血管可能会出现变化。眼科医生将会在视网膜的各个部位发现血斑(称为罗特斑)和异常血管(毛细血管扩张)。

长时间的贫血会导致心脏病，甚至可能导致心脏病发作。此外，贫血通常几乎导致轻微的症状，例如头晕、疲倦和呼吸困难。如果眼科医生及早发现，患者可以寻求治疗以改善根本原因并预防心脏病。

糖尿病和代谢综合征

糖尿病是另一种可能长时间不被发现的疾病，主要由于病情发展缓慢且症状轻微。通常情况下，眼科医生可能是第一个在眼科检查后发现一些线索的专家。当血液中的糖含量过高时，视网膜中的小毛细血管可能会受损，导致血管斑点(出血)和视网膜内新生血管的异常生长。如果不加以控制，这些血管的异常生长会导致眼睛内部出血并最终导致失明。

通常，糖尿病不仅会导致心脏病，还会导致肾功能衰竭，神经末梢和四肢失去知觉。保护心脏需要从预防糖尿病、胰岛素抵抗和代谢综合征开始，这是一系列危险因素，最终会导致心脏病、中风和糖尿病。包括肥胖、高胆固醇和高血压等症状。坚持运动并维持健康的体重，以防止代谢综合症。

结论

如上所述，视网膜能够揭示许多可能影响人们身体健康的疾病。作为视网膜专家，我发现眼睛与人们的心脏和身体其他部分紧密相关，令人感到有趣和惊讶。因此，每个人进行详细的眼睛和视网膜检查对于检测和治疗早期疾病尤为重要。

罗特斑

糖尿病性视网膜病变

18 特写

Congratulations to all winners* and thank you for your participation!*Winners have been notified via phone or email.

1. Opt for lean meat, fish, seafood and ___________________ instead of fatty and/or processed protein.

2. Do not overconsume good fats, as they possess the same amount of _________ as bad fats.

3. Remember to ________ the skin and fat from meat and poultry before consumption.

4. Cut down or avoid dipping of ____________.

5. Select __________ cooking methods such as boiling, steaming, baking and grilling, instead of deep-frying.

6. Choose cooking oil with higher ____________ fats such as rice bran oil, groundnut oil and canola oil, and use the oil sparingly.

7. Pick up your _________ regimen again i.e. 150 minutes of moderate-intensity exercise.

8. Cut down on the frequency of consuming sweetened beverages and drink more _______ instead.

9. Replace your remaining Chinese New Year goodies with 2 servings of _____ daily.

10. Limit deep-fried food to no more than ______ a week.

ANSWERS (Mar – May 2019)

Post Chinese New Year:

19Nutrition

unsaturated

condiments

healthier

fruit

calories

twice

plant-based protein

exercise

remove

water

20 Nutrition

Simply email/fax this page to heartline@heart.org.sg / 6258 5240 by 31 August 2019.

Name: ______________________________________________ NRIC: ______________________________________________

Email: ______________________________________________ Mobile: ______________________________________________

All winners will be notified via phone or email. Good luck!

Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 September 2019.

Choose the right answer for each question.

1. Which is/are the good fat(s)?a. Saturated fatb. Unsaturated fatc. Trans fatd. All of the above

2. What type of cooking oil contains the highest amount of saturated fat?

a. Rice bran oilb. Peanut oilc. Coconut oild. Sunflower oil

3. Which of the following does not contain cholesterol?

a. Margarineb. Butterc. Fishd. None of the above

4. Which of the following is not white meat?a. Porkb. Chickenc. Seafoodd. All of the above

5. On a food label ingredient list, what does the first ingredient represent?

a. The first ingredient in alphabetical orderb. The lowest ingredient weightc. The highest ingredient weightd. Randomised order, does not stand for anything

6. What is the recommended daily limit of added sugar?

a. 2 to 5 teaspoonsb. 5 to 8 teaspoonsc. 8 to 11 teaspoonsd. 11 to 14 teaspoons

7. What is the recommended daily limit of sodium?

a. 1,500mgb. 2,000mgc. 2,500mgd. 3,000mg

8. What is a whole grain?a. Branb. Germc. Contains 3 layers of bran, germ

and endospermd. All of the above

Submit your correctanswers and 5 lucky winners will receive an interesting book on Health Myths and Facts in our lucky draw!

How well DO you know your food?

21

Simply email/fax this page to heartline@heart.org.sg / 6258 5240 by 31 August 2019.

Name: ______________________________________________ NRIC: ______________________________________________

Email: ______________________________________________ Mobile: ______________________________________________

All winners will be notified via phone or email. Good luck!

Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 September 2019.

Event Review

On 4th May 2019, the Singapore Heart Foundation celebrated Mother’s Day with Chef Lennard Yeong – a finalist on MasterChef Asia and in-house chef

at Miele. To encourage healthier eating, Chef Lennard specially prepared a four-course heart-healthy menu to celebrate the remarkable role that mothers play. The dishes were inspired by the most important women in our lives and are innovative, delicious, easy to whip up, and most importantly healthy.

A Heart-HealthyMother’s Day Spreadspecially created by MasterChef Asia finalist Lennard Yeong

The first two recipes can be found on pages 22 & 23 and the other two recipes will be in our next issue of heartline. A short cooking demonstration by Chef Lennard can also be found on our Facebook page at www.facebook.com/heartfoundation or you may scan this QR code:

A personal health condition was one of the reasons that spurred Chef Lennard Yeong to work with SHF on this special menu, to inspire heart-healthier lifestyles. Unknown to many, he has Wolff-Parkinson-White syndrome, a condition which can lead to periods of rapid heart rate. He discovered this during an army medical check-up 8 years ago. Since then, it has pushed him to adopt a more heart-healthy lifestyle by eating healthier and exercising more often.

The menu served to friends of the media and our cardiac patients included:

❤ Tomato Dashi Soba with Steamed Prawns

❤ Steamed Chicken Breast Wrapped in Lettuce with Ginger-Scallion Sauce & Lotus Root Chips

❤ Marinated Salmon on Vegetable Quinoa

❤ Coconut Granita with Berry Foam and Pine Nuts

This Instagram-worthy meal will certainly warm any mother’s heart!

番茄荞麦面汤配蒸虾Recipe contributed by Mr Lennard Yeong. 本食谱由杨钦崴先生提供。

Tomato Dashi Sobawith Steamed Prawns

Nutrients per Serving 每份营养

Energy 能量: 118.4 kcal 千卡

Protein 蛋白质: 8.5 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 0.9 g 克 (0.2 g 克)

Carbohydrate 碳水化合物: 18.8 g 克

Sodium 钠: 321.9 mg 毫克

Cholesterol 胆固醇: 27.6 mg 毫克

Dietary fibre 膳食纤维: 0.9 g 克Serves 份量: 1 人份

Ingredients 材料:

• Tomatoes,3wholes 番茄，3个• Plumvinegar,1tbsp 梅子醋，1汤匙• Lowsodiumsalt,2pinches(optional) 低钠盐(可选)，2撮• Kombu,1pcof2”square(optional) 海带(可选)，1块5公分方块• Prawns,2 虾 ，2只• Whitepepper,1pinch 白胡椒，1撮• Shaoxingwine,1tsp(optional) 绍兴酒(可选)，1茶匙• Springonions(sliced),1/2tsp 葱(切片)， ½茶匙• Coriander,1/4tsp 香菜，¼茶匙• Waterchestnut(diced),1/4tsp 马蹄(切块)，¼茶匙• Gingerflower,1/4tsp 姜花，¼茶匙• Soba,50g 荞麦面， 50克

Method 做法:

1. Blendthetomatoesandplaceitintoacheesecloth.Placethekombu(optional)inabowlandallowthetomatojuicetodripintothebowlovernight.

将番茄混合后放入薄纱棉布中。将海带(可选)放入碗中，等待一夜，让番茄汁慢慢滴入碗中。

2. Onthenextday,seasonwiththeplumvinegarandapinchofsalt.Placethemixtureintherefrigeratorandchilltillcold.

第二天，用梅子醋和少许盐调味，并放入冰箱冷藏。3. Mix theprawnswithapinchofwhitepepper, 1pinchofsalt (optional)anda tspofShaoxingwine

(optional).Letitmarinatefor1hour. 将虾与1小撮白胡椒、1小撮盐(可选)和一茶匙的绍兴酒(可选)混合后，腌1小时。4. Afterthat,steamtheprawnsforaround3minutes.Allowtocooldown,thenchill. 将腌好的虾，蒸大约3分钟，待冷却后冷藏。 5. Boilthesobafor1.5minutesandthenchillitinicewater. 将荞麦面在沸水中煮1.5分钟，然后在冰水中冷却。6. Toplate,addalltheitemsintoabowlanditisreadytobeserved. 摆盘时，将所有原料放入碗中即可食用。

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Mr Lennard Yeong’s Profile杨钦崴先生简介

Lennard was a finalist on MasterChef Asia and currently works as the in-house chef for Miele. He is also an avid home cook and is a Tastehunter for World’s 50 Best.杨钦崴是MasterChef Asia决赛入围者之一。目前作为Miele的内部厨师。他也是World’s 50 Best的其中一位Tastehunter。

22 Recipes

蒸鸡胸肉生菜卷配生姜葱酱与莲藕片

Recipe contributed by Mr Lennard Yeong. 本食谱由杨钦崴先生提供。

Steamed Chicken Breast Wrapped in Lettuce

with GinGer-Scallion Sauce & lotuS root chipS

Nutrients per Serving 每份营养

Energy 能量: 216.6 kcal 千卡

Protein 蛋白质: 10.9 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 15.8 g 克 (2.4 g 克)

Carbohydrate 碳水化合物: 7.3 g 克

Sodium 钠: 369.3 mg 毫克

Cholesterol 胆固醇: 25.6 mg 毫克

Dietary fibre 膳食纤维: 1 g 克

Serves 份量: 1 人份

Ingredients 材料:• Chickenbreast,70g 鸡胸肉，70克• Water,300g 水，300克• Lowsodiumsalt,10g+1pinch(optional) 低钠盐，10克 + 1撮(可选)• Lettuceleaves,2pcs 生菜，2片• Springonions(sliced),40g 葱(切片)，40克

• Ginger(Grated),10g 生姜(末)，10克• Oliveoil,10g 橄榄油，10克• Sesameoil,5g 芝麻油，5克• Lotusroot(thinlysliced),2–3pcs

莲藕(切成薄片)，2-3片

Method 做法: 1. Mix the water and salt together to create a brine. Chill the

mixture. 将水和盐混合后制成盐水，待盐水冷却。 2. Removetheskinfromthechickenbreastandplacethechicken

breastinthebrine.Brinethechickenfor1.5hours. 将鸡胸肉去皮后放入盐水中，腌制1.5小时。3. Rinse off any excess brine under tap water and steam the

chickenfor8-10minutes. 用自来水冲洗掉多余的盐水，再将鸡肉蒸8-10分钟。 4. Steamthelettuceleavesfor1minutetilltheysoften. 将生菜蒸1分钟至其软化。 5. Wrapthecookedchickenbreastinthelettuceandclingwrapit. 将煮好的鸡胸肉放在生菜中，紧紧包卷起来。 6. Forthesauce,heattheoliveoilinapan.Stirinthespringonions

andgingertillsoft. 制作酱汁；将橄榄油倒入锅中加热，放入葱和姜炒至柔软。 7. Allow the mixture to cool before adding the sesame oil. If

preferred,youmayaddapinchofsalttoo. 待葱姜混合物冷却后加入芝麻油，也可以加一点盐(可选)。 8. Tossthelotusrootsliceswitholiveoilandlaythemontoapiece

ofparchmentpaper.Placeanemptytrayontopofthe lotusrootslicesandbakeat160°Cfor25minutes.

将莲藕片放入橄榄油中翻炒，然后将莲藕片放在一张烘培纸上。用一个空烤盘盖住莲藕片，在160℃下烘烤25分钟。

9. Toserve,spoonsomegingerscallionsauceontheplate,placethe lettucewrapped chicken breast on top of the sauce andfinishoffwithlotusrootchips.

摆盘时，舀一些生姜葱酱在盘子，将生菜鸡胸肉卷放在酱汁上，再放上莲藕片。

Tip 提示: Reducethebriningtimeforalowersodiumintake!减少腌制时间能降低钠摄取量！

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23食谱