How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOK CHIN YONG
Consultant Neurologist and Internal Medicine Physician
Sunway Medical Centre Velocity
FIRST, LET’S TAKE A LOOK AT STROKE

Stroke is a medical emergency caused by the disruption of blood flow to your brain.

Without enough oxygen, your brain will stop working properly. This is why stroke is often considered the brain’s version of a heart attack.

 

Ischaemic stroke

This occurs when there is blood flow disruption to the brain. This can occur when the blood vessels in your brain are blocked by blood clots or other substances.

This is the most common type of stroke and is often linked to poorly controlled type 2 diabetes, high blood pressure, and/or high blood cholesterol levels.

Haemorrhagic stroke

This type of stroke occurs when there is internal bleeding in the brain. Accumulated blood in certain areas of the brain can exert pressure to brain tissues in these areas and damage these tissues.

While not as common as ischaemic stroke, this type of stroke is especially dangerous because the affected person’s symptoms can get worse very quickly and urgent medical attention is needed to prevent permanent brain damage and even death.

MOST STROKE SURVIVORS EXPERIENCE GAIT DISABILITY

Stroke is one of the main causes of disability.

2005 statistics from the American Heart Association revealed that more than 80% of stroke survivors suffer from gait disability—the loss of mobility due to impaired ability to walk normally.

Gait disability can affect the survivor’s quality of life.

However, there are also other repercussions of this disability on the person: the person’s confidence and sense of independence can be compromised.

Furthermore, gait disability is linked to increased risks of cardiovascular diseases and death in people approaching 80.

Because of this, gait therapy is an important aspect of rehabilitation for a stroke survivor.

ALL IS NOT LOST, AS THE BRAIN HAS A CHANCE TO ADAPT & RECOVER

The brain is an amazing organ. The network of nerves and other tissues involved in brain function can adapt to changes by reorganizing themselves, or ‘rewire’ in response to these changes.

“This can happen after a stroke,” Dr Kok explains, “as the brain begins to compensate for the damage caused by the stroke.”

This process, called brain neuroplasticity, can involve the formation of new connections between remaining healthy nerves and ‘recruiting’ other parts of the brain to take over the functions that were handled by the now-damaged part of the brain.

Much research is being done on the neuroplasticity of the brain to explore possible ways to improve the rehabilitation process of people that had a stroke or other brain injuries that affect their normal day-to-day function.

Currently, research data increasingly suggests that techniques that can stimulate the part of the brain affected by stroke can help improve the rehabilitation of the lost function linked to that part of the brain.

HENCE, GAIT THERAPY IS AN ESSENTIAL COMPONENT OF A STROKE SURVIVOR’S REHABILITATION

Dr Kok Chin Yong mentions that the restoration of a stroke survivor’s ability to walk can be a complex process.

The stroke survivor’s inability to walk normally is usually due to the stroke disrupting the function of the nerve pathways in the region of the brain that plans and controls movement called the motor cortex.

Furthermore, the stroke survivor also often suffers from other debilitations that make it harder for them to walk, such as changes in their muscle tone and strength as well as impaired heart function.

Additionally, the more gait therapy is delayed, the harder it is to achieve a good outcome because the organs involved in walking will further weaken and waste away due to lack of use.

Hence, gait therapy should be prioritized as soon as it is feasible to do so.

ROBOTICS-ASSISTED GAIT THERAPY CAN BENEFIT STROKE SURVIVORS CONSIDERABLY
If you have not read Dr Foong Chee Chong’s explanation of what robotic-assisted gait therapy is, you can do so by clicking here. Have a read, and then hit the back button to come back here and continue reading—it will help you better understand the rest of this article!

Dr Kok explains that the first line of rehabilitation is conventional physiotherapy.

“During this stage, we will assess the patient’s suitability for robotics-assisted gait therapy,” he explains, adding that the criteria for suitability are similar to those explained by his colleague Dr Foong is the above-linked article.

“The main benefit of the use of robotics is that many patients can regain their normal physiological walking at a faster rate than conventional physiotherapy,” he shares.

He elaborates that this is due to the robotic exoskeleton stimulating the neuroplasticity of the patient’s brain, helping it to relearn how to order and control the movement of the patient’s lower limbs at a much faster rate.

He reiterates that such outcome is more likely achieved when the robotics-assisted gait therapy is initiated as early as it is feasible to do so.

Hence, he encourages stroke survivors to consult their doctors further on whether such a therapy is suitable for them.

THIS IS THE SECOND PART OF THE SERIES LEARNING TO WALK AGAIN

Below are the articles in this series:

  1. A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again
  2. How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate (you’re reading this article now)

References:

  1. Duncan, P. W., Zorowitz, R., Bates, B., Choi, J. Y., Glasberg, J. J., Graham, G. D., Katz, R. C., Lamberty, K., & Reker, D. (2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36(9), e100–e143. https://doi.org/10.1161/01.STR.0000180861.54180.FF
  2. Newman, A. B., Simonsick, E. M., Naydeck, B. L., Boudreau, R. M., Kritchevsky, S. B., Nevitt, M. C., Pahor, M., Satterfield, S., Brach, J. S., Studenski, S. A., & Harris, T. B. (2006). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA, 295(17), 2018–2026. https://doi.org/10.1001/jama.295.17.2018
  3. Su, F., & Xu, W. (2020). Enhancing brain plasticity to promote stroke recovery. Frontiers in neurology, 11, 554089. https://doi.org/10.3389/fneur.2020.554089
  4. Selves, C., Stoquart, G., & Lejeune, T. (2020). Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions. Acta neurologica Belgica, 120(4), 783–790. https://doi.org/10.1007/s13760-020-01320-7

A Cardiologist Talks About a Procedure to Treat Coronary Artery Disease

WORDS DR TIMOTHY JAMES WATSON

FEATURED EXPERT
DR TIMOTHY JAMES WATSON
Consultant Cardiologist
Pantai Hospital Batu Pahat
PERCUTANEOUS CORONARY INTERVENTION

Percutaneous coronary intervention (PCI for short) is a mechanical solution for obstructive coronary artery disease.

An overview of coronary artery disease. Click image for a larger, clearer version.

This solution essentially pushing the plaques to the side of the vessel to restore blood flow to the heart.

Stents and balloons are used to widen the blood vessel affected by plaque that blocks blood flow. Click the image for a larger, clearer version.

Firstly, this helps to relieve symptoms and, in unstable patients, saves lives.

Nonetheless, it doesn’t reverse the atherosclerotic process.

However, the advent of newer technologies such as drug-eluting balloons likely help with positive remodeling of the artery, such as enlargement without needing a stent.

ATTACHING A FINE ULTRASOUND CAMERA TO PCI CAN IMPROVE OUTCOME

During the coronary angiogram, a fine ultrasound camera is inserted into the angiogram catheter and fed into the heart blood vessel.

The ultrasound camera is then slowly withdrawn whilst taking a series of pictures from inside the blood vessel.

The doctor can then use these pictures to get live data of the plaque and size of the blood vessel to help make treatment decisions.

This procedure, called intravascular ultrasound-guided percutaneous coronary intervention (IVUS-guided PCI), has been repeatedly shown to improve outcomes and is highly recommended in many cases.

The IVUS procedure takes only 5 minutes or so and the patient will be unaware of what is going on.

PREPARING FOR A PERCUTANEOUS CORONARY INTERVENTION

Percutaneous coronary intervention is generally a straightforward and fairly low-risk procedure.

  • Of course, feelings of anxiety are natural. So, it is best to come to the hospital with a friend or family to accompany you.
  • Eat all your medications as normal, especially the blood thinning medication.
  • For the diabetes medication, your doctor may ask you to withhold one or two doses before/after the procedure.
  • Prolonged fasting is generally not required pre-procedure. A few hours should be ample.
AFTER THE PROCEDURE

In the majority of cases recovery from PCI is very rapid.

There may be some discomfort or bruising at the puncture site, but this should quickly resolve within a few days to a week.

Thereafter most patients will be back to normal very quickly.

IJN and Pfizer Shines the Spotlight on a Rare but Deadly Heart Disease

WORDS LIM TECK CHOON

FEATURED EXPERT
DATO’ DR AZMEE MOHD GHAZI
Consultant Cardiologist & Clinical Director
Heart Failure and Heart Transplant
National Heart Institute (IJN)

On May 8 this year, the National Heart Institute (IJN) and Pfizer Malaysia came together to promote greater awareness of transthyretin amyloid cardiomyopathy (often shortened to ATTR-CM), a rare, life-threatening disease.

An overview of ATTR-CM. Click on the image for a larger, clearer version. Image courtesy of Pfizer and IJN.
WHAT IS TRANSTHYRETIN AMYLOID CARDIOMYOPATHY?
  • ATTR-CM is caused by unstable transthyretin proteins that misfold and aggregate into amyloid fibrils that build up in the heart and other parts of the body.
  • This build-up of amyloid then causes the heart muscle to stiffen over time, eventually leading to heart failure.
  • Treatment is available, but detection of this disease tends to occur only at advanced stages due to lack of awareness of the disease.

“Diagnosis of ATTR-CM was often delayed or underdiagnosed due to the lack of optimal diagnostic modalities,” says Dato’ Dr Azmee Mohd Ghazi, a consultant cardiologist.

WHAT HAPPENS WHEN ONE HAS ATTR-CM?

According to Dato’ Dr Azmee:

  • ATTR-CM can lead to progressive heart failure, arrhythmias, and conduction system diseases (diseases that affect the ability of the heart to transmit electrical signals that keep the heart beating), all of which can result in sudden cardiac death due to fatal arrhythmias or complete heart block.
  • Once diagnosed, the average life expectancy for people with ATTR-CM is about 2 to 3.5 years, depending on the sub-type, if left untreated.

“Given how similar ATTR-CM symptoms are to other diseases’ symptoms, getting an accurate diagnosis from the onset can be an uphill battle,” Dato’ Dr Azmee. “However, medical advancements ensure that there are multiple channels to diagnose ATTR-CM, including nuclear scintigraphy and echocardiography.”

He adds that studies have also found that a multidisciplinary approach, involving multiple health departments, works best to facilitate earlier diagnosis and management of the disease.

SYMPTOMS TO WATCH OUT FOR
Symptoms of ATTR-CM, courtesy of Pfizer and IJN. Click on the image for a larger, clearer version.

Symptoms of ATTR-CM are not specific, and they are often similar to symptoms of other conditions such as an abnormal heart rhythm, muscle weakness, and bladder dysfunction.

Nonetheless, one should be alert for these symptoms and consult a doctor for confirmation, as early detection will improve the odds for a better treatment outcome.

Can Stress Cause Heart Diseases in Young Adults? A Cardiologist Explains

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TIMOTHY JAMES WATSON
Consultant Cardiologist
Pantai Hospital Batu Pahat
HOW COMMON IS HEART DISEASE AMONG YOUNG ADULTS? 
Dr Timothy:

Heart disease is common. In general, the risk factors are:

  • Male gender
  • Advancing age
  • Smoking
  • Diabetes
  • High blood pressure or hypertension
  • High levels of fats in the blood or hyperlipidaemia
  • Family history
  • Physical inactivity.

Young people that develop heart disease often are significantly overweight, or they have smoking or uncontrolled diabetes from young as major risk factors.

HOW ABOUT FATAL HEART DISEASE?
Dr Timothy:

Fatal heart disease is rare in otherwise apparently fit young people.

Nonetheless, we all know of people that have heart attacks or those who even collapse at a young age.

In many cases there is an underlying driving factor, such as smoking, or an underlying heart muscle defect such as hypertrophic cardiomyopathy

CAN STRESS INCREASE A YOUNG ADULT’S RISK OF HEART DISEASE?
Dr Timothy:

Stress may also play a role, but this is hard to define. Stress is a very personal matter.

For example, some people thrive in stressful environments, while others struggle. How this translates into cardiac risk is not clear-cut, especially as there is no universal definition or measurement scale for stress.

WHAT IS YOUR ADVICE TO YOUNGER ADULTS WHEN IT COMES TO STRESS MANAGEMENT?
Dr Timothy:

We all feel stressed. Sometimes it can be a motivating factor, but sometimes it can be overwhelming and daunting.

It is important to be comfortable and happy in life. Find things you enjoy.

Work hard but don’t do things to excess. This includes overworking, overeating, etc.

Find a job you enjoy. After all, you will spend a significant amount of your time at work.

Find time to relax yourself and keep your body fit and healthy. A simple evening walk may be enough. Jogging or cycling with your family may be even better.

Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!

DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

HOW THE FLU AFFECTS YOUR HEART

When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.

 

An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.

OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.

FLU VACCINATION CAN PROTECT YOUR HEART

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).

References:

  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351

Could Stem Cell Therapy Be the Future of Medicine in Malaysia?

WORDS LIM TECK CHOON

FEATURED EXPERTS
DR LEE TJEN JHUNG
Consultant Cardiologist
National Heart Institute (IJN)
DATO’ DR RAJBANS SINGH
Consultant in Internal Medicine & Geriatric Medicine
President of the Malaysian Wellness Society

Stem cells are a unique type of cell in our body. This is because they are the only type of cells that can develop, under the right triggers and condition, into a variety of more specialized cells, such as blood cells, muscle cells, bone cells, and more.

HOW STEM CELLS ARE USEFUL 
  • Researchers can generate a variety of human cells from stem cells in the laboratory. These cells are then used to test new medications for possible side effects.
  • Research is also conducted on generating healthy cells that can replace those in our body that are dying or damaged due to age or disease. Such use of stem cells is called regenerative medicine.
THE 2 TYPES OF HUMAN STEM CELLS
  • Hematopoietic stem cells (usually abbreviated as HSCs), which are found in cord blood, bone marrow, and peripheral blood
  • Mesenchymal stem cells (MSCs), which as found in the gel-like substance (Wharton’s jelly) of the umbilical cord, bone marrow, fat tissue, and tooth pulp
REGENERATIVE MEDICINE IS THE FUTURE?

Judging from the versatility of stem cells when used to produce of a variety of healthy human cells, regenerative medicine has obvious benefits for people whose tissues are damaged or dying due to diseases as well as people in need of tissue transplant.

Just some of the cells that can be generated from stem cells in the laboratory. Click the image above for a larger version.
Promising for treating heart diseases

Dr Lee Tjen Jhung, a cardiologist affiliated with the National Heart Institute (IJN), says, “While heart diseases are usually treated with medication, angioplasty and by-pass surgery, cell-based regenerative therapy is gaining popularity in the cardiovascular field due to the ability of mesenchymal stem cells to provide new blood in areas affected by restricted blood flow as well as promote the formation of new blood vessels.”

An answer to ageing-related health issues?

Dato’ Dr Rajbans Singh, the President of the Malaysian Wellness Society, points out that stem cells can play a crucial role in treating aging-related health problems.

He elaborates: “At birth, the human body has approximately 80 million active stem cells However, by age 40, less than 25 million active stem cells are functional. Ageing leads to a massive loss of stem cells in the body, affecting the ability of organs and tissues to repair and regenerate as the body gradually ages and deteriorates.”

Here’s a general, simplified overview of how the whole procedure works
  1. Stem cells are grown in a laboratory, and then manipulated to grow and specialize into a more specific type of cells (heart muscle cells, blood cells, etc)
  2. These cells are then implanted into the person that can benefit from this procedure, for example a person with heart disease could be implanted with heart muscle cells, injected into their heart
  3. These transplanted cells will then play a role in repairing and/or replacing the affected damaged tissue or organ of that person.

In reality, the procedure is not so straight forward, as there are many potential complications to take into account.

Nonetheless, the promise of regenerative medicine is too good to resist, hence researchers are continuously looking into creating and fine-tuning various procedures that can hopefully one day reduce or even replace our reliance on medications!

THE STEM CELL CONTROVERSY

There is considerable ethical debate on the use of stem cells that are sourced from fertilized egg cells or embryos that are donated for research.

These days, many centres that offer stem cell therapy claim to source their stem cells ethically—from the umbilical cords of young and healthy women after they have delivered their babies.

In Malaysia, the sourcing and processing of stem cells are governed by the Current Good Manufacturing Practices or cGMP, issued by the National Pharmaceutical Regulatory Agency (NPRA). You can view it here (link opens in a new tab).

Important Things That You Should Know About Silent Heart Attacks

WORDS LIM TECK CHOON

FEATURED EXPERT
DR PATRICK TIAU WEI JYUNG
Consultant Cardiologist
Sunway Medical Centre

Dr Patrick Tiau reveals that silent heart attacks, also known as silent myocardial infarction, account for 45% of heart attacks.

These heart attacks are “silent” because they occur without the usual, recognizable symptoms of a heart attack.

COMMON SYMPTOMS OF HEART ATTACK
  • Chest pain (often described as heavy or pressure sensation)
  • Radiating pain in the arm, neck, or jaw
  • Sudden shortness of breath
  • Sweating
  • Dizziness
HOWEVER, THESE SYMPTOMS ARE USUALLY NOT PRESENT WHEN ONE HAS A SILENT HEART ATTACK!
Because of this, many people may not know that they have experienced one until days or even weeks after.

However, Dr Patrick shares that there are some early warning signs to look out for.

SIGNS THAT YOU MAY HAVE HAD A SILENT HEART ATTACK

It’s good to consult a doctor when you have concerns, especially if you experience these signs and fall under the high-risk below (see below).
  • Feeling tired
  • Indigestion
  • Nausea
  • Sweating.

Dr Patrick says, “We have come across many patients who have dismissed the early warning symptoms as simply feeling tired, indigestion, nausea or sweating. By the time they seek out medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to a reduced blood flow to their heart, and that has caused them to have a silent heart attack.”

Silent heart attacks can lead to more serious health complications if left untreated over an extended period of time, such as an increased risk of another, potentially more deadly heart attack.

COMMON RISKS OF SILENT HEART ATTACKS
RISKS THAT CANNOT BE AVOIDED 
  • Age. The risk increases as we grow older.
  • Gender. Men are more at risk than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
  • Family history. The risk is higher for people with a family history of heart diseases.
RISKS THAT CAN BE MODIFIED 
  • Smoking. Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
  • High cholesterol. Individuals with elevated cholesterol levels can lead to formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.
  • High blood pressure: Having high blood pressure puts extra strain on the heart muscle. Over time, this causes the heart muscle to stiffen, thicken, and perform less optimally.
  • Individuals that are overweight or obese, especially when their weight tends to sit at the waist, are more at risk even if they do not have any other risk factors.
  • Physical inactivity. Doing regular exercise helps protect the heart by keeping under control other risk factors such as cholesterol, blood pressure, diabetes, and obesity.

“Undeniably our heart health is essential to allowing us to have a well-balanced and fulfilling life,” he says. “The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going. In combatting heart attacks, the most important thing to remember is that prevention is definitely better than cure.”

DR PATRICK’S TIPS TO REDUCE YOUR RISK OF SILENT HEART ATTACKS

Make the necessary small changes to daily lifestyle to reduce one’s risk factors. These changes include:

  • Regularly monitor blood pressure and cholesterol
  • Get sufficient exercise
  • Quit smoking
  • Eat a balanced diet of fruit, vegetables, lean meats and whole grains
  • Ensure that one’s blood pressure, cholesterol and blood sugar are well-controlled
  • Inform a doctor as soon as possible about any unusual symptoms that may indicate a silent heart attack

Once you go home from the hospital, it is essential that you keep taking your medications as prescribed. “This will ensure your heart health is kept in check, possibly for the rest of your life,” says Dr Patrick.

Consider joining a support group. Dr Patrick acknowledges that heart attack survivors may start to develop feelings of shock, sadness, and anxiety. This is normal, and these feelings can be managed with the right support.

“Some people find it helpful to join a support group where they can talk with others that have gone through a similar experience or seek out companionship and encouragement through avenues such as the gym, or yoga classes,” he advises.

What Every Parent Should Know about Congenital Heart Defects in Children

WORDS DR CHOO KOK KUAN

FEATURED EXPERT
DR CHOO KOK KUAN
Consultant Paediatrician and Paediatric Cardiologist
Subang Jaya Medical Centre

The most common heart disease among children is known as congenital heart defects.

This condition occurs when the heart or the blood vessels near the heart do not develop normally before birth.

HOW COMMON IS THIS CONDITION?

According to our Ministry of Health, the incidence of congenital heart defects among children is about 8 to 10 per 1,000 live births.

With an average of 500,000 deliveries in Malaysia each year, the number of children born with congenital heart defects is about 5,000 a year, of which two-thirds will require surgical intervention.

THE CAUSES & RISK FACTORS

Most congenital heart defects have no known cause.

They may sometimes run in families.

Some congenital heart defects may be associated with genetic disorders, such as Down syndrome, Turner syndrome, Williams syndrome, etc.

Some children have a higher risk of developing congenital heart defects if the mother has diabetes or rubella, or has taken certain medications such as anti-epileptic drugs, during pregnancy.

DETECTION OF CONGENITAL HEART DEFECTS

Sometimes a heart defect can be diagnosed before a baby is born.

However, defects are usually identified days or even months after birth, when symptoms become obvious.

Less serious congenital heart defects may not show any noticeable signs or symptoms, so they may only be diagnosed later in childhood.

It is also possible to have a heart defect and show no symptoms at all.

POSSIBLE SIGNS THAT A BABY OR YOUNG CHILD MAY HAVE CONGENITAL HEART DEFECTS
  • Rapid breathing
  • Bluish discolouration commonly noticed around the lips, fingernails, palms of the hands, and soles of the feet
  • Shortness of breath during feeding, leading to poor weight gain
  • Poor growth
  • Recurrent lung infection
WILL A CHILD WITH CONGENITAL HEART DEFECTS BE OKAY?

As a result of medical advancements, the outlook for congenital heart diseases is increasingly positive.

Most children with this condition reach their adulthood.

In fact, children with simple conditions may lead completely normal lives, while those with more complex conditions usually face more challenges that can nevertheless be addressed with the right measures in place.

6 THINGS THAT EVERY PARENT OF CHILDREN WITH CONGENITAL HEART DEFECTS SHOULD KNOW AND DO
  1. Heart medications can be very strong and dangerous if not given correctly. Parents must understand how much medicine to give and how to give it. If the child takes a blood thinner, parents must have clear instructions on how to give this medicine safely.
  2. Ensure the child eats well and receives adequate nutrition. They often tire when eating, so they eat less and may not get enough calories.
  3. Prevention of infections is crucial. Although an infection in the heart (endocarditis) is uncommon, children with heart defects have a greater risk of developing this. Good dental hygiene goes a long way toward preventing endocarditis by reducing the risk of tooth or gum infection. Parents can get more information from cardiologist about the latest guidelines on antimicrobial prophylaxis against infective endocarditis. These children must also get all the recommended vaccinations.
  4. Most children with a congenital heart defect can be physically active without restrictions. In fact, children are encouraged to be physically active to keep their hearts fit and to avoid obesity, unless they have a few specific heart conditions.
  5. Emotional support will help children who may have self-esteem issues because of how they look. They may have scars from surgery, and they may be smaller, or have limits on how active they can be.
  6. As children transition to adulthood, parents can gradually teach them about their heart defect and guide them in how to care for their own health without being overly protective.