Diagnosis And Treatment Of Coronary Heart Disease in Singapore

Coronary heart disease (or ischemia heart disease) is a common condition in Singapore. This happens when your coronary artery becomes too narrow or completely blocked. There is then a reduced amount of blood flow to your heart muscles. Over time it can lead to a more serious condition like heart failure. In this article, we will explore the diagnosis and the options for the treatment of coronary heart disease in Singapore.

Diagnosis Of Coronary Heart Disease

During diagnosis, a medical practitioner will do a thorough checkup on your body and heart. Commonly, they will ask you about your family history and your medical history to gain more detailed information about you. The doctors suspect coronary heart disease, they will also run some diagnostic tests on your heart. The test that they will run on you can be different from those conducted for another patient, because it will depend on the symptoms that you are showing. Common tests that they may conduct on patients include:

Electrocardiogram (ECG)

This is a quick and painless test, to measure the electrical activity on your heart. It is performed to identify if there is an abnormal heartbeat, or if there is damage to your heart muscle.

Exercise Treadmill Test

An exercise treadmill test (also called “exercise stress test”) gives doctors broad information about how well the heart copes with exercise. It can help detect underlying problems that are not present during resting ECGs. During exercise, our muscles require more oxygen – this causes the heart to pump more blood. This test can show if the exercise caused any reduction in blood supply to the heart or any abnormal heart rhythms.

Stress Echocardiography

Exercise stress echocardiography combines exercise stress testing with echocardiography. Echocardiography (often called an “echo”) is a non-invasive imaging technique that uses ultrasound waves to create detailed images of the heart. This procedure helps doctors evaluate the heart’s structure and function, including its chambers, valves, and blood flow.

During an exercise stress echocardiography, echocardiographic images of the patient’s heart is taken both before, and after controlled exercise. By comparing the “before” and “after” images, the doctor can ascertain the heart’s response to physical exertion and determine if there is any reduction in blood flow to the heart.

For patients who are unable to undergo exercise on a treadmill, an alternative test is Dobutamine stress echocardiography. This test combines an echocardiogram with the use of a medication called dobutamine. Dobutamine is used to increase the heart rate in placed of actual exercise on a treadmill. This test similarly helps to determine any abnormalities or limitations in the blood supply to the heart muscle.

CT Coronary Angiogram

A CT coronary angiogram is a specialised imaging test that, unlike traditional coronary angiography, uses computed tomography (CT) technology to visualise the coronary arteries. It involves injecting a contrast dye into the bloodstream, which makes the arteries visible on the CT scan. This non-invasive procedure helps doctors detect and evaluate blockages, narrowing, or other abnormalities in the coronary arteries that can lead to heart disease.

Coronary Angiography 

This procedure is carried out to help the doctor to visualise your coronary arteries (blood vessels that supply blood to the heart muscles). This is needed as the heart appears as a silhouette on ordinary x-rays and the coronary arteries cannot be seen. During coronary angiography, a small tube (catheter) is inserted via a large artery in the groin or in the wrist. The catheter is then advanced to the heart and positioned at the openings of the coronary arteries. A special dye is injected through the catheter to aid visualisation. The catheters will be removed after the procedure.

Coronary Heart Disease Treatment – What Are The Options?

There are a number of effective coronary heart disease treatment options available, ranging from lifestyle changes to advanced surgical procedures. This article explores the various treatments, when they are used, and their associated costs in private healthcare in Singapore.

1. Lifestyle Changes and Medications

For many patients, the first line of coronary heart disease treatment involves lifestyle modifications and medications. These are typically recommended for individuals with mild to moderate coronary heart disease, or as a preventive measure for those at risk.

• Lifestyle Changes: Adopting a heart-healthy diet, engaging in regular exercise, quitting smoking, and managing stress can significantly improve heart health. These changes help reduce cholesterol levels, lower blood pressure, and prevent further plaque buildup.
• Medications: Commonly prescribed medications include statins (to lower cholesterol), beta-blockers (to reduce heart rate and blood pressure), and aspirin (to prevent blood clots). Other drugs, such as nitrates, may be used to relieve chest pain (angina).

When are These Treatments Used: These treatments are often the first step for newly diagnosed patients or those with early-stage coronary heart disease.

Cost in Singapore: Medications may range from S$50 to S$300 per month, depending on the type and dosage. Lifestyle changes, while cost-effective, may require additional expenses for dietitians or fitness programs.

2. Angioplasty And Stenting

When medications and lifestyle changes are insufficient, more invasive procedures like angioplasty and stenting may be recommended. This coronary heart disease treatment is ideal for patients with significant blockages.

• Procedure: During angioplasty, a thin tube (catheter) with a balloon at its tip is inserted into the blocked artery. The balloon is inflated to widen the artery, and a stent (a small mesh tube) is often placed to keep the artery open.
• Benefits: This minimally invasive procedure improves blood flow to the heart and relieves symptoms like chest pain.

When Is This Treatment Used: Angioplasty is typically performed when blockages are severe but not extensive enough to require bypass surgery.

Cost in Singapore: In private healthcare, angioplasty with stenting can cost between S$15,000 and S$30,000, depending on the complexity of the procedure and the type of stent used.

3. Coronary Artery Bypass Grafting (CABG)

For patients with multiple or severe blockages, Coronary Artery Bypass Grafting (CABG) is often the most effective coronary heart disease treatment. This surgical procedure involves creating new pathways for blood to flow around the blocked arteries.

• Procedure: A surgeon uses blood vessels from another part of the body (usually the leg, arm, or chest) to bypass the blocked arteries. This restores normal blood flow to the heart.
• Benefits: CABG is highly effective for severe coronary heart disease and can significantly improve quality of life and longevity.

When Is This Treatment Used: CABG is recommended for patients with multiple blockages, left main coronary artery disease, or those who have not responded to other treatments.

Cost in Singapore: In private hospitals, CABG may cost between S$30,000 and S$50,000, depending on the number of bypasses required and the patient’s overall health.

Choosing the Right Treatment

The choice of coronary heart disease treatment depends on the severity of the condition, the patient’s overall health, and their preferences. Early diagnosis and intervention are crucial for better outcomes. In Singapore, private healthcare offers access to state-of-the-art treatments, but costs can be significant. Patients are advised to consult with a cardiologist to determine the most appropriate and cost-effective treatment plan.

Learn More: How To Choose The Best Cardiologist >>

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