Heart Attack, Angioplasty and Stenting

Heart Facts and Heartening Trends
“Longer the Belt Line, shorter the Life Line”-Dr V P Nair

Dr. V.P. Nair, MBBS, MRCP (UK), MRCP (Ireland), FRCGP (UK), FRCP (Edinburgh) FRCP (Ireland) FAMS (Cardiology, S`pore) FICA (USA) FACC (USA) FRCP (London)
Consultant Interventional Cardiologist, Mount Elizabeth Medical Centre, Singapore

Heart attack due to Coronary Artery Disease (CAD) is the number one killer in the world.
The recognized risk factors for coronary heart disease are, tobacco smoking, high blood pressure, dyslipidemia, high levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL), diabetes, advancing age, male gender, obesity, family history of heart disease, sedentary life style, chronic stress and in some cases elevated blood homocystine levels.

Basic investigations for the detection of coronary artery disease include history and physical examination, Electrocardiography (ECG), blood tests, urine analysis and chest X-Ray. Special tests such as Treadmill exercise stress test, Echocardiography, 24 hour ECG Holter monitoring, MIBI scan, stress echo, multi-directional computerized tomography – MDCT also known as multi slice CT (MSCT) including coronary calcium score, magnetic resonance imaging or MRI of the heart, and the gold standard Coronary Angiogram are necessary as and when indicated.


Blocked arteries can be treated with medications, bypass surgery, ballooning (angioplasty) or stenting. Newer medications, off pump Coronary Artery Bypass Graft and modern Drug Eluting Stents have revolutionized treatment of coronary artery disease and improved quality of life. The current players in the well-documented drug eluting stents in Singapore are Cordis Cypher Sirolimus drug –eluting stent (Cipher Select, Cypherselect plus) and Boston Scientific Taxus Paclitaxel drug-eluting stents (express, liberte). The other drug eluting stents available are Medtronic`s Endeavour, Abbott`s Zomaxx, Guidant`s Xience everolimus, Concor`s Co Star with a bio reabsorbable polymer, and the endothelial progenior coated Genous stent. The only caveat is that two anti-platelet medications such as aspirin and clopidogril (Plavix) should be continued for six months to one year and often for life following the stent implantation. This can be a real problem when a major surgery is required in the future due to the potential of bleeding due to the usage of the antiplatelet medications. In such a situation, you should always consult the expert. You have to be very careful and adhere strictly with life style modifications such as low fat, low sugar, low salt diet, and regular exercise. You should also continue taking the other relevant medications.


Using sophisticated MRI and other parameters after s a long –term study of 2,744 people with a median age of 45, a group of cardiologists led by Dr. James de Lemos at the University of Texas Southwestern Medical Centre in Dallas USA reported in the prestigious American College of Cardiology on 14 August 2007, that there is a direct relationship between waist size and early indications of heart disease, regardless of patient’s overall weight. I am very delighted at this new scientific statement, as way back in 1992 the Straits Times news paper in Singapore quoted me with my statement of 1992 that apple shaped tummy, the so called pot belly is not appropriate, as fat accumulated in the abdomen can easily find access to the blood stream, whereas fat deposited in the bullocks, the so-called pear bottom has no such access and is comparatively safe. As such, “longer the belt line shorter the life line”(Dr V P Nair 1992). So Let us keep our belt Line within the normal range by diet control and regular exercise.

I invite your comments
Dr V P Nair