When one talks about heart disease, it is often assumed that it is related to coronary artery disease and heart attack. Although it is indeed the most common cause of heart disease in adults, other heart diseases do exist. They are as follows below.

Congenital Heart Disease

Congenital heart disease is caused by birth defects. These abnormalities are usually diagnosed by the attending paediatrician at birth and referred to a paediatric cardiologist. The Paediatric cardiologist would make the initial evaluation using an ultrasound echocardiogram. The cardiologist would then discuss and refer to the cardiac surgeon when surgical treatment is warranted. 

At times, the condition is detected later in childhood during routine preschool health screening or by the family physician as an incidental finding when the child is seen for common illness such as cold and cough. Again, the child will be referred to the paediatric cardiologist for evaluation. Simple holes in the heart can be closed by the paediatric cardiologist with catheter-based devices. Others who require more complex reconstruction would be referred to the paediatric heart surgeon.

Valvular Heart Disease

These are diseases affecting heart valves. In Singapore, these are seen in older individuals and are often due to degenerative process. Rheumatic heart disease which occurs in the younger population is rarely seen in Singapore with its higher living standards, but still seen in developing countries. Again these conditions are detected by the family physician when reviewed for related symptoms or as an incidental finding and referred to a cardiologist. The cardiologist would initially manage and evaluate the valve disease with medication. If the valve disease is significant, the cardiologist will refer to the cardiac surgeon for further management either valve repair or replacement with prosthetic valves. In selected older patients, the valve can be replaced (TAVI) or repaired using catheter-based procedures.

Cardiomyopathy

This is an uncommon disease resulting from progressive weakness of heart muscles. Again they would get referred to a cardiologist who will evaluate and manage with medicine. If the disease progresses, the cardiologist may consider referring the patient to a pacemaker heart specialist. In others where the disease progress to advanced heart failure, heart transplantation or implantation of battery-operated mechanical heart pumps (LVAD) may need to be considered. The cardiologist will refer the patient to specialised team of heart failure cardiologist and cardiac surgeons who would carry out further evaluation and advice on therapy. In obstructive cardiomyopathy, the thickened muscular band within the left cavity of the heart may be obstructive to the blood flow out of the heart. A surgical procedure will be required to excise the obstructive muscular band if indicated. Often the adjacent mitral valve may require repair at the same time.

Coronary Artery Disease

Please refer to the blogs on “Who Is at Risk for a Heart Attack?” and Coronary artery bypass surgery.

Miscellaneous group of heart disease

These are patients with abnormal heart rhythms, high blood pressure, pulmonary hypertension (high blood pressure in the lungs). They are mostly treated with medications. Tumours or growths occurring in the heart are rare and will require surgery.  

Diseases affecting the cardiovascular system

Broadly speaking there are two groups of diseases that affect the blood vessels. They are:

  1. Diseases causing narrowing of blood vessels. They share the same causes of coronary artery disease. They are common in patients having diabetes and smokers. They result in cramps in leg muscles on walking or non-healing ulcers and gangrene in the leg.
  2. Diseases causing dilation of the large arteries such as the aorta resulting in an aneurysm. The risk is that they can rupture spontaneously resulting in exsanguination. Another acute condition is the dissection of the aorta where the blood vessel wall splits due to high blood pressure or ulceration of aorta by atherosclerosis, resulting in sudden onset of pain requiring emergency admission to a hospital and may require emergency treatment, in the form of emergency surgery or implantation of specialised stents.

Please refer to the section on vascular surgery.

Who is a Cardiac Surgeon?

When heart disease or vascular disease cannot be managed adequately by the cardiologist, the patient is referred to the cardiovascular surgeon, who is specialised in reconstructing or repair the heart or blood vessels by surgical operation.

The training of cardiac surgeon is a long, arduous process. It takes about 8 – 10 years of training before a surgeon starts operating independently. The cardiac surgeon also undergoes training in surgery of the blood vessels and lungs. Hence, they are also known as Cardiothoracic and Vascular surgeons. After the broad training, a surgeon may then decide to subspecialise in paediatric cardiac surgery, thoracic surgery or more specialised parts of cardiac surgery in addition to routine heart surgery.

Nowadays most cardiac surgery such as heart bypass surgery, valve surgery can be performed with a very low risk of less than 3% as long as the patient’s heart is not severely damaged. The post-operative recovery is rather rapid and they are discharged within seven days after the surgery. The purpose of the surgery is to get the patients back to an active lifestyle and not to make them a cripple. Most patients are ready to return to work after 3 – 4 weeks.