Cardiology Archives

According to the World Health Organization, every year 17 million people  globally die from cardiovascular diseases, particularly heart attacks and strokes. It has been projected that by the year 2025, about 1.56 billion people worldwide will suffer from high blood pressure or hypertension. One in four persons will be afflicted by hypertension and that is alarming.

Hypertension is a common and serious medical condition that can lead to many health problems such as stroke, coronary heart disease, kidney and heart failures. More disturbing than the figures is the fact that these lethal medical problems sometimes show no symptoms.

Normal blood pressure pushes our heart to our body so it can receive the oxygen and nutrients required. The pressure rises and falls during the day, but when it stays elevated over time, it is called high blood pressure or hypertension. The common approach in managing hypertension is by using clinical blood pressure readings, but this is not always accurate and can lead to a false sense of security. A seemingly healthy person can suffer from arrhythmia, a condition in which the heart beats with an irregular or abnormal rhythm and an ECG may not pick it up.

The devices and systems that physicians used in laboratories and hospitals to manage hypertension do not provide accurate readings of the blood pressure and may not detect any form of arrhythmia. They are also expensive (US$30K to US$40K) and beyond the reach of general practitioners.

A doctor from Singapore, who was frustrated with the limitations of the existing clinical measuring equipment, decided to conduct intensive research and came up with an innovative watch-like device, BPro, that can be used in a clinical setting.

BPro

Dr TING Choon Meng, CEO of HealthSTATS International, invented this device that monitors blood pressure and can predict and prevent sudden heart attack and stroke. This has caught the interest of doctors and researchers worldwide.

BPro is a revolutionary device that provides the medical practitioners and researchers alike with unprecedented capabilities in acquiring highly reproducible & accurate real time arterial pulse wave data and 24-hr Ambulatory Blood Pressure Monitoring [ABPM]. These breakthroughs are achieved both by innovative hardware design and an application software, A-Pulse Casp, also developed by Dr. Ting.

The software was tested and validated in three separate clinical trials involving 12,000 patients. The only other way to get such measurements is by inserting a catheter into the groin.

With its ease of use and integrated application software packages it has the potential to become the standard for medical care for hypertension and related illnesses.

Unlike other methods available in the market, the BPro does not restrict movement or disrupt sleep. It is the only device in the world that takes a person’s blood pressure without the wearer being aware of its presence.

BPro has won numerous international awards and received accreditations from European CE-MDD Mark, FDA, China, Australia and New Zealand agencies.

Major healthcare establishments in many countries are either testing or  using the BPro.  High profile patients, including celebrities, politicians and royalties who prefer to remain anonymous are also using this device.

Dr Ting has developed two scaled-down models, the US$2,700 A-Pulse CasPro, meant for GP clinics, and the US$350 A-Pulse CasPal, for patients to use at home. These two devices have just been approved by the United States Food and Drug Administration.

A-Pulse Casp

The A-Pulse Casp is being used in a study of 1,200 pregnant women at the KK Women’s and Children’s Hospital in Singapore.

The trial aims to track the health of both mothers and babies – from the time they are in the womb, and as they develop and grow.

The objectives of the study are to uncover better ways to prevent and treat metabolic diseases such as obesity and Type 2 diabetes and to establish the normal central blood pressure ranges during pregnancy.

In another large-scale trial in USA, 50,000 Americans will use these devices, to track how the measurements are associated with diabetes.

The American company, Save 1 Heart, will buy 100 of the machines for use in the diabetes trial, as well as others on thyroid and heart disease.

‘We ran various trials and found it was a world-leading device recommended by top doctors,’ said Mr Isaac Casados, founder of Save 1 Heart.

Richard Ryckoff, a retired American living in Phuket, is enjoying life in the Thai resort. He spends his time doing his favorite pastime, cycling and reading. Then recently he felt breathless even when not exercising.

He consulted a cardiologist and the initial prognosis wasn’t positive. He got in touch with my American partner Planet Hospital and within a week he was in Singapore for medical treatment.

He went through a number of tests at the National University Hospital under the supervision of A/Prof Theo Kofidis, a specialist in minimally invasive surgery for heart valve. Richard was told he may need a mitral heart valve replacement but luckily Prof Kofidis managed to repair his valve without replacement.

After staying at the ICU for 3 days and another week at the normal ward, Richard was discharged and went home to Phuket today.

prof-kofidis-examining-richard1 me-prof-kofidis-and-richard

Prof Kofidis examining Richard                     Myself, Prof Kofidis and Richard

before discharge from hospital

Every year about 200,000 patients in the United States need a new heart valve because they have severe aortic stenosis. This is a condition in which the aortic valve starts to narrow and affect the efficient flow of blood from the heart to the other parts of the body. This can lead to congestive heart failure and sudden death.

Open-heart surgery is a very common procedure for such heart patients. However for some who are too old, too sick or may have had chest surgery before, this is not the option.

A less invasive procedure is now available for these patients. The doctor has to mount a valve on a catheter and then insert it into the patient’s groin or chest and thread it towards the heart.

heart-valve-surgery-minimally-evasive1

This technique does not require stopping the heart and placing the patient on a heart-lung bypass machine, so weaker or sicker patients can endure the procedure. Without valve replacement, the life expectancy of patients with severe aortic stenosis is typically less than five years.

This two-hour procedure to replace the damaged aortic valve with a ‘stent-supported valve’ was pioneered in France in 2002.  In February 2009, Singapore became the first country in Asia to perform it.

Since then, five elderly patients have undergone this procedure at the Singapore General Hospital’s National Heart Centre. This treatment is recommended only to patients who have no other options or who are suffering from narrowed-valve symptoms like chest pain and breathlessness.

This procedure is still relatively new and how long the valve will last and the long term effects are still unknown. Comparatively the synthetic valves used in conventional open-heart surgery lasts 10 to 20 years.  For this reason, the hospital is not promoting the procedure to younger patients and those who are eligible for standard surgery.

There are also risk factors and a patient undergoing such procedure can die from a punctured blood vessel.

The success rates for this transcatheter technique in USA and Europe have been reported to be 90%.

The conventional valve costs about US$3000 while the new valve is almost 10 times more, though this is expected to be reduced in time.

With an ageing population in Singapore, the heart centre expects to treat an increasing number of patients with valve problems.