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heartline Sep 2021 - Nov 2021 Flipbook PDF
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heartline Official Publication of Singapore Heart Foundation
September 2021 - November 2021
FROM HYPERTENSION TO HEART ATTACK: How Survivors Embrace the New Norm
10 ACTIVITIES TO REDUCE YOUR BLOOD PRESSURE
MCI (P) 030/09/2021
患有高血压？ 您也有患上 心房颤动的风险
myheart.org.sg
heartfoundation
HeartSG
singaporeheartfoundation
FEATURE
EDITOR’S NOTE
HYPERTENSIVE?
YOU COULD BE AT RISK OF ATRIAL FIBRILLATION TOO Dear Readers,
EDITORIAL COMMITTEE EDITOR Mr Patrick Deroose MEMBERS Dr Chan Wan Xian Dr Chee Tek Siong Prof Terrance Chua Dr C Sivathasan SECRETARIAT Mr Vernon Kang Mr Teng Chiun How Ms Chng Kheng Leng Ms Samantha Chan Ms Gillian Lim
heartline
a quarterly publication of the Singapore Heart Foundation 9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837 6354 9340 6258 5240 [email protected] The information provided in heartline is for educational purposes only. It should not be used for diagnosing or treating a heart problem or a disease, and should not be substituted for professional health care. Opinions expressed by contributors and advertisers do not necessarily reflect those of the SHF. The SHF does not endorse any products or services in heartline advertisements. All rights reserved. Copyright is held by SHF. No portion of this publication can be reproduced without the permission of SHF. To advertise in heartline, please email [email protected] or call 6354 9340. Terms and conditions apply. Want a copy of heartline delivered to your doorstep or emailed to you? Register on myheart.org.sg, via the QR code or call 6354 9360.
What do earthquakes, nuclear power stations and hypertension have in common? The catastrophic events they bring are almost always preceded by inconspicuously small precursors often ignored at risk. In the control room of a nuclear power station, technicians and engineers watch moving dials intently. Boring, I would say, but these men and women know how a small deviation in the dials can signal a catastrophe. As Edward D Blandford noted in his article “Key Reactor Accidents, Incidents and Anomalies”, the Three Miles Island accident – the United States’ most significant commercial nuclear power plant accident – was a result of engineers’ ignorance of the first signs of an open pilot-operated relief valve (PORV). Small precursors were similarly overlooked in other significant cases, such as the Chernobyl and Fukushima Daiichi nuclear incidents. Precursor incidents are damaging in themselves and point to conditions that could lead to much worse accidents; hence, they must be acted upon promptly and competently. At a glacier near the South Pole, evidence has shown how a small slow motion slip on a glacier can trigger stronger and faster earthquakes many miles away. This is consistent with Grace Barcheck’s findings published in the Science Daily, “We found that there was almost always a precursory slow slip before an earthquake.” Similarly, catastrophic events caused by hypertension such as cerebral bleeding, congestive heart failure, kidney failure and stroke are often forewarned. Their subtle warning signs cannot be ignored and require medical attention. Yet, it is difficult to motivate people to seek help if there are no severe symptoms. My wife passed away due to a ruptured cerebral aneurysm, probably due to uncontrolled hypertension. She had no symptoms and did not seek medical attention. I wish she had the habit of going for checkups every six months. They would have included blood pressure taking and could have prevented her death. I learned my lesson the hard way. With current technology, there is no excuse not to monitor blood pressure closely. Take your prescribed medication regularly, stick to a healthy diet, stop smoking, exercise regularly, recognise the signs of an impending catastrophe and act upon them appropriately. Do not fall into the same trap; for the sake of your loved ones, adopt a heart-healthy lifestyle.
Designed by: Klauss Design Printed by: Drummond Printing Pte. Ltd.
2 // heartline
About 1 in 10 people aged 80 and above suffers from atrial fibrillation (AF). The condition, with risks that increase with age, is expected to affect more in Singapore due to her ageing population. Hypertension, or high blood pressure, exacerbates the problem. Not only is it a common medical condition deeply rooted in our community, hypertension also puts a person at risk of developing AF as it perpetuates its existence and makes management of AF difficult. Get to know AF better and learn its correlation with hypertension to minimise your risk.
Patrick Deroose
What is AF? Atrial fibrillation is the most common heart rhythm disorder where the atria (upper chambers of the heart) quiver instead of pump blood to the ventricles (lower chambers of the heart). Patients with AF may experience unpredictable episodes of fast and irregular heart rhythm, feel tired more easily, and experience chest discomfort and breathlessness. These AF episodes may be transient (called paroxysmal AF) or present all the time (persistent AF).
An electrocardiogram (ECG) recording is typically needed to diagnose AF. Consistent ECG recordings over several days may be required to diagnose paroxysmal AF as these AF episodes are fleeting. Untreated AF may lead to stroke, heart failure and the slowing of heart rate leading to fainting spells.
heartline // 3
FEATURE
How does hypertension lead to AF? Hypertension and AF are significantly related. Both conditions are risk factors of stroke, heart failure and mortality. Approximately 60-80% of people with AF have concomitant hypertension. Hypertension occurs when the blood pressure in the arteries is raised. This causes the heart to pump harder, leading to the thickening and stiffening of the heart muscles. These changes alter the blood pressure measurements within the heart chambers. The affected atrium gives rise to its chamber dilatation and changes its electrical properties. Such changes place hypertensive patients at risk of developing AF. AF can lead to heart failure and stroke When AF occurs, the normal heart rhythm is overtaken by the disrupted electrical
FEATURE
circuits, causing a fast and irregular heart rhythm. The quivering atrium then slow down blood flow and this increases the chance of blood clot formation (thromboembolism). When small pieces of blood clot are pumped out of the heart to the brain, a stroke occurs. The irregular heart rhythm also causes the heart to work less efficiently and may cause the patient to tire easily, feel breathless and even lead to heart failure. Furthermore, hypertension activates the renin-angiotensin-aldosterone system (RAAS) in the body – a system that regulates blood pressure and fluid balance. Excessive activation of RAAS leads to inflammation and oxidative stress, which perpetuates AF and increases the risk of blood clot formation.
An example of an Apple Watch ECG showing atrial fibrillation.
Controlling hypertension and AF The close link between the disease process of hypertension and AF provides opportunities to prevent AF in patients with hypertension. 1. Medication Hypertension treatment that targets the control of the RAAS by using angiotensinconverting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) can reduce the risk of AF. Some medications such as beta-blockers and calcium channel blockers lower blood pressure and can control the fast heart rhythms caused by AF at the same time. Potent blood thinners (anticoagulants) like apixaban, dabigatran, rivaroxaban and warfarin also reduce the risk of stroke in patients with AF. While one of the major side effects of anticoagulation is bleeding in the brain, it is reported to occur in less than 1% of patients. Hence, good blood pressure control is needed to reduce the risk of bleeding, especially in patients with uncontrolled hypertension. Some patients may be prescribed antiarrhythmic drugs (AADs) to restore regular heart rhythm. Suitable patients may undergo catheter ablation for AF as well. It is a minimally invasive procedure that
utilises catheters to melt away abnormal electrical circuits in the atria, thereby restoring normal heart rhythm. 2. Good diet and exercise A healthy lifestyle, with regular exercise and a low-salt and low-fat diet, reduces the occurrence of hypertension. With good blood pressure control, the risk of developing AF and its further complications can be reduced. 3. Health screening If you have hypertension, AF can be picked up during screenings. This can be done during clinic consultations with pulse-taking or an ECG recording. With the advent of wearable ECG watches and devices with an ECG monitoring function, you can also keep a close eye on your heart rhythm beyond a clinic setting. Good blood pressure control continues to be of utmost importance if one develops AF in the presence of hypertension. Having hypertension and/or AF is not a death sentence. One can go on to have a productive and full life by adopting a healthy lifestyle, taking prescribed medications as instructed and having regular reviews with a doctor.
Article is contributed by Dr Teo Hooi Khee, Associate Consultant at the National Heart Centre Singapore; and Assoc Prof Ching Chi Keong, Board member of Singapore Heart Foundation, Director of Cardiac Electrophysiology and Pacing, and Senior Consultant, Department of Cardiology at the National Heart Centre Singapore.
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heartline // 5
FEATURE
FEATURE
FROM HYPERTENSION TO HEART ATTACK:
HOW SURVIVORS EMBRACE THE NEW NORM Hypertension, or high blood pressure (BP), affects slightly less than 1 in 4 adults aged 30 to 69 in Singapore. Often referred to as the silent killer, hypertension can go unnoticed for years with patients displaying few or no signs of discomfort until catastrophe – a heart attack or stroke – strikes. Heart survivors, Ms Christina Yuen (64), Mr Stanley Kwan (55), Mr Tan Boen Hian (73) and Mr Tochi Singh (67), shared with heartline how lifestyle disorders had brought about their hypertension and heart conditions, and how they are coping with a “new norm”. By GILLIAN LIM Photos SAMANTHA CHAN, EILEEN LEE
What was your lifestyle before your heart attack? Stanley: I took oily food like fried chicken once every week. My work was quite stressful and I also neglected my exercise. I found out that I had high BP – about 145 over 90 on average – when I did a health check. I tried to practise Qigong to get active and reduce my BP, but it was insufficient. Boen Hian: I led a rather active lifestyle – I liked to jog and cycle. But I loved eating too: siu yoke (roasted pork belly) at least twice a month and instant noodles twice a week to try out different flavours. And every day after dinner, I would have a scoop of ice cream.
Mr Tan Boen Hian
Tochi: I was a taxi driver on the night shift, so when I got hungry at 2am, I had no choice (but to) eat roti prata, mee goreng, or whatever that was available. That led to me being overweight — I was 110kg at one point. I found out I had hypertension when I went for a medical checkup. My BP was somewhere above 140 (over 90). Christina: I was very occupied with work, so I only exercised occasionally. But I was quite conscious of my diet. When I was hospitalised for an illness in 2014, the doctor also diagnosed that my BP was rather high – above 160 over 90. When did your heart attack occur?
Mr Stanley Kwan
6 // heartline
Mr Tochi Singh
Stanley: It was the last day of 2013 (at age 48). After a feast in the office, I went home for a nap and woke up to find myself breathless and my heart constrained. My cousin drove me to the hospital immediately. Within 15 minutes, I was in the operating theatre for stent insertion. My artery was more than 90% blocked.
it. One night after dinner, I had the same cramp in my arms but this time it did not go away. I measured my BP, and it was very high at about 250 (over 90). My family sent me to the hospital, where I was diagnosed with a heart attack. Doctors managed to insert one stent to the almost 100% blocked artery and later performed open-heart surgery on the other two arteries.
Boen Hian: For about two years before my heart attack, I often felt cramps in my arms when I cycled. As they would usually go away after a short rest, I thought it was just due to my bad posture and I ignored
Tochi: I was walking to the car park when I broke out in a sweat and felt a sharp pain in (my chest). I went to the hospital, and the doctor told me that I had a heart attack. heartline // 7
FEATURE
MYTH & FACTS
3
HYPERTENSION MYTHS YOU SHOULD UNLEARN
Heard a rumour or two on ways you can manage hypertension? We debunk some myths surrounding this silent killer. By GILLIAN LIM
2
Ms Christina Yuen
Christina: I had a minor heart attack during hip surgery. I was shocked. What lifestyle changes have you made since then? Stanley: Exercise is no more an option; it is a must. I also try to refrain from oily food — instead of once a week, I cut down to once a month. Christina: For my hypertension and heart condition, I have to take three tablets daily without fail for the rest of my life. I also have to go for regular checkups, exercise, stick to a healthy diet and manage stress. Cardiac rehab has given me the confidence that it can improve my heart condition. Boen Hian: My present diet is free of grease, no trans fat and sugar reduced. I also joined the Singapore Heart Foundation Heart Wellness Centre to continue with my physical exercises.
MANAGING BLOOD PRESSURE IS A LIFELONG COMMITMENT. Scan QR code to catch this interview in full.
8 // heartline
Tochi: I shortened my working hours, stopped eating oily and deep-fried foods, and stayed away from anything with a lot of salt. What is one piece of advice you would give to anyone? Boen Hian: Going through an open-heart surgery like a bypass is a very traumatic experience in anyone’s life. So, prevent getting into such situations by controlling your diet, taking less salt and sugar, and doing plenty of exercise. Christina: Adopting a healthy lifestyle must start young because hypertension is long-term, and there is no cure. I want to caution ladies that heart disease is one of the top killers of women in Singapore. So stay active, have a heart-healthy diet, go for health screenings and be attentive to the signs and symptoms of heart disease.
Make changes that matter: 1. Eat a well-balanced diet that is low in salt (sodium) 2. Do moderate to vigorous-intensity exercises 150 min a week 3. Maintain a healthy weight 4. Limit alcohol 5. Manage stress 6. Quit smoking
1
A plant-based diet can reverse high blood pressure
FACT: You cannot cure hypertension, but you can manage the condition. While plant-based diets have been linked to lowering blood pressure in several studies, reversing hypertension is another matter. The antihypertensive effect brought about by plant-based diets can be attributed to their high-fibre and low-fat composition. Vegans are also found to consume less sodium than non-vegans – this is especially helpful in lowering high blood pressure. However, while plant-based meals are perceived to be healthy, several factors account for their nutritional value, namely how the meal is prepared – deep-fried or doused heavily in dressing, and the type of ingredient used – refined carbohydrates or processed foods. Thus, though it can be said that a plantbased diet prepared with a healthy method helps lower blood pressure, it cannot reverse hypertension.
Stress-induced high blood pressure is harmless
FACT: Stress can have dire consequences on the heart. In stressful situations, adrenaline hormones are released, causing blood pressure to rise. Additional pressure on the blood vessel walls can make them stiffer and decrease blood flow through the body. These may lead to severe blood clots that can cause blockages in the heart and lungs, especially if one has narrow arteries. Stress can also influence behaviour. Under pressure, one may feel the need to turn to comfort food or engage in risky behaviours like smoking. Over a prolonged period, these behaviours can contribute to a rise in blood pressure and, subsequently, an increased risk of cardiovascular disease.
3
I can stop medication when my blood pressure returns to normal
FACT: Even when blood pressure readings are regulated, one should not stop the prescribed medication unless otherwise advised by a healthcare professional. A normal blood pressure reading could be the effect of medication and various factors. Discontinuing one’s medication may put one at risk of a heart event. Always consult a doctor for medical advice if unsure.
heartline // 9
NUTRITION
Flavourful
SALT SUBSTITUTES
Do you find yourself turning to the salt shaker for just a touch more flavour when cooking? Do you know that when you do that, you could end up consuming more salt than you should?
The daily salt intake of an average adult in Singapore is almost twice the recommended amount of 5g. Instead of going heavy-handed on the salt, add these lesser-known salt alternatives to your cooking repertoire to enhance the flavour of your dish without piling on the sodium and keep cardiovascular disease at bay. By GILLIAN LIM
Mushroom
Surprise! Dried shiitake mushrooms turn into a seasoning packed with umami when powdered. Naturally-occurring glutamate in shiitake gives its rep as a flavour enhancer. Adding it instead of salt to your food reduces sodium content without sacrificing taste.
As crucial a flavour-enhancer as salt but often overlooked, are lemons which work similar magic on your tongue as salt. Like saltiness, acidity increases salivation and makes food more mouthwatering. So a squeeze of lemon juice or a sprinkle of lemon zest or citrus bits is as good as a pinch of salt in enhancing the flavours of meat and seafood dishes.
Garlic
Lemon
These flavourful bulbs hold an onion-like aroma and a distinctive taste, serving a powerful punch when eaten. Add a generous amount of garlic to your soups, sauces and marinades instead of salt for a sodiumfree kick that lingers. There’s also hope for the sodiumladen French fries – simply season with garlic powder instead of salt!
Love it or hate it. Garnish with its dried or fresh leaves (Cilantro) for an extra earthy, lemony flavour. Ground coriander seeds have a similar ability to salt – they accentuate the taste of both sweet and savoury dishes.
Coriander Cinnamon With slightly sweet and peppery undertones, this warm spice is a suitable salt replacement for baked goods. You can also use it to deepen the flavour of curries, roast vegetables, Bolognese sauce or stewed fruit, or add a hint of warmth to cooked oats and lattes. 10 // heartline
heartline // 11
6 WAYS Avoid caffeine or smoking 30 minutes before the blood pressure measurement.
TO GET A MORE ACCURATE BLOOD PRESSURE READING
爱从心开始!
FROM THE HEART Go to the bathroom before taking measurement. A full bladder may cause the blood pressure readings to be inaccurate.
The Singapore Heart Foundation is a non-profit social service agency committed to promoting heart health in Singapore, as well as preventing and reducing disability and death due to cardiovascular disease and stroke. All funds raised will go towards community education, subsidies for cardiac rehabilitation programmes, financial assistance for needy heart patients and CPR+AED training programmes.
Your upper arm should be bare of constrictive, tight-fitting or thick clothing (e.g. sweater).
TAXI
Every $10 allows a Pri 5 student to partake in Blood Pressure Initiative @ Schools.
Every $30 offers 1 session of highly subsidised cardiac rehabilitation
Every $50 provides transport allowance for 1 needy heart patient to visit the hospital for medical treatment and emergency relief.
YES, I WANT TO CONTRIBUTE! Refrain from talking and moving during measurement.
Sit quietly and relax before the measurement.
MONTHLY INTERBANK GIRO DONATION 每月财路捐助 [ ] $50 [ ] $75 [ ] $100 [ ] Other Amount 其他金额 $ Name of Bank & Branch 银行名称和分行
Full Name 姓名 / Company’s Name 公司名称
Take two readings at least 2 minutes apart.
NRIC / FIN / UEN No.
Our/My Name (s) as in Bank Account 姓名（银行户口姓名）
Address 地址
Bank Account Number 户口编号 Address 地址
Telephone No. / HP No. 电话或手机号码 Contact Number(s) 联络号码
I WISH TO DONATE 我愿意捐助 [ ] $50 [ ] $100 [ ] $300 [ ] $500 [ ] $1,000 [ ] $5,000 [ ] $10,000 [ ] Other Amount 其他金额 $ Cheque No. 支票号码 By local crossed cheque made payable to: Singapore Heart Foundation
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* For thumbprint(s), please go to the branch with your identification.
FOR SINGAPORE HEART FOUNDATION’S COMPLETION
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Account No. to be Debited
Donor Reference No. S
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12 // heartline
Our/My Signature(s)/ Thumbprint(s)* (As per bank record) & Date 签名/指印与日期
ED
[ ] VIA ONLINE GIVING.SG (Singapore Heart Foundation)
(a) We/I hereby instruct the Bank to process Singapore Heart Foundation’s instructions to debit our/ my account. (b) The Bank is entitled to reject Singapore Heart Foundation’s debit instruction if our/my account does not have sufficient funds and charge us/me a fee for this. The Bank may also at your own discretion, allow the debit even if this results in an overdraft on the account and imposes charges accordingly. (c) The authorisation will remain in force until termination by the Bank’s written notice sent to our/ my address last known to the Bank or upon receipt of our/my revocation through Singapore Heart Foundation.
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F
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Signature & Name of Approving Officer 签名与日期
We adhere to a very strict policy regarding donor privacy. By submitting this form, you hereby consent to SHF collecting, using and disclosing your personal data for the purposes of processing donations, performing donor related activities, carrying out fundraising appeals and events and submission of donation data to the IRAS for tax deduction computation. SHF is an Institution of Public Character (IPC) and all local donations are 2.5 times tax deductible - subject to changes in law, if any. Please provide NRIC / FIN / Company UEN No. for Tax Exemption.
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身份证 / 外国证件 / 企业登记编号
Golf Asia
Every $120 provides blended CPR+AED training for 2 individuals, increasing the pool of ready-trained responders during cardiac arrests cases to help improve overall community survival rates.
EVENT REVIEW
Postage will be paid by addressee. For posting in Singapore only.
UNDERSTANDING AND MANAGING ATRIAL FIBRILLATION Atrial Fibrillation (AF) is the most common heart rhythm disorder with risks that increase with age – as many as 9% of people over 80 years old suffer from AF. Our recent webinar put this condition in the spotlight, with experts weighing in on early detection, treatment and management of AF to improve outcomes. By ZINNIA LAU
BUSINESS REPLY SERVICE PERMIT NO. 07420
SINGAPORE HEART FOUNDATION 9 Bishan Place #07-01 Junction 8 (Office Tower) Singapore 579837
Not only does AF increase the risk of stroke five-fold, but it can also lead to heart failure and impair quality of life. Worryingly, some people with AF do not display any symptoms, so the condition often goes undiagnosed until they experience life-threatening conditions. In his presentation, Assoc Prof Ching Chi Keong, SHF Board Member, also Senior Consultant of Cardiology and Director of Cardiac Electrophysiology & Pacing at the National Heart Centre Singapore, spoke about the causes, symptoms and treatments for AF, reassuring viewers that AF is not a death sentence.
A SMALL TOKEN FROM YOU CAN MAKE A DIFFERENCE Your support will help us to empower heart attack survivors like Mr Lyou in their quest to regain control over their heart health. Once a professional rally racer during the late 1960s, Mr William Lyou’s life came to a complete slowdown after a sudden heart attack. Reminiscing fondly about his days on the fast lane, he recalled the shock of the episode as it robbed him of his fitness and ability to enjoy his past hobbies such as tinkering with cars. Even worse – it had almost cost him his life. Things started looking up for Mr Lyou after he joined the Singapore Heart Foundation’s Heart Wellness
www.myheart.org.sg
Programme in Aug 2019. Under the care of our in-house physiotherapists who have guided thousands of beneficiaries like himself through exercises tailored to their conditions, Mr Lyou is now making steady progress and is able to jog again for short distances. Additionally, he receives guidance from our in-house dietitian and nutritionist who assist cardiac patients with making hearthealthier choices in their diets. Our highly subsidised cardiac rehabilitation programme empowers beneficiaries with the knowledge to take better care of their heart. Let’s support their journey together.
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SCAN HERE TO DONATE TO SINGAPORE HEART FOUNDATION
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Ms Chan Pui Yee, Assistant Principal Physiotherapist at Singapore Heart Foundation, shared how exercise can decrease the risk of developing AF and its recurrence. Workouts that she recommended for AF patients include aerobic, resistance and flexibility exercises, which are beneficial to the heart.
Mr Eugene Tan, Medical Social Worker at National Heart Centre Singapore, shared about the social implications of AF and the social service agencies that patients and caregivers can approach for support. He also emphasised the importance of self-care to manage the stress that could arise from the challenges patients face.
The webinar, held on 19 Jun 2021 via SHF’s Facebook and YouTube channel, received a total of 1,088 views. Thank you Pfizer Singapore for supporting this webinar. Scan this QR code to catch up on the webinar:
heartline // 15
KEEP ACTIVE
KEEP ACTIVE
10 ACTIVITIES
TO REDUCE YOUR BLOOD PRESSURE Did you know regular physical activity can make your heart stronger? A stronger heart can pump more blood with less effort, thus reducing the force on your arteries, lowering your blood pressure (BP). Here are 10 simple activities* you can do to reduce your BP and more! By SAMANTHA CHAN
YOGA Relieves emotional stress
CLIMBING STAIRS Strengthens your heart and lungs
DANCING Improves balance and strength
BRISK WALKING Eases joint pain
* Check with your doctor or physiotherapist before you embark on any of the activities mentioned. 16 // heartline
DOING HOUSEHOLD CHORES Reduces family stress and builds family bonds
STRENGTH TRAINING Burns huge amount of calories
CYCLING Good for strength and stamina
STRETCHING Increases your flexibility
GARDENING Reduces your stress levels with mindfulness
SWIMMING Increases your heart rate without stressing your body
Scan the QR code for more exercises suitable for heart patients or at-risk individuals:
heartline // 17
ADVERTORIAL
3 BENEFITS OF OATS IN DAILY DIET
Oats are a type of whole-grain packed with vitamins, minerals and antioxidants that prevent inflammation and reduce the risk of cardiovascular disease. Here are 3 benefits of adding oats to your daily diet:
1. Improve cholesterol levels 2. Regulate blood sugar levels 3. Aid in satiety and digestion
Oats are rich in fibre. They contain beta-glucan, a form of soluble fibre that binds to cholesterol and removes them from our body, thus improving cholesterol levels and reducing the risk of cardiovascular disease.
Not only does betaglucan in oats assist with cholesterol management, but it also regulates blood sugar levels and releases a steady source of energy.
Bonus! Oats are easy to prepare. Have them for breakfast by adding milk and topping with fresh fruits of your choice. You can also make oats into a quick snack by blending them with nuts and peanut butter. Give them a mix, chill in the fridge, shape them into small pieces, and these energy bites are ready to be enjoyed!
The fibre in oats helps to slow down digestion and increases satiety, keeping one fuller for longer periods of time. It also helps to increase stool size and bulk and promote regular bowel movements.
Back to Office:
Health and Heart First As Singapore eases into gradual re-opening, workplaces will once again welcome the return of employees working onsite. According to research by Cisco, 97% of workers want a safer office to return to. Here are 3 ways employers can create a healthy workplace to house happy and productive staff. By JOANNE SU
1. Focus on safety Ensuring health and safety in the workplace has always been important before COVID-19. Take a holistic approach and enhance safety practices beyond COVID-19 measures, such as ensuring that your workplace is heart safe too. There are around 6,200 cardiovascular deaths in Singapore every year, with an increasing number classified as workrelated by the Workplace Safety and Health Institute. For example, a worker died at the workplace while carrying out strenuous work that triggered a heart attack. Work Injury Compensation records showed 68 such deaths in 2017, up from 26 in 2012. With these statistics in view, consider what you would do if an employee were to face a life-threatening cardiovascular event such as a sudden cardiac arrest. Appropriate and swift emergency responses matter in these moments. If CPR+AED is applied immediately after a sudden cardiac arrest, the victim’s chance of survival reaches close to 50%. Raise your workplace’s responsiveness to cardiovascular emergencies by installing an Automated External Defibrillator (AED) in highly visible, easy-to-access common areas. Registering your AED in the national AED registry will also increase its visibility to other building occupants and community first responders who use the myResponder
18 // heartline
app. This allows bystanders to retrieve AEDs quickly and help with CPR till emergency medical services arrive. 2. Promote wellness Care for your staff’s mental and physical well-being by offering scheduled breaks for workers to refresh, as recommended by the WSH Council. Company HR teams can also consider introducing weekly exercise programmes before or after work to encourage healthy habits and promote interaction between workmates after a long period of isolation. The Singapore Heart Foundation has easyto-follow workout videos on Facebook and YouTube. All you need is ample space and the right attire! 3. Increase engagement As hybrid work arrangements become more commonplace, workspaces have to create opportunities for interaction and community engagement when all staff are scheduled to work from office. Team building activities can encourage colleagues to get to know one another better and bond closer, creating a positive workplace environment. CPR+AED training is an example of a team bonding activity that combines the above while levelling up the capacity of your staff to be competent in responding to cardiovascular emergencies at work. Scan this QR code to register your AED and increase its visibility at your workplace. heartline // 19
专题
患有高血压？
您也有患上心房颤动的风险
80岁及以上的人群中，约十分之一患有心房颤动(Atrial Fibrillation，AF)简称房颤。 其风险随着年龄增长而提高，预计在人口老化的新加坡会带来更大的影响。而高血压会 加剧这个问题。高血压不仅是长存于我们社群的常见疾病，它也会提高人们患上房颤的 风险。这是因为高血压导致房颤的持续存在，令房颤的管理变得困难。深入认识房颤， 并了解它和高血压的密切关系，能将您的风险降至最低。
何谓房颤？
房颤通常需要心电图 (ECG) 记录来诊断。
房颤是最常见的心律失常，是当心房（心脏
对于房颤短暂发作难以捕捉的患者，则需
的上腔室）颤动却没将血液泵送到心室（心
要连续几天的心电图记录，才能准确诊断
脏的下腔室）。无可预知的房颤发作可能导
阵发性房颤。
专题
高血压如何导致房颤？
变得快速且不规律。接着，颤动的心房会
血压与房颤息息相关。它们都可以能造成
减慢血流，提高了血凝块形成（血栓栓塞）
中风、心力衰竭和死亡。约60至80%的房
的几率。
颤患者伴有高血压。 当小血块从心脏泵出到大脑，就发生中 当动脉里的血压升高时，就会引发高血
风。不规则的心律也会导致心脏的工作效
压。这会导致心脏更用力泵血，进而令心
率降低，并可能导致患者容易疲倦、呼吸短
肌变厚和变硬。这些变化会改变心室内的
促，甚至心脏衰竭。
血压测量值。受影响的心房引起其心室扩 张，并改变其电特性。这类变化使高血压患
此外，高血压会激活体内可调节血压和体
者面临房颤的风险。
液平衡的肾素-血管紧张素-醛固酮系统 (RAAS)。RAAS的过度激活会导致炎症和氧
房颤可导致心脏衰竭和中风
化应激，从而使房颤持续存在并增加血栓
当房颤发生时，正常心律因电信号紊乱，
形成的风险。
致患者出现快速及不规则的心律、胸部不 适、呼吸短促，并更容易感到疲倦等。房颤
未经治疗的房颤可能会导致中风、心力衰
发作可以是短暂（称为阵发性房颤）或持续
竭，以及因心率减慢而引起的昏厥。
存在（持续性房颤）的。
20 // heartline
heartline // 21
专题
专题
心脏病发作后： 幸存者如何发现高血压并接受新常态 本地30至69岁的成年人中，略少于四分之一患有高血压。这个慢性疾病常被称为无声杀 手。由于患者一般只有微不适感或毫无迹象，因此可能多年都没察觉到自己有此病症， 直到心脏病发或中风。幸存者袁女士（64 岁）、关伟雄先生（55 岁）、陈文贤先生 （73 岁）
苹果手表心电图显示心房颤动。
控制高血压和房颤 高血压病程与房颤之间的密切关联，也为
者也可以接受导管消融以治疗房颤。这是
高血压患者预防房颤提供了机会。
异常电路，从而恢复正常的心律。
1. 药物控制
2. 良好饮食及运动
以控制RAAS为目标而使用血管紧张素转换
健康的生活方式、定期运动和低盐低脂肪
酶抑制剂(ACE-Is)或血管紧张素II受体阻
的饮食，可以减少患上高血压的概率。通
滞剂(ARB)的高血压治疗，也可起到降低房
过良好的血压控制，可以降低发生房颤及
颤风险的作用。一些药物（如β受体阻滞剂
其进一步并发症的风险。
和 Tochi Singh 先生（67 岁）与本刊分享，不良生活方式如何导致他们患上高血压和病 发作，以及如何应对劫后余生的“新常态”。
一种微创手术，利用导管来烧断心房中的
和钙通道阻滞剂）可降低血压，同时控制由 房颤引起的快速心律。
3. 定期进行健康检查 如果患上高血压，健康检查时能侦测到房
阿哌沙班、达比加群、利伐沙班和华法林等
颤。这可以通过脉搏测量或心电图记录来
强效血液稀释剂（抗凝剂），也可降低房颤
侦测。随着可穿戴的心电图手表和具有心
患者中风的风险。虽然抗凝治疗的主要副
电图监测功能的设备的出现，您还可以在
作用之一是脑出血，但据报道只发生在不
诊所环境之外密切关注自己的心律。
到1%的患者身上。因此，需要良好的血压 控制才可降低出血风险，尤其是高血压未
患上高血压或房颤或两者，不等于被判了
得到妥善控制的患者。
死刑。通过贯彻健康的生活方式，按照指 示服用处方药并定期接受医生的检查，一
医生也可为一些患者开抗心律失常药物
人还是可以继续充实幸福的生活。
(AAD)，令他们恢复正常的心律。合适的患
本文翻译自新加坡国家心脏中心副顾问张惠琪医生和新加坡心脏基金董事会会员曾志强副教授联合撰写的文章。 曾志强医生也是新加坡国家心脏中心心脏电生理学与起搏主任、心脏病学系高级顾问。
22 // heartline
关伟雄先生
heartline // 23
专题
专题
心脏病发之前，您的生活方式怎么样？ 关：我每星期吃一次炸鸡类的油腻食物。 我的工作压力很大，而且忽略了运动。一 次做健康检查时，我发现血压偏高——平 均约145/90。我试着练气功以保持活跃， 希望降低血压，但还是不足够。 陈：我过着相当活跃的生活方式，喜欢慢 跑和骑脚踏车。但我也爱吃。每月至少两 顿烧肉；每星期两次吃速食面，因此想尝
袁女士
试不同的口味。而每天晚餐后，我都会吃 一勺冰淇淋。
陈文贤先生
Tochi：我是夜班德士司机，每当凌晨2点 么吃什么，别无选择。这导致我超重，曾经 体重达110公斤。我去体检时，发现患上高
油炸食品，远离任何盐量高的食物。
要。我也尽量避免油腻食物；减少到每月
您会给大家什么建议？
一次，而非每星期一次。
陈：对任何人来说，经历这样的心脏绕道 手术是非常痛苦的体验。为避免陷入此类
血压；血压超过140 （舒张压90）。 袁：我忙于工作，只是偶尔锻炼一下。但
袁：依我的高血压和心脏病情况，下半辈
情况，应控制饮食、减少盐和糖的摄入，并
子每天都必须服用三种药，不可中断。我
定期运动。
还必须定期检查、运动、保持健康饮食和
我很注意自己的饮食。2014年我因病住 院，当时医生也诊断出我血压偏高，超过 （舒张压90）。 160
应付压力。心脏复健给了我信心，它可以
袁：贯彻健康的生活方式必须从年轻开
改善我的心脏状况。
始，因为高血压是长期的，无法治愈。我想 提醒女士们，心脏病是新加坡女性的头号
Mr Tochi Singh
关：那是2013年的最后一天（当时48岁）。 在办公室参加聚餐后，我回家小睡一会。 醒来就发现自己气喘吁吁，心脏也收紧
250/90。家人送我到医院，我被诊断出
了。我表弟立即开车送我去医院。15分钟
心脏病发。医生设法将一个支架插入几乎
内，我就进入手术室进行支架植入。我的
100%阻塞的动脉，随后对另外两条动脉进
动脉阻塞超过90%。
行心脏绕道手术。
陈：在我心脏病发前两年左右，我骑脚踏
Tochi：当时我正走向停车场，突然冒出一
车时经常感到手臂抽筋，但休息片刻后症
身冷汗，感觉（胸口）剧痛。到医院，医生说
状就会消失，我以为这只是因为自己姿势
我心脏病发了。
不妥，所以就没多加留意。某天晚餐后， 我的手臂又出现同样的抽筋情况，但这次
袁：我在进行髋关节手术时，出现轻微的
它没有消失。我量了血压，非常高，约为
心脏病发。我很震惊。
24 // heartline
Tochi：我缩短了工作时间，不再吃油腻和
关：运动不再是一种选项，而是一种必
肚子饿时，我只能吃印度煎饼、炒面，有什
您何时心脏病发？
从那时起，您在生活方式上做出了哪 些改变？
陈：我现在的饮食不含油脂，没有反式脂
杀手之一。因此应保持活跃、坚持有益心
肪并减少糖分。我还加入了新加坡心脏基
脏的健康饮食、进行健康检查并留意心脏
金的心脏复健中心，继续进行体能锻炼。
病的迹象和症状。
控制血压是一项 终生的承诺。 扫描QR码，观看 完整采访视频。
作出重要的改变 1. 坚持低盐 （钠）的均衡饮食 2. 每星期做150分钟中等至高强度运动 3. 保持健康体重 4. 限量饮酒 5. 管理压力 6. 戒烟
heartline // 25
破解迷思
破解迷思
HEART TRUTHS
厘清高血压
1 IN 2 SINGAPOREAN adults HAs BORDERLINE HIGH TO HIGH BLOOD CHOLESTEROL. *
三大误区
关于控制高血压的谣言，您听说过多少？ 这期我们来破解围绕这个无声杀手的一 些误区。
2
压力引起的高血压没有危害。
真相: 压力能对心脏产生严重的后果。在压 力大的处境中，肾上腺素会被释放，致使 血压升高。血管壁上的额外压力会使它们 变硬，造成身体的血流量减少。这些可能 导致严重的血栓，进而造成心脏和肺部阻
1
IT DOESN’T MATTER IF YOU ARE YOUNG OR OLD.
植物性饮食可以逆转高血压。
真相: 高血压无法治愈，但可以受到控制。
压力也会影响行为。在压力下，人们可能
虽然有几项研究显示植物性饮食与降低血
不自觉移情于未必健康的美食，或沉溺于
压有关，但这不等同于逆转高血压。
吸烟等危害心脏健康的高风险行为。久而 久之，这些行为就会导致血压升高，进而
植物性饮食带来的抗高血压效应，可归因
High blood cholesterol is a risk factor in the development of coronary heart disease.
Consuming 2 grams of Plant Sterols daily can help reduce your cholesterol levels. Drink MARIGOLD HL Milk with Plant Sterols for a heart-friendly diet and enjoy the same delicious milk that is high in calcium and protein and low in fat and lactose.
MARIGOLD HL Milk. The Perfect Balance of Highs and Lows.
*Source: Ministry of Health, National Health Survey 2010
26 // heartline
增加患心血管疾病的风险。
于它们的高纤维和低脂肪成分。另外，素 食者亦比非素食者摄取更少的钠——这对 降低高血压特别有帮助。然而，虽然植物性 膳食被认为是健康的，但其营养价值仍取
Plant Sterols have been proven to lower blood cholesterol.
塞，这对于动脉狭窄的人士尤为明显。
3
当血压恢复正常时，我可以 停止服药。
决于几个因素，比如膳食的制备方式——
真相: 即使血压读数受到调节，仍不应停止
油炸或掺入大量调味品；以及所用食材的
服用处方药，除非医疗保健专业人员另有
类型——精制碳水化合物或加工食品。
建议。正常的血压读数可能是药物和各种 因素带来的效应；停药可能使某人面临心
因此，虽说以健康方式制备的植物性饮食
脏病发的风险。如有疑虑，请务必咨询医
有助于降低血压，但仍无法逆转高血压。
生以获得医疗建议。
RECIPE
RECIPE QUIZ
Chapati with cucumber yoghurt dip 印度麦饼配黄瓜酸奶蘸酱 INGREDIENTS CHAPATI Atta flour
200g
Lower sodium salt
¼ tsp
Warm water
120ml or to desired dough texture
Olive oil CUCUMBER YOGHURT DIP Preparation time 准备时间 : 50 min
½
Chilling time for Yoghurt Dip 酸奶蘸酱的冷藏时间: Min. 2 hours
Japanese cucumber (peeled, seeded and thinly sliced) Greek yoghurt
25g
Serves 分量: 4
Fresh calamansi juice
½ tbsp or to taste
NUTRIENTS PER SERVING 每份营养
Fresh mint (chopped)
2 tsp
Medium-sized tomato (juiced and diced)
½
Cooking time 烹饪时间: 20 min
CHAPATI 印度麦饼 Energy 能量
179kcal
Protein 蛋白质
5.3g
材料
Fat (Saturated Fat) 脂肪(饱和脂肪)
0.8g (0.2g)
印度麦饼
Carbohydrate 碳水化合物
37.7g
Sodium 钠
18.16mg
Dietary Fibre 膳食纤维
5.2g
CUCUMBER YOGHURT DIP 黄瓜酸奶蘸酱
阿塔面粉
200克
较低钠盐
茶匙
温水
120毫升或依据
所需的面团质感
橄榄油
Energy 能量
14.8kcal
Protein 蛋白质
1.1g
Fat (Saturated Fat) 脂肪(饱和脂肪) Carbohydrate 碳水化合物
0.2g (0.1g)
日本黄瓜 半根 (去皮、去籽并切成薄片)
2.3g
希腊酸奶
25克
新鲜桔子汁
Sodium 钠
10.1mg
半汤匙或依据 口味
Cholesterol 胆固醇
0.3mg
新鲜薄荷(切碎)
Dietary Fibre 膳食纤维
0.3g
中等大小的番茄 (榨汁和切丁)
2茶匙 半个
28 // heartline
黄瓜酸奶蘸酱
METHOD Forming the dough 1. Sieve the atta flour, and add warm water and lower sodium salt. Mix and knead the mixture to form a soft dough. 2. Use a damp cloth to cover the dough and let it rest for 20 minutes.
做法
Making the dip 3. While waiting, mix the cucumber, greek yoghurt, calamansi juice and fresh mint together. 4. Add the freshly juiced tomato juice and diced tomato into the mixture and mix well. 5. Place the mixture into the fridge to chill for at least 2 hours or overnight. 6. Add some diced cucumbers, tomatoes, and a small stalk of mint to the dip as garnish.
蘸酱
Rolling of dough 7. Clean the table top or work top, and spread some flour on the surface to prevent the dough from sticking to the surface. 8. Divide the rested dough into 4 portions. 9. Coat the individual dough with some atta flour before rolling them into circles of 15cm diameter. 10. Coat the rolled pieces of dough with some atta flour on both sides to prevent them from sticking to one another. Cooking of dough 11. Heat up a non-stick pan, and spread some olive oil evenly on the pan. 12. Place the dough on the heated pan and wait till large bubbles form on the chapati. 13. When bubbles are formed, flip the chapati and cook the other side for 30 seconds. 14. Wait for brown spots to appear at the bottom, and turn it over again. 15. Remove any air bubbles that are formed during the process. 16. Keep flipping the chapati until you obtain your preferred colour. 17. Serve with the cucumber yoghurt dip. Enjoy!
制作面团 1. 将阿塔面粉过筛，加入温水和较低钠盐。 混合并揉捏混合物，形成柔软的面团。 2. 用湿布盖住面团，静置20分钟。
3. 等待期间，将黄瓜、希腊酸奶、桔子汁 和新鲜薄荷混合在一起。 4. 将鲜榨的番茄汁和番茄丁加入混合物 中，搅拌均匀。 5. 将混合物放入冰箱，冷藏至少2小时或 过夜。 6. 在蘸酱中加入一些黄瓜丁、番茄和一小 株薄荷作为装饰。 擀面团 7. 在清洁的桌面或工作台撒一些面粉以防 止面团粘着表面。 8. 将醒发好的面团分成4份。 9. 先涂一些阿塔面粉在个别面团上，再将 面团擀成直径为15公分的圆圈。 10. 将擀好的面团两面都沾上面粉，以防止 互相粘着。 煮面团 11. 加热不粘锅后，在锅面均匀地涂抹一些 橄榄油。 12. 将面团放入热锅。 13. 当气泡在印度麦饼形成时，翻转并将另 一面烹煮 30秒。 14. 待底部出现褐色斑点时，再次翻转。 15. 去除在此过程中形成的任何气泡。 16. 继续翻转印度麦饼，直到它呈现您所满 意的颜色。 17. 配黄瓜酸奶蘸酱一起享用！
Tip! You can also choose to air-fry the dough at 180˚C for 3 min per side. 提示！您也可以选择使用气炸锅以180˚C烘烤面团，每面3分钟。
heartline // 29
ADVERTORIAL
ACTIVITY
THE POWER OF PECANS This tiny but mighty nut holds more than just a crunch – they boast a long list of essential nutrients. Here are reasons why pecans are elite. Top of its class
Pecans are ranked among the most nutritious nuts. Not only are they packed with good fats, fibre, and different vitamins and minerals, they are supercharged with antioxidants that can protect the body from oxidative stress and inflammation commonly associated with chronic diseases.
Rich in fibre
A handful (~30g) of pecans is just the right amount to satiate hunger while maintaining a healthy and balanced diet. In addition, fibre is known to promote digestive health and this handful of pecans, containing 3g of fibre, is all that's needed to fulfill 10% of our recommended daily fibre intake.
Fights cardiovascular disease
These fibrous nuts also contain high amount of good fats known as monounsaturated and polyunsaturated fat. Incorporating good fats and fibre into your diet helps lower bad cholesterol (LDL-cholesterol) in our bodies, thus reducing our risk of cardiovascular disease.
Help Hugo Defeat the Salt Monster Add some colour to this page and seek out the list of healthier salt alternatives. Make this your shopping list the next time you visit the supermarket!
Tip! Choose unsalted, raw or baked pecans with no added sugar, salt and flavouring for maximum enjoyment of this natural goodness! Reach for a handful of pecans for a satisfying snack or toss them into your breakfast oats, yoghurt and salads for that extra crunch!
L M X R A X E V UW F N T N H UO F H B I S E MC R Y MH T QD J Y D K J A S I T N I MO P S A I O R I AND Y R Y T U N I F E C F Y N I Z NM E Q E UGU B L T Q F O K S E I M U S H R OOM Y N T E AM S X F X R Y W BW I QN S P Y Z B N XOR RMU HC I U T Y K OR K E L P R E OH P E L F L AA T V N E J R Y O I WQ P N L I A G I K Y N M D I O L F E S U J T E Y L CNCAC F D E C X C ORW L R AG T P U B N K Y AC E E H N U K R E K NAOA P Q L I S A B Z U R T F C T R E G L Z N X E F N A U V PWD F MV E MD S GA A Y O R O S E MA R Y Z A B D L E T B A S N L N Y U I K CN P S A T G T F L GW U K D V O X B L A C K P E P P E R Y Y R E G N J A D S H T QM J UW T I P H J F D
LIST OF WORDS: Garlic Black Pepper Rosemary Coriander Mushroom
Cayenne Pepper Oregano Basil Kelp Mint
Complete this word search to win a copy of Your Heart Matters by Dr Mak Koon Hou and Louisa Zhang.
Fun fact Did you know that pecans have taken trips to the moon? They made their debut during the Apollo 161 space mission and quickly became the astronauts’ snack of choice thanks to its ability to stay fresh and be eaten in space. Smithsonian National Air and Space Museum https://airandspace.si.edu 30 // heartline
Y E P L J A V ROA N Y
ANSWERS TO NUTRITION QUIZ IN JUN-AUG ISSUE 1. 4 tsp 2. 3.5 tsp 3. 10 tsp
4. 7 tsp 5. 5 tsp 6. 8 tsp
5 copies to give away!
Simply email/fax this page to [email protected] / 6258 5240 by 30 Nov 2021. Name: ______________________ Email: ____________________ Mobile: _______________ All winners will be notified via phone or email. Good luck! Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 Sep 2021.
1
heartline // 31