March 2016 - May 2016

MCI (P) 084/10/2015 fb.com/heartfoundationmyheart.org.sg twitter.com/heartSG Heart4Life

Cardiology for the Layman #1Heart Murmur

03

新加坡心脏基金-爱心辅助金

12

20

Official Publication of the Singapore Heart Foundation

A woman’s heart attackcauses & symptoms

may differ from a man’s

PATRONESM Goh Chok Tong

NATIONAL HEART COUNCIL

PRESIDENTDr Richard Hu

VICE PRESIDENTSMr Sat Pal KhattarMr Lee Koon ChoyMr Shaw Vee Meng

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 45TH

BOARD OF DIRECTORS

CHAIRMANProf Terrance Chua

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee-Chew

HONORARY SECRETARYProf Tan Huay Cheem

ASSISTANT HONORARYSECRETARYMr Goh Chiew Seng

HONORARY TREASURERMr Chong Chou Yuen

MEMBERSDr Chee Tek SiongMrs Elsie FohDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeA/Prof May LwinDr Mak Koon HouMr Peter SimDr C SivathasanMr Melvin Yap

SPECIAL ADVISORMr Tan Boon Chiang

HONORARY ADVISORSProf Koh Tian HaiMr Liak Teng LitMr Lim Soon HockA/Prof Lim Yean TengDr Lily NeoMr Tan Kin LianMr Wong Yew Meng

EDITORIAL COMMITTEE

EDITORMr Patrick Deroose

MEMBERSProf Terrance ChuaDr Chee Tek SiongDr C Sivathasan

SECRETARIATMr Vernon KangMs Stephanie HoMs Mabel Tang

2 Editor’s Note

heartline is a quarterly publication of the Singapore Heart Foundation.9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg

The information provided in heartline is for educational purposes only. It should not be used for diagnosingor 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 info@heart.org.sg or call 6354 9340. Terms and conditions apply.

Want a copy of heartline delivered to your doorstep? Call 6354 9340 for a copy of the subscription form.

Designed by: Vacain Design Pte Ltd • Printed by: Print & Print Pte Ltd

Patrick Deroose

DEAR READERS,

I recently moved to France and it has been an interesting experience. Three weeks ago, I tried looking for a barber shop because of a much needed haircut but I was unable to find one, not even with my best French. All the “coiffeurs” were unisex.

Paris claims to be the world’s fashion capital.During my recent stay, I noticed a trend - some of the latest fashion collections were gender fluid, combining both male and female elements. There seems to be a convergence taking shape in the fashion scene. Slowly but surely, genderless labels are popping up. Slogans such as Utilitarian, Uniform and Unisex used by some startup companies, remind me of the Chinese Communist Party’s grey pantsuit in 1949 (rarely seen nowadays, except during the Pyongyang Fashion Week).

This made me think how differently medicine is evolving. With the rapid development in genetics, we are moving in the opposite direction towards a personalised diagnosis and treatment plan. This trend has nothing to do with gender equality, but it recognises that each of us is unique. "Mass customisation" of medicine is where tailor-made prevention plans can be carved out for each individual. I would love to see the day that this becomes a reality.

Today, we have to rely on a less futuristic approach to prevent cardiovascular disease (CVD). But even in the future, the risk factors of CVD

will prevail. Hence, the Singapore Heart Foundation remains committed to help everyone stay heart healthy and at

the same time, embrace new scientific developments when they become a reality.

3Feature

What are innocent (or functional/physiological) heart murmurs?

These murmurs are usually due to an increase in blood flow velocity through a perfectly normal heart or blood vessels. Certain conditions such as anemia, fever, during or immediately after an exercise, pregnancy, hyperactive thyroid gland or a healthy child can cause a change in the blood flow velocity. In such conditions, the heart and its surrounding structures are perfectly normal. No treatment for the heart is necessary, however the underlying conditions such as fever and hyperactive thyroid gland have to be investigated and treated accordingly. These innocent heart murmurs are commonly present in most healthy children. Similarly, no treatment or further investigation is needed for the heart if the doctor is convinced that the murmurs are innocent.

What are pathological heart murmurs?

These murmurs are a result of defective heart valves, an abnormal connection between the right and left heart chambers or an abnormal conduit between the heart and its surrounding structures. As such, the doctor may need to conduct some investigations to ascertain the underlying cause, its severity and net effect on the overall heart function. The patient may require a follow-up and treatment, depending on the three factors listed earlier.

Hole in heart

Ultrasound of the heart

Mitral valve prolapse

Article contributed by Dr Chee Tek Siong

Cardiology for the Layman #1

HeartMurmur

When a doctor informs his patient that he has heard a heart murmur, the patient or the patient’s

parents/guardian will feel uncomfortable or frightened almost immediately at the mention of this “heart disease”.

Examples of pathological heart murmurs

1. Defective heart valves: a) Congenitally defective (e.g. bicuspid aortic valve, mitral valve prolapse); b) A result of our aging process (e.g. aortic sclerosis); c) Infection (e.g. rheumatic fever or infective endocarditis), or d) Secondary to systemic illnesses (e.g. rheumatoid arthritis, syphilis).

These valves are either unable to close (regurgitation), open normally (stenosis), or a combination of both.

What is a heart murmur?

A heart murmur is an unusual sound heard during a heartbeat. This is due to a rapid (sometimes turbulent) flow of blood through the heart chambers, heart valves or connection conduit between the blood vessels or a blood vessel and a heart chamber. Heart murmurs can be either innocent (sometimes also known as functional or physiological murmurs) or pathological.

1970 Singapore National Heart Association (SNHA) was formed under the Chairmanship of the late Mr Tan Boon Chiang,

on 6th April 1970.

4 Feature

2. Abnormal connection between the right and left heart chambers (e.g. atrial septal defect, ventricular septal defect) are usually congenital in origin. The defects may be simple, complicated or multiple in a person.

3. Conduit connection between the heart chamber and the surrounding blood vessel or between two blood vessels (e.g. coronary arteriovenous fistula, patent ductus arteriosus) are also congenital in origin.

What to expect if there are heart murmurs?

If your doctor is certain that the heart murmurs are not due to an underlying heart problem (i.e. innocent murmurs), then no treatment or further investigation is necessary. The child or the patient can lead a normal life and no restriction on physical activity is needed.

Sometimes, when the doctor is less certain, he may conduct some of the following investigations, such as a chest X-ray, electrocardiogram (ECG), echocardiogram, exercise stress test, 24-hour ECG monitoring, computerised tomographic (CT) scan or cardiac catheterisation.

Further investigations and follow-ups are necessary if the murmurs are pathological. Depending on the underlying cause and the severity of the murmurs, the doctor may continue to monitor the patient’s condition if it is mild. He may also prescribe some medications, if the condition is moderate in severity.

However, if the underlying heart condition is severe or if it has resulted in deterioration of the heart function, more aggressive treatment may be necessary. For instance, an open heart surgery can be a repair or replacement operation and it has become a much safer procedure these days. Alternatively, some less invasive procedures have been successfully performed on selected patients (e.g. percutaneous transluminal mitral commissurotomy, transvenous aortic valve implantation).

Leaking valve

Do I need to take antibiotics if I have heart murmurs?

Previously, doctors would advise patients who had pathological heart murmurs to take antibiotics before dental or other surgical procedures, in order to prevent an infection. However, this recommendation has now been changed. Most patients with heart murmurs are not required to take prophylactic antibiotics before undergoing dental or surgical procedures, except in a few rare situations.

Summary

A heart murmur is a worrisome “diagnosis” for some people. Most murmurs present especially in children and adults however, are innocent murmurs. No treatment is necessary and the affected person can lead a normal life and do physical activities. Even if the murmurs are pathological, many of the conditions are mild or moderate. As such, regular follow-ups with or without medications are all that is necessary. For those whose conditions are more severe, surgery may be indicated.

1972 SNHA organised the first heart conference in Singapore, the 5th International 10-day Teaching Seminar in Cardiovascular Epidemiology and the 5th Asian Pacific Congress of Cardiology.

Dr Chee Tek Siong is a Member of the Singapore Heart Foundation’s Board of Directors.He is also a Consultant Cardiologist in private practice.

6 SHF Initiative

Since 1970, the Singapore Heart Foundation (SHF) has taken a proactive role in promoting national heart health in the community. As part of its continuous mission to help those in need, a funding scheme named the ‘Heart Support Fund’ (HSF) was formed for needy heart patients. Over the years, the HSF has helped

numerous needy cardiac patients and their families. Take Mr Kee Twan Loy for example, who is a sole breadwinner of his family of three. His ailing wife is unable to work and his only son is still a student, studying part-time in the university. Mr Kee has very little savings as he did not earn a lot before his heart attack occurred. After the heart attack, he was forced to leave his job and his current new job pays him less than half of what he used to earn.

Under such circumstances, Mr Kee is eligible to apply for the emergency relief assistance from the HSF, through his hospital’s medical social worker (MSW). His application was approved promptly and he was offered free cardiac rehabilitation at the SHF-Heart Wellness Centre. Mr Kee has also made a conscientious effort to adopt a healthy lifestyle, so as to minimise his risk of another heart attack.

Needy Cardiac Patients Cost has been cited in many countries as one of the barriers to receiving prompt cardiac treatment and rehabilitation. However, with the generosity of supportive donors, SHF is able to offer heavily-subsidised rehabilitation to all clients and financial aid for those at a disadvantage through the HSF. SHF works closely with MSWs from the various healthcare institutions to identify cardiac patients who may be facing financial difficulties, as well as those who require financial aid but do not qualify for any assistance scheme. The table below highlights the four specific areas where patients may require the most financial assistance on.

1 Heart transplantPatients undergoing a heart transplant surgery are entitled to the Heart Transplant Subsidy

from the Ministry of Health. As there is a maximum cap on this subsidy, patients who are unable to settle the outstanding balance of their operation and subsequent follow-up treatments, may request for additional financial support from SHF through their MSW.

SHF will assist each heart transplant patient up to a maximum of $20,000. Further funding beyond this limit is subject to review by the SHF-HSF Committee.

3 Emergency relief assistanceSome patients are the sole

breadwinners in their respective families. After being caught unaware by the sudden occurrence of their cardiac condition, these patients may be unable to resume their former jobs after receiving treatment, and may face difficulties in finding a replacement job. Others may also suffer from income loss, due to taking time off from work to attend cardiac rehabilitation programmes or for follow-up medical appointments.

To help such patients adjust during the difficult phase, the HSF provides emergency relief assistance of $300-$800/month for a maximum period of three months and on a case-to-case basis, up to an additional three months for each patient following the treatment of their heart condition. Further funding beyond this limit is subject to review by the SHF-HSF Committee.

4 Medication, transportation, ancillary devices and other miscellaneous equipment

Cardiac patients are mostly prescribed with medication for the rest of their lives. Depending on their heart condition, some of them require drugs that are not subsidised because they are classified as a non-standard prescription. As such, these drugs are expensive to purchase, causing a huge financial burden on the patients and their families. Similarly, others may require many types of long-term medication to manage their conditions and again, the high costs can strain these patients financially.

Frequent routine follow-ups at the hospitals may also take a physical and financial toil on patients, as many are often too frail to use public transportation, hence they rely heavily on taxis to get there. Under the HSF, SHF has started a Cab Charge scheme to reimburse the taxi fares, so that patients are compliant with the follow-ups or rehabilitation appointments.

The HSF also assists needy patients in other aspects, which are currently not covered by their subsidies and grants. For instance, some patients may require assistive devices, such as a wheelchair and oxygen concentrators. These equipment are essential to ensure quality of life for the cardiac patients, but they are usually not subsidised under the MediShield Life scheme.

The HSF is also pro-rehab and is supportive of any approved therapy for needy heart patients, as recommended by the cardiologist.

2 Mechanical heart devicePatients receive a 65-80% subsidy for the implantation of mechanical heart devices,

using the Health Science Development Fund from the Ministry of Health. However, the balance cannot be paid using the patient’s existing Medifund.

Patients with financial constraints may apply to SHF for help through their MSW. The HSF is able to provide a subsidy of up to $20,000, to defray the cost of each patient’s mechanical heart device. Further funding beyond this limit is subject to review by the SHF-HSF Committee.

1974 SNHA donated the first Coronary Care Ambulance to the Singapore General Hospital. This prototype ambulance contained monitoring and telemetric equipment to enable cardiac status to be assessed early.

Heart Support Fund

7SHF Initiative

Eligibility Criteria1. Applicant must be a cardiac patient seeking assistance for cardiac

related problems.2. Applicant must be a Singapore citizen/Singapore Permanent

Resident residing in Singapore. 3. Only subsidised patients are eligible for application.4. Prior to application, applicant must first: • ExploreusingMedifundtopayfortheirmedicaltreatment. • ExhausttheirMedisaveaccountsandthoseoftheirfamilymembers.

• ExploreusingtheMedisaveresourcesoftheirnon-immediate

family members. • ExplorethepossibilityofobtainingpayoutsfromMediShield

and/or health insurance schemes. • Consultthebusinessofficeoftheirrespectivehospitalsonthe

option of paying their medical bills by instalment.

Heart Support Fund Application Procedure

1977 SNHA’s dream to establish the Singapore Myocardial Infarction Registry was fulfilled. This registry formed an

important landmark in data collection for patients with acute infarction in Singapore.

Needy cardiac patients may approach their hospital medical social workers, who will write in to SHF for funding.For more information, please contact the Heart Wellness Centre at 6354 9340.

ANeedy cardiac

patient requires financial aid

BCase to be

reviewed by MSW of hospital

DReview

and approval by SHF

(3–7 days)

EApproval letter given, cheque issued within

2 weeks by SHF

FMSW to issue receipt to SHF

CMSW to submit report to SHF

indicating amount of financial aid

requested

Approved OR

Rejected

Option to Appeal

Patient Support GroupsIn addition, the SHF encourages patients to gather and form Patient Support Groups (PSGs). This is to provide invaluable peer and emotional support to heart patients and their families, adjusting to life after a heart attack and to motivate them to maintain healthier lifestyles.

Such social interaction will give the patients renewed confidence in life.

Interested PSGs seeking financial assistance for their activities will be assessed on the eligibility criteria below:1. PSG must play an important role in providing essential care and support to both the patient with heart disease and their family, or following

a heart attack/cardiovascular surgery.2. PSG may vary in their objectives, but the support group must identify some of the following as their aims: a. Establish and maintain contact with other people facing similar problems. b. Provide psychological support to both patient and family. c. Maintain contact with rehabilitation professionals. d. Provide information on convenient locations for exercise & leisure activities and proper utilisation of these facilities. e. Provide a safe environment for supervised regular exercise sessions. f. Communicate with other PSGs in the area. g. Offer a visiting service to heart patients who have recently been discharged from hospital. h. Arrange social events and gatherings regularly.3. PSG must have a letter of support from a cardiologist or

rehabilitation personnel of a medical institution in Singapore.4. PSG seeking financial assistance must have a minimum of 10

members.

8 Editorial

In 2014, cardiovascular disease (CVD) was the principal cause of all deaths worldwide, as well as in Singapore for both genders. Research has revealed that younger women may ignore or miss

the earliest symptoms of an impending heart attack, resulting in a delay when seeking for help. Hence, it is important for women to realise that CVD is not just a “man’s disease”, and that their risk will increase further upon menopause.

Thankfully, CVD is mostly preventable through leading a healthy lifestyle, such as eating a balanced diet which comprises of whole grains, quality protein, fruits and vegetables. A healthy meal is not just about the caloric content. So, start making small changes now - replace your refined grains (e.g. white bread, rice) with whole grains (e.g. oats, brown rice). For instance, a bowl of sweet or savoury porridge made with rolled oats or oatmeal, garnished with some fruits and/or nuts is a quick fix for a tasty yet hearty breakfast. Having 3 or more servings of whole grains daily, have been reported to lower the risk of CVD by 20% to 30%. Risk factors such as fasting blood glucose, insulin sensitivity, total cholesterol, LDL-C, blood pressure and weight gain, were reduced as well.

Cultivating good habits is all about exposure. By exposing yourself more frequently to healthy food, you will come to realise that leading a healthy lifestyle is not that difficult after all!

9Health Bites

A new study has revealed that adults who score well on the American Heart Association’s (AHA) Life Simple 7 checklist - a calculator designed to educate the public on positive lifestyle habits to reduce heart attack and stroke, may be at a reduced risk of heart failure. The 12-year study assessed 3,201 adults of an average age of 59 years old, during which 188 of them developed heart failure. The checklist focuses on the 7 cardiovascular health factors - managing blood pressure & cholesterol, reducing blood sugar, physical activity, eating healthily, losing weight and not smoking. It was found that for every one point increase in cardiovascular health score on the calculator, the participant’s risk for heart failure reduced by 23%.

Seven healthy habits may reduce heart failure risk

Sudden cardiac arrest may follow missed warning signs

Slow heart rate does not increase risk of heart disease

Scan here to find out your heart score

Many patients who have a sudden cardiac arrest, may have missed warning symptoms such as chest pain and breathlessness, which could have potentially improved their survival chances. Almost half of the time, patients may experience warning signs four weeks ahead and repeated symptoms 24 hours before their heart abruptly stops beating. In the past, it was thought that sudden cardiac

arrest is an unexpected event, with almost no time to intervene. However, this new study has revealed that those who managed to seek help by calling for an

ambulance, increased their survival rate by 32%. It was also found that older patients and those with a history of heart disease were more likely to call for help.

Bradycardia is a condition where the heart beats slower than normal (< 50 beats/minute in an adult at rest). A normal adult heart usually beats between 60-100 beats/minute at rest. It can cause dizziness, breathlessness, fainting or chest pain due to the lack of oxygen-rich blood though the body. A ten-year analysis of 6,733 participants with no history of cardiovascular disease, showed that a heart rate of less than 50 was not associated with a higher risk of cardiovascular disease. However, there may be a possible association between bradycardia and higher mortality rates in people who take heart rate modifying medicine, such as beta blockers and calcium channel blockers.

Do you wish to receive heart health related news on a regular basis? Subscribe to our e-newsletter Heart Mattersby emailing mabel@heart.org.sg with your name, email address and contact number.

HealthBites

1985 SNHA raised funds with the Rotary Club of Pandan Garden (Singapore) to establish the first CPR training centre in Singapore.

11Event Reviews

On 12th December 2015, ‘PLAY SWEAT LIVE’ was organised by the Singapore Heart Foundation (SHF), to encourage clients

from both Heart Wellness Centres to engage in a series of fun-filled activities. The event was held at Bishan-Ang Mo Kio Park,

in conjunction with our annual year-end festive celebration. SHF aims to create a friendlier and healthier environment in motivating clients to

bond with one another, as well as to keep up a healthy lifestyle.

A total of 78 Heart Wellness Centre clients together with their family members, assembled bright and early at 8am for registration, while enjoying

a morning refreshment custard bun sponsored by Gardenia.

To get everyone moving, a group warm-up session was conducted before the various exciting games. In conjunction with Singapore’s Golden Jubilee, nostalgic games such as Five Stones, Chapteh and Knock Down Cans, were played for a ride down memory lane. Each group was given a score card for each game station and it was evident that our clients were having a ball of a time.

Another highlight of the event was “Zumba Gold”, which was conducted by Vivafit. Clients were attentively coached in a series of low-intensity workouts to sweat it all out!

After the great workout, clients were rewarded with beautifully assembled snack boxes and catered bento sets. The event ended with a prize presentation to the top 3 highest scoring teams, attractive lucky draw prizes were given away, and all clients received a goodie bag each in appreciation for their participation.

SWEATLIVE

(PLAY)

1988 SNHA funded the semi-automatic defibrillators for ambulance service at the Singapore General Hospital.

The defibrillators were found to be so useful that all hospital ambulances are now equipped with these units.

Causes:Heart attacks caused by blockages in the main arteries leading to the heart can occur in both men and women. However, the way the blockages form a blood clot may differ. Compared to men, women can have less severe blockages that do not require any stents; yet the heart’s coronary artery blood vessels are damaged which results in decreased blood flow to the heart muscle. The result is the same – when blood flow to the heart is decreased for any reason, a heart attack can occur. If doctors do not correctly diagnose the underlying cause of a woman’s heart attack, they may not be prescribing the right type of treatments after the heart attack. Medical therapies are similar regardless of the cause of the heart attack or the severity of the blockages. However, women are undertreated compared to men despite proven benefits of these medications.

Treatment:Women face greater complications from attempts to restore blood flow because their blood vessels tend to be smaller, they are older and have increased rates of risk factors, such as diabetes and high blood pressure. The recommended guidelines for medications medications are consistently underutilised in women, leading to worse outcomes. Also, cardiac rehabilitation is prescribed less frequently for women and even when it is prescribed, women are less likely to participate in it or complete it.

Symptoms:While the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain.

Risk factors:Risk factors for heart attacks also differ in degree of risk in men compared to women. For example, high blood pressure is more strongly associated with heart attacks in women and if a young woman has diabetes, her risk for heart disease is 4 to 5 times higher than that of a young man.

12 GRFW 2016

A woman’s heart attack may have different underlying causes, symptoms and outcomes compared to men, according to a scientific statement published in the American Heart Association’s journal Circulation.

The statement is the first scientific statement from the American Heart Association on heart attacks in women. It notes that there have been dramatic declines in cardiovascular deaths among women due to improved treatment and prevention of heart disease as well as increased public awareness.

“Despite stunning improvements in cardiovascular deaths over the last decade, women still fare worse than men and heart disease in women remains underdiagnosed, and undertreated, especially among African-American women,” said writing group chair Laxmi Mehta, M.D., a noninvasive cardiologist and Director of the Women’s Cardiovascular Health Program at The Ohio State University.

This article is adapted from a scientific statement by the American Heart Association.

A woman’s

may differ from a man’scauses & symptom

sheart attack

Statement Highlights• Womenfrequentlyhavedifferentunderlyingcausesofheartattacksthanmen,suchasthetypesofplaquebuild-up.• Compared tomen,women tend to be undertreated and arelesslikelytoparticipateincardiacrehabafteraheartattack.• Riskfactors(suchashighbloodpressureanddiabetes)increaseheartattackriskinwomenmoreseverelythaninmen.

13GRFW 2016

Pledge Your Heart Walk 2016Held in conjunction with the annual GRFW campaign, the SHF will be organising a walk, which aims to motivate and increase the awareness for physical activity to help curb the development of CVD in women. The walk encourages women of all ages to bring along their family members and friends to kick-start a heart healthy lifestyle together.

Each participant will receive an exclusive gift pack:• 1xFinishermedal• 1xeventdrawstringbag• 1xLuckyDrawchance• Otherattractiveprizes

Registration* opens in April 2016, so stay tuned @ www.myheart.org.sg or SHF’s Facebook page @ www.fb.com/heartfoundation for more details!

*Limited slots are available and registration is based on a first come, first served basis.

1992 SNHA was recognised as an Institution of Public Character and Dr Low Lip Ping became its Chairman. SNHA organised

the Asia Pacific Congress of Cardiac and Electrophyscology.

Go Red for Women?What isGo Red for Women (GRFW) is an international awareness campaign dedicated to the prevention, diagnosis and control of cardiovascular disease (CVD) in women. The American Heart Association initiated the GRFW movement in 2004, to empower women with the right knowledge and essential tools to take charge of their heart health. The World Heart Federation, together with its members, has taken the campaign global to highlight the fact that heart disease and stroke combined, is the No. 1 killer of women.

The GRFW campaign was launched in Singapore in 2005, as many women are still unaware of the dangers posed by this “silent killer”. In 2013, a heart health survey conducted by the Singapore Heart Foundation (SHF), revealed that only 11% of Singaporean women were aware that heart disease is their leading cause of death.

EVENT: Pledge Your Heart Walk 2016

CATEGORY: 3.5km non-competitive walk

DATE: 25th June 2016 (Saturday)

TIME: 7:00am – 11:00am

VENUE: Marina Bay Waterfront Promenade

GUEST-OF-HONOUR: Ms Low Yen Ling Parliamentary Secretary, Ministry of Education& Ministry of Trade and Industry

Do you wish to

participate in this cause

as an organisation or in

a group? Write to us at

grfw@heart.org.sg for

more information!

TM Red Dress Design, Trademarkof the American Heart Association.

14 Nutrition

Across:

3. An Asian woman with a waist circumference of ≥ 90cm is at a _____ risk of getting health diseases, as those ≤ 80cm.

5. It is not neccessary to go for an annual health screening because I feel healthy. (True or False)

6. A person with a BMI between 18.5 to 22.9 is at a _____ risk of developing heart disease, high blood pressure, stroke and diabetes.

7. LDL is the _____ cholesterol.9. _____ and diabetes increase the risk of hypertension.

Down:

1. A _____ blood pressure is less than 130/80 mmHg.2. For those without any known coronary risk factors,

the desirable cholesterol levels should be less than 3.4mmol/L for LDL and between 1.0 to 1.5 mmol/L for HDL. (True or False)

4. Sedentary lifestyle, smoking and an _____ diet can lead to an increased risk in cardiovascular diseases.

7. We can measure obesity through _____ and body fat percentage.

8. A consistent fasting blood glucose of 7mmol/L or ____ is considered to be diabetic.

The DIRECTDONORDEBITPROGRAMME(DDDP) is designed toencourage individuals to give small donations to SHF on a regular basis, for our life-saving

programmes. SHF would like to thank the following DDDP Event Site Sponsors, who have generously provided their venues for our various roadshows.

1997 Dr Wee Kim Wee became the patron of SNHA. The first National Heart Council members were appointed.

ANSWERS FOR CROSSWORD PUZZLEDEC 2015 - FEB 2016

TOGETHER, WE CAN WORK TOWARDS A HEART HEALTHIER NATION!

15Nutrition

little creature

Across:

4. Too much fructose intake may cause the development of fatty liver disease. (True/False)

6. Overconsumption of sugar can lead to an _____ risk in metabolic syndrome.

7. One teaspoon of sugar is approximately _____ grams.8. The recommended daily intake of added sugar by the Health

Promotion Board is no more than _____% of dietary energy.9. Added sugar is also known as _____ calories.

Down:

1. Excessive intake of sugar can lead to weight gain and _____.

2. Both natural sweeteners and processed sugar can affect blood sugar level. (True/False)

3. Hidden sugar can be found in processed fruits, frozen yoghurts, _____ etc.

5. Different types of sugar contain different amount of calories. (True/False)

10. One of the _____ causes of obesity is excessive sugar intake.

• 1X750mlbottleofNaturelExtraVirginOliveOil• 1X500gpacketofNaturelOrganicHomMali

Mixed Brown Rice + Red Rice• 1kgpacketofCaptainOats• 1XbottleofSalbaChiaSeeds• 2XKoreanrealnanodualbristletoothbrushes• 1Ximportedpillboxwith3functionalusages

Simply email/fax this page to heartline@heart.org.sg /6258 5240 by 31May2016.

Name: _____________________________________________________

NRIC: _____________________________________________________

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 1June2016.

We wish to thank the following prize sponsors:Lam Soon Singapore Pte Ltd, Captain Oats, Salba Singapore, HAP Nutrition Pte Ltd and iTrade Marketing.

Complete the crossword puzzlewith the correct answers, and stand a chance to win 1 of 5 hampers (worth more than $50) in our lucky draw!

SugarSneaky

2000 SNHA celebrated the first-ever World Heart Day on 24th September 2000 with a series of events such as

Heart Taxis, Heart Trees, Heart Expo and Affairs of the Heart.

17Event Reviews

2003 SNHA changed its name to the Singapore Heart Foundation (SHF) with a more vibrant & complementary logo and

a meaningful tagline, “Your Heart We Care”.

Asia PCR Singapore LIVE 2016, the premier cardiovascular course in Asia, was held at the Suntec Singapore Convention & Exhibition Centre from 21st to 23th January 2016. There

was a turnout of 2,177 participants during the 3-day course.

To create awareness and promote good heart health, B. Braun Singapore initiated the 'Lock a Heart, Do Your Part' campaign at its booth. Delegates were encouraged to pledge for a healthier heart by penning words of motivation and heartfelt messages onto a card provided. These cards were then attached with a heart-shaped lock and secured onto a giant heart grid.

B. Braun donated $1 to the Singapore Heart Foundation, for every lock on the grid and at the end of the event, approximately $500 was raised for the Foundation.

In an effort to promote a heart-healthy lifestyle, the Singapore Heart Foundation has been collaborating with the Nanyang Technological University – National Institution

of Education (NTU-NIE) to provide both fitness workouts & health screenings for lecturers, students and staff in the past four years.

8 mass fitness workout sessions are organised annually for the faculty, with an estimated turn up rate of 100 participants/session. SHF ensures that the fitness routines are created and tailored to target those between the ages of 21 to 60 years old, so that they can get the best benefits out of the one hour full-body cardio workout. To further motivate and enhance the participants’ exercise experience, SHF has also introduced a variety of workouts such as the ‘Strength Chair Workout’, which was a hit among them. This particular workout is

suitable for beginners and older adults, as it has lesser load on the lower body joints, but the same degree of difficulty on the upper body and abdominal exercises. Other genres of workout include the Zumba Gold, Hi-Low Intensity, Bollywood, Hip hop, K-pop, kickboxing, etc.

In addition, SHF also organises a Healthy Lifestyle booth at the university quarterly, to increase awareness of the necessity of health screenings for presence of any risk factors. The booth offers complimentary nutrition & fitness counselling and basic health screening – measurement of blood pressure levels, total body fat & visceral fat percentage, body mass index (BMI), height & weight and a test for atrial fibrillation (a common but under-diagnosed heart rhythm disorder). The university also supports the initiative by giving out complimentary fruits to each participating staff and student.

Lock a heart,Do your part

什么是无害(或功能性的/生理性的)心脏杂音？

这种杂音通常是因非常正常的心脏或血管中的血液流速增加而造成的。某些情况可以改变血液流动速度，例如贫

血、发烧、运动时或运动后、怀孕、甲状腺分泌过多或甚至是健康儿童。这些情况中心脏及其周围结构是非常正

常的。没有必要进行心脏治疗，除非是发烧和甲状腺分泌过多所引起的状况，才需进行相应治疗。这种无害的心

脏杂音常见于大多数健康儿童。若医生确定杂音无碍，就不需要对心脏进行治疗或进行进一步的检查。

什么是病态心脏杂音？ 这种杂音是不健全的心脏瓣膜、左右心室之间的异常连接或心脏与周围结构的异常连接造成的。若是这种情况，

医生则需要展开检查确定潜在病因、严重性以及对整个心脏功能的基本影响。根据之前列出的三个因素，病人将

需要进行跟踪检查。

心膜缺损

心脏超声

二尖瓣脱垂

徐德祥医生的文章

若医生告知他听到了心脏杂音，病人或病人父母/监护人一听到这种“心脏病”，马上会感到不安或恐慌。

病态心脏杂音举例

1. 不健全的心脏瓣膜：

a) 先天性缺陷(例如：两瓣叶主动脉瓣、二尖瓣脱垂)；

b) 衰老的结果(例如：主动脉瓣硬化)

c) 感染(例如：风湿性发烧或恶性心内膜炎)，或

d) 全身疾病继发状况(例如：类风湿关节炎、梅毒)。

这些心脏瓣膜或是不能关闭(关闭不全)或是不能正常打

开(狭窄)，或是两者兼而有之。

什么是心脏杂音呢？

心脏杂音是在心脏跳动过程中听到的异常声音，这是血液快速通过

(有时涌流)心房心室、心脏瓣膜或血管之间连接管或血管与心房心

室之间的连接管造成。心脏杂音可能是无害的(有时称为功能性杂

音或生理性杂音)或病态的。

2004 SHF established its first Cardiac Rehabilitation Centre at 10 College Road.

2005 SHF launched the Go Red For Women campaign.

18 特写

外行人的心脏病学(一)

2. 左右心房心室之间的异常连接(例如：心房间隔

缺损、心房心室间隔缺损)通常是先天性的，这

些缺陷可能简单，也可能复杂或多样化。

3. 心 室 与 周 围 血 管 连 接 或 血 管 之 间 的 连 接 ( 例

如：冠状动静脉管、开放性动脉导管)，也是

先天性的。

若患有心脏杂音会发生什么？

若您的医生确定心脏杂音不是因为潜在心脏问题造成(例如：无害心脏杂音)，那么就没有必要进行治疗或进

一步的检查。孩子或病人能正常生活，不需要限制身体活动。

有时，医生不是很确定，就会进行一系列的检查，

例如：胸部X光扫描、心电图、超生心电图、运动测

试、24小时心电图监控、电脑断层扫描(CT)或心脏

导管术。

若杂音是病态的则必须进行检查以及后续检查。根

据杂音的潜在成因与严重程度，医生可能对轻度病

情进行监控，对中度病情进行药物治疗。

但是若是严重的潜在心脏状况或导致心脏功能恶

化，则需要更强的治疗方法。例如，开心手术可分

成为修复或替代操作，近来已经成为一个更加安全

的治疗程序。或者对病人进行选择性且创伤较小的

治疗处理(例如：二尖瓣交界分离术、主动脉瓣植入

术)，这已经获得了成功实行。

心脏瓣膜症

若我的心脏有杂音，需要吃抗生素吗？

以前，为了预防感染，医生会建议心脏有杂音的病人在进行牙齿治疗或其他手术治疗前服用抗生素。但是，

现在这个建议已经更改了。许多患有心脏杂音的病人在进行牙齿治疗或手术治疗前不需要服用预防抗生素，

一些罕见情况除外。

总结

心脏杂音的“诊断”给一些人造成困扰。在儿童与成年人中特别常见的心脏杂音多属于无害杂音，没有必要

进行治疗，患有这种心脏杂音的人可以正常生活，并从事体育活动。即便杂音是病态的，许多情况都是轻

微或中度的。如果是这种情况，不管有无进行药物治疗，都必须进行定期检查咨询。对于情况比较严重的病

人，可能需要手术治疗。

徐德祥医生是新加坡心脏基金的董事会成员。他也是一位私人执业的心脏科顾问医师。

19特写

2006 The SHF-Isetan Foundation Heart Wellness Centre in Bishan was officially opened by former President of Singapore,

Mr S R Nathan.

2007 To find out the health status of lower-income residents in Singapore, SHF started its Health Mapping Exercise programme.

自1970年以来，新加坡心脏基金会(SHF)已经在社会中为倡导国家心脏健康计划扮演了积极的角

色。这一持续的使命中的部分职责就是帮助那些有需要的人，为帮助穷困的心脏病人，一个被命

名为“爱心辅助金”(HSF)的资助计划成立了。多年来，HSF帮助许多贫困心脏病患者和他们的家

庭。以纪传礼先生为例；他是一家三口中唯一可以养家糊口的人。他患病的妻子无法参与工作，

而他唯一的儿子仍是一个在读学生，在大学兼任求学。纪先生仅有很少储蓄，在他的心脏病发作

之前也没有赚很多钱。在心脏病发作后，他被迫离开了之前的工作，并且新工作的收入也不及在

过去工作中挣的一半。

在这种情况下，纪先生在医院的医务社会工作员们(MSW)的协助下，尝试申请了HSF的紧急援

助。申请及时的被批准了，他可以在SHF-心脏健康康复中心免费得到心脏病康复治疗。纪先生也

认真努力采取新的健康的生活方式，以减少再一次的心脏病发作的风险。

贫困心脏病患者

治疗费用问题已被许多国家认作为阻碍心脏病患者接收治疗和康复的其中一个障碍。但值得感激的是，由于长期捐赠者的慷慨捐

助，SHF也能够向所有处于不利处境的患者提供高额补贴康复和经济援助。SHF与各个医疗机构医务社会工作者(MSW)有着密切

合作，从中确定心脏患者可能会面临财务困难，以及那些需要经济援助，却不符合任何援助计划条件的患者。下表强调了四个病

人可能最需要经济援助的情况。

心脏移植手术

接受心脏移植手术的病人有资格

从卫生部得到心脏移植补贴。

此补贴有最高上限，当病人无法自行

解决他们手术和随后的后续治疗余额

时，可以通过他们的医务社会工作者

向SHF要求额外的财政支持。

SHF最多可以为每一个心脏移植病人资助$20,000。超额的资

金须经通过SHF-HSF委员会审查。

紧急救助援助

有些病人是家庭中唯一的经济

支柱。当知道他们的心脏突然发生状况

后，这些患者可能在接受治疗后无法恢

复之前的工作，并且面临重新找工的难

题。由于从工作中抽出时间来参加心脏

康复计划或后续医疗预约问题，一些患

者可能也遭受到收入损失。

HSF可提供超过三个月，$300-800/月

的紧急救助援助资金来帮助这些病人

改善困境，并在以案例情况的基础上，

为每个病人提供额外三个月的心脏病治

疗。超额的资金须经通过SHF-HSF委员

会审查。

药物、交通、辅助设备和其他杂项设备

心脏病患者大多需接受终生的药物治疗。根据他们的

心脏病情，其中一些需要的药物，并不能提供补贴，因为它

们被归类为非标准处方。因此，购买这些药物是昂贵的，

这为病患和他们的家属造成巨大的经济负担。同样地，其

他病患可能需要长期服用许多药物来控制他们的病情，这为这

些病人带来经济上很大的压力。

频繁的往来于医院进行治疗也可能对病人带来身体和经济上的辛劳，由于许多患

者经常感到虚弱而不使用公共交通，因此他们严重依赖出租车服务。在HSF支持

下，SHF已经开始提供出租车花费报销计划，所以患者可跟进后续计划或康复的治

疗预约。

HSF还资助目前在其他方面不能领受补贴的贫困患者，例如，一些患者可能需要辅

助设备，如轮椅和制氧机。这些设备对于确保心脏病人的生活质量是必不可少的，

但他们这些需求通常不适用于MediShield生活补贴范围内。

HSF支持贫困心脏病患者通过心脏病专家推荐做职业康复。

心脏机械设备

病 患 领 受 的 心 脏 机 械 设 备 植 入 补

贴，65%-80%来自于卫生部健康科学发展基

金。然而，病患却不能通过已存在的医疗基

金用于偿付余额。

有着经济约束的病患可以通过他们的医务社

会工作者向SHF要求支助。HSF能够提供高达

$20,000的补贴，以用于支付每个病人心脏机械设备的成

本。超额的资金须经通过SHF-HSF委员会审查。

爱心辅助金

20 特写

2009 SHF launched the Cardiopulmonary Resuscitation + Automated External Defibrillator (CPR+AED) Certification Course.

1 2

3 4

申请人合格标准

1. 申请人必须是一个心脏病患者并寻求心脏病相关问题的帮助。

2. 申请人必须是新加坡公民或新加坡永久居民并居住在新加坡。

3. 只有受补贴病人具有申请资格。

4. 申请该程序之前，申请人必须首先符合:

• 发掘并使用Medifund来支付他们的医疗。

• 用尽自身与其家庭成员Medisave帐户。

爱心辅助金申请过程

贫困的心脏病患者可寻求医疗机构医务社会工作者，他们可向SHF填写基金申请。为寻求更多资讯，请与心脏健康康复中心取得联系（电话：6354 9340）

A贫困病患需求经济援助

案例将由各个医疗机构医务社会工作者(MSW)审查

医疗机构医务社会工作者(MSW)向SHF提交关于

病患所要求经济援助金额的报告

由SHF复审和批准(3-7天)

授予批准信，支票将在2周内由SHF发出

医疗机构医务社会工作者(MSW)向SHF发出收据

B D E FC 批准

拒绝

或

选择上诉

21特写

2011 Organised the inaugural National Life Saving Day and broke a Guinness Record for the largest CPR training session,

involving 7,909 participants. We also launched SHF’s first mobile app - Heart4Life.

病患支持团体

此外，SHF鼓励病人聚集并形成病人支持小组(PSGs)。这是为心脏病患者与其家人提供无价的同行感和情感支持，并让患者适应

心脏病发作后的生活，激励他们能开始更健康的生活方式。

这样的社会互动能入患者在生活中重拾信心。

感兴趣的PSGs寻求金融援助的活动将评估合格标准如下:

1. PSG必须给予心脏病患者和他们的家庭必要的关怀和支持，或密切注意患者心脏病发作或心血管手术后的情况。

2. PSG的目标或有不同，但有关支持团体必须确定以下某些为其条件：

a. 与其他面临类似问题的人建立和维持联系。

b. 为病人及家属提供心理支持。

c. 与康复专业人员保持联系。

d. 为运动和休闲活动提供方便的地点和使用这些设施

的妥当性。

e. 为监督定期锻炼活动提供一个安全的环境。

f. 与本区域的其他病人支持小组进行沟通。

g. 为近期出院的心脏病人提供访问服务。

h. 定期安排社交活动和聚会。

3. PSG必须提供来自新加坡医疗机构的心脏病或康复人

员的支持信。

4. 每个PSG寻求金融援助必须拥有至少10位成员。

• 发掘并使用非直属家人的Medisave资源。

• 发掘可获得MediShield奖金和/或医疗保险奖金的

可能性。

• 申请人在各自医院的咨询业务办公室，选择分期付

款来支付他们的医疗费用。

22 Recipes

Recipe contributed by Ms Toh Yun Xuan, Nutritionist at SHF. Modified from girlsmakefood.com.本食谱由新加坡心脏基金(SHF)的营养师卓芸萱女士提供。资料是从girlsmakefood.com修改。

Preparation Time 准备时间: Overnight 过夜 / 2 days 两天Cooking Time 烹饪时间: 50 minutes 分钟

Serves 分量: 8 人份

Rice Pudding 可可米粒布丁

Method 做法: Unsweetened almond milk 未加糖的杏仁奶1. In a container, cover the raw almonds with water up to an inch. 将生杏仁放入一个容器中，加水直至浸过杏仁1英寸。 2. Soak it overnight or up to 2 days in a refrigerator (soak longer for creamier

texture). Drain the water and blend the almonds with 3 cups of water for 2 minutes. 过夜浸泡或者在冰箱中搁置两天(若希望更浓稠就需要泡得久一些)。沥干水份

后，将杏仁放入搅拌机并加入3杯水，搅拌2分钟。

3. Strain the blended almonds with a cheese cloth and squeeze out as much milk as possible. Then, set aside.

用滤布沥干搅拌后的杏仁泥，挤出尽可能多的杏仁奶，然后搁置一边。

Cocoa Rice Pudding 可可米粒布丁 1. Over a medium heat, mix the brown rice, almond milk, cinnamon and salt evenly in a

pot and bring it to a boil. 中火加热，将糙米、杏仁奶、肉桂和盐放在锅中混合均匀，直至煮沸。2. Reduce the heat to low and cover the pot to cook the mixture for about 1 hour or to

the texture of the rice that you prefer. Stir the mixture occasionally to prevent the rice from sticking onto the bottom of the pot.

将火调小，盖上锅盖煮大约1小时或煮至您所喜欢的软硬度，不时搅拌以免米粒粘在锅底。

3. Once a desired texture has been achieved, remove the pot from the heat and stir in the honey and cocoa powder evenly.

一旦煮至您所喜欢的软硬度，将锅从火上移开，加入蜂蜜和椰子粉并搅拌均匀。4. Finally, garnish with berries and serve warm. Alternatively, refrigerate the pudding

and serve it chilled. 最后，点缀浆果，趁热食用，或者将布丁放在冰箱里冷却后食用。

Nutrients per Serving 每份营养

Energy 能量:138.3 kcal 千卡

Protein 蛋白质:3.2 g 克

Fat (Saturated fat) 脂肪(饱和脂肪):3.8 g 克 (0.2 g 克)

Carbohydrate 碳水化合物:29.5 g 克

Sodium 钠:17.1 mg 毫克

Cholesterol 胆固醇:0 mg 毫克

Cocoa

2014 Our second Heart Wellness Centre - the SHF-Life Insurance Association Heart Health Hub in Fortune Centre was officially opened by MP Ms Denise Phua.

Ingredients:• Short grain brown rice, 1 cup• Cinnamon, ½ teaspoon• Sea salt, 1 pinch• Honey, ¼ cup• Unsweetened cocoa powder, ¼ cup• Unsweetened almond milk, 3 cups - Raw almonds, 1½ cup - Water, 3 cups + soakingGarnish• Berries

材料:• 短糙米，1杯• 肉桂粉，½茶匙• 海盐，1小撮• 蜂蜜，¼杯• 未加糖的可可粉，¼杯• 未加糖的杏仁奶，3杯 - 生杏仁，1½杯 - 水，3杯，浸泡配菜• 浆果(莓类)

Method 做法: Guacamole 鳄梨酱1. Cut the avocado into half and remove the pit. 将牛油果切成两半，取出果核。2. Scoop the flesh into a bowl and mash it with lemon juice, until a smooth consistency

is achieved. 将果肉挖出来放入碗中，与柠檬汁混合直至均匀(直到光滑

稠度)。

Burrito 卷饼 1. Cook the corn on a pan for 10 minutes or until slightly

charred. Set aside to cool. Then, slice off the kernels. 将玉米放入锅中加热10分钟，直至轻微发焦，放在

一边冷却，然后剥下玉米粒。2. Heat some oil in a frying pan and add in the kidney beans,

paprika and corn kernels. Stir gently until warmed through. 加热炒锅，在其中放一些油，加入红腰豆、红椒粉和玉米粒， 轻轻翻炒并炒熟。3. Grill the tortilla wraps on a pan until grill marks appear on the underside. Repeat the

process for all wraps. 将墨西哥薄饼放在锅中加热直至饼下部出现烤印，然后将所有薄饼加热。4. Spread a little guacamole evenly on each wrap and place the kidney bean mixture and lettuce on it. 在每张薄饼上均匀涂抹鳄梨酱，将红腰豆混合物与莴苣放在上面。5. Roll it to serve. 卷起来食用。

23食谱

Recipe contributed by Ms Toh Yun Xuan, Nutritionist at SHF. Modified from nutritionaustralia.org.本食谱由新加坡心脏基金(SHF)的营养师卓芸萱女士提供。资料是从nutritionaustralia.org修改。

Ingredients:• Corn on cob, 5 sticks• Extra virgin olive oil, 2½ teaspoons • Red kidney beans, 1.5kg (rinsed and drained)• Paprika, 2½ teaspoons• Avocado, 2½ whole• Lemon juice, 2½ teaspoons• Lettuce, 5 cups (shredded)• Wholemeal tortilla wraps, 10 pieces

材料:• 玉米棒，5支• 特级初榨橄榄油，2½茶匙• 红腰豆，1.5千克（洗净并沥干）• 红椒粉，2½茶匙• 牛油果，2½粒• 柠檬汁，2½茶匙• 莴苣（生菜），5杯（切碎）• 全麦墨西哥薄饼，10片

Red Kidney

Bean Burrito

Preparation & Cooking Time: 1 hour 30 minutes准备与烹饪时间：1小时30分钟

Serves 分量: 10 人份

墨西哥红豆卷饼Nutrients per Serving 每份营养

Energy 能量:458.4 kcal 千卡

Protein 蛋白质:19.8 g 克

Fat (Saturated fat) 脂肪(饱和脂肪):12.8 g 克 (3.3 g 克)

Carbohydrate 碳水化合物:71.2 g 克

Fibre 纤维:21.5 g 克

Sodium 钠:317.4 mg 毫克

Cholesterol 胆固醇:0 mg 毫克

Tip! 提示！

Add in quinoa as a source of whole grain and replace the tortilla wrap with a lettuce bowl for a lower calorie intake.加入藜麦作为全麦来源，将墨西哥薄饼换成莴苣叶，降低热量摄入。

2015 SHF organised its first pet walkathon "Woof-a-thon". The Foundation also launched the first FREE AED Loan Programme

in Singapore, to encourage the public to equip their events with this life-saving device for times of need.

材料:• 短糙米，1杯• 肉桂粉，½茶匙• 海盐，1小撮• 蜂蜜，¼杯• 未加糖的可可粉，¼杯• 未加糖的杏仁奶，3杯 - 生杏仁，1½杯 - 水，3杯，浸泡配菜• 浆果(莓类)

www.myheart.org.sg