For Johana Hamid, it started with a feeling of tiredness in 2021. “When I did my household chores, I would feel tired, weak and a bit breathless. I would rest for five to 10 minutes and be okay after that,” said the 74-year-old.
Johana did not think much of this and believed it was a natural part of ageing.
This led to two bad falls in 2021 and 2022 while the retiree was simply going about her day at home. She was hospitalised each time. She even hit her head during her second fall and had to call an ambulance.
Doctors treated Johana’s physical injuries, but did not suspect the fall was related to a heart condition.
However, two years later, in August 2023, after Johana underwent a routine heart health checkup, she unexpectedly fainted and was hospitalised.
This time, doctors performed thorough scans, and transferred her to the National Heart Centre Singapore (NHCS). She was diagnosed with severe aortic stenosis.
This is a degenerative heart condition in which the valve between the heart and the main artery that carries blood to the rest of the body becomes narrowed, making it harder for the heart to pump blood effectively.
Symptoms of aortic stenosis include breathlessness, chest pain or tightness, dizziness, irregular heartbeat and fainting. (Photo: iStock/Wasan Tita)
Aortic stenosis typically manifests as symptoms such as breathlessness, chest pain or tightness, dizziness, irregular heartbeat or palpitations, and fainting episodes.
“Women have more atypical symptoms, such as a feeling of tiredness, or just giddiness without fainting. They may also downplay their symptoms,” said Assistant Professor Ho Kay Woon, senior consultant at the NHCS’s department of cardiology, who treated Johana.
This is why symptoms are often dismissed by patients and overlooked by doctors, resulting in the condition being diagnosed at a severe stage, as in Johana’s case. However, this can be dangerous, as this progressive condition may eventually lead to heart failure, if left untreated.
“For late-stage patients, once symptoms develop, the mean survival time (without surgery) is about two to five years,” Assoc Prof Ho said.
Aortic stenosis accounts for two to three per cent of heart conditions globally, and is most common among those in their seventies and eighties, Assoc Prof Ho said.
“About three per cent over 70 will develop this condition. This percentage increases to about 10 per cent for patients aged 80 and above,” he added. “With the ageing population, as well as increasing life expectancy in Singapore, we are expecting that the number of aortic stenosis cases will increase.”
Age increases the risk of the aortic stenosis because, as we age, calcium deposits can accumulate on the valve, causing it to thicken, he said.
Aortic stenosis often goes undetected unless patients go for a routine health checkup with their general practitioner, which involves the doctor detecting heart murmurs through a stethoscope. This is because patients may be absolutely without any symptoms, especially in the earlier stages of the condition, Assoc Prof Ho explained.
Assoc Prof Ho recommends that seniors get a health checkup at thediabetes.
In the case of aortic stenosis, if a heart murmur is detected, the diagnosis needs to be confirmed via an
Early diagnosis is useful because it enables doctors to help patients manage any conditions that lead to calcium deposits, control cholesterol levels and recommend lifestyle changes such as quitting smoking, to slow down disease progression.
Medication for aortic stenosis may include diuretics to reduce fluid buildup in the body, as well as other medicines to lower heart rate, reduce blood pressure and help the blood vessels open more fully.
These medications are mainly for managing symptoms and preventing complications. They cannot stop the progression of the disease. Hence, doctors will monitor the patient with multiple heart scans over time.
Patients should also be on the lookout for symptoms so that any exacerbation can be treated in a timely manner.
One elderly patient fell down twice and was hospitalised each time but doctors did not suspect she had a heart condition until her third fall. (Photo: iStock/Toa55)
Surgery is recommended for patients with severe aortic stenosis and who have developed the symptoms described above.
“A normal valve opens to about three to four square centimetres. When the valve cannot open more than one square centimetre, or even less, this is considered severe,” Assoc Prof Ho said.
He added that another factor doctors look at is the speed of red blood cell flow across the heart valve – a tighter heart valve increases the speed that blood cells travel.
This conservative approach to surgery is because of its considerable risks, especially for elderly patients with multiple medical conditions, Assoc Prof Ho said.
“We need to time these procedures carefully in order for patients to benefit from it without being too late in treatment,” he said.
Traditionally, open heart surgery with surgical valve replacement was the primary treatment option for aortic stenosis. In this procedure, doctors make an incision in the chest to access the heart, identify the narrowed valve, remove it and replace it with either a metallic or biological valve.
However, since 2009, a minimally invasive procedure, the Transcatheter Aortic Valve Implantation (TAVI) has been available in Singapore. NHCS treats about 100 patients with this procedure each year, said Assoc Prof Ho.
TAVI involves a small puncture, typically to the leg or groin area. A catheter is inserted through the artery and guided to the heart, where a replacement biological valve (usually made of animal tissue) within a metal stent is positioned within the narrowed valve.
The new valve expands and pushes the old, narrowed valve to the side, taking over its function to allow for improved blood flow from the heart to the rest of the body.
Aortic stenosis surgery is a minimally invasive procedure called Transcatheter Aortic Valve Implantation, which involves making a small puncture at the leg or groin, rather than open heart surgery. (Photo: iStock/Pornpak Khunatorn)
Because this procedure is minimally invasive, it involves lower risk and a shorter recovery time compared with open heart surgery. It is particularly suited to older patients aged 75 and above, said Assoc Prof Ho.
However, the biological valve only lasts for eight to 12 years, and hence is not suitable for younger patients aged 65 and below who may have to undergo multiple procedures in their lifetime. Such patients will benefit more from open heart surgery with a metallic valve.
For patients between 65 and 75 years, doctors will assess suitability on a case-to-case basis, said Assoc Prof Ho.
Both procedures require patients to be on lifelong blood thinners, with the metallic valve requiring stronger blood thinners because it attracts more clot formation.
Assoc Prof Ho told CNA Women that patients show a marked improvement in symptoms after surgery, and go on to live as long as patients without aortic stenosis.
Johana, who underwent TAVI in January 2024 has since made a full recovery. “I was hospitalised for five days, and told not to carry heavy things for at least two months. After that, I had no symptoms at all. I don’t feel any pain and I don’t feel tired anymore.”
Assoc Prof Ho noted that awareness of the condition is relatively low, particularly among older patients.
A cardiologist advises seniors to get routine health checkups and reduce risk factors for aortic stenosis by controlling their blood pressure and cholesterol. (Photo: iStock/Edwin Tan)
His general advice for seniors: Reduce risk factors by controlling your blood pressure and cholesterol, quit smoking and go for routine checkups.
“This prevents them from having too late a diagnosis such that aortic stenosis may irreversibly affect the heart function,” he said.
“Some patients dismiss symptoms, hoping that the condition will get better just with medication alone. But this condition is progressive. It doesn’t get better by itself, and when it eventually becomes severe, treatment needs to be done,” he added.
A patient that Assoc Prof Ho treated experienced breathlessness and was diagnosed with severe aortic stenosis. However, she downplayed her symptoms and refused surgery for two to three years.
“The condition progressively got worse, and the next time we saw her, she was acutely ill and admitted to hospital with low blood pressure and fluid accumulation in the lungs,” he recalled.
Fortunately for this patient, Assoc Prof Ho and his team were able to expedite the surgery, perform it successfully and she is now well.
Patients who put off surgery for too long may increase the risk of surgery as their condition progresses in severity and they advance in age, Assoc Prof Ho explained.
“It's important to increase awareness because there is effective treatment available,” he said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...
Johana did not think much of this and believed it was a natural part of ageing.
This led to two bad falls in 2021 and 2022 while the retiree was simply going about her day at home. She was hospitalised each time. She even hit her head during her second fall and had to call an ambulance.
Doctors treated Johana’s physical injuries, but did not suspect the fall was related to a heart condition.
However, two years later, in August 2023, after Johana underwent a routine heart health checkup, she unexpectedly fainted and was hospitalised.
This time, doctors performed thorough scans, and transferred her to the National Heart Centre Singapore (NHCS). She was diagnosed with severe aortic stenosis.
This is a degenerative heart condition in which the valve between the heart and the main artery that carries blood to the rest of the body becomes narrowed, making it harder for the heart to pump blood effectively.
Symptoms of aortic stenosis include breathlessness, chest pain or tightness, dizziness, irregular heartbeat and fainting. (Photo: iStock/Wasan Tita)
Aortic stenosis typically manifests as symptoms such as breathlessness, chest pain or tightness, dizziness, irregular heartbeat or palpitations, and fainting episodes.
“Women have more atypical symptoms, such as a feeling of tiredness, or just giddiness without fainting. They may also downplay their symptoms,” said Assistant Professor Ho Kay Woon, senior consultant at the NHCS’s department of cardiology, who treated Johana.
This is why symptoms are often dismissed by patients and overlooked by doctors, resulting in the condition being diagnosed at a severe stage, as in Johana’s case. However, this can be dangerous, as this progressive condition may eventually lead to heart failure, if left untreated.
“For late-stage patients, once symptoms develop, the mean survival time (without surgery) is about two to five years,” Assoc Prof Ho said.
COMMON BUT UNDERDIAGNOSED
Aortic stenosis accounts for two to three per cent of heart conditions globally, and is most common among those in their seventies and eighties, Assoc Prof Ho said.
“About three per cent over 70 will develop this condition. This percentage increases to about 10 per cent for patients aged 80 and above,” he added. “With the ageing population, as well as increasing life expectancy in Singapore, we are expecting that the number of aortic stenosis cases will increase.”
Age increases the risk of the aortic stenosis because, as we age, calcium deposits can accumulate on the valve, causing it to thicken, he said.
FACTORS THAT INCREASE THE RISK OF AORTIC STENOSIS
- Age
- Congenital heart defects
- High blood pressure
- High cholesterol
- Smoking
- Radiation therapy to the chest area to treat cancer, as this can damage heart structures
- Rheumatic fever
- Chronic kidney disease, which may lead to more calcium buildup in the body and aortic valve
- Menopause, where oestrogen levels drop, and may contribute to higher cholesterol levels and increased LDL (bad cholesterol)
Aortic stenosis often goes undetected unless patients go for a routine health checkup with their general practitioner, which involves the doctor detecting heart murmurs through a stethoscope. This is because patients may be absolutely without any symptoms, especially in the earlier stages of the condition, Assoc Prof Ho explained.
Assoc Prof Ho recommends that seniors get a health checkup at thediabetes.
In the case of aortic stenosis, if a heart murmur is detected, the diagnosis needs to be confirmed via an
TIMELY DIAGNOSIS OF AORTIC STENOSIS IS IMPORTANT
Early diagnosis is useful because it enables doctors to help patients manage any conditions that lead to calcium deposits, control cholesterol levels and recommend lifestyle changes such as quitting smoking, to slow down disease progression.
Medication for aortic stenosis may include diuretics to reduce fluid buildup in the body, as well as other medicines to lower heart rate, reduce blood pressure and help the blood vessels open more fully.
These medications are mainly for managing symptoms and preventing complications. They cannot stop the progression of the disease. Hence, doctors will monitor the patient with multiple heart scans over time.
Patients should also be on the lookout for symptoms so that any exacerbation can be treated in a timely manner.
One elderly patient fell down twice and was hospitalised each time but doctors did not suspect she had a heart condition until her third fall. (Photo: iStock/Toa55)
Surgery is recommended for patients with severe aortic stenosis and who have developed the symptoms described above.
“A normal valve opens to about three to four square centimetres. When the valve cannot open more than one square centimetre, or even less, this is considered severe,” Assoc Prof Ho said.
He added that another factor doctors look at is the speed of red blood cell flow across the heart valve – a tighter heart valve increases the speed that blood cells travel.
This conservative approach to surgery is because of its considerable risks, especially for elderly patients with multiple medical conditions, Assoc Prof Ho said.
“We need to time these procedures carefully in order for patients to benefit from it without being too late in treatment,” he said.
SURGERY AND RECOVERY FROM AORTIC STENOSIS
Traditionally, open heart surgery with surgical valve replacement was the primary treatment option for aortic stenosis. In this procedure, doctors make an incision in the chest to access the heart, identify the narrowed valve, remove it and replace it with either a metallic or biological valve.
However, since 2009, a minimally invasive procedure, the Transcatheter Aortic Valve Implantation (TAVI) has been available in Singapore. NHCS treats about 100 patients with this procedure each year, said Assoc Prof Ho.
TAVI involves a small puncture, typically to the leg or groin area. A catheter is inserted through the artery and guided to the heart, where a replacement biological valve (usually made of animal tissue) within a metal stent is positioned within the narrowed valve.
The new valve expands and pushes the old, narrowed valve to the side, taking over its function to allow for improved blood flow from the heart to the rest of the body.
Aortic stenosis surgery is a minimally invasive procedure called Transcatheter Aortic Valve Implantation, which involves making a small puncture at the leg or groin, rather than open heart surgery. (Photo: iStock/Pornpak Khunatorn)
Because this procedure is minimally invasive, it involves lower risk and a shorter recovery time compared with open heart surgery. It is particularly suited to older patients aged 75 and above, said Assoc Prof Ho.
However, the biological valve only lasts for eight to 12 years, and hence is not suitable for younger patients aged 65 and below who may have to undergo multiple procedures in their lifetime. Such patients will benefit more from open heart surgery with a metallic valve.
For patients between 65 and 75 years, doctors will assess suitability on a case-to-case basis, said Assoc Prof Ho.
Both procedures require patients to be on lifelong blood thinners, with the metallic valve requiring stronger blood thinners because it attracts more clot formation.
Assoc Prof Ho told CNA Women that patients show a marked improvement in symptoms after surgery, and go on to live as long as patients without aortic stenosis.
Johana, who underwent TAVI in January 2024 has since made a full recovery. “I was hospitalised for five days, and told not to carry heavy things for at least two months. After that, I had no symptoms at all. I don’t feel any pain and I don’t feel tired anymore.”
DON’T SKIP CHECKUPS OR OVERLOOK SYMPTOMS
Assoc Prof Ho noted that awareness of the condition is relatively low, particularly among older patients.
A cardiologist advises seniors to get routine health checkups and reduce risk factors for aortic stenosis by controlling their blood pressure and cholesterol. (Photo: iStock/Edwin Tan)
His general advice for seniors: Reduce risk factors by controlling your blood pressure and cholesterol, quit smoking and go for routine checkups.
“This prevents them from having too late a diagnosis such that aortic stenosis may irreversibly affect the heart function,” he said.
“Some patients dismiss symptoms, hoping that the condition will get better just with medication alone. But this condition is progressive. It doesn’t get better by itself, and when it eventually becomes severe, treatment needs to be done,” he added.
A patient that Assoc Prof Ho treated experienced breathlessness and was diagnosed with severe aortic stenosis. However, she downplayed her symptoms and refused surgery for two to three years.
“The condition progressively got worse, and the next time we saw her, she was acutely ill and admitted to hospital with low blood pressure and fluid accumulation in the lungs,” he recalled.
Fortunately for this patient, Assoc Prof Ho and his team were able to expedite the surgery, perform it successfully and she is now well.
Patients who put off surgery for too long may increase the risk of surgery as their condition progresses in severity and they advance in age, Assoc Prof Ho explained.
“It's important to increase awareness because there is effective treatment available,” he said.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...