Ask a Cardiologist: Dr Paul Ong from Mount Elizabeth Novena Hospital Singapore

Ask a Doctor ForumCategory: CardiologyAsk a Cardiologist: Dr Paul Ong from Mount Elizabeth Novena Hospital Singapore
Dr Paul Ong asked 1 year ago
I am Dr Paul Ong, Cardiologist practicing at Mount Elizabeth Novena Hospital Singapore. Ask Me Anything! I am a senior consultant cardiologist and subspecialized in interventional cardiology. I graduated with honours from the University of Cambridge and pursued my cardiology specialist training in the London “golden circuit” of heart centres at Hammersmith, Royal Brompton and Harefield Hospitals. I was appointed NHS cardiology consultant and Cathlab Director at the Lister Hospital and the Royal Brompton and Harefield NHS Trust in 2006. Iwas subsequently elected as Fellow of Royal College of Physicians and Fellow of the European Society of Cardiology in 2008. After 23 years in England, I moved to Singapore in 2009 and headed the Interventional Cardiology Service at Tan Tock Seng Hospital. Within a decade, my team had transformed TTSH to become one of the best interventional cardiology centres in SE Asia. Having served as a senior doctor in England and Singapore opened my mind to a global perspective on heart disease management and helped me remain sensitive to local practice nuances. I pride myself as one of the pioneers to embrace the trans-radial approach in coronary angioplasty when the technique was still new. I have dedicated my time to proctor many doctors in Singapore and Asia to practise this safer technique. I also played a pivotal role in introducing and adopting numerous cutting edge technologies in Asia Pacific. This included renal denervation for hypertension, intravascular lithotripsy for treating calcified blood vessels and Impella heart pump to protect the very sick patients during high risk angioplasty. I am the first cardiologist to perform Robotic assisted angioplasty in SE Asia. I have demonstrated many of these novel techniques in live cases sharing my experience with other doctors around the globe through international medical conferences. In the last decade, I have made over a hundred trips to lecture and proctor angioplasty in Asia. I was instrumental in securing funding to start a heart attack angioplasty programme in Myanmar. Many cardiology fellows in the UK and SE Asia have benefited from my training. Today, a lot of them are established opinion leaders in their countries. I am internationally renowned for my expertise in Primary Angioplasty to treat heart attack patients. I am the founder of the Asia Primary Angioplasty Congress (APAC) and the Asia Physiology and Coronary Imaging Course (APACi). I was also the Asia Champion of the Stent Save a Life initiative. These provided the ideal platform for specialists to exchange ideas and deliver better cardiac care in Asia. I am one of the few interventional cardiologists from Singapore to initiate my own multi-centre clinical trials studying hundreds of heart attack patients across Asia. I was principal investigators of more than 20 large scale randomised clinical trials. I have over 60 high impact scientific publications in international medical journals. In recognition of my contribution in the field of interventional cardiology, I am regularly invited to sit in organising committee of scientific meetings and advisory boards. Learn more about me here: I am excited to be here to share/discuss Heart Health with everyone. I will be actively sharing questions. Whether you’ve got questions about cardiac care or cardiac procedures such as coronary angioplasty, ask me anything! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
14 Answers
Shiling answered 1 year ago

I was diagnosed with mitral stenosis and have went for balloon valvotomy. However, I am still experiencing heart palpitations four months after the procedure. Is this normal post-surgery?

Dr Paul Ong replied 1 year ago

Mitral stenosis is frequently associated with an irregular heart rhythm called atrial fibrillation (AF). Patient with inadequate AF heart rate control may experience palpitation, lethargy and breathlessness on everyday activities. While valvotomy may have improved the mitral stenosis it does not necessarily improve the heart rhythm control. It would be prudent to revisit the heart specialist to ensure there was no residual procedural related complications and assess the underlying heart rate and rhythm. Most of the time, some adjustment of medication is all that is required to control the symptoms of palpitation.

Keng Soon answered 1 year ago

My father had stent surgery roughly 10 years ago. Recently, he started experiencing chest pain again. Considering he is now 71 years old, would undergoing another stent placement be safe for him?

Dr Paul Ong replied 1 year ago

Patients who have stent placed in the past unfortunately is not immune to development of further coronary artery disease. Heart disease is part of the inevitable aging process. It also depends on how meticulous we control the risk factors over the years like cholesterol, diabetes and hypertension etc.
At the age of 71 with history of previous stent and new onset symptoms of chest pain, it is absolutely essential that he seeks advice from a cardiologist promptly.

The chest pain may be due to development of a new narrowing in his heart arteries, blockage of the old stent or other medical condition. Age is not the only criteria to determine safety of heart procedure. But to answer your question, repeat stenting is a usually a safe procedure in elderly patients.

Early investigation and dealing with the symptoms is a priority. Not knowing what it is and not treating it in a in an appropriate and timely manner is much more risky.

Weixiong answered 1 year ago

I have been monitoring my cholesterol level for the past three weeks. Although I take medication, the level does not improve. I am worried because there is a history of heart failure in my family. My father has it. I am 50 years old. What should I do?

Dr Paul Ong replied 1 year ago

The first step to bring down the cholesterol level is to get the lifestyle right. Building up a regular cardio-exercise regime such as walking, jogging, swimming or cycling is alway a good start. Do not neglect the diet. Avoid deep fried food, shell fish, and remove the skin from the poultry and excess fat from the meat. Eat plenty of vegetables and fruits.

If all these measures are not successful your doctor may prescribe you with a medication. The most common types of cholesterol lowering pill are the “statins”. They are very safe and very effective in lowering the cholesterol especially the “bad cholesterol” LDL. These drugs take time and we usually see the result after 2 to 3 months. These drugs invariably bring down the LDL level and if not your doctor will adjust the dose upwards or change it to a more potent formula.

Nicholas answered 1 year ago

There are a lot of stories about people who do not drink or smoke suddenly dropping dead when running a marathon. Why does this happen? I am 45 years old and have been jogging intensively since the lockdown started. There is no history of heart disease in my family. I'm still worried though.

Dr Paul Ong replied 1 year ago

I am really pleased that you are making good effort to stay strong and healthy during the lockdown. We do hear news of apparently fit and healthy people suddenly passed away during intensive exercise. Marathon in particular does put our cardiovascular system under extreme stress.

If you are very worried, I suggest you get a heart screening test done. This should at the very least get a full physical examination, sugar and cholesterol tests, an ECG and an ultrasound of your heart. Your heart specialist may decide to carry out more specific tests like treadmill and CT scan depending on the initial findings. At 45 years of age, it is probably advisable to get a health check irrespective of whether you are running a marathon.

SP answered 1 year ago
Is it common to have resting heart rate below 50?
Dr Paul Ong replied 1 year ago

It is uncommon to have a resting heart rate below 50 beats per minute. Some of the explanations of such a slow heart rate will include
1. medication especially common in older patients taking beta-blockers for high blood pressure or heart failure
2. extremely fit athletes
3. older age patients
4. people on heart rate control medication

In any case such a slow heart rate may result in tiredness, breathless on exertion and sudden lost of consciousness.

If such slow heart rate is associated with symptoms of faint or near faint, you should approach your doctor urgently.

Lifang answered 1 year ago

After having stent implant surgery, my father said his heart beats louder. This worries him because he feels weaker than before. Is this a normal development of the surgery?

Dr Paul Ong replied 1 year ago

No this is not a common complain after stent implantation. You should consult the cardiologist who performed the procedure for further evaluation. Often patients are prescribed beta-blockers (eg atenolol, bisoprolol) once the diagnosis of coronary artery disease is made and this group of medication can make one feel less energetic.

Wai Kwang answered 1 year ago

Sometimes when I feel tired, I can feel my heart skip a beat. This is usually followed by a feeling of something shifting in my heart. I am a 50 year old male. Should I give my heart a check?

Dr Paul Ong replied 1 year ago

This is a common complain and may be due to an extra heart beat (ectopic beat). The threshold of seeking further consultation depends on how much the symptoms are bothering you and your background cardiovascular risks. If say you are 50 year old with hypertension, diabetes and a smoker you should go and have your heart checked anyway.

Anba answered 1 year ago

My husband had a pacemaker implanted in his heart two years ago. Lately he has been complaining about pain in his head and being dizzy. We are thinking about an MRI, but we heard that you can’t do one if you have a pacemaker. Is this true? What can we do about this?

Dr Paul Ong replied 1 year ago

The pain in his head and being dizzy may or may not have anything to do with the pacemaker. Many modern pacemakers are MRI compatible so do check with the doctor whether your husband device is MRI safe. Alternative to MRI brain, CT brain scan is a fair alternative to MRI in patients with older pacemaker model.

Harold answered 1 year ago

My brother is 56 years old. He has heart valve regurgitation. He had heart surgery to fix it five years ago. This year, his symptoms came back. He is now quite depressed and doesn’t want to undergo another surgery because he believes the condition will just recur again. Would there be any chance for recurrence if he undergoes surgery again? Is heart valve replacement a permanent solution?

Dr Paul Ong replied 1 year ago

I understand it must be extremely depressing to suffer a relapse of the valvular leakage 5 years post surgery. Unfortunately, I do not have the specific details as to the specific valve (we have 4 different heart valves) involved so it is difficult to give a fair comment. The general rule in facing these difficult circumstances, I would encourage your brother to get a second opinion and get a different perspective of the problem and evaluate the treatment option further.

Randell answered 1 year ago

How long do bypass grafts last? Would it need intervention again?

Dr Paul Ong replied 1 year ago

Bypass grafts or more specifically coronary artery bypass grafts can be divided into 3 different types. They are a. internal mammary artery graft (IMA); b. saphenous vein graft (SVG) and radial artery graft (RAG). I have frequently come across widely patent IMA grafts which are more than 10 years old some over 20 years old. IMA is no doubt the best bypass conduit available. SVG are harvested from the leg veins and they last for 6 to 8 years on average. RAG is a newer conduit that has gained popularity over the last 20 years. The lifespan is somewhere in between the IMA and the SVG.

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