Concerning Heart

Echo Predicts Mortality in Aortic Stenosis

2011-06-19T21:19:00.000-07:00

from AMERICAN SOCIETY OF ECHOCARDIOGRAPHY - 22ND ANNUAL SCIENTIFIC MEETING

Population: Elderly patients with normal LV function & did not undergo Aortic Valve Replacement

Poor survival with

Greater LV concentric remodeling

Lower stroke volume

Elevated LV filling pressures

Elevated PA pressure

Gastric Bypass Does More Than Just Reduce Weight

2011-05-02T22:51:00.000-07:00

April 29, 2011 (New York, NY) -- Gastric-bypass surgery may provide benefits to patients with type 2 diabetes beyond the benefits that can be directly attributed to weight loss, a new study finds [1].

According to Dr Blandine Laferrère (St Luke's Roosevelt Hospital, New York, NY) and colleagues, recent studies that show a strong correlation between the concentrations of plasma branched-chain amino acids (BCAAs) and related metabolites with insulin resistance and loss of insulin sensitivity raise the possibility that the rapid remission of diabetes seen in many diabetic patients after gastric-bypass surgery may be related to the pronounced changes in BCAAs or other metabolites and not the weight loss alone.

In a study published in the April 27, 2011 issue of Science Translational Medicine, Laferrère et al found the total amino acids and BCAAs decreased in the gastric bypass surgery group but not in a similar group of patients who lost the same amount of weight (10 kg) with diet alone. Also, the metabolites derived from BCAA oxidation decreased only in the surgery group. Levels of acylcarnitines and BCAAs and their metabolites were inversely correlated with proinsulin concentrations, C-peptide response to oral glucose, and the insulin-sensitivity index after weight loss, whereas the BCAAs and their metabolites were uniquely correlated with levels of insulin resistance.

read more here

Now you see me, now you don't: The bioabsorbable stent in clinical practice

2011-04-13T20:43:00.000-07:00

Washington, DC - Predicting the future is a fool's game, and predicting successful drug and device therapy in cardiovascular medicine is just as tricky.

When bioabsorbable stents emerged on the radar of interventionalists this past decade, some dared to dream that they might one day have a stent that would do its job, then disappear, eliminating the long-term use of dual antiplatelet therapy, without a subsequent risk of stent thrombosis. In addition, bioabsorbable stents wouldn't interfere with diagnostic evaluations using noninvasive imaging, such as MRI and computed tomography (CT). Equally important, the technology offered the promise of doing away with vessels loaded up with multiple stents, the so-called full metal jacket, which has the potential to interfere with future coronary surgery.

After a number of years, one stent, a fully bioabsorbable everolimus-eluting stent (BVS, Abbott Vascular) shows promise and is furthest along in clinical development, but not everybody is sure of the role the vanishing scaffolds will play in everyday practice. Some experts see a more expansive role for the devices, even implanting the stents into vulnerable arteries that are not yet significantly closed, with the intention of making an unhealthy vessel healthy again. Others, however, see interventionalists implanting the stents only in a minority of patients.

New CT method gets calcium score and coronary anatomy in a single scan

2011-04-13T20:38:00.000-07:00

Dr James Otton (St Vincent's Hospital, Sydney, Australia) and colleagues presented results from theirProspective Evaluation of an Algorithm for Coronary Calcium Estimation, a study of their algorithm for quantifying extraluminal coronary calcium in the major epicardial vessels from a contrast-enhanced CT scan.

Measuring calcium score from a single contrast CT has been tried before, but it has usually been impossible to accurately measure calcium across the whole range of Agatston scores, Otton told heartwire. "The key to [our] success was realizing, first, that it is not possible to adequately separate contrast from arterial-wall calcium using solely the traditional axial measurement approach, and second, that traditional calcium-score thresholds don't apply to high-resolution contrast-enhanced coronary CT."

Instead, Otton et al tested coaxial analysis—looking at the coronary artery in short axis—which allows for precise separation of the contrast-filled lumen and the vessel wall and can be mostly automated with standard software tools, he explained. The researchers also found that a lot of noncalcified material appears in the Hounsfield range of 130 to 200 Hounsfield units (HU) on high-resolution coronary CT scans, while the true calcium generally greatly exceeds 200 HU. This finding is supported by previous intravascular ultrasound (IVUS) studies.

SIMPLE FACTS ABOUT SATURATED / UNSATURATED / TRANSFATTY ACIDS (TFA)

2010-11-22T01:26:00.001-08:00

Simple facts about saturated / unsaturated / transfatty acids (TFA)

SATURATED FAT CAUSES ARTEROSCLEROSIS

SOURCES

ANIMALS

PLANTS

Beef, Beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheeses and other dairy products made from whole and 2 percent milk

coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter

TRANS UNSATURATED FATTY ACIS (TFA) CAUSES ATHEROSCLEROSIS

SOURCES

NATURAL

PROCESSED FOOD

beef, pork, lamb and the butterfat in butter and milk

making margarine, shortening, cooking oils cookies and white bread

TFA IS MORE ATHEROGENIC THAN SATURATED FAT (CAUSES MORE DAMAGE)

UNSATURATED FAT DOES NOT CAUSE ATHEROSCLEROSIS

SOURCES

salmon, trout, herring, avocados, olives, walnuts and liquid vegetable oils such as soybean, corn, safflower, canola, olive and sunflower

Unsaturated fat = polyunsaturated fats + monounsaturated fats

Replacing saturated and TFA with unsaturated fat helps reduce blood cholesterol levels

American Heart Association recommends

Choose a diet rich in fruits, vegetables wholegrain, high fibre foods and fat free and low fat diary most often

Keep total fat intake between 25 to 35% of calories (mainly mono and poly unsaturated fats)

TFA less than 1% Calories

To reduce TFA in diet

Look for food labeled ZERO TFA

Use unhydrogenated vegetable oils (canola, sunflower or olive oil)

Soft margarine instead of harder stick forms and butter

Limit these

High TFA

French fries

Doughnuts

Cookies

Muffins

Pies

Cakes

Limit Saturated Fats = Limit TFA

Limit commercially fried foods – has large amount of Saturated Fats and TFA

Barbershops a cut above for BP checks in African American men

2010-10-31T19:03:00.000-07:00

HYPERTENSION

Barbershops a cut above for BP checks in African American men

OCTOBER 28, 2010 | Steve Stiles

Chicago, IL - In the Texas of 150 years ago, the town barber was probably also the guy who pulled an aching tooth. A cadre of barbers in today's Texas were true to their healthcare-provider heritage by participating in a hypertension-screening outreach experiment that helped many of their customers with hypertension to get their blood pressures under control.

In a unique randomized trial [1], African American men who were patrons of black-owned barbershops in Dallas County, where they had their BP regularly measured and were encouraged to contact a physician when it was elevated, showed a mean 7.8-mm-Hg drop in systolic pressure over 10 months.

That was only 2.5-mm-Hg more of a drop (p=0.08) than seen in a comparator group of men who had received standard educational pamphlets on high BP in African Americans, but no BP checks or other encouragement to assess blood pressure, at the barbershops.

"That doesn't sound like much of a blood-pressure fall for any one person, but at the population level it's a very large effect," lead author Dr Ronald G Victor (Cedars-Sinai Heart Institute, Los Angeles, CA) observed for heartwire.

read more here

LIST OF MUSLIM FOOD OUTLET IN HONG KONG

2010-10-25T04:29:00.000-07:00

ISLAMIC CENTRE CANTEEN

5th floor Masjid Ammar and Osman Ramju

Sadick Islamic Centre

40 Oi Kwan Road

Wan Chai Hong Kong

EBENEEZER'S KEBAB

Shop No G04

Wan Chai Central Building

89 Lockhart Road

Wan Chai Hong Kong

EBENEEZER'S KEBAB

Ground floor

52 Lockhart Road

Wan Chai Hong Kong

EBENEEZER'S KEBAB

Ground Floor

California Place

25 D'Aguilar Streeet

Lan Kwai Fong

Central Hong Kong

EBENEEZER'S KEBAB

G01C

Astoria Building

32 Ashley Road

Tsim Sha Tsui

Kowloon

EBENEEZER'S KEBAB

Shop No 2,3 & 5

Ground Floor

Multifield Plaza

5-7A Prat Avenue

Tsim Sha Tsui

Kowloon

EBENEEZER'S KEBAB

Shop 11 & 12

Ground Floor

Hong Kong Gold Coast

No 1 Castle Peak Road

Tuen Mun

New Terrritories

EBENEEZER'S KEBAB

Shop G03A

Discovery Bay Plaza

Discovery Bay

Lantau Island

ISTANBUL KEBAB

Shop F-1

Ground Floor

Rose Mansion

1 Hart Avenue

Tsim Sha Tsui

Kowloon

ISTANBUL KEBAB

Ground floor

34A Lock Road

Tsim Sha Tsui

Kowloon

MUGHAL CLUB

Room 211 2nd Floor

Hai Phong Mansion

53-55 Hai Phong Road

Tsim Sha Tsui

Kowloon

THE GREAT INDIAN KEBAB FACTORY

Shop 8

Level 2

Miramar Shopping Centre

132 Nathan Road

Tsim Sha Tsui

Kowloon

SPICE RESTAURANT

2nd Floor

Prosperous Centre

No 1 Knutsford Terrace

Tsim Sha Tsui

Kowloon

ZIAFAT RESTAURANT

6th Floor

Harilela Mansion

81 Nathan Road

Tsim Sha Tsui

Kowloon

THE NEW SANGEET INDIAN RESTAURANT

Shop UG06 - 08

Upper Ground Floor

Toyo Mall

Intercontinental Plaza

94 Granville Road

Tsim Sha Tsui

Kowloon

JOJO INDIAN CUISINE

2nd Floor

David House

37 - 39 Lockhart Road

Wan Chai Hong Kong

RANG MAHAL

Flat B 1st Floor

Percival House

83 Percival Street

Causeway Bay (near Times Square)

Hong Kong

JANSHAN CELEBRATING INDIAN CUISINE

1st floor

Amber Lodge

23 Hollywood Road

Central

Hong Kong

SHAFFI'S INDIAN RESTAURANT

Shop 7

Ground Floor

Fau Tsui Street

Yuen Long

New Territories

POPEYE'S CHICKENS AND BISCUITS

7T103 & 7E161

Level 7

Passenger Terminal 1

Hong Kong International Airport

Lantau Island

HABIBI RESTAURANT

1st Floor

Grand Progress Building

15 - 16 Lan Kwai Fong

Central

Hong Kong

HABIBI CAFE

112 - 114

Wellington Streeet

Central

Hong Kong

WARUNG MALANG

Flat B2

2nd Floor

Dragon Rise Building

9-11 Pennington Streeet

Causeway Bay

Hong Kong

BLITAR CAFE

201 Causeway Bay Centre

19 - 23 Sugar Street

Causeway Bay

Hong Kong

NAIL IN COFFIN FOR TRANSMYOCARDIAL LASER SURGERY

2010-10-14T00:01:00.000-07:00

I remember few months back there was a great "ho ha" about a certain tertiary teaching hospital buying "state of the art" transmyocardial laser surgery.

A lot of my patients were asking me whether he / she should be referred for it. Below is an article from medscape. It is really a nail in coffin for this therapy.. Furthermore, what a waste of public funding..

Lasers Vaporised from NICE Guideline Recommendations for Refractory Angina

Christine Wright

Posted: 10/04/2010; Br J Cardiol. 2010;17(4):159-160

Introduction

As from May 2009 the National Institute for Health and Clinical Excellence (NICE) have removed transmyocardial laser revascularisation (TMLR) from the list of treatments for refractory angina.^[1] From their analysis of efficacy they found no evidence of improved myocardial perfusion, ejection fraction or prognosis. There was also no evidence for improvement in exercise tolerance or Canadian Cardiovascular Society (CCS) class when compared with other treatments. Furthermore, looking at the data on safety, randomised controlled trials showed evidence of increased myocardial infarction in the TMLR-treated patient group, as well as evidence of left ventricular perforation.

There have been reservations regarding this technique for many years and it would seem to be a valid decision on behalf of the specialist advisers. It seems appropriate, therefore, to look at how to best treat this complex group of patients.

FROM HEARTWIRE : "MACSTATIN"

2010-08-28T21:55:00.000-07:00

The "MacStatin": Fast food with some ketchup, salt, and a statin to go

AUGUST 13, 2010 | Michael O'Riordan

London, UK (updated) - Pushing the envelope of primary prevention to a point few doctors are likely to be comfortable with, a group of British cardiologists are proposing a rather radical strategy to neutralize the risk of cardiovascular disease caused by unhealthy eating habits.

They suggest that fast-food restaurants, such as McDonald's, offer customers a statin to go with their meal, one that could be found alongside the salt, sugar, ketchup, and mayonnaise. The statin, they say, could be sprinkled atop customers' Quarter Pounders, into their milkshakes, or onto their supersized French fries to offset the mounds of fat found in these unhealthy meals [1].

Consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add.

The "mischievous" strategy, outlined in the August 15, 2010 issue of the American Journal of Cardiology, is not intended to encourage individuals to think they can eat unhealthily because the statin, which the authors dubbed the MacStatin—slogan: "I'm neutralizing it!"—is a panacea for all risks. Instead, they stress that medical direction should continue to place drug therapy behind lifestyle interventions, such as healthy eating, smoking cessation, and regular exercise.

"I am not crazy, and I do not tell my patients that they can eat unhealthily and get away with it," Dr Darrel Francis (Imperial College London, UK), senior author of the report, told heartwire. "We're simply providing a calculation for the medical community to think about the size of the effect of a statin tablet vs an unhealthy meal and to also consider the irony that you can have harmful condiments provided free of charge, in unlimited quantities, and yet people think this one simple, potentially protective additive would be crazy to add. And I don't know why they would think that."

read more here

FROM HEARTWIRE: Who's the boss? White House recommends physicians join hospitals, large groups

2010-08-28T20:37:00.000-07:00

Who's the boss? White House recommends physicians join hospitals, large groups

AUGUST 27, 2010 | Robert Lowes

Adapted from Medscape Medical News—a professional news service of WebMD

Washington, DC - The White House is advising physicians to accept a life in Big Medicine—as a hospital employee or member of a large group practice—in the wake of healthcare reform [1].

Some leaders of organized medicine, however, are objecting to the government message.

"We're not ready to write off the small practices," Dr J Fred Ralston, president of the American College of Physicians (ACP), said in an interview. "We think there needs to be more than one delivery model."

"America is not a one-size-fits-all country," added Dr M Todd Williamson (North Georgia Neurological Clinic, Lawrenceville), a spokesperson for the Coalition of State Medical and National Specialty Societies, which campaigned against the new healthcare-reform law, now called the Affordable Care Act.

America is not a one-size-fits-all country.

Ralston and Williamson were responding to an article by two White House officials and one ex-official about the implications of healthcare reform for medicine that was published August 23, 2010 in the Annals of Internal Medicine. The authors are Nancy-Ann DeParle, director of the Office of Health Reform; Dr Ezekiel Emanuel, special advisor for health policy with the Office of Management and Budget; and Dr Robert Kocher, who stepped down in July from the National Economic Council.

The economic forces put in motion by the [Affordable Care Act] are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups," they write. Physicians who embrace the changes and opportunities created by the law "are likely to deliver the greatest benefits to their patients, the health system, and themselves" and "will be rewarded in the future payment system."

it started with a dream..

2010-08-26T21:47:00.001-07:00

went searching high and low for ideal house..

we found a place..

missed by many people scouting for house..

in the middle of ipoh town..

it took so long to get it going.. because it is a deceased tittle..

after almost a year.. we finally got it..

got contractor to demolish the house..

next step

get architect to design house plan..

MID RAMADHAN

2010-08-26T19:32:00.000-07:00

WE HAVE PASSED THE HALF WAY MARK OF RAMADHAN. IT IS THE TIME TO INTENSIFY OUR PRAYERS. IT IS TME TO REFLECT ON OURSELVES.

MAY BE IS THE TIME TO COOL DOWN.. TO PONDER.. TO BE GRATEFUL..

INSYAALLAH

MAY THIS RAMADHAN BE FRUITFUL TO ALL OF US..

Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity

2010-08-01T23:17:00.000-07:00

FROM HEARTWIRE..

ACUTE CORONARY SYNDROMES

Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity

JULY 28, 2010 | Reed Miller

Boston, MA - Improving the ability of emergency medical services (EMS) to move ST-segment-elevation-MI (STEMI) patients directly to existing PCI facilities is a more cost-effective regional strategy than building and staffing more PCI labs, a new computer simulation study shows [1].

In a study published online July 27, 2010 in Circulation: Cardiovascular Quality and Outcomes, Dr Thomas Concannon (Tufts University, Boston, MA) and colleagues estimated incremental treatment costs and quality-adjusted life expectancies of 2000 patients with STEMI who received PCI or fibrinolytic therapy in simulations of emergency care in a regional hospital system in Dallas County, TX.

PCI is generally more effective than fibrinolytic therapy for the treatment of STEMI, but most US hospitals are not equipped for PCI. Because the cost/benefit ratio of delaying any treatment in order to reach a PCI lab is different for each patient, depending on where they are and their specific condition, Concannon et al's model examined each case, Concannon told heartwire. "And in a county of pretty significant size, we were able to show that EMS detection and diversion would work better than hospital construction."

The researchers compared a base case strategy of no new construction or staffing with several different hospital-based strategies that entailed building new PCI laboratories or extending the hours of existing laboratories and then compared all of those strategies with a system in which EMS transported all STEMI patients to the existing PCI-capable hospitals.

5 SIMPLE HEALTHY STEPS TO WEIGH REDUCTION

2010-07-30T19:01:00.000-07:00

1. DO 10 000 STEPS PER DAY..

GET A PEDOMETER - any pharmacy

PARK YOUR CAR FURTHER THAN USUAL

DO NOT TAKE SHORT CUTS.. TAKE LONG CUT

PROPER SHOES OF COURSE..

10 000 IS ARBITRARY.. DO MORE IF YOU CAN

2. AVOID HUNGER

YOU WILL EAT MORE IF YOU ARE HUNGRY..

TAKE SMALL HEALTHY FREQUENT MEALS.. (2 HOURLY)

ALL KIND OF FOOD IS OK.. AS LONG AS THE PORTION IS CORRECT..

3. DRINK 3 BIG GLASS OF WATER AND EAT 3 GREEEN APPLES BEFORE ANY MEAL..

THEY FILL UP YOUR STOMACH.. MAKES YOU SATISFIED HENCE LESS OF YOUR USUAL DIET

4. SET SMALL REASONABLE TARGET

IDEAL WEIGHT REDUCTION SHOULD BE 0.5 TO 1KG PER WEEK..

IT WILL BE A SLOW PROCESS.. ITS WORTH IT

5. YOU MUST ENJOY DOING THIS..

IF THIS IS BORING.. YOU WILL QUIT..

USE YOUR IMAGINATION.. MAKE THE ABOVE 4 SOMETHING YOU LOOK FORWARD EVERY DAY..

MARTIN LUTHER KING.. YOU DONT HAVE TO SEE THE WHOLE STAIRS.. JUST TAKE THE FIRST STEP..

FDA approves another triple-drug combination for resistant hypertension: Tribenzor

2010-07-26T19:36:00.000-07:00

from heartwire

HYPERTENSION

FDA approves another triple-drug combination for resistant hypertension: Tribenzor

JULY 26, 2010 | Shelley Wood

Parsippany, NJ - The FDA has granted marketing approval to another three-drug combination for the treatment of hypertension in patients unable to get their blood pressure controlled with any two of the three classes of drugs that make up the combination [1]. The new product, Tribenzor (Daiichi Sankyo), combines the angiotensin-receptor blocker olmesartan (40 mg), the calcium-channel blocker amlodipine (10 mg), and the diuretic hydrochlorothiazide (HCTZ) (25 mg).

read more here

TO ALL SMOKERS...

2010-07-26T01:55:00.001-07:00

to all smokers.. never mind if you want to keep smoking and kill yourself.. but just remember this.. almost all tobacco company is connected to zionist organization... every time you puff.. you are giving them a bullet to kill innocent palestinian children..

look carefully at their logos.. they all have illuminati symbols..

And Illuminati is strongly connected to zionist movement..

if you decide to kill yourself.. with cigarette.. remember palestine

Asian cigarettes too have illuminati symbols.. are they connected to zionist movement?

HDL NOT SO IMPORTANT IF LDL IS VERY LOW..

2010-07-23T17:55:00.000-07:00

from medscape

July 23, 2010 (Boston, Massachusetts) — A post hoc analysis of the JUPITER trial has shown that when patients have very low concentrations of LDL cholesterol attained through the use of potent statin therapy, "good" HDL cholesterol may no longer be predictive of cardiovascular risk [1].

This is the first time this has been observed in a primary-prevention population, although there are similar data from contemporary secondary-prevention statin trials, say Dr Paul MRidker (Brigham and Women's Hospital, Boston, MA) and colleagues in their paper published in the Lancet.

They emphasize, however, that HDL was predictive of cardiovascular risk in patients taking placebo in JUPITER, so "our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment."

Raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol.

In an accompanying comment [2], Drs Derek J Hausenloy (University College, London, UK), Lionel Opie (University of Cape Town, South Africa), and Derek Yellon (University College, London) say that it is "unclear" why HDL concentrations did not predict cardiovascular risk at very low concentrations of LDL cholesterol in those treated withrosuvastatin in JUPITER. But given that more potent drugs for raising HDL cholesterol are on the horizon, the issue will require more research and needs to be examined in large randomized trials, they say.

The findings from this study "should not detract from the fact that raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol; the problem, in most cases, is how to achieve this strategy," they stress

read more here

IT IS SO EASY...

2010-07-22T20:45:00.000-07:00

IT IS SO EASY TO EXERCISE. A LOT OF US GIVE SO MANY EXCUSES.. NO TIME.. TO HOT.. NO PROPER SHOES.. NO PROPER ATTIRE.. TOO BUSY WITH HOUSE CHORES..

I am actually a strong advocate of active lifestyle and always emphasize on exercise. I came across this website and it is very interesting one

http://www.thewalkingsite.com/10000steps.html

Walking is actually the most natural way for us to exercise. Normal people walk about 3000 - 4000 steps per day. I just hooked myself to a pedometer and my normal walking per day was 6000 steps per day.

So if you have too many excuses to exercise, perhaps this might help.

Take the first step of your day to complete 10000 today... It is so easy to be active..

BRUCE TREADMILL SCORE

2010-07-16T02:54:00.000-07:00

Atherosclerosis Prevention and Treatment in Children and Adolescents

2010-07-15T18:59:00.000-07:00

This is an interesting article about how early atherosclerosis start and ways to approach it

http://www.medscape.com/viewarticle/722756

DOA 12 PINTU - FROM DATUK HJ FADZILAH KHAMSAH

2010-07-15T18:31:00.000-07:00

IT HAS BEEN SO LONG

2010-07-13T21:42:00.000-07:00

it has been so long since I have been blogging. I have been rather busy lately. I am planning to start a monthly buletin for doctors and public regarding heart and its related disease..

BP targets..

2009-07-15T19:30:00.000-07:00

less than 140/90 mm Hg for all
less than 130/80 mm Hg for cardiovascular equivalent
less than 125/75 mm Hg for proteinuria > 1g/24H

simple quotes..

2009-07-15T19:19:00.000-07:00

You only have to do a little each day, to get a ton done

From The Universe

CME FOR UITM DOCTORS

2009-03-29T23:58:00.000-07:00

15TH MAY 2009
1030AM TO 1230 PM
BILIK SUNSET
TELUK BATIK RESORT

UPDATE IN TREATMENT GUIDELINES OF HYPERTENSION IN MALAYSIA
ACUTE CORONARY SYNDROME
BASIC ECG FOR PRIMARY CARE

FOCUS GROUP MEETING

2009-03-29T23:50:00.001-07:00

4th APRIL 2009
730PM

TOPIC : A difficult hypertension case

VENUE : Laksamana Cheng Ho Restaurant

LIVING THE LIFE TO THE FULLEST..

2009-03-29T22:45:00.000-07:00

TIPS I PICKED UP FROM MY SISTER

never stop learning
concentrate in what you do and be good in what you do
be passionate in what you do
never stop asking "why"

BEEN VERY BUSY LATELY..

2009-03-10T09:00:00.000-07:00

Sorry guys.. I have been very busy lately. I have not been writing as frequent as I have promised. So far, things have been working out well in Ipoh Specialist Hospital.

1. February 09 was a very busy month for me. In private practice, busy means good. Furthermore, I have been very fortunate to be given the trust by my patients and relative to take care of them. It is actually a great responsibility for us to do the best for our patient.

2. I always pray that all my patients do well. I am only an instrument of god in the process of healing. Sometimes doctors tend to forget that... afterall we are all human beings. part of the healing process, not only through medications and interventions.. It also must come spiritually as well.

3. Over the weekend, I just attended one of my patient's daughter wedding ceremony. It was a rather simple ceremony in Kuala Kangsar. I was very touched by the very warm welcome by the host. It has taught me a very important lesson. Not all patients who come to private hospital came from rich back ground. Most of them actually came from poor social background. They came to see us, doctors in private practice because they trust us. They invested large amount of money for them to be well.

4. Monday was a public holiday, to celebrate the birthday of our Prophet Muhammad. My kids were grumbling that I had to run my clinic on a public holiday. Fortunately my wife took them for a spin and window shopping. At night, we went to Jusco and my children were very delighted. We did not buy anything spectacular, just some groceries. But the happiness in their face tells me a lot. They really enjoy being together...

5. I had a rather mixed day today. It started busy with echocardiogram and stress tests. Followed by admissions. During lunch, I had an appointment with my tax consultant. And guess what! have to pay income tax additional 40K!!! I got a slap on my face!!!The moral of the story is.. you must get a good tax consultant cum company secretary. This could have been avoided if my accounts have been monitored regularly. I have learnt an important lesson now.. control your spending accordingly. If your actual income exceeded what hae been projected by your company secretary.. alert them as soon as possible. They would be able to reschedule your income tax payment.

6. Just heard the news that the government is injecting RM 30B to boost the economy. Which is about 9% of our GDP. I am still waiting the effects of the 1st finamcial stimulus. Wonder how much money would actually need to recover our economy.. The finance minister forgot one thing.. small business like us.. no incentives at all.. The government should reduce the corporate tax to about 22 to 23%. This would ensure small business like us could survive.. I hope my tax money would be spend wisely by the goverment...

Give us peace in our time..

2009-01-09T20:17:00.000-08:00

1. It is very disheartening to see images of war. Let alone seeing it done to innocent people. About 700 poeple have been killed and thousands more injured in this recent bout of attack on Gaza. This is not millitary mission, this is ethnic cleansing.

2. Israeli backed by US have been very verocious in clearing the Gaza from traces of Palestine. What have the innocent people has to do with it?

3. So I call upon everyone, boycot US products. Boycot companies directly contribute to Israeli. Regardless who you are, muslim or non muslims. The bottom line is killing innocent people is wrong. We have other companies which produce similar quality or even better then them.

4. We should start buying local produce. There are a lot of variety of nice local produce. They are fresh, healthy and cheap. Furthermore, the buck stops here...

5. Let us all pray for peace in Palestine in what ever religion you are..

MSCT is not very accurate after all

2009-01-02T01:16:00.000-08:00

Diagnostic Accuracy of 64-Slice computed tomography coronary angiography: Prospective, Multicenter, Multivendor Study. Meijboom et. al. JACC 2008 52:2135 - 44.

1. This trial assess how accurate is 64 multislice CT angiography (MSCT) in detecting significant coronary artery disease when compared to the conventional coronary angiogram (CCA). CCA is the gold standard for diagnosing coronary artery disease.

2. The study recruited 360 patients with stable and unstable angina. All patients underwent both MSCT and CCA. Out of 360 patients, 246 have significant coronary artery narrowing (using the gold standard CCA).

3. Out of 246 with significant coronary artery narrowings, 244 were detected with MSCT (99% sensitive). So it is fairly accurate in thse group of patients which are symptomatic.

4. Of those without significant coronary artery narrowings, 114 patients, 41 of then were wrongly labelled as having significant narrowings by MSCT (64% specific).

5. If you have angina with negative MSCT, the chance of you not having significant coronary narrowings is 97%. When you angina and have a positive MSCT, the chance of you having significant coronary narrowing is 86%.

Summary

1. The patients in this study have symptoms, so there are quite a lot of them would have significant coronary heart disease. I would usually subject them directly to coronary angiogram espcially if they have ECG changes or elevated cardiac markers. MSCT in this situation is rather redundant. If the patient do not have ECG or ecardiac markers changes, I would subject them to either stress testing with or without imaging.

2. MSCT is not really that accurate in this group of patients especially if it is positive.

3. Nevertheless, if you have clear, negative MSCT, rest assured, you dont have significant coronary artery narrowing.

4. So back to square one, I only reserve MSCT to patient with chest pain who cannot exercise and for those with interconduction delay (eg bundle branch blocks).

5. With judicious and careful CCA, the amount of contrast use and total radiation can be significantly less than MSCT. The average radiation exposure from MSCT varries from 9.5 to 13.6 mSv, compared to CCA, 0.8mSv (which is about 10 times of routine CCT). The average amount of contrast for CCA is about 30 mls, as compared to 75 to 100 mls for MSCT.

How to look at your cholesterol profile?

2009-01-02T01:00:00.000-08:00

Elevated cholesterol level (hyperlipidaemia) is an important cardiovascular risk factor. Most of us would go to doctor or “pathology labs” requesting to check our cholesterol (lipid) levels. Patients fast for at least 12 hours (excluding medications and clear fluids) before blood taking. Hence, Fasting Serum Lipid (FSL) or Fasting Lipid Profile (FLP). There would be at least 4 parameters that we look at. Three of them are cholesterol-bound-protein (lipoproteins); Total Cholesterol (TC), High Density Lipoprotein (HDL) and Low Density Lipoproteins (LDL). The final parameter would be Triglyserides (TG).

Lipoprotein is produced by liver and excreted into the bloodstream. These lipoproteins have essentially two main components, lipid and protein. Immediately after being released in the blood, these lipoproteins have low lipid but high protein content. Hence it is called HDL. As these lipoprotein moves around the circulation, it absorbs lipids or cholesterol. This will increase the quantity of lipid in these lipoproteins. Hence it is called LDL. LDL then is reabsorbed by liver. Cholesterol then is excreted or released as bile.

TG is actually fatty acid which comes from our diet. The excessive energy which is not used up by our body is converted into TG which then stored in fat cells.

pathways of lipids..

So we actually measure the lipoprotein levels as a reflection of our cholesterol profile. This is because free cholesterol is absent from our blood. It is a hydrophobic molecule.

HDL and LDL have low and high lipid content respectively. Hence increased HDL level is a good sign as it acts as a scavenger to lipid. Increase LDL however is a sign that there is too much cholesterol in our circulation. The higher the LDL, the high the risk of cardiovascular event (eg stroke or heart attack). The FSL measurements are given in either µmol/L or mmol/L.

Of these 4 parameters, LDL has the strongest link to cardiovascular disease. Numerous studies have shown that the lower the LDL level the lower the risk of cardiovascular event. TC, HDL and TG levels are not as strong predictor of cardiovascular events.

These measurements should take into account the patient profile too. Each patient has his or her own target cholesterol levels. The high the risk, the lower the LDL level should be.

LDL targets

High Risk Patients (previous heart attack / type II DM) less than 2.0mmol/l

Intermediate Risk Patients (hypertension) less than 2.5mmol/l

Low Risk Patients less than 3.0mmol/l

Until these targets are reached, only then one should consider modifying the other lipid profile parameters, namely TG and HDL.

Tomorrow the big day..

2008-12-27T21:56:00.000-08:00

I will be starting tomorrow at my new clinic. Very excited. Hopefully I can help a lot of people and I pray to God that my venture would be a spiritually rewarding one.

I would like to thank these people to make it happen for me..

My wife

She has been very patient and hard working past few weeks sorting out the clinic and our new home. She also have given me comfort and shoulder to lean on through difficult times.

My 4 lovely kids

Siti Aishah, Muhammad Adam, Siti Umayrah and Muhammad Amirul. They may not understand much but they are the ones who have inspired me to become who I am. And all these are for them..

My parents

They were initially have mixed feelings about me coming back to Ipoh. They were very happy indeed as I am closer to them but on the other hand they felt that I should stay in Kedah. Nevertheless, they helped me find a house, clean it fix a few broken glasses and finally help me move in. They do this with sincerity and nothing in this world can replace them.

Syariman and Haslina

I sincerely thank them with the bottom of my heart, particularly Syariman. He single handedly fix the Astro and few other things. Haslina too has been very helpful...

Mr Yau of Binnova Interior Decorator

He has done an excellent job with my clinic renovation.

Tn Hj Nasiruddin, ISH General Manager

He has helped me a lot with the clinic and a few other things..

Dr Ng Teng Chun, Cardiologist ISH

Well, he was then one who called me somewhere in April 08 and telling me that ISH is looking for another cardiologist.

ISH personel

Especially the PR department, Store department and Cleaners...

So tomorrow is the big day...

Let us all pray for it..

Dr Hasral Noor Hasni

Cardiologist and Physician

Suite 2-10

ISH

UPDATE ON CLINIC RENOVATIONS DEC 25TH 08..

2008-12-24T23:26:00.001-08:00

Finally my clinic is almost ready... except for my chair, patient and relative chairs in my consultation room and sofa in the clinic waiting area.

View from the corridor.. my clinic is at an angle..

compass at waiting area

Consultation room, and finally sink is been installed

Clinic counter

display built in cabinet..

my degrees...

This evening I prayed Jemaah Asar with some of Abah's friends our relatives and of course Man in my consultation room. I am really grateful that I can start my practice in Ipoh.

MERRY CHRISTMAS AND HAPPY NEW YEAR

2008-12-24T00:05:00.000-08:00

ayat seribu dinar

2008-12-23T20:04:00.000-08:00

CLINIC RENOVATION by 23rd December 2008..

2008-12-23T19:55:00.001-08:00

waiting area.. wall paper just paste yesterday evening..

looks cool with the chinese writing..

may add some flowers and side table..

inside the clinic..

they have not fix the johnson suisse sink..

nurse counter

LCD TV 32inch LG..

contractor talking on phone...

by the way..

my clinic in Ipoh Specialist Hospital will be officially open on 29th December 2008. This coincide with Awal Muharam and Siti Umayrah's birthday

DR HASRAL NOOR HASNI

CONSULTANT CARDIOLOGIST AND PHYSICIAN

SUITE 2-10

IPOH SPECIALIST HOSPITAL

This afternoon, will go out for furniture hunting..

LOW MOLECULAR WEIGHT HEPARIN

2008-12-23T18:56:00.001-08:00

ANTICOAGULATION IS VERY ESSENTIAL IN MANAGEMENT OF ACUTE CORONARY SYNDROME. (ANTICOAGULATION = MAKING THE BLOOD THINNER THAN USUAL) IT HAS BEEN SHOWN TO IMPROVE MORTALITY AND MORBIDITY. PREVIOUSLY WE USED UNFRACTIONATED HEPARIN (UFH) AS AN INFUSION FOR ABOUT 48 HOURS. THE DRUG ITSELF IS VERY CHEAP. HOWEVER, IT REQUIRES INFUSION PUMP AND CLOSE MONITORING APTT (A MEASUREMENT OF THE DEGREE OF THINNING OF BLOOD).

THEN THE LOW MOLECULAR WEIGHT HEPARIN (LMWH) CAME INTO PICTURE. THE ATTRACTIVENSS IS THAT IT IS ONLY GIVEN AS SUBCUTANEOUS INJECTION (LIKE INSULIN) TWICE A DAY FOR TOTAL OF 6 DOSES. ENOXAPARIN (CLEXANE), ONE OF THE LMWH HAS BEEN SHOWN TO BE MORE SUPERIOR THAN UFH. THE PROBLEM IS THAT THE EARLIER GENERATION LMWH IS PORCINE BASED. THIS MAY NOT BE VERY PLEASING TO THE EARS OF MUSLIMS...

RECENTLY GLAXOSMITHKLINE PRODUCED A NEW ANTICOAGULATION, FONDAPARINUX (ARIXTRA) WHICH IS NOT PORCINE BASED. ARIXTRA HAS BEEN SHOWN TO BE SUPERIOR THAN LMWH IN REDUCING FURTHER MORTALITY AND MORBIDITY IN ACUTE CORONARY SYNDROME. IT IS GIVEN AS ONCE DAILY SUBCUTANEOUS INJECTION FOR 3 DAYS.

SO PLEASE ASK YOUR DOCTOR REGARDING THE CHOICES OF ANTICOAGULATION.

HOW CORONARY ANGIOPLASTY/STENTING BEING DONE

2008-12-23T16:30:00.000-08:00

Coronary intervention is a medical procedure to relieve the narrowings or blockages of the coronary arteries. These blockages are caused by cholesterol deposits. They are called either plaques or stenoses. Almost 98% of coronary angioplasty nowadays uses stent, tiny metal scaffolding, which have been shown to reduce the chances of renarrowing (restenosis). Patients are usually given antiplatelet medications (aspirin and clopidogrel prior to this procedure) and antithombotic agent (low molecular weight heparin or unfractionated heparin).

Using the same access as coronary angiogram, the doctor will insert a different catheter called the guiding catheter. This catheter’s tip will be placed at the origin of the coronary artery. Guide wire which is as thin as our hair is then inserted into the guiding catheter. The doctor will gently glide the guide wire to pass across the plaque or stenosis. The tip of the guide wire is usually placed at the far end of the coronary artery (distal end). All the coronary devices that enter the coronary arteries over ridding the guide wire.

The plaque or stenosis is the prepared further with either predilatation or rotational arterectomy prior to stent insertion. Predilatation uses small coronary balloon. The doctor places the coronary balloon at the stenosis, expand the balloon and pushes the cholesterol filled stenosis or plaque into the coronary artery wall.

The doctor places the stent at the stenosis or plaque. The balloon is then inflated and pushes the stent to the coronary artery wall. It forms scaffolding and holds the artery open. The stent is left behind to maintain blood flow down the coronary artery.

After all the balloon and guide wire removed from the coronary artery, final pictures is taken and the procedure is completed.

If its transradial approach, the sheath is removed and NICHBAN is applied immediately. If its transfemoral approach, the sheath is removed only after the ACT is below 150 (usually after 1 to 2 hours upon completion of the procedure).

THIS TIME ITS ON VIDEO MODE...

2008-12-18T06:51:00.000-08:00

THIS IS THE VIDEO MODE OF THIS PREVIOUSLY POSTED CASE..

TRANSRADIAL PRIMARY PTCA TO RCA

No objection to Sime Darby stake in IJN: Najib

2008-12-17T22:33:00.000-08:00

This is probably one of the saddest day in my life. IJN shares will be bought by a public listed company. Which means that profit will come into play now. I have worked in IJN 2003 to 2007 and felt very proud that IJN had mould me into what I am now.

I am not too sure why the government agree to selling stakes to IJN to PLC. At the end of the day, the patients will suffer. About 85% of patients are government officers, pensioners and from poor social economic status. They may not be able to afford further care from this institution.

The newly developed Cardiology Department in Hospital Serdang has only 2 cardiac catheteization labs, as compared to 4 (may be up to 8 if the new wing is fully functioning) in IJN. The infrastructure is not there to cope with the demands from the public.

If IJN wants to be more profitable, then they should tap to medical tourism. Get more international patients and use their reputation as one of the world's best.

Leave IJN alone!

Once again, hands off IJN, please!

Sime Darby eyes IJN

Sime Darby Confirms Its Interest In Aquiring IJN Stake - Bernama

Sime Darby eyes stake in hospital operator IJN

TOWARDS BETTER HUMAN RELATIONSHIP

2008-12-13T17:02:00.000-08:00

This is something I found during my visit to dentist. He put up a nice poster without the name of the author. Something I like to share to make this world a better place to live..

1. Be polite and well-mannered

2. Remember people’s name

3.Be cheerful and remember to smile

4. Practice appreciation

5. Show a sincere interest in others

6. Be a good listener

7. Be patient, tolerant and understanding

8. Always be kind and helpful

9. Don’t argue with people

10. Watch your speech

11. Never criticize without complementing

12. Avoid controversial or sensitive issues

13. Don’t brag, be humble

14. Observe punctuality

15. Always keep promises

16. Treat others with respect

17. See the good in people

18. Admit our mistakes

19. Nurture relationship

20. Do unto others as you would have others do unto to you

21. Try our best to be the best

PTCA LAD TRANSFEMORAL APPROACH

2008-12-10T06:21:00.000-08:00

For this presentation, I used Windows Movie Maker..

The patient had no periprocedural complications and was discharged well the following day. I decided not to proceed with ptca to lad during the acute setting due to financial constrains.

WHAT IS CORONARY ANGIOGRAM?

2008-12-03T23:19:00.000-08:00

1. Medical procedure to look at degree of narrowing (stenosis) in coronary arteries that run on the surface of heart muscle.

2. Patient and family will be advice regarding its indication, risk and preparation by the physician.

3. Coronary angiogram can be done either as inpatient or outpatient (daycare) basis. The choices of either depends upon the patient's condition. If the patient is stable, usually the coronary angiogram can be done as daycare.

4. Patient is required to fast at least 4 hours prior to this procedure.

5. The procedure is performed by puncturing an artery either at the wrist (transradial) or groin (transfemoral).

6. A small tube about 2mm diameter called diagnostic catheter is inserted through the arterial access.

7. Using guide wire, the diagnostic catheter is then positioned just at the mouth/origin of the coronary blood vessels.

8. Contrast solution is then injected though the catheter. As it flows down the coronary arteries, CINE is taken.

9. A few views were taken for each left and right coronary systems.

10. This procedure takes about 5 to 10 minutes.

11. At the end of the procedure, the doctor will explain to patient and family members regarding the findings and further plans.

12. If the plan is for coronary angioplasty, then with the same sheath, the doctor can proceed immediately. This will take further 30 to 60 minutes, depending on the complexity of the procedure.

13. At the end of this procedure, the sheath is removed. If the procedure was transradial (wrist), a specialized plaster, NICHIBAN, is applied to the wrist for about 4 hours. If the procedure was transfemoral (groin), a technician will press manually over the groin for about 15 minutes followed by lying flat for 6 hours.

14. Patients are advised not to move the wrist excessively for about 5 days if the procedure is transradial.

15. Patients are advised not to carry heavy objects and walk vigorously after transfemoral angiogram.

16. Patients are usually advice to seek medical attention if the developed pain, swelling at puncture site, fever and chest discomfort.

TRANSRADIAL PRIMARY PTCA TO RCA

2008-12-02T00:33:00.000-08:00

THIS IS AN INTERESTING CASE THAT I DID RECENTLY. 47 YEAR OLD MAN PRESENTED 4 HOURS CHEST DISCOMFORT. CORONARY RISK FACTORS ARE SMOKER AND HYPERTENSION. 12 LEAD ECG SHOWED ST ELEVATION IN INFERIOR LEADS. HIS HAEMODYNAMICS REMAINED STABLE. CRUSHED ASPRIN 300MG, CLOPIDOGREL 300MG AND SUBLINGUAL GLYCERINE TRINITRATE WAS GIVEN STAT TO PATIENT.

HE WAS TAKEN TO CATH LAB 50 MINUTES AFTER PRESENTATION. THE ARTERIAL ACCESS WAS FROM THE RIGHT RADIAL ARTERY. USING DIAGNOSTIC OPTITORQUE 5F DIAGNOSTIC CATHETER, THE LEFT AND RIGHT CORONARY ARTERIES WERE CANNULATED. THE LEFT CORONARY SYSTEM WAS ESSENTIALLY NORMAL.

THE RIGHT CORONARY ARTERY (RCA) WAS OCCLUDED WITH THROMBUS FROM THE PROXIMAL SEGMENT.

I THEN PROCEED TO PERFORM CORONARY ANGIOPLASTY OF RCA. THE RCA WAS ENGAGED WITH JR 3.5 6F GUIDING CATHETER. THE LESION WAS CROSSED EASILY USING COUGAR XT GUIDE WIRE. THROMBUS ASPIRATION WAS PERFORMED USING EXPORT CATHETER. I FOUND MINIMAL AMOUNT OF RED THROMBUS. THE LESION WAS PREDIALATED WITH SPRINTER LEGEND 2.0X10MM INFLATED AT 12 ATM

I PROCEED WITH STENTING USING ENDEAVOUR 2.5X30MM STENT DEPLOYED AT 14 ATM. THE IMMEDIATE ANGIOGRAHIC RESULTS WAS GOOD WITH NO RESIDUAL STENOSIS, TIMI III FLOW FLOW AND TMP III MYOCARDIAL BLUSH

THE DOOR TO BALLON TIME WAS 65 MINUTES. THE RADIAL ACCESS SHEATH WAS REMOVED AND NICHIBAN WAS APPLIED FOR HAEMOSTASIS.

THE PATIENT WAS NURSED IN ICU OVERNIGHT. 12 LEAD ECG SHOWED COMPLETE ST RESOLUTION AND HIS CK PEAKED AT 871U/L. HE WAS DISCHARGED WELL ON DAY 3 ADMISSION.

HIS MEDICATIONS UPON DISCHARGED ARE

1. CLOPIDOGREL 75MG DAILY

2. CARDIPRIN 100MG DAILY

3. ATORVASTATIN 80MG DAILY

4. RAMIPRIL 10MG BD

STRATEGY IN WEIGHT MANAGEMENT

2008-10-29T23:49:00.000-07:00

1. LIFE STYLE CHANGES

2. ANTI-OBESITY DRUGS

3. VLCD (VERY LOW CALORIE DIET) - UNDER MEDICAL SUPERVISION

4. SURGERY

Lifestyle change is an important part of weight management. it consist of proper diet and physical activities.

The aim is to achieve gradual weight reduction of 0.5 to 1 kg per week. Ideally the negative energy balance should be about 500 to 1000 kcal per day. Its all about supply and demand.

Eg. If your daily food consumption is 3000 kcal per day (which is quite a lot), you need to exercise and burn your calories about 3500 to 4000 kcal.

MANAGEMENT OF OBESITY

2008-10-27T18:48:00.000-07:00

GOALS OF OBESITY MANAGEMENT

1. Achieve weight loss

2. Maintain reduced weight

3. Prevent weight gain

4. Treat obesity complications

WEIGHT LOSS

1. Target initial weight loss of about 10%

2. Attempt weight loss about 0.5 to 1 kg per week

THE LATEST..

2008-10-27T06:42:00.000-07:00

ITS OFFICIAL..

I AM JOINING IPOH SPECIALIST HOSPITAL FROM 15TH DECEMBER 2008

AS RESIDENT CONSULTANT CARDIOLOGIST AND PHYSICIAN

ALLAH IS GRACIOUS..

AMIN

BENEFITS OF WEIGHT REDUCTION

2008-10-23T18:23:00.000-07:00

Blood Pressure

Reduction in systolic and diastolic blood pressure

Reduction in dose and number of antihypertensive drugs

Lipid Profile

Reduction in LDL cholesterol and triglyserides

Increase in HDL cholesterol

Diabetes

Reduction in development of type II DM

Improvement in blood glucose control (reduction in HbA1c)

Osteoarthritis

Reduction in development of secondary osteoarthritis

Reduction in obesity related death risk

HRH SULTAN KEDAH WITH ME

2008-10-20T09:47:00.000-07:00

HRH Sultan of Kedah visit to Kedah Medical Center

HEALTH RISK FOR OBESITY

2008-10-16T19:49:00.000-07:00

1. Hypertension

2. Hyperuricaemia (gout)

3. Dyslipidaemia (elevated and abnormal cholesterol levels)

4. Type II diabetes

5. Insulin resistance syndrome

6. Polycystic ovarian syndrome

7. Coronary heart disease

8. Heart failure

9. Left ventricular hypertrophy (abnormal thickening of heart muscle)

10. Cerebrovascular accident (stroke)

11. Obstructive sleep apnoea (snoring)

12. Gallstone disease

13. Fatty liver

OBESITY CLASSIFICATION

2008-10-15T18:47:00.001-07:00

There are 3 methods of diagnosing and classifying obesity

1. Body Mass Index (kg/m2) BMI = weight (kg)/[height x height (m2)]

Classification	BMI	Risk of Obesity Complications
Underweight	Less than 18	Low
Normal range	18 to 23	Normal risk
Preobesity	23 to 27	Increased risk
Grade I obesity	27 to 35	High risk
Grade II obesity	35 to 40	Very high risk
Grade III obesity	More than 40	Extremely high risk

2. Waist Circumference (measured at umbilicus/belly button)

Male obesity more than 90 cm (36inch)

Female obesity more than 80cm (32inch)

3. Waist to Hip Ratio

Male obesity more than 0.9

Female obesity more than 0.8

INVASIVE CARDIAC LABORATORY

2008-10-15T01:33:00.000-07:00

FACTS ABOUT OUR HEART

2008-10-14T20:19:00.000-07:00

Our heart beats on average 50 to 80 beats per minute or about 100,000 times per day. It pumps blood about 5 liters per minute or about 2000 gallons per day.

By the time we reach 70 years old, our heart has been beating for 2.5 billion times and pumping blood about 50 million gallons.

PENANG CARDIOVASCULAR SYMPOSIUM 2008

2008-09-20T07:42:00.000-07:00

ACEI, ARB OR COMBINATION FOR HEART FAILURE

http://docs.google.com/Presentation?docid=dfkxwwtm_3fw6bt9c7&hl=en

Selamat menyambut ramadhan

2008-09-01T18:50:00.000-07:00

selamat menyambut ramadhan

SECONDARY PREVENTION FOR PATIENT WITH CORONARY ARTERY DISEASE (AHA/ACC 2006)

2008-08-06T00:42:00.000-07:00

Smoking	Complete cessation No exposure to environmental tobacco smoke
Blood Pressure Control	130/80mmhg
Lipid Management	LDL-C, less than 2.0mmol/l
Physical Activity	30 minutes, 7 days per week
Weight Management	BMI 18 to 23kg/m2 Waist circumference (Men <38>
Diabetes Management	HbA1c <7%
Antiplatelet	Aspirin indefinitely (75 to 162mg daily) Add Clopidogrel 75mg daily post acute coronary syndrome or stenting Warfarin for AF
Renin Angiotension Aldosterone blockers	ACE Inhibitors for all patients ARB for ACE Inhibitor intolerance ACE Inhibitor and ARB combination for heart failure Aldosterone receptor blocker for NYHA class III and IV
Beta Blockers	Myocardial infarction, acute coronary syndrome, heart failure

Secondary prevention: "Post cardiac event"

RISIKO PENYAKIT JANTUNG KORONARI

2008-07-24T18:26:00.000-07:00

RISIKO BOLEH DI UBAH

Tekanan darah tinggi
Kandungan lemak berlebihan/hypercholestrolaemia
Kencing manis/Type 2 Diabetes Mellitus
Tabiat merokok
Kegemukan
Kurang aktiviti fizikal
Ketegangan/stress

RISIKO TIDAK BOLEH DIUBAH

Keturunan
Jantina lelaki
Umur

thesecret

2008-07-22T19:21:00.000-07:00

A very interesting video i picked up.
Here is the link..
http://video.google.com/videoplay?docid=-1052811701025164889&ei=N5WGSJ6FOpKywgOVxIiRCA&hl=en

The myth and truth about cardiac CT

2008-07-13T04:18:00.000-07:00

I think I am jumping the gun talking about cardiac CT before talking about coronary heart disease in general. The reason being there are a lot of us simply request for cardiac CT for no obvious reason. (cardiac CT=multislice CT=CTA coronary).

Advantage of multislice CT coronary
1. Avoidance for arterial puncture and coronary catheter manipulation, in which deemed fairly safe.
2. Cheaper than conventional coronary angiogram
3. Outpatient setting
4. Highly sensitive for proximal lesions

Disadvantages of multislice CT coronary
1. Excessive radiation exposure – 3x standard coronary angiogram
2. Excessive contrast use – 3x standard coronary angiogram, hence higher risk for kidney complication
3. Image quality dependent upon patient heart rate
4. Distal segments may be poorly visualized in some patient
5. Presence of calcium may cause underestimation of coronary artery narrowing

In my opinion, multisclice CT coronary is appropriate for
1. "Intermediate risk" chest pain that has an equivocal/non interpretable stress test.
2. Atypical chest pain in patients who can’t adequately perform treadmill stress test.
3. Unusual coronary anatomy.
4. New onset heart failure
(based on Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging (JACC Vol 48, No 7, 2006, 1475-97)

Mulitslice CT coronary is not suitable for
1. Known coronary heart disease
2. High probability coronary heart disease based upon clinical assessment

Tasik Temenggor Trip 2008

2008-07-12T20:50:00.000-07:00

Dr Suresh, Dr Regu and Me

Concerning Heart

2008-07-12T07:20:00.000-07:00

There are quite a lot of my patient asking me to blog, as one of the way to educate the public.

So I thought this is really exciting. But the problem is, I have never done this before. So one fine night, after a good hiking adventure at Bukit Tongkat Ali, Pokok Sena, with my trustworthy colleague, Dr. Regunathan (his a plastic surgeon), I take the first step.

ANIMALS	PLANTS
Beef, Beef fat, veal, lamb, pork, lard, poultry fat, butter, cream, milk, cheeses and other dairy products made from whole and 2 percent milk	coconut, coconut oil, palm oil and palm kernel oil (often called tropical oils), and cocoa butter

NATURAL	PROCESSED FOOD
beef, pork, lamb and the butterfat in butter and milk	making margarine, shortening, cooking oils cookies and white bread