Heart Disease Singapore: Symptoms, Causes, and Treatment

By Dr Reginald Liew

Cardiovascular disease is one of the leading causes of death in Singapore, responsible for over 30 percent of deaths in 2024. Stress, sedentary lifestyle, smoking, and diets high in fat and sugar contribute significantly to this trend.

In this article, we examine the most common heart diseases in Singapore, along with key information about each one.

What is Heart Disease?

Heart or cardiovascular disease (CVD) refers to conditions that affect the heart and blood vessels, including coronary artery disease, abnormal heart rhythms, heart failure, and congenital defects.

In Singapore, CVD accounts for almost 1 in 3 deaths annually (Singapore Heart Foundation, 2024).

Common Types of Heart Diseases in Singapore

While several heart conditions affect Singaporeans, there are specific heart diseases that occur more frequently.

1. Coronary artery disease (CAD): Coronary artery disease occurs when the coronary arteries that supply blood to the heart muscle become narrowed or blocked by fatty deposits known as plaques.
   This process, known as atherosclerosis, limits oxygen supply to the heart and increases the risk of a heart attack. Over time, CAD can cause angina (chest pain), shortness of breath, or heart attacks if a plaque ruptures and fully blocks an artery.
2. Heart rhythm disorders (arrhythmias): Arrhythmias happen when there's a problem with the heart's electrical system, causing the heart to beat too fast, too slow, or irregularly. Common examples include atrial fibrillation, bradycardia, and tachycardia.
3. Heart valve disease: The heart's four valves (aortic, mitral, tricuspid, and pulmonary) control blood flow through the heart's chambers. Valve disease develops when one or more valves narrow, leak, or fail to close properly. This affects blood flow and can progress to heart failure if left untreated.
4. Heart Failure: Heart failure occurs when the heart cannot pump enough blood to meet the metabolic needs of the body, or only does so with elevated ventricular filling pressure.
   This can either happen when the heart muscle is too weak to pump blood to the body (systolic failure) or when the heart muscle is too stiff to relax and fill properly (diastolic failure).
   This condition doesn't mean the heart has stopped, but rather that it's struggling to meet the body's demands.
5. Congenital heart disease: Congenital heart disease refers to structural abnormalities of the heart present at birth. These defects may involve the heart walls, valves, or blood vessels. Examples include septal defects, Tetralogy of Fallot, and transposition of great arteries. Some defects are detected in infancy, while others may remain unnoticed until adulthood.

Symptoms of Cardiovascular Disease

The symptoms of cardiovascular diseases vary based on the type:

Symptoms of coronary artery disease

The symptoms include chest tightness during physical activity, unusual fatigue that doesn't improve with rest, and shortness of breath when climbing stairs or walking quickly. In severe cases, there could be a heart attack.

Symptoms of arrhythmias

Symptoms include palpitations, irregular heartbeat, dizziness, fainting spells, and chest pain in some cases.

Symptoms of heart failure

You may experience shortness of breath (especially at night or when lying down) that requires extra pillows to sleep. There's also persistent coughing, swollen ankles or abdomen, and increased fatigue.

Symptoms of valve disease

It presents with fatigue, chest discomfort, and palpitations. There could also be swollen ankles and abdomen from fluid accumulation.

Some people who have CVDs remain asymptomatic until advanced stages, making regular heart screening important, especially for those with risk factors.

Causes and Risk Factors of Heart Diseases

The causes of heart diseases differ by condition, but shared risk factors include:

• High blood pressure: Research shows that hypertension doubles the risk of developing heart failure and significantly raises the risk of stroke.
• High cholesterol
• Diabetes
• Smoking
• Obesity or overweight (BMI > 23 for Asians)
• Physical inactivity
• Family history of heart disease
• Ageing

Diagnosis of Cardiovascular Disease

When doctors suspect cardiovascular disease, they don't rely on a single test. Instead, they combine a detailed clinical history, physical examinations, and diagnostic tests to confirm the diagnosis and understand how far the disease has progressed.

Here's what some diagnostic tests involve, and what the results might show.

Electrocardiogram (ECG/EKG)

Records the heart's electrical activity using electrodes attached to the skin.
A normal heart shows a steady rhythm (sinus rhythm) with no abnormal waves.

If there's a CVD, there may be irregular rhythms (arrhythmias), signs of a past heart attack (changes in the ST segment or Q waves), or poor blood supply to the heart (ischemia).

Echocardiogram (Echo)

Uses ultrasound waves to create moving images of the heart. If there's a CVD, the Echo might show enlarged heart chambers, weakened pumping ability (low ejection fraction), valve leaks (regurgitation), or narrowing (stenosis). Mostly used to identify valve diseases.

Stress Test (Exercise Treadmill Test)

Monitors how the heart responds to exercise or medication that simulates exercise. There could be chest discomfort, shortness of breath, or ECG changes suggesting reduced blood flow (ischemia).

Cardiac Catheterisation (Coronary Angiogram)

Identifies narrowing and blockages in the flow of the coronary arteries.

Blood Tests (e.g., Lipid Profile, Cardiac Biomarkers)

High LDL or triglycerides increases the risk of heart disease.

Troponin levels: Even slightly elevated levels can indicate heart muscle damage

BNP or NT-proBNP: These hormones rise when your heart is under stress

Treatment for Cardiovascular Disease

Treatment depends on the condition and severity. It usually consists of lifestyle modifications, medications, and some procedures.

1. Lifestyle Modifications

Doctors often start by addressing habits that directly affect the heart:

• Eat a healthy diet: A heart-protective diet rich in vegetables, fruits, whole grains, and lean protein; limiting salt, sugar, and trans fats.
• Regular exercise: At least 150 minutes of moderate activity per week (walking, cycling, swimming).
• Weight management: Maintaining a healthy BMI (18.5 and 22.9kg/m2) lowers strain on the heart.
• Quitting smoking: Smoking cessation reduces risk almost immediately.
• Limiting alcohol: Excessive intake raises blood pressure and triglycerides.

2. Medications

Different classes of drugs are prescribed depending on the condition:

• Cholesterol-lowering drugs: Statins (e.g., atorvastatin, simvastatin) reduce LDL cholesterol and plaque buildup. Drugs like Ezetimibe lower cholesterol absorption.
• Blood pressure medications: ACE inhibitors (e.g., enalapril, lisinopril) or ARBs (e.g., losartan) relax blood vessels and lower strain on the heart. Beta-blockers (e.g., metoprolol, propranolol) slow the heart rate and reduce oxygen demand.
  Calcium channel blockers (e.g., amlodipine, diltiazem): relax vessel walls and lower blood pressure. Diuretics (e.g., hydrochlorothiazide, furosemide): help remove excess salt and water.
• Antiplatelet and blood-thinning drugs
  Aspirin (low-dose) prevents clots in high-risk patients, while clopidogrel or ticagrelor prevents platelet clumping after stents or heart attacks. Warfarin or DOACs (e.g., apixaban, rivaroxaban) used in atrial fibrillation to prevent stroke.
• Other heart-specific drugs
  
  • Nitrates (e.g., nitroglycerin): relieve chest pain (angina) by widening blood vessels.
  • Digoxin: sometimes used in heart failure or arrhythmias to strengthen contractions.
  • SGLT2 inhibitors (e.g., empagliflozin): newer diabetes drugs now proven to improve heart failure outcomes.

3. Medical Procedures & Surgical Interventions

If medication isn't enough, your doctor may recommend:

• Angioplasty and stent placement: A balloon is used to open a blocked artery, then a stent (mesh tube) keeps it open.
• Coronary artery bypass grafting (CABG): Surgeons create a new path around blocked arteries using vessels from another part of the body.
• Valve repair or replacement: For patients with diseased heart valves.
• Implantable devices: They include pacemakers to correct slow heart rhythms and implantable cardioverter-defibrillators (ICDs) to prevent sudden cardiac death.
• Heart transplant: Can be done in rare cases of severe heart failure, when all other treatments fail.

4. Cardiac Rehabilitation

Most patients are also referred to a cardiac rehab programme, which combines supervised exercise, dietary counseling, stress management, and education.

Prevention: How to Lower Your Risk of Cardiovascular Diseases

While congenital conditions cannot be prevented, most CVD risk can be reduced by:

• Exercising regularly (start with brisk walking, progress to jogging/swimming).
• Maintaining BMI within the Asian healthy range.
• Eating a heart-healthy diet (vegetables, fruits, whole grains, and less processed foods).
• Quitting smoking and moderating alcohol intake.
• Managing stress and ensuring 6–8 hours of quality sleep.

When to Seek Medical Help

If you experience chest pain, palpitations, fainting, or unexplained shortness of breath, do not dismiss these as minor issues. They may indicate an underlying heart disease that requires urgent medical evaluation.

Final Thoughts: Protecting Your Heart Health

Heart diseases are common in Singapore but highly treatable when identified early. Recognising symptoms, addressing risk factors, and seeking timely treatment can make the difference between managing a condition and facing life-threatening complications.

At the Harley Street Heart & Vascular Centre, our multidisciplinary team of cardiologists offers advanced diagnostics, personalised treatment, and long-term heart health management.

Book an appointment today and take the first step towards protecting your heart.

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