HomeInterviewsDr. Paul Chiam, Senior Consultant, Cardiology, Mount Elizabeth Hospital

Dr. Paul Chiam, Senior Consultant, Cardiology, Mount Elizabeth Hospital

Matters of The Heart

Dr. Chiam, what drove you to specialize in the field of cardiology? How do you incorporate holistic healthcare in your practice?
During my time in medical school, conducting a variety of rotations in different medical fields, I found myself liking Cardiology the most. Especially because the heart is essentially linked to everything and responsible for the pumping of blood to all the vital organs and body parts. Additionally, the technology in this field is developing at a fast pace. Hence, we have a lot of tools at our disposal such as Ultrasound, Electrical Machine readings of the heart, etc. Things that we do now are much more developed and allows us to conduct innovative procedures; for example, minimally invasive valve replacement, improving the electrical system of the pacemakers and so on.

What would you say is the most prominent healthcare risk when it comes to our hearts? What kind of cardio disease is most prevalent in South-Asia?
I think the most common health problem we see is people coming in with blockages of the heart arteries and vessels; the probability persists throughout all geographical locations. Secondly, we see a lot of cases pertaining to heart valve problems, where the valves have become very narrow or leaky. The third most common causes are heart muscle diseases where the muscles become weak and thicken. So. Our main focus of treating and preventing heart diseases is to reduce the burden of coronary artery blockages and issues.
As we grow older, the chances of developing artery blockages increase. Therefore, age is one of those factors that we cannot possibly change or control in this case.
High blood pressure and cholesterol also contribute to the risk factors. More so, smoking tends to increase the risk by many many folds as time goes by.

What should you do if you suspect you are having a heart attack? How effective is the precise application of these techniques?
The patients who have suffered heart attacks tell us that their pain at the moment was quite severe. They usually describe the pain as an incredible crushing or squeezing pain, as if an enormous weight is crushing their chest. This results in a feeling of breathlessness, nausea, and sweating. The pain lasts for 15-20 mins approximately, non-stop. Thus, anyone experiencing the following sensations of a heart attack must first try to reach a hospital as soon as possible; as certain biological changes might take place simultaneously for which general precautions won’t work. Once they reach the hospital, we confirm the heart attack by conducting an ECG – an electrical reading of the heart. Following that, we provide the patient oxygen and aspirin which acts as a generic blood thinner, which they can straight away chew and it decreases the immediate risk of death.

The definitive treatment is conducting an emergency Angioplasty, where we use small tubes to open up the arteries; the entire procedure can be conducted within 15-30 mins of the patient entering the hospital. Using balloons and accompanying stands, we open up the artery to resolve the block. Hence, the earlier the procedure is done, the better as the heart muscles will be completely dead in the next 12 hours. The angioplasty is a minimally invasive procedure done under local anesthesia. It’s performed by creating a small puncture wound and passing a 2mm tube into the artery. Subsequently, we expand the balloon inside to open up the blockage.

In the past, the conventional means was to do an open heart surgery to replace the valve; whilst allowing for the risks and probable complications of this procedure. In the last 12 years, TAVI has allowed us to replace the valve on a beating heart, without the need to cut open a patient’s chest.

Give us an account of the Health Manpower Development Plan (HMDP) scholarship of 2006 and your subsequent subspecialty of interventional cardiology?
In Singapore, when we specialize in Cardiology, the training is three years, along with an exam at the end of the tenure. Then we get inducted into the Certified Registrar of being a Cardiologist specialist. After that, we work for a year or so and then have the opportunity to apply for the HMDP scholarship; funded by The Ministry of Health in Singapore. The funds allow us to train overseas, which resulted in my training in New York City for approximately 2 years. Following that, we can then choose our field of specialty; as per the acceptance of the hospital and Ministry of Health, Singapore. My choice was Interventional Cardiology, where we use innovative means to open heart blocks and replace damaged valves through minimally invasive procedures.

Suppose I am absolutely unaware of what TAVI is, how would you explain the procedure to me?
Transcatheter Aortic Valve Implantation (TAVI) also known as Transcatheter Aortic Valve Replacement (TAVR) in North America, is a new technology that has to do with the aortic valve. It’s a valve which leads all the blood out of the heart to the rest of the body, as the heart pumps. As we grow older, the valve gets degenerated as calcium deposits thicken and the pathway becomes severely narrow. Sometimes, resulting in feelings of chest pain and tiredness. The severe cases lead to an average survival rate of 50% in 2 years.

In the past, the conventional means was to do open-heart surgery to replace the valve; whilst allowing for the risks and probable complications of this procedure. In the last 12 years, TAVI has allowed us to replace the valve on a beating heart, without the need to cut open a patient’s chest.

The minimal incision is done through the groin as we pass a minuscule tube, leading all the way to the heart. The new valve is sort of compressed down into the tube and using the aided balloons, we open up the valve. TAVI procedure has shown equivalent prowess and even better than the conventional open-heart surgery. TAVI was commercialized in 2007 and I was the first person to conduct it in Asia in the year 2009. The success rates currently stands between 97-99%.

What are the various means of treatment available at Mount Elizabeth for cardiological diseases? How do they fare to any alternative means (if present)?
At Mount Elizabeth Hospital, we have the full range of treatments from Angioplasty to some of the very complex heart artery treatments. In the past, the only option was bypass surgery; the success rates for patients with 100% blocks undergoing bypass, was uncertain. Nowadays, we can achieve 80% success rates in re-opening 100% blocks as per the new technology. We have TAVI procedures available and treatments for patients with Atrial Fibrillation with high risks of strokes. More so, we have the Watchman procedure especially for patients who have suffered from severe strokes.

What are the current scopes of research you are interested in?
My main interest right now is on the technology in conducting the heart valve replacement through minimally invasive means. Additionally, I’m looking into the means of performing angioplasty through the wrist as an alternative to conventional heart artery angioplasty

If you had one piece of advice for your patients, what would it be?
Lead a healthy lifestyle with the required moderation of key health factors like fitness, diet and rest. Developing restraint and discipline over your daily activities is a prerequisite to live a fulfilled everybody yearns for.

What are the prospects of Bangladesh in respect to the alliance between Parkway Hospital and Mount Elizabeth, in meeting the healthcare needs of the country?
It’s all about the environment. The essence of Mount Elizabeth and Parkway Hospital is a complete package of treatment and subsequent recovery; tailored made as per the needs of the patient. Here we offer the current cutting edge technology available to perform high risk and complicated cases. On the other hand, we also provide an integrated system of recovery which is an essential element for overall health after treatments.