December 2016 - February 2017

MCI (P) 102/11/2016 fb.com/heartfoundationmyheart.org.sg twitter.com/heartSG

Official Publication of the Singapore Heart Foundation

Cardiology for the Layman #3Chest Pain: Am I having

a heart attack?

03

心理健康与心脏健康

05

21

Mental Health & Heart Health

@singaporeheartfoundation

PATRONESM Goh Chok Tong

NATIONAL HEART COUNCIL

PRESIDENTDr Richard Hu

VICE PRESIDENTSMr Sat Pal KhattarMr Shaw Vee Meng

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 45TH

BOARD OF DIRECTORS

CHAIRMANAdj Prof Terrance Chua

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee-Chew

HONORARY SECRETARYProf Tan Huay Cheem

ASSISTANT HONORARYSECRETARYMr Goh Chiew Seng

HONORARY TREASURERMr Chong Chou Yuen

MEMBERSDr Chee Tek SiongMrs Elsie FohDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeA/Prof May LwinDr Mak Koon HouMr Peter SimDr C Sivathasan

HONORARY ADVISORSProf Koh Tian HaiMr Liak Teng LitMr Lim Soon HockA/Prof Lim Yean TengDr Lily NeoMr Tan Kin LianMr Wong Yew Meng

EDITORIAL COMMITTEE

EDITORMr Patrick Deroose

MEMBERSAdj Prof Terrance ChuaDr Chee Tek SiongDr C Sivathasan

SECRETARIATMr Vernon KangMs Stephanie HoMs Mabel Tang

2 Editor’s Note

heartline is a quarterly publication of the Singapore Heart Foundation.9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg

The information provided in heartline is for educational purposes only. It should not be used for diagnosingor treating a heart problem or a disease, and should not be substituted for professional health care. Opinions expressed by contributors and advertisers do not necessarily reflect those of the SHF.The SHF does not endorse any products or services in heartline advertisements.

All rights reserved. Copyright is held by SHF.No portion of this publication can be reproduced without the permission of SHF.To advertise in heartline, please email info@heart.org.sg or call 6354 9340.Terms and conditions apply.

Want a copy of heartline delivered to your doorstep?Call 6354 9340 for a copy of the subscription form.Designed by: Vacain Design Pte Ltd • Printed by: Print & Print Pte Ltd

Patrick Deroose

DEAR READERS,

As we come to the end of 2016, soon we will be ushering in 2017 where New Year’s resolutions will be made – “This year I will do this or that”. Some of you may vow, “This year I will stop smoking!” Unfortunately, the road to hell is paved with good intentions. Most of the New Year’s promises will end up broken and unfulfilled. Although the health benefits of smoking cessation are well known, many smokers find it challenging to stop. I hear the stubborn smoker proclaim “I need the cigarette because of my stressful job” or “I make a choice and in the end, it is me who is responsible for my own health”.

But is the last statement really true? With concerns about secondhand smoke, smoking during pregnancy, the number of fires started by a cigarette butt and the high use of resources (human, technological and financial capital) to treat smoking related diseases, does that statement hold true? When expressed in dollar savings, a smoke-free society could certainly reorganise its priorities. If this is indeed an issue that society has to deal with, we all know that the “carrot and stick” approach may not work that well. Should we not use the persuasive power and influence of the masses then?

In 2012, the UK started the “Stoptober” campaign (quit smoking in October). Results showed that the number of smokers who were willing to attempt the cessation programme increased by 50%, with 5% of long-term smokers giving up the habit all together. Launched by Public Health England, the campaign is supported by local governments, professional health care associations and lay volunteers. France has started a similar campaign “Moi(s) sans Tabac” this year and I am looking forward to the research results. Smokers account for 34.6% of adults in France, versus 17% in the UK. What impact will this campaign have on the conversion rate and ultimately, the French health care cost?

The campaign includes advertising, media exposure, educational and support sessions, as well as an attractive cessation kit. There is a good uptake of the kits which contain de-stressing tips and relaxation techniques. Survey results have indicated that many people smoke due to stress. A campaign which is well designed, customised to the audience’s needs and supported by a broad base of society, could be the trigger for a New Year’s resolution - one that is hopefully kept.

As this is the last issue of heartline for the year 2016, there is only one thing left to do and that is to say a big thank you!

Thank you to the SHF staff, for their unwavering dedication to our cause.Thank you to our members, for without you, there is no SHF.Thank you to our volunteers, for your time and effort freely given to us.Thank you to our sponsors and partners, your support keeps us going.Thank you to the SHF management team, your leadership inspires us.Thank you to my editorial committee members, for your contributions. You have become friends.

So I wish all of you a Happy New Year 2017, and may the Year of the Rooster bring you happiness, good heart health and prosperity!

3Feature

Article contributed by Professor Tan Huay Cheem

Chest pain represents one of the most frequent complaints in the Emergency Room and is also the hardest to assess. This is because a variety of cardiac

and noncardiac conditions can produce chest discomfort or pain. History taking remains the most important technique for distinguishing among the many causes. A detailed description of the symptom complex enables the clinician to characterise the chest pain. 5 components are typically considered - quality, location, duration of pain, factors that provoke the pain and factors that relieve the pain.

Angina pectoris, or “heart pain”, may be a warning symptom prior to the onset of a heart attack. It is a form of chest discomfort which has been described as “choking” or “pressing”, “squeezing”, “strangling”, “constricting”, “bursting” or “burning” in character. Angina is most commonly felt in the midline of the chest, but can manifest exclusively in the jaw or neck, the left shoulder or arm, especially in the ulnar aspect.

The typical patient is one who clenches his fist while describing the symptom, the so-called Levine sign. Angina is almost never sharp or stabbing, and it usually does not change with position or respiration. The anginal episode usually lasts for minutes.

A fleeting discomfort or a dull ache lasting for hours is rarely angina. It is generally caused by exertion or emotional stress and relieved by rest. The intensity of effort required to bring about the symptom seems to vary from day to day and throughout the day in the same patient. The anginal threshold is generally lower in the morning than at any other time of the day, thus activities that may cause angina in the morning might not do so later in the day. Rarely, the back interscapular region (between the shoulder blades) or right shoulder may be involved.

Typical angina is:1. Substernal (behind the breast bone) chest discomfort

with a characteristic quality and duration2. Provoked by exertion or emotional stress 3. Relieved by rest or nitrates (medicine taken under the

tongue or in the form of a spray)

Atypical angina meets two of the above characteristics, while noncardiac chest pain meets one or none.

Angina is further classified as stable or unstable. Unstable angina is defined as angina that presents at rest, or as severe new-onset angina or increasing angina. It represents a state in which the patient is at a higher risk of developing acute coronary events such as acute myocardial infarction (heart attack) or death.

Cardiology for the Layman #3

Chest Pain: Am I having a

heart attack?

(According to the Canadian Cardiovascular Society Classification)

Occurs with strenuous activities

Class IAngina

Class IIAngina

Occurs with moderate activity such as walking uphill or more than one block on level ground

Class IIIAngina

Occurs with marked limitations of ordinary

physical activity

Class IVAngina

Characterised by rest angina

Angina Grading

4 Feature

Professor Tan Huay Cheem is the Honorary Secretary of the Singapore Heart Foundation’s Board of Directors.He is also the Director at the National University Heart Centre, Singapore (NUHCS).

The pain from a heart attack is anginal pain amplified several folds. It is not relieved by rest and the patient frequently has associated symptoms of profuse cold sweat, nausea, vomiting, dizziness and shortness of breath. In severe cases, the patient may even lose consciousness completely from a cardiac arrest.

While angina pectoris is the most important cause of chest pain, it has to be distinguished from other causes too. The differential diagnoses or other causes include aortic dissection (or ‘tearing’ of the aortic wall), which may manifest as severe chest pain that radiates to the back, and is migratory from its point of origin at the back down the spine, to other sites, following the path of the dissecting hematoma (or blood clot). The pain is maximal at its onset and may actually lessen in intensity with time, unlike heart attack pain which builds up in a crescendo pain after it begins.

Another common cause is acute pericarditis or ‘inflammation of the heart covering’. It is characterised by a precordial (front of the chest) pain that is preceded usually by a history of viral upper respiratory tract infection. It is sharper than anginal discomfort, typically left-sided, and is made worse by inhaling, turning in bed, swallowing or twisting the body. It may lessen when the patient sits up and leans forward. Chest wall pain of musculoskeletal origin is common in patients who are anxious about heart disease. Costochondritis or Tietze syndrome is characterised by focal chest wall pain and point tenderness (front of ribs), which is frequently aggravated by movement or coughing.

Emotional stress and anxiety precipitating functional or psychogenic pain (Da Costa syndrome or neurocirculatory asthenia) manifests as a dull, persistent ache below the left nipple that lasts for hours; and is punctuated by brief sharp stabs of 1-2 seconds duration. Esophageal discomfort from reflux esophagitis (‘heartburn’) may also mimic that of ischemic (anginal) heart pain. However, the symptom is usually brought on by food digestion and recumbency and the patient may experience a sour taste in the mouth.

Distinguishing chest pain arising from the heart with other causes may be difficult and it takes an experienced doctor to make an accurate diagnosis. The advice will be to seek immediate medical attention by calling for an ambulance service. Heart attack and some of the other causes may be easily diagnosed by performing a resting electrocardiogram for the patient.

5Feature

Depression and Other Issues

Many forms of mental health issues can affect heart diseases. There is the temporary state of depression or a more severe, clinical case. You can also have varying levels of anxiety and stress, just to name a few of the most well-known problems.

Research does not firmly link stress and heart diseases, but there’s a growing belief that it’s an additional risk factor, and maybe even more dangerous than some others, said Nieca Goldberg, M.D., medical director for the Joan H. Tisch Center for Women's Health at NYU’s Langone Medical Center.

“Stress can increase hormones like adrenaline and cortisol, and can impact your blood pressure and heart rate,” she said.

Heart, Stroke Patients Must Be Wary

Having heart diseases or stroke can cause anxiety or depression. It is important to handle these in a healthy way.”

“It’s not just that they want to smoke and eat,” Dr. Jacobs said. “They don’t have the energy to get out of bed and go to rehab and do the things they need to regain their physical health.”

It makes sense that someone might think, “I just had a heart attack, I should be depressed.” But minimising their sadness and dismissing it, could start them down a slippery slope.”

What should be done?

Start by discussing how you are feeling, both physically and mentally, with your healthcare provider. He or she will be able to help, refer you to the most appropriate care or provide the best place to start.

You should monitor yourself and your loved ones, especially those dealing with heart diseases or stroke.

“Doctors are going to say, ‘Are you still smoking? How are you doing with your diet? Are you checking your blood pressure? How’s your mood been? Are you enjoying the same things that used to give you enjoyment?’ ” - Dr Jacobs said. “Whether someone is clinically depressed or just anxious, they need follow-up care.”

For years, doctors thought the connection between mental health and heart health was strictly behavioural – such as the person who is

feeling down seeking relief from smoking, drinking or eating fatty foods.

That thinking has started to change. Research shows there could be physiological connections too. The biological and chemical factors that trigger mental health issues also could influence heart diseases.

The head-heart connection should be on

everyone’s radar,” said Barry Jacobs, Psy.D., a clinical psychologist

and director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pa.

“It’s not just being unhappy. It’s having biochemical changes that predispose

people to have other health problems, including heart

problems.

& Heart HealthArticle is republished from the American Heart Association.

Mental Health

7

Do you wish to receive heart health related news on a regular basis? Subscribe to our e-newsletter Heart Mattersby emailing mabel@heart.org.sg with your name, email address and contact number.

BitesHealth

We all know that exercise is good, but is it important to believe so as well? A study involved 76 men and women aged between 18 to 32 years, who exercised for 30 minutes on a bicycle ergometer. Before the test, subjects were divided into different groups and shown a film that either praised the positive effects of cycling on health or not. In addition, participants were questioned on their well-being, their mood and whether they already believed in the positive effects of physical activity. Those who already believed in the positive effects enjoyed the exercise more, improved their mood more, and reduced their anxiety more than less optimistic subjects. In addition, participants with greater expectations before the beginning of the study and those who had seen a positive film, were more relaxed on a neuronal level. The results suggest that beliefs and expectations could possibly have long-term consequences, for instance on our motivation to engage in sports.

Exercise does more good if you believe it will

World’s largest study shows effects of long- term exposure to air pollution and traffic noise on blood pressureIn the world’s largest study, long-term exposure to air pollution has been shown to be associated with a greater incidence of high blood pressure. 41,000 non-hypertensive participants living in 5 countries were assessed for 5 to 9 years, where 15% were found to develop hypertension or started on blood pressure-lowering medications during the follow-up period in later years. Researchers also found that for every 5 µg/m3 of PM2.5 (particulate matter ≤2.5 microns) present, the risk of hypertension increased by 22% for those living in the most polluted areas versus those in the least polluted areas. Higher soot concentration was also a risk factor. Exposure to chronic traffic noise increased the risk of hypertension by 6% for those living on noisy streets with average noise levels of 50 decibels, as compared to those living on quieter streets with average noise levels of 40 decibels during the night. Lastly, noise is thought to affect the functioning of both the nervous and hormonal systems.

Early prevention of high cholesterol A large study in England tested 10,000 children of around age one for high cholesterol and genetic mutations known to be associated with familial hypercholesterolemia (FH) - a genetic disorder that often leads to early heart diseases. 40 children tested positive for FH, at a rate of about one in 270 children. Their parents were then screened and overall, out of every 125 people tested, one person at high risk of early heart attack was identified. When high-risk children are identified, they can then take preventive measures such as exercising, avoiding smoking, eating healthily and taking statin medication (when older). Testing the cholesterol of babies during routine vaccination visits, could prevent hundreds of heart attacks in young adults each year. However, do note that this is an initial proposition from the study, and more in-depth research should be done first.

Health Bites

The DIRECT DONOR DEBIT PROGRAMME (DDDP) is designed toencourage individuals to give small donations to SHF on a regular basis, for our life-

saving programmes. SHF would like to thank the following DDDP Event Site Sponsors, who have generously provided their venues for our various roadshows.

TOGETHER, WE CAN WORK TOWARDS A HEART HEALTHIER NATION!

ANSWERS (Sep 2016 - Nov 2016)

8 Nutrition

GET THE FATS riGHT!

Categorise the food according to the types of fat (i.e. monounsaturated fat, polyunsaturated fat).

GOOD FATS(Monounsaturated fats, polyunsaturated fats)

BAD FATS(Saturated fats, trans fats)

Black & white sesame seeds Chocolate

Avocado French fries

Almond Cake

Salmon Ice cream

Olive Oil Cookie

Walnut Fried Chicken

Cashew Nut Donut

Congratulations to all winners* and thank you for your participation!*Winners have been notified via phone or email.

9Nutrition

Simply email/fax this page to heartline@heart.org.sg / 6258 5240 by 28 February 2017.

Name: ______________________________________________ NRIC: ______________________________________________

Email: ______________________________________________ Mobile: ______________________________________________

All winners will be notified via phone or email. Good luck!Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 March 2017.

• 1X750mlbottleofNaturelExtraVirginOliveOil• 1X500gpacketofNaturelOrganicHomMali

Mixed Brown Rice + Red Rice• 1kgpacketofCaptainOats• 1XbottleofSalbaChiaSeeds• 2XKoreanrealnanodualbristletoothbrushes• 1Ximportedpillboxwith3functionalusages

Search for the answers in the heart.

1. Having 2 to 3 servings of _____ per day may help to benefit the heart. 2. Always opt for _____ protein over processed protein (e.g. sausages,

ham, luncheon meat, etc.). 3. Consume a _____ variety of 2 servings of fruits and 2 servings of

vegetables every day. 4. Stay _____ by achieving at least 150 minutes of physical activity

every week.5. Whole-grains and _____ vegetables are a source of carbohydrate. 6. Limit _____ food to no more than twice per week.7. Cut down on added _____ to reduce your sodium intake.8. Consume healthier fats by replacing saturated and trans fats with

_____ fats.9. Drink water instead of sugar-_____ drinks to help you maintain a

healthy weight.10. Men should not drink more than _____ standard* drinks a day and

women no more than one. *1 standard drink = 10g of pure alcohol; 1 can of beer (330ml), 1 glass of wine (175ml), or 1 nip of spirits (35ml)

• Hearty Resolutions •

We wish to thank the following prize sponsors:Lam Soon Singapore Pte Ltd, Captain Oats, Salba Singapore, HAP Nutrition Pte Ltd and iTrade Marketing.

Submit your correct answers and stand a chance to win 1 of 5 hampers (worth more than $50) in our lucky draw!

12 National Heart Week/World Heart Day 2016

The Singapore Heart Foundation celebrated its annual National Heart Week/World Heart Day on 1st October at the Hard Court next to Yishun MRT

this year. Centered on the theme of ‘Power Your Life’, the carnival saw an attendance of 3,000 members of the public as a line-up of family-friendly activities was planned to heighten public awareness of cardiovascular disease risk factors, and how to make right choices for their hearts.

To encourage positive behavioural change towards better heart health and blood pressure (BP), the Foundation together with Nanyang Polytechnic School of IT, developed

the ‘BP Matters’ mobile app which was launched at the event. Often touted as a “silent killer”, high blood pressure or hypertension, typically does not exhibit any symptoms until significant damage has been done to the heart and arteries. With the ‘BP Matters’ app, patients with high blood pressure can easily monitor and record their blood pressure at home, then share the readings with their doctor during check-ups. Guest of Honour Associate Professor Muhammad Faishal Ibrahim, Parliamentary Secretary, Ministry of Education & Ministry of Social and Family Development, MP for Nee Soon GRC, was at the event to launch the ‘BP Matters’ app.

Participants were engaged with educational and interactive activities, for instance in the Hearty MasterChef Challenge, where they whipped up nutritious and delicious meals. Blood pressure monitor stations and a ‘Know Your Numbers’ photo wall were set up for members of the public to measure their blood pressure (BP), take a photo with their BP numbers and make a pledge to keep

their blood pressure readings healthy.

To get heart rates pumping, ‘Zumba for Heart’ and ‘Chair Aerobics’ sessions were held to reinforce the importance of exercising regularly, in the fight to combat hypertension and heart diseases.

Scan here to install the app!

For Android devices

For iPhones

13National Heart Week/World Heart Day 2016

Other highlights at the carnival included a cardiac risk assessment screening, CPR+AED certification course, heart-health quizzes, nutri-educational exhibition, myResponder app (R-AEDi) and Dispatcher-Assisted first REsponder (DARE) booths.

To show how healthy food can be delicious at the same time, there were also live cooking demonstrations by:

Celebrity Chef Martin Yeo, who whipped up chicken fingers using Captain Oats

Celebrity Chef Rayner, who used the Philips Airfyer to dish up Chicken Yakitori and Mediterranean Salmon en Papillote

In addition, as excessive salt intake has been suggested to increase one’s risk towards hypertension (a common condition that affects one in four adult Singaporeans), the ‘Salt taste test: Are you salty?’ enabled participants to measure their salt sensitivity at three different concentrations.

A big thank you to all our National Heart Week/World Heart Day 2016 sponsors, partners, volunteers and the 3,000 of you who turned up for the event. See you again next year!

Supporting Organisations: Main Sponsors:

Health Screening Partner: Culinary Partner:

In-kind Sponsors:

Prize Sponsors:

14 Event Reviews

For the 3rd consecutive year, SHF has once again partnered with Edwards Lifesciences on their annual family day to promote an active lifestyle away from work and also to encourage family bonding. The event, titled "Edwards’ Family Day 2016: Shine with Edwards", took place at the Sentosa Palawan Beach on 17th September and saw over 1,500 participating employees and their families. Besides having a mass workout, there were also sports games, charity booths and some interactive carnival games for all to have some fun!

Edwards Lifesciences, the global leader in the science of heart valves and hemodynamic monitoring, has generously donatedUSD $80,000 to the Singapore Heart Foundation in support of our lifesaving programmes. The cheque was presented by Mr Rainer Wolf (right), Vice President & General Manager and Ms Joanne Page (middle), Senior Human Resource Director for Global Supply Chain Operations & Quality from Edwards Lifesciences to Ms Jeslin Sin (left), Director of Programmes from SHF.

SHF participated in the event by conducting blood pressure screenings, as well as selling some of our exclusive merchandise to raise funds. Together with received donations, a total of $1,735 was raised from the event.

We would like to thank the following in-kind sponsors for their generosity and unwavering support!

Sponsors:

Edwards’ Family Day 2016:Shi ithn w warddEe s

15

On 8th October 2016, more than 250 guests comprising of Heart Wellness members, Heart Support Fund beneficiaries, staff and Board members attended SHF’s

Heart Wellness Centre’s 10th anniversary celebration at the Joyden Hall @ Bugis+. Many guests came dressed in touches of red - the theme colour for the celebratory event and had fun participating in the pre-event activities such as nutrition games (Fats I–Learn, Salt-It Out) and handicraft (keychain design with decoupage art & bookmark quilling). There was also a photo booth for guests to take home memories of their happy moments.

A sumptuous buffet spread was prepared for all guests and the banquet tables were beautifully decorated with heart shaped balloons, tea light candles and red gerberas. Ms Sylvia Tham was our emcee for the afternoon.

The celebration kick-started with an opening performance “龙腾虎跃”put together by the Nanyang Academy of Fine Arts Chinese Chamber Ensemble. After the performance, Chairman of the Heart Wellness Centre Committee, Professor Tan Huay Cheem delivered his welcome speech. Mr Vernon Kang (SHF CEO) and Mr Goh Chiew Seng (SHF Board Member) then joined Prof Tan to complete the painting of a commemorative art piece, which depicts the 4 elements for a heart-healthy lifestyle; eat healthy, exercise regularly, no smoking and rest well.

Thereafter, SHF Board members and Heart Wellness Centre staff went up on stage to sing a happy birthday song and to cut the cake. Mr Leong Kwok Cheong, a HWC heart patient was invited to share his heart attack experience and rehabilitation journey with the Heart Wellness Centre.

We were honoured to receive a timely grant of US$80,000 from the Edwards Lifesciences Foundation. Dr Chia Wai Tuck, representative from the Foundation gave a brief speech and handed the mock cheque to Prof Tan.

There were more entertaining performances for the rest of the afternoon: • A5-memberChineseOrchestrawasputupbyDingYiMusic

Company with two captivating and nostalgic songs -“细水长流” and“明天会更好”

• Dhwani Srinivasan (aged 7) and Elizabeth Russell (aged 9)from The Academy of Flute & Performances enchanted the audience with their lovely flute performances

• NTUDanceSportAcademywowedtheaudiencewiththeirgroovy moves to the tune of Jive, Cha Cha and Romantic Rumba

In the HWC Got Talent contest, four teams of Heart Wellness members showed off their vocal prowess with songs in English, Mandarin, Japanese and even Hindi! A video skit titled “First Day in HWC” was put up by the Heart Wellness staff as the finale performance. Laughter filled the air as guests were able to identify with many of the scenes during their own first day in HWC.

Ang paos (red packets) were handed out to the Heart Support Fund beneficiaries by the Heart Support Fund Committee Chairperson, Dr Goh Ping Ping and all guests brought home a goodie bag each. To end the event, the best dressed lady and gentleman each walked away with a Polar heart rate watch worth more than $180. The grand winner for the HWC Got Talent contest went to Mr Roger Ravi Kesavan with his rendition of “Speedy Gonzales”. He clinched a cash prize of $300 and a golden microphone trophy!

We hope that all guests enjoyed the afternoon, organised specially by the Heart Wellness Team. From all of us at SHF, we sincerely express our heartfelt gratitude to all sponsors, donors and volunteers for their support in making this event a great success!

Event Reviews

ShF’S heart Wellness Centre Turns 10!

Our esteemed sponsors: Caffe Pralet, Creative Culinaire The School Pte Ltd, Ding Yi Music Company, Eu Yan Sang International Ltd, Lam Soon Singapore Pte Ltd, Nanyang Academy of Fine Arts, NTU Dance Sport Academy, Malaysia Dairy Industries Pte Ltd, Polar Electro Singapore Pte Ltd, Reflex-O Recreations Pte Ltd, Sam Leong @ Forest Cooking School, Singapore Pools (Private) Limited, Tan Tock Seng Hospital, The Academy of Flute & Performances, World Kitchen (Asia Pacific) Pte Ltd.

典型的心绞痛：

1.具有典型特征和持续时间的胸骨后胸部不适。

2.由劳力或情绪刺激诱发。

3.透过休息或服硝酸盐类药物(舌下或喷雾)缓解。

非典型心绞痛符合以上特点中的两个，而非心源性胸

痛则只符合一个或都不符合。

心绞痛可进一步分为稳定型和不稳定型。不稳定型心

绞痛被定义为休息时发作，或严重的新发心绞痛，或

心绞痛加重。这种状态表示患者有较高风险发生急性

冠脉事件，如急性心肌梗死(心脏病)或死亡。

(根据加拿大心血管学会分类标准)

发生于剧烈

活动时

I类心绞痛

II类心绞痛

发生于中等活动时，

如走上坡路或在平地

上步行超过一个街区

III类心绞痛

发生于极为有限的

普通体力活动时

IV类心绞痛

特点是休息时

发生心绞痛

心绞痛分级

胸痛是急诊室最常见的主诉之一，也是最难评估。这

是因为各种心脏和非心脏问题都可能产生胸部不适或疼

痛，因此病史采集仍是在许多原因中进行鉴别的最重要

技术。对复杂症状的详细描述使临床医生能够了解胸痛

的特征，通常要考虑5个特征——胸痛的性质、位置、

持续时间、促发疼痛的因素，以及舒缓疼痛的因素。

心绞痛或「心口痛」可能是心脏病发作前的预警症状，

即一种胸部不适，其特点被描述为「窒息感」或「压迫

感」、「挤压感」、「扼杀感」、「收缩感」、「爆炸

感」或「燃烧感」。心绞痛最常见于胸部的中线，但也

可仅出现在下颏或颈部、左肩或左臂，尤其是在尺侧。

典型的病人在描述症状时会紧握拳头，这在医学上被称

为莱文症 (Levine sign)。心绞痛几乎从来不是锐痛或刺

痛，并且通常不会随体位或呼吸而改变。心绞痛发作通

常持续几分钟。

瞬间的不适或持续几小时的钝痛很少是心绞痛。心绞痛

通常由劳力或情绪刺激引起，可透过休息缓解。在同一

位患者中，引起症状所需的劳力强度可能每天都不同，

甚至一天之内都会不同。引起心绞痛的劳力强度通常在

早上比一天中的其他任何时间都较低，因此在早上可能

导致心绞痛的活动，在其他的时间里可能不会导致心绞

痛。在极少见的情况下，也会累及背部的肩胛间区(肩

胛骨之间)或右肩部。

陈淮沁教授的文章

18 特写

外行人的心脏病学(三)

胸痛：我是心脏病发作了吗？

心脏病发作时的疼痛是放大数倍的心绞痛。

休 息 也 无 法 缓 解 ， 患 者 经 常 伴 随 如 冷 汗 淋

漓、恶心、呕吐、头晕和呼吸急促症状。在

严重的情况下，患者可能甚至因心脏骤停而

完全失去知觉。

虽然心绞痛是胸痛的最重要原因，但也需要

与其他的胸痛原因相鉴别。鉴别诊断或其他

原因包括主动脉夹层(主动脉壁「撕裂」)，

这可能表现为剧烈的胸痛，放射到背部，是

从背部起源点沿脊柱向下转移至其他部位，

即顺着导致夹层的血肿(或血凝块)的路径。

疼痛开始时最为剧烈，可能随时间而减轻，

与心脏病发作的疼痛不同，后者开始后会逐

渐加重。

另一常见的原因是急性心包炎(「心脏包膜的

炎症」)，特点是心前区(胸部前面)疼痛，发

病前通常有病毒性上呼吸道感染史。比心绞

痛的不适更为尖锐，通常位于左侧，吸气、

在床上翻身或扭动身体会加剧。病人坐起，

身体前倾时可减轻。源于肌肉骨骼的胸壁痛

常见于过于担心心脏病的患者，肋软骨炎或

泰齐氏综合症的特点是局部胸壁痛和点性压

痛(前肋骨)，常为移动或咳嗽所加剧。

情绪刺激和焦虑促发的功能性或心因性疼痛

(达科斯塔综合症或心血管神经衰弱)表现为左

乳头下持续钝痛，持续几小时，同时穿插有持

续1~2秒的短暂尖锐刺痛。反流性食管炎引起

的食管不适(「烧心」)也可能与缺血性胸痛(心

绞痛)相似，然而这种症状通常由食物消化和躺

卧引起，患者口内可能感到酸味。

心脏原因与其他原因引起的胸痛可能很难鉴

别，需要有经验的医生作出准确的诊断。建议

呼叫救护车寻求医学急救服务，透过为病人进

行静息心电图检查，可比较容易的对心脏病发

作或其他原因作出诊断。

陈淮沁教授是新加坡心脏基金董事会名誉秘书及心脏复健中心委员会主席。

他也是新加坡国立大学心脏中心(NUHCS)的主任。

19特写

抑郁症和其他问题

多种形式的心理健康问题都可能会影响心脏疾病。可能导致暂时的抑郁状态或更严重的临床抑郁症病例。还可能产生不同程度的焦虑和压力，这里只是列举几个众所周知的问题。

纽约大学朗格尼医学中心 (Langone Medical Center)琼•H•蒂施女性健康中心 (Joan H. Tisch Center for Women's Health) 医疗主任、医学博士尼卡•戈德堡 (Nieca Goldberg) 说，研究并未证明压力和心脏病之间的必然联系，但是越来越多的研究人员认为，压力是另一个危险因素，而且可能比另一些因素更危险。

她说：“压力会使肾上腺素和皮质醇等荷尔蒙增加，而且可能影响血压和心率。”

心脏病、中风患者必须保持警惕

心脏病或中风可能引起焦虑或抑郁。必须以健康的心态面对心脏病和中风。

雅各布 (Jacobs) 博士说：“并不是他们想要抽烟和吃东西。他们没有足够的精力下床、去康复中心做一些他们需要的事情来恢复身体健康。”

可以理解的是，有些人可能会这么想，“我刚刚患上心脏病，我应该沮丧。”但是若减少他们的悲伤并最终消除沮丧情绪， 其实是会导致他们的病情每況愈下。

应该做些什么？

首先应当和你的医疗服务提供者谈论你在生理上和心理上的感觉。他们将能够帮助你或者告诉你最适当的治疗方式或最好的起点。

你应当监督自己和你的亲人，尤其是患有心脏病或中风者。

雅各布 (Jacobs) 博士说：“医生们会问，‘你还在抽烟吗？你的饮食控制得如何？你检查血压了吗？你近来心情如何？你仍然喜欢那些一直带给你快乐的事情吗？’无论是患有临床抑郁症还是只是焦虑，都需要后续护理。”

多年来，医生们认为心理健康与心脏健康之间的关系仅限于行为上的关系，例如，情绪低落的人通过吸烟、喝酒或吃高脂肪食物来寻求安慰。

这种观点开始有所转变。研究表明，二者还可能存在生理关系。引发心理健康问题的生物和化学因素还可能影响心脏疾病。

21特写

心理健康与心脏健康

文章转载自美国心脏协会

每个人都应当重视大脑和心脏的关

系。不只是情绪低落而已，还将产生

生化变化，让人们出现其他健康

问题，包括心脏问题。

宾夕法尼亚州斯普

林菲尔德克劳泽-吉斯通家庭

医学住院医师项目(Crozer-Keystone

Family Medicine Residency Program)临床心

理学家兼行为科学主任、心理学博士巴里·

雅各布(Barry Jacobs)表示：

22 Recipes

Fusion PastaSalad Jar 融合式面食 沙拉瓶

Nutrients per Serving 每份营养Energy 能量: 374 kcal 千卡

Protein 蛋白质: 19 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 18 g 克 (2 g 克)

Carbohydrate 碳水化合物: 35 g 克

Sodium 钠: 319 mg 毫克

Cholesterol 胆固醇: 0 mg 毫克

Dietary fibre 膳食纤维: 11 g 克

Ingredients 材料:

• Wholemealpasta,160g 全麦面食，160克• Edamame,480g 毛豆，480克• Redcapsicum,80g(julienne) 红椒，80克(切丝)• Yellowcapsicum,80g(julienne) 黄椒，80克(切丝)• Carrots,160g(julienne) 胡萝卜，160克(切丝)• Japanesecucumber,160g(julienne) 日本黄瓜，160克(切丝)• Brownricecake,21/2pieces 糙米糕，2½块

Dressing沙拉酱• 100%Peanutbutter,2tbsp 100%花生酱，2茶匙• Ricevinegar,11/4tbsp 米醋，1¼茶匙• Lightsoysauce(lesssodium), 11/4tbsp 淡酱油(少钠)，1¼茶匙• Extravirginoliveoil,11/4tbsp 特级初榨橄榄油，1½茶匙• Blacksesameseeds,1tbsp 黑芝麻籽，1茶匙

Preparation Time 准备时间: 30 minutes 分钟

Cooking Time 烹饪时间: 12 minutes 分钟

Serves 份量: 4 jars 瓶

Method 做法:

1. Cook thepastaasperpackaging instructions.Then,setaside.

把面根据包装的说明指示煮好，然后放凉。2.Addtheedamameintoapotofboilingwaterforabout5

minutes.Donotovercookortheywillbecomemushy. 把毛豆放在沸水中煮大概5分钟。注意别把毛豆煮

得太熟以免它们呈糊状。3.Drain the edamame and cool them under cold running

watertostopthecooking.De-shellthebeansbygentlysqueezingthepodswithyourfingerstoreleasethem.

把毛豆排干，然后在冷流水中凉却。用手指轻轻的按毛豆来除壳。

4.In a separate bowl, combine the peanut butter, ricevinegarandlightsoysauce.Then,slowlydrizzletheoliveoilandsesameseedsintothemixturewhilestirring.Stiruntilsmooth.

在另外一个碗上把花生酱，米醋和淡酱油搅拌。再搅拌当中慢慢地加入橄榄油和黑芝麻籽。继续搅拌直到完全混合。

5.Preparethetoppingbycrushingthebrownricecakes. 把糙米糕压碎做成配料。6.Separateallingredientsinto4portions,1portion/jar. 把所有食材分成4份，1份／瓶。7. Lay the mason jar in the following order or as you

preferanditisreadytobeserved! a.Dressing(base)/b.Pasta/c.Redcapsicum d.Yellowcapsicum/e.Edamame/f.Carrots g.Japanesecucumber/h.Brownricecake 把食材按照以下顺序或根据你的偏好放入玻璃瓶

当中就完成了！ a.沙拉酱(底层)/b.面食/c.红椒 d.黄椒/e.毛豆/f.胡萝卜 g.日本黄瓜/h.糙米糕

RecipecontributedbyMsTohYunXuan,SeniorNutritionistatSingaporeHeartFoundation.Modifiedfromhttp://foxeslovelemons.com.本食谱由新加坡心脏基金（SHF）的高级营养师卓芸瑄女士提供从http://foxeslovelemons.com修改。

23食谱

RecipecontributedbyMsTohYunXuan,SeniorNutritionistatSingaporeHeartFoundation.本食谱由新加坡心脏基金（SHF）的高级营养师卓芸瑄女士提供。

Preparation Time 准备时间: 30-40 minutes 分钟

Cooking Time 烹饪时间: 25-30 minutes 分钟

Serves 份量: 4 人份

Ingredients 材料:

• Chickenbreasts,600g 鸡胸肉，600克• Rosemary,11/2–2tsp 迷迭香，1½–2茶匙• Limejuice,2whole 青柠汁，2粒• Salt,1/3tsp 盐，1/3茶匙• Carrot,1small(julienne) 胡萝卜，1小根(切丝)• Asparagus,150g 芦笋，150克• MixedBabySpinach,150g 什锦小菠菜，150克

Dressing沙拉酱• Freshcranberries,3/4cup 新鲜蔓越莓，¾杯• Applesauce(noaddedsugar),40g 苹果酱(无添加糖)，40克• Water,2tbsp 水，2汤匙• Sugar,2tsp 糖，2茶匙

Method 做法:

Dressing沙拉酱1. Boilapotofwaterwithsugar.Stirtodissolve

thesugar. 把水和糖放入锅中煮滚。不时搅拌确保糖

完全溶解。2. Add in the cranberries and boil briefly.Then

reduce the heat and simmer for about 10minutesoruntiltheberriespop.

加入蔓越莓再继续煮滚一会儿。转小火，熬制10分钟左右或煮到蔓越莓爆开。

3. Stirintheapplesauceandsetaside. 加入苹果酱，搅拌，让后放凉。

ChickenRoll鸡卷1. Preheattheovento200°C. 将烤箱预热至200°C。2. Cutthechickenbreastto4thinslices(towrap). 把鸡胸肉切薄成4片(卷用)。3. Marinate the meat with rosemary, lime juice

andsalt. 加入迷迭香，青柠汁和盐来腌制鸡胸肉。4. Separate the carrots and asparagus into 4

portions. 把胡萝卜与芦笋分成4分。5. Laythecarrotsandasparagusontopofeach

chickensliceandrollthemup. 把胡萝卜与芦笋放在每一片鸡胸肉上，然

后卷起来。6. Place the chicken rolls individually onto an

aluminiumfoil,thenrollandwrapthemupnicely. 把鸡卷个别的放在铝箔上，然后包起来。7. Putthewrappedchickenrollsintothepreheated

ovenandcookfor25to30minutes. 把包好的鸡卷放在预热好的烤箱里，烹煮

25至30分钟。8. Cutthechickenrollshorizontally(sushistyle)and

laythemontheplatewithmixedbabyspinach. 平切鸡卷(像寿司)，然后把它们和什锦小

菠菜摆在盘子上。9. Drizzlethedressingontothesalad. 把沙拉酱洒在沙拉上。10.Optional: Use the dressing as a dip too! Grill

the chicken lightly on a non-stick pan overmediumheatbeforecutting.

沙拉酱也可以当作浸酱使用！你也可以使用中火把鸡胸肉稍微烧烤，然后切块。

Chicken Roll Saladwith Cranberry Applesauce Dressing

Tip!Add1/2cupto3/4cupofcookedwholemealpastatomakeitabalancedmeal!

提示!加½至¾杯煮熟的全麦面食来完成一个营养均

衡的膳食!

蔓越莓苹果酱

鸡卷沙拉

Nutrients per Serving 每份营养Energy 能量: 152 kcal 千卡

Protein 蛋白质: 24 g 克Fat (Saturated fat) 脂肪(饱和脂肪):2 g 克 (1 g 克)

Carbohydrate 碳水化合物: 9 g 克

Sodium 钠: 192 mg 毫克

Cholesterol 胆固醇: 55 mg 毫克

Dietary fibre 膳食纤维: 3 g 克