Friday, May 30, 2008


I must try and use this column to try and highlight some clinic problems, so that you all can take note of some important personal lessons. I had a most unpleasant encounter today at the clinic. One of my patient for the last 18 years, a 60 year old Chinese male, entered my consultation room, obviously very downhearted and sad. He is a known diabetic and had CAD for which I did an angioplasty about 18 years ago. He is now well and stable. As he entered my consult room, I asked him, how was his diabetic control and why was he so upset. He told me that 1 month ago, his son, who was 37years old just came home from work, collapsed and died. I am also reminded that about 2 months ago, a colleague of mine in Bangsar, also died suddenly while resting in his clinic after running his clinic. Sudden cardiac death ( death that occurs within 24 hours of the patient becoming unwell. 95% of these deaths is due to cardiac causes, usually CAD ), is usually due to an heart attack, or just primary ventricular fibrillation ( a condition where the heart just develop a sudden irregular cardiac rhythm which results in the heart stopping ). Primary ventricular fibrillation may or may not be due to CAD, although the majority are. Sometimes cardiomyopathy too can cause primary ventricular fibrillation. Coming back to my patient, of course after checking him, I spend the rest of my time consoling and counselling him. It is so sad. What more knowing that perhaps both the deaths were preventable. If only the son had gone for a check-up. As for my colleague, it seems that he had a known history of CAD, but was delaying his definitive treatment. Using these cases as examples. I would like to advise that all males 40 years and above and all females 50years and above, should see your friendly cardiologist for a routine cardiac checkup, including blood test and also a stress ECG. I do not advocate a cardiac CT scan, as I do not find it accurate enough for CAD diagnosis. It is much better as a CAD diagnosis exclusion. As a modification, maybe the age of checkup should be lowered by 10 years if there is a strong family history or other important coronary risk factors. Certainly, those who are not well, with unexplained chest pains, breathlessness, palpitations or dizziness, should go for a checkup when they feel unwell. Maybe with a checkup, we can pick up CAD earlier and so avoid some of the sudden cardiac deaths that we hear every so often nowadays. If we can learn that, then perhaps my patient's son, did not die in vain.

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