HEALING HEARTS WITH COMPASSION
Your Dedicated Cardiologist

Some signs of heart disease include chest pain, pain at the neck, jaw, upper abdomen, shortness of breath, choking sensation, cold sweats, leg swelling, and irregular heartbeats.

Cardiovascular disease is the leading cause of death globally. Early stages of cardiovascular disease and risks factor are often silent and regular screening is important for detection, prevention, and treatment.

A family history of heart disease can increase your risk of developing heart disease. It's important to share this information with your doctor so they can recommend appropriate screenings and preventative measures.

An echocardiogram is an ultrasound test that uses sound waves to create pictures of your heart. It can help your doctor diagnose heart conditions by helping to ascertain the size, structure and function of the heart. It has virtually no risks involved as it is a non-invasive scan with no radiation involved.

For your first appointment, you should bring any relevant medical records, a list of current medications, your insurance card, and any questions you may have for the doctor.

If your insurance has changed, it's best to contact the clinic directly to update your information and confirm coverage.

Maintaining a healthy lifestyle is key to avoiding heart disease. This includes regular exercise, a balanced diet, regular check-ups, and avoiding smoking and excessive alcohol.

You can book an appointment at The Heart Specialist Clinic at Parkway East through the clinic's website or by calling the clinic directly.

High levels of cholesterol can increase your risk of heart disease. It's important to have your cholesterol levels checked regularly and to maintain a healthy diet and lifestyle to keep your cholesterol levels in check.

The treatment options for heart disease or vascular disease can vary depending on the specific condition and the patient's overall health. The doctors at The Heart Specialist Clinic at Parkway East can provide a personalised treatment plan based on your needs.

The Heart Specialist Clinic at Parkway East features a team of cardiologists with diverse expertise. Dr. Paul Lim specialises in Electrophysiology & Pacing, Dr. Lim Tiong Keng specialises in Advanced Cardiac Imaging, and Dr. Chee Tek Siong specialises in Echocardiography & Cardiac Intensive Care.

If you were seen in the hospital, a follow-up appointment at the clinic may be necessary. It's best to contact the clinic directly to schedule this.

The doctors at The Heart Specialist Clinic believe that by addressing not only the physical aspect but also the emotional, psychological, and social well-being of their patients, they can make a substantial difference to their lives.

What is a treadmill stress test? A treadmill stress test is a diagnostic tool used to evaluate the electrical activity of the heart during exercise, which helps to diagnose or exclude coronary artery disease or irregular heart rhythms (arrhythmias) . What might you expect during a treadmill stress test? During a treadmill stress test, you can expect the following: Preparation: Before the test, you will be asked to change into comfortable clothing. Electrodes will be attached to your chest, arms, and legs to monitor your heart rate and rhythm. Your blood pressure will also be taken, and a baseline electrocardiogram (ECG) will be recorded. Exercise: You will then be asked to walk or run on a treadmill while the speed and incline gradually increase. The goal is to reach your target heart rate or until you reach a certain level of fatigue. Monitoring: Throughout the test, your heart rhythm, blood pressure, and ECG will be closely monitored for abnormalities. The medical team will be looking for any signs of chest pain, shortness of breath, irregular heart rhythms or other symptoms that may indicate a problem with your heart. Cool down: After the test, you will be asked to cool down by walking slowly on the treadmill or standing still. Your heart rate and blood pressure will continue to be monitored until they return to baseline levels. Results: Once the test is completed, the results will be analysed by your cardiologist. Depending on the results, further testing or treatment may be recommended. A treadmill stress test typically takes around 30-60 minutes to complete. What are the risks of a treadmill stress test? A treadmill stress test is generally considered a safe and non-invasive procedure. However, as with any medical test, there are some risks involved which include: Chest pain or discomfort: Some people may experience chest pain or discomfort during the test. Irregular heartbeat: There is a small risk of developing an irregular heartbeat or arrhythmia during the test. Heart attack: Although rare, there is a small risk of experiencing a heart attack during the test. This is more likely to occur in people with a history of heart disease or other risk factors. Dizziness or fainting: Some people may experience dizziness or lightheadedness during the the test is completed. Injury: There is a small risk of injury from falling off the treadmill or tripping during the test. However, this is rare and can usually be prevented by following the instructions of the medical team conducting the test.

What is a CT coronary angiogram? A computed tomography coronary angiogram (CTCA) is a non-invasive medical test that uses computed tomography (CT) imaging to create detailed pictures of the heart and blood vessels. It can also produce three-dimensional images of the heart and coronary arteries that supply blood to the heart muscle. CT coronary angiography can be used to diagnose and evaluate various heart conditions, such as coronary artery disease, congenital heart defects, and certain structural abnormalities. What to expect during a CT coronary angiogram? During a CT coronary angiogram (CTCA), you will be asked to lie on a narrow table that slides into a doughnut-shaped scanner. The CT scanner will take multiple X-ray images of your heart and blood vessels from different angles. Here are the steps you can expect during the procedure: You will be asked to change into a hospital gown and remove any jewellery or metal objects. An intravenous (IV) line will be inserted into your arm, through which contrast material will be injected. Electrodes will be attached to your chest to monitor your heart rate and rhythm. You will be asked to hold your breath for a few seconds at a time during the scan. During the procedure, you may feel a warm sensation as the contrast material is injected into your vein. The CT scanner will make a series of clicking and whirring noises during the procedure, which is normal. After the procedure, you can usually go home the same day, and you will be advised to drink plenty of fluids to help flush the contrast material from your body. What are the risks of a CT coronary angiogram? Like any medical procedure, a CT coronary angiogram (CTCA) carries some risks. However, these risks are generally low, and most people do not experience any complications. Some of the potential risks include: Allergic reaction to contrast material: Some people may have an allergic reaction to the contrast material used during the CTCA. This can range from mild itching to a severe allergic reaction known as anaphylaxis, which is rare. Kidney problems: In rare cases, the contrast material can cause kidney problems in people who have pre-existing kidney disease or who are taking certain medications. Radiation exposure: CT scans use X-rays, which can expose you to a small amount of radiation. However, the amount of radiation used in a CTCA is typically low, and the risk of radiation-related problems is generally very small. Pregnancy risks: If you are pregnant, there is a small risk that the radiation from the CTCA could harm your developing fetus. Other risks: There is a small risk of bleeding or infection at the site where the IV line is inserted into your arm.

What is an ambulatory electrocardiogram monitor / holter? An ambulatory electrocardiogram (ECG) monitor or holter is a portable device that records the electrical activity of the heart over an extended period of time, typically 24 to 48 hours, or even up to several weeks. The ambulatory ECG monitor is used to diagnose and monitor heart rhythm disorders. What to expect during a holter? During a Holter monitor test, you can expect the following: Preparation: The healthcare provider will place small, adhesive patches (electrodes) on your chest, which are connected to a small, portable ECG recorder (Holter monitor) that you will wear during the monitoring period. The monitor is typically worn for 24 to 48 hours, although it can sometimes be worn for up to several weeks. Recording period: You will be instructed to go about your normal daily activities while wearing the monitor. You may also be asked to keep a diary of your activities and symptoms during the recording period. The electrodes and monitor may cause some discomfort or irritation, but this should be minimal. Removal of the monitor: After the recording period is complete, your cardiologist will review the data and analyze the results. Follow-up: Your cardiologist will discuss the results of the Holter monitor test with you and make recommendations for further testing or treatment if necessary.

What is an echocardiogram? An echocardiogram is an ultrasound test that uses sound waves to create detailed images of the heart's structure and function. Echocardiograms are used to diagnose and monitor various of heart conditions, such as heart valve problems, heart muscle diseases, and congenital heart defects. What to expect during an echocardiogram? During an echocardiogram, you will be asked to lie down on an examination table, typically on your left side. The technician will apply a gel to your chest, which helps the sound waves to travel through the skin. The technician will then place a handheld device called a transducer on your chest and move it around to get different views of your heart. You may be asked to hold your breath or change positions during the test to get better images. The test is painless and usually takes about 30 to 60 minutes to complete. After the test, the gel will be wiped off your chest, and you will be able to resume your normal activities immediately. Your doctor will review the images and discuss the results with you.

What is a stress echocardiogram? A stress echocardiogram (also called an echocardiographic stress test) is a diagnostic medical test that combines an exercise stress test with echocardiography (ultrasound of the heart). The test is designed to evaluate how well your heart functions during physical activity, and aims to detect problems with the heart's blood supply or certain heart valve abnormalities. What to expect during a stress echocardiogram? During a stress echocardiogram, you can expect the following: Preparation: You will be asked to change into a hospital gown and remove any jewellery or clothing that may interfere with the ultrasound. Electrodes will be attached to your chest to monitor your heart's electrical activity. Baseline echocardiogram: You will receive an echocardiogram to establish a baseline measurement of your heart's function at rest. Exercise or pharmacological (medication) stress test: You will either walk on a treadmill or have a medication infused through a drip tube to simulate exercise. All this will occur while being monitored for changes in heart rate, blood pressure, and symptoms. Echocardiogram during stress: When your target heart rate is achieved, the technician will perform another echocardiogram to assess the blood flow and function of your heart under stress. Recovery period: You will continue to be monitored as your heart rate returns to normal. The entire test typically takes 45 to 60 minutes What are the risks of a stress echocardiogram? A stress echocardiogram is generally considered a safe procedure, but as with any medical test, there are some potential risks. These may include: Abnormal heart rhythms (arrhythmias) during or after the exercise portion of the test. Low blood pressure or dizziness during or after the exercise portion of the test. Chest pain or discomfort. Very rarely, heart attack or stroke. It's important to note that these risks are rare and the benefits of the test typically outweigh the risks. Additionally, the test is performed under the supervision of trained medical professionals who are equipped to handle any complications that may arise. Your doctor will review your medical history and assess your overall health to determine whether the benefits of the test outweigh the risks for you. If you have concerns about the risks of a stress echocardiogram, be sure to discuss them with your doctor before the test.

What is ambulatory Blood pressure monitoring? Ambulatory blood pressure monitoring (ABPM) measures blood pressure over a 24-hour period. The ABPM device consists of a cuff that is placed around the patient's upper arm and connected to a small recording device worn on a belt or strap. The device is programmed to take multiple readings at regular intervals over the course of the 24-hour wear period, usually every 15 to 30 minutes during the day and every 30 to 60 minutes at night, while they go about their daily activities and sleep. The data is later downloaded and analysed. What is the benefit of ambulatory blood pressure monitoring ? ABPM is used to diagnose and monitor high blood pressure (hypertension), which is a common and serious health condition that can lead to heart disease, stroke, and other complications. ABPM provides more accurate and comprehensive information about a patient's blood pressure patterns than a single blood pressure reading taken in a healthcare setting. It can help healthcare providers to determine if a patient has hypertension, to rule out white coat hypertension (elevated blood pressure due to anxiety in a clinical setting) or masked hypertension (normal blood pressure in a clinical setting but elevated outside of it), and to determine if there is a need for adjustment of hypertensive medication.

What is a tilt table test? A tilt table test is a medical diagnostic test that is used to evaluate the cause of fainting or near-fainting spells (syncope). During the test, the patient lies flat on a special table that is positioned upright to simulate standing. Heart rate, heart rhythm and blood pressure are monitored continuously. Tilt table testing can help doctors identify the underlying cause of fainting, with the focus on the diagnosis of vasovagal syncope which is a faint triggered by prolonged standing or unpleasant stimulus. It is a safe and non-invasive test that can provide valuable information for the diagnosis and treatment of syncope. What might you expect during a tilt table test? If you are scheduled to undergo a tilt table test, here is what you can generally expect: Preparation: You may need to avoid eating or drinking for several hours before the test, as instructed by your healthcare provider. Procedure: During the test, you will lie flat on a special table that can be tilted upright. The table will be tilted gradually to simulate standing, while your heart rate and blood pressure are monitored continuously. You will be securely strapped to the table to ensure your safety. Duration: The test can take up to an hour, with possible need for medication being administered under the tongue or through your veins. Symptoms: You may experience symptoms such as dizziness, lightheadedness, or fainting during the test. This is common, and your healthcare team will be present to monitor your symptoms and keep you safe. After the test: After the test, you will be monitored for a short period to ensure that you are feeling well enough to leave. Your healthcare provider will review the results of the test with you and discuss any next steps, such as additional testing or treatment. What are the risks? Tilt table testing is generally safe, but there is a small risk of fainting or falling during the test. Your healthcare team will be present throughout the test to ensure your safety and comfort.

What is an electrocardiogram? An electrocardiogram (ECG) is a non-invasive test that measures the electrical activity of the heart. This test involves attaching small electrodes to the skin on the chest, arms, and legs, which detect and record the electrical signals produced by the heart. The ECG machine then converts these signals into a visual representation of the heart's electrical activity and this representation is known as an ECG waveform. The ECG waveform provides important information about the heart's rhythm, rate, and pattern of electrical flow. It can help diagnose a variety of heart conditions, including arrhythmias (irregular heartbeats), heart attacks, and other problems that may manifest as abnormalities in the electrical activity of the heart.

What is a Cardiac Magnetic Resonance Imaging (MRI)? A cardiac MRI (magnetic resonance imaging) is a medical imaging technique that uses a powerful magnetic field to produce detailed images of the heart's structure, size, and function, including the heart muscle, chambers, valves, and blood vessels. It can also show areas of heart muscle inflammation, damage or disease. What to expect during a Cardiac MRI? During a cardiac MRI (magnetic resonance imaging) scan, you can expect the following: Preparation: You may be asked to change into a hospital gown and remove any metallic objects as these can interfere with the MRI scan. You may also receive an injection of a MRI specific contrast dye to help produce clearer images of your heart. Positioning: You will lie down on a padded table that slides into the MRI machine. You will be given earplugs to reduce the noise from the MRI machine, which can be loud and repetitive. Scanning: During the scan, you will need to lie still and hold your breath for short periods of time. The MRI machine will produce a series of images of your heart, which can take up to an hour or more to complete. Follow-up: After the scan is complete, you can return to your normal activities. The MRI images will be analysed by a radiologist, who will interpret the results and send a report to your cardiologist. During the cardiac MRI, you should not experience any pain or discomfort. However, some people may feel anxious inside the MRI machine, which can be loud and confining. If you experience any discomfort or anxiety, you can notify the healthcare team.

A loop recorder, also known as an implantable loop recorder (ILR), is a small device that is implanted under the skin of the chest to monitor the heart's electrical activity. It allows prolonged monitoring of a patient’s heart rhythm for up to 3 years in order to detect and record abnormal heart rhythms that may be episodic and not captured during a regular electrocardiogram (ECG). The loop recorder continuously records the heart's electrical activity, but only stores the data when it detects an abnormal rhythm. It has a memory loop that can hold several minutes of data, which can be stored on demand when the person feels unwell for the healthcare team to review Loop recorders are typically recommended for patients who have experienced symptoms such as palpitations, fainting spells, or dizziness, but have not been able to capture the arrhythmia on a regular ECG or Holter monitor. Loop recorders are minimally invasive devices that are implanted under local anaesthesia. They are typically small, about the size of a memory stick, and have a battery life of several years. They are generally well-tolerated by patients and have a low risk of complications. They are removed when the battery runs out.

What is a pacemaker? A pacemaker is a small medical device that helps regulate the heart's rhythm in patients with significantly slow heart rhythms. The pacemaker consists of a small generator, which contains a battery and electrical circuits, and one or more leads (thin wires) that are threaded through a vein into the heart. The generator is usually placed under the skin of the chest, just below the collarbone. The pacemaker works by monitoring the heart's rhythm and delivering small electrical pulses to the heart when necessary to keep it beating at a regular rate. The electrical pulses are delivered through the leads to the heart muscle, where they stimulate the heart to contract. Modern pacemakers are typically programmable and can be adjusted to meet the specific needs of each patient. Some pacemakers also have additional features, such as the ability to record heart activity and transmit the data to a healthcare provider for monitoring and analysis. The general longevity of the pacemaker battery ranges from 7 to 10 years depending on the frequency of use and will be replaced when its battery is depleted. Who requires a pacemaker? Some of the most common reasons why a person may require a pacemaker include: Sinus node dysfunction: The sinus node is the heart's natural pacemaker, and is responsible for generating the electrical signals that control the heartbeat. If the sinus node is not working properly, it can cause a slow heart rate or cause the heart to intermittently stop beating. Thus a pacemaker is required to act as a backup generator to ensure heart rhythm reliability. Heart block: Heart block occurs when the electrical signals that control the heartbeat are blocked or delayed as they move through the heart. This can cause a slow or irregular heartbeats, and the heart may also stop beating. In such circumstance, this is dangerous and people with serious forms of heart block require a pacemaker to regulate their hearts. Heart block in this context refers to a block in the electrical flow in the heart and is different from blood vessel blockage called coronary artery disease. What might I expect during a pacemaker implant? A pacemaker implantation procedure is typically performed under local anaesthesia with sedation if necessary and takes about 1-2 hours to complete. This is what you might expect when undergoing a conventional pacemaker implantation procedure: Preparation: Before the procedure, you will usually be given medication to help you relax. The skin in the area where the pacemaker will be implanted will be cleaned and you will be given medication to numb the area. Insertion of the generator and leads: Your electrophysiologist will make an incision near the collarbone to create a space to position the generator called a pocket. A needle will be used to insert one or more leads through a vein into the heart. The leads will be positioned in the appropriate location within the heart and tested to ensure they are working properly. The leads will be connected to the generator and tested again to ensure they are working properly and the whole apparatus will be placed in the pocket under the skin. Closure: The incisions will be closed with stitches. A small bandage or dressing will be placed over the incision site. Testing and programming: Once the pacemaker is implanted, the device will be tested and programmed it to meet your specific needs. This may involve adjusting the pacing rate, sensitivity, and other settings to optimise the device's function. Monitoring post procedure: After the procedure, you will be monitored in the hospital for a few hours or overnight to ensure that the device is functioning properly and that there are no immediate complications. You may experience some soreness, swelling, or bruising at the incision site, but these symptoms should improve within a few days. Your healthcare team will provide you with instructions on how to care for the incision site and how to resume your normal activities. What are the risks of conventional pacemaker implant? Pacemaker implantation is generally considered to be a safe procedure with a low risk of complications. However, as with any medical procedure, there are some potential risks and complications associated with pacemaker implantation. These include: Infection: There is a small risk of infection at the site where the pacemaker is implanted. Signs of infection may include fever, swelling, redness, and pain at the site of the incision. If an infection does occur, it may require antibiotic treatment and removal of the pacemaker. Bleeding: There is a small risk of bleeding during the procedure, particularly if the patient is taking blood-thinning medications. In some cases, bleeding may require additional treatment or transfusion of blood products. Pneumothorax (Air leak in the lung): In rare cases, the needle used to access the vein during pacemaker implantation may puncture the lung, causing air to leak into the chest cavity. This is known as a pneumothorax, and may require additional treatment or monitoring. Damage to surrounding structures: There is a small risk of damage to surrounding structures, such as blood vessels, nerves, or the lung, during the procedure. Lead displacement or malfunction: In rare cases, the pacemaker leads may become dislodged or malfunction, which may require additional treatment or revision of the pacemaker system. There is a very small risk of the leads causing a blood leak out of the heart. Overall, the risks of pacemaker implantation are generally low, and most patients experience few or no complications. Your cardiologist can provide you with more information about the risks and benefits of pacemaker implantation should you require it.

What is cardiac resynchronisation therapy? Cardiac resynchronisation therapy (CRT) is pacing mode that aims to make the heart’s chamber squeeze (contract) in a more efficient way and can improve cardiac function in certain people with heart failure. The therapy involves the use of a specialised pacemaker called a cardiac resynchronisation therapy device, often with defibrillator functions (CRT-D), that is surgically implanted under the skin of the chest. The device works by sending electrical signals to both of heart's pumping chambers (ventricles), which helps to coordinate the heart's contractions and improve its pumping ability. It is only beneficial in patients heart failure and abnormal electrical pattern of flow through the heart which leads to a lack of coordination in the contractions of the heart's chambers. Re-synchronising the hearts pumping action in such patients can help reduce symptoms of heart failure, such as shortness of breath and fatigue, and improve quality of life. It may also reduce the risk of hospitalization and death in some people who are eligible for it. Unfortunately, not everyone will benefit from it and hence it is not offered to all heart failure patients. What might a patient expect during a conventional CRT-D implant? A CRT-D implantation procedure is typically performed under local anaesthesia and sedation. It takes about 2-3 hours to complete. This is what to expect in a CRT-D implant. Preparation: Before the procedure, you will usually be given medication to help you relax. The skin in the area where the CRT-D will be implanted will be cleaned and you will be given medication to numb the area. Insertion of the generator and leads: Your electrophysiologist will make an incision near the collarbone to create a space to position the generator called a pocket. A needle will be used to insert two or more leads through a vein into the heart. The leads will be positioned in the appropriate location within the heart and tested to ensure they are working properly. The leads will be connected to the generator and tested again to ensure they are working properly and the whole apparatus will be placed in the pocket under the skin. Closure: The incision will be closed with stitches. A small bandage or dressing will be placed over the incision site. Testing and programming: Once the CRT-D is implanted, the device will be tested and programmed it to meet your specific needs. Monitoring post procedure: After the procedure, you will be monitored in the hospital for a few hours or overnight to ensure that the device is functioning properly and that there are no immediate complications. You may experience some soreness, swelling, or bruising at the incision site, but these symptoms should improve within a few days. Your healthcare team will provide you with instructions on how to care for the incision site and how to resume your normal activities. What are the risks of a CRT-D implant? Infection: There is a small risk of infection at the site where the ICD is implanted. Signs of infection may include fever, swelling, redness, and pain at the site of the incision. If an infection does occur, it may require antibiotic treatment and removal of the ICD. Bleeding: There is a small risk of bleeding during the procedure, particularly if the patient is taking blood-thinning medications. In some cases, bleeding may require additional treatment or transfusion of blood products. Pneumothorax (Air leak in the lung): In rare cases, the needle used to access the vein during ICD implantation may puncture the lung, causing air to leak into the chest cavity. This is known as a pneumothorax, and may require additional treatment or monitoring. Damage to surrounding structures: There is a small risk of damage to surrounding structures, such as blood vessels, nerves, or the lung, during the procedure. Lead displacement or malfunction: In rare cases, the CRT-D leads may become dislodged or malfunction, which may require additional treatment or revision of the CRT-D system. There is a very small risk of the leads causing a blood leak out of the heart. Device malfunction: In rare cases, the CRT-D may malfunction leading to failure to deliver a shock when needed, which could be life-threatening, or delivering an inappropriate shock when not required. Allergic reaction: Some patients may have an allergic reaction to the contrast dye that is used to identify the blood vessels that the leads are positioned in. Your cardiologist will carefully weigh the potential risks and benefits of CRT-D implantation before recommending the procedure. It is important to discuss any concerns you may have with your cardiologist before the procedure.

What is an implantable cardiac defibrillator? An implantable cardiac defibrillator (ICD) is a relatively small electronic device that is implanted under the skin, usually at the chest to restore a patients heart's rhythm in event of a life-threatening irregular heart rhythm (arrhythmia). Dangerous arrhythmias include ventricular tachycardia or ventricular fibrillation, which can cause the heart to beat too quickly or erratically with its ability to pump blood and may result in fainting or sudden cardiac death.. The ICD consists of a pulse generator, which contains a battery and electrical circuits, and one or more leads (thin wires) that are usually threaded through a vein into the heart. The generator is usually placed under the skin of the chest. There are some defibrillators that have the leads placed entirely under the skin with no wires within the heart itself. The ICD works by monitoring the heart's rhythm and delivering very rapid electrical pulses or an electrical shock to the heart when necessary to terminate dangerous arrhythmias and restore normal rhythm. Modern ICDs are typically programmable and can be adjusted to meet the specific needs of each patient. The general longevity of the ICD battery ranges from 7 to 10 years depending on the frequency of use and it will need to be replaced when its depleted. Overall, ICDs are a safe and effective treatment for certain types of heart rhythm disorders, and can help prevent sudden cardiac death in patients who are at high risk. Who requires an ICD? Implantable cardiac defibrillators (ICDs) are typically recommended for patients who are at high risk of sudden cardiac death due to certain heart rhythm disorders. Some of the conditions that may warrant the use of an ICD include: Prior history of cardiac arrest: Patients who have survived prior sudden cardiac arrest are at high risk of another episode of collapse and will be offered an ICD. Significant Heart Failure: Patients with weak hearts are at increased risk of dangerous arrhythmias and guidelines recommend pre-emptive implantation of ICD in some patients to prevent out of hospital collapse and sudden cardiac death Certain inherited heart conditions: These conditions can increase the risk of sudden cardiac death and an ICD may be recommended in some cases. What might a patient expect during a conventional ICD implant An implantable cardiac defibrillator (ICD) implantation procedure is typically performed under local anaesthesia and sedation. It takes about 1-2 hours to complete. This is what to expect in a conventional ICD implant. Preparation: Before the procedure, you will usually be given medication to help you relax. The skin in the area where the ICD will be implanted will be cleaned and you will be given medication to numb the area. Insertion of the generator and leads: Your electrophysiologist will make an incision near the collarbone to create a space to position the generator called a pocket. A needle will be used to insert one or more leads through a vein into the heart. The leads will be positioned in the appropriate location within the heart and tested to ensure they are working properly. The leads will be connected to the generator and tested again to ensure they are working properly and the whole apparatus will be placed in the pocket under the skin. Closure: The incision will be closed with stitches. A small bandage or dressing will be placed over the incision site. Testing and programming: Once the ICD is implanted, the device will be tested and programmed it to meet your specific needs. Monitoring post procedure: After the procedure, you will be monitored in the hospital for a few hours or overnight to ensure that the device is functioning properly and that there are no immediate complications. You may experience some soreness, swelling, or bruising at the incision site, but these symptoms should improve within a few days. Your healthcare team will provide you with instructions on how to care for the incision site and how to resume your normal activities. What are the risks of an ICD implant? Infection: There is a small risk of infection at the site where the ICD is implanted. Signs of infection may include fever, swelling, redness, and pain at the site of the incision. If an infection does occur, it may require antibiotic treatment and removal of the ICD. Bleeding: There is a small risk of bleeding during the procedure, particularly if the patient is taking blood-thinning medications. In some cases, bleeding may require additional treatment or transfusion of blood products. Pneumothorax (Air leak in the lung): In rare cases, the needle used to access the vein during ICD implantation may puncture the lung, causing air to leak into the chest cavity. This is known as a pneumothorax, and may require additional treatment or monitoring. Damage to surrounding structures: There is a small risk of damage to surrounding structures, such as blood vessels, nerves, or the lung, during the procedure. Lead displacement or malfunction: In rare cases, the ICD leads may become dislodged or malfunction, which may require additional treatment or revision of the ICD system. There is a very small risk of the leads causing a blood leak out of the heart. Device malfunction: In rare cases, the ICD may malfunction leading to failure to deliver a shock when needed, which could be life-threatening, or delivering an inappropriate shock when not required.

Catheter ablation is a procedure used to treat atrial fibrillation (AFib). During the procedure, one or more thin, flexible catheters are inserted through a vein in the groin and guided to the heart. The catheter delivers energy, such as radio frequency or cryotherapy, to destroy small areas of heart tissue that are causing the irregular heartbeats. The procedure aims to create scar tissue in the heart that will prevent the electrical signals that cause atrial fibrillation from passing into the heart chambers. It can be performed under local or general anesthesias. Catheter ablation is generally considered a safe and effective treatment option for patients with atrial fibrillation who have not responded to medication. The success rate of the procedure varies depending on the severity of the condition, but studies have shown that it can be effective in up to 50-80% of cases. After the procedure, patients may experience some discomfort or chest pain for a few days, but most can resume their normal activities within a few days to a week. The doctor will monitor the patient's heart rhythm and may adjust their medication as needed to prevent AFib from recurring. Overall, catheter ablation of AFib is a minimally invasive procedure that can provide relief from symptoms and improve a patient's quality of life. However, it is important to discuss the risks and benefits of the procedure with a doctor to determine if it is the best treatment option for each individual case. What to expect during an atrial fibrillation ablation? The procedure is typically performed by an electrophysiologist (a doctor who specializes in treating heart rhythm disorders) in a hospital or specialized electrophysiology lab. Here are some things you can expect during an AFib ablation procedure: Pre-procedure preparation: Before the procedure, you will typically need to fast for several hours to ensure your stomach is empty. You may also need to stop taking certain medications for a period of time before the procedure. Your doctor may also perform some tests, such as an echocardiogram or CT scan to prepare for the procedure. Anesthesias: You will be given either local anesthesias (which numbs the area where the catheters will be inserted) or general anesthesias (which puts you to sleep) for the procedure. Your doctor will determine which type of anesthesias is best for you based on your individual case. Catheter insertion: Your doctor will insert a small, flexible catheter through a vein in your groin and guide it up to your heart. This catheter contains one or more small electrode that is used to deliver energy to the heart tissue. Mapping: Once the catheter is in place, your doctor will use it to map the electrical activity in your heart and identify the areas that are causing the abnormal heartbeat. Ablation: Using the electrode on the catheter, your doctor will deliver energy (such as radio frequency, cryotherapy or pulse field energy) to the abnormal heart tissue to destroy or isolate it. This process is called ablation. Recovery: After the procedure, you will need to lie still for several hours while your doctor monitors your heart rhythm and blood pressure. You will typically need to stay in the hospital overnight for observation. You may experience some discomfort or soreness at the catheter insertion site, but this should resolve within a few days. Overall, an AFib ablation procedure typically takes several hours to complete, and the recovery time can vary depending on the individual. What are the risks of atrial fibrillation ablation Catheter ablation for atrial fibrillation (AFib) is generally considered a safe procedure, but as with any medical procedure, there are potential risks involved. Some of the risks associated with catheter ablation for AFib include: Bleeding or hematoma: During the procedure, there is a risk of bleeding from the site where the catheter was inserted. This can result in a hematoma (a collection of blood outside the blood vessels). Infection: There is a small risk of infection at the site where the catheter was inserted or in the heart. Blood clots: There is a risk of blood clots forming in the heart or in the blood vessels near the heart. These can cause serious complications, such as a stroke or pulmonary embolism. Damage to surrounding structures: The catheter or the energy delivered through it can cause damage to surrounding structures, such as the esophagus (food tube), the blood vessels, or the heart itself. Nerve damage: The procedure can damage the nerves around the heart but this is usually temporary. Recurrence of AFib: Despite the procedure, some patients may still experience atrial fibrillation after catheter ablation. Other complications: Other potential complications include heart attack, stroke, or abnormal heart rhythms. It's important to note that serious complications are rare, and most patients experience only minor discomfort and recover fully within a few days.

What is a coronary angiogram A coronary angiogram is a cardiac procedure used to visualise the coronary arteries, which supply blood to the heart muscle. During the procedure, a contrast dye is injected into the coronary arteries, and X-ray images are taken to assess blood flow and detect any blockages or narrowing. What might you expect during a coronary angiogram? You can expect the following during a coronary angiogram Preparation: Before the procedure, you will be asked to change into a hospital gown and lie down on an X-ray table. The healthcare team will prepare the insertion site (usually in the groin or arm) by cleaning and numbing the area with a local aesthetic. Catheter insertion: Once the area is numb, the catheter will be inserted into the artery and carefully guided up to the heart using X-ray guidance. You may feel some pressure or discomfort as the catheter is inserted, but the procedure is generally well-tolerated. Injection of contrast dye: Once the catheter is in position, a contrast dye will be injected into the coronary arteries, and X-ray images will be taken as the dye flows through the arteries. You may feel a warm sensation or flushing as the dye is injected, but this is normal and typically subsides quickly. Monitoring: During the procedure, the healthcare team will monitor your vital signs and communicate with you to ensure that you are comfortable and aware of what is happening. Catheter removal and recovery: After the procedure, the catheter will be removed, and pressure will be applied to the insertion site to prevent bleeding. You will need to lie still for several hours to allow the insertion site to heal properly, and you may need to stay in the hospital overnight for observation. Follow-up: Your cardiologist will discuss the results of the angiogram with you and help you understand what the findings mean for your heart health. What are the risks of a coronary angiogram? Coronary angiography is generally a safe procedure, but like any medical procedure, it carries some risks. Some of the potential risks associated with a coronary angiogram include: Bleeding or hematoma: There is a risk of bleeding at the insertion site, which may require additional medical attention or surgery in rare cases. Infection: There is a risk of infection at the insertion site or in the bloodstream, which may require antibiotics or additional medical attention. Allergic reaction: Some people may have an allergic reaction to the contrast dye used during the procedure, which can range from mild to severe. Blood clots: The catheter used during the procedure can dislodge a blood clot, which can cause a heart attack, stroke, or other complications. Radiation exposure: The X-rays used during the procedure expose the patient to a small amount of radiation, which can increase the risk of cancer over time. Kidney irritation: The contrast dye used during the procedure can irritate the kidneys, especially in people with pre-existing kidney disease. The healthcare team will take steps to minimise the risks associated with the procedure.

What is percutaneous Coronary Intervention Percutaneous coronary intervention (PCI), also known as coronary angioplasty or balloon angioplasty, is a medical procedure used to treat blockages in the coronary arteries of the heart. It usually follows a coronary angiogram after blockages in the blood vessels to the heart are detected. Via the same access from the blood vessels of the risk or groin, a small balloon with a stent (a small mesh like tube) at the tip of the catheter is inflated to compress the plaque against the artery walls and widen the narrowed or blocked artery. The stent remains to prevent the blood vessel from closing up again. PCI is commonly used to treat coronary artery disease, a condition in which cholesterol plaque builds up inside the arteries that supply blood to the heart. This can cause symptoms such as chest pain, shortness of breath, and fatigue. PCI aims to relieve these symptoms and prevent heart damage by restoring blood flow to the heart muscle. What are the risks of percutaneous coronary intervention? Percutaneous coronary intervention (PCI), also known as coronary angioplasty or balloon angioplasty, is generally a safe and effective procedure. However, like any medical procedure, it does carry some risks. Some of the potential risks of PCI include: Bleeding: The catheter insertion site may bleed, particularly if the artery is accessed through the femoral artery in the groin. Infection: There is a small risk of infection at the catheter insertion site or at the site of the stent placement. Heart Artery damage: There is a risk of damage to the arteries of the heart during the procedure, which can cause additional blockages or a significant bleeding around the heart. Blood clots: Blood clots can form on the stent or in the artery, which can lead to heart attack or stroke. Kidney damage: The contrast dye used during the procedure can damage the kidneys, particularly in patients with pre-existing kidney disease. Allergic reaction: Some patients may be allergic to the contrast dye used during the procedure, which can cause a rash or more serious allergic reactions. Restenosis: In some cases, the treated artery can become narrow again after the procedure despite all the physicians efforts to prevent this. The healthcare team will take steps to minimise the risks associated with the procedure.

What is an electrophysiology study Electrophysiology study (EPS) is a medical procedure used to evaluate the electrical activity of the heart and diagnose heart rhythm disorders also known as arrhythmias. The electrophysiology study can help identify the location and cause of abnormal heart rhythms, as well as determine the effectiveness of certain medications or treatments. It can also help in the planning of further treatment, such as catheter ablation. The procedure involves the use of one or more catheters, which is a long, thin tube that is inserted into a blood vessel in the groin or arm and threaded up to the heart. Catheter ablation is the delivery of radio frequency energy or cold energy via the catheter, targeting specific areas of to destroy abnormal electrical tissue within the heart, interrupting the electrical pathway that was causing the arrhythmia. Catheter ablation is generally considered a safe and effective treatment for arrhythmias such as supra ventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia (VT). It is often recommended when medication alone is not effective in controlling the arrhythmia, or when medication causes unwanted side effects. EPS and catheter ablation are typically performed by an electrophysiologist who is a cardiologist specialising in arrhythmia management and requires specialised equipment and training. What to expect during an electrophysiology study Before an electrophysiology study, you will typically have a consultation with a cardiologist to discuss the procedure and answer any questions you may have. You may be asked to avoid eating or drinking for several hours before the test. During the procedure, you will be given a local aesthetic to numb the area where the catheter will be inserted. A sedative may also be given to help you relax. The catheter will be inserted through a small incision in the skin, usually in the groin or arm, and guided to the heart using X-ray imaging. Once in place, the catheter will be used to measure the electrical signals generated by the heart and to stimulate the heart to provoke abnormal rhythms. You may feel some pressure or discomfort during the procedure, but it should not be painful. You will be monitored throughout the procedure, including your heart rate and blood pressure. The procedure usually lasts between one and four hours, depending on the complexity of the case. Afterward, you will need to lie still for a few hours to allow the catheter insertion site to heal. You may be able to go home the same day, although in some cases, you may need to stay overnight for observation. After the procedure, you should avoid strenuous activity and heavy lifting for a few days and follow any other instructions given by your doctor. Your doctor will discuss the results of the procedure with you and recommend any necessary treatment. What are the risks of electrophysiology study and catheter ablation Electrophysiology study (EPS) and catheter ablation are generally considered safe procedures, but there are some potential risks and complications, including: Bleeding or hematoma at the catheter insertion site. Infection at the catheter insertion site. Blood vessel damage. Heart damage. Perforation or puncture of the heart or other nearby organs. Stroke or transient ischemic attack (TIA). Irregular heart rhythms or arrhythmias. Blood clots. Radiation exposure from X-rays or other imaging technologies. Allergic reactions to medication or contrast agents used during the procedure. These risks are generally rare, and most people do not experience any complications.

What is Cardiac Screening? Cardiovascular screening involves detecting cardiovascular disease before symptoms arise and also identifying conditions that lead to cardiovascular disease and treat them to reduce cardiovascular risk. Who should consider Cardiac Screening? Local health authorities recommend that cardiovascular screening can start as early as at 18 years of age. Regular screening for cardiac risk factors should occur from the age of 40 but should start earlier if there are pre-existing medical problems. Cardiac screening is also recommended for people intending to commence on strenuous physical activity. For people with inheritable cardiac conditions, family screening may also be indicated. Your cardiologist will review your cardiovascular risk profile and recommend appropriate tests when necessary. What does Cardiac Screening involve? Screening involves a review with a cardiologist who will take a detailed medical history, including whether there is a significant family history of early heart disease or stroke, and a physical examination to check for heart disease. Blood pressure assessment is performed in the clinic. Blood tests are performed to assess a person’s cholesterol profile and screen for diabetes. Further cardiac investigations may be performed depending on a patient’s cardiac risk profile which can include an electrocardiogram, computed tomography cardiac calcium score or stress testing. Other investigations may also be recommended depending on family history or cardiac disease. Why is cardiac screening important? Prevention is better than cure. This is true especially for your heart since cardiac disease can lead to permanent and irreversible damage to the heart. Early detection and treatment can improve outcomes and reduce the risk of complications We offer comprehensive cardiac screening services to help you assess your heart health and identify any potential issues early on.

Please bring your insurance card and any relevant documents, such as referral letters, medical reports, or test results. If you have any questions about your insurance coverage or claim, please inform our staff in advance.

We recommend checking with your insurance provider to confirm coverage for your specific heart condition. Some insurance policies may have exclusions or limitations on certain treatments or procedures. Our clinic can provide a detailed medical report for your insurance claim upon request.

Yes, our clinic offers direct billing to select insurance providers. Please check with our staff to see if your insurance provider is eligible for direct billing. Please note that direct billing may not cover the full cost of your treatment or procedure, and you may still need to pay for any outstanding balances or fees.

Our clinic accepts a wide range of insurance panels, including but not limited to AXA, NTUC Income, Great Eastern Prudential, Fullerton Health, iXchange, Adept and BUPA. Please check with your insurance provider to confirm if our clinic is in their panel.

If your insurance claim is rejected, please contact your insurance provider directly for more information on the reason for the rejection. Our clinic can also provide additional documentation or support if needed. Alternatively, you may consider appealing the decision with your insurance provider or seeking alternative payment options, such as a payment plan or government subsidies.

Yes, our clinic can assist with insurance claims. We can provide the necessary medical reports and documentation to support your claim. However, please note that the approval and payment of insurance claims are ultimately determined by your insurance provider, and we cannot guarantee the outcome of your claim.

Electrophysiology & Pacing is a specialized area of cardiology that focuses on diagnosing and treating heart rhythm disorders. Investigations can range from performing a simple electrocardiogram to wearable devices for prolonged monitoring of a persons heart rhythm for days to implantable devices to monitor the heart rhythm for years. Medication is the mainstay of treatment but in selected cases, an electrophysiology study, which is a procedure that studies the electric flow in the heart and advanced catheter ablation techniques to treat abnormal circuits in the heart. Other patients may require implantation of pacemakers and defibrillators. Of course, lifestyle measures plays a big role also in controlling heart rhythm disorders.

Dr. Paul Lim is a senior consultant cardiologist who specialises in management of a wide range of cardiac disorders, from coronary artery disease (blood vessel narrowing) to heart failure (weakness of the heart muscle to prevention of cardiovascular disease. In addition, his subspecialty expertise lies in electrophysiology and pacing, which is the field of treating complex abnormal rhythms of the heart and prevention of sudden cardiac death.

Dr. Paul Lim is committed to treating each patient with the same level of care and compassion that he would provide to his own loved ones. He believes in building long-term relationships based on trust, respect, and excellent care.

You can book an appointment with Dr. Paul Lim through the clinic's website or by calling the clinic directly.

Electrophysiology & Pacing has evolved significantly over the years, with advancements in methods to define the electric flow in the heart and also ablation modalities to treat abnormal circuits. Cardiac devices such as pacemakers and defibrillators are far more complex nowadays with better algorithms to improve patient outcomes. Dr Paul Lim will be happy to share more on this if you are interested.

As a cardiologist, Dr. Paul Lim is experienced in treating a broad spectrum of cardiac conditions. His sub-specialisation in electrophysiology involves management of abnormal electrical activity of the heart and the prevention of sudden cardiac death. These electrical disorders range from slow heart rates to abnormally fast heart rhythms.

The success rate of Electrophysiology & Pacing procedures can vary depending on the specific condition being treated, a person’s overall health, and many other factors. Naturally procedures will only be offered if there is a clear indication and need for it with a reasonably high degree of success. Benefits should outweigh risks.

The clinic's website does not provide specific information about insurance acceptance. It's best to contact the clinic directly to inquire about insurance coverage.

Heart rhythm disorders can manifest in a variety of ways. Some conditions cause fast heart beats, out of proportion to a person’s activity, and some people can feel that their pulse or heart rates feel irregular in rhythm. Fluttering of the heart, skipped heart beats or extra heart beats can be sensations experienced too. Abnormally slow heart rhythms may cause giddiness, near fainting or in more severe cases, loss of consciousness. However, there are a significant proportion of people who do not feel anything at all despite having abnormal heart rhythms and many are only detected when an electrocardiogram (ECG) are performed. ECG screening is recommended for some patients.

Dr Paul Lim does not offer routine telemedicine consults but this can be arranged on a case by case basis

Electrophysiology and pacing are rapidly advancing fields. Check out our main website on new advances that are emerging in these interesting and exciting times for electrophysiology and pacing.