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MESSAGES TO
Heart Disease

Heart Disease

A DxD Session with Dr Julian Tan


Ended on Thu Nov 15 2018
Ended

Top Answers


the total cost for an angioplasty in Singapore depends on whether you go to a private or public institution.

HospitalTotal cost of angioplasty in Singapore
Public, subsidised$4,800 - $9,000
Public, unsubsidised$20,000 - $30,000
Private$40,000 - $60,000


The total angioplasty bill size that I've quoted above typically includes:

  • The price of the heart stent (costs will increase based on the type and number of stents inserted)
  • Cardiologist fees for the actual procedure
  • Anaesthetic fees
  • 2 - 3 days of hospital stay
  • Medication and other consumables

angioplasty procedure and cost in Singapore

An overview of how inserted heart stent helps open up your blocked heart vessels.

This is what a price breakdown of the total angioplasty procedure in a public hospital, as a subsidised patient (eg. Ward C) looks like:

  • Angiogram (dye test to detect blockages): $1,474
  • Angioplasty (PCI): $4,379
  • C class ward stay for 2 days: $672
  • X-Ray and tests: $496
  • Medications and consumables: $213
  • Cardiologist procedure fees, OT and anesthesia charges: $3,492

Total cost of angioplasty procedure: $10,726

The most important factors that will determine how much an angioplasty in Singapore will cost you are:

1. Whether you choose a private or public hospital in Singapore

2. The length of hospital stay you require (2 - 3 days are required, on average)

3. How many heart stents you require during the angioplasty

4. The type of heart stents used. The most commonly used heart stents in Singapore are drug-eluding stents. Less commonly, bare metal stents are used. Drug-eluding stents can cause about $2000 alone, while bare metal stents cost about $400. Bioresorbable vascular scaffolds (BVSs) cost even more.

At your consultation, the cardiologist will be able to recommend which type of stent is most suitable for you, and how many stents you required. 

It's important that you ask for full price transparency of the procedure. Many hospitals do not include prices for essential provisions such as anaesthesia and theater costs in the initial price quote for you. 

If you want to get more personalised quotes for an angioplasty tailored to your condition, it helps if you reached out to a few doctors directly.

Finally, yes, you are also able to claim government grants and subsidies, as well as claim from your Medisave for the angioplasty if you are Singaporean or a PR.

31 Jul 2018

A heart stent is a metal tube that's inserted into your narrowed heart artery during an angioplasty. It acts as an internal support framework to keep the artery open by pressing plaque back against the artery wall. 

There are many different types of heart stents available in Singapore:

Bare Metal Stent (seldomly used nowadays) – a metallic mesh tube.

Drug-eluting Stent – a metallic stent that's been coated with medication to prevent re-narrowing of the heart vessel.

Bioresorbable Vascular Scaffold (BVS) – a non-metallic mesh tube that slowly dissolves once the blocked artery can function naturally again and stay open on its own.

There's no one "best heart stent”. However, there may be a better suited heart stent for you, according to your condition. This is why I alway make sure to explain the characteristic of the heart stent that you will be receiving.

16 Oct 2018

Your heart pumps blood around your body through blood vessels.

Heart disease often begins when heart vessels become blocked by a build-up of fatty deposits called plaque. This makes it harder for vessels to supply blood to the heart. 

Signs and symptoms that you have blocked heart vessels may include:

  • Chest pain (angina)
  • Shortness of breath
  • Heaviness in your chest
  • Pain in your jaw or down the arms
  • Heartburn
  • Nausea
  • Vomiting
  • Heavy sweating

Whenever I suspect that a patient has heart disease and blocked heart vessels, I'll perform a physical examination and a few tests. These tests include:

1. An Electrocardiogram (ECG)

An ECG records your heart’s electrical activity in order to identify an abnormal heartbeat or damage to the heart muscle.

2. Stress test

A stress test evaluates your heart rate and rhythm while you are exercising.

3. Echocardiogram

An echocardiogram measures the chambers and heart function using sound waves. It's also able to check your valves and major blood vessels.

4. Coronary angiogram

A coronary angiogram is a test used to find out where the blocked heart vessels are, and how much narrowing there is.

16 Oct 2018

This is a common question that often confuses my patients, because they sound similar!

An angiogram is merely a diagnostic tool used to reveal blockages in heart vessels.

On the other hand, an angioplasty is a treatment that involves inserting heart stents to improve blood flow to heart muscle. Widening a narrowed heart vessel results in fewer angina symptoms and a better quality of life.

A coronary angiogram and angioplasty may be done soon after a heart attack, or if you have angina. 

It's possible that you will go on to have an angioplasty WHILE having an angiogram as part of the same procedure.

16 Oct 2018

Treating heart disease usually begins with lifestyle changes and/or medications that help improve blood flow to your heart muscle.

However, your angiogram will clearly show the blockage in your coronary arteries. I always make sure to explain ALL available treatment options to my patients.

The treatment that's best for you depends on:

  1. How bad your heart disease and symptoms are
  2. Location and severity of the heart vessel blockages
  3. Any other medical conditions that you may have
  4. Your ability to take long-term blood thinning tablets
  5. Your lifestyle
  6. Your preferred treatment 

I emphasized the last point, because at the end of the day, our job as doctors is simply to give you the best advice on all your available treatment options.

Indeed, an angioplasty may NOT be the best treatment in the following situations:

  • You've got many narrowed areas in several different heart vessels 
  • There is a very tight blockage in your heart vessel
  • The catheter cannot reach a blockage because of a tight corner

This is why I always tell my patients that it's important they take the time to understand all their treatment options.  

16 Oct 2018

here are the main 4 steps during the angioplasty procedure:

angioplasty procedure and cost in Singapore

1. Preparation

cardiologist preparing for angioplasty

A coronary angiogram usually takes about 30 minutes. You'll be lying under an X-ray camera in a cath lab while your cardiologist monitors the procedure on a television screen.  

You'll then receive a local anaesthetic injection into either your arm or groin (depending on where the catheter will be inserted).

2. The catheter is inserted into in the narrowed part of your heart artery

When this area is numb, a narrow tube (sheath) is inserted into the artery. 

A thin, flexible plastic tube called a catheter will be threaded through the sheath. The catheter is guided through the artery until it reaches the point of blockage.

3. The balloon is inflated and the stent expands, pushing the plaque back against the artery wall

4. The balloon is then deflated and removed, leaving the stent propping open the artery

The sheath in your arm or groin will be taken out at the end of the procedure. Pressure will then be applied to the insertion site for up to 20 minutes to stop any bleeding.

16 Oct 2018

I'm glad to hear that you are determined to make healthier lifestyle choices to get the best results after your angioplasty!

I warn all my patients that an angioplasty is NOT a cure for heart disease.

It can certainly help to control your symptoms, but it does NOT fix the underlying heart disease that caused the symptoms in the first place.

To reduce the risk of further heart issues, you'll need to make important changes to your lifestyle.

All my patients get a customised care plan and cardiac rehabilitation programme after their angioplasty.

Getting the best results after your angioplasty reallly depends on your willingness to see the cardiac rehab programme through:

  • Create a plan to stop smoking.
  • Try to lose weight, even if it’s only a few kilos. Even a 3 to 5 kg weight loss can significantly reduce your risk of heart disease.
  • Make exercise a part of your daily routine. Regular physical activity releases hormones such as endorphins and vasodilators that help you maintain healthy blood vessels.
  • Monitor your blood pressure, cholesterol, and blood sugar. Also be sure to limit your sodium intake and eat healthy foods.
  • Take all medications prescribed by your doctor.
  • Visit your doctor regularly. 

Finally, you should aim to return to work and all your other activities sooner - this lowers your chances of having further chest pain and anxiety.

16 Oct 2018

Private heart specialists typically charge about $150 - $200 for a first consultation.

Medications will typically add on another $100 - $200 in total to your final bill.

At the National Heart Centre, the rates for seeing a cardiologist are as follows:

ConsultationSingapore CitizenPrivate
First Consultation$$57$120 - $155
Follow-up Consultation$38 $79 - $112


Even if you go as a new patient via a polyclinic referral, rest assured that a consultant will still be seeing you on your first visit.

However, you'll usually first be seen by a Medical Officer beforehand.

o qualify for subsidised care to see a , you need to:

  • Be a Singaporean or a Permanent Resident (holding a Singapore NRIC), and
  • Obtain a referral letter from a Polyclinic, or from an SAF medical officer/camp

Patients who do NOT qualify for any subsidies include:

  • All foreigners
  • Those referred to see a specific cardiologist
  • Referrals made by a private doctor or private hospital

Medisave can be used for the following approved treatments -

1. Withdrawal limit of $500 per Medisave account per year:

Approved chronic diseases:

  • Diabetes
  • Pre-diabetes (Pre-DM)
  • Hypertension
  • Cholesterol and lipid Disorders
  • Stroke
  • Ischaemic Heart Disease

2. Withdrawal limit of $600 per Medisave account per year: 

  • Outpatient MRI scans
  • CT scans
  • Ultrasound scans
16 Oct 2018

There are 3 main categories of Singaporeans whom are most at risk for heart disease:

1. Strong family history of heart disease

You will have an increased risk of heart attacks if your parents or siblings have cardiovascular disease, even if you have a healthy diet and exercise regularly. 

Consequently, you should be screened regularly for risk factors if you belong to this group.

A heart specialist will be able to order tests and set up a treatment plan (which includes lifestyle modifications and potentially medications) which can reduce your risk for heart attacks. 

2. Significant cholesterol disorders

Singaporeans in this group often have extremely high cholesterol that can’t be lowered by lifestyle or diet changes alone. 

Your low-density lipoprotein (LDL, or bad cholesterol) level should be lower than 100. 

3. Multiple risk factors

Other key risk factors for heart disease include:

  • BMI: High BMIs are linked to increased risk for heart disease.
  • High blood pressure: A reading of 140/90 is considered high, and increases your risks of heart disease.
  • High blood sugar: Many Singaporeans have diabetes - it's one of the most important risk factors for heart disease.
  • Waist circumference: The “normal” measurements are less than 90 cm for women and less than 80 cm for men.

If you test on the high side for any of these numbers, you may benefit from seeing a cardiologist.

When you have multiple risk factors, it makes preventing and controlling heart disease all the more complicated.

A heart doctor will be able to formulate, and help you stick to a plan to improve your heart health.

One of the key ways we do this is by monitoring your heart health numbers, helping you understand what t and giving you the right tools to meet your goals.

16 Oct 2018

Great question! Your friend is entirely right. 

Not many people know this, but there are actually 3 main "types" of cardiologists in Singapore, according to their further sub-specialty training and qualifications. These are:

  1. Non-Invasive Cardiologist
  2. Interventional Cardiologist
  3. Electrophysiologists (EP)

1. Non-Invasive Cardiologist

Non-invasive heart doctors manage patients in the outpatient setting. Their role is to prevent and manage heart-related problems, such as hypertension and heart failure.

They are adept at performing diagnostic heart screening tests to uncover heart issues, such as exercise tests or MRI imaging.

2. Interventional Cardiologists

Invasive heart doctors receive additional sub-specialty and fellowship training in performing "angioplasties", or cardiac catheterizations.

This is my role of expertise, and I often liken it to "plumbing" as it involves unblocking clogged heart arteries. Interventional cardiology is also a field that one has to be deeply passionate about, as you have to perform the procedure countless times before becoming an expert.

I've accumulated years of experience in interventional cardiology by practicing in high-volume centres in Singapore such as the National Heart Centre Singapore, National University Heart Centre and Tan Tock Seng Hospital.

3. Electrophysiologists (EP)

Electrophysiology is the study of bio-electrical impulses of heart. These electrical impulses control the pace of one’s heartbeat. When this stops functioning, abnormal heart rhythms can result. 

Not very long ago, inserting a pacemaker was the only option to correct irregularities of the heart. However, EPs can now administer drug therapy, or burn away nerves that cause malfunctioning of the heart in order to treat abnormal heart rhythms.

16 Oct 2018