Heart Failure Centre
Mission
The mission of Novena Heart Failure Center is to focus on the multidisciplinary management of heart failure patients to achieve the best outcomes. It puts to bear on the problem of heart failure specialists from different subspecialties. It is built on the foundations of professionalism, compassion and cost-effective treatment.
Composition
The Novena Heart Failure Center team comprises of 4 cardiologists and 2 cardiothoracic surgeons who have extensive experience in the treatment of heart failure patients.
The Healthcare Team
Dr. Kenneth Ng, MBBS, MMed, MRCP, FAMS, Heart Failure and Transplant Cardiologist
Dr. Jimmy Lim, MBchB, MRCP, FAMS, Interventional Cardiologist
Dr. Raymond Lee, MBBS, FRCP, FAMS Cardiovascular Imaging Cardiologist
Dr. Hsu Li Fern, MBBS, MBBS, FRCP, AFS, FESC, FAMS Electrophysiology and Pacing Therapy Cardiologist
Dr. Eugene Sim, MBBS, FRCS (Glasgow), FRCS (Edinburgh), FAMS Cardiothoracic Surgeon and Stem Cell Therapist
Dr. Lim Chong Hee, MBBS, FRCS, FAMS, Heart Failure, Transplant and Mechanical Circulatory Support Surgeon
Diagnostic Capabilities
- Cardiovascular risk factor screening
- Full range of heart failure laboratory testing including BNP
- Electrocardiogram
- Echocardiography, including transesophageal echocardiography and Doppler studies
- Stress testing and Holter monitoring
- Endomyocardial biopsy
- Outpatient cardiac catheterization
- Intravascular ultrasound
- Full range of cardiac nuclear medicine procedures including radionuclide ventriculography and positron emission tomography
- Magnetic resonance Imaging and spectroscopy
Medical Therapy
Optimising Medical Therapy
Oral medication is the bedrock of heart failure therapy. However, it is often overlooked and many patients are not put on the necessary life-saving medications. We will ensure that all the important and necessary medications are started and up titrated to the optimal dose.
Disease Management
Heart failure is considered a chronic disease with a progressively worsening course. It is therefore important to teach the patients how to take care of themselves well by fluid and salt restriction and weighing themselves daily. We have a telephonic follow-up system to monitor the progress of each patient and to encourage compliance to the interventions prescribed.
Cardiac Resynchronization Therapy (CRT)
Patients who have symptomatic heart failure may benefit from a pacing therapy called CRT especially if there is evidence of a widened QRS complex on the ECG and an ejection fraction of less than 40%. It involves the implantation of a pacemaker that has both right and left sided leads and the pacing will result in the left ventricle contracting more synchronously.
Cardiac Contractility Modulation (CCM)
For symptomatic heart failure patients who do not qualify for CRT or who are non-responders to CRT, they may benefit from a different type of pacing therapy called CCM. This novel therapy involves implanting a pacemaker which stimulates the heart during a contraction cycle to improve the heart function.
Home Dobutamine Therapy
There is a group of advanced heart failure patients, who are not heart transplant candidates, but who are very symptomatic despite optimal medical therapy and who are in a low output state. To improve their quality of life, they may benefit from dobutamine therapy which is an infused medication which helps to increase heart contractility function at home. This therapy does not inhibit the patient from moving around as the pump and medication are portable.
Surgical Therapy
Surgical Revascularization
Ischemic heart disease is the most common cause of heart failure. Patients who have chest pain or breathlessness and have severe coronary artery disease will benefit from revascularization often from coronary artery bypass surgery. We consider coronary artery bypass surgery a more complete form of revascularization for severe coronary artery disease.
Valve Surgery
Significant valve stenosis or regurgitation is not an uncommon cause of heart failure. Surgical correction if done at the right time will relieve the patient of heart failure symptoms as well as to prolong survival.
Left Ventricular Reduction Surgery
The heart will remodel after suffering an insult especially a heart attack. Part of the heart muscle will die and thin out and become aneurysmal. This will impair the functional dynamics of the heart. Patients who have this problem and who are symptomatic may benefit from surgical efforts to reverse this remodelling by re-shaping the heart back to a more normal shape.
Mechanical Circulatory Device Support
Patients with advanced heart failure and who are already on optimal medical therapy and who are still symptomatic or who require frequent admissions to the hospital or who are hemodynamically unstable may be candidates for mechanical circulatory support. This therapy can be used as a bridge to heart transplantation or as destination therapy. For temporary circulatory support, we utilise extracorporeal membrane oxygenator (ECMO) or Centrimag Levotronix. For longer term support or destination therapy, we implant the HEARTMATE II LVAD which has a good record for reliability and longevity.
THE NOVENA HEART FAILURE CENTER IS LOCATED WITHIN NOVENA HEART CENTRE.