Ministry of Health Clinical Practice Guidelines: Lipids.

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.

15 Sukaman Memorial Lecture: ST Segment Elevation: New Electrocardiographic Insights in 2014.

Of all the non-arrhythmic electrocardiographic (ECG) abnormalities, ST segment elevation (ST elevation) is the most important with regard to diagnosis, prognosis and management.

Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis.

Background: We aimed to study patients with prosthetic valve endocarditis (PVE) and analyse factors associated with in-hospital adverse events.

Methods: A review of all patients who underwent echocardiography at a local university hospital with definite PVE (modified Duke's criteria) was performed. Adverse events of in-hospital mortality and redo valve surgery were identified.

Relationship between apnoea-hypopnoea index and angiographic coronary disease phenotypes in patients presenting with acute myocardial infarction.

Background: Relationship between obstructive sleep apnoea and atherosclerosis has not been confirmed using coronary angiography. We sought to investigate the relationships between the apnoea-hypopnoea index (AHI) and angiographic coronary disease phenotypes.


Methods: SYNTAX score, lesion complexity, and thrombus burden grade were determined in 125 patients presenting with acute myocardial infarction and had undergone a screening sleep study.

Myocardial infarction in singapore: ethnic variation in evidence-based therapy and its association with socioeconomic status, social network size and perceived stress level.

Background: Singapore is a multiethnic Asian country comprising predominantly Chinese, Malays, and Indians. We sought to study the disparities in evidence-based therapy for people from these three ethnic groups who were admitted to hospital with ST-segment elevation myocardial infarction (STEMI). We also examined its association with socioeconomic level and social network size and the influence on psychological stress level.

Demographics of severe valvular aortic stenosis in Singapore.

Introduction: The treatment of aortic valve stenosis (AS) is seeing renewed interest mainly due to the availability of transcatheter therapies. However, the number of epidemiological studies of this disease in Singapore is limited. We aimed to describe the aetiology and clinical presentation of AS in Singapore, as well as patients' attitudes toward it.

Reperfusion therapies reduce ischemic mitral regurgitation following inferoposterior ST-segment elevation myocardial infarction.

Background: The presence of ischemic mitral regurgitation (IMR) after ST-segment elevation myocardial infarction (STEMI) portends a poorer prognosis. The possible influence of reperfusion therapy in restoring mitral valve competence in inferoposterior STEMI has not been well elucidated.

Methods And Results: We studied 423 consecutive patients with a first inferoposterior STEMI and determined the presence of IMR in patients treated with reperfusion therapy versus medical therapy.

Correlation between high density lipoprotein-cholesterol and remodeling index in patients with coronary artery disease: IDEAS (IVUS diagnostic evaluation of atherosclerosis in Singapore)-HDL study.

Serum level of high density lipoprotein (HDL)-cholesterol is associated with risk of coronary artery disease. We correlated the serum level of cholesterol with coronary artery remodeling index of patients with coronary artery disease. A total of 120 patients with de novo lesions located in native coronary artery were studied.

Relation between combining evidence-based medications on mortality following myocardial infarction in patients with and without renal impairment.

Background: Antiplatelet agents, beta-blockers, statins and ACE inhibitors have been shown to reduce mortality in patients following myocardial infarction (MI). However, it is uncertain if the combination of these agents has a similar impact on mortality following MI in patients with renal dysfunction.

Methods: We studied 5529 consecutive patients with confirmed MI between January 2000 and December 2003.

Diverse clinical spectrum of stress-induced cardiomyopathy.

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is an uncommon disorder characterized by apical ballooning. The etiology and pathophysiology of this syndrome has not been fully evaluated. This case series examined the clinical characteristics and outcomes of 10 patients with confirmed stress-induced cardiomyopathy.

Computer-based testing of the modified essay question: the Singapore experience.

Background: The modified essay question (MEQ), featuring an evolving case scenario, tests a candidate's problem-solving and reasoning ability, rather than mere factual recall. Although it is traditionally conducted as a pen-and-paper examination, our university has run the MEQ using computer-based testing (CBT) since 2003.

Aims: We describe our experience with running the MEQ examination using the IVLE, or integrated virtual learning environment (https://ivle.

Heart failure mortality in Southeast Asian patients with left ventricular systolic dysfunction.

Background: Prognostic indicators and mortality in multiethnic Southeast Asian patients with heart failure (HF) may be different.

Methods And Results: The study population comprised 225 inpatients with HF with a left ventricular ejection fraction of 40% or less who were discharged alive. Five years later, survival and causes of death were determined.

Variant angina in a 6-year-old boy.

We describe a case of variant angina and acute inferior myocardial infarction in a previously well 6-year-old boy with a strong family history of ischemic heart disease.

Absence of ST elevation in ECG leads V7, V8, V9 in ischaemia of non-occlusive aetiologies.

Background And Objective: Occlusion of the circumflex coronary artery may present with either ST elevation typical of inferior or lateral myocardial infarction, ST depression or a normal 12-lead electrocardiogram (ECG). In patients presenting with ST depression, concomitant ST elevation in the posterior leads V7, V8 and V9 is believed to reflect ST-elevation myocardial infarction of the posterior wall. However, to be confident of this diagnosis, it is necessary to know that posterior ST depression does not occur in acute subendocardial ischaemia.

Bridge over troubling spasm: is the association of myocardial bridging and coronary artery spasm a distinct entity? Three case reports.

The association of coronary artery spasm and myocardial bridging is very uncommon and may represent a distinct clinical entity. Three patients are described, presenting with acute coronary syndrome associated with myocardial bridging and coronary artery spasm. The relationship and respective roles of myocardial bridging and spasm, however, remain uncertain and may be consequent to a direct effect on endothelial function from the compressive effect of myocardial bridging.

Early repolarization pattern occurring with the wolff-Parkinson-white syndrome.

A 35-year-old male presented with the combined ECG abnormality of the early repolarization pattern and the Wolff-Parkinson-White syndrome. This has not been previously reported.