29th April 2023, Dr Chee L Khoo
We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…
25th April 2023, Dr Chee L Khoo
We may not have many patients with neuropathic pain but patients with neuropathic pain can be heartsinks. Most of the time, nothing seems to work. It can be quite frustrating when anti-depressants after anti-depressants don’t work. The old tricyclics often don’t work either. What about pregabalin? Nope. What about gabapentin? Nope. What about long-acting opioids or tramadol?…
9th April 2023, Dr Chee L Khoo
One of the most important contributor to atherosclerosis is elevated cholesterol levels. Familial hypercholesterolaemia (FH) is a genetic disease that manifests as a disorder of cholesterol metabolism by mutations in hereditary genes usually in an autosomal dominant manner. Data suggest that 1 in 200 Caucasians are heterozygous for FH and that 1 in 160,000–300,000 are homozygous, which are much higher prevalence than those estimated a decade earlier (1).…
1st April 2023, Dr Chee L Khoo
Two months ago, we explored heart failure in cancer survivors exposed to anthracyclines in a dose dependent manner. Anthracyclines are a common agents used in chemotherapy against breast cancer and lymphomas. Heart failure may appear as early as within 12 months of receiving anthracyclines and the incidence continues to grow over time. There have been a lot of work done on the possible molecular pathways in the development of the cardiotoxicity, the prevention strategies explored and the development of “safer” anthracycline derivatives.…
26th March 2023, Dr Chee L Khoo
We have always known that revascularisation for coronary artery disease (CAD) improve symptoms (and quality of life) but sadly does not always improve survival. Mounting evidence indicates that non-epicardial coronary causes of angina and ischaemia, including coronary microvascular dysfunction, vasospastic disorders, and derangements of myocardial metabolism, are more prevalent than flow-limiting stenoses, raising concerns that many important causes other than epicardial CAD are neither considered nor probed diagnostically.…
25th March 2023, Dr Chee L Khoo
It’s not really an article you want to read at the eve of a major event. I am off to Paris this week for my second overseas marathon. My cardiologist thinks I am medically crazy to do a marathon at all. So far, I have kept up my side of the bargain by keeping my heart rate to the recommended maximal heart rate during my training (and mostly during the events).…
12th March 2023, Dr Chee L Khoo
Myopia, especially high myopia is associated with increased risk of irreversible blinding conditions, including myopic retinopathy, retinal detachment, choroidal neovascularisation, and glaucoma (1-4) leading to a heavy cost burden on individuals and communities (5). So, it makes sense to see whether we could prevent or delay the onset of myopia or at least slow its progression.…
11th March 2023, Dr Chee L Khoo
Where did it come from? You would have fielded questions from more than a few patients about this new wonder cholesterol lowering drug that is coming to Australia “soon”. That’s what one of the current affairs media was hinting during the week. Of course, they make it sound as if everyone on statins is crying with muscle aches and pains.…
27th February 2023, Dr Chee L Khoo
We might see one case every 5 years in primary care. It might not be common but a missed diagnosis can be devastating. Patients rarely present to emergency department or the vascular surgeon without presenting to primary care first. Giant cell arteritis (GCA) is now thought of as a systemic inflammatory disease. Although glucocorticoids remain the mainstay of treatment , in the last few decades, new knowledge have dramatically changed the way we diagnose and treat GCA.…
27th february 2023, Dr Chee L Khoo
We have covered many aspects of the diagnosis, definition and management of heart failure quite extensively over the last 18 months on GPVoice. If you have been following the conversation, you will realise that the diagnosis previously very subjective. We depended much on symptoms according to the New York Heart Association (NYHA) classification to guide diagnosis, investigations and most importantly, management.…
13th February 2023, Dr Chee L Khoo
Survival rates amongst our cancer patients have improved dramatically over the years with the advent of better chemotherapy regimen. This is particularly the case in breast cancer and the different lymphomas. One of the adverse effects is cardiotoxicity in patients exposed to anthracyclines which can be life-threatening and can occur immediately or in the longer term.…
13th February 2023, Dr Chee L Khoo
Now that I know how common metabolic-dysfunction associated fatty liver disease (MAFLD) is especially amongst those patients with elements of metabolic syndrome, it’s hard not to assume that every second patient have MAFLD. We also know that not all MAFLD has abnormal liver function tests (LFTs). So, if you only suspect or screen only those with abnormal LFts, then you are going to miss many MAFLD.…