A renowned cardiologist with a subspecialty in Interventional Cardiology, Dr. Paul Chiam has been repeatedly recognized for his commitment to patient care and valuable contributions to the field of cardiology. A well-recognized expert in his chosen field, Dr. Chiam is best known for leading the team who performed the first Transcatheter Aortic Valve Replacement performed in Asia. He has also proctored several TAVR programs and centres in various Asian countries including South Korea, Hong Kong, Vietnam, Malaysia, Thailand, and the Philippines.
Since his undergraduate days, Dr. Chiam has exhibited his dedication to excellence. After graduating from the National University of Singapore (NUS) in 1996, he sought his postgraduate diploma and became a Member of the Royal College of Physicians (MRCP) in the UK, after which he obtained his Master of Medicine degree, with a Gordon Ransome Gold Medal, from the NUS in 2001. His dedication to cardiology began in 2002 when he started his specialization at the National Heart Centre Singapore, a course he finished by 2005. He then took up a sub-specialty in Interventional Cardiology through a scholarship from the Health Manpower Development Plan (HMDP), which included eighteen months of hands-on training at the Lenox Hills Heart and Vascular Institute of New York. This was followed by three months of training at the University of Buffalo in New York, under the Department of Endovascular Neurosurgery.
Dr. Chiam is also committed to further advancing knowledge in his field of interest; he has repeatedly been invited as a guest faculty or speaker at major international cardiovascular conferences including The American College of Cardiology Scientific Sessions and The American Heart Association Scientific Sessions, among many others. He has also conducted workshops and performed cases during live transmissions to several Asian countries. His various works on different cardiology topics have appeared in a large number of publications. He was also previously the Senior Consultant of the National Heart Centre Singapore’s cardiology department. Currently, he sits as the Co-Chair of the Scientific Committee of the Asian Pacific Society of Interventional Cardiology and is a member of the American College of Cardiology Peripheral Vascular Disease Section Leadership Council.
Dr. Paul Chiam strives to be recognized as the most trusted and reliable partner in heart care not just in Singapore but also across the globe. With over 12 years of experience, Dr. Chiam is a highly qualified specialist dedicated to working closely and hand in hand with cardiac patients to provide them with a new lease on life in spite of their heart problems.
Ambulatory Blood Pressure (24-hr ABP)
Ambulatory blood pressure monitoring is a noninvasive procedure that aims to obtain accurate blood pressure readings over a 24-hour period using oscillometry or auscultatory devices that automatically takes blood pressures every 20 minutes. After 24 hours, the patient will return to the clinic where the information will be downloaded from the device. Based on the result, the specialist may alter the treatment program that the patient is currently in or introduce a new treatment plan to effectively address the condition.
An Aortic Valvuloplasty is a surgical procedure used to repair a narrowed or stenotic aortic valve, usually due to calcium and plaque buildup. The procedure involves placing a balloon catheter inside the valve to widen the valve opening and allow blood to flow freely and normally. An Aortic Valvuloplasty is a less invasive option to other alternative treatment, which is replacing the aortic valve. Due to improvements in the technology of balloon catheters as well as advancements in techniques, Aortic Valvuloplasty is now more widely used, often as a part of a percutaneous aortic valve treatment. It is also especially considered in certain special situations, such as when the patient is a symptomatic pregnant woman, or the patient requires an urgent surgery for non-cardiac health problems.
Cardiology Follow Up
A follow-up consultation is required for patients who have undergone diagnostic tests so the results can be discussed with them. This is also a must for patients who have undergone certain procedures such as valvuloplasty and angioplasty to treat common heart conditions. The goal of a follow-up consultation is to assess if previous procedures were successful and ensure that no complications have developed.
Complex Percutaneous Coronary Angioplasty
A Complex Percutaneous Coronary Angioplasty is an advanced treatment procedure for patients suffering from complex coronary artery disease. A Percutaneous Coronary Intervention or Angioplasty is a non-surgical procedure that treats narrowed coronary arteries where plaques have accumulated by inserting a deflated balloon through a catheter and inflating it on site to widen the affected arteries. In multiple complex plaque buildups that can no longer be resolved by standard percutaneous intervention, patients often need to undergo more complex treatments, which may involve reoperative CABG, Coronary Endarterectomy, and several specialized treatment procedures. These procedures, which can now be performed with the use of remote-controlled robotic enhancements, often require more advanced equipment, techniques, and strategies.
ECG / EKG
An ECG or Electrocardiogram has become one of the standards in determining the overall cardiac performance including the organ’s electrical activity and blood flow (with Doppler). In a 12 Leads ECG, at least 10 electrode pads are placed on the chest and the limbs (arms and legs) in order to generate data on the electrical activity of the heart in 12 angles or leads during specific intervals (e.g., 10 seconds). The procedure gives a clearer and more detailed idea of the heart’s function during the entire cardiac cycle. This is a completely non-invasive diagnostic exam and does not require any local or general anesthesia.
Sometimes referred to as EKG or ECG, an echocardiogram is a popular cardiac diagnostic procedure performed to evaluate the function and structure of the heart, including the blood vessels and arteries. It can be used to detect any blockage or problems with the heart's electrical activity. ECG relies on sound waves that are being bounced off by the body to create an image of the organ. During the entire procedure, the patient is wide awake with electrode pads attached to various areas of the body including the chest. After applying a special gel, a transducer is used to give off sound waves that are then echoed. Sometimes the blood flow is tracked using a Doppler. EKG lasts from 15 to 30 minutes while the results are typically released to the diagnosing physician within a week after the procedure.
Patients who are experiencing symptoms of heart or cardiovascular diseases are advised to undergo diagnostic tests such as ECG and Treadmill Stress Test. However, before these are performed by specialists at the Heart and Vascular Centre, a consultation will be carried out first. It is here where the specialist will discuss the risks and benefits of the procedures, as well as review your medical history and that of your family. Your lifestyle and the medications that you’re currently taking will also be discussed. Based on the results, the cardiologist will be able to identify the type of diagnostic tests to be performed to identify the causes of your symptoms.
Holter (24 hour ECG)
ECG, which stands for electrocardiogram, is performed to record the electrical activity of the heart when the patient is performing certain activities like walking. In this diagnostic test, the doctor places several small metal electrodes to the patient’s chest with wires that are connected to a small, lightweight recorder called a Holter monitor. Using this device, the heart’s electrical activity can be monitored and recorded for 24 hours. This diagnostic test is recommended by cardiologists if the patient is suspected of having abnormal heart rate rhythm or arrhythmia.
Patients who have undergone diagnostic tests such as ECG or Ambulatory Blood Pressure are provided with a detailed medical report that contains complete information about the result of the test/s. These results are also explained in layman’s terms to help patients understand their conditions. Depending on the result of the tests, the patient may be presented with treatment or management options. Details of the options will also be thoroughly explained to help them make a well-informed decision.
A Mitral Valvuloplasty is a minimally invasive cardiology procedure that treats stenosis or the narrowing of the mitral valve. The procedure is necessary especially when the stenosis has compromised the normal function of the mitral valve, thus causing a blockage that hinders proper blood circulation. When the mitral valve is compromised, the patient will experience heart failure symptoms, which include palpitations, chest pain, dyspnea on exertion, and, in later stages, thromboembolism. The main goal of a mitral valvuloplasty is to increase the width of the mitral valve opening to restore the normal flow of blood. The valve is dilated with the use of a balloon that is inserted into place using a catheter, which is threaded through a vein and guided towards the heart.
Peripheral Artery Disease Angioplasty and Stenting
A Peripheral Artery Disease Angioplasty and Stenting are surgical procedures that combine balloon catheterization and the use of a stent to treat the diseases of the peripheral arteries. Peripheral arterial disease (PAD) is diagnosed when the arteries that supply blood to a patient’s limbs or organs, except for the heart, are hardened or clogged. This is considered a potential cause of heart attack and stroke, so it is best treated at the earliest possible time. A peripheral angioplasty is used to widen the narrowed areas while a tiny metal cylinder called a stent is placed inside the artery to maintain the opening. An angioplasty and stenting is the first-line interventional treatment for peripheral artery disease and is often prescribed when medications and lifestyle changes no longer improve the condition of the patient.
Transcatheter Aortic Valve Replacement (TAVR)
A Transcatheter Aortic Valve Replacement or TAVR is a procedure prescribed for patients with severe symptomatic aortic stenosis, characterized by the narrowing of the aortic valve opening. This is a special procedure that is used for high-risk patients or when the patient cannot tolerate the open-chest surgery used for replacing the aortic valve, which is the standard method of treatment used for this condition. The TAVR is a less invasive option that can repair the valve instead of replacing it. The procedure involves putting a collapsible replacement valve within the damaged valve through a catheter; the new valve is then expanded and gradually pushes the old valve out of the way. Since it is done through a catheter, the procedure can be performed with very small surgical openings without affecting the chest bones. The lower risk makes a TAVR more suitable for patients who are not good candidates for invasive open-chest operations.
Transradial Coronary Artery Angioplasty
A Transradial Coronary Artery Angioplasty is an alternative method of performing a Coronary Artery Angioplasty. Instead of using the femoral artery as the entry point for the catheter used in diagnosis and treatment, this procedure uses the right radial artery located in the wrist. Although the artery is smaller, it is just the right size to accommodate most modern catheters, balloons, and stents. Due to the position of the femoral artery, where it is also hidden under layers of fatty tissue, the traditional method of coronary artery angioplasty was susceptible to a lot of risks. Thus, the transradial approach offers some advantages over the more traditional transfemoral approach, such as a lower risk of major vascular complications and improved patient comfort, but it can provide similarly effective and feasible results.
Treadmill Exercise Test
The Treadmill Stress Test is a cardiac diagnostic exam performed with an electrocardiogram to measure the volume of oxygen that the body can take, especially when it is under a certain level of stress. During this test, the patient is attached to several electrode pads that are connected to an EKG machine. He then performs treadmill exercises such as walking or running while the electrodes transmit data pertaining to his heart rhythm and blood pressure. Inclines and level of difficulty are often changed every 3 minutes or until the patient has achieved his best heart rate or can no longer complete the test.
Specialists at the Heart and Vascular Centre offer ward consultation where they visit the patient in the hospital where they are confined. The specialist will then assess their condition and order tests before making a diagnosis. This service is the same as when the patient schedules an initial consultation with the specialist. Your medical history, symptoms, and the results of the previous tests will also be discussed. Based on the findings, the diagnosing physician will present treatment or management options that may include taking medicines, making lifestyle changes, or procedures such as angioplasty or stenting to treat the condition.