A heart for his work

AS A BOY, Julian Tan was inspired to a career in medicine after he watched his paediatrician father go to the hospital at odd hours in the night to help sick children. He also binge-watched medical documentaries on television, becoming fascinated with the heart and its inner workings.

Today, the energetic interventional cardiologist runs his own private practice, Julian Tan Heart Specialist Clinic Pte Ltd, at The Heart Specialist Clinic in Mount Elizabeth Medical Centre.

"My company's core business is in providing comprehensive, affordable and personable heart healthcare," Dr Tan says.

As an interventional cardiologist, Dr Tan likens his complex trade to plumbing. Meanwhile, his colleagues involved in cardiac imaging are like photographers, while those focusing on electrophysiology and rhythm are like electricians.

As a "plumber", Dr Tan treats heart diseases, such as clogged arteries, with minimally-invasive, catheter-based techniques.

One such technique is known as a coronary angioplasty, a procedure to open up arteries which have become clogged due to fatty deposits or plaque.

To unclog the arteries, tubes called catheters are inserted through the leg or the wrist. Then, a tiny balloon at the end is inflated to push plaque to one side and stretch the artery open.

Mesh tubes known as stents are often inserted to help keep the artery open. The stents might release controlled doses of drugs to prevent scar tissue from developing and clogging the artery again.

"One not only has to have the head knowledge, but the dexterity and coolness of mind, when faced with life-threatening conditions during the angioplasty," Dr Tan says.

After the stent insertion, patients still need to make lifestyle changes and control risk factors like diabetes, high cholesterol and high blood pressure, he says.

A passion for heart plumbing

Dr Tan brings with him a wealth of experience from his past work in high-volume centres in Singapore like National Heart Centre Singapore, National University Heart Centre and Tan Tock Seng Hospital, and in Australian hospitals like Alfred Heart Centre and Epworth Hospital.

He is accredited to practise interventional cardiology in most of the private hospitals in Singapore. He is also a visiting consultant at restructured hospitals in Singapore: Tan Tock Seng Hospital, Ng Teng Fong General Hospital and Khoo Teck Puat Hospital.

At his clinic, his patients comprise both locals and foreigners and expatriates. He is in his element when he puts on his scrubs and face mask to perform the angioplasty procedure.

"I have a deep passion for my work as a 'plumber'. I look forward every day to going to work," he says.

"I am not only helping someone who is ill, but also getting to do what I enjoy a lot. My patients feel more assured knowing that the doctor performing the angioplasty procedure is not just competent, but very passionate about it."

Latest developments

Looking ahead, newer developments in angioplasty involve inserting the catheter to perform the heart procedure through the wrist ("transradial approach") instead of through the leg ("transfemoral approach").

There are fewer bleeding complications, the recovery time is shorter, mobility can be achieved faster and there is more patient comfort, Dr Tan says. His patients prefer the wrist procedure as it is more comfortable and safer, he says.

Meanwhile, the latest in stent technology is the "disappearing" stent.

"These bioresorbable scaffolds (BRS) work the same way as current coronary stents in the market, but they dissolve in the bloodstream after a few years, and almost nothing is left behind in the newly opened artery," Dr Tan says.

With new techniques, even chronic total occlusions, or the total blockage of the artery, can be treated by angioplasty instead of traditional open heart bypass surgery.

However, this can take many hours to complete even for experienced doctors, he says.

Yet just because it has become easier to treat heart disease doesn't mean that people should take heart health for granted, he says.

"Not only old people have heart attacks. My youngest patient was a 21-year-old who smoked since he was 14."

Another myth is that only pain in the left chest suggests a heart attack.

Other symptoms could include central chest pressure, excessive cold sweating, jaw ache, neck pain, left arm numbness and stomach pain, he says.

Improving service delivery

Looking back, the year 2017 has been a slow year for most doctors in private practice, and the outlook for 2018 is cautious.

Fewer foreigners came because of Singapore's strong currency and as the medical infrastructure of neighbouring countries improved, Dr Tan says.

"However, we'll continue to improve on our service delivery, on top of refining our skills and expertise as medical experts in our fields."

Ultimately, his energy, experience and passion for his work allow him to serve his patients well using the latest techniques in interventional cardiology, Dr Tan says.

"You can be assured of receiving comprehensively holistic, affordable and personable heart healthcare when you visit Julian Tan Heart Specialist Clinic."