17 August 2005

Heart Disorders & SAF Servicemen

ST Forum, Aug 17, 2005
Take hard-to-detect heart disorder seriously

THERE has been a spike in sudden deaths recently among Singapore Armed Forces (SAF) national servicemen and regulars after seemingly harmless exercises.

It was subsequently discovered in the post-mortems that the victims suffered from a hard-to-detect heart disorder called Mitral Valve Prolapse (MVP).

From the recent exchange of letters in the Forum between Mr Terence Lim and Mindef, the public has also discovered that a complex defect such as MVP cannot be diagnosed during the SAF's enlistment check-up.

Nothing less than a heart scan at a cardiac centre will detect MVP. Unfortunately, this also means not all sufferers are aware that they have this disorder.

Therefore, I would expect Mindef's Medical Corps to take a more serious stand on such a disorder.

To my chagrin, my recent letters to the corps have been unfruitful.

Mindef informed me that MVP comes in various degrees of severity, and less serious cases do not warrant medical downgrading of afflicted servicemen.

When I asked about the specific criteria regarding severity, Mindef replied that such information was 'classified'.

Why would Mindef keep such information classified? With increasing public demands for transparency in government bodies, Mindef would do well to provide more information on this issue.

Undetected MVP has cost lives - it cannot be any more serious than that.

Therefore, the public has an interest in knowing Mindef's policy with regard to MVP and the specific criteria warranting medical downgrading.

I was also saddened to learn that MVP is a misunderstood illness within our medical fraternity. For mild MVP, practitioners here dismiss it as inconsequential and regard patients as functionally normal.

I beg to differ. Even at the mildest level, MVP causes inexplicable panic attacks, chest pains, breathlessness, depression and lethargy.

Just because such symptoms are wholly dependent on patient testimony, doctors harbour a suspicion that patients may be exaggerating their symptoms.

If pushed to their physical limits, patients with mild MVP can still suffer seizures like severe MVP sufferers.

We seem to harbour a callous attitude that if something cannot be detected by a machine, it is beneath consideration.

We must change the way we view MVP, even in its mildest manifestation, before more lives are expended needlessly.

Oliver Tan Kok Song


Mr Wang thinks Oliver Tan Kok Song has some of his facts wrong. MVP does come in varying degrees of severity and it is certainly not true that "even at the mildest level, MVP causes inexplicable panic attacks, chest pains, breathlessness, depression and lethargy".

Mr Wang himself has MVP (and not only that, he had ASD - atrial septal defect, more commonly known as a hole in the heart). Both conditions went undetected throughout his NSF days, until a routine FFI medical examination prior to ORD. Surprisingly, the conditions were first detected by a young, inexperienced-looking doctor wielding a normal stethoscope (and only subsequently confirmed using more sophisticated equipment).

Mr Wang was completely asymptomatic. He never had panic attacks, chest pains etc. He underwent openheart surgery during his university holidays to repair the ASD, but left the MVP alone. Within two months, Mr Wang was back to a normal routine, and within six months, Mr Wang was back to an active vigorous lifestyle. During his university days, Mr Wang climbed Mount Kinabalu; ran a half-marathon; finished a biathlon (1.5 km swim 10K run) and was a member of his hostel's road race team. Today, Mr Wang still runs and swims regularly.

Evander Holyfield himself became the world heavyweight boxing champion before discovering that he actually had MVP and ASD (like Mr Wang). This was after a boxing match when Evander's heartbeat was found to have gone irregular. Then again if you put a normal, average man in the same boxing ring as one of those 95kg, 100% muscle, ear-biting Tyson types, I bet you that the normal, average man's heartbeat is going to go irregular anyway.

I do agree with Mr Oliver Tan that MINDEF should be more transparent about its medical classification system.


Evander Holyfield on his way
to Pes C, for loss of ear.

7 comments:

Anonymous said...

I don't know anything about MVP, but perhaps those with the "mildest" MVP have different experiences. Maybe some of them do experience symptoms while others like you don't?

Mr Wang Says So said...

The funny thing about MVP is that it is not supposed to be able to kill you when you exercise vigorously.

All MVP patients have some kind of heart murmur (a kind of heartbeat irregularity). Most MVP patients are completely asymptomatic. Some MVP patients experience crushing chest pains; panic attacks etc -

but the chest pain actually has no known physiological cause; it is just as likely to come whether you're sitting on a sofa reading a magazine or whether you're running the 2.4km;

and because it is not a "genuine" cardiac infarction, there is actually no damage to the heart muscle and you cannot possibly die from an MVP chest pain.

MVP has been linked to a hyper-sensitive nervous system; the person can be extra sensitive to coffee, drugs etc; some have cold sweats -

but it really doesn't threaten your life.

Heavenly Sword said...

Every time I have to take IPPT, I will worry about this. The worst way of dying is to collapse while doing IPPT especially the 2.4km run...

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