Medically reviewed by Dr Pinakin V Parekh, Consultant Interventional Cardiologist, Trident Heart Centre Singapore
Medicine doesn’t stand still, and neither does Dr Pinakin V Parekh. Over more than 20 years in cardiology, he’s made a habit of asking a simple question: is there a better way to help this patient? That question has led him to incorporate a range of modern diagnostic and interventional tools and techniques into his everyday practice at Trident Heart Centre, from a portable ultrasound he can use right in the consultation room, to newer ways of looking at blood vessels too small to see on a standard scan, to gentler options for treating hardened arteries.
A Doctor Who Keeps Learning
Ask Dr Pinakin what’s changed most in his 20-plus years of practising cardiology, and he won’t just talk about new machines. He’ll talk about patients — the ones whose conditions were harder to catch, or harder to treat, with the tools available at the time.
That’s part of why he’s always paid close attention to new developments in his field: not for the sake of having the newest equipment, but because each new tool tends to answer a question he’s asked himself many times over the years: how do I get a clearer picture, and a better outcome, for the person in front of me?
Here are three examples of how that shows up in his day-to-day practice.
A Portable Ultrasound, Right in the Consultation Room
Dr Pinakin keeps a portable, wireless ultrasound machine on hand during patient visits, allowing him to perform certain point-of-care cardiac assessments during the consultation rather than always requiring a separate imaging appointment.
He uses it so that he can:
- Check how well your heart valves are opening and closing
- Get a real-time look at your left ventricular function — how well your heart’s main pumping chamber is working
- Pick up on any leakage, where blood flows backward through a valve that isn’t sealing quite right
- Check for fluid around the heart
- Take a look at your heart chamber sizes
For Dr Pinakin, the appeal is simple: the sooner he can see what’s going on, the sooner he and his patient can have an informed, unhurried conversation about what it means, instead of leaving that conversation for another day.
Looking at What a Standard Scan Can’t Show
Sometimes, a patient comes in with chest pain or breathlessness, has a standard angiogram done, and hears the frustrating news: “your arteries look clear.” For some patients, that’s genuinely reassuring. For others, it doesn’t quite explain what they’re feeling, and Dr Pinakin has learned not to stop there.
That’s because some heart problems live in blood vessels far too small to see on a standard angiogram. This is known as coronary microvascular disease, or microcirculation dysfunction, and it can cause real symptoms even when the bigger, more visible arteries are perfectly fine.
To look further, Dr Pinakin can use a thin sensor-fitted wire during certain angiogram procedures to directly measure pressure and flow inside the smallest vessels. He uses this technique so that he can offer patients an answer beyond “everything looks normal”, because for someone who knows something isn’t right, that answer matters.
Treating Heavily Calcified Arteries: More Than One Technique
Over time, cholesterol-related plaque can become hardened with calcium. When a coronary artery is heavily calcified, the calcium can make it more difficult to expand a balloon or properly expand a stent.
Interventional cardiologists have several techniques available to modify calcified plaque, and the most appropriate approach depends on the location, severity and characteristics of the blockage.
Dr Pinakin uses different calcium-modification techniques where clinically appropriate. One option Dr Pinakin uses for heavily calcified blockages is a newer balloon with a textured, beaded surface. Unlike a conventional smooth balloon, the raised areas on its surface concentrate pressure at specific points when the balloon is inflated within the calcified artery. This focused pressure can help crack and modify the hardened calcium, making the blockage more amenable to further treatment.
Another option is shockwave therapy. This uses sonic pressure waves delivered through a specialised balloon to help disrupt calcium within the artery, making it easier to expand the vessel and treat the blockage.
Drilling techniques also have an important role. These devices physically modify or remove calcified plaque and may be needed when a balloon-based approach is not suitable or cannot cross the blockage. They can also carry their own procedural risks, so the decision to use atherectomy depends on the anatomy and circumstances of the individual case.
The goal is not to use one technique for every calcified blockage, but to have different tools available and select the approach that is most appropriate for the particular artery and lesion being treated.
What This Means for You as a Patient at Trident Heart Centre
- You may be able to get certain heart checks done during your consultation, without a separate visit
- If your symptoms don’t match a “clear” standard scan, there are further ways to investigate what might be going on
- If you’re facing a calcified blockage, there may be additional technique options available to you
Dr Pinakin will always explain which of these are relevant to your specific situation. These tools are used thoughtfully, based on individual need, not applied to everyone by default.
About Dr Pinakin V Parekh
Dr Pinakin V Parekh is a Preventive, General and Interventional Cardiologist with over 20 years of experience, and the founder of Trident Heart Centre, with clinics at Gleneagles and Farrer Park Hospital in Singapore. He’s known among his patients for staying closely engaged with new developments in his field, not for the sake of novelty, but because he genuinely enjoys the process of learning something that might help the next patient who walks through his door.
Have questions about your heart health, or a procedure you’ve been advised to consider? Book a consultation with Dr Pinakin at Trident Heart Centre.
