Heart Attacks are Preventable!

EP284: Risk Factors

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on understanding the various risk factors associated with different types of heart disease. Rather than discussing heart disease as a single condition, Dr. Bishop explores how risk factors vary depending on whether the problem involves coronary arteries, heart valves, the electrical system, or the heart muscle itself. The episode aims to educate listeners on preventative measures and early detection strategies. Key Takeaways: Heart disease encompasses multiple types of problems beyond blocked arteries, including electrical issues, valve problems, and muscle dysfunction, each with distinct risk factors. Age is the most significant risk factor for coronary artery disease, as atherosclerotic plaque buildup is largely a response to arterial wear and tear over time. Blood pressure is one of the most important modifiable risk factors, as higher blood pressure accelerates wear and tear within arteries and plaque development. Men face coronary artery disease risk approximately one decade earlier than women, making sex an inherent biological risk factor. Familial hypercholesterolemia, characterized by extremely high cholesterol levels running in families, can lead to premature heart attacks (before age 50 for men, 60 for women). Lifestyle factors including obesity, lack of exercise, diabetes, depression, and low socioeconomic status all significantly increase heart disease risk. Atrial fibrillation risk increases dramatically with age, alcohol consumption, high blood pressure, and obesity, and once developed is difficult to reverse. Congenital valve abnormalities like bicuspid aortic valves can lead to earlier wear and failure, emphasizing the importance of family health history screening. Sudden cardiac death can result from ventricular electrical problems, particularly in hearts damaged by previous heart attacks or those with familial electrical abnormalities. Genetic predisposition plays a crucial role in dilated and hypertrophic cardiomyopathies, making family history assessment essential for early intervention. Read more

EP283: Heart Disease - What is it?

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction: Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on understanding heart disease. He aims to help Australians understand the various causes and mechanisms of heart disease, noting that one person suffers a heart attack every 20 minutes in Australia, with many cases potentially preventable through proper knowledge. Key Takeaways: Heart disease most commonly refers to problems with the arteries, where cholesterol builds up in a process called atherosclerosis, which can rupture suddenly and cause a myocardial infarction (heart attack). Atherosclerotic plaques can also gradually narrow arteries, restricting blood flow during exercise and causing the heart muscle to become oxygen-starved, similar to leg cramps during prolonged physical activity. Electrical problems in the heart can cause various conditions including atrial fibrillation (irregular pulse), supraventricular tachycardia (rapid heartbeat), and sudden cardiac death, with symptoms ranging from palpitations to blackouts. The heart's four valves (tricuspid, pulmonary, mitral, and aortic) can malfunction through wear and tear, with the aortic valve becoming narrowed and the mitral valve prone to leaking. Heart muscle itself can be directly affected by infections (myocarditis), inflammation (pericarditis), and bacterial infections on the valves (subacute bacterial endocarditis). Toxins such as alcohol and chemotherapy drugs (particularly anthracyclines) can damage the heart and impair its function. Infiltration of substances into the heart, such as amyloid protein (similar to Alzheimer's pathology) or iron, can disrupt normal heart function by accumulating between cells. Heart disease encompasses multiple pathological mechanisms beyond arterial problems, requiring broad diagnostic thinking when evaluating patients with cardiac issues. Read more

EP282: St Lukes Joins Forces With Healthy Heart Network To Combat Heart Disesase in Tasmania

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Episode Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network based in Hobart, hosts this episode focused on addressing Tasmania's significant heart disease problem. He is joined by Luke Cameron, Chief Health Officer of St Luke's Health, to discuss an exciting new partnership aimed at improving cardiovascular health outcomes in Tasmania. The episode centers on a pilot study using coronary artery calcium scoring via CT scanning as a more precise method for identifying and assessing individual heart disease risk. Key Takeaways: Heart disease is the leading cause of death in Tasmania, accounting for approximately one in eight deaths, with around 38,000 Tasmanians currently living with heart disease. Traditional risk calculators are population-based tools that don't accurately reflect individual risk, whereas CT scanning for coronary artery calcium provides precision medicine by directly visualizing plaque buildup in arteries. The St Luke's Health and Dr. Warrick Bishop partnership will launch a pilot study recruiting 100 participants for virtual heart assessments, with recommendations for coronary artery calcium score CT scans based on results. Calcium scoring identifies calcification in arteries, which appears as bright white spots on CT scans and serves as a surrogate marker for cholesterol deposits and plaque buildup. Medical practitioners have been reluctant to mainstream calcium scoring because double-blind, randomized controlled trials (the gold standard for evidence) are ethically impossible to conduct with this diagnostic tool. Lifestyle modifications like exercise and healthy eating don't necessarily eliminate plaque once it has formed, making direct scanning the most reliable way to assess individual cardiac status rather than guessing based on risk factors. Coronary artery calcium CT scanning costs hundreds of dollars—comparable to a set of tires—and is currently self-funded as there is no Medicare rebate, though it's available through GPs and Dr. Bishop's VirtualHeartCheck.com website. The pilot study has already achieved 20-30% uptake from St Luke's Health members within days of launch, indicating strong community interest in better heart health outcomes. Coronary artery disease kills one in four people, making it responsible for more deaths than all cancers combined, underscoring the critical importance of screening and prevention. Read more

EP281: Drunk Mice and Grafting Hearts

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Episode Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on cardiovascular health and emerging medical research. The episode covers two fascinating scientific studies: one on a liver hormone that may help treat severe alcohol intoxication, and another on the best graft options for coronary artery bypass surgery. Both topics have practical implications for emergency medicine and cardiac care. Key Takeaways: Fibroblast growth factor 21 (FGF21) is a liver-produced peptide hormone that shows promise in treating severe alcohol intoxication by stimulating the brain to release norepinephrine (adrenaline). In mouse studies, FGF21 injection helped severely intoxicated mice regain balance and alertness nearly twice as fast as untreated mice (1 hour 40 minutes vs. 3 hours 46 minutes). FGF21 works by triggering the body's "fight or flight" response through norepinephrine release, which increases alertness and attention in the brain. The hormone is not a "party drug" and will neither allow intoxicated individuals to drive safely nor prevent hangovers. FGF21 appears to work specifically on alcohol intoxication and showed no effect on other sedatives like diazepam, barbiturates, or ketamine. The left internal mammary artery is the superior graft conduit for coronary artery bypass surgery, with the radial artery from the wrist being the second-best option. A 10-15 year Australian study confirmed current best practices for selecting graft conduits in bypass surgery, providing important guidance for surgical planning discussions. FGF21 also shows potential benefits for treating non-alcoholic fatty liver disease, weight loss, and insulin control beyond its acute intoxication applications. Read more

EP280: Talking Osteoporosis With Doctor Cooley (Rhuematologist) Part 3

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, interviews Dr. Helen Cooley, a rheumatologist from Hobart, in the third episode of a series on osteoporosis. This episode focuses specifically on the medications used to treat osteoporosis, their mechanisms of action, implementation strategies, and how to guide patients through treatment options, using a postmenopausal woman with significant osteoporosis as a case study. Key Takeaways: Treatment decisions for osteoporosis must be patient-centered and fully involve the patient in weighing risks and benefits against their individual circumstances. Bisphosphonates (such as alendronate/Fosamax and risedronate) are long-established oral medications taken weekly that work by slowing bone turnover to prevent bone loss, with compliance being a significant challenge. Intravenous bisphosphonates like zoledronic acid offer convenience as an annual infusion lasting 3-5 years, but can cause significant aches and pains for 24-48 hours after administration. Denosumab (Prolia) is a monoclonal antibody injection given every six months that blocks osteoclast activity, but requires continuity of treatment as rapid bone loss occurs if injections are missed. Anabolic agents like teriparatide and romosozumab actually build new bone rather than just slow loss, but are currently only accessible after fracture and failure of other treatments with very low T-scores. The risk of osteonecrosis of the jaw (a serious dental complication) from bisphosphonates is rare at approximately 1 in 20,000 patients, significantly lower than the 30-40% fracture risk in untreated osteoporotic women. Treatment selection should consider patient preference regarding delivery method (oral tablets, intravenous infusions, or subcutaneous injections) and tolerance for potential side effects. Adequate vitamin D levels and normal kidney function are prerequisites for certain osteoporosis medications, particularly intravenous bisphosphonates. Pre-treatment dental evaluation and completion of necessary invasive dental work before starting bisphosphonates can prevent anxiety and reduce complication risks. Read more

EP279: Talking Osteoporosis With Doctor Cooley (Rhuematologist) Part 2

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Episode Summary Introduction: Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Helen Cooley, a Hobart-based rheumatologist. The discussion focuses on managing osteoporosis in patients, particularly perimenopausal and postmenopausal women, with emphasis on lifestyle interventions and diagnostic approaches to determine fracture risk. Key Takeaways: Comprehensive medical history is essential when evaluating patients for osteoporosis, including childhood illnesses, medication use (particularly glucocorticoids, epilepsy treatments, and breast cancer drugs), and previous fractures. Fracture risk assessment tools like the Garvin Risk Calculator (available free online) should be used to guide treatment decisions rather than relying solely on bone density test numbers. Smoking and alcohol consumption significantly impact bone health beyond their other health effects and should be specifically addressed in lifestyle counseling. Weight-bearing exercise such as walking and resistance activities are crucial for building and maintaining bone density, though care must be taken with fall-prone elderly patients. Obtaining calcium from dietary sources (dairy, leafy greens, nuts, and fortified soy products) is preferable to supplements due to conflicting evidence about calcium supplementation increasing heart disease risk. When calcium supplements are necessary, they should be divided across meals with food, and calcium citrate may be better absorbed than calcium carbonate, especially in patients taking proton pump inhibitors. Vitamin D deficiency is common, particularly in winter months in Tasmania, and is important for calcium and phosphate absorption; supplementation may benefit those in nursing homes or with limited sun exposure. Vitamin K2, while theoretically beneficial for bone mineralization, has conflicting evidence for treating osteoporosis and is best obtained through dietary sources like leafy green vegetables rather than supplements. Medication decisions for osteoporosis should be considered when hip fracture risk is around 4% or overall fracture risk reaches 16-20% over 5-10 years. Read more

EP278: Talking Osteoporosis With Doctor Cooley (Rhuematologist) Part 1

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Helen Cooley, a rheumatologist colleague. The episode focuses on osteoporosis, a silent but serious condition affecting over a million Australians, with the discussion covering its definition, risk factors, prevalence, and screening recommendations. Key Takeaways: Osteoporosis is characterized by thin, fragile bones with larger holes and finer branches (similar to Swiss cheese), making them more susceptible to fractures compared to normal bone density (like honeycomb). Osteopenia, osteoporosis, and osteomalacia are related but distinct conditions; osteopenia represents lower-than-normal bone density without meeting osteoporosis criteria, while osteomalacia involves soft weak bones from vitamin D deficiency. DEXA bone density scans measure bone density against peak bone mass achieved in the 20s and 30s, providing a score-based assessment that guides osteoporosis diagnosis. Age and menopause are primary risk factors, with women experiencing significant bone density loss at menopause due to declining estrogen levels, and both genders experiencing gradual decline with aging. Multiple conditions increase osteoporosis risk, including rheumatoid arthritis, lupus, Crohn's disease, celiac disease, thyroid disorders, and the female athlete triad in elite athletes. Lifestyle factors such as smoking and excessive alcohol consumption are modifiable risk factors that contribute to osteoporosis development. Osteoporosis remains a "silent disease" until a fracture occurs; approximately 60% of Australians aged 50+ have osteoporosis or osteopenia, with 700,000 fractures annually attributed to low bone density. Medicare-supported screening with DEXA scans is recommended at age 70 for general populations, though earlier screening is warranted for those with identified risk factors or family history. Hip fractures in older adults carry severe consequences: approximately 50% of patients never return home, and 30% die within 12 months of the fracture. Family history of osteoporosis warrants earlier screening consideration, though early detection doesn't automatically require medication; lifestyle interventions should be prioritized first. Read more

EP277: ABC Interview 2: The Silent Killer, Blood Pressure

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, discusses blood pressure management with host Kim in this episode. The conversation focuses on why high blood pressure is often called a "silent killer," how it develops, and practical lifestyle strategies to manage it effectively. Through accessible explanations and real-world examples, Dr. Bishop emphasizes that preventing heart disease is possible when people understand and take action on key health factors. Key Takeaways: High blood pressure is a "silent killer" because people often cannot feel when their blood pressure is elevated, allowing damage to accumulate without awareness. Blood pressure exists on a spectrum, and the ideal level varies significantly between individuals based on factors like age and overall health. There is a dangerous gap between feeling fine and experiencing severe symptoms—slight elevations in blood pressure cause ongoing wear and tear on arteries over time. Multiple factors cause high blood pressure, including genetic inheritance, stress, aging (arterial stiffness), alcohol consumption, and excess weight. There is a direct relationship between weight loss and blood pressure reduction: losing one kilogram results in approximately one millimeter of mercury reduction in blood pressure. Losing 5-10 kilograms through lifestyle changes can be as effective as most blood pressure medications, providing significant health benefits without pharmaceutical intervention. Alcohol consumption can elevate blood pressure, and reducing or eliminating alcohol may help lower readings. Regular blood pressure monitoring is critical because many people don't know their current levels, making detection the first essential step. Lifestyle interventions like weight loss and stress reduction are powerful, achievable tools for managing heart health. Heart disease remains the leading cause of death globally, yet many cases could be prevented with proper knowledge and action. Read more

EP276: ABC Interview - Why is Blood Pressure Important?

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Dr. Warrick Bishop, a cardiologist, CEO of the Healthy Heart Network, and podcast host, discusses the critical importance of blood pressure management with his co-host Rick. The episode focuses on explaining what blood pressure is, why it matters for overall health, and practical strategies for managing it effectively. Dr. Bishop emphasizes that heart disease is preventable in Australia with proper knowledge and monitoring. Key Takeaways: Blood pressure measures the force of blood in the vascular system during heartbeats, with systolic (top number) representing the heart's squeeze and diastolic (bottom number) representing wear and tear on blood vessels. High blood pressure causes cumulative damage to the entire vascular system over years, increasing risks of heart attack, stroke, atrial fibrillation, cardiac failure, kidney damage, and dementia. There is no single "perfect" blood pressure number; it varies by age, body size, and individual factors, but should be as low as possible without causing symptoms of dizziness or lightheadedness. Blood pressure is highly volatile and fluctuates throughout the day based on stress, hydration, and other factors, making 24-hour monitoring essential for accurate diagnosis. Currently available smartwatches and wearable devices cannot reliably measure blood pressure; medical-grade 24-hour monitors remain the gold standard for outpatient assessment. Weight loss is highly effective for blood pressure management—dropping one kilogram of body weight can reduce systolic blood pressure by approximately one millimeter of mercury. Even a modest 5mm reduction in blood pressure can decrease the risk of major cardiovascular events by 10%, making management critically important. Lifestyle modifications including diet, exercise, and stress management should be the first approach before medication, with excellent results documented in clinical practice. Blood pressure is often called a "silent killer" because most people experience no symptoms, making regular monitoring essential for early detection and prevention. A Medicare rebate is now available for 24-hour blood pressure monitoring, making this diagnostic tool more accessible to Australian patients. Read more

EP275: Interview With Heart Surgeon Peter Tesar

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, interviews Peter Tessa, a cardiothoracic surgeon at Prince Charles Hospital in Queensland. The episode explores patient journeys through open heart surgery, examining how different patient types—those with cardiac symptoms, asymptomatic patients requiring preventive surgery, and emergency cases—experience and navigate major surgical interventions differently. Key Takeaways: Patient acceptance of surgery varies significantly based on symptom status; symptomatic patients have often mentally rationalized the need for surgery, while asymptomatic patients must process an unexpected threat to their perceived health. Emergency surgical patients face unique psychological challenges, experiencing shock and disorientation, requiring surgeons to build trust quickly by demonstrating competence and confidence rather than overwhelming them with detailed risk discussions. Pre-operative counseling should focus on realistic expectations of post-operative recovery, using relatable analogies (sports injuries, flu-like symptoms) to help patients understand that feeling terrible after surgery is normal and anticipated, not a sign of complications. Understanding the natural history of surgical recovery—including predictable timelines for pain, swelling, and gradual improvement—allows clinicians to coach patients effectively and prevent them from losing hope during difficult recovery phases. Different patient personalities require different engagement strategies; controlling personalities may resist relinquishing bodily autonomy to surgeons, necessitating a shift from a transactional "client" mindset to a collaborative "patient" partnership. Post-operative coaching is critical; maintaining the patient's mental resilience and forward momentum through daily encouragement and validation that their progress matches anticipated recovery patterns prevents psychological setbacks. Modern healthcare excels at extending lifespan but often fails to teach patients how to "grab life" and enjoy quality of living after recovery—an increasingly important aspect of holistic patient care. Family support, pre-morbid personality traits, and rehabilitation attendance significantly influence surgical outcomes and should be integrated into the overall treatment and coaching strategy. Establishing belief and confidence in the surgeon before surgery creates a psychological foundation that helps patients survive the operative period and recover more successfully afterward. Read more