Heart Attacks are Preventable!

EP231: Cardiac Devices

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 is a practicing cardiologist and author dedicated to educating patients about heart health, believing that informed patients receive better care. In this episode, he discusses various interventions and technologies available to treat heart failure, ranging from established medical devices to cutting-edge and experimental approaches. The episode explores how both current and future technologies can help patients with severely compromised cardiac function. Key Takeaways: Biventricular pacemakers synchronize both sides of the heart to restore symmetric contractions, helping hearts that squeeze inefficiently due to lack of coordination. Implantable cardioverter-defibrillators (ICDs) function like portable paddles placed under the skin with wires in the heart, automatically delivering electrical shocks to prevent sudden cardiac death when needed. Ventricular assist devices (VADs) are portable pumps that can be carried like a small device, supporting heart function while patients heal or await heart transplantation. Heart transplantation remains an option for patients with hearts beyond repair, though it is a major surgical procedure. Stem cell therapy shows promise as a future treatment, using undifferentiated cells to regenerate damaged heart tissue and restore normal cardiac function. Laboratory-grown heart cells can be generated in petri dishes and implanted back into damaged hearts to repair tissue. Xenotransplantation using genetically modified pig hearts is being actively developed to overcome organ rejection and address the shortage of human donor hearts. Despite these advanced technologies, lifestyle modifications including exercise, sensible diet, and weight control remain foundational treatments for heart failure. Medications continue to be essential tools that support heart function and maintain proper fluid balance in cardiac patients. Treatment decisions regarding devices and operations should be guided by individual cardiologists based on each patient's specific circumstances. Read more

EP230: No Longer Fearful

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. Introduction Dr. Eric Bishop is a practicing cardiologist and passionate educator dedicated to helping patients understand heart health through accessible education. In this episode, Dr. Bishop demystifies cardiac failure—a condition that causes significant anxiety in many patients—by explaining what it actually means, how it develops, and the importance of prevention. The episode emphasizes that educated patients receive better healthcare outcomes and that understanding the physiological mechanisms behind heart failure is key to managing the condition effectively. Key Takeaways: Cardiac failure is characterized primarily by shortness of breath (especially during exertion) and fluid retention, typically beginning in the feet and ankles. The heart can fail in two distinct ways: through reduced contractility (inability to pump properly) or through impaired relaxation (stiffness that prevents proper filling). Heart failure results from an evolutionary mismatch—the body's ancient survival mechanism interprets reduced blood flow as blood loss and retains fluid, which paradoxically worsens the condition by overloading an already failing heart. Cardiac failure is more prevalent in aging populations and in patients with pre-existing heart conditions such as hypertension, previous heart attacks, or prior cardiac surgery. Treatment focuses on two main goals: supporting heart function and removing excess fluid from the body. Prevention is more effective than treatment—maintaining a healthy lifestyle, regular exercise, controlled blood pressure, and reduced cardiovascular risk factors are the best ways to avoid developing cardiac failure. Any patient diagnosed with cardiac failure should consult with a cardiologist for proper evaluation and personalized treatment planning. Read more

EP229: Tanya And Warrick—Hearts 4 Hearts Interview

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 practicing cardiologist and author dedicated to patient education in heart health, interviews Tanya Hall, CEO of Hearts for Hearts, a national charity supporting Australians living with heart disease and arrhythmias. The episode explores Hearts for Hearts' mission of support, education, and advocacy for heart rhythm disturbance patients, with Tanya sharing both the organization's work and her personal journey as a heart patient herself. Key Takeaways: Hearts for Hearts is a national charity specializing in supporting, educating, and advocating for Australians with heart disease, particularly arrhythmias, with services extending to New Zealand. The organization operates heart buddy groups, runs national screening events (such as AF Awareness Week), and conducts advocacy work with federal government to improve patient access to therapies. A key advocacy focus during COVID-19 was securing funding for remote monitoring of patients with pacemakers and defibrillators, allowing cardiologists to monitor patients from home safely. Hearts for Hearts has successfully advocated for increased access to catheter ablation treatment for atrial fibrillation and arrhythmias in hospitals, reducing patient wait times. The organization was founded by Tanya Hall, who is herself a heart patient and sought information and support during a three-year period of hospitalization in her early 30s, discovering a significant gap in available resources. Hearts for Hearts serves thousands of members through multiple support modalities, including in-person peer support groups, telephone support, and virtual Zoom meetings. The organization develops patient education materials through a rigorous process involving patient focus groups, medical advisory committees, and patient review to ensure materials are accessible and understandable. Hearts for Hearts supports patients with various heart conditions including atrial fibrillation, ventricular tachycardia, and congenital heart disease, linking patients with similar conditions to prevent isolation. The screening events run by Hearts for Hearts have successfully identified undiagnosed atrial fibrillation and prevented strokes, representing a significant public health impact. Read more

EP228: Covid-19 and Arrythmia

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 is a practicing cardiologist who hosts educational podcasts aimed at helping patients understand their heart health. In this episode, Dr. Bishop addresses common questions from patients regarding COVID-19 and its specific implications for those with arrhythmias and other cardiac conditions. The episode focuses on clarifying misconceptions and providing practical guidance for cardiac patients during the pandemic. Key Takeaways: Patients with well-controlled arrhythmias and no other comorbidities are not necessarily at increased risk from COVID-19, as the virus primarily affects those with diminished immunity. Atrial fibrillation in isolation does not significantly increase COVID-19 risk, but when combined with other conditions like hypertension, diabetes, or heart failure, it becomes a marker for higher risk. Ventricular arrhythmias (rhythms from the heart's lower chambers) are more concerning as they typically indicate underlying heart dysfunction and carry increased risk for poor COVID-19 outcomes. Pacemaker patients are not inherently at higher risk from COVID-19 and should utilize remote monitoring options when available to avoid hospital exposure. Patients with defibrillators or cardiac resynchronization devices have compromised left ventricular function and should exercise particular caution due to elevated COVID-19 risk. Current evidence does not support discontinuing ACE inhibitor or angiotensin II blocker medications due to COVID-19 fears, despite theoretical concerns about lung receptor interactions. The hypertension rate observed in severe COVID-19 cases matches the baseline hypertension rate in general populations, suggesting no specific increased risk. The virus can survive up to 72 hours on hard surfaces, 24 hours on soft surfaces, and several hours in the air, making proper hygiene and handwashing essential preventive measures. Soap and alcohol-based products effectively combat the virus due to its lipid coating, as do bleach and peroxide solutions. Read more

EP227: What Are NAFLD and NASH?

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 is a practicing cardiologist and author dedicated to improving patient care through health education. In this episode, he discusses non-alcoholic fatty liver disease (NAFLD) and its inflammatory progression to non-alcoholic steatohepatitis (NASH), conditions that are becoming increasingly prevalent as they now surpass alcoholic fatty liver disease as the leading cause of liver fat accumulation. Key Takeaways: NAFLD (non-alcoholic fatty liver disease) is fat accumulation in the liver unrelated to alcohol consumption, while NASH represents the inflammatory stage of this disease that can progress to cirrhosis. Morbid obesity is the single biggest driver of NAFLD, and rising obesity rates in communities are directly increasing the incidence of fatty liver disease. Insulin resistance, stemming from obesity or type 2 diabetes, causes a shift in free fatty acid release and accumulation within liver cells, distorting liver architecture and function. Fructose consumption significantly contributes to fatty liver development; while fruit is healthy, excessive fructose from fruit juice, fruit wraps, and processed foods can overload the liver in people at risk. NAFLD often produces no symptoms, but central obesity (fat around the midsection) and abnormal liver enzyme blood tests may indicate fatty liver disease. Progressive liver disease can develop serious complications including cirrhosis, liver failure, itching, bleeding problems, jaundice, and ultimately requires transplantation to survive. Weight reduction is the most critical intervention; Dr. Bishop recommended bariatric surgery for a patient whose dietary efforts failed, resulting in 35+ kilograms of weight loss and improved liver function. Ezetimibe, a cholesterol-lowering medication, has a protective effect on NAFLD through its action on the NCP1L2 receptor and can be used alongside statins. Statins are not detrimental to NAFLD progression and may offer slight protective benefits, contrary to previous concerns. Awareness and early intervention are essential, as NAFLD is an underrecognized obesity complication that will increasingly impact mortality if left unaddressed. Read more

EP226: Dog Therapy and Exercise vs Fish Oil

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 is a practicing cardiologist and author dedicated to educating patients about heart health, believing that informed patients receive better care. In this episode, he discusses two recent research studies: one examining dog therapy in emergency departments and another investigating exercise and fish oil supplementation for men at high risk of heart failure. Key Takeaways: A randomized controlled trial from Saskatchewan, Canada demonstrated that just 10 minutes of dog therapy in emergency departments produced clear, measurable reductions in pain and anxiety compared to standard care (100 patients in each arm). Animal-related therapies like dogs and cats show growing evidence of helping patients alleviate anxiety, fears, and concerns, with potential applications beyond emergency departments to hospital wards, day units, and chemotherapy suites. A University of Texas study found that high-intensity interval training significantly improved physical capacity and VO2 max in overweight, hypertensive men at risk for heart failure, but did not result in weight loss. Exercise alone, without dietary changes, is unlikely to produce weight loss even though it provides important cardiovascular benefits; addressing diet is essential for weight management. Fish oil supplementation (1.6 grams of omega-3 fatty acids) showed no measurable benefits in the study, though fish oil may be beneficial for high-risk cardiac patients and those with elevated triglycerides when using specific EPA subfraction. The research supports the principle "sweat it out, don't pill it out"—lifestyle modification through exercise and diet is more effective for high-risk heart failure patients than pharmaceutical supplementation alone. Read more

EP225: Interview With Rob Zecchin—Cardiac Rehabilitation

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 practicing cardiologist and patient education advocate, hosts this episode featuring Rob Zekin, a rehabilitation nurse and president of the New South Wales cardiac rehabilitation organization. With over three decades of experience in cardiac nursing and rehabilitation program development, Rob discusses the critical role of cardiac rehabilitation in helping patients recover physically and psychologically from cardiac events while addressing underrepresented populations and conditions that often lack adequate rehabilitation support. Key Takeaways: Cardiac rehabilitation is an accelerated recovery process—both physical and mental—that provides holistic support including education, medical care, and exercise guidance for patients recovering from cardiac events like heart attacks, stents, or bypass surgery. Exercise is accessible medicine; patients don't need gym memberships or special equipment—simply walking in good shoes can maintain cardiovascular fitness at a beneficial level. Family and community involvement is essential to rehabilitation success, particularly for dietary changes, lifestyle modifications, and identifying genetic cardiac risk in children and siblings of patients with premature cardiac disease. Aboriginal and Torres Strait Islander cardiac rehabilitation programs benefit significantly from culturally tailored approaches, including Aboriginal health workers, evening classes, and family participation rather than individual-only interventions. Women are underrepresented in cardiac rehabilitation despite experiencing gender-specific conditions like spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (stress cardiomyopathy) that require specialized psychological and physical support. Individualized treatment is more effective than generic group programs; rehabilitation must account for each patient's starting point, specific cardiac event, type of intervention, and personal circumstances rather than applying one-size-fits-all protocols. Bypass surgery patients show higher program adherence because the visible scar serves as a daily reminder of the need for behavior change, while stent patients are often less compliant because they're told they're "fixed" and underestimate ongoing cardiac risk. Stents provide temporary blood flow improvement, not a permanent cure; patients require ongoing medication, lifestyle modifications, and rehabilitation to prevent clot formation and disease progression. Under-resourced rehabilitation programs limit access through restricted hours, inadequate staffing, and lack of after-hours or weekend availability, preventing working patients from participating despite the clear cost-benefit of preventing future cardiac events. Standard cardiac rehabilitation programs typically last 6-12 weeks (or longer for heart failure patients), with duration determined individually based on the patient's deconditioning level and recovery needs rather than a fixed timeline. Read more

EP224: Knowing What To Eat But Not Eating It—Interview With Sally-Anne Pisk

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 practicing cardiologist and author passionate about patient education in heart health, hosts this episode featuring Sally-Ann Prisk, author and founder of "Eating For You"—an organization dedicated to transforming people's mindset around healthy eating. Together, they explore how emotional conditioning and mindfulness can help people make sustainable, nourishing food choices rather than relying solely on dietary knowledge. Key Takeaways: Most people struggling with eating habits have adequate nutritional knowledge; the real barrier is addressing their beliefs and thoughts about food that prevent lasting change. Food-comfort associations are often formed in childhood through conditioning—for example, receiving sweet treats when hurt or upset creates a lifelong link between discomfort and certain foods. The "Eating For You" approach is based on mindfulness practice, focusing on creating awareness and making conscious choices rather than forming restrictive new habits. Dysfunctional eating patterns can be inherited through behavioral modeling from family members rather than genetics, as children unconsciously adopt their parents' coping mechanisms with food and stress. Mindfulness acts as a "circuit breaker" that creates a pause between emotional triggers and automatic responses, allowing people to question whether they truly need food or something else. The intention of mindfulness practice is not to stay calm all day, but to develop awareness of when the mind has drifted and to quickly recenter and refocus. Daily meditation practice serves as a training ground for mindfulness, helping people learn to focus on one thing before applying the skill to food choices and emotional awareness. Alcohol and cigarette use often cluster with dysfunctional eating patterns as parallel coping mechanisms, requiring the same mindful awareness approach for behavioral change. Sally-Ann's personal experience with grief-related comfort eating, despite her dietitian training and extensive nutritional knowledge, demonstrated that education alone cannot override deeply ingrained emotional eating patterns. Women often experience key health markers during major life transitions like childbirth, menopause, and parenthood, which is why Sally-Ann's work predominantly focuses on women's unique lifestyle and biological experiences. Read more

EP223: Cholesterol Therapy in 2022

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 is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he provides a comprehensive update on cholesterol therapy in 2022, addressing the confusion surrounding cholesterol management and discussing current and emerging treatment options. The episode emphasizes that while cholesterol lowering is clearly beneficial for high-risk patients with existing plaque buildup, there remains reasonable debate about preventative treatment in otherwise healthy individuals. Key Takeaways: For high-risk patients who have experienced a heart attack or stroke, lowering cholesterol definitively reduces future cardiovascular risk, and lower cholesterol levels show no clear threshold of being "too low." Statin side effects, particularly muscle aches and pains, occur in 5-15% of patients and are dose-related, meaning higher doses carry greater risk of side effects. Ezetimibe is an underutilized, generic, and affordable medication that works synergistically with statins by binding cholesterol in the gut, providing better cholesterol reduction than higher-dose statin monotherapy. PCSK9 inhibitor monoclonal antibodies (injected fortnightly or monthly) can reduce LDL cholesterol by up to 60% through a different mechanism than statins, offering powerful cholesterol control for high-risk patients. Inclicerene, an mRNA interference drug targeting PCSK9, is nearing completion of clinical trials and offers approximately six months of sustained LDL reduction from a single injection—similar conceptually to a vaccination against heart disease. Bempedoic acid is an emerging therapy that works upstream of statins via a liver-specific pathway, potentially offering an alternative for patients experiencing statin muscle intolerance without affecting muscle tissue. Gene-editing RNA therapy and other novel agents like Evanacumab (angiopoietin-like-3 inhibitor) are in development and represent an exciting future for cholesterol management, with primate studies showing potential for lifelong cholesterol reduction. The broader challenge is that many high-risk patients are not currently meeting cholesterol targets despite available medications, indicating a gap between current treatment options and their actual utilization in clinical practice. Read more

EP222: A Fishy Tail of Confusion

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 practicing cardiologist and author, hosts this educational podcast dedicated to helping patients understand heart health. In this episode, Dr. Bishop explores the science behind fish oil supplementation, examining the evidence for its cardiovascular benefits and clarifying the roles of its two main components: EPA (eicosapentaeic acid) and DHA (docosahexaeonic acid). The discussion reveals surprising findings about which forms of fish oil are actually effective and introduces related treatment strategies for high-risk patients. Key Takeaways: Fish oil contains two main active components—EPA and DHA—that are commonly listed on supplement labels, but the evidence for their individual and combined benefits remains unclear. Low-dose fish oil supplements (like standard fish oil tablets) show minimal to no outcome benefit for intermediate-risk individuals, as demonstrated by recent studies. Purified EPA at pharmacological doses (approximately 4 grams daily) has demonstrated dramatic risk reduction in high-risk individuals with elevated triglycerides, as proven by the REDUCE-IT and JELIS trials. Combinations of EPA and DHA have not shown clear outcome benefits in clinical trials, suggesting that mixing the two compounds may negate EPA's beneficial effects, though the mechanism is unknown. Raised triglyceride levels may be a marker for underlying insulin resistance and inflammatory processes, making triglyceride management a key health priority. Phenofibrate (lipidil), a fibrate agent, is highly effective for reducing microvascular complications in diabetic patients, particularly preventing diabetic eye disease and peripheral amputation. Eating whole fish remains a healthy dietary choice, though the interaction between EPA and DHA in natural fish sources has not been studied. High-risk patients with cardiovascular disease, elevated triglycerides, and pre-diabetic or diabetic status should discuss purified EPA supplementation with their healthcare provider. For diabetic patients with raised triglycerides, phenofibrate is considered essential for preserving vision and peripheral circulation to prevent blindness and limb loss. Read more