Heart Attacks are Preventable!

EP164: Interview With Greg Page (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 Summary Introduction Dr. Warrick Bishop, a practicing cardiologist and patient educator, interviews Greg Page, the original Yellow Wiggle, in part two of a discussion about Greg's cardiac arrest and heart disease journey. The episode focuses on Greg's recovery process, cardiac rehabilitation, medication regimen, and his newfound mission to educate the public about cardiac health and emergency response. Key Takeaways: Greg experienced cardiac arrest and underwent successful resuscitation, followed by five days of hospitalization before beginning a six-week cardiac rehabilitation program. Cardiac rehabilitation emphasized walking and controlled exercise rather than bed rest, as modern medicine recognizes that keeping the heart conditioned post-event is crucial for recovery. Greg's medication regimen includes dual antiplatelet agents (aspirin and an anticoagulant) to prevent blood clots around the stent, beta-blockers to reduce heart rate and prevent future cardiac events, electrolytes (potassium and magnesium) to maintain heart rhythm, statins for cholesterol, and supplements like Coenzyme Q10 and hawthorn. Despite pre-existing fitness being advantageous for recovery, beta-blockers dampened Greg's sympathetic nervous system, requiring harder exercise to reach target heart rates during rehabilitation. Greg's left ventricle ejection fraction (LVEF) improved significantly during rehabilitation, moving from borderline levels (45%) back toward normal range (55%), eliminating the need for an internal defibrillator implant. Broken ribs from CPR were Greg's most uncomfortable physical symptom during recovery, taking six to seven weeks to heal, though he feels fully recovered now. Greg has adopted a mission to educate older people about the distinction between cardiac arrest and heart attack, and the critical importance of CPR and AED use in saving lives. AEDs (automated external defibrillators) are user-friendly devices that anyone can operate safely—they only deliver shocks when needed and provide voice guidance throughout the process. Read more

EP163: Interview With Greg Page (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 Dr. Warrick Bishop, a practicing cardiologist and patient education advocate, interviews Greg Page, the original Yellow Wiggle, about his experience with sudden cardiac arrest and coronary artery disease. Despite appearing to be a healthy, fit 48-year-old with no major risk factors, Greg suffered a life-threatening cardiac event on January 17, 2021, when a blood clot suddenly formed in his left anterior descending artery during a Wiggles performance, causing him to collapse on stage. Key Takeaways: Being physically fit and active is not the same as being healthy; you can appear fit while having underlying cardiac risk factors Sudden cardiac arrest can occur without warning symptoms; Greg had no chest pain, heaviness, or typical warning signs before his event Approximately 50% of heart attacks occur in arteries that are not significantly narrowed until plaque ruptures and a clot forms, making them impossible to detect through standard flow-limiting assessments Cholesterol readings alone are poor predictors of who will have a cardiac event; they become meaningful only after a problem is identified and treatment begins Family history of heart disease matters, but its absence doesn't eliminate risk; Greg had minimal family history yet still experienced a major cardiac event Poor diet habits (high saturated fat, cheese, processed foods) can contribute to plaque buildup even in people who exercise regularly Symptoms of heart disease can be misattributed to other causes; shortness of breath during exertion may be dismissed as normal fatigue rather than a warning sign Prompt CPR and emergency response from bystanders is life-saving; Greg's survival depended on immediate recognition and intervention by people around him Fasting is essential for accurate cholesterol testing; non-fasted tests can produce misleading readings that may falsely reassure patients Some heart attack symptoms can be subtle or atypical, with people experiencing discomfort for extended periods without realizing they're having a cardiac event Read more

EP162: Doctor Warrick and Doctor Kostner Talking Triglycerides

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, interviews Dr. Karam Kostner about triglycerides—an often-misunderstood but important lipid in cardiovascular health. This episode explores what triglycerides are, why they matter for heart health, and practical strategies for managing elevated levels through lifestyle and medical interventions. Key Takeaways: Triglycerides are fats (lipids) that sit on cell membranes and transport proteins in the bloodstream, and comprise most of the body's stored fat in adipose tissue like belly fat. Unlike cholesterol, triglyceride levels fluctuate significantly with food intake and should be measured after a 12-hour fast for baseline assessment, though non-fasting levels also provide valuable information about daily patterns. Very high triglycerides (above 10 mmol/L in fasting state) significantly increase the risk of pancreatitis, a serious inflammatory condition of the pancreas. High triglycerides contribute to cardiovascular disease by promoting the formation of small, dense LDL particles that are more likely to deposit in artery walls, potentially accelerating atherosclerosis. Key drivers of elevated triglycerides include obesity, diabetes, smoking, hormonal changes (estrogen, testosterone), alcohol consumption (4-5+ standard drinks daily), low thyroid function, and genetic conditions affecting triglyceride metabolism. Non-pharmacological approaches are highly effective for triglyceride reduction: reducing saturated fat intake, losing weight, quitting smoking, exercising, limiting alcohol, and supplementing with omega-3 fish oil (EPA/DHA). Fish oil supplements are more practical than eating fish for triglyceride reduction, requiring 4 grams of EPA/DHA daily—equivalent to eating salmon three times daily, achievable through high-strength capsules or liquid supplements. Statins are ineffective for triglyceride management specifically, lowering them only 20-40%, making dietary and lifestyle interventions the primary treatment strategy for hypertriglyceridemia. Read more

EP161: Darren Lehmann 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 about heart health, hosts this episode featuring Darren Lehman, the former coach of the Australian cricket team. Darren shares his personal experience of suffering a heart attack on his 50th birthday and undergoing triple bypass surgery, along with his journey through cardiac rehabilitation and lifestyle transformation. The episode focuses on recognizing warning signs of cardiovascular disease, the importance of family support, and the critical role of cardiac rehabilitation in recovery. Key Takeaways: A heart attack can strike without obvious warning signs; Darren had gradually declining exercise capacity that went unnoticed until his acute event at age 50 on his birthday. Family history of heart disease is a significant risk factor that can "creep up" on you—Darren's father also died of a heart attack, highlighting the importance of genetic predisposition awareness. Gradual reduction in exercise capacity is easy to miss because it happens slowly, similar to not noticing how quickly children grow when you see them daily. Smoking is a major modifiable risk factor; Darren was a heavy smoker and quit immediately after his heart attack when confronted with the reality of his condition. The paramedics and medical team's quick response and clear communication were crucial—GTN spray provided relief, and an angiogram revealed three blocked arteries requiring immediate triple bypass surgery. Post-operative recovery involved more than physical healing; Darren experienced cognitive side effects including memory issues and difficulty recalling words, which gradually improved over time. Cardiac rehabilitation programs are invaluable and should ideally be compulsory rather than just recommended, providing education on heart health, medications, nutrition, psychology, and peer support. Having family members participate in rehabilitation sessions is critical for emotional support and helping loved ones understand the patient's journey and lifestyle changes needed. Open-heart surgery involves significant physical pain during recovery but also profound mental and emotional challenges, particularly the fear of leaving family behind. Being an active, fit individual does not guarantee immunity from heart disease—hereditary factors can cause sudden cardiac events in seemingly healthy people, making respect for cardiovascular risk essential. Read more

EP160: Doctor Warrick Interviewed by Doctor Kostner About Cardiac CT Imaging For Risk

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 focused on patient education, hosts this episode with Dr. Karim Kostner, a Brisbane-based cardiologist specializing in preventive cardiology and lipid management. In a unique role reversal, Dr. Kostner interviews Dr. Bishop about cardiac imaging technology and its role in modern cardiology practice, exploring why clinicians image arteries and how imaging should be applied to guide patient care. Key Takeaways: Imaging arteries provides clinicians with critical information to guide treatment intensity and prevention strategies, as the approach differs significantly between patients with clear arteries versus those with substantial plaque buildup. Patients increasingly want to know what's happening in their own arteries, making imaging an important tool for informed consent and patient engagement in their care. Modern CT technology has advanced dramatically over the past decade, allowing physicians to freeze the moving heart and capture detailed, reproducible images of coronary arteries and plaque composition. Functional testing (like stress tests) should be used when patients present with symptoms, while anatomical imaging (like CT scans) is more appropriate for asymptomatic risk assessment in appropriately selected populations. Imaging is generally recommended for risk assessment in men around age 50 and women around age 60, particularly those with risk factors such as family history, high cholesterol, or hypertension. Calcium scoring without contrast provides a baseline measure of plaque burden, while CT coronary angiography with contrast injection reveals plaque composition, narrowings, and other anatomical details to guide therapy decisions. For severely elevated cholesterol cases like familial hypercholesterolemia, imaging may be considered in younger patients (males age 30+, females age 40+) when multiple risk enhancers are present. Serial imaging in asymptomatic patients with zero calcium scores can reasonably be repeated at approximately five-year intervals, though this varies based on age, sex, and individual risk factors. The radiation dose from cardiac CT is relatively low (approximately one millisievert), equivalent to a mammogram, making it a safe imaging modality. The risk of allergic reaction to contrast injection is extremely low (one in 200,000), and contrast should only be used when calcium is present on initial scoring. Read more

EP159: Cardiac Rehabilitation Nurse 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 patient education advocate, welcomes Angela Hartley, a registered nurse and cardiac rehabilitation specialist from the United Kingdom. Angela shares her journey from cardiac nursing in Australia to establishing her own private cardiac rehabilitation business, filling a critical gap in post-hospital cardiac care and patient support. Key Takeaways: There is a significant gap in cardiac care after patients leave the hospital following cardiac events, with many feeling unsupported once standard NHS rehabilitation (6-8 weeks) ends. Effective cardiac rehabilitation combines one-to-one personalized exercise programs with accountability, homework assignments, and regular check-ins to prevent patients from returning to old unhealthy habits. Group support components are valuable in rehabilitation, allowing patients to connect monthly in social settings where they can share experiences, gain emotional support, and learn from others further along in their recovery journey. Men and women experience different rehabilitation journeys: men tend to be more pragmatic and results-oriented, while women often need greater emotional support and may struggle with prioritizing their own health after years of caring for families. Men frequently experience depression and emotional challenges after cardiac events, particularly regarding loss of capability, while women are often shocked by their diagnosis; creating a safe space for emotional processing is essential. Partner involvement in rehabilitation—particularly at initial assessments and in group settings—helps ensure families understand the recovery process and provides reassurance about safe exercise progression. Bypass surgery patients typically experience more physical pain, postural issues, and upper body discomfort, while stent patients face greater psychological challenges due to the invisible nature of their intervention and uncertainty about stent durability. Patients who undergo major surgery (bypass grafting) tend to be more motivated to change lifestyle habits than those receiving less invasive stenting procedures, who may underestimate the severity of their cardiac event. A foundational "fitness pyramid" approach works best, starting with walking as the base and gradually building to more challenging exercises based on individual assessment and heart rate zones. Three key patient tips include: going slower than expected, maintaining consistency, and recognizing that cardiac rehabilitation is a long-term lifestyle commitment rather than a short-term intervention. Read more

EP158: Fats, Oils, And Lipids

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. In this episode, he tackles the complex but important topic of hydrocarbons, fats, oils, and lipids, using creative metaphors to make the chemistry accessible. Dr. Bishop believes that understanding the language and science behind these compounds will help patients better understand nutrition, storage, and medical treatments related to cardiovascular health. Key Takeaways Hydrocarbons are molecules made up only of hydrogen and carbon atoms, forming the basis of fuels like petrol, and can be arranged in chains or rings. A useful way to understand hydrocarbons is to imagine carbon atoms as children with four arms that must always hold something (represented as hydrogen atoms or "hula hoops"). Saturated hydrocarbons/fatty acids have single bonds between carbon atoms and hold the maximum number of hydrogen atoms possible, typically solid at room temperature. Unsaturated fatty acids contain double bonds between some carbon atoms (where they "hold hands" with multiple arms), making them no longer hold the maximum hydrogen possible. Monounsaturated fatty acids have one double bond in the chain, while polyunsaturated fatty acids have multiple double bonds. Trans fats are created through chemical manipulation where the bonds between carbons are distorted (arms crossed), and these are associated with raising bad cholesterol and worse health outcomes. Cis bonds are the normal, natural bonds between carbon atoms (running parallel), whereas trans bonds result from artificial processing. Fatty acids are created by adding oxygen to hydrocarbon chains, specifically adding a hydroxyl group (oxygen and hydrogen together) to the end of the chain. Saturated fatty acids with 16 carbon atoms are solid at room temperature and are the main component of animal fats commonly seen in meat and bacon. Read more

EP157: Talking About Viagra

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 patient education about heart health. In this episode, he provides a comprehensive overview of Viagra, discussing its mechanism of action, uses, availability, dosing, and important safety considerations—particularly for cardiac patients who may encounter dangerous drug interactions. Key Takeaways: Viagra (sildenafil) is a phosphodiesterase-5 inhibitor that increases nitrous oxide in blood vessels, relaxing them and improving blood flow to the penis and lungs. The drug was discovered by Pfizer in 1989 while researchers were actually searching for anti-anginal medications, making its primary use a serendipitous discovery. Alternative phosphodiesterase inhibitors exist in the market, including Levitra (which works more rapidly) and Cialis (which has a longer half-life). In Australia, Viagra can be accessed through prescription or online retailers, with 100mg tablets available cheaply; splitting higher-dose tablets with a pill cutter provides the most cost-effective option. Viagra is most effective for erectile dysfunction caused by psychological factors or age-related fatigue, not for dysfunction stemming from arterial disease or nerve damage, which require specialist evaluation. A critical warning exists against combining Viagra with nitrate-based medications (GTN spray, isosorbide mononitrate), as this combination can cause dangerous drops in blood pressure. Patients taking Viagra who develop chest pain and call an ambulance must inform paramedics about the medication to prevent life-threatening interactions with emergency GTN treatment. Viagra can cause side effects including facial flushing, vision and hearing issues, and priapus (prolonged, problematic erection), so first-time users should start with very low doses. Beyond erectile dysfunction, Viagra is prescribed for pulmonary hypertension, where increased blood flow to the lungs helps reduce dangerously high lung pressure. The medication should be taken approximately 30 minutes before use and remains effective for two to four hours. Read more

EP156: Palliative Care

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, believing that educated patients receive better healthcare. In this episode, Dr. Bishop discusses palliative care—a topic he encounters frequently in his cardiology practice and considers essential for patients with serious illnesses. He uses the World Health Organization's definition of palliative care as a framework to explain its importance and address misconceptions about end-of-life care. Key Takeaways Palliative care affirms that dying is a normal process of life, requiring us to acknowledge mortality as an inevitable part of existence rather than something to deny or ignore. Palliative care neither hastens nor postpones death; instead, it allows nature to take its course while supporting quality of life without artificially extending or shortening the dying process. Pain and distressing symptoms—including lung secretions affecting breathing, constipation, bloating, and fluid accumulation—can be effectively managed through various medical and non-pharmaceutical interventions. Palliative care addresses both psychological and spiritual needs of patients and families, recognizing that suffering extends beyond the patient to their loved ones. A multidisciplinary team approach including primary care doctors, specialists, palliative care physicians, nurses, occupational therapists, social workers, physiotherapists, and spiritual counselors provides comprehensive support. Improving quality of life through palliative care can positively impact the illness itself, even though prolonging life is not the goal. Palliative care should be initiated early in chronic illness—not just when patients are near death—to provide support during uncertain and difficult treatment phases. Major barriers to palliative care include insufficient open conversation about end-of-life planning and a critical shortage of palliative care physicians, particularly in rural and remote areas. Read more

EP155: Discussion With Dr. Karam Kostner About HDL Cholesterol

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 about heart health, hosts this episode with special guest Dr. Karam Kostner, a cardiologist specializing in cholesterol and lipids. Together, they explore high-density lipoprotein (HDL) cholesterol—what it is, how it works, and what influences its levels in the body. Key Takeaways: HDL is called "good cholesterol" because it transports cholesterol back to the liver for excretion, acting as the body's natural regulator of cholesterol levels. HDL levels are primarily genetically determined, controlled by apolipoproteins like apolipoprotein A1, though lifestyle factors can modify these levels. HDL particle size and composition vary significantly—smaller HDL particles can be more effective at reverse cholesterol transport than larger ones, making HDL assessment more complex than LDL evaluation. Lifestyle factors that reduce HDL include smoking, obesity, and diabetes, while exercise, weight loss, and moderate alcohol consumption increase HDL levels. Hormonal changes such as menopause in women and testosterone use in men can negatively impact HDL levels. Common medications to raise HDL include niacin and fibrates, which are particularly useful for diabetics and those with metabolic syndrome; however, CETP inhibitors that dramatically increase HDL have not been shown to reduce cardiovascular events. Emerging experimental approaches like injecting apolipoproteins to create more effective HDL show promise in early trials but lack large-scale clinical evidence for practical use. HDL testing is minimally affected by fasting status (only about 5% variation), unlike triglyceride testing which requires fasting. While diets rich in monounsaturated fats and omega-3 oils may increase HDL, they often also increase LDL and total cholesterol, potentially negating protective benefits. HDL is protective only to a certain degree; high HDL cannot fully compensate for elevated LDL or other poor lipid profiles in preventing coronary disease. Read more