Heart Attacks are Preventable!

Know Your Real Risk of Heart Attack (Audiobook Now Available - Sample)

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: This episode features a cardiologist reflecting on a pivotal experience from 2005 when a patient he had previously given cardiac clearance to suffered a heart attack during a fun run. Though the patient was successfully resuscitated, the incident prompted the speaker to recognize the limitations of his prior assessment and motivated him to explore how modern technology can improve cardiac risk detection and management. The episode introduces the broader context of heart disease in Australia, where approximately 55,000 people suffer heart attacks annually—roughly one every 10 minutes. Key Takeaways: Early cardiac testing results (like exercise treadmill tests) can appear normal yet miss significant coronary artery disease that may develop or be undetected at the time. Even appropriate medical assessment and reassurance based on available information at the time can have limitations that become apparent in hindsight. The speaker's experience highlights the emotional and professional impact of reassuring patients who later experience cardiac events. Modern medical technology has evolved significantly over the past 10-15 years, offering new opportunities for better cardiac risk assessment and management. Heart attacks typically result from narrowing or blockage of coronary arteries and can require various interventions including medication, hospitalization, balloon angioplasty, stents, or bypass surgery. Patients typically do not expect to experience cardiac problems, suggesting a gap between actual risk and perceived risk in the general population. There is a need for improved methods of dealing with cardiac risk through better investigation protocols and management strategies. Read more

EP137: Supplements and Nutraceuticals For Lowering Cholesterol - Interview With Dr. Karam Kostner

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, hosts this episode with his colleague and friend Dr. Karam Kostner to discuss nutraceuticals—natural plant and animal components—that can help lower cholesterol as alternatives or complements to pharmaceutical drugs. The episode addresses the growing interest in these supplements fueled by social media discussions about statin side effects and the desire for more "natural" cholesterol management options. Key Takeaways: Red yeast rice contains the same active ingredient as statins (derived from fungus) but lacks the rigorous quality control and standardized dosing of pharmaceutical-grade statins, making its effectiveness and safety less predictable. Fish oil/omega-3 fatty acids (EPA and DHA) are highly effective at lowering triglycerides at doses of 2-4 grams and provide additional benefits for brain health, inflammation, and joint health, making them particularly valuable for pre-diabetic patients. The effectiveness of fish oil in preventing sudden cardiac death and heart failure remains controversial, with conflicting results across different clinical trials and studies. When purchasing fish oil supplements, the critical factor is the amount of EPA and DHA per dose; liquid formulations (1 gram per milliliter) are most cost-effective, while standard capsules contain only 300 milligrams of active ingredients. Plant sterols lower LDL cholesterol by 10-15% by preventing dietary cholesterol absorption; they are available as tablets, powders, or in enriched foods like margarines and cereals. Polycosanol provides modest cholesterol reduction of 8-12% but carries side effects including headaches and increased bleeding, making it less safe than other nutraceutical options discussed. Coenzyme Q10 does not lower cholesterol itself but may help offset statin-related muscle side effects; magnesium is a cheaper alternative with comparable efficacy and additional heart health benefits. Niacin (vitamin B3) at high concentrations effectively lowers LDL, increases HDL, decreases triglycerides, and reduces lipoprotein A, but its significant flushing side effects limit patient tolerance and compliance. Read more

Audiobook Now Available - Atrial Fibrillation Explained (Sample)

Audiobook Now Available - Atrial Fibrillation Explained Read more

EP136: Narrowed Artery to the Kidney

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 through his podcast and Healthy Heart Network. In this episode, Dr. Bishop explores renal artery stenosis—a narrowing of the arteries supplying the kidneys—and explains why this condition is an interesting and important cause of elevated blood pressure that clinicians need to recognize. Key Takeaways: The kidneys receive approximately 25% of the blood pumped by the heart at rest and depend heavily on adequate blood flow to filter waste products, maintain fluid balance, and remove toxins from the body. Renal artery stenosis occurs when an artery supplying a kidney becomes narrowed, reducing blood flow to that organ and triggering a compensatory response. When a kidney senses reduced blood flow, it releases renin, which initiates a hormonal cascade converting angiotensin 1 to angiotensin 2, a potent hormone that constricts blood vessels throughout the body and raises blood pressure. Renal artery stenosis is a significant cause of difficult-to-control high blood pressure, particularly in young patients with severely elevated readings. Fibromuscular dysplasia, a condition characterized by fibrosis and narrowing of arterial muscle tissue, commonly causes renal artery stenosis in middle-aged women. Atherosclerotic plaque buildup in renal arteries is a frequent cause of renal artery stenosis in elderly patients. In the rare but serious case of bilateral renal artery stenosis (narrowing in both kidneys), ACE inhibitors and angiotensin II receptor blockers can cause a sudden, significant decline in kidney function by blocking the compensatory renin-angiotensin system. Patients with difficult-to-treat high blood pressure who experience a precipitous drop in kidney function after starting ACE inhibitors or AT2 blockers should be evaluated for bilateral renal artery stenosis. Read more

EP135: Discussing High Cholesterols in Families - Familial Hypercholesterolaemia

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 Dr. Karam Kostner, a lipidologist and cardiologist specializing in familial hypercholesterolemia (FH). The episode explores familial hypercholesterolemia—an inherited condition causing dangerously high cholesterol levels from birth—and discusses why early diagnosis and treatment are critical for preventing premature heart disease. Key Takeaways: Familial hypercholesterolemia is an autosomal dominant inherited condition affecting approximately 1 in 200-300 Australians, with higher prevalence in certain populations including Lebanese, Middle European, Mormon, and Ashkenazi Jewish communities. FH is not a matter of "if" but "when" patients develop coronary disease; however, it is entirely treatable through early intervention starting in childhood, potentially preventing heart attacks and delaying disease progression. Diagnosis relies on clinical calculators (such as the Dutch Lipid Score or Simon-Broom criteria) that assess LDL cholesterol levels, family history, clinical signs, and cardiovascular disease history, with genetic testing confirming defects in LDL receptors, ApoB, or PCSK9 genes. Treatment typically begins with statins at age 10, progressing to combination therapy with ezetimibe in young adults, and PCSK9 inhibitors for those with inadequate response; severe cases may require apheresis (a dialysis-like procedure) or liver transplant. Cardiac CT imaging is valuable for visualizing arterial plaque buildup and improving patient engagement with treatment, using radiation doses comparable to mammograms and helping clinicians determine appropriate therapy intensity. Family screening is essential because detecting one FH patient enables identification of siblings, children, and other relatives; Australia and New Zealand have established an FH registry to facilitate family follow-up. Distinguishing FH from general high cholesterol requires careful assessment of LDL levels, family history of early cardiovascular disease, and clinical features like Achilles tendon thickening or corneal rings. Additional risk factors such as smoking, high blood pressure, diabetes, and obesity significantly accelerate coronary disease development in FH patients, making aggressive management of these conditions crucial. Recent Medicare rebate approval for genetic testing by specialists will improve accessibility and support family screening initiatives across Australia. Read more

EP134: Discussing Statin Intolerance With Dr. Karam Kostner

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, hosts this episode with guest Dr. Karam Kostner, a lipid expert and cardiologist from Queensland. The discussion focuses on statin intolerance—a common concern among patients—exploring its definition, prevalence, and practical management strategies in clinical practice. Key Takeaways: Statin intolerance is defined as the inability to tolerate at least two different statins due to clinical side effects, though true intolerance is less common than patients perceive. Muscle pain occurs in approximately 5% of statin users taking higher doses (atorvastatin 80mg, rosuvastatin 40mg), but most musculoskeletal pain is coincidental rather than statin-caused. Rhabdomyolysis, the most serious muscle-related side effect, is extremely rare (approximately 1 in 10,000 to 1 in 80,000 patients) and involves significant muscle pain with CK elevation of 5-10 fold above normal limits. Statins actually prevent vascular dementia and cognitive decline in most patients; short-term memory loss attributed to statins is extremely rare despite popular concerns. Studies show that in a placebo-controlled challenge, approximately 75% of patients reporting statin intolerance could tolerate statins when blinded, while only 25% experienced genuine side effects. Different statins carry different risk profiles; older statins like fluvastatin and pravastatin show lower muscle-related side effects compared to high-dose atorvastatin and rosuvastatin. While statins may slightly increase glucose levels in pre-diabetic patients, this small risk is offset by cardiovascular benefits in diabetic patients. Clinical management strategies include trying multiple statins at varying doses, using low-dose statins three times weekly, and adding ezetrol to achieve cholesterol targets. Magnesium orotate (800-1200mg daily) is an evidence-based, safe, and cost-effective supplement that reduces statin-related muscle symptoms in many patients. Coenzyme Q10 supplementation may help some patients resistant to magnesium, though conclusive evidence from large trials is limited. Read more

EP133: Funny Beats In The Heart - Ventricular Ectopic Beats (VEB)

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 passionate health educator who believes informed patients receive better healthcare. In this episode, he provides a comprehensive explanation of ventricular ectopic beats—irregular heartbeats that cause palpitations—including how they occur, why they feel alarming, and how to manage them in patients with structurally normal hearts. Key Takeaways: Ventricular ectopic beats are characterized by a "funny thump or flop" sensation in the chest, often feeling like the heart will jump out of the body, and typically occur when patients are relaxing. Diagnosis involves using a Holter monitor to record heart activity while the patient notes when palpitations occur, allowing doctors to match symptoms with the abnormal electrical pattern on an ECG. An ultrasound of the heart is essential to confirm the heart is structurally and functionally normal; ectopic beats in structurally abnormal hearts represent a different and more serious concern. Ventricular ectopic beats occur when cells in the ventricles become "agitated" and fire abnormally between regular heartbeats, causing electrical signals to spread inefficiently across the heart rather than through normal conduction pathways. The sensation people feel results from the irregular beat coming early, a pause that follows, and then a stronger-than-normal beat that occurs because more blood has accumulated during the longer pause. Ectopic beats are more likely to occur during relaxation or lower heart rates; when the heart beats quickly during exercise, it's difficult for extra beats to "squeeze in," similar to inserting a stick between the spokes of a spinning bicycle wheel. Stress is a major trigger for ventricular ectopic beats, along with gastric and esophageal reflux issues due to the neurological proximity between the heart and digestive system. These beats are generally benign and do not require medication; they typically resolve on their own as stress decreases and life circumstances change. Recommended management strategies include omega-3 supplements (effective in 60-70% of patients as a membrane stabilizer), magnesium supplementation, relaxation techniques, and increasing physical activity. Read more

EP132: A Patient With Hard-to-Treat Heart Palpitations

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 heart health education. In this episode, he speaks to the Healthy Heart Network membership group and shares a compelling clinical story about palpitations, a symptom that has been appearing frequently in his practice. Through a patient case study spanning several months, Dr. Bishop illustrates an important lesson about the relationship between emotional wellbeing and cardiac symptoms. Key Takeaways: Palpitations are a common cardiac symptom that can present with rapid heartbeats (supraventricular tachycardia) or irregular beats (ventricular ectopic beats), and diagnosis typically requires monitoring devices like Holter monitors. Medical interventions for palpitations include beta blockers and calcium channel blockers as first-line treatments, with electrophysiological ablation procedures available as an advanced option for certain arrhythmias. Not all palpitations have a purely physiological cardiac cause; anxiety, stress, and emotional distress can significantly contribute to or even be the primary driver of palpitation symptoms. A patient's emotional and psychological state—including relationship stress and anxiety—can manifest as physical cardiac symptoms that fail to respond to standard medical treatments. Sometimes the most important diagnostic tool is asking open-ended questions and listening carefully to patients; Dr. Bishop's direct inquiry about what else might be going on revealed the true underlying issue. Lifestyle interventions such as magnesium and fish oil supplementation may help manage certain types of palpitations alongside or instead of pharmaceutical approaches. Resolution of emotional stressors can lead to complete resolution of cardiac symptoms, demonstrating the mind-body connection in heart health. As a physician, recognizing the limits of medical expertise and acknowledging when issues fall outside one's specialty is crucial for truly helping patients. Read more

EP131: Controlling Blood Pressure With A Procedure, Renal Artery Denervation

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 is a practicing cardiologist and author dedicated to patient education in heart health, believing that informed patients receive better care. In this episode, he explores renal denervation, a cutting-edge procedure that targets the sympathetic nerves controlling blood pressure around the kidneys. The discussion centers on the recent Spiral HTN trial, which demonstrates promising results for this non-medication approach to treating high blood pressure. Key Takeaways: Renal denervation involves destroying the sympathetic nerves (fight-or-flight nerves) that run along the renal arteries to the kidneys, which contribute to elevated blood pressure regulation. The concept originated in Melbourne in the 1990s when researchers hypothesized that sympathetic nerves controlling the kidneys could be contributing to high blood pressure, leading to the first procedure in 2007. The Simplicity 3 trial, which used a sham control procedure, showed disappointing results with minimal blood pressure reduction differences, effectively halting the technology's advancement for years. The failure of Simplicity 3 was partly attributed to non-standardized catheters and operators with insufficient experience in the technique, rather than the concept being fundamentally flawed. The new Spiral HTN trial used an improved catheter design with a corkscrew curl that allows easier application and nerve destruction without requiring extensive operator expertise. The Spiral HTN trial showed statistically significant results: 24-hour blood pressure reduction of 4 mm Hg systolic and office blood pressure reduction of 6.5 mm Hg systolic compared to sham procedure. The procedure was found to be incredibly safe with zero procedural complications reported in the trial. Blood pressure reductions achieved through this procedure offer approximately a 20% relative risk reduction in cardiovascular events for patients. This technology could reduce medication burden for patients with difficult-to-control hypertension and may improve the natural day-night blood pressure variation pattern. The procedure may primarily benefit patients with recalcitrant (difficult-to-treat) hypertension, and future considerations include cost and potential Medicare reimbursement eligibility. Read more

EP130: COVID-19 From A Cardiologist's Perspective

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 is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode, he addresses COVID-19 from a cardiological perspective, focusing on practical guidance for patients during the pandemic and clarifying misconceptions about blood pressure medications and COVID-19 risk. Key Takeaways: Phone consultations have become a vital tool for delivering healthcare during COVID-19, with the Australian government quickly implementing this option to maintain patient care while people isolate at home. For phone consultations to work effectively, patients should be punctual, find a quiet location free from interruptions, and consider using speakerphone so family members or carers can participate. First consultations are best conducted face-to-face when possible, as they require building rapport and reading non-verbal cues; however, phone consultations work well for follow-ups, especially for elderly, frail, or mobility-impaired patients. Patients should prepare for phone consultations by writing a list of issues they want to discuss and presenting them early in the call, along with an up-to-date medication list, to maximize the limited time available. A study in The Lancet suggesting ACE inhibitors increase COVID-19 risk was purely theoretical and lacked supporting evidence; the paper did not even verify whether hypertensive patients were taking these medications. Blood pressure medications, including ACE inhibitors and angiotensin-2 receptor blockers, should not be discontinued, as hypertension and diabetes rates in COVID-19 patients match general population rates with no clear evidence of increased risk. Patients should organize a sensible 4-6 week supply of medications by liaising with their pharmacist and potentially arranging delivery, allowing delivered medications to sit for four days to eliminate any viral contamination. Hoarding medications selfishly and unnecessarily—such as clearing pharmacy shelves of Ventolin inhalers or other essential medications—deprives vulnerable patients of life-saving treatments and represents thoughtless behavior during the crisis. Patients should follow standard COVID-19 precautions including hand washing, social distancing, and avoiding contact with people recently on cruise ships, while maintaining sensible preparation without overreacting. Read more