Heart Attacks are Preventable!

EP81: Ejection Fraction And Understanding The Percentages

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 through his podcast network. In this episode, Dr. Bishop explains ejection fraction—a key measure of how well the heart's left ventricle pumps blood—and clarifies common misconceptions about what the percentages actually mean. The episode aims to help patients interpret their ejection fraction measurements correctly and avoid unnecessary alarm from misunderstanding the terminology. Key Takeaways: Ejection fraction measures the percentage of blood the left ventricle expels with each heartbeat, not a percentage of a 100% maximum capacity. The left ventricle is shaped like a hollowed bullet and is composed entirely of muscle that contracts and relaxes in a pumping motion. Diastole is the resting phase when blood flows into the left ventricle, while systole is the contraction phase when the heart pumps blood out. A normal ejection fraction ranges from 55% to 65%, meaning the heart typically expels about 60% of the blood in the chamber with each beat. The heart cannot expel all blood in a single contraction; some blood always remains in the chamber, which is why ejection fraction never reaches 100%. When a patient has an ejection fraction of 40%, they are being compared to the normal 60%, representing a 33% reduction in function—not a 60% reduction as some patients mistakenly believe. Many patients misinterpret ejection fraction percentages by comparing them to a 100% baseline, leading them to feel worse about their condition than the actual clinical situation warrants. Exercise and exertion can increase ejection fraction through a recruitment process, demonstrating the heart's ability to respond to increased demand. Understanding ejection fraction terminology correctly is crucial for patients to accurately perceive their cardiac health status and avoid unnecessary anxiety. Read more

EP80: Causes or Aetiology of Heart Failure

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 education about heart health. In this episode, Dr. Bishop provides a comprehensive overview of cardiac failure, beginning with a fundamental explanation of how the circulatory system works before systematically exploring the various causes and mechanisms that lead to heart failure. The episode emphasizes how understanding these underlying causes is essential for patients to grasp their own cardiac conditions. Key Takeaways: The circulatory system functions as a closed loop with one-way valves and heart contractions that ensure blood flows in a single direction: from the lungs through the body's organs and back to the heart. Breathing mechanics play an important role in circulation; negative pressure created during inhalation helps draw blood back toward the chest cavity and assists overall blood flow. Heart failure can occur through three primary mechanisms: damage to the heart muscle itself, improper loading of the heart, or problems with the heart's electrical system affecting heart rate regulation. Coronary artery disease is one of the most common causes of heart failure, either through permanent scarring from heart attacks or through causing muscle cramping due to insufficient blood supply under stress. Diastolic dysfunction (failure of the heart to relax properly) can develop from insufficient blood flow, causing the heart to become stiff and creating back-pressure that leads to fluid buildup in the lungs and shortness of breath. Toxic substances including excessive alcohol, recreational drugs like cocaine, anabolic steroids, and heavy metals (copper, lead, cobalt, iron) can directly damage the heart muscle and impair its pumping ability. Certain medications, particularly chemotherapy agents used in cancer treatment, can have detrimental effects on heart muscle function despite their therapeutic benefits. Infections and autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus can cause inflammation that damages the heart muscle and impairs its function. Infiltration of foreign substances into heart tissue—including cancer metastases, amyloid protein deposits, and excessive fat or glycogen—can prevent normal muscle function and lead to cardiac failure. Metabolic problems including thyroid dysfunction, calcium imbalances, growth hormone abnormalities, and nutritional deficiencies (such as vitamin B1 deficiency) can directly impact heart muscle performance. Read more

EP79: Cardiac Failure History and Features

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. Episode Summary Dr. Warrick Bishop, a practicing cardiologist and author, hosts this episode of the Healthy Heart Network to educate patients about cardiac failure and heart health. The episode provides a comprehensive overview of cardiac failure, tracing its recognition from ancient civilizations through modern medical understanding and treatment approaches. Dr. Bishop explains how patients present with cardiac failure symptoms and introduces the classification system used by cardiologists to assess severity. Key Takeaways: Cardiac failure has been documented for thousands of years, with ancient Babylonians, Egyptians, and Greeks recording symptoms of fluid retention and shortness of breath known as "dropsy." Historical treatments for fluid overload included ineffective and harmful methods such as bloodletting, leeching, lancing, purgatives, and inducing sweating before modern diuretics were developed in the 1940s-1950s. Modern diuretic medications work by holding salt in the urine, allowing the kidneys to safely remove excess fluid and water from the body through a natural excretion process. Common symptoms of cardiac failure include shortness of breath on exertion (climbing stairs, carrying groceries), fatigue, lethargy, and visible swelling in the legs or abdomen. Orthopnea is shortness of breath triggered by lying flat, caused by excess fluid in the circulation moving toward the chest by gravity and congesting the lungs—relieved by sitting upright. Paroxysmal nocturnal dyspnea is sudden nighttime shortness of breath that occurs when fluid shifts from body tissues into the circulation during sleep, a precursor to orthopnea that improves with standing and fresh air. The New York Heart Association Classification uses four stages to measure cardiac failure severity, ranging from negligible symptoms during normal activities to shortness of breath at rest or with minimal activity. Understanding how cardiac failure presents and progresses helps both patients and doctors communicate effectively about functional limitations and treatment needs. Read more

EP78: PCSK-9 Inhibitors

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. Episode Summary Dr. Warrick Bishop, a practicing cardiologist and author, discusses PCSK9 inhibitors—a new class of cholesterol-lowering drugs. The episode explores how these monoclonal antibodies work at the molecular level, their clinical benefits compared to traditional statins, and their current availability in Australia, with particular focus on how high-risk patients can access them. Key Takeaways: Statins remain the foundation of cholesterol management as they are effective, affordable, well-tolerated, and extensively studied over two decades. PCSK9 inhibitors are monoclonal antibodies that prevent the breakdown of LDL receptors, allowing them to be recycled and remove more bad cholesterol from the bloodstream. PCSK9 inhibitors can lower LDL cholesterol by 50-60% more than statins combined with ezetimibe in high-risk patients. The discovery of PCSK9's role in cholesterol management came through genetic research showing that people with low PCSK9 levels had better cardiovascular outcomes and longevity. Clinical trials (Fourier and Odyssey) have demonstrated mortality benefits with PCSK9 inhibitors, particularly in high-risk patient populations. In Australia, PCSK9 inhibitors are currently government-funded only for patients with familial hypercholesterolemia who meet specific criteria. Private patients unable to meet PBS criteria can self-fund PCSK9 inhibitors for approximately $1,500-$3,000 annually, with potential health fund contributions reducing out-of-pocket costs to around $100-150 per month. PCSK9 inhibitors are particularly valuable for patients who are intolerant or unresponsive to statins, ezetimibe, nicotinic acid, and other traditional cholesterol-lowering agents. These drugs also lower lipoprotein(a) levels, providing additional cardiovascular benefit for patients with elevated levels of this risk factor. Read more

EP77: Blood Pressure - How Low To Go?

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, Dr. Bishop addresses a common clinical concern: blood pressure management, specifically discussing a recent patient case where a GP reduced the patient's blood pressure medication based on low readings despite the patient experiencing no symptoms. Key Takeaways: Blood pressure directly reflects the workload and effort of the heart; lower blood pressure means less strain on the heart as a pump. Chronically elevated blood pressure causes wear and tear on the heart, leading to thickening of the left ventricle and dilation of the left atrium. High blood pressure significantly increases the risk of developing atrial fibrillation and can eventually lead to heart failure over a lifetime. For patients with existing heart failure, lowering blood pressure as much as possible is critical to reduce the workload on an already compromised heart. Beta-blocker medications like bisoprolol are often pushed to the highest tolerable dose because maximizing these medications provides optimal cardiac protection. The purpose of measuring blood pressure is to determine if it is too high and needs to be lowered—not to check if it is too low. Low blood pressure without symptoms is beneficial and requires no adjustment to medication; symptoms, not numbers alone, should guide treatment decisions. Over-medication causing symptoms such as lightheadedness, dizziness upon standing, or wobbliness should prompt a reduction in blood pressure medication. The ideal approach is achieving the lowest possible blood pressure without causing any symptoms, maximizing heart protection while maintaining quality of life. Read more

EP76: What Is Heart Failure?

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 introduces cardiac failure (heart failure) as a critically important condition affecting over 38 million people worldwide, including 10% of those over 75 years old. Dr. Bishop emphasizes the need to demystify the terminology and explain the condition in accessible terms, while exploring how evolutionary biology helps us understand why cardiac failure produces its characteristic symptoms. Key Takeaways: The term "cardiac failure" can be unnecessarily frightening to patients; using alternative terminology like "dicky ticker" may be less confronting while still accurately describing the condition. Cardiac failure is a widespread condition with significant global impact, affecting over 38 million people worldwide and having consequences for individuals, families, communities, and economies. The heart is a pump responsible for supplying blood to all organs in the body, so dysfunction can compromise circulation to multiple organ systems beyond just the heart. Common symptoms of cardiac failure include shortness of breath (especially during exercise), fluid retention and swelling, fatigue, lethargy, depression, and impaired function of organs like the kidneys and liver. Evolutionary mechanisms designed to preserve circulation during acute blood loss (such as fluid retention triggered by ancient survival receptors) become counterproductive in chronic cardiac failure. Receptors in the heart, major blood vessels, and kidneys evolved to detect circulatory inadequacy and trigger fluid retention—a response that saved our ancestors but now worsens cardiac failure symptoms. The shortness of breath and fluid accumulation characteristic of cardiac failure result from ancient physiological preservation responses that are misplaced in the modern cardiac context. Understanding the evolutionary basis of cardiac failure symptoms provides valuable insight into how the condition should be managed long-term. Read more

EP75: Bad Joints, Good Heart, Glucosamine

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 cardiovascular health expert, hosts the Healthy Heart Network podcast. In this episode, he explores recent research on glucosamine—a popular supplement commonly used for joint and cartilage health—and its potential cardiovascular benefits. The discussion centers on a recent UK meta-analysis of glucosamine trials that suggested a possible reduction in cardiovascular events among users. Key Takeaways: Recent pooled data from approximately 15 glucosamine trials suggests a potential reduction in cardiovascular events among glucosamine users Glucosamine likely exerts anti-inflammatory effects, which may be beneficial since inflammation plays a role in plaque formation and coronary disease The landmark Cantos trial demonstrated that targeted anti-inflammatory agents (canakinumab) significantly reduced cardiovascular events, providing strong evidence that inflammation is a key factor in heart disease Current research is exploring other anti-inflammatory agents like colchicine (traditionally used for gout) as potential cardiovascular treatments While the glucosamine data is promising and theoretically sound, it remains speculative and should not yet be considered standard therapy for heart disease prevention Glucosamine appears to be safe for cardiovascular health with no adverse effects observed in current data People taking glucosamine for joint pain can do so with confidence, knowing it may offer modest cardiovascular benefits as an added bonus Further trials are ongoing to better understand the relationship between anti-inflammatory interventions and cardiovascular disease prevention Read more

EP74: Antiplatelet With Antibiotic Action - Serendipity In Action

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 hosts the Healthy Heart Network podcast/videocast, where he discusses recent cardiology news and research. In this episode, he shares a fascinating discovery about Ticagrelor, an antiplatelet medication commonly used after acute coronary syndromes, which researchers have observed may have unexpected antibiotic properties against multidrug-resistant bacteria. Key Takeaways: Ticagrelor, an antiplatelet drug given to patients receiving stents after heart attacks or unstable angina, was observed to correlate with lower infection rates in those patients compared to those who didn't receive it. Researchers followed up on this observation by conducting structured studies to investigate whether Ticagrelor actually has antibiotic properties beyond its known effect on blood platelets. Ticagrelor appears to have an antimicrobial mechanism of action that is completely separate from its P2Y12 receptor activity used to prevent blood clotting in stents. The drug demonstrates particular promise against multidrug-resistant bacteria, which have developed resistance to many modern antibiotic therapies—a major clinical problem. The therapeutic doses required to kill bacteria in petri dish studies are far too high for safe human use, as they would cause dangerous bleeding. The goal of future research is to identify and isolate the specific antibiotic component of Ticagrelor so it can be purified separately from its antiplatelet effects. Scientists aim to develop a new class of antibiotic therapy based on the active ingredient from Ticagrelor, potentially targeting difficult multidrug-resistant gram-positive bacteria. This discovery represents an example of serendipitous scientific discovery, where an incidental observation led to a potentially groundbreaking therapeutic avenue. Read more

EP73: SAMHRI Meeting - May 10 & 11, 2019

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 educator who believes that informed patients receive the best healthcare. In this episode, he shares key insights and learnings from the South Australian Heart and Medical Research Institute weekend conference (May 10-11), which covered cholesterol management, prevention strategies, peripheral vascular disease, cardiac failure, and heart attack treatment across a broad range of cardiovascular topics. Key Takeaways: PCSK9 inhibitors can safely lower LDL cholesterol to very low levels (around 0.6 mmol/L) in high-risk post-heart attack patients, reducing future cardiac events, with genetic evidence showing no harm even at levels as low as 0.25 mmol/L. Current Australian guidelines recommend LDL cholesterol below 1.8 mmol/L for post-event patients, but emerging research suggests lower targets may be more beneficial. Sodium-glucose transport blockers (SGLT2 inhibitors) are a new drug class that helps diabetics while also providing cardiac failure benefits, but requires careful monitoring to prevent ketoacidosis with normal blood sugar. The REDUCE-IT trial demonstrated that high-dose EPA (fish oil component) significantly benefits patients with high triglycerides over a 10-year period, though the mechanism and patient selection criteria remain not fully understood. Cholesterol crystals within arterial plaque trigger inflammation, and agents like colchicine (historically used for gout) may help reduce this inflammatory response. Lowering LDL cholesterol to very low levels does not cause memory or cognitive problems, as confirmed by the Ebbinghaus study and genetic evidence. Managing patients with atrial fibrillation who require stents is complex and controversial, requiring balance between anticoagulation (for stroke prevention) and antiplatelet therapy (to prevent stent clotting). The Global Leaders Trial showed that Ticagalor as a single agent worked better than standard regimens at 12 months but lost efficacy by 24 months, suggesting potential long-term compliance issues. Cardiac failure treatment involves numerous options including ACE inhibitors, AT2 blockers, spironolactone, beta blockers, SGLT2 inhibitors, and iron infusions, requiring careful individualized management. Read more

EP72: We Can Do Better

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 filmed from the Maldives, Dr. Bishop shares two case studies that illustrate gaps between optimal cardiac care and current clinical practice, highlighting the importance of patient advocacy in healthcare decisions. Key Takeaways: Stress tests alone are insufficient for assessing arterial health; they only detect significant blockages that are already late in the disease process and may miss early plaque buildup. Patients with family history of heart disease should advocate for direct imaging of their arteries rather than relying solely on functional tests like treadmill assessments. Performing stress tests on asymptomatic patients who are clearly fit may reflect business interests rather than genuine clinical necessity. CT coronary angiography (with contrast) provides valuable information about plaque presence and quantity, enabling better risk stratification and treatment intensity decisions. A 30% arterial narrowing on CT imaging is non-flow-limiting and will not cause symptoms, as approximately 70% narrowing is needed to produce hemodynamic obstruction. Proceeding to invasive coronary angiography after a non-flow-limiting finding on CT without symptoms constitutes over-servicing and carries unnecessary risks to patients. Invasive coronary angiography cannot show greater detail than CT for a 30% lesion and is therefore an inappropriate follow-up test in asymptomatic patients. Over-servicing wastes community resources and increases individual patient costs while exposing patients to unnecessary procedural risks. Patients must actively ask questions and seek appropriate imaging to ensure they receive evidence-based care aligned with their actual risk profile. Healthcare technology must be used with integrity and clinical judgment to serve patient outcomes rather than financial incentives. Read more