Welcome, my name is Dr Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honored for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, Warrick Bishop here. I hope you're well. And thank you so much for tuning in and listening to my podcast. I really do hope you find it interesting. and informative. Today I'd like to talk about heart disease. We throw that word around a lot but really what does it mean? Well there's a number of things that can cause heart disease but when we talk about it broadly we are most commonly talking about the arteries of the heart giving rise to problems. When we think about the arteries playing up we think about the process of cholesterol Building up within the arteries. Now just about everyone has heard of that. And is aware of arteries, cholesterol and heart problems. The term we use for build up of cholesterol within the arteries is atherosclerosis. And that really just pertains to a fatty scarred build up within the arteries. Now the trouble with atherosclerotic plaque is it can rupture suddenly. And if a sudden rupture occurs in an artery, then the artery can block because blood clots at the site of that rupture. And then blood doesn't get to the heart tissue. Now, layman speak would call that a heart attack. In medical speak, we tend to call that a myocardial infarction. Infarction is the word we use to describe pathologically. The damage to tissue when it doesn't get blood and dies. Myo pertains to muscle. Cardiole pertains to heart. So heart, muscle, death from lack of blood flow. Myocardial infarction. That's probably the most common. condition that we would refer to and think about when we think about heart disease. Now of course an atherosclerotic plaque may not rupture it may just get narrower and narrower and narrower to such a degree that when someone exercises or exerts themself not enough blood flows through that narrowing and therefore the heart muscle is relatively starved of oxygen. In that situation think of cramp in your leg if you've played sport for a long period of time, just not enough blood flow, and really the heart responds in a very similar way. So when we think about heart disease, most commonly we think about the arteries because they tend to be the thing that goes wrong most often. However, there's lots of other things that can go wrong, so let me share a little bit. Around some of those things. We can see the heart go wrong from an electrical perspective. And there's a whole number of ways that that can occur. Often when we think about it, people will describe things like palpitations as their symptom associated with that. But people can also have blackouts. We can think of an electrical problem that's centered mainly on the... Atria of the heart, the upper chambers, these would be things like atrial fibrillation, which is an irregular pulse. It could be what we call a supraventricular tachycardia, where the heart beats rapidly and quickly. The bottom part of the heart can also be affected. Sometimes people can get ectopic beats that thump and bump in their chest. Sometimes the heart can go into chaotic rhythm spontaneously. This is sudden cardiac death and can be seen in different families or in different cardiac conditions and lead to death quite out of the blue. Sometimes the electrical signal doesn't pass from the top of the heart to the bottom of the heart. And that can be a problem. People just black out. Luckily, pacemakers can fix that. The valves can also go wrong. There are four major valves in the heart, the tricuspid, the pulmonary, the mitral and the aortic, respectively between the right atrium, right ventricle, right ventricle and lungs, left atrium and left ventricle and left ventricle and aorta. The valves can go wrong, particularly the mitral and aortic valves are the most common to suffer. The aortic valve gets wear and tear and can get a bit crusty and narrowed and so reduce the ability for the heart to pump freely into the body. The mitral valve can suffer from wear and tear as well and can fail by leaking. Rather than getting narrowed, it doesn't close properly and that leads to back pressure, which can be a big problem of its own. The pulmonary valve is uncommonly affected. The tricuspid valve tends to be problematic, secondary to other problems with the heart. Generally, module regurgitation is a problem at the same time. The heart muscle can independently be affected when we think about heart disease. The concept of myocarditis, an infection. of the heart or an inflammation of the heart muscle is something that many of us will have heard about during this time of COVID as one of the complications of COVID and the vaccine was inflammation of the sac around the heart, pericarditis, and inflammation of the heart muscle itself. So heart muscle can also be impacted when we think about diseases of the heart. As I alluded to, infection can be important. when we think about the heart muscle being affected. But infection can also affect the valves. And believe it or not, one of the most dangerous conditions that we deal with is a bacterial infection, where the bacteria sit on the valves of the heart, most commonly the mitral and aortic valve, but it can be any of the valves. An infection, a bacterial infection like this, generally is called subacute bacterial endocarditis because it often takes weeks to present and people are very unwell with it. Interestingly, there's often a history of some exposure of the bloodstream with some sort of bacterial source, maybe a drip put in the arm, maybe an operation, maybe even the teeth being cleaned and gum disease allowing access. to the circulation of bacteria from the mouth. But viruses can also affect the heart directly, and we do sometimes see infective causes of heart muscle disease. There's even a parasite in South America which can give rise to heart muscle problems. Over and above that, we have to think of toxins that can lead to heart disease. And one of the common toxins, which is fairly freely available, unfortunately, is alcohol. Too much alcohol is a big problem for the heart and can certainly stop the heart working properly. The important group of drugs that can impact the heart are drugs that are often used for chemotherapy, particularly the anthracycline group of drugs. Your doctor would generally tell you if you've been exposed to that sort of medication, if you've gone through some sort of cancer treatment therapy, they'll generally make sure that your heart is being screened during the therapy process to keep a close eye and ensure that there's no evidence of toxicity. One of the other ways that the heart can go wrong is with... a process that we would call infiltration. And that's when something that shouldn't be within the heart makes its way into the heart and alters its function. Many of us may well have heard of amyloid affecting the brain of people with Alzheimer's disease. Amyloid's a protein that ends up in the brain and, if you like, pushes in between the cells that should be communicating with each other. If you like, winkles its way in and causes deranged function within the brain well amyloid can do the same in the heart amyloid can sneak in between the cells and by doing that derange the way the cells work and alter the way the heart contracts and relaxes so amyloid is a protein type structure that can be problematic we see other things infiltrate The heart, such as iron infiltrates, we see some congenital abnormalities of metabolism lead to infiltration within the heart. We even see some conditions like sarcoid lead to infiltration of tissue within the heart that shouldn't be there. So, when we think of heart disease, most commonly we think of the arteries. But really importantly, there's many other aspects related to the heart that potentially can give rise to problems and require us to think broadly about what could be the trouble for this particular person who we're dealing with. So arteries, the electrical system and the valves, the muscle infection, toxins, drugs and even things that can infiltrate the heart. Well, I'm going to... end there on heart disease and what might lead to it I hope you found this informative if you've enjoyed this podcast or others I'd love you to share this with someone you know and invite them to subscribe I've been so grateful for some of the positive feedback I've had and I've noticed that this podcast is dropping in and out of the top 100 medical podcasts in Australia and I'd love to cement my place in that top 100 so please feel free to share. If you have any queries or questions or even suggestions for future podcasts, drop us a note at info at drWarrickbishop.online. I'm going to wish you the very best for now. I hope you live as well as possible for as long as possible. Bye for now. Join the Healthy Heart Network and become part of our growing community. Do you want to know more about your heart health and know more about your risk of heart attack? For $5, get lifetime access valued at over $55. The Healthy Heart Network has been designed to support and help you understand your risk of heart attack, your risk level where you are right now, and the positive steps you can take to reduce that risk. Check it out at www.healthyheartnetwork.com. and press the join the family button.
