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 honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. This is ABC Radio Hobart, where we check in with our friendly breakfast cardiologist. Dr. Warrick Bishop, who works here in Hobart and is author of many books, including one that tells you about the difference between heart attack and heart failure. G'day, Warrick. Morning, Rick. How are you? Yeah, good. I want to touch on this AI diagnostic tool as well after the weekend's kerfuffle in Western Australia. I think some doctors were getting AI to write their notes for them. And the AMA have said, just stop using it. We don't even know what it does, but it might do some amazing things. But first, Warrick, what's the difference between heart attack and heart failure? Look, heart attack is what we often see depicted by Hollywood with an individual generally all stressed who suddenly gets chest pain, grabs their chest and collapses. Most commonly, that would be, in layman's terms, a heart attack where there's a sudden blockage. of one of the major arteries to the heart. So the heart muscle just doesn't get enough blood. And obviously there's a big consequence to that. And the heart can go out of rhythm. That's why people die. Because if it goes out of rhythm, it just doesn't work properly. And without any blood going to the brain, you collapse. Cardiac phase is a different story. It's where the heart just isn't providing enough blood to the organs of the body full stop. And that leads to all sorts of issues. including things like fatigue, which you might imagine if your body's just not getting the energy it needs. But one of the amazing things about cardiac failure, Rick, is what we see as a consequence of the heart not working properly is really a reflection of evolutionary development that we had from millions of years ago. So if you think about our ancestors, if they had an accident, cut their leg, got bitten by a saber-toothed tiger but survived, they would have bled and they would have lost blood and that loss of blood could have jeopardized their existence. So evolution allowed us to hold on to extra fluid, retain fluid, if you like, if our body's sensors thought that we'd lost blood. Well, if the heart's not pumping properly, it sends a message to the body's sensors saying, oh, there's not enough blood in the system because the... The pump's not working properly. The body's receptors don't realise it's the pump. They think we've been bitten by a saber-toothed tiger. And so the kidneys swing into action and start holding on to more fluid than we really need. And so in cardiac failure, we actually get this retention of fluid. And if you think about the circulation being a closed system to a large degree, that fluid has to accumulate somewhere. And most often, it accumulates either in the lungs. giving people shortness of breath, or accumulates in the legs, giving people swollen ankles. So these are clearly things we should be having an eye out for. Do people often mistake that for something else but a gout? Well, the legs get quite puffy, both legs simultaneously. So if one leg got swollen and was painful, that could be gout. But with cardiac failure, generally both. both legs will get swollen. And people will notice, you know, they can't put their shoes on, for example, or their shortness of breath is such that a flight of stairs that previously was pretty straightforward has become much harder. Some people even note that when they lay down flat, that they get short of breath. And that's because the fluid redistributes within the body so that extra fluid ends up in the lungs if you lay down flat. But these things you do need to get an eye out for, particularly since we see cardiac failure more and more in the populations, they get older. And so people will sometimes put down the changes in their exercise capacity to just getting a bit older and not be early to get it seen to by the doctor. What do you need to do to deal with it? And is this an emergency situation or a GP situation? Look, cardiac failure can present in a couple of different ways. It can come on very suddenly. And of course, if that's the case, then there's marked shortness of breath. And these people will invariably end up in accident emergency departments, most likely picked up by the ambulance because of shortness of breath in the middle of the night. But the slower development of shortness of breath or a bit of peripheral edema, swelling in the legs, this would be picked up by the patient and may well be reported to the GP. And that would necessitate... being sent off to a cardiology clinic to get further examination, particularly the sort of scanning we can do on the heart, allows us to get a very good insight into how the heart's squeezing or relaxing because the heart can actually fail in two different ways. It cannot squeeze well enough or it cannot relax well enough. So we get very good information about knowing what to do if we've got the right tests done. 13 to 7 ABC Radio, Hobart. You're listening to Dr. Warrick Bishop, our friendly breakfast cardiologist. Of course, this is health information. It's not advice. Get your own advice from your own health professionals. Warrick, is it easy to treat? Look, we've got a range of very effective medications these days, and it's important to get these medications in as soon as possible to the best doses that the patient can tolerate. I wouldn't say it's easy to treat, but there is certainly a path through. And the sooner we can identify it, the sooner we can get people on the right medication at the right doses, the better they will do. Now, this Perth company over the weekend was saying that they're developing this AI that can read scans and find plaques that are almost invisible to the eye and get a much better diagnosis. Because they said like 50% of heart attacks are diagnosed after the person's dead. Yeah, it's not quite that high, but there's a large number of people who have heart attacks who have no symptom up until the time that it occurs, and that's because the plaque within the artery ruptures, and when the plaque ruptures, a clot forms on top of that plaque, and that clot then blocks the artery. Now, the bit that catches people out is up until the time that the plaque ruptures in about 40% of people. It's not limiting the blood flow. So there is no symptom whatsoever because enough blood is getting through to the heart to allow that person to do what they want to do on a daily basis without any clue. So it is a big deal. It's not quite as bad as you say, but it's still a very significant consideration. The interesting thing about that particular article is that the... AI technology that they're talking about is currently being used in the US through a company called Clearly, CL, I think it's E-E-R-L-Y, Clearly. And they are a commercialised company using AI to interpret cardiac scans. really do the very work that I do every week when I sit down and report my own heart scans for my patients. So is this potentially like time-saving, industry-changing, or is it the kind of disruption that means that money will get diverted out of public health funding and into private companies? I think I tend to respect the concerns of the AMA. and their response over the weekend, I think it's really important that we understand that this could be an incredible tool that could make a huge difference time-wise. If you think about the amount of time someone like me takes to read a scan or a radiologist, for example, looking over chest CTs of someone who's got a lesion in their lung and they're looking over hundreds of scans over many, many years for an individual patient, these tools could look at those scans. Far quicker without physical human input required with a high degree of accuracy. These machines don't get tired. They don't need a coffee break or a lunch break. So there's a potential for an enormous amount of work to be done. So no question at all, Rick, that there's opportunity with AI that's going to be incredible. But I think it's really important, which is what the AMA has flagged, to say.
