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. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Thank you so much for taking the time to listen. Today I'd like to talk about some of the... treatments we use as a sort of overarching podcast in regards to cardiovascular health. Well, when we think about any intervention, when it comes to almost any aspect of medicine, we always first think about lifestyle. And importantly for cardiovascular disease, it's no different. Lifestyle is hugely important. Of course, we want to see patients, as part of their journey, embrace healthy dietary choices. And currently, broadly speaking, we would be recommending a Mediterranean-style diet. Well, what does that mean? Probably not pizza and pasta every night. Probably more along the lines of healthy greens, plenty of olive oil, fish fairly regularly, maybe some nuts, Maybe a bit of meat, but fairly sparing. Maybe not too much bread or pasta. As you're probably aware, even the Italians only eat small servings of pasta as an entree before their mains. So keeping the carbohydrates down as part of that Mediterranean-style diet makes a lot of sense. Well, what about exercise? Of course we love people to exercise. And the more, the better. We talk about 10,000 steps. Truth be told, when you look at the research, you probably only have to do 7,500 to get the same benefit. The American and Australian Heart Foundations recommend that you undertake about five episodes of 30 minutes of exercise, such as brisk walking, of moderate intensity per week for cardiovascular health. And we're starting to see more and more information really support the role of resistance or weight training. So if you can do anything in that space to stress your muscles and stress your bones, it's probably not a bad thing. And it's probably a good thing for your heart as well. So that's diet and lifestyle. Obviously, if you're carrying too much weight, look at ways to try and reduce that as best you can. Drop the weight before it gets too much. It's always easier to lose 1, 2, 3 or 4 kilos than it is to lose 5, 10, 15, 20 kilos. So for what it's worth, always try and keep an eye to your weight for yourself and your loved ones. Then we get to medications. And when we think about medications for cardiovascular health, we can think about preventative therapies, but also symptomatic therapies. Well, when it comes to preventative therapies, there are things such as aspirin, blood pressure lowering tablets, cholesterol lowering tablets. We've got drugs that can help with rhythm. We've got a whole bedrock of drugs that we now use as part of four keystones of therapy for cardiac failure. And we also have drugs to thin the blood. I won't go into these in detail, but you can get a sense of how broad the impact of these different medications can be. We can also treat symptoms with medication and anti-anginal medication, drugs that slow down the heart and therefore slow the demand of the heart and reduce therefore oxygen demand. can offset angina. So can drugs that open up the arteries. We can treat cardiac failure with drugs that cause the body to lose fluid and therefore reduce symptoms. And of course, we can control rhythm and rate of the heart if for some reason it's beating irregularly. But we also can stick things in people and do things to people. And when it comes to the arteries, Most of you would be aware we can stick little wire cages in blockages within arteries and open those blockages up. They're called stents and they've really revolutionized what we're able to do. They've been around for nearly 20 odd years and the technology is broadly available and continues to improve. If arteries are a problem, we can go beyond stents and we can do undertake. bypass grafting. Well, this is really quite significant and major surgery, but can offer significant relief and prognostic benefit for the appropriate patients. When we think about the valves of the heart, this is an area that's really changing and evolving in leaps and bounds. We have the opportunity, of course, to undertake open heart surgery and fix a valve. Now this has been done for some time and we can use metallic valves, which last a very long time, but they do carry some risk of clot forming on them, so we tend to run those patients on warfarin long term. If we don't have a mechanical valve, we can have tissue valves, and these are often derived from tissue from a cow. or tissue from a pig, referred to as bovine or porcine, respectively. These tissue valves don't tend to last quite as long as the mechanical valves, but they do offer the benefit of not necessarily needing warfarin in the longer term. The really exciting thing about valves and what's on the horizon is that we're now generating valves that can be implanted percutaneously so by going in through a small opening in the leg these valves can be guided up into position and deployed with nothing more than a small incision no requirement for the invasive open heart surgery of the past this of course can only be done in certain situations but it is becoming more and more possible and certainly far more accessible. A very exciting spot currently, the aortic valve is the one that we are most likely to target, but it won't be long before we're routinely targeting the mitral valve and tricuspid valve in appropriate clinical circumstances. When it comes to arrhythmia or irregular heartbeat, We've had for a long time direct cardio reversion or DCR. This is putting paddles across the chest and giving people a whack of electricity to shock the heart back into a normal beat. Well, you've seen that on telly and you've been aware of that for years. But we also have fantastic technology that's delivered by our electrophysiology colleagues. And this is called electrophysiological ablation. catheters are used, these catheters are passed by the leg into the heart, so minimally invasive, and an electrophysiologist, a specialist in this area, will direct particular ablative technology, and that might be cold therapy or heat therapy or radio frequency therapy, to particular targets within the heart to break circuits and stop problematic or troublesome rhythms. Really quite amazing. Now, all this is what we're currently doing and what the horizon holds, I'm not exactly sure, but I would not be surprised if in the next five to ten years we start to see a role for stem cell therapy to help hearts that have been damaged. And this could be a fascinating space where also... almost certainly going to see mRNA technologies being used more and more in the space of cardiovascular therapy. Well, there's a bit of an overview, talking obviously starting at the starting point of lifestyle, diet and exercise, medications for prevention and symptoms, what we can do to the arteries, what we can do to the valves, and what we can do for arrhythmias. The really interesting times, however, I think are going to be ahead. But right now, they're incredibly exciting and only going to get better. Well, I hope you found that an interesting and informative presentation on the treatments for cardiovascular related issues. If you've got any queries or questions, drop us a note. Again, thank you so much for taking the time to listen. For now, I'm going to wish you the very best and please live as well as possible for as long as possible. Take care and bye for now. Did you know that coronary artery disease kills one in four people? So most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com.au. It'll give you information about risk and what else can be done to be even more precise.
