**EP314: Navigating Heart Disease - Treatment Options and Beyond**
**Dr. Auric Bishop:** Welcome, my name's Dr. Auric 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, and 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.
**Dr. Warwick Bishop:** Hi, my name's Dr. Warwick Bishop, and welcome to my podcast and videocast station. As always, I'm really grateful you've taken the time to tune in, and I hope I can give you something interesting, informative, and practical for your own heart health and best health journey.
Today, I'm going to be talking about, well, I guess we could call it navigating heart disease and touching on some of the treatment options that are currently available to us. Because when an individual turns up to see their cardiologist, they're probably wondering, "What next?"
Well, when we think about "what next" after we've made a diagnosis, it’s invariably reasonably straightforward. In general terms, we would implement, as a basis, lifestyle changes. We'd put in place, depending on the condition, most commonly some sort of medical management, and then we would be thinking about potential procedures or even surgical options. The future might even see gene therapy or stem cell therapy. So let's talk through some of these things in a fairly helicopter sort of way, just as a reference for thinking processes should you need to go through some sort of heart health journey yourself.
Well, lifestyle is a bedrock for the care of pretty well any heart-related condition. So obviously, someone who's had bad arteries, we would be looking at minimizing their risks. If they were overweight and diabetes or pre-diabetes was contributory, we'd be looking at weight loss and exercise strategies. If they had coronary artery disease, we'd be looking at exercise strategies. But let's think about other situations, things like palpitations.
We know that there are different sorts of palpitations. Atrial fibrillation is a pretty common irregular rhythm that affects three to four hundred thousand people in Australia and about 10 to 15 percent of people over 80 years of age. Well, atrial fibrillation can be triggered by stress. It can also be triggered by alcohol. So if we're thinking about lifestyle changes, something as simple as avoiding stressful situations could be very important for an individual with atrial fibrillation. So could reducing alcohol.
Depending on the condition, we'd also think about medical management. Again, it's very common to see people with a build-up of plaque or cholesterol in the arteries. For those people, lowering cholesterol becomes absolutely central to what we do. We tend to aim for certain targets. For people with high blood pressure, we might use specific antihypertensive therapies. And for people who've got problems with their arteries and a risk of clots forming in the arteries, we use aspirin-type drugs.
Aspirin-type drugs are broadly called antiplatelet drugs because those drugs reduce the stickiness of those small components that live within the blood that help the body clot. The problem is with coronary artery disease; a clot forming in the artery is the wrong place. A clot forming at a skin site where you've had a laceration or a cut makes perfect sense so you don't bleed to death. But medications are very important. Whenever we look at medications for an individual and their condition, we need to put into context the risk and benefit of those particular medications for that individual based on their specific condition.
Well, that's pretty straightforward. How about we think about procedures next? We can do all sorts of different procedures, from putting in a pacemaker to undertaking an invasive coronary angiogram, where we put a needle in one of the arteries and pass a tube up into the arteries of the heart and squirt dye in. We also do procedures like treadmill tests. We do procedures in atrial fibrillation where we, if you like, burn out small areas of the heart where we believe the irregular rhythm arises from.
So procedures are something that can help us with further evaluation or can even help us with therapy. And again, they're very specific to the condition, but of course, they offer some opportunity for, as I said, better information or even a therapeutic intervention. Again, we always put into context the risk and benefit for that individual patient and their specific situation. Anything where we're sticking tubes inside of people very often can carry some risks, so that needs to be considered and put into context. And certainly, in the setting of elective procedures, the patient needs to be well informed and appropriately consented.
Well, sometimes in cardiology, we go beyond lifestyle, beyond medication, and beyond procedures, and then we may be looking down the barrel of surgery. Now, surgery is a big deal when it comes to the heart because generally, we need to open the chest up completely for the surgeon to have an adequate view and adequate access to the heart. The most common surgical procedure we would see is coronary artery bypass grafting sternotomy. So the sternum, the breastbone, if you like, is split completely. Those bones are then separated by special retractors that allow the surgeon and the surgical team access to the heart.
Now, you're probably aware that when they operate on the heart, most often they will put the heart on bypass so that they can keep the heart still and operate on it while it's still, but redirect the patient's blood out of the body through a device that literally exchanges oxygen and carbon dioxide and pumps the blood back into the body—a bypass machine. So surgery is a big deal. We do it for arteries, we do it for valves if required, and we do it for the aorta, the big blood vessel that comes out of the heart.
Interestingly, I've been through that process. I had surgery on my aorta. The particular procedure I had was a wrap around the aorta, which meant that it could be performed while my heart continued to beat. So I had open heart surgery without a bypass machine being required. But surgery is a big deal, and it certainly requires considered risk evaluation, pros and cons discussed extensively with the patient, and then proceeding as appropriate.
So there you have it. When we think about treatment options for navigating heart disease, we start with lifestyle and all the appropriate lifestyle interventions that we can think of, in particular for that person's condition. We think about medical management. We've got an armamentarium of fantastic medications that can work for atrial fibrillation, for coronary artery disease, for cardiac failure, for palpitations—a whole range. And we use those as appropriate.
We've got fantastic procedural interventions from invasive diagnostics to therapies that are done in a procedural way, and of course, there's surgery. The future undoubtedly is going to hold such things as genetic therapy and stem cell therapy, but we've not seen those yet. We're seeing the very beginnings of RNA molecules, interfering RNA molecules being used in therapeutic ways, but I think we're going to see possible stem cell and genetic manipulations which may reinvigorate or restore cardiac function, and these can only be a little while away. Watch this space.
For now though, I'm going to wish you the very best. I do hope you live as well as possible for as long as possible. Thank you again for tuning in, and bye for now.
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