**EP345: 5 Highlights From PD 2024**
**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 honoured 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. I really appreciate you tuning in, and I really hope I can give you something that's informative and engaging. Look, today I'd like to share with you my experience from a conference I went to recently. It was the 2024 Port Douglas Heart Meeting and Expo. The last time this was on was about four or five years ago, and then of course COVID came along. This particular meeting is one that's an absolute highlight in my calendar anyway, and I know for a number of other general cardiologists. It's really highly regarded. And that's because the organizers have gone to great lengths to get tremendous international presenters who really provide great clinical guided teaching. Clinical guided teaching means it's the very stuff that we do in our consulting rooms on a day-to-day basis.
Well, what I'd like to share with you is some of the highlights or some of the interesting bits and pieces that popped up on day one. So the conference was kicked off on the 5th of June. The first session was about using echocardiography in clinical practice. The organizing committee had arranged for international speakers, and a number of those had come from the Mayo Clinic, which is a very famous hospital in the US, well known. So we had very senior clinicians from the Mayo Clinic speaking with us. One of the first to speak to us was Dr. Rika Mankad, who shared some information about echo services in the Mayo Clinic.
But one of the fascinating things that she spoke about was a case that had endocarditis. Well, what does that mean? Endocarditis is an infection on the valves. Now, in this particular case, the infection on the valves looked like a little cauliflower of bacteria sitting on those valves. It was quite large, almost a centimeter in size. We know that vegetations or clumps of bacteria on the valve can be extremely destructive to the valve. That condition, bacterial endocarditis, carries a very high risk of mortality. Equally important is that that lump of bacteria can break off and travel somewhere else in the body. We call that embolize. If that goes to the brain, it causes a stroke. If it goes to the kidney, it can cause a renal infarct. This is the morbidity of bacterial endocarditis.
Well, as she was discussing this particular case, she described a piece of equipment called an angiovac. Now, I'd never heard of this, but basically it was a tube, like a vacuum cleaner, that's entered into the bloodstream, guided using ultrasound control, into the right location to literally get to the spot where it could suck the clumps of bacteria, these vegetations, off the valve, reducing the infective load. Wow! So that was a great start—a piece of equipment and tech I'd never heard of before. Absolutely fascinating! Imagine how useful that would be, having a vacuum cleaner to clean up stuff inside your heart.
We then went on to talk and get educated around the intervention for timing of valves. Now, historically, we've waited for aortic and mitral valves to really show signs of failure, represented by the individual patient having a decrease in their exercise capacity or some symptom of some descript. To a degree, it seems that we're now seeing this guide recommendation change a bit. Historically, the risks of surgery were relatively high, but surgical techniques have got better and better. The risk of the surgery has got less. We've also started to understand that as we leave the heart longer and longer under strain because the valve's not working properly, the ventricle, the main pumping chamber of the heart that's associated with that valve, may undergo change. Changes that are features of wear and tear as a consequence of that valve being too tight for too long.
Those changes that they talk about are things like fibrosis and scarring. You can imagine that if that fibrosis and scarring progresses too far, then even if you do replace the valve, you may not get the response you want because the ventricle has already been damaged. So a really important point: we're starting to think about intervening earlier when it comes to aortic stenosis and mitral regurgitation. That information was presented by Dr. Rick Nishimura, who was a fantastic presenter and incredibly clear and articulate in the way he shares information and knowledge.
We also had Carol Warnes, who's a world-recognised expert in the management of pregnancy and peripregnancy-related heart issues. She really talked about the high-risk patients going through pregnancy and the individuals who needed to be seen before they even get pregnant. The risks can be at least discussed, perhaps pregnancy avoided, or perhaps pregnancy undertaken, but with appropriate risk mitigation.
Well, who are the group of women at high risk when it comes to pregnancy and heart-related issues? Women with high pulmonary pressures—so that's pressure in the lungs being elevated—carry significant risk because of the strain on the right heart and the changes hemodynamically when the child is delivered. As you might imagine, women whose left ventricular function is reduced, so women whose heart just doesn't pump properly, can really be in significant trouble. Women with bad valve disease, as you might guess, if this valve disease is impacting on heart function, then when you really need that hemodynamic reserve during the time of labour and delivery, if the valve is not functioning as it should, there can be a lot of hemodynamic consequence from that.
Severe aortic dilatation—these are people who have some sort of connective tissue disorder. Aortic dilatation is when the ascending aorta, which is the big blood vessel above the aortic valve, dilates because the integrity of the tissue is just not right. There are conditions like bicuspid aortic valve, Marfan's disease, and Ehlers-Danlos syndrome, which have that association. As that aorta dilates, you can imagine there's a risk of something going wrong with that aorta during the time of pregnancy because of the strain, and if there is a tear or a rupture of that aorta, that's just an unsalvageable situation in most cases.
Interestingly, there's also a condition called peripartum cardiomyopathy. Now, the interesting thing about that is we don't really understand what causes it. When the child's delivered, it improves. About 30% will continue to have a bad heart ongoing, but 70% will recover, which is good, but a reasonable proportion will have the same problem again should they consider going through another pregnancy. So, significant caution there.
Our next speaker was Aaron Baggish, and he was fantastic talking about the athlete's heart. When we think about the athlete's heart, there are two changes we see with the heart in athletes who train at an elite level. In the space of endurance, the heart tends to get bigger and bigger so that it works like a large bucket, if you like, squeezing less often but squeezing more. Versus athletes who train in strength, where the heart tends to thicken up and become more powerful for each ejection.
It does. So, really interesting situation where we know that excessive training—well, I say excessive training, but elite training—we're talking several hours most days of the week, can actually lead to changes in the heart, which are responses to the stimuli of that sort of training regime that the individual athlete follows. We also spoke about the mitral valve, and one of the leading cardiologists in Europe, Jerome Bax, spoke about mitral valve function and how we assess the appropriate timing for mitral valve correction, including this concept of strain technology where we can use what we call longitudinal strain, which is a marker of how the heart contracts and relaxes to try and understand if there is damage starting to happen to the myocardium or the muscle when we're thinking about the timing of mitral valve surgery.
Jerome Bax also spoke about the use of clips passed in through the blood vessels to clip the leaflets of the artery in the situation where they're not closing properly. So, percutaneous closures or surgeries, if you like, of the mitral valve as a way to improve function.
So, all these were highlights and snippets from the first day, which were absolutely fascinating. I'm excited to say that the rest of the conference meeting was absolutely fantastic, and I will pull together some of the other highlights and share those with you as well. I hope you've enjoyed those. If you have any queries or questions, drop us a note at info@drwarwickbishop.online, and if you have any topics you'd like us to cover, please email us on the same email address.
For now, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. I really appreciate you tuning in, and I hope you found something interesting from today's session. Take care and bye for now.
**Dr. Auric Bishop:** Hi. Ever wondered what your risk of heart attack is? You should. It's the single biggest killer in the Western world. We're talking one death less than every 30 minutes in Australia. One death less than every 60 seconds in the United States, 9 million deaths globally per annum. Well, how do you check your risk? You can go to www.virtualheartcheck.com.au. You'll find out about your risk and what can be done beyond that to be even more precise.
