Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, I'm Dr. Warrick Bishop and welcome to my podcast and videocast channel. Today I'm filming from the Maldives. I've been lucky enough to be invited by the Perfect Wave Surfing Group who organise charter tours through the Maldives to be part of their health program seminar series. So a really great opportunity for me to be here. engaging with some of the clients and some of the people who are currently staying in the resort, I've had a couple of stories that I really feel I need to share with you as they completely exemplify the sort of quest that I'm on to improve the gap between what can be done and should be done and what is being done. Now, one of the people of the group I had the opportunity to speak with the other night one-on-one after one of our presentations. And his name was, we'll call him David. David's a 45-year-old man who had some family history of heart attack. He presented to his local cardiologist after referral from the GP to get checked out. And David really wanted to know what was going on with his heart. Well, his cardiologist... put him through a treadmill test and reassured him that he was fine. Now David has been surfing since he was knee-high to a grasshopper and now he's tall enough to be the tree a grasshopper lives in. He surfs for hours at a time without any symptoms whatsoever and I bet, like me, you would guess that he'd do well at a treadmill test. Well, no surprise, he did well. David actually asked about whether he should get imaging of his heart, and his cardiologist said, oh, well, we can do it, but it's not that important. Point one, there is no question in my mind that unless we look at the health of the arteries, we cannot assess the health of the arteries indirectly using a stress test. The stress test will literally only tell us if there's a tight blockage or narrowing in the arteries, and that's so late in the process. that we may well have missed the boat. So David, even though he was angling to try and get imaging of the heart, was put off by the cardiologist treating him. In my mind, I think this is a failure of care and misses the opportunity to really put in place the best management strategy for David over the next five to 10 years. If his arteries are clear on imaging, great, reassurance and send him on his way. If his arteries show buildup of plaque, then what's the next step? What intensity of therapy is going to be required to deal with that? No, in my mind, a treadmill test in this situation for someone who is otherwise asymptomatic on exertion is really just a way for a cardiologist to make sure that they're keeping their business turning over. And I don't think that's good enough. And I think you, as an individual, as part of that care process, needs to be aware of that and ask the questions that are important for you. to get the best care. Now while I was talking to David, he had a friend who was about the same age in his mid to late 40s, early 50s and his friend had in fact gone to his cardiologist again in the same city, a major city in Australia, had seen that cardiologist and asked for a CT scan to try to get an assessment of his cardiovascular risk. Well, to the credit of that cardiologist, he did organise the scan. Now, not only did he organize a calcium score, which is a non-contrast set of images, but he also organized for injection of contrast so that it could outline the arteries. And I think this can be really valuable if there is any plaque there, because it just gives us so much more information. It turns out that the result of the injection of contrast, the CT coronary angiogram, so the CT of the heart taking a picture of the arteries, demonstrated a 30% narrowing in one of the arteries. Now, that's great information. This should mean that this person now has an appreciation or there is a documentation of the amount of plaque in this person's heart and therefore the intensity of therapy we should put in together with aspirin, blood pressure, other lifestyle measures. But importantly, with a 30% narrowing on CT imaging, this person won't have any symptoms at all. 30% narrowing in the arteries is just not enough to cause a problem. We normally need about 70% or more on CT imaging to get the beginnings of a hemodynamic flow-limiting problem in the arteries. Well, the problem with this particular case is that the cardiologist for this second patient said, look, let's get a coronary angiogram, an invasive test. where they literally put a tube into the arteries of the heart to get higher resolution pictures, this cardiologist said, let's get that test so that we can be sure. Well, second problem. There is no question that a 30% lesion on CT will not show as anything more than a 30% lesion on CT, on invasive coronary angiography. And in this situation... proceeding to a more invasive test in this absence of symptoms in my mind is not only completely wrong in terms of therapy and intervention and management it carries great risk and it really costs the community a lot of money as well as the individual patient so following up a CT that shows any plaque particularly if it's shown on CT as non-flow limiting with an invasive coronary angiogram, is not being cautious. In my mind, it's over-servicing. You need to know that. We need to know that. We need to change the way this technology is being handled, and it needs to be used with a degree of integrity so that we get the answers we need for individual patients and the best outcomes, not only for the individual we're dealing with, but for the entire community. I hope that makes a bit of sense. I hope you feel comfortable to ask questions and get the answers you deserve. Our Healthy Heart Network supports all that information and covers all that so that you can own your own best medical health care. So I'm going to wrap it up from now. As always, I'm going to wish you the very best of health and I'm going to say goodbye from the Maldives. Take a look. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
