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Revolutionising Heart Health With Dr John Osborne · Hardiness with Dr Paul Taylor

• 0:10
  Speaker 1: Doctor John Osborne. Welcome to the podcast. Thank you so much, Balt.
• 0:14
  Speaker 1: It is a pleasure, in an honor to be here.
• 0:17
  Speaker 1: It's an absolute pleasure to have you on.
• 0:19
  Speaker 2: As I said just just before we started, I've got
• 0:22
  Speaker 2: a bit of a vested interest in this area, which
• 0:26
  Speaker 2: most of my listeners know about. But so you call
• 0:29
  Speaker 2: yourself a preventative cardiologist, which I am a big fan
• 0:32
  Speaker 2: of for obvious reasons, and for those who don't know,
• 0:38
  Speaker 2: I got diagnosed with a bicuspod aotic valve.
• 0:41
  Speaker 1: John will go through what that is, but only.
• 0:45
  Speaker 2: Because I play soccer with a cardiologist and said, hey,
• 0:48
  Speaker 2: I want to get a bit of a screen. I'm
• 0:50
  Speaker 2: I'm not a big believer in cholesterol as a predictor
• 0:55
  Speaker 2: of of other partencies.
• 0:57
  Speaker 1: Think there's so much more to it, which Johnald guintu.
• 1:00
  Speaker 1: But oh, John, talk.
• 1:01
  Speaker 2: Us through maybe a little bit a kind of anatomy
• 1:06
  Speaker 2: of the heart. Are you talk to yourself? You'd say
• 1:08
  Speaker 2: that you're a general contractor.
• 1:10
  Speaker 1: So yeah, so when people ask me what I do,
• 1:12
  Speaker 1: I love to say, because I'm a little snarky, I'll say,
• 1:15
  Speaker 1: when they what do you do? And I say, well,
• 1:17
  Speaker 1: I'm just a general contractor. I do some electrical I
• 1:19
  Speaker 1: do some plumbing, right, So that that's kind of what
• 1:23
  Speaker 1: cardiology is. It's electrical and plumbing basically.
• 1:26
  Speaker 2: Right, And that my cardiologist had actually said to me, Hey,
• 1:30
  Speaker 2: when I was getting tested, we'll look at the rooms of.
• 1:33
  Speaker 1: Your heart and the electrics and the plumbing.
• 1:36
  Speaker 2: So so talk us through those things and to people,
• 1:40
  Speaker 2: and and what typically tends to go wrong with the
• 1:44
  Speaker 2: rooms the electrics there, plumbing.
• 1:46
  Speaker 1: Yeah, no, that's a great example the most common issue
• 1:51
  Speaker 1: that people encounter over the course of their lives. And again,
• 1:56
  Speaker 1: it can be a whole spectrum of things. Right. You
• 1:59
  Speaker 1: can have valve isshue like you had. You can have
• 2:02
  Speaker 1: plumbing issues, but basically the water supply right to the heart,
• 2:07
  Speaker 1: right that supplies the blood, oxygen, nutrients and all that.
• 2:12
  Speaker 1: You can have fluid around the heart, you can have cardiomyopathies,
• 2:16
  Speaker 1: weakness heart. So any of the parts of this order
• 2:18
  Speaker 1: of this complex machine, and also electrical issues can go wrong.
• 2:25
  Speaker 1: But probably statistically the most likely thing to go wrong
• 2:28
  Speaker 1: that most people encounter will be the formation of and
• 2:33
  Speaker 1: the deposition of plaque in the blood vessels, which if
• 2:38
  Speaker 1: it extends enough, will cause anything from heart attacks and
• 2:42
  Speaker 1: by the way that same plaque that forms in the
• 2:44
  Speaker 1: blood vessels to heart can also form anywhere else in
• 2:47
  Speaker 1: your body. Right. It can be in the neck causing strokes.
• 2:50
  Speaker 1: It can be in the legs causing what we'll call
• 2:53
  Speaker 1: peripheral arterial disease, that is build up of plaque and
• 2:56
  Speaker 1: blockages and the legs where people can't walk, and in
• 2:59
  Speaker 1: the worst scenarios, actually leads to amputation and things like that.
• 3:04
  Speaker 1: So plaque can be very systemic. It can be in
• 3:07
  Speaker 1: any blood vessel of your body, but more times than
• 3:11
  Speaker 1: not it sort of manifests or comes out in the heart,
• 3:15
  Speaker 1: causing blockages, which can cause symptoms like shortens of breath, heaviness, tightness,
• 3:22
  Speaker 1: chest pain. We call it angina, particularly with exertion or
• 3:26
  Speaker 1: when you exercise or work out or go upstairs or whatever,
• 3:30
  Speaker 1: and typically improved with rest. So if your symptoms get
• 3:33
  Speaker 1: worse with exercise, improved with rest. If you have a
• 3:37
  Speaker 1: heaviness of tightness, of burning an ache, usually not a
• 3:40
  Speaker 1: sharp pain or knife like or lancinating pain or ice
• 3:45
  Speaker 1: pick type pain, but usually more of a heaviness of
• 3:48
  Speaker 1: pressure eche burning somebody sitting in my chest works with activity,
• 3:54
  Speaker 1: worse with exercise gets better with rest. You need to
• 3:58
  Speaker 1: give me a call because that could certainly be a
• 4:01
  Speaker 1: symptom of what we call angina. But here's the problem.
• 4:04
  Speaker 1: Plaque behaves in ways that you probably don't think of,
• 4:07
  Speaker 1: and we don't really well explain it to the lay public.
• 4:12
  Speaker 1: You can have zero symptoms. I feel fine. Just got
• 4:16
  Speaker 1: off the soccer field like you did, and have a
• 4:20
  Speaker 1: massive heart attack. Right, So what happens most of the
• 4:24
  Speaker 1: time is plaque builds up in the heart. It mostly
• 4:28
  Speaker 1: forms out in the wall of the vessel. So think
• 4:30
  Speaker 1: of the vessel, the blood vessel, as a donut. Right.
• 4:33
  Speaker 1: We get really worried about the donut hole, But actually
• 4:36
  Speaker 1: where all of this is occurring is actually in the
• 4:39
  Speaker 1: donut itself, And when plaque builds up, it literally will
• 4:44
  Speaker 1: expand outwards into the donut, not inwards into the donut hole.
• 4:49
  Speaker 1: And all of this is occurring and you have absolute
• 4:52
  Speaker 1: no symptoms. I feel fine. I like to say I
• 4:55
  Speaker 1: had a normal stress test last week and it was normal.
• 4:58
  Speaker 1: And you could have extensive deposition of plaque and build
• 5:03
  Speaker 1: up in those blood vessels and have absolutely no symptoms
• 5:06
  Speaker 1: and past stress tests all day long. Oh, you can
• 5:09
  Speaker 1: even pros us an exercise stress test. Absolutely. Yeah. So
• 5:13
  Speaker 1: let me tell you a little secret of cardiology. Okay,
• 5:17
  Speaker 1: I don't do stress tests anymore, and I'll tell you why. Right, So,
• 5:21
  Speaker 1: if you go to a cardiologist, right, no matter where
• 5:24
  Speaker 1: you're at, what country, right, if you go to a cardiologist,
• 5:27
  Speaker 1: you'll get predictably an EKG pretty worthless. You'll get a
• 5:33
  Speaker 1: stress test pretty worthless. And even if you you know,
• 5:37
  Speaker 1: if those things look worrisome or concerning or whatever, you
• 5:41
  Speaker 1: might graduate to a invasive heart catheterization or angigram as
• 5:46
  Speaker 1: we call it. That's the invasive test. We put catheters.
• 5:49
  Speaker 1: I call them silly straw haus right, they're big long tubes.
• 5:53
  Speaker 1: When I trained, we did them through the groin. Right
• 5:56
  Speaker 1: now we've only the only change in that procedure is
• 5:59
  Speaker 1: now we go through the When I suspect you probably
• 6:01
  Speaker 1: had that done, it's through the wrist. Yes, it's it's
• 6:04
  Speaker 1: less risk of bleeding and such. But any of those
• 6:08
  Speaker 1: tests can absolutely one hundred percent every day missplaque. Interesting
• 6:15
  Speaker 1: and particularly with stress tests. Here here's the thing you
• 6:19
  Speaker 1: need to know. It takes a seventy percent blockage of
• 6:23
  Speaker 1: the doughnut hole of the channel we called the lumen
• 6:27
  Speaker 1: before you have symptoms or flunk a stress test. So
• 6:32
  Speaker 1: if you're completely normal or ten thirty fifty sixty sixty
• 6:38
  Speaker 1: nine percent, your stress test will be normal. So the
• 6:43
  Speaker 1: good news bad news is our vessels are bigger than
• 6:46
  Speaker 1: they need to be. Right, we have huge reserve. Right.
• 6:49
  Speaker 1: The downside is we have huge reserves, so they need
• 6:52
  Speaker 1: to be really plugged up before we ever manifest symptoms
• 6:57
  Speaker 1: or show up or or flunk as float FLUNKU stress test.
• 7:02
  Speaker 1: So they're very insensitive and insensitive to early disease. And
• 7:07
  Speaker 1: in fact, I always think of this if you think
• 7:10
  Speaker 1: of heart disease versus cancer, right with a stress test,
• 7:14
  Speaker 1: waiting for symptoms or waiting till your flunk a stress test,
• 7:17
  Speaker 1: it really is only detecting cancer at the stage four
• 7:22
  Speaker 1: widely metastatic, widely advanced level. Impossible toct it at stage three,
• 7:28
  Speaker 1: two or one. And then it gets worse because when
• 7:33
  Speaker 1: we do a stress test, it's all predicated upon blood
• 7:36
  Speaker 1: flow and interrupting blood flow. But again, our vessels are
• 7:39
  Speaker 1: really big. We can put up with a lot of
• 7:41
  Speaker 1: plaque and blockage in the vessels and still have adequate
• 7:43
  Speaker 1: blood flow even with exercise right. The other problem is
• 7:48
  Speaker 1: we're not actually visualizing the blood vessels, right, we're just
• 7:51
  Speaker 1: looking at blood flow. So even with what's called nuclear cardiology,
• 7:56
  Speaker 1: where we do we do about ten million of those
• 7:58
  Speaker 1: in the US. With nuclear cardiology, there's a twenty five
• 8:04
  Speaker 1: to forty percent false negative rate. That means there is
• 8:07
  Speaker 1: a severe block and you just should have picked it
• 8:09
  Speaker 1: up and it missed it. So that's re interesting.
• 8:13
  Speaker 2: Did you say, oh, John, you've just gone You're sorry,
• 8:22
  Speaker 2: you just you just pot out there for a little
• 8:24
  Speaker 2: second and okay, and so you said a Did you say,
• 8:28
  Speaker 2: just recap on that?
• 8:28
  Speaker 1: Did you say twenty five to forty percent false negative
• 8:32
  Speaker 1: false negative rate? Right, so we pat you on the back,
• 8:35
  Speaker 1: say you have the heart of than an eighteen year old,
• 8:37
  Speaker 1: and then you have heart attack next week, next month,
• 8:39
  Speaker 1: next year. So high rates of false negatives, which is
• 8:44
  Speaker 1: really concerning. Secondarily concerning is a high rate of false positives. Right,
• 8:49
  Speaker 1: So there is no blockage, you do the stress test
• 8:52
  Speaker 1: looks funny, equivocal, right, then you graduate to an invasive
• 8:56
  Speaker 1: hardcast twenty thousand bucks in the US of tests. You know, die,
• 9:03
  Speaker 1: risk of heart attacks, strokes, damage to the kidneys, infection,
• 9:07
  Speaker 1: bleeding right only to find out, yeah, you look fine.
• 9:12
  Speaker 1: And in fact, here's an interesting statistic. Currently, of all
• 9:17
  Speaker 1: the people go undergoing diagnostic invasive heart casts like you
• 9:21
  Speaker 1: had before your heart bowl procedure, seventy percent of the time,
• 9:28
  Speaker 1: even despite stress test looks funny or they have symptoms
• 9:31
  Speaker 1: or whatever, seventy percent of the time will find no
• 9:34
  Speaker 1: significant blockage. So if you have to go to the
• 9:36
  Speaker 1: calf lab, you already stand only a thirty percent chance
• 9:40
  Speaker 1: of them finding some bad blockage. Seventy percent of the
• 9:43
  Speaker 1: time it's it's a false alarm. Still twenty thousand dollars
• 9:47
  Speaker 1: and hopefully no complications ensued. But and we do it
• 9:51
  Speaker 1: in the US. We do two point five million diagnostic
• 9:54
  Speaker 1: hart casts a year, ten million at Nuclear stress US
• 10:00
  Speaker 1: a year. Wow, And these are thousands and thousands and
• 10:04
  Speaker 1: thousands of dollars. Now, with the technology I've used, and
• 10:09
  Speaker 1: I've been using it for twenty five years, it became
• 10:11
  Speaker 1: so good literally twenty years ago this year, back in
• 10:14
  Speaker 1: two thousand and five, that I stopped cathing people and
• 10:17
  Speaker 1: stopped doing doing stress tests because there really was no
• 10:20
  Speaker 1: value to it. So stress tests heartcasts are all twentieth
• 10:26
  Speaker 1: century technology.
• 10:28
  Speaker 2: Really even so the is sorry just recap joining is
• 10:33
  Speaker 2: the heart cut is not the like a ct angiogram?
• 10:37
  Speaker 1: Is that? No, So a heart cath is when they're
• 10:40
  Speaker 1: usually done in a hospital, it's it's like an oar
• 10:43
  Speaker 1: kind of scenario, right, everybody's gowned up and stuff, and
• 10:47
  Speaker 1: then they take these catheters just long long tubes straws basically,
• 10:53
  Speaker 1: and in the old days where I trained, we'd put
• 10:55
  Speaker 1: them in the groin. Nowadays and really the only thing
• 10:58
  Speaker 1: that's changed last thirty years as we go through the wrist.
• 11:01
  Speaker 2: Uh.
• 11:01
  Speaker 1: But then we take that catheter that tube, advance it
• 11:05
  Speaker 1: all the way up into the heart and then inject
• 11:07
  Speaker 1: dye directly into the blood vessels of the heart while
• 11:11
  Speaker 1: we're taking X ray movie pictures and watching that die
• 11:15
  Speaker 1: fill the vessels, right, and if we see it tapering
• 11:18
  Speaker 1: or an hour glass, we can go, okay, there's a blockage,
• 11:20
  Speaker 1: right right, gotcha. That's that's what they did on That's
• 11:25
  Speaker 1: what they did on me.
• 11:25
  Speaker 2: And I remember I was lying there looking at the
• 11:27
  Speaker 2: screen and seeing my see seeing my arteries on in
• 11:31
  Speaker 2: the screen.
• 11:31
  Speaker 1: Which it was pretty cold. Yeah, yeah, yeah, I stopped
• 11:35
  Speaker 1: doing those twenty years ago. Twenty years ago, Yeah, that's
• 11:40
  Speaker 1: how good cardiac CT is, right.
• 11:44
  Speaker 2: Okay, so so you are not so talk us through then.
• 11:49
  Speaker 1: For that preventive I mean, that's kind of one of
• 11:51
  Speaker 1: the aspects of preventative cardiology. Right, So tell us what
• 11:56
  Speaker 1: exactly what a cardiac CET is. Sure that what I
• 12:02
  Speaker 1: evolved to twenty years ago. And I'll tell you why.
• 12:05
  Speaker 1: Is what's called cardiac CT. CT stands for compute commuted sorry,
• 12:10
  Speaker 1: computed tomography. Right, So that is the big donut. Right.
• 12:14
  Speaker 1: We have two main imaging tools, right, we use MR.
• 12:19
  Speaker 1: So that's the big I call that the coffin. Right,
• 12:22
  Speaker 1: that's the that's the big tube. They stuff you in
• 12:24
  Speaker 1: the big tube. It's kind of tight, right, that's an MR.
• 12:27
  Speaker 1: That's not what we use it, all right. We use
• 12:30
  Speaker 1: a big open doughnut, right, So you're not stuffed in anything.
• 12:34
  Speaker 1: It's just you're in the middle of a big donut.
• 12:37
  Speaker 1: And so we use that machine. These are fancy versions
• 12:40
  Speaker 1: of CT. We've been doing CT since the seventies. But uh,
• 12:44
  Speaker 1: you know, we we have what I call the iPhone
• 12:46
  Speaker 1: seventeen version of CARDIACCT machines, very high resolution, extremely fast,
• 12:54
  Speaker 1: and amazing AI built into that. As you can imagine
• 12:58
  Speaker 1: and then also very low radiation, because these CT machines
• 13:03
  Speaker 1: do emit radiation, so we want to make sure that
• 13:05
  Speaker 1: we minimize that for lots of good reasons, so we
• 13:08
  Speaker 1: use a very In fact, our machine, I have to
• 13:11
  Speaker 1: glow a minute. Our machine was the first machine of
• 13:16
  Speaker 1: its type, a six hundred and forty slice machine installed
• 13:19
  Speaker 1: in North America. That was three years ago. Now right
• 13:23
  Speaker 1: now they're eight of these in the US, but ours
• 13:25
  Speaker 1: was the very first.
• 13:26
  Speaker 2: WOW because my understanding was that CT skins used to
• 13:30
  Speaker 2: be quite high radiation.
• 13:31
  Speaker 1: You're saying, us is the newer version that's lower radiation. Yeah,
• 13:35
  Speaker 1: So in the old days, right, twenty twenty five years ago,
• 13:40
  Speaker 1: the dose of radiation could be could be pretty high.
• 13:43
  Speaker 1: So we measure that in something called millisebts, right, to
• 13:46
  Speaker 1: make sense of that, every year on the face of
• 13:49
  Speaker 1: the Earth exposed to gamma rays from the Sun and
• 13:52
  Speaker 1: isotopes that are around us that everybody is exposed to,
• 13:56
  Speaker 1: we'll get about three milliseverts of radiation exposure year. Right,
• 14:01
  Speaker 1: Even if you lived in a lead box, you're gonna
• 14:02
  Speaker 1: get three millisiverts of radiation. In the old days, the
• 14:05
  Speaker 1: radiation doses could be about twenty milliseiverts. Okay, so equivalent
• 14:10
  Speaker 1: to several years of background exposure. By the way, nuclear
• 14:13
  Speaker 1: stress tests, of which we do again very insensitive, high
• 14:17
  Speaker 1: rates of false positive negatives. We reviewed that before. We
• 14:20
  Speaker 1: do ten million of those in the years, ten million
• 14:23
  Speaker 1: of those a year in the US. Unfortunately, still they're
• 14:27
  Speaker 1: going to give you about thirty to forty milliseiverts of radiation.
• 14:32
  Speaker 1: It's a lot. And I've run into patients so go,
• 14:35
  Speaker 1: oh yeah, every year I come in from my nuclear
• 14:37
  Speaker 1: stress test year and year out right, So you're getting
• 14:42
  Speaker 1: roughly ten to fifteen years worth of background radiation. With
• 14:47
  Speaker 1: the current state of the art CT machines, we can
• 14:51
  Speaker 1: take these incredible high resolution images of the heart. There
• 14:54
  Speaker 1: are three dimensional images, which I'll talk about here in
• 14:56
  Speaker 1: a second, and we can do that at a radiation
• 15:00
  Speaker 1: dose of point two milissey verts. Wow, Jesus, that's it.
• 15:07
  Speaker 2: And you're getting, as you alluded to Joan, you're getting
• 15:11
  Speaker 2: a much better image. You're you're getting as close to
• 15:14
  Speaker 2: an image as if you took the heart art and
• 15:16
  Speaker 2: how to look.
• 15:17
  Speaker 1: At it and turned I call it and my staff
• 15:19
  Speaker 1: always cautions me about doing this, but I'm going to
• 15:21
  Speaker 1: do it. I call it the virtual autopsy. Okay, emphsis
• 15:26
  Speaker 1: on the virtual not the autopsy. And literally what we
• 15:29
  Speaker 1: can see. And here's the problem with plaque, right, So
• 15:32
  Speaker 1: plaquell doesn't really grow inward, at least not early on.
• 15:38
  Speaker 1: Plaque literally will be warehoused in the wall of the vessel. Right,
• 15:43
  Speaker 1: So cholesterol is building up in the in the blood
• 15:45
  Speaker 1: vessel wall and the and the vessel goes well, wait
• 15:48
  Speaker 1: a minute, I don't want to get a blockage, so
• 15:50
  Speaker 1: it actually expands outwards, right, so it literally uses the
• 15:54
  Speaker 1: wall of the vessel, the doughnut. I call it to
• 15:58
  Speaker 1: warehouse that cholesterol is. It's going to deposited in the
• 16:00
  Speaker 1: in the vessel. Right, Yeah, you're getting a bulge. You're
• 16:03
  Speaker 1: not getting a growth inside. Late Okay, years to decades later,
• 16:09
  Speaker 1: the vessel basically will almost double in size. Then it
• 16:14
  Speaker 1: begins to grow inward. But remember we don't have symptoms
• 16:19
  Speaker 1: j just binanjina until we have a seventy percent blockage
• 16:22
  Speaker 1: of the donut hole. But all of the disease in
• 16:24
  Speaker 1: the early stuff is all occurring in the doughnut. Okay, side, gotcha.
• 16:30
  Speaker 1: When we do stress tests, the threshold detection starts at
• 16:34
  Speaker 1: a seventy percent blockage of the donut hole. It's believable
• 16:39
  Speaker 1: that it's stressed. And I used to cath people. This
• 16:42
  Speaker 1: is why I stop cathing people twenty years ago. When
• 16:44
  Speaker 1: we do CARDIACCT, it really is the virtual autopsy. We
• 16:49
  Speaker 1: can see everything in the heart. We can see your
• 16:51
  Speaker 1: bicuspoard valve. We can see the heart function, the squeeze
• 16:54
  Speaker 1: the heart, if you hold old heart attacks, congenital heart disease,
• 16:57
  Speaker 1: holes in the heart, fluid around the heart, right, anything
• 17:00
  Speaker 1: that you can see on an echo cardigram like you've had,
• 17:04
  Speaker 1: that's the ultrasound we do at the heart. We can
• 17:07
  Speaker 1: see on cardiact except much higher resolution. So we get
• 17:10
  Speaker 1: all that free data like a free echo. Right.
• 17:14
  Speaker 2: So John, a quick quick question here, So, so, why
• 17:17
  Speaker 2: would you do an echo cardiogram rather than the CT.
• 17:22
  Speaker 2: Is it just a cost thing and an equipment availability.
• 17:25
  Speaker 1: Partly is cost, but it really depends upon the question
• 17:29
  Speaker 1: you're answering. So if I want to know, is the
• 17:31
  Speaker 1: heart's squeezing normally? Is is the pump pumping normally? Do
• 17:36
  Speaker 1: I have old heart attacks? Do I have what we
• 17:38
  Speaker 1: call cardiomopity, another's weakness of the heart muscle. Do I
• 17:44
  Speaker 1: have congenital heart disease or what we call structural heart disease?
• 17:47
  Speaker 1: In other words, the chambers aren't hooked up to the
• 17:49
  Speaker 1: right pipes. So stuff you're born with. If I have
• 17:52
  Speaker 1: a valve, I'm worried about, is it leaky? Is it narrowed?
• 17:55
  Speaker 1: Is it by cuspid? Echo is great to be able
• 17:58
  Speaker 1: to look at all those things. Okay, it's it's not evasive,
• 18:01
  Speaker 1: no radiation, right, there's no harm. It's great. What the
• 18:05
  Speaker 1: one thing it doesn't tell you, though, is the blood
• 18:08
  Speaker 1: vessels of the heart, the coronary arteries. We see none
• 18:11
  Speaker 1: of that on echo. So when the question is do
• 18:14
  Speaker 1: I have plaque, forget about even blockages, right because you
• 18:18
  Speaker 1: easily they have lots of plaque and no blockages, right
• 18:20
  Speaker 1: because people worry about blockages. But that's really a late
• 18:24
  Speaker 1: manifestation of a twenty to thirty year long disease. Right.
• 18:30
  Speaker 1: What echo does not tell you, cannot tell you, is
• 18:33
  Speaker 1: anything about the blood vessels that supply the heart muscle,
• 18:36
  Speaker 1: the coronary arteries. That's where we use CT Now we
• 18:39
  Speaker 1: get the free echo, I like to say, right, so
• 18:42
  Speaker 1: when we do cardiact, we can look at the valves
• 18:44
  Speaker 1: by customer valves, leaky valves, narrow valves, prolapsing valves, the
• 18:48
  Speaker 1: heart function, the squeeze of the heart, the thickness of
• 18:51
  Speaker 1: the heart muscle, blah blah, all those things. Right, So
• 18:54
  Speaker 1: we get all that data for free. But most importantly
• 18:57
  Speaker 1: and the main reason is to determine if we have
• 19:00
  Speaker 1: any plaque build up in the blood vessels. Okay, and it.
• 19:05
  Speaker 2: Does an echo or any of those other tasks, whether
• 19:09
  Speaker 2: it's a MRI or any of those things, do they
• 19:14
  Speaker 2: pick up anything that the cardiac cet does not pick up.
• 19:19
  Speaker 1: So the other tool we do use as an imaging tool,
• 19:23
  Speaker 1: we talk about echo. Cheap, easy accessible and a radiation
• 19:26
  Speaker 1: great for heart function valves, structural stuff, leaky valves, narrow valves. Right,
• 19:31
  Speaker 1: that's its domain. If you have a cardiomyopathy, that is
• 19:36
  Speaker 1: a weakening of the heart muscle, and that could be
• 19:38
  Speaker 1: the variety of things genes, viruses, some obscure causes, old
• 19:43
  Speaker 1: heart attacks. Right, So if you need to look at
• 19:45
  Speaker 1: the heart muscle or rarely, it doesn't happen often, but
• 19:49
  Speaker 1: you can get tumors of the heart things like that.
• 19:51
  Speaker 1: So if you need to look at the heart muscle,
• 19:53
  Speaker 1: Is there a problem with the heart muscle? Is it squeezing? Okay?
• 19:57
  Speaker 1: Are there tumors of the heart? MR is really good
• 20:00
  Speaker 1: for that. What MR is not good at because it
• 20:03
  Speaker 1: has actually quite low resolution, right because with CARDIACT we
• 20:08
  Speaker 1: have very high resolution. We have resolution now with the
• 20:11
  Speaker 1: current CT machines that we use coupled with amazing AI,
• 20:16
  Speaker 1: we can see down to about a quarter of a
• 20:20
  Speaker 1: millimeter or two hundred and fifty microns, okay, which is
• 20:24
  Speaker 1: very high resolution. MR. We're stuck at about two to
• 20:28
  Speaker 1: three millimeters, so it just doesn't have resolution to be
• 20:31
  Speaker 1: able to see the coronary arteries and see plaque and
• 20:34
  Speaker 1: those issues. So if it and when you need to
• 20:38
  Speaker 1: understand if is there plaque, how much plaque, where it's
• 20:42
  Speaker 1: located quantified plaque which we can now do with AI,
• 20:45
  Speaker 1: which I'll touch on in a minute, that that really
• 20:47
  Speaker 1: is the domain of CARDIACCT. And I don't see anything
• 20:50
  Speaker 1: in the in the near term, in the next several
• 20:53
  Speaker 1: years that's going to replace CARDIACCT as far as other
• 20:56
  Speaker 1: imaging technologies at this moment.
• 20:58
  Speaker 2: Interesting okay, And now my understanding as well, just to
• 21:03
  Speaker 2: go into these things and their effectiveness, is that an
• 21:07
  Speaker 2: echo is the results of the echo are largely dependent
• 21:12
  Speaker 2: on the person doing the echo. There's a lot of
• 21:15
  Speaker 2: subjects heavily around it, right, because.
• 21:17
  Speaker 1: Well, yeah, two parts, Paul, Yes, the echo tech which
• 21:22
  Speaker 1: is critical. These are really really high, highly trained people
• 21:25
  Speaker 1: to become really good. It's probably about five to ten years,
• 21:30
  Speaker 1: so you've become really good, right, Okay, So that's just
• 21:34
  Speaker 1: acquiring the images. Then you need what I call the
• 21:38
  Speaker 1: nut behind the wheel, the person reading the echo. So
• 21:42
  Speaker 1: it's really dependent upon and then of course the echo equipment, right,
• 21:46
  Speaker 1: So you really have to make sure that every one
• 21:48
  Speaker 1: of those boxes is ticked off the right equipment, the
• 21:52
  Speaker 1: right experience tech, and the right reader to really extract
• 21:58
  Speaker 1: appropriately because again you can miss stup, you can overcool
• 22:01
  Speaker 1: stuff with again wrong equipment, tech or reader. So yeah,
• 22:05
  Speaker 1: so there's a lot, a lot of experience that requires
• 22:09
  Speaker 1: and the right equipment and the right tech to be
• 22:11
  Speaker 1: able to really extract all all of the data. And
• 22:14
  Speaker 1: there's an amazing amount of data that we can derive
• 22:17
  Speaker 1: from echo cardiogy echo cardiography. But again you have to
• 22:21
  Speaker 1: have all three uh uh legs of that stool uh
• 22:26
  Speaker 1: be there yep? Yeah, interesting, And then I obviously.
• 22:31
  Speaker 2: So I had an echo and then I had a
• 22:33
  Speaker 2: trans of sophageal echo where they stick this tube down
• 22:37
  Speaker 2: your throat, all right, and it goes down there. And John,
• 22:41
  Speaker 2: you'll you'll laugh at this because I went in to
• 22:44
  Speaker 2: get it done and they were they were going to
• 22:47
  Speaker 2: give me an anesthetic, and I said, that's not worry
• 22:51
  Speaker 2: about the anesthetic.
• 22:52
  Speaker 1: And the guys like, are you crazy in the head,
• 22:54
  Speaker 1: And I'm like, well.
• 22:55
  Speaker 2: Because I would have to stay in the hospital for
• 22:57
  Speaker 2: two hours and I had something to do. Let on,
• 23:00
  Speaker 2: So I did one of those without an anesthetic, which
• 23:03
  Speaker 2: was a touch, A touch, uncomfortable, it's gonna be said, yes, yes,
• 23:09
  Speaker 2: they prepped me just in kiss.
• 23:12
  Speaker 1: They said, look, I'm happy to try this.
• 23:14
  Speaker 2: We're gonna prep you just in kiss and if it doesn't,
• 23:17
  Speaker 2: you know, if you're gagging too much, then and.
• 23:19
  Speaker 1: We'll do that.
• 23:20
  Speaker 2: But anyway, because that gives you a bit more insight,
• 23:24
  Speaker 2: doesn't it. When you got that tube done, it's much
• 23:26
  Speaker 2: closer to the heart and you can see stuff that
• 23:28
  Speaker 2: you don't normally say on a normal echo.
• 23:31
  Speaker 1: Yeah, exactly. It sort of takes it from not quite
• 23:34
  Speaker 1: black and white, we'll say, color TV to HDTV as
• 23:38
  Speaker 1: far as the resolution because you really get that probe
• 23:41
  Speaker 1: where the ultrasound probe is located basically right on top
• 23:45
  Speaker 1: of the heart by swallowing it. Because your esophagus, your
• 23:49
  Speaker 1: food bite literally sits directly behind the heart, so you
• 23:52
  Speaker 1: can get it right on top of the heart and
• 23:54
  Speaker 1: get much better higher resolution images of the of the
• 23:57
  Speaker 1: heart by doing the te.
• 24:00
  Speaker 2: Cool Now we will dive into the whole plaque thing
• 24:05
  Speaker 2: and go really deep on this. It's just one thing
• 24:07
  Speaker 2: I wanted to cover off though. Can you let people
• 24:10
  Speaker 2: know about leaky valves?
• 24:13
  Speaker 1: Right? And so why and why if you're born.
• 24:17
  Speaker 2: With a bicusp of valve like me with two leafs
• 24:20
  Speaker 2: on your aortic valve, and why is that more prone
• 24:24
  Speaker 2: to leaking? And then if you have a normal tri
• 24:28
  Speaker 2: cusp of aortic valve and what sort of factors? Is
• 24:32
  Speaker 2: it all just lifestyle or is it just aging that
• 24:35
  Speaker 2: causes that valve to leak? If you're exercising more, does
• 24:39
  Speaker 2: it is it more likely to leak or less likely
• 24:41
  Speaker 2: to leak? Just talk about the leaky.
• 24:43
  Speaker 1: Valve stuff first, and then we'll go on.
• 24:47
  Speaker 2: And there's one other thing I want to talk about,
• 24:49
  Speaker 2: the chambers and the thickening of the of the wall,
• 24:52
  Speaker 2: the pathological versus physiological and athletes. Maybe just give our
• 24:56
  Speaker 2: listeners an overview of that and then we'll go back
• 24:58
  Speaker 2: and dive deeper into.
• 24:59
  Speaker 1: The Yeah, so great question. So just to kind of
• 25:03
  Speaker 1: remove some of the medical leaves from this. So, the
• 25:06
  Speaker 1: aortic valve, which is one of the four heart valves,
• 25:09
  Speaker 1: it's the last valve where the blood passes out of
• 25:12
  Speaker 1: the heart and to the rest of the body, is
• 25:15
  Speaker 1: a critical valve. And and basically, I mean lots of
• 25:18
  Speaker 1: things can happen to You can have congenital abnormalities, malformations, trauma,
• 25:23
  Speaker 1: all kinds of stuff. But the valve is normally has
• 25:28
  Speaker 1: three leaflets. Okay, we call them cusps, but they're just leaflets,
• 25:31
  Speaker 1: and they're very very tightly it's very very tight fit
• 25:35
  Speaker 1: and finish, right, so they perfectly open and close. They
• 25:39
  Speaker 1: do that one hundred thousand times a day, by the way,
• 25:42
  Speaker 1: and they fit perfectly together so that when the heart
• 25:46
  Speaker 1: is filling with blood and that valve is closed, the
• 25:50
  Speaker 1: blood does not leak back through that valve, right, They
• 25:53
  Speaker 1: perfectly perfectly closes and then when it opens, they're very
• 25:57
  Speaker 1: thin but incredibly strong. They're very thin, so that they
• 26:02
  Speaker 1: basically fold back, and then when the heart squeezes and
• 26:05
  Speaker 1: pumps the blood out, they provide no basically no resistance
• 26:09
  Speaker 1: to the flow of blood through that valve. So the
• 26:12
  Speaker 1: normal trek custom of valve, if you were to look
• 26:14
  Speaker 1: at it from the surgeon's view, looks like a Mercedes
• 26:17
  Speaker 1: Ben sign you're older, maybe a peace sign, but it
• 26:22
  Speaker 1: looks like a Mercedes Ben sign looking at it from
• 26:24
  Speaker 1: the surgeon's view. Right. With a bicusp of valve, what
• 26:27
  Speaker 1: happens is that those three leaflets, two of the leaflets
• 26:33
  Speaker 1: get stuck together. Okay, imagine like a perforation, but it
• 26:37
  Speaker 1: doesn't perforate right, So two of those leaflets are stuck together.
• 26:41
  Speaker 1: And the thought is that again that valve is opening
• 26:45
  Speaker 1: closing one hundred thousand times a day. After about fifty
• 26:49
  Speaker 1: ish maybe sixty years, that valve, because the fit and
• 26:53
  Speaker 1: finish isn't perfect, will begin to calcify, will begin to
• 26:57
  Speaker 1: fibros right, and you'll see calcification and building up the valve,
• 27:01
  Speaker 1: and that can either cause one of two things. More typically,
• 27:04
  Speaker 1: the valve gets narrowed right, so it becomes very stiff.
• 27:08
  Speaker 1: It's not thin. It doesn't open and close easily, and
• 27:11
  Speaker 1: the valve itself becomes very thick and restricts the blood
• 27:15
  Speaker 1: flow coming out of the heart. We call that aortic
• 27:17
  Speaker 1: valve stenosis or narrow okay. And as if that as
• 27:22
  Speaker 1: that valve narrows, the blood still has to get out
• 27:26
  Speaker 1: of the heart, and so the heart has to work
• 27:28
  Speaker 1: even harder to push even harder through that thin that
• 27:32
  Speaker 1: that thin that small hole rather and so it just
• 27:37
  Speaker 1: like muscle, the heart muscle will bluck up, bulk up too.
• 27:40
  Speaker 1: The work the heart muscle does is blood pressure work,
• 27:43
  Speaker 1: so it will literally thicken up. Okay. Now, a similar
• 27:47
  Speaker 1: kind of thing can happen in highly conditioned people. One
• 27:50
  Speaker 1: is called eccentric the other is called eccentric hypertrophy eccentric hyperchevy,
• 27:57
  Speaker 1: which is what athletes get and very you know, conditioned,
• 28:00
  Speaker 1: aerobic people and all that get. Uh. There is some thickening,
• 28:04
  Speaker 1: but the whole heart gets a little bigger, the walls
• 28:06
  Speaker 1: of the heart little thicker, and that's completely normal, and
• 28:09
  Speaker 1: that's conditioning. In in uh, concentric hypertrophy, which is pathological,
• 28:15
  Speaker 1: which is abnormal because of the restriction in this case
• 28:19
  Speaker 1: of that valve becoming narrowed. The heart really doesn't large,
• 28:23
  Speaker 1: but it begins to get very, very thick, and that
• 28:26
  Speaker 1: is that is abnormal. Right. The good news is you
• 28:29
  Speaker 1: get the valve fixed and and that gets better too.
• 28:33
  Speaker 2: Yeah, but it isn't there a point. There's a certain
• 28:36
  Speaker 2: point because that chimber will start to strike. Well, I'm
• 28:39
  Speaker 2: talking about regard sitation here, which is the the other issue. Right,
• 28:43
  Speaker 2: So most of the by custom valves, it's a it's
• 28:46
  Speaker 2: aortic valvestinosis.
• 28:47
  Speaker 1: The valve gets narrowed, okay, and then creates these issues
• 28:52
  Speaker 1: and and the symptoms of that would be you get
• 28:54
  Speaker 1: shorter breath when normally you wouldn't write normal activity. You
• 28:57
  Speaker 1: just can't can't do it. I could mow the lawn,
• 28:59
  Speaker 1: now I can't chest pain because all that thick muscle
• 29:02
  Speaker 1: requires a lot more blood flows. So you start getting
• 29:04
  Speaker 1: engine or chest pain even though there are no blockages
• 29:07
  Speaker 1: in the blood vessel of the heart. And then the
• 29:09
  Speaker 1: worst sign is you begin to faint and pass out
• 29:11
  Speaker 1: because literally you're not pushing enough blood through that valve.
• 29:15
  Speaker 1: And when that starts happening, you're just about ready to go. Right.
• 29:23
  Speaker 1: The other issue, which is not as common as nosis,
• 29:26
  Speaker 1: is leakage, or we call it regurgitation or leakage, in
• 29:30
  Speaker 1: which case, again the valves get less flexible. They're open adequately,
• 29:37
  Speaker 1: but they need to be able to also close, and
• 29:40
  Speaker 1: they don't close adequately, which case the valve then stays
• 29:43
  Speaker 1: open when it should be closed, and all that blood
• 29:45
  Speaker 1: that it just pumped out of the heart, a lot
• 29:48
  Speaker 1: of that then regurgitates or leaks back into the chamber.
• 29:52
  Speaker 1: So the problem is now the heart has to pump,
• 29:56
  Speaker 1: you know, and I'll make up in numbers. You've got
• 29:58
  Speaker 1: the blood coming into the left and via the normal
• 30:01
  Speaker 1: pathway from the lungs. But then you have all the
• 30:03
  Speaker 1: blood that leaked back when it shouldn't have leaked back.
• 30:06
  Speaker 1: So now you're pumping and again on make up numbers,
• 30:09
  Speaker 1: two quarts when it should pump one quart. And the
• 30:13
  Speaker 1: issue there is that that's a more potentially even more
• 30:16
  Speaker 1: dangerous issue because the heart can begin to enlarge because
• 30:20
  Speaker 1: of all that extra volume it has to pump. And
• 30:23
  Speaker 1: there is a point, there almost is no point where
• 30:25
  Speaker 1: the valve kit gets too narrowed as long as you're
• 30:28
  Speaker 1: you know, have a pulse and breathing where fixing that
• 30:31
  Speaker 1: valve won't correct the problem. Right, even if the heart
• 30:34
  Speaker 1: gets very bulked up and you've had a long time
• 30:36
  Speaker 1: and all that stuff, if you fix the valve, the
• 30:39
  Speaker 1: heart will recover. But if the valve is leaky, there
• 30:43
  Speaker 1: is a limit to how much it can You know
• 30:45
  Speaker 1: how much you can stretch out that sweater, Yeah, and
• 30:48
  Speaker 1: you can stretch it out if it's been long enough
• 30:51
  Speaker 1: and severe enough. And even if you fix the valve,
• 30:55
  Speaker 1: the heart stops working properly. So even fixing the valve
• 31:00
  Speaker 1: in the setting of aortic valve regurg station or leakage,
• 31:03
  Speaker 1: if you wait too long, can be really dangerous because
• 31:06
  Speaker 1: you fix the valve and the heart shot.
• 31:10
  Speaker 2: This is why I'm a very lucky boy because when
• 31:14
  Speaker 2: they find me, so my mine for the listeners, I
• 31:17
  Speaker 2: don't know if I said at the start mine was proactive.
• 31:19
  Speaker 2: I asked because I played soccer with a cardiologist that said, hey, Matt, I.
• 31:23
  Speaker 1: Want to know.
• 31:24
  Speaker 2: I really want to know what my heart looks like.
• 31:27
  Speaker 2: I really don't care about the cholesterol, like, high's my
• 31:30
  Speaker 2: heart working. And they find that my regurgitation level was
• 31:35
  Speaker 2: at about fifty percent, so I'm all the blood going,
• 31:40
  Speaker 2: that's right. And if I had to choose between stenosis
• 31:44
  Speaker 2: or narrowing versus leakage regurgitation stenosis every day. Right, because again,
• 31:51
  Speaker 2: if you make it to the O R, we fix
• 31:53
  Speaker 2: the valve, the heart will be fine.
• 31:55
  Speaker 1: Yeah. Wait too long with a leaky valve, with aortic
• 31:59
  Speaker 1: valve regurge station, and you may fix the valve and
• 32:03
  Speaker 1: the hard hard shot, hard heart shot, you get heart
• 32:06
  Speaker 1: and we call that heart failure. John, Is that is that?
• 32:09
  Speaker 1: Is that what's known as heart failure? Yeah? That's heart
• 32:12
  Speaker 1: failure right, that's not reversible. Yeah.
• 32:15
  Speaker 2: And now I was not kicking the ars off that
• 32:18
  Speaker 2: I think by I think my surgeon said, I'm look,
• 32:20
  Speaker 2: this is from memory. You might be able to correct it,
• 32:22
  Speaker 2: but he said, once it gets to sixty sixty five percent,
• 32:26
  Speaker 2: you pretty much guaranteed that you're gonna have heart failure.
• 32:30
  Speaker 1: Yeah. Yeah, And and you know, we we have lots
• 32:32
  Speaker 1: of phisticated weights with echo by the way, to measure
• 32:34
  Speaker 1: how much blood is coming back, how big that leaky
• 32:37
  Speaker 1: hole is. We can do all that with echo. It's phenomenal. Uh.
• 32:41
  Speaker 1: But yeah, I mean it can get very leaky. And
• 32:44
  Speaker 1: as I said, if you happen to pick it up late, uh,
• 32:47
  Speaker 1: it's bad. It's really bad, So kudos. Yeah, well, I'll
• 32:53
  Speaker 1: tell you what it's.
• 32:54
  Speaker 2: It's the message to everybody out there is be proactive
• 32:58
  Speaker 2: about your health. Because if I hadn't been proactive by
• 33:01
  Speaker 2: my health, I would I would not be around in
• 33:05
  Speaker 2: ten years, I would probably guess, if not before that,
• 33:08
  Speaker 2: because your aortic can also stretch, which mine had started
• 33:11
  Speaker 2: to do, and that could just burst one day and
• 33:13
  Speaker 2: then you die instantly, right.
• 33:15
  Speaker 1: Yeah, and very commonly with a bi cusped valve. I
• 33:18
  Speaker 1: talked to you the earlier before. But with the bi
• 33:21
  Speaker 1: cust valve. The other thing goes along with that is
• 33:23
  Speaker 1: you get an aneurysm of the awards, right, Yeah, I
• 33:27
  Speaker 1: caught the A word. We don't like the A word,
• 33:29
  Speaker 1: right because people think appropriately bad stuff, which it is.
• 33:33
  Speaker 1: And as that a word of stretches and enlarges, there
• 33:39
  Speaker 1: are no symptoms whatsoever. The first symptom of that, if
• 33:43
  Speaker 1: you get an aortic dissection, it literally gets so big
• 33:46
  Speaker 1: that it rips open. And the mortality rate once that
• 33:51
  Speaker 1: a word of rips open is ten percent per hour.
• 33:56
  Speaker 2: Oh wow, yeah, because your blood's just leak and out
• 34:00
  Speaker 2: of your body.
• 34:01
  Speaker 1: Yeah, it's really bad, right yeah, And a lot of
• 34:05
  Speaker 1: the problems is that it can mimic even with an
• 34:07
  Speaker 1: award execsion, it can cause chest pain. You know, unless
• 34:11
  Speaker 1: you're thinking of it, you could easily miss the diagnosis
• 34:14
  Speaker 1: and then that patient is sitting in the er for
• 34:16
  Speaker 1: a few hours as you're scratching your head. What's going
• 34:18
  Speaker 1: on with them? Right? EKG looks good? Right, but they
• 34:23
  Speaker 1: can have a ruptured a ORDA and again our the
• 34:26
  Speaker 1: mortality rate is ten percent per hour once it ruptured
• 34:31
  Speaker 1: a damn. Yeah, so you got your valve fixed, your
• 34:36
  Speaker 1: heart's great, and you didn't have an aneurysm of the order,
• 34:39
  Speaker 1: which is awesome, right, But again, the aneurysms are particularly
• 34:42
  Speaker 1: danger I mean, all this stuff is dangerous, right because
• 34:44
  Speaker 1: the symptoms are very delayed. The process starts decades before,
• 34:49
  Speaker 1: but the symptoms are delayed until it's catastrophic. But if
• 34:53
  Speaker 1: once that aword ruptures, it is really bad. And up
• 34:56
  Speaker 1: until it ruptures, zero symptoms.
• 35:00
  Speaker 2: And this is interesting, right because for me, I was
• 35:03
  Speaker 2: still playing soccer over thirty five soccer at fifty three
• 35:06
  Speaker 2: years old, had no symptoms. Now, on reflection, John, you
• 35:12
  Speaker 2: know my I noticed my fitness going down, my cardiovascular fitness.
• 35:17
  Speaker 1: On reflection, but three. You know, right, you're competing against
• 35:22
  Speaker 1: all these thirty five, thirty six year old guys, right,
• 35:25
  Speaker 1: and go, eh, I'm just getting older. And that's the
• 35:28
  Speaker 1: really duplicitous part of this process because you can easily
• 35:33
  Speaker 1: go I'm just getting older. Right, It's not hard and fine, right,
• 35:38
  Speaker 1: So it really can really be very diluding.
• 35:42
  Speaker 2: And and what my cardiologists said, he said, people who
• 35:45
  Speaker 2: you know, like me, who are into their fitness, you notice, hey, teez,
• 35:50
  Speaker 2: my fitness is dropping off, and you just work harder.
• 35:53
  Speaker 1: You work harder, and you can you can accelerate the issue. Right.
• 35:57
  Speaker 2: So it's it's a bloody tricky thing. Now let's come
• 36:01
  Speaker 2: back to the plaque. And so when you do have
• 36:05
  Speaker 2: a little bit of plaque, it can be either calcified
• 36:09
  Speaker 2: or non calcified. And now my understanding of that has
• 36:13
  Speaker 2: changed a little bit that the calcification can actually be
• 36:16
  Speaker 2: a good thing because it's stable.
• 36:19
  Speaker 1: Right, So it's all those through steable versus unstable plaque. Sure,
• 36:23
  Speaker 1: so we'll go all the way back to the beginning.
• 36:25
  Speaker 1: So when plaque is beginning to develop, and I want
• 36:28
  Speaker 1: to point out one thing, Paul, you mentioned it earlier,
• 36:31
  Speaker 1: and you're absolutely correct. Whether you form plaque or not
• 36:36
  Speaker 1: is very, very poorly correlated with your cholesterol levels. Yeah. Right.
• 36:43
  Speaker 1: I saw a guy last month, sixty five, felt fine,
• 36:48
  Speaker 1: no symptoms, had a normal stress test a year or
• 36:50
  Speaker 1: two ago. We put him the CT machine. Of his
• 36:53
  Speaker 1: three major blood vessels of the heart, one was completely
• 36:57
  Speaker 1: blocked off and two in the other branches had severe
• 37:01
  Speaker 1: blockages in them. Okay, no symptoms, feel fine, normal stress test.
• 37:06
  Speaker 1: Right on top of that, I said, any cholesterol issues. Now,
• 37:09
  Speaker 1: I had all his labs, right, I look at his
• 37:11
  Speaker 1: cholesterol numbers. His cholesterol numbers were perfect. He looked like
• 37:16
  Speaker 1: somebody already on drugs to treat cholesterol. That's how great
• 37:19
  Speaker 1: they were, right, So I completely agree with you. Cholesterol
• 37:24
  Speaker 1: is the paradox, right. The stuff that forms the plaque
• 37:28
  Speaker 1: is cholesterol, right, is that is the fertilizer. However, your
• 37:32
  Speaker 1: cholesterol levels really tell you nothing about is that cholesterol sticking? Right? Yeah?
• 37:38
  Speaker 1: And then conversely, I saw young woman she's seventy two,
• 37:43
  Speaker 1: had a you know, years of high cholesterol, and I said,
• 37:47
  Speaker 1: I don't care what your cholesterol is. I only care
• 37:49
  Speaker 1: if it's sticking. We put her in the machine. She
• 37:52
  Speaker 1: had no plaque. So cholesterol member, when we measure cholesterol,
• 37:57
  Speaker 1: only measures cholesterol floating eye in the bloodstream, tells me
• 38:02
  Speaker 1: nothing about is it sticking? Right?
• 38:04
  Speaker 2: Does a particle size John give you ld so small
• 38:08
  Speaker 2: danse LDL is a bit risk.
• 38:10
  Speaker 1: You've looked at that and you know that was kind
• 38:13
  Speaker 1: of a fad a number of years ago. In reality,
• 38:17
  Speaker 1: it really doesn't give you much useful information. If you
• 38:21
  Speaker 1: and I'll tell you, I'll tell you, you and your audience
• 38:24
  Speaker 1: the the three cholesterol tests you need right one you
• 38:29
  Speaker 1: only need once and I'll tell you what that is.
• 38:31
  Speaker 2: Uh.
• 38:31
  Speaker 1: But if you want to have a good hand, exactly
• 38:33
  Speaker 1: help you little a. So if you want to have
• 38:35
  Speaker 1: a really good handle on your cholesterol levels, remember that
• 38:38
  Speaker 1: doesn't tell me if it's sticking. The only way to
• 38:40
  Speaker 1: know if it's sticking is you get in the machine.
• 38:42
  Speaker 1: We look under the hood. Right, that's where cardie xCT
• 38:44
  Speaker 1: plays comes into play. But on the cholesterol front, you'll
• 38:48
  Speaker 1: get a standard lipid profile that's your total treelis rides
• 38:52
  Speaker 1: hl ld l okay, but again, really doesn't tell me
• 38:56
  Speaker 1: if it's sticking or not. You'll get an LP little
• 38:58
  Speaker 1: a once that's a a form of cholesterol that's pretty common.
• 39:03
  Speaker 1: It is a really, really nasty form of cholesterol. It's
• 39:05
  Speaker 1: super sticky, it's super clotty, and it's super inflammatory, so
• 39:10
  Speaker 1: it really promotes the formation of black It is one
• 39:14
  Speaker 1: hundred percent genetic and twenty percent will have it, eighty
• 39:18
  Speaker 1: percent won't. So we check that once. If it's high,
• 39:22
  Speaker 1: then we know and we can take care of it.
• 39:24
  Speaker 1: If you're normal, it will never become abnormal. Does not
• 39:27
  Speaker 1: vary with diet, exercise, weight loss, anything that you know
• 39:32
  Speaker 1: that you can change lifestyle wise. So elp, Lila, we
• 39:35
  Speaker 1: check once. If it's normal, you're done. You don't have it. Yahoo,
• 39:38
  Speaker 1: great for you, great for your family, great for your kids.
• 39:41
  Speaker 1: If it is high, then we actually have people say, hey,
• 39:44
  Speaker 1: I need to talk to my brother, my sister, my kids.
• 39:46
  Speaker 1: Sometimes even depending with our age, mom and dad. So
• 39:49
  Speaker 1: ELP little a lipid profile. And then the last one
• 39:51
  Speaker 1: that's really replaced the particle number, particle size, all that
• 39:55
  Speaker 1: kind of stuff. It's cheaper, it's quicker, it's more accurate,
• 39:59
  Speaker 1: is called APO B or apove protein B. So that
• 40:03
  Speaker 1: really is all you need to have your cholesterol checked.
• 40:07
  Speaker 2: But again, and do you put any stock in APO
• 40:09
  Speaker 2: B to a po a reshield.
• 40:12
  Speaker 1: All race shows are non useful. Whether it's HDL ratios
• 40:19
  Speaker 1: blah blah blah, treglistride HDL, LDL, total cholesterol HDL. Even
• 40:24
  Speaker 1: a POA a boy is a little bit better, more
• 40:27
  Speaker 1: cientific way of measuring HDL, which is what ApoA is.
• 40:30
  Speaker 1: But any of those race shows are terribly useless. Remember
• 40:34
  Speaker 1: all those race shows were derived because we're trying to guess, right,
• 40:39
  Speaker 1: we don't know. We're trying to guess by numbers. If
• 40:43
  Speaker 1: you have the deposition of plaque in your blood vessels, right, yes,
• 40:47
  Speaker 1: and we're talking risk, right, if your ratio is high
• 40:49
  Speaker 1: or lower. God knows your risk is higher or lower.
• 40:53
  Speaker 1: But that's risk. I don't deal in risk anymore. I
• 40:57
  Speaker 1: put you in the machine and we see it there.
• 41:00
  Speaker 1: It's not it's binary, it's zeros and one. Right, Because
• 41:04
  Speaker 1: it's all those and many quote hard tests that many
• 41:07
  Speaker 1: people are still doing. They'll get you know, the multi
• 41:10
  Speaker 1: thousand dollars panel, and you got greens and reds and
• 41:14
  Speaker 1: yellows and all that stuff. All of that was predicated
• 41:18
  Speaker 1: upon I have no idea how to see plaque. I
• 41:21
  Speaker 1: didn't have a way to see plaque or measure it
• 41:23
  Speaker 1: detected or use AAR that we now do. So I'm
• 41:25
  Speaker 1: going to get these numbers to try to guess if
• 41:29
  Speaker 1: you have plaque. Yes, well that's a waste of time, money,
• 41:32
  Speaker 1: and blood. Get the machine.
• 41:35
  Speaker 2: I'm not without risks, as you said earlier on John,
• 41:38
  Speaker 2: copying some of these procedures that are are not as
• 41:42
  Speaker 2: predictive as c T. You know, any proceadure that you
• 41:44
  Speaker 2: have is going to have risks. Of course, any medications,
• 41:47
  Speaker 2: which we'll get onto medication, Any medications have risks with it, right, So.
• 41:52
  Speaker 1: We don't really treat risk anymore. We either treat people
• 41:55
  Speaker 1: who have plaque yeah, or they don't have plaque yeah,
• 41:59
  Speaker 1: And that's it. I mean people at have high cholesterol
• 42:01
  Speaker 1: and have no plaque have perfect cholesterol lots of plaque.
• 42:04
  Speaker 1: So I completely agree with you. Cholesterol is a really
• 42:08
  Speaker 1: really poor indicator of what that cholesterol is sticking. Remember,
• 42:12
  Speaker 1: we're just measuring how much cholesterol is, you know, floating
• 42:15
  Speaker 1: by in your bloodstream tells you nothing about it is
• 42:18
  Speaker 1: it's sticking.
• 42:19
  Speaker 2: And my understanding, John, is that about fifty percent of
• 42:23
  Speaker 2: people who have a heart attack have got normal cholesterol.
• 42:27
  Speaker 1: Oh absolutely, yeah, right, So using cholesterol to guess whether
• 42:32
  Speaker 1: a plaque or not. You will lose every time. Right,
• 42:35
  Speaker 1: that's a casino game. Wow, wouse always wins, right, So.
• 42:46
  Speaker 2: What is very clear And I think just to recap
• 42:48
  Speaker 2: for the listeners, cholesterol almost useless. You want to know
• 42:53
  Speaker 2: your LP little A, and you want to know your
• 42:56
  Speaker 2: APO B, and you want to know about the stickiness city.
• 43:00
  Speaker 2: The cardiac CT is absolutely the way to go, but
• 43:04
  Speaker 2: probably different, John in here in Australia than in the States,
• 43:09
  Speaker 2: because of our medical system, right, is a little bit different.
• 43:14
  Speaker 1: And you know, going straight.
• 43:17
  Speaker 2: To cardiac CT probably not going to happen, right, because
• 43:22
  Speaker 2: they want to do.
• 43:22
  Speaker 1: The cheaper tests first. Well, what's what's interesting is in
• 43:26
  Speaker 1: reality cardiac CT is a fit is rather ten to
• 43:34
  Speaker 1: five percent of the cost of a heart CAF. Really yeah,
• 43:39
  Speaker 1: oh it's dramatically cheaper. Wow, And right, depending on what
• 43:45
  Speaker 1: kind of stress tests there's different kinds of stress tests
• 43:47
  Speaker 1: and all that again generally will be even cheaper than
• 43:51
  Speaker 1: a stress test. And if you do cardiac KMAR, which
• 43:54
  Speaker 1: we kind of talked about, which is a great tool
• 43:56
  Speaker 1: to look at the heart and muscle and such, is
• 43:59
  Speaker 1: like real expensive, right, I mean that's a few thousand
• 44:02
  Speaker 1: bucks is actually quite inexpensive. Medicare reimbursement in the US
• 44:10
  Speaker 1: for cardio xCT is three hundred and seventy eight bucks.
• 44:13
  Speaker 1: How much is that as much as the cost of
• 44:15
  Speaker 1: the actual thing? Yeah, so Medicare reimbursement right for our
• 44:19
  Speaker 1: Medicare cost is three hundred and seventy eight bucks. Wow wow,
• 44:25
  Speaker 1: Yeah for than stress tests, dramatically cheaper than a heartcat,
• 44:28
  Speaker 1: dramatically cheaper than an MR so way more. In reality,
• 44:32
  Speaker 1: it's not cost. The biggest thing is habit. Right. So,
• 44:36
  Speaker 1: I trained thirty years ago, CARDIACDT didn't exist, couldn't even
• 44:40
  Speaker 1: imagine it, right sor I was trained in stress tests
• 44:43
  Speaker 1: and heart casts, and I did all those things. And
• 44:45
  Speaker 1: then roughly about the turn of the century twenty first century,
• 44:49
  Speaker 1: we began to develop some really crude early machines. These
• 44:53
  Speaker 1: weren't even the iPhone one. I'll call it the iPhone
• 44:55
  Speaker 1: point five, but they're using basically crude versions of cardiac CT,
• 45:01
  Speaker 1: and I could see, Oh, I get where this is going. Hardware,
• 45:05
  Speaker 1: software technology, We'll all kick in and guess what this is?
• 45:11
  Speaker 1: Where the path is going. So that's when I switched
• 45:14
  Speaker 1: over twenty five years ago to CARDIACCT, and then in
• 45:19
  Speaker 1: two thousand and five the first of what would call
• 45:21
  Speaker 1: sixty four slice machines came out. That really where the
• 45:26
  Speaker 1: rubber met the road, right, that's what I we really,
• 45:29
  Speaker 1: you know, And that's twenty years ago when I gave
• 45:31
  Speaker 1: up doing hartcats because on a hartcath, even a heartcath
• 45:35
  Speaker 1: which many of my colleagues would call it gold standard,
• 45:37
  Speaker 1: here's the problem. All I can see is the donut hole.
• 45:39
  Speaker 1: We talked about the donuts and doughnut hole. All I
• 45:42
  Speaker 1: can see is the donut hole. I have no idea
• 45:45
  Speaker 1: what's happening in the donut Is their is their lipid
• 45:48
  Speaker 1: rich plack? Is their soft plaque? Is it growing outside? Right?
• 45:52
  Speaker 1: So you can have a perfectly normal heartcath and still
• 45:55
  Speaker 1: have substantial plaque or athroscrosis because it's tiding in the wall.
• 46:00
  Speaker 1: You could only see that well two tests CARDIACT. Now
• 46:04
  Speaker 1: we have AI to even which is the microscope applied
• 46:08
  Speaker 1: to CARDXCT. It's CARDIACT now with AI, which is new
• 46:12
  Speaker 1: over the last four years. But the only other way
• 46:16
  Speaker 1: that I could see the plaque we can now see, detect, measure, track,
• 46:21
  Speaker 1: and quantify is with CARDIACCT and AI. The only other
• 46:26
  Speaker 1: way that we could detect that plaque, measure that plaque,
• 46:30
  Speaker 1: quantify that plaque is with an autopsy jasus and most
• 46:35
  Speaker 1: people decline that opportunity. So CARDIACC is pretty easy thing.
• 46:39
  Speaker 1: So in reality, preventive cardiology is really predicated upon fantastic
• 46:45
  Speaker 1: imaging using CARDIACCT and now AI. There's no role for
• 46:48
  Speaker 1: stress tests, there's no role for hard guests. And by
• 46:50
  Speaker 1: the way, even the t that you had, Yeah, we
• 46:53
  Speaker 1: get such beautiful pictures that in my patients with aortic
• 46:56
  Speaker 1: valve disease like you do. We take the pictures. It
• 46:59
  Speaker 1: takes literally one second to take the images, right, several
• 47:02
  Speaker 1: thousand slices all in less than a second. We get
• 47:05
  Speaker 1: all that echo data. We can measure the valve, look
• 47:08
  Speaker 1: at the valve, do all that stuff. I can also
• 47:10
  Speaker 1: make sure your coronaries are okay, which is the real
• 47:12
  Speaker 1: reason you had the heart gap. In one test that's
• 47:16
  Speaker 1: a fraction of the cost of all the stuff you
• 47:18
  Speaker 1: went through and completely non evasive. We put an ivy
• 47:21
  Speaker 1: in your arm sticking the doughnut. The actual scan with
• 47:25
  Speaker 1: this particular machine we have which is pretty fancy it
• 47:28
  Speaker 1: but you know, it might take five or ten seconds.
• 47:31
  Speaker 1: Ours is less than a second to get these incredible
• 47:34
  Speaker 1: high resolution three dimensional images. And then literally we can
• 47:37
  Speaker 1: take your hard apart, fly up and down the vessels,
• 47:39
  Speaker 1: turn them, spin them, rotate them, and then use AI
• 47:42
  Speaker 1: to detect the soft plaque. That's the active plaque, the lava,
• 47:46
  Speaker 1: the lipid rich plaque, right, that is the stuff that ruptures,
• 47:49
  Speaker 1: breaks off, flakes off, cause heart attacks or if that's
• 47:52
  Speaker 1: something in the neck, a stroke. That is always the
• 47:56
  Speaker 1: plaque that starts the whole process. But over time the
• 48:00
  Speaker 1: plaque will naturally or with help medications, diet, exercise, lifestyle
• 48:06
  Speaker 1: will actually convert from the lava, the soft, lipid rich,
• 48:10
  Speaker 1: waxy buttery stuff into the hard stable plaque, which is
• 48:15
  Speaker 1: the calcified stuff that's the cement. Once it's the cement,
• 48:18
  Speaker 1: that's the cinder cone, the extinct volcano. It's not going
• 48:21
  Speaker 1: to break off, break off, flake off, rupture, cause problems.
• 48:26
  Speaker 1: It's just an old scar, right. So our goal is
• 48:29
  Speaker 1: to is to identify the lipid rich soft plaque at
• 48:34
  Speaker 1: the same time see if there's blockages. But again, you
• 48:36
  Speaker 1: can have a perfectly normal heartcap no blockages, and have
• 48:38
  Speaker 1: extensive plaque and the blood vessels, identify the soft plaque,
• 48:44
  Speaker 1: quantify that soft plaque now with AI, and then treat that.
• 48:47
  Speaker 1: And the goal is, as you said before, really to
• 48:50
  Speaker 1: get it into that hard calcified plaque. And we're really
• 48:55
  Speaker 1: doing two things. We're converting cholesterol that's already in the
• 48:58
  Speaker 1: blood vessel into the hard plaque, and we're preventing any
• 49:01
  Speaker 1: further cholesterol get in the vessel to cause more plaque
• 49:05
  Speaker 1: build up in the first place. And that's how we're
• 49:07
  Speaker 1: going to cure heart disease, that is strokes and heart attacks.
• 49:11
  Speaker 1: The plaque stuff, right, which different than the fould stuff
• 49:14
  Speaker 1: that you have, that is change. That is wow. So
• 49:19
  Speaker 1: I would hurt analogy. I would argue, with the tools
• 49:23
  Speaker 1: we currently and the knowledge and the tools, the literature
• 49:27
  Speaker 1: even the tools to treat plaquetop plaque, we literally have
• 49:32
  Speaker 1: the cure for heart disease. Here's our problem. We don't
• 49:37
  Speaker 1: look for the cancer. We have the cure for cancer, yeah,
• 49:42
  Speaker 1: but we don't look for it early. We wait till
• 49:44
  Speaker 1: it shows up. We wait to have symptoms chest bay
• 49:47
  Speaker 1: and angina need stents or balloons. All of that is
• 49:50
  Speaker 1: the equivalent in the world of cancer of stage four
• 49:52
  Speaker 1: advanced metastatic cancer. Right, none of the tools we have
• 49:55
  Speaker 1: available that we historically have used in the twentieth century, cats, echoes,
• 50:01
  Speaker 1: stress tests, EKGs, none of them are early detection tools.
• 50:06
  Speaker 2: So you we're really talling the difference here between health
• 50:09
  Speaker 2: care and sick cur because most most healthcare is actually
• 50:13
  Speaker 2: sick cur it is health care.
• 50:16
  Speaker 1: So you know, we do colonoscopies, we do pap smears,
• 50:18
  Speaker 1: we now do chess sets and smokers for lung cancer.
• 50:23
  Speaker 1: You know, we do all these things to detect early cancers.
• 50:26
  Speaker 1: But the disease that kills more of us, whether you
• 50:30
  Speaker 1: or Australia, than any of those other cancers dramatically is
• 50:34
  Speaker 1: heart disease that we can now pick up decades before
• 50:37
  Speaker 1: we get in trouble and take care of it and
• 50:39
  Speaker 1: treat it so it becomes a big nothing burger. But
• 50:43
  Speaker 1: historically we haven't.
• 50:45
  Speaker 2: And high expensive of these machines, John the particularly Yeah, I'd.
• 50:52
  Speaker 1: Pocket about two point three million dollars.
• 50:55
  Speaker 2: Right, and how expensive as it would be an MRI
• 50:57
  Speaker 2: machine any idea.
• 50:59
  Speaker 1: Oh it pans. I mean there's a span of them,
• 51:01
  Speaker 1: but those are those are certainly in that same price
• 51:04
  Speaker 1: range up to several million dollars. Wow. Okay. So so
• 51:07
  Speaker 1: it's like in the big scheme of things, and they
• 51:09
  Speaker 1: have to be super cool with helium. So the upkeep
• 51:13
  Speaker 1: oh man, it's ah yeah, that thing burns through money
• 51:17
  Speaker 1: so that the cost over the life cycle is significantly
• 51:22
  Speaker 1: and then the texts are not inexpensive too, right, because right,
• 51:25
  Speaker 1: and but then when when you when you think about then.
• 51:30
  Speaker 2: The return on investment, and I'm talking about the global
• 51:33
  Speaker 2: return on investment in terms of preventing and saving lives,
• 51:37
  Speaker 2: you know, you compare it against the old technology
• 51:40
  Speaker 1: That I hate to do this, but I've got all right,
• 51:46
  Speaker 1: I guess you get too