Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients.
Podcast Summary
Introduction
Dr. Warrick Bishop, a practicing cardiologist and author focused on patient education, hosts this episode with Dr. Karim Kostner, a Brisbane-based cardiologist specializing in preventive cardiology and lipid management. In a unique role reversal, Dr. Kostner interviews Dr. Bishop about cardiac imaging technology and its role in modern cardiology practice, exploring why clinicians image arteries and how imaging should be applied to guide patient care.
Key Takeaways:
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Imaging arteries provides clinicians with critical information to guide treatment intensity and prevention strategies, as the approach differs significantly between patients with clear arteries versus those with substantial plaque buildup.
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Patients increasingly want to know what's happening in their own arteries, making imaging an important tool for informed consent and patient engagement in their care.
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Modern CT technology has advanced dramatically over the past decade, allowing physicians to freeze the moving heart and capture detailed, reproducible images of coronary arteries and plaque composition.
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Functional testing (like stress tests) should be used when patients present with symptoms, while anatomical imaging (like CT scans) is more appropriate for asymptomatic risk assessment in appropriately selected populations.
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Imaging is generally recommended for risk assessment in men around age 50 and women around age 60, particularly those with risk factors such as family history, high cholesterol, or hypertension.
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Calcium scoring without contrast provides a baseline measure of plaque burden, while CT coronary angiography with contrast injection reveals plaque composition, narrowings, and other anatomical details to guide therapy decisions.
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For severely elevated cholesterol cases like familial hypercholesterolemia, imaging may be considered in younger patients (males age 30+, females age 40+) when multiple risk enhancers are present.
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Serial imaging in asymptomatic patients with zero calcium scores can reasonably be repeated at approximately five-year intervals, though this varies based on age, sex, and individual risk factors.
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The radiation dose from cardiac CT is relatively low (approximately one millisievert), equivalent to a mammogram, making it a safe imaging modality.
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The risk of allergic reaction to contrast injection is extremely low (one in 200,000), and contrast should only be used when calcium is present on initial scoring.
