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.

EP398: Stiff Old Hearts With Dr. Fiona Foo Part 1

Introduction: Dr. Warwick Bishop, a cardiologist and author, hosts this episode featuring returning guest Dr. Fiona Foo, a cardiologist at Sydney Cardiologist Group with expertise in both interventional cardiology and prevention. The episode focuses on heart failure with preserved ejection fraction (HFpEF), a condition increasingly prevalent in the population that particularly affects women and older adults, caused by a stiff heart that doesn't relax well rather than one that doesn't pump effectively.

Key Takeaways:

• Heart failure with preserved ejection fraction (HFpEF) occurs when the heart becomes stiff and cannot relax properly, yet produces similar symptoms to reduced ejection fraction heart failure including shortness of breath and fluid accumulation.

• HFpEF predominantly affects women, who outnumber men two to one, particularly post-menopausal women with hypertension as a major risk factor.

• Age is one of the most significant risk factors for HFpEF, with prevalence increasing as populations age; the incidence of HFpEF is now rising faster than reduced ejection fraction heart failure.

• Key risk factors for HFpEF include hypertension, obesity, diabetes, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, and non-obstructive coronary artery disease.

• Shortness of breath when lying flat or bending over is a highly sensitive symptom of HFpEF, caused by fluid redistribution in the body and increased pressure in the lungs due to evolutionary adaptations designed for acute blood loss that malfunction in modern aging populations.

• Brain natriuretic peptide (BNP) is an important diagnostic marker that distinguishes heart-related shortness of breath from lung-related shortness of breath, helping clinicians differentiate between cardiac and pulmonary causes.

• Natriuretic peptides released by the heart under strain serve protective functions by promoting fluid excretion, vasodilation, and inflammation reduction, making them crucial targets for modern heart failure therapies like Entresto.

• The body compensates for inadequate heart function by retaining fluid, which under gravity accumulates in the legs while standing but redistributes to the lungs when lying down, explaining positional breathing difficulties in heart failure patients.