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Speaker 1: Doctor John Osborne. Welcome to the podcast. Thank you so much, Balt.

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Speaker 1: It is a pleasure, in an honor to be here.

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Speaker 1: It's an absolute pleasure to have you on.

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Speaker 2: As I said just just before we started, I've got

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Speaker 2: a bit of a vested interest in this area, which

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Speaker 2: most of my listeners know about. But so you call

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Speaker 2: yourself a preventative cardiologist, which I am a big fan

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Speaker 2: of for obvious reasons, and for those who don't know,

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Speaker 2: I got diagnosed with a bicuspod aotic valve.

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Speaker 1: John will go through what that is, but only.

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Speaker 2: Because I play soccer with a cardiologist and said, hey,

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Speaker 2: I want to get a bit of a screen. I'm

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Speaker 2: I'm not a big believer in cholesterol as a predictor

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Speaker 2: of of other partencies.

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Speaker 1: Think there's so much more to it, which Johnald guintu.

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Speaker 1: But oh, John, talk.

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Speaker 2: Us through maybe a little bit a kind of anatomy

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Speaker 2: of the heart. Are you talk to yourself? You'd say

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Speaker 2: that you're a general contractor.

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Speaker 1: So yeah, so when people ask me what I do,

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Speaker 1: I love to say, because I'm a little snarky, I'll say,

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Speaker 1: when they what do you do? And I say, well,

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Speaker 1: I'm just a general contractor. I do some electrical I

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Speaker 1: do some plumbing, right, So that that's kind of what

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Speaker 1: cardiology is. It's electrical and plumbing basically.

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Speaker 2: Right, And that my cardiologist had actually said to me, Hey,

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Speaker 2: when I was getting tested, we'll look at the rooms of.

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Speaker 1: Your heart and the electrics and the plumbing.

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Speaker 2: So so talk us through those things and to people,

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Speaker 2: and and what typically tends to go wrong with the

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Speaker 2: rooms the electrics there, plumbing.

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Speaker 1: Yeah, no, that's a great example the most common issue

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Speaker 1: that people encounter over the course of their lives. And again,

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Speaker 1: it can be a whole spectrum of things. Right. You

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Speaker 1: can have valve isshue like you had. You can have

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Speaker 1: plumbing issues, but basically the water supply right to the heart,

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Speaker 1: right that supplies the blood, oxygen, nutrients and all that.

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Speaker 1: You can have fluid around the heart, you can have cardiomyopathies,

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Speaker 1: weakness heart. So any of the parts of this order

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Speaker 1: of this complex machine, and also electrical issues can go wrong.

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Speaker 1: But probably statistically the most likely thing to go wrong

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Speaker 1: that most people encounter will be the formation of and

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Speaker 1: the deposition of plaque in the blood vessels, which if

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Speaker 1: it extends enough, will cause anything from heart attacks and

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Speaker 1: by the way that same plaque that forms in the

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Speaker 1: blood vessels to heart can also form anywhere else in

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Speaker 1: your body. Right. It can be in the neck causing strokes.

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Speaker 1: It can be in the legs causing what we'll call

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Speaker 1: peripheral arterial disease, that is build up of plaque and

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Speaker 1: blockages and the legs where people can't walk, and in

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Speaker 1: the worst scenarios, actually leads to amputation and things like that.

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Speaker 1: So plaque can be very systemic. It can be in

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Speaker 1: any blood vessel of your body, but more times than

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Speaker 1: not it sort of manifests or comes out in the heart,

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Speaker 1: causing blockages, which can cause symptoms like shortens of breath, heaviness, tightness,

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Speaker 1: chest pain. We call it angina, particularly with exertion or

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Speaker 1: when you exercise or work out or go upstairs or whatever,

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Speaker 1: and typically improved with rest. So if your symptoms get

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Speaker 1: worse with exercise, improved with rest. If you have a

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Speaker 1: heaviness of tightness, of burning an ache, usually not a

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Speaker 1: sharp pain or knife like or lancinating pain or ice

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Speaker 1: pick type pain, but usually more of a heaviness of

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Speaker 1: pressure eche burning somebody sitting in my chest works with activity,

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Speaker 1: worse with exercise gets better with rest. You need to

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Speaker 1: give me a call because that could certainly be a

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Speaker 1: symptom of what we call angina. But here's the problem.

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Speaker 1: Plaque behaves in ways that you probably don't think of,

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Speaker 1: and we don't really well explain it to the lay public.

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Speaker 1: You can have zero symptoms. I feel fine. Just got

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Speaker 1: off the soccer field like you did, and have a

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Speaker 1: massive heart attack. Right, So what happens most of the

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Speaker 1: time is plaque builds up in the heart. It mostly

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Speaker 1: forms out in the wall of the vessel. So think

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Speaker 1: of the vessel, the blood vessel, as a donut. Right.

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Speaker 1: We get really worried about the donut hole, But actually

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Speaker 1: where all of this is occurring is actually in the

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Speaker 1: donut itself, And when plaque builds up, it literally will

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Speaker 1: expand outwards into the donut, not inwards into the donut hole.

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Speaker 1: And all of this is occurring and you have absolute

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Speaker 1: no symptoms. I feel fine. I like to say I

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Speaker 1: had a normal stress test last week and it was normal.

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Speaker 1: And you could have extensive deposition of plaque and build

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Speaker 1: up in those blood vessels and have absolutely no symptoms

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Speaker 1: and past stress tests all day long. Oh, you can

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Speaker 1: even pros us an exercise stress test. Absolutely. Yeah. So

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Speaker 1: let me tell you a little secret of cardiology. Okay,

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Speaker 1: I don't do stress tests anymore, and I'll tell you why. Right, So,

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Speaker 1: if you go to a cardiologist, right, no matter where

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Speaker 1: you're at, what country, right, if you go to a cardiologist,

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Speaker 1: you'll get predictably an EKG pretty worthless. You'll get a

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Speaker 1: stress test pretty worthless. And even if you you know,

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Speaker 1: if those things look worrisome or concerning or whatever, you

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Speaker 1: might graduate to a invasive heart catheterization or angigram as

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Speaker 1: we call it. That's the invasive test. We put catheters.

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Speaker 1: I call them silly straw haus right, they're big long tubes.

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Speaker 1: When I trained, we did them through the groin. Right

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Speaker 1: now we've only the only change in that procedure is

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Speaker 1: now we go through the When I suspect you probably

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Speaker 1: had that done, it's through the wrist. Yes, it's it's

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Speaker 1: less risk of bleeding and such. But any of those

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Speaker 1: tests can absolutely one hundred percent every day missplaque. Interesting

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Speaker 1: and particularly with stress tests. Here here's the thing you

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Speaker 1: need to know. It takes a seventy percent blockage of

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Speaker 1: the doughnut hole of the channel we called the lumen

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Speaker 1: before you have symptoms or flunk a stress test. So

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Speaker 1: if you're completely normal or ten thirty fifty sixty sixty

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Speaker 1: nine percent, your stress test will be normal. So the

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Speaker 1: good news bad news is our vessels are bigger than

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Speaker 1: they need to be. Right, we have huge reserve. Right.

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Speaker 1: The downside is we have huge reserves, so they need

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Speaker 1: to be really plugged up before we ever manifest symptoms

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Speaker 1: or show up or or flunk as float FLUNKU stress test.

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Speaker 1: So they're very insensitive and insensitive to early disease. And

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Speaker 1: in fact, I always think of this if you think

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Speaker 1: of heart disease versus cancer, right with a stress test,

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Speaker 1: waiting for symptoms or waiting till your flunk a stress test,

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Speaker 1: it really is only detecting cancer at the stage four

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Speaker 1: widely metastatic, widely advanced level. Impossible toct it at stage three,

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Speaker 1: two or one. And then it gets worse because when

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Speaker 1: we do a stress test, it's all predicated upon blood

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Speaker 1: flow and interrupting blood flow. But again, our vessels are

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Speaker 1: really big. We can put up with a lot of

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Speaker 1: plaque and blockage in the vessels and still have adequate

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Speaker 1: blood flow even with exercise right. The other problem is

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Speaker 1: we're not actually visualizing the blood vessels, right, we're just

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Speaker 1: looking at blood flow. So even with what's called nuclear cardiology,

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Speaker 1: where we do we do about ten million of those

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Speaker 1: in the US. With nuclear cardiology, there's a twenty five

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Speaker 1: to forty percent false negative rate. That means there is

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Speaker 1: a severe block and you just should have picked it

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Speaker 1: up and it missed it. So that's re interesting.

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Speaker 2: Did you say, oh, John, you've just gone You're sorry,

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Speaker 2: you just you just pot out there for a little

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Speaker 2: second and okay, and so you said a Did you say,

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Speaker 2: just recap on that?

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Speaker 1: Did you say twenty five to forty percent false negative

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Speaker 1: false negative rate? Right, so we pat you on the back,

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Speaker 1: say you have the heart of than an eighteen year old,

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Speaker 1: and then you have heart attack next week, next month,

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Speaker 1: next year. So high rates of false negatives, which is

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Speaker 1: really concerning. Secondarily concerning is a high rate of false positives. Right,

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Speaker 1: So there is no blockage, you do the stress test

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Speaker 1: looks funny, equivocal, right, then you graduate to an invasive

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Speaker 1: hardcast twenty thousand bucks in the US of tests. You know, die,

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Speaker 1: risk of heart attacks, strokes, damage to the kidneys, infection,

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Speaker 1: bleeding right only to find out, yeah, you look fine.

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Speaker 1: And in fact, here's an interesting statistic. Currently, of all

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Speaker 1: the people go undergoing diagnostic invasive heart casts like you

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Speaker 1: had before your heart bowl procedure, seventy percent of the time,

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Speaker 1: even despite stress test looks funny or they have symptoms

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Speaker 1: or whatever, seventy percent of the time will find no

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Speaker 1: significant blockage. So if you have to go to the

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Speaker 1: calf lab, you already stand only a thirty percent chance

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Speaker 1: of them finding some bad blockage. Seventy percent of the

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Speaker 1: time it's it's a false alarm. Still twenty thousand dollars

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Speaker 1: and hopefully no complications ensued. But and we do it

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Speaker 1: in the US. We do two point five million diagnostic

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Speaker 1: hart casts a year, ten million at Nuclear stress US

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Speaker 1: a year. Wow, And these are thousands and thousands and

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Speaker 1: thousands of dollars. Now, with the technology I've used, and

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Speaker 1: I've been using it for twenty five years, it became

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Speaker 1: so good literally twenty years ago this year, back in

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Speaker 1: two thousand and five, that I stopped cathing people and

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Speaker 1: stopped doing doing stress tests because there really was no

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Speaker 1: value to it. So stress tests heartcasts are all twentieth

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Speaker 1: century technology.

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Speaker 2: Really even so the is sorry just recap joining is

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Speaker 2: the heart cut is not the like a ct angiogram?

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Speaker 1: Is that? No, So a heart cath is when they're

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Speaker 1: usually done in a hospital, it's it's like an oar

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Speaker 1: kind of scenario, right, everybody's gowned up and stuff, and

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Speaker 1: then they take these catheters just long long tubes straws basically,

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Speaker 1: and in the old days where I trained, we'd put

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Speaker 1: them in the groin. Nowadays and really the only thing

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Speaker 1: that's changed last thirty years as we go through the wrist.

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Speaker 2: Uh.

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Speaker 1: But then we take that catheter that tube, advance it

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Speaker 1: all the way up into the heart and then inject

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Speaker 1: dye directly into the blood vessels of the heart while

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Speaker 1: we're taking X ray movie pictures and watching that die

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Speaker 1: fill the vessels, right, and if we see it tapering

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Speaker 1: or an hour glass, we can go, okay, there's a blockage,

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Speaker 1: right right, gotcha. That's that's what they did on That's

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Speaker 1: what they did on me.

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Speaker 2: And I remember I was lying there looking at the

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Speaker 2: screen and seeing my see seeing my arteries on in

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Speaker 2: the screen.

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Speaker 1: Which it was pretty cold. Yeah, yeah, yeah, I stopped

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Speaker 1: doing those twenty years ago. Twenty years ago, Yeah, that's

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Speaker 1: how good cardiac CT is, right.

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Speaker 2: Okay, so so you are not so talk us through then.

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Speaker 1: For that preventive I mean, that's kind of one of

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Speaker 1: the aspects of preventative cardiology. Right, So tell us what

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Speaker 1: exactly what a cardiac CET is. Sure that what I

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Speaker 1: evolved to twenty years ago. And I'll tell you why.

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Speaker 1: Is what's called cardiac CT. CT stands for compute commuted sorry,

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Speaker 1: computed tomography. Right, So that is the big donut. Right.

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Speaker 1: We have two main imaging tools, right, we use MR.

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Speaker 1: So that's the big I call that the coffin. Right,

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Speaker 1: that's the that's the big tube. They stuff you in

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Speaker 1: the big tube. It's kind of tight, right, that's an MR.

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Speaker 1: That's not what we use it, all right. We use

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Speaker 1: a big open doughnut, right, So you're not stuffed in anything.

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Speaker 1: It's just you're in the middle of a big donut.

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Speaker 1: And so we use that machine. These are fancy versions

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Speaker 1: of CT. We've been doing CT since the seventies. But uh,

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Speaker 1: you know, we we have what I call the iPhone

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Speaker 1: seventeen version of CARDIACCT machines, very high resolution, extremely fast,

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Speaker 1: and amazing AI built into that. As you can imagine

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Speaker 1: and then also very low radiation, because these CT machines

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Speaker 1: do emit radiation, so we want to make sure that

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Speaker 1: we minimize that for lots of good reasons, so we

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Speaker 1: use a very In fact, our machine, I have to

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Speaker 1: glow a minute. Our machine was the first machine of

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Speaker 1: its type, a six hundred and forty slice machine installed

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Speaker 1: in North America. That was three years ago. Now right

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Speaker 1: now they're eight of these in the US, but ours

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Speaker 1: was the very first.

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Speaker 2: WOW because my understanding was that CT skins used to

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Speaker 2: be quite high radiation.

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Speaker 1: You're saying, us is the newer version that's lower radiation. Yeah,

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Speaker 1: So in the old days, right, twenty twenty five years ago,

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Speaker 1: the dose of radiation could be could be pretty high.

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Speaker 1: So we measure that in something called millisebts, right, to

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Speaker 1: make sense of that, every year on the face of

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Speaker 1: the Earth exposed to gamma rays from the Sun and

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Speaker 1: isotopes that are around us that everybody is exposed to,

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Speaker 1: we'll get about three milliseverts of radiation exposure year. Right,

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Speaker 1: Even if you lived in a lead box, you're gonna

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Speaker 1: get three millisiverts of radiation. In the old days, the

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Speaker 1: radiation doses could be about twenty milliseiverts. Okay, so equivalent

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Speaker 1: to several years of background exposure. By the way, nuclear

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Speaker 1: stress tests, of which we do again very insensitive, high

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Speaker 1: rates of false positive negatives. We reviewed that before. We

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Speaker 1: do ten million of those in the years, ten million

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Speaker 1: of those a year in the US. Unfortunately, still they're

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Speaker 1: going to give you about thirty to forty milliseiverts of radiation.

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Speaker 1: It's a lot. And I've run into patients so go,

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Speaker 1: oh yeah, every year I come in from my nuclear

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Speaker 1: stress test year and year out right, So you're getting

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Speaker 1: roughly ten to fifteen years worth of background radiation. With

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Speaker 1: the current state of the art CT machines, we can

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Speaker 1: take these incredible high resolution images of the heart. There

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Speaker 1: are three dimensional images, which I'll talk about here in

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Speaker 1: a second, and we can do that at a radiation

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Speaker 1: dose of point two milissey verts. Wow, Jesus, that's it.

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Speaker 2: And you're getting, as you alluded to Joan, you're getting

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Speaker 2: a much better image. You're you're getting as close to

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Speaker 2: an image as if you took the heart art and

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Speaker 2: how to look.

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Speaker 1: At it and turned I call it and my staff

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Speaker 1: always cautions me about doing this, but I'm going to

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Speaker 1: do it. I call it the virtual autopsy. Okay, emphsis

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Speaker 1: on the virtual not the autopsy. And literally what we

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Speaker 1: can see. And here's the problem with plaque, right, So

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Speaker 1: plaquell doesn't really grow inward, at least not early on.

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Speaker 1: Plaque literally will be warehoused in the wall of the vessel. Right,

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Speaker 1: So cholesterol is building up in the in the blood

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Speaker 1: vessel wall and the and the vessel goes well, wait

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Speaker 1: a minute, I don't want to get a blockage, so

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Speaker 1: it actually expands outwards, right, so it literally uses the

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Speaker 1: wall of the vessel, the doughnut. I call it to

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Speaker 1: warehouse that cholesterol is. It's going to deposited in the

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Speaker 1: in the vessel. Right, Yeah, you're getting a bulge. You're

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Speaker 1: not getting a growth inside. Late Okay, years to decades later,

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Speaker 1: the vessel basically will almost double in size. Then it

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Speaker 1: begins to grow inward. But remember we don't have symptoms

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Speaker 1: j just binanjina until we have a seventy percent blockage

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Speaker 1: of the donut hole. But all of the disease in

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Speaker 1: the early stuff is all occurring in the doughnut. Okay, side, gotcha.

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Speaker 1: When we do stress tests, the threshold detection starts at

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Speaker 1: a seventy percent blockage of the donut hole. It's believable

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Speaker 1: that it's stressed. And I used to cath people. This

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Speaker 1: is why I stop cathing people twenty years ago. When

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Speaker 1: we do CARDIACCT, it really is the virtual autopsy. We

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Speaker 1: can see everything in the heart. We can see your

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Speaker 1: bicuspoard valve. We can see the heart function, the squeeze

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Speaker 1: the heart, if you hold old heart attacks, congenital heart disease,

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Speaker 1: holes in the heart, fluid around the heart, right, anything

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Speaker 1: that you can see on an echo cardigram like you've had,

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Speaker 1: that's the ultrasound we do at the heart. We can

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Speaker 1: see on cardiact except much higher resolution. So we get

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Speaker 1: all that free data like a free echo. Right.

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Speaker 2: So John, a quick quick question here, So, so, why

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Speaker 2: would you do an echo cardiogram rather than the CT.

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Speaker 2: Is it just a cost thing and an equipment availability.

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Speaker 1: Partly is cost, but it really depends upon the question

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Speaker 1: you're answering. So if I want to know, is the

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Speaker 1: heart's squeezing normally? Is is the pump pumping normally? Do

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Speaker 1: I have old heart attacks? Do I have what we

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Speaker 1: call cardiomopity, another's weakness of the heart muscle. Do I

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Speaker 1: have congenital heart disease or what we call structural heart disease?

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Speaker 1: In other words, the chambers aren't hooked up to the

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Speaker 1: right pipes. So stuff you're born with. If I have

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Speaker 1: a valve, I'm worried about, is it leaky? Is it narrowed?

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Speaker 1: Is it by cuspid? Echo is great to be able

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Speaker 1: to look at all those things. Okay, it's it's not evasive,

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Speaker 1: no radiation, right, there's no harm. It's great. What the

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Speaker 1: one thing it doesn't tell you, though, is the blood

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Speaker 1: vessels of the heart, the coronary arteries. We see none

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Speaker 1: of that on echo. So when the question is do

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Speaker 1: I have plaque, forget about even blockages, right because you

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Speaker 1: easily they have lots of plaque and no blockages, right

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Speaker 1: because people worry about blockages. But that's really a late

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Speaker 1: manifestation of a twenty to thirty year long disease. Right.

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Speaker 1: What echo does not tell you, cannot tell you, is

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Speaker 1: anything about the blood vessels that supply the heart muscle,

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Speaker 1: the coronary arteries. That's where we use CT Now we

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Speaker 1: get the free echo, I like to say, right, so

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Speaker 1: when we do cardiact, we can look at the valves

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Speaker 1: by customer valves, leaky valves, narrow valves, prolapsing valves, the

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Speaker 1: heart function, the squeeze of the heart, the thickness of

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Speaker 1: the heart muscle, blah blah, all those things. Right, So

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Speaker 1: we get all that data for free. But most importantly

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Speaker 1: and the main reason is to determine if we have

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Speaker 1: any plaque build up in the blood vessels. Okay, and it.

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Speaker 2: Does an echo or any of those other tasks, whether

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Speaker 2: it's a MRI or any of those things, do they

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Speaker 2: pick up anything that the cardiac cet does not pick up.

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Speaker 1: So the other tool we do use as an imaging tool,

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Speaker 1: we talk about echo. Cheap, easy accessible and a radiation

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Speaker 1: great for heart function valves, structural stuff, leaky valves, narrow valves. Right,

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Speaker 1: that's its domain. If you have a cardiomyopathy, that is

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Speaker 1: a weakening of the heart muscle, and that could be

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Speaker 1: the variety of things genes, viruses, some obscure causes, old

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Speaker 1: heart attacks. Right, So if you need to look at

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Speaker 1: the heart muscle or rarely, it doesn't happen often, but

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Speaker 1: you can get tumors of the heart things like that.

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Speaker 1: So if you need to look at the heart muscle,

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Speaker 1: Is there a problem with the heart muscle? Is it squeezing? Okay?

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Speaker 1: Are there tumors of the heart? MR is really good

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Speaker 1: for that. What MR is not good at because it

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Speaker 1: has actually quite low resolution, right because with CARDIACT we

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Speaker 1: have very high resolution. We have resolution now with the

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Speaker 1: current CT machines that we use coupled with amazing AI,

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Speaker 1: we can see down to about a quarter of a

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Speaker 1: millimeter or two hundred and fifty microns, okay, which is

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Speaker 1: very high resolution. MR. We're stuck at about two to

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Speaker 1: three millimeters, so it just doesn't have resolution to be

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Speaker 1: able to see the coronary arteries and see plaque and

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Speaker 1: those issues. So if it and when you need to

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Speaker 1: understand if is there plaque, how much plaque, where it's

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Speaker 1: located quantified plaque which we can now do with AI,

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Speaker 1: which I'll touch on in a minute, that that really

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Speaker 1: is the domain of CARDIACCT. And I don't see anything

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Speaker 1: in the in the near term, in the next several

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Speaker 1: years that's going to replace CARDIACCT as far as other

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Speaker 1: imaging technologies at this moment.

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Speaker 2: Interesting okay, And now my understanding as well, just to

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Speaker 2: go into these things and their effectiveness, is that an

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Speaker 2: echo is the results of the echo are largely dependent

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Speaker 2: on the person doing the echo. There's a lot of

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Speaker 2: subjects heavily around it, right, because.

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Speaker 1: Well, yeah, two parts, Paul, Yes, the echo tech which

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Speaker 1: is critical. These are really really high, highly trained people

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Speaker 1: to become really good. It's probably about five to ten years,

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Speaker 1: so you've become really good, right, Okay, So that's just

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Speaker 1: acquiring the images. Then you need what I call the

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Speaker 1: nut behind the wheel, the person reading the echo. So

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Speaker 1: it's really dependent upon and then of course the echo equipment, right,

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Speaker 1: So you really have to make sure that every one

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Speaker 1: of those boxes is ticked off the right equipment, the

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Speaker 1: right experience tech, and the right reader to really extract

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Speaker 1: appropriately because again you can miss stup, you can overcool

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Speaker 1: stuff with again wrong equipment, tech or reader. So yeah,

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Speaker 1: so there's a lot, a lot of experience that requires

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Speaker 1: and the right equipment and the right tech to be

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Speaker 1: able to really extract all all of the data. And

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Speaker 1: there's an amazing amount of data that we can derive

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Speaker 1: from echo cardiogy echo cardiography. But again you have to

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Speaker 1: have all three uh uh legs of that stool uh

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Speaker 1: be there yep? Yeah, interesting, And then I obviously.

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Speaker 2: So I had an echo and then I had a

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Speaker 2: trans of sophageal echo where they stick this tube down

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Speaker 2: your throat, all right, and it goes down there. And John,

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Speaker 2: you'll you'll laugh at this because I went in to

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Speaker 2: get it done and they were they were going to

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Speaker 2: give me an anesthetic, and I said, that's not worry

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Speaker 2: about the anesthetic.

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Speaker 1: And the guys like, are you crazy in the head,

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Speaker 1: And I'm like, well.

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Speaker 2: Because I would have to stay in the hospital for

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Speaker 2: two hours and I had something to do. Let on,

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Speaker 2: So I did one of those without an anesthetic, which

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Speaker 2: was a touch, A touch, uncomfortable, it's gonna be said, yes, yes,

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Speaker 2: they prepped me just in kiss.

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Speaker 1: They said, look, I'm happy to try this.

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Speaker 2: We're gonna prep you just in kiss and if it doesn't,

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Speaker 2: you know, if you're gagging too much, then and.

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Speaker 1: We'll do that.

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Speaker 2: But anyway, because that gives you a bit more insight,

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Speaker 2: doesn't it. When you got that tube done, it's much

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Speaker 2: closer to the heart and you can see stuff that

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Speaker 2: you don't normally say on a normal echo.

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Speaker 1: Yeah, exactly. It sort of takes it from not quite

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Speaker 1: black and white, we'll say, color TV to HDTV as

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Speaker 1: far as the resolution because you really get that probe

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Speaker 1: where the ultrasound probe is located basically right on top

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Speaker 1: of the heart by swallowing it. Because your esophagus, your

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Speaker 1: food bite literally sits directly behind the heart, so you

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Speaker 1: can get it right on top of the heart and

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Speaker 1: get much better higher resolution images of the of the

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Speaker 1: heart by doing the te.

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Speaker 2: Cool Now we will dive into the whole plaque thing

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Speaker 2: and go really deep on this. It's just one thing

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Speaker 2: I wanted to cover off though. Can you let people

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Speaker 2: know about leaky valves?

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Speaker 1: Right? And so why and why if you're born.

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Speaker 2: With a bicusp of valve like me with two leafs

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Speaker 2: on your aortic valve, and why is that more prone

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Speaker 2: to leaking? And then if you have a normal tri

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Speaker 2: cusp of aortic valve and what sort of factors? Is

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Speaker 2: it all just lifestyle or is it just aging that

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Speaker 2: causes that valve to leak? If you're exercising more, does

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Speaker 2: it is it more likely to leak or less likely

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Speaker 2: to leak? Just talk about the leaky.

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Speaker 1: Valve stuff first, and then we'll go on.

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Speaker 2: And there's one other thing I want to talk about,

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Speaker 2: the chambers and the thickening of the of the wall,

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Speaker 2: the pathological versus physiological and athletes. Maybe just give our

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Speaker 2: listeners an overview of that and then we'll go back

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Speaker 2: and dive deeper into.

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Speaker 1: The Yeah, so great question. So just to kind of

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Speaker 1: remove some of the medical leaves from this. So, the

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Speaker 1: aortic valve, which is one of the four heart valves,

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Speaker 1: it's the last valve where the blood passes out of

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Speaker 1: the heart and to the rest of the body, is

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Speaker 1: a critical valve. And and basically, I mean lots of

429
00:25:18,240 --> 00:25:23,240
Speaker 1: things can happen to You can have congenital abnormalities, malformations, trauma,

430
00:25:23,280 --> 00:25:28,000
Speaker 1: all kinds of stuff. But the valve is normally has

431
00:25:28,080 --> 00:25:31,080
Speaker 1: three leaflets. Okay, we call them cusps, but they're just leaflets,

432
00:25:31,600 --> 00:25:35,880
Speaker 1: and they're very very tightly it's very very tight fit

433
00:25:35,920 --> 00:25:39,199
Speaker 1: and finish, right, so they perfectly open and close. They

434
00:25:39,200 --> 00:25:41,359
Speaker 1: do that one hundred thousand times a day, by the way,

435
00:25:42,080 --> 00:25:46,800
Speaker 1: and they fit perfectly together so that when the heart

436
00:25:46,840 --> 00:25:50,000
Speaker 1: is filling with blood and that valve is closed, the

437
00:25:50,040 --> 00:25:53,400
Speaker 1: blood does not leak back through that valve, right, They

438
00:25:53,440 --> 00:25:56,639
Speaker 1: perfectly perfectly closes and then when it opens, they're very

439
00:25:57,640 --> 00:26:02,520
Speaker 1: thin but incredibly strong. They're very thin, so that they

440
00:26:02,600 --> 00:26:05,480
Speaker 1: basically fold back, and then when the heart squeezes and

441
00:26:05,520 --> 00:26:09,080
Speaker 1: pumps the blood out, they provide no basically no resistance

442
00:26:09,240 --> 00:26:12,399
Speaker 1: to the flow of blood through that valve. So the

443
00:26:12,480 --> 00:26:14,760
Speaker 1: normal trek custom of valve, if you were to look

444
00:26:14,800 --> 00:26:17,480
Speaker 1: at it from the surgeon's view, looks like a Mercedes

445
00:26:17,520 --> 00:26:22,919
Speaker 1: Ben sign you're older, maybe a peace sign, but it

446
00:26:22,920 --> 00:26:24,840
Speaker 1: looks like a Mercedes Ben sign looking at it from

447
00:26:24,840 --> 00:26:27,480
Speaker 1: the surgeon's view. Right. With a bicusp of valve, what

448
00:26:27,560 --> 00:26:32,679
Speaker 1: happens is that those three leaflets, two of the leaflets

449
00:26:33,040 --> 00:26:37,439
Speaker 1: get stuck together. Okay, imagine like a perforation, but it

450
00:26:37,480 --> 00:26:41,320
Speaker 1: doesn't perforate right, So two of those leaflets are stuck together.

451
00:26:41,840 --> 00:26:45,320
Speaker 1: And the thought is that again that valve is opening

452
00:26:45,359 --> 00:26:49,320
Speaker 1: closing one hundred thousand times a day. After about fifty

453
00:26:49,680 --> 00:26:53,440
Speaker 1: ish maybe sixty years, that valve, because the fit and

454
00:26:53,480 --> 00:26:56,960
Speaker 1: finish isn't perfect, will begin to calcify, will begin to

455
00:26:57,040 --> 00:27:01,000
Speaker 1: fibros right, and you'll see calcification and building up the valve,

456
00:27:01,240 --> 00:27:04,520
Speaker 1: and that can either cause one of two things. More typically,

457
00:27:04,920 --> 00:27:07,840
Speaker 1: the valve gets narrowed right, so it becomes very stiff.

458
00:27:08,200 --> 00:27:11,520
Speaker 1: It's not thin. It doesn't open and close easily, and

459
00:27:11,680 --> 00:27:15,439
Speaker 1: the valve itself becomes very thick and restricts the blood

460
00:27:15,440 --> 00:27:17,680
Speaker 1: flow coming out of the heart. We call that aortic

461
00:27:17,920 --> 00:27:22,520
Speaker 1: valve stenosis or narrow okay. And as if that as

462
00:27:22,560 --> 00:27:26,000
Speaker 1: that valve narrows, the blood still has to get out

463
00:27:26,040 --> 00:27:28,720
Speaker 1: of the heart, and so the heart has to work

464
00:27:28,800 --> 00:27:32,680
Speaker 1: even harder to push even harder through that thin that

465
00:27:32,680 --> 00:27:37,080
Speaker 1: that thin that small hole rather and so it just

466
00:27:37,160 --> 00:27:39,720
Speaker 1: like muscle, the heart muscle will bluck up, bulk up too.

467
00:27:40,160 --> 00:27:43,200
Speaker 1: The work the heart muscle does is blood pressure work,

468
00:27:43,680 --> 00:27:47,400
Speaker 1: so it will literally thicken up. Okay. Now, a similar

469
00:27:47,600 --> 00:27:50,880
Speaker 1: kind of thing can happen in highly conditioned people. One

470
00:27:50,960 --> 00:27:57,080
Speaker 1: is called eccentric the other is called eccentric hypertrophy eccentric hyperchevy,

471
00:27:57,080 --> 00:28:00,639
Speaker 1: which is what athletes get and very you know, conditioned,

472
00:28:00,800 --> 00:28:04,400
Speaker 1: aerobic people and all that get. Uh. There is some thickening,

473
00:28:04,440 --> 00:28:06,920
Speaker 1: but the whole heart gets a little bigger, the walls

474
00:28:06,960 --> 00:28:09,480
Speaker 1: of the heart little thicker, and that's completely normal, and

475
00:28:09,520 --> 00:28:15,320
Speaker 1: that's conditioning. In in uh, concentric hypertrophy, which is pathological,

476
00:28:15,359 --> 00:28:19,119
Speaker 1: which is abnormal because of the restriction in this case

477
00:28:19,240 --> 00:28:22,959
Speaker 1: of that valve becoming narrowed. The heart really doesn't large,

478
00:28:23,280 --> 00:28:26,240
Speaker 1: but it begins to get very, very thick, and that

479
00:28:26,320 --> 00:28:29,520
Speaker 1: is that is abnormal. Right. The good news is you

480
00:28:29,560 --> 00:28:32,080
Speaker 1: get the valve fixed and and that gets better too.

481
00:28:33,119 --> 00:28:36,280
Speaker 2: Yeah, but it isn't there a point. There's a certain

482
00:28:36,320 --> 00:28:39,880
Speaker 2: point because that chimber will start to strike. Well, I'm

483
00:28:39,920 --> 00:28:43,680
Speaker 2: talking about regard sitation here, which is the the other issue. Right,

484
00:28:43,720 --> 00:28:46,680
Speaker 2: So most of the by custom valves, it's a it's

485
00:28:46,800 --> 00:28:47,960
Speaker 2: aortic valvestinosis.

486
00:28:47,960 --> 00:28:51,120
Speaker 1: The valve gets narrowed, okay, and then creates these issues

487
00:28:52,320 --> 00:28:54,360
Speaker 1: and and the symptoms of that would be you get

488
00:28:54,400 --> 00:28:57,440
Speaker 1: shorter breath when normally you wouldn't write normal activity. You

489
00:28:57,600 --> 00:28:59,560
Speaker 1: just can't can't do it. I could mow the lawn,

490
00:28:59,600 --> 00:29:02,840
Speaker 1: now I can't chest pain because all that thick muscle

491
00:29:02,880 --> 00:29:04,840
Speaker 1: requires a lot more blood flows. So you start getting

492
00:29:04,880 --> 00:29:07,520
Speaker 1: engine or chest pain even though there are no blockages

493
00:29:07,680 --> 00:29:09,680
Speaker 1: in the blood vessel of the heart. And then the

494
00:29:09,680 --> 00:29:11,600
Speaker 1: worst sign is you begin to faint and pass out

495
00:29:11,680 --> 00:29:15,360
Speaker 1: because literally you're not pushing enough blood through that valve.

496
00:29:15,680 --> 00:29:22,560
Speaker 1: And when that starts happening, you're just about ready to go. Right.

497
00:29:23,440 --> 00:29:26,320
Speaker 1: The other issue, which is not as common as nosis,

498
00:29:26,400 --> 00:29:30,680
Speaker 1: is leakage, or we call it regurgitation or leakage, in

499
00:29:30,720 --> 00:29:36,760
Speaker 1: which case, again the valves get less flexible. They're open adequately,

500
00:29:37,200 --> 00:29:39,960
Speaker 1: but they need to be able to also close, and

501
00:29:40,000 --> 00:29:43,240
Speaker 1: they don't close adequately, which case the valve then stays

502
00:29:43,320 --> 00:29:45,880
Speaker 1: open when it should be closed, and all that blood

503
00:29:45,880 --> 00:29:48,200
Speaker 1: that it just pumped out of the heart, a lot

504
00:29:48,240 --> 00:29:52,640
Speaker 1: of that then regurgitates or leaks back into the chamber.

505
00:29:52,880 --> 00:29:56,080
Speaker 1: So the problem is now the heart has to pump,

506
00:29:56,400 --> 00:29:58,600
Speaker 1: you know, and I'll make up in numbers. You've got

507
00:29:58,600 --> 00:30:00,960
Speaker 1: the blood coming into the left and via the normal

508
00:30:01,040 --> 00:30:03,400
Speaker 1: pathway from the lungs. But then you have all the

509
00:30:03,440 --> 00:30:06,440
Speaker 1: blood that leaked back when it shouldn't have leaked back.

510
00:30:06,680 --> 00:30:09,240
Speaker 1: So now you're pumping and again on make up numbers,

511
00:30:09,400 --> 00:30:13,200
Speaker 1: two quarts when it should pump one quart. And the

512
00:30:13,200 --> 00:30:16,640
Speaker 1: issue there is that that's a more potentially even more

513
00:30:16,680 --> 00:30:20,800
Speaker 1: dangerous issue because the heart can begin to enlarge because

514
00:30:20,840 --> 00:30:23,280
Speaker 1: of all that extra volume it has to pump. And

515
00:30:23,320 --> 00:30:25,760
Speaker 1: there is a point, there almost is no point where

516
00:30:25,800 --> 00:30:28,240
Speaker 1: the valve kit gets too narrowed as long as you're

517
00:30:28,480 --> 00:30:31,440
Speaker 1: you know, have a pulse and breathing where fixing that

518
00:30:31,520 --> 00:30:34,640
Speaker 1: valve won't correct the problem. Right, even if the heart

519
00:30:34,720 --> 00:30:36,760
Speaker 1: gets very bulked up and you've had a long time

520
00:30:36,800 --> 00:30:39,600
Speaker 1: and all that stuff, if you fix the valve, the

521
00:30:39,600 --> 00:30:42,920
Speaker 1: heart will recover. But if the valve is leaky, there

522
00:30:43,000 --> 00:30:44,960
Speaker 1: is a limit to how much it can You know

523
00:30:45,000 --> 00:30:47,920
Speaker 1: how much you can stretch out that sweater, Yeah, and

524
00:30:48,240 --> 00:30:51,560
Speaker 1: you can stretch it out if it's been long enough

525
00:30:51,560 --> 00:30:54,440
Speaker 1: and severe enough. And even if you fix the valve,

526
00:30:55,360 --> 00:30:59,800
Speaker 1: the heart stops working properly. So even fixing the valve

527
00:31:00,120 --> 00:31:02,880
Speaker 1: in the setting of aortic valve regurg station or leakage,

528
00:31:03,160 --> 00:31:06,240
Speaker 1: if you wait too long, can be really dangerous because

529
00:31:06,280 --> 00:31:10,120
Speaker 1: you fix the valve and the heart shot.

530
00:31:10,240 --> 00:31:14,120
Speaker 2: This is why I'm a very lucky boy because when

531
00:31:14,160 --> 00:31:17,240
Speaker 2: they find me, so my mine for the listeners, I

532
00:31:17,280 --> 00:31:19,360
Speaker 2: don't know if I said at the start mine was proactive.

533
00:31:19,400 --> 00:31:23,640
Speaker 2: I asked because I played soccer with a cardiologist that said, hey, Matt, I.

534
00:31:23,640 --> 00:31:24,160
Speaker 1: Want to know.

535
00:31:24,640 --> 00:31:26,480
Speaker 2: I really want to know what my heart looks like.

536
00:31:27,080 --> 00:31:29,920
Speaker 2: I really don't care about the cholesterol, like, high's my

537
00:31:30,160 --> 00:31:35,400
Speaker 2: heart working. And they find that my regurgitation level was

538
00:31:35,440 --> 00:31:39,720
Speaker 2: at about fifty percent, so I'm all the blood going,

539
00:31:40,120 --> 00:31:44,880
Speaker 2: that's right. And if I had to choose between stenosis

540
00:31:44,920 --> 00:31:50,840
Speaker 2: or narrowing versus leakage regurgitation stenosis every day. Right, because again,

541
00:31:51,800 --> 00:31:53,800
Speaker 2: if you make it to the O R, we fix

542
00:31:53,880 --> 00:31:55,000
Speaker 2: the valve, the heart will be fine.

543
00:31:55,520 --> 00:31:59,160
Speaker 1: Yeah. Wait too long with a leaky valve, with aortic

544
00:31:59,200 --> 00:32:03,320
Speaker 1: valve regurge station, and you may fix the valve and

545
00:32:03,720 --> 00:32:06,360
Speaker 1: the hard hard shot, hard heart shot, you get heart

546
00:32:06,600 --> 00:32:09,240
Speaker 1: and we call that heart failure. John, Is that is that?

547
00:32:09,320 --> 00:32:12,040
Speaker 1: Is that what's known as heart failure? Yeah? That's heart

548
00:32:12,080 --> 00:32:15,160
Speaker 1: failure right, that's not reversible. Yeah.

549
00:32:15,280 --> 00:32:18,080
Speaker 2: And now I was not kicking the ars off that

550
00:32:18,200 --> 00:32:20,880
Speaker 2: I think by I think my surgeon said, I'm look,

551
00:32:20,960 --> 00:32:22,600
Speaker 2: this is from memory. You might be able to correct it,

552
00:32:22,680 --> 00:32:25,920
Speaker 2: but he said, once it gets to sixty sixty five percent,

553
00:32:26,000 --> 00:32:28,320
Speaker 2: you pretty much guaranteed that you're gonna have heart failure.

554
00:32:30,120 --> 00:32:32,360
Speaker 1: Yeah. Yeah, And and you know, we we have lots

555
00:32:32,360 --> 00:32:34,920
Speaker 1: of phisticated weights with echo by the way, to measure

556
00:32:34,960 --> 00:32:37,760
Speaker 1: how much blood is coming back, how big that leaky

557
00:32:37,800 --> 00:32:41,280
Speaker 1: hole is. We can do all that with echo. It's phenomenal. Uh.

558
00:32:41,320 --> 00:32:44,239
Speaker 1: But yeah, I mean it can get very leaky. And

559
00:32:44,240 --> 00:32:47,600
Speaker 1: as I said, if you happen to pick it up late, uh,

560
00:32:47,440 --> 00:32:53,480
Speaker 1: it's bad. It's really bad, So kudos. Yeah, well, I'll

561
00:32:53,520 --> 00:32:54,360
Speaker 1: tell you what it's.

562
00:32:54,440 --> 00:32:57,959
Speaker 2: It's the message to everybody out there is be proactive

563
00:32:58,000 --> 00:33:01,640
Speaker 2: about your health. Because if I hadn't been proactive by

564
00:33:01,720 --> 00:33:05,040
Speaker 2: my health, I would I would not be around in

565
00:33:05,080 --> 00:33:08,440
Speaker 2: ten years, I would probably guess, if not before that,

566
00:33:08,480 --> 00:33:11,440
Speaker 2: because your aortic can also stretch, which mine had started

567
00:33:11,440 --> 00:33:13,520
Speaker 2: to do, and that could just burst one day and

568
00:33:13,520 --> 00:33:15,160
Speaker 2: then you die instantly, right.

569
00:33:15,080 --> 00:33:18,880
Speaker 1: Yeah, and very commonly with a bi cusped valve. I

570
00:33:18,920 --> 00:33:20,920
Speaker 1: talked to you the earlier before. But with the bi

571
00:33:21,000 --> 00:33:23,320
Speaker 1: cust valve. The other thing goes along with that is

572
00:33:23,360 --> 00:33:27,640
Speaker 1: you get an aneurysm of the awards, right, Yeah, I

573
00:33:27,720 --> 00:33:29,480
Speaker 1: caught the A word. We don't like the A word,

574
00:33:29,560 --> 00:33:32,840
Speaker 1: right because people think appropriately bad stuff, which it is.

575
00:33:33,200 --> 00:33:39,040
Speaker 1: And as that a word of stretches and enlarges, there

576
00:33:39,040 --> 00:33:42,760
Speaker 1: are no symptoms whatsoever. The first symptom of that, if

577
00:33:43,520 --> 00:33:46,160
Speaker 1: you get an aortic dissection, it literally gets so big

578
00:33:46,200 --> 00:33:51,280
Speaker 1: that it rips open. And the mortality rate once that

579
00:33:51,720 --> 00:33:55,800
Speaker 1: a word of rips open is ten percent per hour.

580
00:33:56,760 --> 00:34:00,640
Speaker 2: Oh wow, yeah, because your blood's just leak and out

581
00:34:00,720 --> 00:34:01,320
Speaker 2: of your body.

582
00:34:01,360 --> 00:34:05,720
Speaker 1: Yeah, it's really bad, right yeah, And a lot of

583
00:34:05,720 --> 00:34:07,840
Speaker 1: the problems is that it can mimic even with an

584
00:34:07,880 --> 00:34:11,840
Speaker 1: award execsion, it can cause chest pain. You know, unless

585
00:34:11,840 --> 00:34:14,320
Speaker 1: you're thinking of it, you could easily miss the diagnosis

586
00:34:14,360 --> 00:34:16,600
Speaker 1: and then that patient is sitting in the er for

587
00:34:16,640 --> 00:34:18,759
Speaker 1: a few hours as you're scratching your head. What's going

588
00:34:18,800 --> 00:34:23,040
Speaker 1: on with them? Right? EKG looks good? Right, but they

589
00:34:23,040 --> 00:34:26,160
Speaker 1: can have a ruptured a ORDA and again our the

590
00:34:26,480 --> 00:34:30,560
Speaker 1: mortality rate is ten percent per hour once it ruptured

591
00:34:31,440 --> 00:34:36,120
Speaker 1: a damn. Yeah, so you got your valve fixed, your

592
00:34:36,120 --> 00:34:39,080
Speaker 1: heart's great, and you didn't have an aneurysm of the order,

593
00:34:39,120 --> 00:34:42,240
Speaker 1: which is awesome, right, But again, the aneurysms are particularly

594
00:34:42,280 --> 00:34:44,360
Speaker 1: danger I mean, all this stuff is dangerous, right because

595
00:34:44,640 --> 00:34:48,880
Speaker 1: the symptoms are very delayed. The process starts decades before,

596
00:34:49,280 --> 00:34:53,160
Speaker 1: but the symptoms are delayed until it's catastrophic. But if

597
00:34:53,200 --> 00:34:56,839
Speaker 1: once that aword ruptures, it is really bad. And up

598
00:34:56,920 --> 00:34:59,480
Speaker 1: until it ruptures, zero symptoms.

599
00:35:00,400 --> 00:35:03,160
Speaker 2: And this is interesting, right because for me, I was

600
00:35:03,200 --> 00:35:06,319
Speaker 2: still playing soccer over thirty five soccer at fifty three

601
00:35:06,360 --> 00:35:12,080
Speaker 2: years old, had no symptoms. Now, on reflection, John, you

602
00:35:12,120 --> 00:35:17,040
Speaker 2: know my I noticed my fitness going down, my cardiovascular fitness.

603
00:35:17,080 --> 00:35:22,720
Speaker 1: On reflection, but three. You know, right, you're competing against

604
00:35:22,760 --> 00:35:25,000
Speaker 1: all these thirty five, thirty six year old guys, right,

605
00:35:25,040 --> 00:35:28,239
Speaker 1: and go, eh, I'm just getting older. And that's the

606
00:35:28,480 --> 00:35:33,640
Speaker 1: really duplicitous part of this process because you can easily

607
00:35:33,680 --> 00:35:38,080
Speaker 1: go I'm just getting older. Right, It's not hard and fine, right,

608
00:35:38,120 --> 00:35:41,320
Speaker 1: So it really can really be very diluding.

609
00:35:42,239 --> 00:35:45,480
Speaker 2: And and what my cardiologists said, he said, people who

610
00:35:45,760 --> 00:35:50,320
Speaker 2: you know, like me, who are into their fitness, you notice, hey, teez,

611
00:35:50,920 --> 00:35:53,480
Speaker 2: my fitness is dropping off, and you just work harder.

612
00:35:53,760 --> 00:35:57,560
Speaker 1: You work harder, and you can you can accelerate the issue. Right.

613
00:35:57,640 --> 00:36:01,799
Speaker 2: So it's it's a bloody tricky thing. Now let's come

614
00:36:01,840 --> 00:36:05,680
Speaker 2: back to the plaque. And so when you do have

615
00:36:05,760 --> 00:36:08,919
Speaker 2: a little bit of plaque, it can be either calcified

616
00:36:09,040 --> 00:36:13,239
Speaker 2: or non calcified. And now my understanding of that has

617
00:36:13,320 --> 00:36:16,360
Speaker 2: changed a little bit that the calcification can actually be

618
00:36:16,520 --> 00:36:18,560
Speaker 2: a good thing because it's stable.

619
00:36:19,040 --> 00:36:23,200
Speaker 1: Right, So it's all those through steable versus unstable plaque. Sure,

620
00:36:23,320 --> 00:36:25,280
Speaker 1: so we'll go all the way back to the beginning.

621
00:36:25,600 --> 00:36:28,279
Speaker 1: So when plaque is beginning to develop, and I want

622
00:36:28,320 --> 00:36:30,560
Speaker 1: to point out one thing, Paul, you mentioned it earlier,

623
00:36:31,719 --> 00:36:35,400
Speaker 1: and you're absolutely correct. Whether you form plaque or not

624
00:36:36,960 --> 00:36:42,120
Speaker 1: is very, very poorly correlated with your cholesterol levels. Yeah. Right.

625
00:36:43,120 --> 00:36:47,520
Speaker 1: I saw a guy last month, sixty five, felt fine,

626
00:36:48,040 --> 00:36:50,680
Speaker 1: no symptoms, had a normal stress test a year or

627
00:36:50,719 --> 00:36:53,799
Speaker 1: two ago. We put him the CT machine. Of his

628
00:36:53,920 --> 00:36:57,000
Speaker 1: three major blood vessels of the heart, one was completely

629
00:36:57,000 --> 00:37:01,240
Speaker 1: blocked off and two in the other branches had severe

630
00:37:01,280 --> 00:37:05,879
Speaker 1: blockages in them. Okay, no symptoms, feel fine, normal stress test.

631
00:37:06,000 --> 00:37:09,880
Speaker 1: Right on top of that, I said, any cholesterol issues. Now,

632
00:37:09,920 --> 00:37:11,360
Speaker 1: I had all his labs, right, I look at his

633
00:37:11,440 --> 00:37:16,080
Speaker 1: cholesterol numbers. His cholesterol numbers were perfect. He looked like

634
00:37:16,120 --> 00:37:19,080
Speaker 1: somebody already on drugs to treat cholesterol. That's how great

635
00:37:19,080 --> 00:37:24,040
Speaker 1: they were, right, So I completely agree with you. Cholesterol

636
00:37:24,640 --> 00:37:28,520
Speaker 1: is the paradox, right. The stuff that forms the plaque

637
00:37:28,719 --> 00:37:32,000
Speaker 1: is cholesterol, right, is that is the fertilizer. However, your

638
00:37:32,040 --> 00:37:38,880
Speaker 1: cholesterol levels really tell you nothing about is that cholesterol sticking? Right? Yeah?

639
00:37:38,880 --> 00:37:42,080
Speaker 1: And then conversely, I saw young woman she's seventy two,

640
00:37:43,120 --> 00:37:47,520
Speaker 1: had a you know, years of high cholesterol, and I said,

641
00:37:47,560 --> 00:37:49,239
Speaker 1: I don't care what your cholesterol is. I only care

642
00:37:49,280 --> 00:37:52,120
Speaker 1: if it's sticking. We put her in the machine. She

643
00:37:52,200 --> 00:37:57,840
Speaker 1: had no plaque. So cholesterol member, when we measure cholesterol,

644
00:37:57,880 --> 00:38:02,000
Speaker 1: only measures cholesterol floating eye in the bloodstream, tells me

645
00:38:02,200 --> 00:38:04,399
Speaker 1: nothing about is it sticking? Right?

646
00:38:04,480 --> 00:38:08,160
Speaker 2: Does a particle size John give you ld so small

647
00:38:08,360 --> 00:38:10,640
Speaker 2: danse LDL is a bit risk.

648
00:38:10,719 --> 00:38:13,200
Speaker 1: You've looked at that and you know that was kind

649
00:38:13,200 --> 00:38:17,160
Speaker 1: of a fad a number of years ago. In reality,

650
00:38:17,320 --> 00:38:21,520
Speaker 1: it really doesn't give you much useful information. If you

651
00:38:21,600 --> 00:38:23,520
Speaker 1: and I'll tell you, I'll tell you, you and your audience

652
00:38:24,800 --> 00:38:29,040
Speaker 1: the the three cholesterol tests you need right one you

653
00:38:29,080 --> 00:38:30,719
Speaker 1: only need once and I'll tell you what that is.

654
00:38:31,160 --> 00:38:31,239
Speaker 2: Uh.

655
00:38:31,480 --> 00:38:33,760
Speaker 1: But if you want to have a good hand, exactly

656
00:38:33,840 --> 00:38:35,520
Speaker 1: help you little a. So if you want to have

657
00:38:35,560 --> 00:38:38,319
Speaker 1: a really good handle on your cholesterol levels, remember that

658
00:38:38,360 --> 00:38:40,440
Speaker 1: doesn't tell me if it's sticking. The only way to

659
00:38:40,480 --> 00:38:42,400
Speaker 1: know if it's sticking is you get in the machine.

660
00:38:42,480 --> 00:38:44,680
Speaker 1: We look under the hood. Right, that's where cardie xCT

661
00:38:44,800 --> 00:38:48,560
Speaker 1: plays comes into play. But on the cholesterol front, you'll

662
00:38:48,600 --> 00:38:52,560
Speaker 1: get a standard lipid profile that's your total treelis rides

663
00:38:52,680 --> 00:38:56,000
Speaker 1: hl ld l okay, but again, really doesn't tell me

664
00:38:56,000 --> 00:38:58,520
Speaker 1: if it's sticking or not. You'll get an LP little

665
00:38:58,520 --> 00:39:03,040
Speaker 1: a once that's a a form of cholesterol that's pretty common.

666
00:39:03,200 --> 00:39:05,879
Speaker 1: It is a really, really nasty form of cholesterol. It's

667
00:39:05,880 --> 00:39:10,719
Speaker 1: super sticky, it's super clotty, and it's super inflammatory, so

668
00:39:10,760 --> 00:39:13,920
Speaker 1: it really promotes the formation of black It is one

669
00:39:14,000 --> 00:39:18,920
Speaker 1: hundred percent genetic and twenty percent will have it, eighty

670
00:39:18,960 --> 00:39:22,320
Speaker 1: percent won't. So we check that once. If it's high,

671
00:39:22,719 --> 00:39:24,319
Speaker 1: then we know and we can take care of it.

672
00:39:24,600 --> 00:39:27,160
Speaker 1: If you're normal, it will never become abnormal. Does not

673
00:39:27,280 --> 00:39:31,799
Speaker 1: vary with diet, exercise, weight loss, anything that you know

674
00:39:32,160 --> 00:39:35,239
Speaker 1: that you can change lifestyle wise. So elp, Lila, we

675
00:39:35,400 --> 00:39:38,160
Speaker 1: check once. If it's normal, you're done. You don't have it. Yahoo,

676
00:39:38,440 --> 00:39:40,640
Speaker 1: great for you, great for your family, great for your kids.

677
00:39:41,160 --> 00:39:44,480
Speaker 1: If it is high, then we actually have people say, hey,

678
00:39:44,520 --> 00:39:46,600
Speaker 1: I need to talk to my brother, my sister, my kids.

679
00:39:46,960 --> 00:39:49,480
Speaker 1: Sometimes even depending with our age, mom and dad. So

680
00:39:49,600 --> 00:39:51,799
Speaker 1: ELP little a lipid profile. And then the last one

681
00:39:51,800 --> 00:39:55,400
Speaker 1: that's really replaced the particle number, particle size, all that

682
00:39:55,520 --> 00:39:59,160
Speaker 1: kind of stuff. It's cheaper, it's quicker, it's more accurate,

683
00:39:59,640 --> 00:40:03,480
Speaker 1: is called APO B or apove protein B. So that

684
00:40:03,560 --> 00:40:06,760
Speaker 1: really is all you need to have your cholesterol checked.

685
00:40:07,239 --> 00:40:09,680
Speaker 2: But again, and do you put any stock in APO

686
00:40:09,760 --> 00:40:11,759
Speaker 2: B to a po a reshield.

687
00:40:12,880 --> 00:40:19,280
Speaker 1: All race shows are non useful. Whether it's HDL ratios

688
00:40:19,280 --> 00:40:24,040
Speaker 1: blah blah blah, treglistride HDL, LDL, total cholesterol HDL. Even

689
00:40:24,080 --> 00:40:27,040
Speaker 1: a POA a boy is a little bit better, more

690
00:40:27,040 --> 00:40:30,200
Speaker 1: cientific way of measuring HDL, which is what ApoA is.

691
00:40:30,680 --> 00:40:34,600
Speaker 1: But any of those race shows are terribly useless. Remember

692
00:40:34,640 --> 00:40:39,600
Speaker 1: all those race shows were derived because we're trying to guess, right,

693
00:40:39,760 --> 00:40:43,160
Speaker 1: we don't know. We're trying to guess by numbers. If

694
00:40:43,200 --> 00:40:47,040
Speaker 1: you have the deposition of plaque in your blood vessels, right, yes,

695
00:40:47,080 --> 00:40:49,680
Speaker 1: and we're talking risk, right, if your ratio is high

696
00:40:49,760 --> 00:40:52,240
Speaker 1: or lower. God knows your risk is higher or lower.

697
00:40:53,000 --> 00:40:56,880
Speaker 1: But that's risk. I don't deal in risk anymore. I

698
00:40:57,040 --> 00:41:00,399
Speaker 1: put you in the machine and we see it there.

699
00:41:00,520 --> 00:41:04,520
Speaker 1: It's not it's binary, it's zeros and one. Right, Because

700
00:41:04,560 --> 00:41:07,719
Speaker 1: it's all those and many quote hard tests that many

701
00:41:07,719 --> 00:41:10,400
Speaker 1: people are still doing. They'll get you know, the multi

702
00:41:10,440 --> 00:41:14,040
Speaker 1: thousand dollars panel, and you got greens and reds and

703
00:41:14,160 --> 00:41:18,239
Speaker 1: yellows and all that stuff. All of that was predicated

704
00:41:18,320 --> 00:41:21,080
Speaker 1: upon I have no idea how to see plaque. I

705
00:41:21,120 --> 00:41:23,040
Speaker 1: didn't have a way to see plaque or measure it

706
00:41:23,120 --> 00:41:25,719
Speaker 1: detected or use AAR that we now do. So I'm

707
00:41:25,719 --> 00:41:28,960
Speaker 1: going to get these numbers to try to guess if

708
00:41:29,040 --> 00:41:32,399
Speaker 1: you have plaque. Yes, well that's a waste of time, money,

709
00:41:32,400 --> 00:41:34,600
Speaker 1: and blood. Get the machine.

710
00:41:35,360 --> 00:41:38,160
Speaker 2: I'm not without risks, as you said earlier on John,

711
00:41:38,480 --> 00:41:42,000
Speaker 2: copying some of these procedures that are are not as

712
00:41:42,040 --> 00:41:44,319
Speaker 2: predictive as c T. You know, any proceadure that you

713
00:41:44,360 --> 00:41:47,000
Speaker 2: have is going to have risks. Of course, any medications,

714
00:41:47,000 --> 00:41:51,000
Speaker 2: which we'll get onto medication, Any medications have risks with it, right, So.

715
00:41:52,280 --> 00:41:54,960
Speaker 1: We don't really treat risk anymore. We either treat people

716
00:41:55,000 --> 00:41:59,239
Speaker 1: who have plaque yeah, or they don't have plaque yeah,

717
00:41:59,280 --> 00:42:01,320
Speaker 1: And that's it. I mean people at have high cholesterol

718
00:42:01,360 --> 00:42:04,000
Speaker 1: and have no plaque have perfect cholesterol lots of plaque.

719
00:42:04,280 --> 00:42:08,160
Speaker 1: So I completely agree with you. Cholesterol is a really

720
00:42:08,200 --> 00:42:12,520
Speaker 1: really poor indicator of what that cholesterol is sticking. Remember,

721
00:42:12,680 --> 00:42:15,360
Speaker 1: we're just measuring how much cholesterol is, you know, floating

722
00:42:15,400 --> 00:42:17,960
Speaker 1: by in your bloodstream tells you nothing about it is

723
00:42:18,000 --> 00:42:18,480
Speaker 1: it's sticking.

724
00:42:19,280 --> 00:42:23,400
Speaker 2: And my understanding, John, is that about fifty percent of

725
00:42:23,480 --> 00:42:26,480
Speaker 2: people who have a heart attack have got normal cholesterol.

726
00:42:27,000 --> 00:42:32,200
Speaker 1: Oh absolutely, yeah, right, So using cholesterol to guess whether

727
00:42:32,200 --> 00:42:35,120
Speaker 1: a plaque or not. You will lose every time. Right,

728
00:42:35,400 --> 00:42:44,279
Speaker 1: that's a casino game. Wow, wouse always wins, right, So.

729
00:42:46,360 --> 00:42:48,800
Speaker 2: What is very clear And I think just to recap

730
00:42:48,840 --> 00:42:53,480
Speaker 2: for the listeners, cholesterol almost useless. You want to know

731
00:42:53,560 --> 00:42:56,000
Speaker 2: your LP little A, and you want to know your

732
00:42:56,000 --> 00:42:59,880
Speaker 2: APO B, and you want to know about the stickiness city.

733
00:43:00,000 --> 00:43:04,400
Speaker 2: The cardiac CT is absolutely the way to go, but

734
00:43:04,960 --> 00:43:09,240
Speaker 2: probably different, John in here in Australia than in the States,

735
00:43:09,440 --> 00:43:14,360
Speaker 2: because of our medical system, right, is a little bit different.

736
00:43:14,960 --> 00:43:17,760
Speaker 1: And you know, going straight.

737
00:43:17,400 --> 00:43:22,000
Speaker 2: To cardiac CT probably not going to happen, right, because

738
00:43:22,000 --> 00:43:22,600
Speaker 2: they want to do.

739
00:43:22,640 --> 00:43:26,719
Speaker 1: The cheaper tests first. Well, what's what's interesting is in

740
00:43:26,800 --> 00:43:34,239
Speaker 1: reality cardiac CT is a fit is rather ten to

741
00:43:34,480 --> 00:43:38,879
Speaker 1: five percent of the cost of a heart CAF. Really yeah,

742
00:43:39,200 --> 00:43:45,400
Speaker 1: oh it's dramatically cheaper. Wow, And right, depending on what

743
00:43:45,480 --> 00:43:47,640
Speaker 1: kind of stress tests there's different kinds of stress tests

744
00:43:47,640 --> 00:43:51,600
Speaker 1: and all that again generally will be even cheaper than

745
00:43:51,600 --> 00:43:54,839
Speaker 1: a stress test. And if you do cardiac KMAR, which

746
00:43:54,840 --> 00:43:56,759
Speaker 1: we kind of talked about, which is a great tool

747
00:43:56,880 --> 00:43:59,000
Speaker 1: to look at the heart and muscle and such, is

748
00:43:59,560 --> 00:44:02,480
Speaker 1: like real expensive, right, I mean that's a few thousand

749
00:44:02,520 --> 00:44:09,680
Speaker 1: bucks is actually quite inexpensive. Medicare reimbursement in the US

750
00:44:10,120 --> 00:44:12,760
Speaker 1: for cardio xCT is three hundred and seventy eight bucks.

751
00:44:13,840 --> 00:44:15,759
Speaker 1: How much is that as much as the cost of

752
00:44:15,800 --> 00:44:19,680
Speaker 1: the actual thing? Yeah, so Medicare reimbursement right for our

753
00:44:19,680 --> 00:44:25,239
Speaker 1: Medicare cost is three hundred and seventy eight bucks. Wow wow,

754
00:44:25,320 --> 00:44:28,520
Speaker 1: Yeah for than stress tests, dramatically cheaper than a heartcat,

755
00:44:28,640 --> 00:44:32,640
Speaker 1: dramatically cheaper than an MR so way more. In reality,

756
00:44:32,680 --> 00:44:36,680
Speaker 1: it's not cost. The biggest thing is habit. Right. So,

757
00:44:36,800 --> 00:44:40,359
Speaker 1: I trained thirty years ago, CARDIACDT didn't exist, couldn't even

758
00:44:40,400 --> 00:44:43,239
Speaker 1: imagine it, right sor I was trained in stress tests

759
00:44:43,280 --> 00:44:45,200
Speaker 1: and heart casts, and I did all those things. And

760
00:44:45,239 --> 00:44:49,440
Speaker 1: then roughly about the turn of the century twenty first century,

761
00:44:49,600 --> 00:44:53,279
Speaker 1: we began to develop some really crude early machines. These

762
00:44:53,280 --> 00:44:55,320
Speaker 1: weren't even the iPhone one. I'll call it the iPhone

763
00:44:55,360 --> 00:45:00,319
Speaker 1: point five, but they're using basically crude versions of cardiac CT,

764
00:45:01,120 --> 00:45:05,320
Speaker 1: and I could see, Oh, I get where this is going. Hardware,

765
00:45:05,760 --> 00:45:11,840
Speaker 1: software technology, We'll all kick in and guess what this is?

766
00:45:11,840 --> 00:45:14,320
Speaker 1: Where the path is going. So that's when I switched

767
00:45:14,360 --> 00:45:19,520
Speaker 1: over twenty five years ago to CARDIACCT, and then in

768
00:45:19,520 --> 00:45:21,560
Speaker 1: two thousand and five the first of what would call

769
00:45:21,680 --> 00:45:26,200
Speaker 1: sixty four slice machines came out. That really where the

770
00:45:26,239 --> 00:45:29,120
Speaker 1: rubber met the road, right, that's what I we really,

771
00:45:29,600 --> 00:45:31,640
Speaker 1: you know, And that's twenty years ago when I gave

772
00:45:31,719 --> 00:45:34,960
Speaker 1: up doing hartcats because on a hartcath, even a heartcath

773
00:45:35,000 --> 00:45:36,960
Speaker 1: which many of my colleagues would call it gold standard,

774
00:45:37,320 --> 00:45:39,760
Speaker 1: here's the problem. All I can see is the donut hole.

775
00:45:39,960 --> 00:45:42,120
Speaker 1: We talked about the donuts and doughnut hole. All I

776
00:45:42,160 --> 00:45:44,920
Speaker 1: can see is the donut hole. I have no idea

777
00:45:45,200 --> 00:45:48,440
Speaker 1: what's happening in the donut Is their is their lipid

778
00:45:48,520 --> 00:45:52,160
Speaker 1: rich plack? Is their soft plaque? Is it growing outside? Right?

779
00:45:52,320 --> 00:45:55,760
Speaker 1: So you can have a perfectly normal heartcath and still

780
00:45:55,760 --> 00:45:59,919
Speaker 1: have substantial plaque or athroscrosis because it's tiding in the wall.

781
00:46:00,320 --> 00:46:04,520
Speaker 1: You could only see that well two tests CARDIACT. Now

782
00:46:04,520 --> 00:46:08,840
Speaker 1: we have AI to even which is the microscope applied

783
00:46:08,880 --> 00:46:12,759
Speaker 1: to CARDXCT. It's CARDIACT now with AI, which is new

784
00:46:12,800 --> 00:46:16,560
Speaker 1: over the last four years. But the only other way

785
00:46:16,640 --> 00:46:20,280
Speaker 1: that I could see the plaque we can now see, detect, measure, track,

786
00:46:21,719 --> 00:46:26,239
Speaker 1: and quantify is with CARDIACCT and AI. The only other

787
00:46:26,280 --> 00:46:30,120
Speaker 1: way that we could detect that plaque, measure that plaque,

788
00:46:30,160 --> 00:46:35,040
Speaker 1: quantify that plaque is with an autopsy jasus and most

789
00:46:35,040 --> 00:46:39,319
Speaker 1: people decline that opportunity. So CARDIACC is pretty easy thing.

790
00:46:39,680 --> 00:46:45,000
Speaker 1: So in reality, preventive cardiology is really predicated upon fantastic

791
00:46:45,040 --> 00:46:48,520
Speaker 1: imaging using CARDIACCT and now AI. There's no role for

792
00:46:48,560 --> 00:46:50,839
Speaker 1: stress tests, there's no role for hard guests. And by

793
00:46:50,840 --> 00:46:53,200
Speaker 1: the way, even the t that you had, Yeah, we

794
00:46:53,280 --> 00:46:56,560
Speaker 1: get such beautiful pictures that in my patients with aortic

795
00:46:56,640 --> 00:46:59,279
Speaker 1: valve disease like you do. We take the pictures. It

796
00:46:59,280 --> 00:47:02,440
Speaker 1: takes literally one second to take the images, right, several

797
00:47:02,480 --> 00:47:05,719
Speaker 1: thousand slices all in less than a second. We get

798
00:47:05,719 --> 00:47:08,279
Speaker 1: all that echo data. We can measure the valve, look

799
00:47:08,280 --> 00:47:10,200
Speaker 1: at the valve, do all that stuff. I can also

800
00:47:10,200 --> 00:47:12,799
Speaker 1: make sure your coronaries are okay, which is the real

801
00:47:12,840 --> 00:47:16,040
Speaker 1: reason you had the heart gap. In one test that's

802
00:47:16,080 --> 00:47:18,480
Speaker 1: a fraction of the cost of all the stuff you

803
00:47:18,520 --> 00:47:21,279
Speaker 1: went through and completely non evasive. We put an ivy

804
00:47:21,320 --> 00:47:25,360
Speaker 1: in your arm sticking the doughnut. The actual scan with

805
00:47:25,400 --> 00:47:28,160
Speaker 1: this particular machine we have which is pretty fancy it

806
00:47:28,440 --> 00:47:31,440
Speaker 1: but you know, it might take five or ten seconds.

807
00:47:31,480 --> 00:47:34,480
Speaker 1: Ours is less than a second to get these incredible

808
00:47:34,560 --> 00:47:37,239
Speaker 1: high resolution three dimensional images. And then literally we can

809
00:47:37,239 --> 00:47:39,720
Speaker 1: take your hard apart, fly up and down the vessels,

810
00:47:39,719 --> 00:47:42,200
Speaker 1: turn them, spin them, rotate them, and then use AI

811
00:47:42,520 --> 00:47:45,680
Speaker 1: to detect the soft plaque. That's the active plaque, the lava,

812
00:47:46,000 --> 00:47:49,400
Speaker 1: the lipid rich plaque, right, that is the stuff that ruptures,

813
00:47:49,840 --> 00:47:52,600
Speaker 1: breaks off, flakes off, cause heart attacks or if that's

814
00:47:52,600 --> 00:47:56,600
Speaker 1: something in the neck, a stroke. That is always the

815
00:47:56,640 --> 00:48:00,440
Speaker 1: plaque that starts the whole process. But over time the

816
00:48:00,480 --> 00:48:06,640
Speaker 1: plaque will naturally or with help medications, diet, exercise, lifestyle

817
00:48:06,880 --> 00:48:10,520
Speaker 1: will actually convert from the lava, the soft, lipid rich,

818
00:48:10,800 --> 00:48:15,120
Speaker 1: waxy buttery stuff into the hard stable plaque, which is

819
00:48:15,160 --> 00:48:18,320
Speaker 1: the calcified stuff that's the cement. Once it's the cement,

820
00:48:18,400 --> 00:48:21,759
Speaker 1: that's the cinder cone, the extinct volcano. It's not going

821
00:48:21,840 --> 00:48:26,840
Speaker 1: to break off, break off, flake off, rupture, cause problems.

822
00:48:26,960 --> 00:48:29,480
Speaker 1: It's just an old scar, right. So our goal is

823
00:48:29,480 --> 00:48:34,200
Speaker 1: to is to identify the lipid rich soft plaque at

824
00:48:34,200 --> 00:48:36,040
Speaker 1: the same time see if there's blockages. But again, you

825
00:48:36,080 --> 00:48:38,640
Speaker 1: can have a perfectly normal heartcap no blockages, and have

826
00:48:38,680 --> 00:48:43,360
Speaker 1: extensive plaque and the blood vessels, identify the soft plaque,

827
00:48:44,040 --> 00:48:47,480
Speaker 1: quantify that soft plaque now with AI, and then treat that.

828
00:48:47,840 --> 00:48:50,160
Speaker 1: And the goal is, as you said before, really to

829
00:48:50,239 --> 00:48:55,279
Speaker 1: get it into that hard calcified plaque. And we're really

830
00:48:55,280 --> 00:48:58,360
Speaker 1: doing two things. We're converting cholesterol that's already in the

831
00:48:58,360 --> 00:49:01,880
Speaker 1: blood vessel into the hard plaque, and we're preventing any

832
00:49:01,920 --> 00:49:05,800
Speaker 1: further cholesterol get in the vessel to cause more plaque

833
00:49:05,800 --> 00:49:07,719
Speaker 1: build up in the first place. And that's how we're

834
00:49:07,719 --> 00:49:11,560
Speaker 1: going to cure heart disease, that is strokes and heart attacks.

835
00:49:11,560 --> 00:49:14,000
Speaker 1: The plaque stuff, right, which different than the fould stuff

836
00:49:14,239 --> 00:49:18,960
Speaker 1: that you have, that is change. That is wow. So

837
00:49:19,320 --> 00:49:23,600
Speaker 1: I would hurt analogy. I would argue, with the tools

838
00:49:23,640 --> 00:49:26,320
Speaker 1: we currently and the knowledge and the tools, the literature

839
00:49:27,080 --> 00:49:32,319
Speaker 1: even the tools to treat plaquetop plaque, we literally have

840
00:49:32,440 --> 00:49:37,080
Speaker 1: the cure for heart disease. Here's our problem. We don't

841
00:49:37,120 --> 00:49:42,399
Speaker 1: look for the cancer. We have the cure for cancer, yeah,

842
00:49:42,440 --> 00:49:44,920
Speaker 1: but we don't look for it early. We wait till

843
00:49:44,960 --> 00:49:47,239
Speaker 1: it shows up. We wait to have symptoms chest bay

844
00:49:47,239 --> 00:49:50,000
Speaker 1: and angina need stents or balloons. All of that is

845
00:49:50,000 --> 00:49:52,680
Speaker 1: the equivalent in the world of cancer of stage four

846
00:49:52,760 --> 00:49:55,840
Speaker 1: advanced metastatic cancer. Right, none of the tools we have

847
00:49:55,920 --> 00:50:01,560
Speaker 1: available that we historically have used in the twentieth century, cats, echoes,

848
00:50:01,960 --> 00:50:06,000
Speaker 1: stress tests, EKGs, none of them are early detection tools.

849
00:50:06,520 --> 00:50:09,080
Speaker 2: So you we're really talling the difference here between health

850
00:50:09,120 --> 00:50:13,760
Speaker 2: care and sick cur because most most healthcare is actually

851
00:50:13,960 --> 00:50:16,040
Speaker 2: sick cur it is health care.

852
00:50:16,120 --> 00:50:18,760
Speaker 1: So you know, we do colonoscopies, we do pap smears,

853
00:50:18,760 --> 00:50:21,880
Speaker 1: we now do chess sets and smokers for lung cancer.

854
00:50:23,280 --> 00:50:26,320
Speaker 1: You know, we do all these things to detect early cancers.

855
00:50:26,880 --> 00:50:29,880
Speaker 1: But the disease that kills more of us, whether you

856
00:50:30,560 --> 00:50:34,759
Speaker 1: or Australia, than any of those other cancers dramatically is

857
00:50:34,800 --> 00:50:37,160
Speaker 1: heart disease that we can now pick up decades before

858
00:50:37,160 --> 00:50:39,560
Speaker 1: we get in trouble and take care of it and

859
00:50:39,560 --> 00:50:43,120
Speaker 1: treat it so it becomes a big nothing burger. But

860
00:50:43,320 --> 00:50:44,520
Speaker 1: historically we haven't.

861
00:50:45,239 --> 00:50:52,640
Speaker 2: And high expensive of these machines, John the particularly Yeah, I'd.

862
00:50:52,440 --> 00:50:54,640
Speaker 1: Pocket about two point three million dollars.

863
00:50:55,040 --> 00:50:57,759
Speaker 2: Right, and how expensive as it would be an MRI

864
00:50:57,960 --> 00:50:59,239
Speaker 2: machine any idea.

865
00:50:59,080 --> 00:51:01,640
Speaker 1: Oh it pans. I mean there's a span of them,

866
00:51:01,880 --> 00:51:04,240
Speaker 1: but those are those are certainly in that same price

867
00:51:04,320 --> 00:51:07,560
Speaker 1: range up to several million dollars. Wow. Okay. So so

868
00:51:07,640 --> 00:51:09,920
Speaker 1: it's like in the big scheme of things, and they

869
00:51:09,920 --> 00:51:13,759
Speaker 1: have to be super cool with helium. So the upkeep

870
00:51:13,920 --> 00:51:16,960
Speaker 1: oh man, it's ah yeah, that thing burns through money

871
00:51:17,600 --> 00:51:21,720
Speaker 1: so that the cost over the life cycle is significantly

872
00:51:22,440 --> 00:51:25,839
Speaker 1: and then the texts are not inexpensive too, right, because right,

873
00:51:25,920 --> 00:51:28,920
Speaker 1: and but then when when you when you think about then.

874
00:51:30,360 --> 00:51:33,840
Speaker 2: The return on investment, and I'm talking about the global

875
00:51:33,920 --> 00:51:37,120
Speaker 2: return on investment in terms of preventing and saving lives,

876
00:51:37,680 --> 00:51:40,279
Speaker 2: you know, you compare it against the old technology

877
00:51:40,680 --> 00:51:46,120
Speaker 1: That I hate to do this, but I've got all right,

878
00:51:46,440 --> 00:51:47,640
Speaker 1: I guess you get too