EP399: Stiff Old Hearts with Dr. Fiona Foo Part 2

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary: EP399 - Stiff Old Hearts with Dr. Fiona Foo Part 2 Introduction: Dr. Auric Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Fiona Foo, an interventional and general cardiologist at Sydney Cardiology Group. This is part two of a discussion on heart failure with preserved ejection fraction (HFpEF), focusing on treatment strategies and prevention of this increasingly common condition where the heart fails to relax properly. Key Takeaways: SGLT2 inhibitors (such as empagliflozin and dapagliflozin) are now first-line treatment for all types of heart failure, including HFpEF, and have been shown to reduce hospitalizations and cardiovascular death. Acute management of heart failure with shortness of breath involves diuretics, primarily furosemide (Lasix), to remove excess fluid and relieve symptoms quickly. Mineralocorticoid receptor antagonists like spironolactone and the newer finerenone help rebalance hormonal pathways disrupted by heart failure and provide long-term benefit for HFpEF patients. Managing underlying comorbidities—including hypertension, diabetes, obesity, and chronic kidney disease—is critical for HFpEF management, as these conditions directly contribute to disease development. Blood pressure control is one of the most significant preventive measures for HFpEF; a target of less than 130/80 mmHg is recommended, with lower being generally better. A 10% reduction in blood pressure meaningfully decreases cardiac workload over 100,000 heartbeats per day and significantly reduces heart failure hospitalization risk. 24-hour blood pressure monitoring provides superior data compared to single or home measurements, revealing the true daily cardiac load and helping optimize treatment targets. Regular exercise provides measurable benefit for HFpEF patients and should be incorporated alongside medical therapy as part of non-pharmaceutical intervention. Blood pressure is often neglected in clinical practice despite being a major modifiable risk factor; patients must actively monitor and manage their blood pressure rather than accept borderline readings.