Passing a STRESS TEST Doesn’t Mean You’re Safe! Harvard Cardiologist Explains

So you're saying a heart catheterization process can cause a stroke or heart attack?

Oh, sure. Yeah, you can dislodge plaque in your aorta.

Oh my God.

Cause kidney failure, strokes, heart attacks. You could have perfectly normal vessels and still end up with a stroke or heart attack. Let me tell you something. There are only 2 kinds of chest pain, the stuff that kills you and everything else.

Welcome to Prevention Is Power Podcast, the podcast that cuts through the noise and gets real about your heart health. I'm your host, J.D. Enright, CEO and co-founder of Clear Cardio, and we're here to help you take control of your cardiovascular future with knowledge, tools, and truth. Dr. Osborne, how are you today?

I am great. Fantastic pleasure, J.D.

Yes, it always is. It always is a pleasure. We've done a lot of these now and they never get boring. I'm always learning something. I know our audience is always learning something. As a patient of yours and a dedicated follower, sensei, I hear a lot from you. I'm lucky. I'm one of the lucky ones that gets to spend so much time with you. Not only in the business of Click Cardio, but as a patient of yours, you're always open and transparent and willing to tell me things that I may not want to hear because it's the right thing for me to hear. So thank you for that.

You're welcome, Grasshopper.

Okay, well, so the topic of this podcast for our listeners, because we've had a number of our listeners ask, hey, would you guys have a conversation about and talk to Dr. Osborne about— I see my doctor and I hear this all the time, right? When I'm having conversations with buddies and playing golf or at the office or what have you. And I'm like, hey, how was your checkup? Do you go to checkups? Do you see a doctor? Do you see cardiologists? A lot of them say they've never seen a cardiologist, even though they're in their 40s and 50s and 60s, because they've never had a symptom, right? They've never had a heart attack or stroke, which, as we know, kills half of us without symptoms. So they just assume everything's fine, right? Even though they may have a sibling or a parent or a friend or somebody who have had heart attacks or strokes, and some have died and some have not. Lucky ones have not. I get up every morning, I feel like I have a stress test.

Right.

Like every day is a stress test for me.

Right.

But they've had a stress test and so let's go. They've had EKG stress tests. They've had, maybe some of them have even gone as far as having an echocardiogram. And we'll talk about, for those of you who are listening or watching or both, these, we're going to go through and I'm going to ask Dr. Osborne and he's going to describe what all of these things are. Yeah. And the benefits and the not benefits of that and how that plays into really understanding cardiovascular disease. But they've had stress tests, they've had echocardiograms, they've had Maybe even heart catheterizations and other types of things. And they say to me, I'm perfectly fine. I have a heart of a 12-year-old or whatever. And I'm like, well, and they don't understand, and I try to explain it to them. So they've asked me to ask you, what's the deal with all of that stuff? What do we say to them? So can you walk us through what they're doing today?

Yeah. So I think a lot of times people get referred to a cardiologist. We're the heart vascular specialist. And therefore, well, this, this guy or girl must know all about this in a, in a very comprehensive, in a very comprehensive way. And therefore, whatever they recommend testing-wise must be the gold standard. Must be the way to fix it.

How does, how does, how does one get referred to a cardiologist in the first place?

I will say most people get referred to cardiologists either maybe they have a lot of risk factors for heart disease, no symptoms, family history, cholesterol, diabetes, blood pressure, maybe tobacco, whatever. So they have a lot of risk factors. They go, you You know, you're at high risk. We need to get you checked out.

Right. Okay.

Yeah. Or the other, the other pathway is you're having symptoms, right? Usually we'll call it chest pain. However, you know, be careful. You know, there are lots and lots and lots of different causes of chest pain. Okay. And I wish I had figured this out a long time ago, but I didn't.

Right.

But I realized several years ago, well, probably a while back, longer than that, that with respect to chest pain, which can be a sentinel symptom of heart disease, right? Or angina, as we call it, or angina. Mm-hmm.

Mm-hmm.

Right. Which basically means The pipes are too narrow to supply enough blood flow to the heart. Right. Let me tell you something that is absolutely true. As it turns out, there are only 2 kinds of chest pain. That's it. Just 2 kinds of chest pain.

Okay. What are they?

The stuff that kills you and everything else.

Okay, so it's binary.

Yeah. So stuff that can kill you. Blockages, right? Aortic aneurysms. Your aorta enlarges, splits, explodes. Explodes, right? Never good.

No.

Right.

Exploding aortas is not something you see.

The risk of mortality from an exploding aorta, an aortic dissection caused by an aneurysm where it enlarges, is 10% per hour.

Wow.

Okay.

Okay.

So blockages, heart disease, plaque buildup, aneurysms of the aorta, aortic dissection. Right. By the way, the aneurysm causes no symptoms whatsoever.

Okay.

Only until it splits and breaks open and explodes do your heart start having symptoms. And then the clock starts ticking. 10% mortality per hour.

Wow.

So that's one kind of chest pain that's lethal. That sounds awful. Yeah, it's pretty terrible. And again, no symptoms until it explodes. Okay. Fluid around the heart, pericardial disease or pericardial inflammation, pericarditis. That can be even fatal. That can be very painful, but it can be fatal as well. Pulmonary embolism. So blood clots thrown up to the lungs, usually coming from the legs.

This is what causes chest pain.

All of these things cause chest pain.

Yeah. And some kill you.

Can all be lethal. Okay. Right. Those are the big 4, I'll say. Blockages, coronary disease, pericardial disease, inflammation around the heart and fluid around the heart, aortic aneurysms, aortic dissection, exploding aortas, and pulmonary embolism.

Can Clear Cardio pick up, like, the Clear Cardio program?

Of course.

Can that pick up all the stuff?

Of course.

Okay, perfect.

Trivial.

So it's not just the plaque. You can see all that stuff.

Oh, yeah. We see all that stuff, too. The big one is blockages.

Got it.

Right. But those other 4 things can also be lethal. So as I kid people, but it's true, right? Those are the things we cannot miss. We cannot misinterpret. We need to find out, make that diagnosis promptly, and take care of you so that you don't end up with a lethal event.

Okay.

So that's, that's the lethal life-threatening heart disease, right?

Right.

Now, lots of other things cause chest pain. And the joke is in cardiology, chest pain is a pretty diffuse big term, right?

Muscular, like muscles.

It could be muscles, right? And it could be anywhere. It could be heart, right? As far as symptoms, anywhere between your earlobes To your belly button. Umbilicus, your belly button.

Okay.

Right. Any of those could cause, could be pain from the heart. However, lots of other things, right? Gallbladder disease, in no particular order. Gallbladder disease, esophageal—

Cause chest pain?

Oh yeah. Oh, absolutely. Can absolutely mimic a heart attack.

No kidding.

Oh, absolutely. Yeah.

Oh, wow.

Yeah. So gallbladder disease, esophageal spasm. So the, your food pipe, your spasm, your esophagus.

They call me a spaz, but I don't know.

Exactly right. So that can spasm and cause chest pain that can very much mimic a heart attack. Heartburn, reflux, right?

I've had that a few times.

Sure.

Too much Mexican food.

And I can't tell you how many people end up in the emergency room Worried they're having a heart attack and it's just heartburn.

When I was at the academy many, many years ago and I was just, what, a teen, and we went out, we were in New Orleans and we probably shouldn't have been drinking, but we were. We were on leave, on short leave, and we drank a lot. And then I had to get up very early next morning. It was a very hot, sweaty day. I thought I was having a heart attack. I went into the infirmary. It turns out I just had gas and I needed to fart. But it felt like I was having a heart attack in my chest.

Exactly.

But it was gas, right?

Yeah. So I always think of These symptoms that could be lethal, life-threatening, or what I call annoying but benign.

Yeah.

Right. And we don't know. Yeah. Right. If you guess wrong, you could die, or else at a minimum, you spend time and money and it's nothing. Right.

So spend the time and money.

Another, another really, really important thing I'm going to underscore as far as the heart goes. Right. The heart's a complex organ. Right. It pumps blood. It obviously has its own blood supply. That's where people get into issues with blockages, narrowings, heart attacks, stuff like that.

Makes you fall in love.

Exactly.

Complex organ.

Yep.

Yep.

It has valves, right? So there's a lot of the parts of the heart that can go bad.

Yeah.

Right.

Yeah.

There's a sac around the heart.

Yeah.

So there, there are a lot of conditions that can generate, you know, problems with the heart, but by far the most common is the buildup of plaque in the blood vessels. Okay. But I always like—

Kills 44% of us.

Exactly right. But I always like to underscore the fact that if you think of it and, and, you know, I'm a pretty simple guy, right? I'm a cardiologist. I only have 2 brain cells.

I doubt that, but okay.

This is how I think of the world, right? When you think of the heart, right, in the biggest, broadest way, there are really just 2 issues. There's electrical and there's plumbing. In fact, sometimes when people say what I do, I say, I'm just a general contractor. I do some electrical, do some plumbing. So the stuff we're talking about today with respect to plaque buildup, all that stuff, that's a plumbing issue.

So what kills you 40% to 44% of the time—

It's a plumbing issue.

Is a plumbing issue, not an electrical issue.

You can have electrical issues, right? The electrical issues, rarely are they lethal by themselves. They can cause symptoms, problems, issue, make you faint, all that stuff. But that's a whole separate issue. So when you go to the cardiologist, you get probably, well, first, before you even meet him or her, you're going to get an EKG.

Okay, so this is the first one. So EKG. So there's a whole bunch of things that doctors do to see if, to determine whether or not you have a risk of a heart attack or stroke. Okay? They're not telling you whether or not you have heart disease or not, but they're telling you you may be at risk of a heart attack or stroke, which is a symptom. Heart attack or stroke is a symptom of the heart disease. Okay, so you're saying EKG. What is an EKG?

So you get an EKG. Here's what an EKG is really good for. An EKG is literally— we put these leads, as we call them, wires on the chest, all that, and it's going to show me the electrical signals being given off by the heart. Okay? So an EKG is really good for heart rhythm problems, electrical issues, right? Heart too fast, too slow, heart blocks on the electrical side of things.

What does that got to do with plaque?

That's the problem, right? It's really good if you have electrical issues. Tells you essentially nothing about plaque, about the plumbing.

Okay, so how many people of the 44% of the people that die of a heart attack or stroke, how many of them die because of electrical systems versus plaque?

Of course, I get people where they're concerned about heart disease, they have symptoms or whatever, and their EKGs are completely normal. In fact, I've had people who've had balloons and stents and bypass surgery and heart attacks, all that kind of crap, and their EKGs are completely normal. Got it, right?

But they do it anyways because you might have an electrical problem they don't know that could be causing the chest pain or whatever problems you might have, the fluttering or whatever. But they do it. Okay, got it. But it has nothing to do with plaque.

Yeah. So the only time an EKG can be helpful on the plumbing side is when you're having symptoms. I'm having chest pain. If you get an EKG, it might maybe, but not all the time, it might pick up the fact you have a blockage when you're having symptoms because you're under stress and it's affecting the heart's rhythm. Exactly. So you can see certain electrical signals that might make you suspicious there's a plumbing problem, but EKGs are not Very accurate.

Lots of false negatives.

KGs look fine and you're in serious doo-doo. Yeah. And lots of false positives where the EKG looks funny and then as it turns out, you're fine.

Could you be having a heart attack and have an EKG look normal?

Absolutely. All the time.

Wow.

And you could not be having a heart attack and EKG could show you crazy, crazy funky. Absolutely right. So not a very good test for plumbing.

Okay. So what's—

but you come in with chest pain, you're going to get an EKG. Really doesn't further advance my diagnostics that much further.

Okay.

Because it's not going to tell me much.

All right, what about a stress test? Because I've done that.

I've run on a treadmill. So you see the doc, right? He or she does the EKG and says, okay, we're going to bring you back for a stress test. So this could be weeks in the future, right? Time goes by, you're worried, you're upset. I'm going to live, I'm going to die. Whatever time goes on, then they'll bring you in for the stress test. So there's lots of different kinds of stress tests, flavors of stress tests, I call it. The simplest is we put EKG leads on your chest and we have you run on a treadmill. Okay? The concept behind that is if I apply a load, a demand on the heart, right? Blood pressure goes up, heart rate goes up, oxygen demand to the heart goes higher. That if your blood vessels are narrowed, however, they have to be really severely narrowed, right?

Okay. How much?

70%.

Wait, 70%?

Correct.

Wow.

Anything less than 70%?

Yeah.

No symptoms won't show up in a stress test.

So 3/4 of your artery needs to be closed down.

Exactly.

Before you're showing any symptoms, right, on a stress test.

Correct.

Couldn't a stress test actually induce a heart attack?

Because we're stressing you.

Yes.

So have people died during their stress tests? Sure. And I guess the good news is—

So why would you ever—

The good news is, well, we have the diagnosis.

So you literally have to put someone on the verge of a heart attack.

Exactly. In order to just show that they're crazy.

That's insane.

Yeah, it's crazy.

Well, don't do stress tests.

Yeah, I don't.

Okay, good.

For a long, long time.

Yeah, I know. We don't do stress. We don't do any of that nonsense.

Yeah. Years ago, that's all we had.

Let's run on a treadmill like a gerbil until you drop dead. Then we know you have it.

If you don't drop dead, you're probably okay.

Yes.

It's crazy. But the threshold of detection of the disease, a plaque, starts at a 70% blockage.

Starts.

Yeah. 85% of all heart attacks are plaque rupture.

Plaque rupture, which you would never see in a heart catheterization. No, no, no.

They do not treat the disease.

They do not treat plaque. So they don't prevent heart attacks and strokes. So stents and balloons do not treat—

They're good for symptom relief. Yeah.

Symptom relief.

If you have severe constrictions.

Yeah.

But they do not prevent heart attacks. They don't prevent Cardiovascular death. And, and we've done multiple, multiple studies. Well, they— well, actually, your heart catheterization causes strokes. Want clarity on your arterial risk? Click now the link in the description to schedule your Clear Cardio patient assessment call. We'll review your risk factors, see if our advanced program fits you or points you in the right direction.

So why did they put— so when I was on the treadmill, and I've had friends like those of you who've ever been in a stress test, you probably relate to this. I was on a, I was doing a stress test running on a treadmill. They were going up, raising the height, you know, to put me under more stress.

Right, exactly.

I hated that. But they also had leads on me.

Sure.

And I had a mask on, right, to breathe through it. Why were they doing all of that? Why were they doing an EKG if they're testing for heart disease on a stress test?

So that's called a cardiopulmonary stress test. Again, lots of different flavors of stress tests. We don't have time to go through all of them. Yeah. But, but I think more importantly how they all, yeah, share the same roots.

Right.

So the purpose of the EKGs is As I apply a load to the heart, make the heart work harder, requires more oxygen, more blood flow on the EKGs, there can be, underscore, can be certain changes on the EKGs that might give me a suspicion there could be a blockage.

Well, a lot of soft language in there. Might, can, sort of.

Exactly. Yeah, that's terrible. So you could have a completely normal stress test and have lots of plaque and have a heart attack the next day, the next week, or on the treadmill itself. Okay. You could have a funky looking stress test and the blood vessels be perfectly fine.

Okay.

The threshold of detection with a stress test, assuming it is completely 100% accurate, which it is not, will only begin to detect the disease of plaque when you have a 70% blockage.

Okay.

Anything less than that, it'll be normal.

Alright, just to set a baseline for our listeners and those who are watching us from home, plaque is what causes the heart attack and the stroke. The absence of plaque in the arterial walls of your arteries means you will not have an ischemia-based heart attack or stroke, correct?

Correct.

Alright, 100%. That is a fact. So what we're looking at is how do today's testing, standard of care testing, not Clear Cardio, that's a whole nother animal. Stress tests don't determine plaque or identify plaque at all. And in fact, could kill you if you did have a plaque rupture or whatever at the time. Okay. So what's next on that list?

Yeah. And so again, just stress tests, anything less than 70%, it'll be normal.

Yes.

But also appreciate because we're not seeing the blood vessels themselves. We're not seeing the plaque.

Right.

With stress tests, you have about a 25% to 40% false negative rate. So there is a severe blockage. It is greater than 70%. Your stress test looks fine, but only 25% to 40%.

Wow.

So do not take a normal stress test to the bank.

It's very inaccurate.

Yeah.

Yeah. The flip side of that doesn't sound very scientific, actually.

No. Yeah. Right. The flip side of that is 25% to 40% false positive rate. That is, the stress test looks funky, And you go, oh, I just had a positive stress test. Well, what happens then? Guess what? You now graduate to an invasive heart cath or angiogram or cardiac catheterization.

Okay. So for those folks that are watching who don't know what a heart cath is or heart catheterization, am I saying that right?

Yeah.

What is a heart catheterization? Sure.

So because we know that stress tests are not terribly accurate, they're certainly not sensitive, but even if they look abnormal, doesn't mean there's blockages. Right.

Okay.

That's a false Positive. The stress test looks funky. You're fine. So in the old days, because I haven't done a heart cath for 20 years.

Yeah.

Because it's all done with cardiac CT now.

That's what Killercardio does.

Yeah. Right. We would then take those poor people to the cath lab. So in the cath lab, that's where we take— I call them silly straws, right? These big long tubes. They're multi-feet long.

Okay.

We take that—

Take the patient—

Tube to the cath lab, right? It's an OR-like situation.

It's an operating room.

Yeah.

Operating room.

Okay. Everybody's in scrubs and masks and all that stuff.

Okay.

All sterile.

We— What do you do with the patient? Does the patient get anesthesia?

Yeah. So we give you, So believe it or not, we give people sort of a, like a twilight anesthesia where you're kind of like, you're not there, but people—

Like last night when I had too much wine.

Yeah, exactly right. Yeah. I was in the twilight zone. Yeah. Kind of sort of like what they do for colonoscopies, if you will. Not quite, but similar.

I don't remember my colonoscopy at all.

Oh yeah. Yeah. They, they use better drugs. Yeah. Yeah. No, these—

I slept really good.

So I, I will tell you, so here's a little interesting thing. The little cocktail we use is a little bit of some injectable Valium-like drugs. Okay. Right. So chill. Plus they're, they actually, cause you not to form memories.

Oh.

Yeah. They're amnestic.

Wow.

So we're introducing pharmacologic amnesia, right? With a little bit of— it's not Valium, but drugs like that.

Can you take away from my childhood, like, you know, trauma? Exactly.

Truth serum.

That'd be a big thing. Oh yeah.

It's all written. It's all written down. Yeah, yeah, yeah. I will— it will be used against you. So, so we give a little Valium-type drugs intravenously. And then the other drug we give is basically a painkiller.

Okay.

It's called fentanyl.

No kidding. Fentanyl. Wow. There's his phone. Sorry about that, guys. He's got the phone. It's all good. He's a busy guy. We've got a lot of patients that are trying to get ahold of him.

So, yeah.

But yeah. So, so they actually give, they actually give patients fentanyl.

Yeah. Yeah.

Yeah. So you hear about it in the news all the time, but it is actually a very valuable tool. Oh, sure.

I mean, we've had it, we've been using it for decades. Right.

Yeah.

Yeah. You know, used appropriate medical supervision and all that. It's a very good drug and, and, and really introduces this nice sort of twilight. So there's a large artery.

Yeah.

Called the femoral artery, right in your groin.

Right. Okay.

Big artery.

So how near your junk is that artery?

A few inches.

Okay. Yeah. All right. So you're in the vicinity of the junkness.

Exactly.

Okay.

Got it. So, and really the only change that's occurred with heart catheterization from 30 years ago to now is that now we go through the wrist. Oh, that's it.

Why? Because it's closer.

It's closer away from the junk.

Okay.

Got it. But in reality, the difference is if we go through the wrist, it's a smaller vessel, right? But I can put what we call a compression Dressing on it that's really tight, and you can get up off the table and leave right away. If we go through the groin, I gotta apply pressure. It could be painful. The vessel is, is actually, you know, an inch, couple inches or so below the skin.

Unless you gotta go deep in. This is right on the surface.

On the surface, just subcutaneous. So if you have bleeding, I can see it. You could bleed here and I couldn't see it.

Got it.

So the big reason that we switch to the wrist is the risk of bleeding. Plus, you know, if we go in the groin, you gotta be on your back for several hours, then you can get a blah, blah, blah. You do it in the wrist.

Yeah.

If you bleed, we'll see it. And then plus you put on compression stocking, compression, compression dressing. Yeah. And very tight. And then you're up and you're off and you don't have to sit on the table. So, so, but that's the only, the only change that occurred.

Got it.

In 30 years of an invasive angiogram. So we take that big silly straw. Yeah. Catheter.

So they rush you into the cath lab. You fail the stress test. Yep.

And it's in, well, actually in reality, for the most part, unless you're having a heart attack right then. Yeah. There's another several weeks, another appointment. Right.

So now you've delayed weeks, maybe months to get in to see the doctors. Right.

Right.

And then who knows what could have happened between that time period of time. But now you've got a stress test that is not very reliable. An EKG that doesn't add the value.

In fact, if you go to the cath lab, as we call it, to do a heart catheterization angiogram, here's the stats. And this has been very constant for the last several decades.

The statistics.

Yeah. Right. 70% of the time we'll find no blockages.

70% of the time.

So yeah, I'm going to the cath lab. It's $20,000 invasive test, risk of bleeding, strokes, heart attacks. Right. We're going to—

Wait, hold on. So you're saying a heart catheterization process can cause a stroke or heart attack?

Oh, sure. Yeah. You can dislodge plaque in your aorta.

Oh my God.

Cause kidney failure, strokes, heart attacks. In fact, you can have perfectly normal vessels and still end up with a stroke or heart attack.

Wow. Because of the catheterization?

Because of the procedure. Right. Wow. Yeah.

Seems like risk to me.

And I mean, I've seen this, right? I've seen people have strokes after heart catheterization.

Yeah.

Right.

Yeah.

And that's not good.

Yeah.

And then we say, oh, but your heart cath was great. There was no blockage.

Wow. So, so that's gonna suck it. So, so you got an EKG that doesn't identify plaque, which is the cause of heart attacks and strokes. You've got a stress test that is flawed at best and doesn't identify plaque, which causes heart attacks and strokes.

Right.

But then if you did fail, whether it was a true failure of a stress test or if it was a false positive, correct, you end up in a catheterization lab, right, with this silly straw going up your arm, right, and which can cause heart attacks and strokes, infections, bleeding, and infections and things like that.

Also, one downside is going through here. There's some important nerves that go to your hands.

Got it.

So that wasn't so much an issue here. But yeah, you can end up With nerve imagery. Okay.

All right. And so, okay, so at least tell me that a heart catheterization can show me plaque that causes heart attacks and strokes.

No.

So it doesn't? No.

Now, it can see blockages.

Okay.

Right.

Yeah.

It can see narrowings to some degree.

Right.

Right.

Do narrowings and blockages, do they cause heart attacks and strokes for the most part?

Not really.

No.

No.

They cause symptoms.

They can cause symptoms.

Like what? Shortness of breath, chest pain, angina, things like that.

Could be just shortness of breath.

Yeah.

Right. I've been working out for years, and then last 3 months, I mean, I can't do it anymore. Or another scenario, guys, right? Is, yeah, I, I, I, I mow the law— the mow the yard.

Yeah.

But I can't do it now cuz I get very short of breath.

Right.

Yeah. Even, even in the absence of, of what we call chest pain or angina. Right. Shortness of breath is what we call an anginal equivalent because the heart's not getting enough blood flow when it needs it cuz the pipes are small.

So if plaque causes heart attacks and strokes 100% of the time, right? Or 99% of the time. Yeah. 99% for ischemia, right? 99%. 99% of the time. And, and the heart catheterization doesn't detect Plaque. It just detects the result of plaque. And that could be a—

Which is a narrowing of the vessel.

Narrowing of the vessel.

Right.

Right. You won't actually see plaque because plaque's in the wall of the artery.

Exactly.

What you're seeing is a result of a symptom of wall of plaque in the artery narrowing the artery.

Right.

And you can, and they can only see it or do anything if it's 70% blocked or better. Yeah.

So we'll not have restriction of blood flow down that vessel that cause symptoms, chest pain, angina. So no symptoms until a 70% blockage.

Okay. And how many heart attacks and strokes are caused by Restrictions in the blood vessel. Very few versus, like, plaque bursting into the artery.

Very few.

Very few.

85% of all heart attacks are plaque rupture.

Plaque rupture, which you would never see in a heart catheterization.

No.

Wow. Okay, so EKG doesn't add any value for plaque, which is the number one cause of all heart attacks and strokes, or 99% of them. A stress test is flawed at best and still doesn't show you where the plaque is and how much plaque you have.

If there is plaque.

Or if there is plaque at all.

No idea.

No idea. A heart catheterization, invasive, can cause— it's expensive.

Right.

It's invasive. It can cause all kinds of complications, including heart attacks and strokes. Won't— can't do anything, like, won't notice anything. You won't have any symptoms unless you have a 70% blockage.

Right.

Blockages don't kill most people.

Right.

And they can only put a stent or balloon to treat the To treat the symptom. Right. If you have a 70% blockage, you're better.

Exactly.

Okay.

And by the way, stents.

Yeah.

And the same thing for surgery, improve blood flow in the setting of a, of a tight constriction. Yeah. Right. They improve blood flow, they improve symptoms. Right now I can mow the lawn without having chest pain, angina, breathing, whatever. They do not treat the disease.

So they don't treat— they don't prevent heart attacks and strokes.

Yeah. So stents and balloons, they're not good for symptom relief.

Yeah.

Symptom relief if you have severe constrictions.

Yeah.

But they do not prevent heart attacks. They don't prevent cardiovascular death. And, and we've done multiple, multiple studies. Yeah. Well, they, well, actually your heart catheterization.

Yeah.

causes strokes. Okay.

So why would anybody do that?

Well, I will admit I did till 20 years ago.

So you haven't done a heart catheterization in 20 years?

Yeah.

Okay. And you see hundreds of patients?

Yeah.

Some with severe heart disease, right? No heart. And okay. Wow. So what else do they do that we shouldn't be doing or don't need to do?

I'll say this just for completeness sake, and this gets back to the electrical side, right? You have palpitations, heart rhythm, maybe you're fainting, passing out, whatever.

Yeah. I was dehydrated a couple of times when I was younger and I got fluttery heart.

So on the electrical side, not the plaque side, but the electrical side, we'll do these things called Holter monitors, right? Invented by Dr. Holter, right? And so these are devices, they're, they're kind of like a size of a pager. They got leads, wires.

Mm-hmm.

Uh, you got EKG leads, kind of a pain in the butt.

Mm-hmm.

When you put 'em on, you can't shower, bathe, swim, whatever. And we'll, we'll leave 'em on maybe 24, 48 hours. Uh, they now have evolved to now we have this little patch-like device that we can slap on there for 7 days. What that's gonna do is giving a 24-hour EKG or 48-hour EKG or a week-long EKG. Very helpful.

Like a snapshot of a couple seconds or something like that?

No, it's actually continuous.

Oh, it's continuous.

Yeah, it's absolutely continuous. So if there's an electrical problem, particularly those that come and go as they typically do, right? So plaque doesn't come and go, but electrical problems can.

Yeah.

Okay.

Right?

So we'll use that to help figure out electrical issues, right? Could be helpful, a little tedious. And these patches and all that are very expensive. We're talking thousands of dollars, right?

Nothing to do with plaque.

Nothing to do with plaque.

Hard plaque.

But, but there is now a tool called the Kardii 6L, Kardii 6L, K-A-R-D-I-I, made by a company called LiveCor, where it will do a medical-grade EKG So now most all the people were, they were concerned about electrical issues. You buy this, it's $129. You can get it on Amazon. Kardia, K-A-R-D-I-A 6L. And if you have palpitations, heart rhythm stuff, whatever, generally that's all you need. And it replaces the Holters and things on your chest and all that stuff.

We'll put a link, we'll put a link, guys.

Yeah.

It's a great product down below the description on the, on this podcast. So if you're interested in that.

But that's a great tool on the electrical side. But I mentioned that to be complete. But within, and sometimes too, as far as diagnostics for heart stuff, sometimes they might recommend cardiac MR or cardiac magnetic resonance. Right. So that's an MR machine, a magnetic resonance machine or an MRI.

That's what I know it by, an MRI.

Yeah.

That's where it goes.

Yeah. Bing, bing, bing, bing, bing, bing, bing, bing, bing.

I call it the coffin.

Right. It's pretty tight.

The coffin of destiny.

The coffin of destiny. Right. So sometimes we'll do MRIs, but that's really to look at the pump function. Right. I told you before, You can have lots of problems with your heart. Some people develop heart failure. The pump's not working well.

Congenital problems.

Stuff like that. So MR is very, very good for that. CT is actually just as good, if not better. But sometimes we'll do MR. Again, pretty expensive, thousands of dollars. Some people can't tolerate the MR machine because it's so constrictive. They get claustrophobia. And then the other thing is, if you have implanted metal, that could be a big, big problem as well. Pacemakers used to be an issue, but that's another sort of diagnostic. That's really more if you have a muscle problem.

Got it.

Tells you nothing about the coronary arteries.

Nothing about plaque.

Nothing about plaque.

Which is the number one killer of all.

Exactly.

Okay.

Got it.

Right.

So I think that kind of rounds out, I mean, there's flavor, different kinds of stress tests and flavors of stress tests. One flavor of stress test that we do, because we knew that the, quote, plain old treadmill stress test, right? EKG treadmill.

Mm-hmm.

Was insensitive, inaccurate, nonspecific, right?

Mm-hmm.

So in order to make it more accurate, what we do, and we literally do about 10 million of these every year in the United States. They're thousands of dollars. Wow.

That's a lot.

is we put the leads on, we put you on the treadmill. If you can't be on the treadmill, you can't walk or whatever for any reason, we can give you drugs that basically stress the heart.

Okay?

But we'll say treadmill. And then what we do is we take a set of pictures after injecting an isotope, a radioactive isotope into your bloodstream. That's going to show me the blood flow to the heart muscle at rest. Remember, you're going to have normal blood flow until you have a 70% blockage.

Got it.

Wow.

Then no symptoms.

No symptoms.

Right.

Then We put you on the treadmill at peak stress. We inject the isotope again to look at blood flow with exercise. So we have a set of blood flow pictures at rest, which hopefully should be normal. And then we have a set of blood flow pictures with exercise. If we see blood flow is markedly different after stress, that is a suggestion you have a blockage.

But again, that will not occur until you have at least a 70% blockage.

So anything less than that, and it's a pretty hefty radiation dose.

And it's showing blockage. It's not showing Plaque.

It's still not looking at plaque.

Can't measure plaque, which is the only, which is the 99% of the time which causes— okay, so let's just recap real quick for the audience, those listening, watching.

So the, the, for those playing the home game.

Yes, exactly. So what we, the entire podcast was based on what is the standard of care for today's modern medicine for determining whether or not you're at risk for a heart attack or stroke? Do you have heart disease? And so we talked about, we talked about a stress test, we talked about an EKG, we talked about, we talked about the heart catheterization.

Oh, we didn't mention the echo.

Oh, echocardiogram.

Yeah, the echocardiogram. Ultrasound. Sorry. Echo, as we call it, or echocardiogram. So that is using ultrasound to take pictures of the heart. Okay. Now, it's a great test. It's simple, it's easy, relatively inexpensive, no radiation, noninvasive.

Right.

So it is a great test to look at the squeeze of the heart, to look for congenital abnormalities, malformations of the heart, like valve. It's great for valves. Right. It's great for all those things. Right. Enlarged chambers, congenital abnormalities. Chambers not hooked to the right pipes, all of those things. And valve issues.

Does it find and show you plaque?

One cannot see plaque on an echo. You can't see the blood vessels of the heart. You can't see the coronary. So it tells you nothing about the blood vessels and plaque unless you've already had a heart attack. And I can show you, oh, there's a scar. But that's all after the fact.

After the fact.

So can't see the blood vessels of the heart. So again, good for heart function, the squeeze of the heart, good for valves. But again, tells me nothing about the blood vessels, Or plaque.

Okay, so, so far we've heard from you that not one single of these tests identify the number one cause of all heart attacks and strokes, which is arterial plaque in the arterial wall. Is— are we hearing that correctly? Is that—

Yeah, absolutely. Okay, so I'll underscore that. So as I said before, I stopped doing heart caths, angiograms, invasive caths 20 years ago. Okay. Because that was the year we got our first 64-slice cardiac CT when they first became commercially available.

Yeah.

Okay. We were one of the first in North Texas to have one of those. And it, the data was so good and I could see stuff I could never see before.

Mm-hmm.

I called it the virtual autopsy. I could see plaque. I could see if you had narrowings, I could see that. But more importantly, I could see plaque and then I could see beyond that. I could see if it's hard plaque, calcified plaque, inactive plaque. I could see it's, if it's what I call the lava, the lipid-rich or cholesterol or soft plaque, none of which you could see on a heart cath angiogram or any other tool. Right.

So it sounds to me that it sounds to, to us here that modern medicine is not very modern at all, is it?

No. So, in fact, because of that Stone Age, I almost immediately with that ability to do it, 5% of the cost, none of the risks of a heart cath or an angiogram, I could see actually the plaque. I can determine what kind of plaque it is, of which you can't do except with cardiac CT. So almost immediately I gave up doing heart caths. It was no longer, why would I do that? Why would you waste your time doing that? Risk, cost. Yeah. Right. And, and I, I, There are things I just couldn't see. Yeah. On, on invasive heart cath, which, quote, back then was the gold standard. Yeah. Unfortunately, many of my colleagues say it is still the gold standard.

Yeah.

And I'm gonna say I haven't done one for 20 years.

Yeah.

And never looked back.

So, so at Clear Cardio, you're the chief medical officer at Clear Cardio. You see a lot of patients. What does, what do you do now? What, what, what is the now, you know, if we can now, you know, put that behind us, we, we recognize and we accept that modern medicine's not modern medicine. It doesn't identify the root cause of heart disease, heart attacks and strokes, which kills 40-something percent of us. Globally. So let's stop doing all of that. Okay. What do you do instead?

Yeah. Tedious. Takes a long time. We're talking a workup that could last weeks to months and tens of thousands of dollars.

Right. So we don't do that anymore.

Right.

What do you do now? Like, what do you do at Clear Cardio to replace all of that that actually gets to the root cause of the disease and shows you?

One test.

One test.

Yeah. We do a cardiac CT. And we started out 20 years ago, light bulb went on for me, stopped doing heart gas with a 64-slice CT machine. Time, technology occurs. Now the state of the art is 640 slices, which is what our machine has.

10 times.

10 times, right? iPhone 1, iPhone 16.

3-dimensional modeling and everything. Yeah.

Beautiful high-resolution 3-dimensional modeling of the heart. So we get basically that echocardiogram, look for structures, dimensions, valves.

You get all that.

You get all that for free.

Yeah.

I like to say. Yeah. But most importantly, we can see those blood vessels. We can do all this kind of crazy stuff with the computers because we have this high-resolution 3-dimensional data. We can fly up and down your blood vessels, turn them, spin them, straighten them out. And if there is plaque, if there's a speck of plaque, we can now see that in a way that we never ever could. It was impossible using cardiac CT to give us the images.

Yeah.

And then layering on top of that, this cutting-edge AI technology.

FDA-approved AI technology. Exactly. Their cardio implants. Yeah.

That sees plaque, sees more plaque than I can see with my eye. Mm-hmm. And then will absolutely reliably quanti— quantify it. So I know exactly how much plaque you have and then break it down into the 2 major kinds of plaque. The hard, which are the hard plaque, the calcified plaque, the inactive plaque. I call that the cinder cone.

The calcium stuff.

The calcium plaque. That's end stage, not going anywhere, no longer active plaque. Most importantly though is what I call the lava, right? A cinder cone, but the lava, which is the lipid-rich soft plaque, that is the active plaque. That is the plaque that ruptures and kills people and causes heart attacks.

So we didn't talk that. You just probably have a good point. So I had a calcium score done once.

Okay.

And I know a lot of my friends have done calcium scores, which is like another one of those tools along with The stress tests and the catheterizations and all of this other stuff. So what does a calcium score tell us? How valuable is that in finding the dangerous plaque?

Yeah, so a calcium score is a little bit closer because now we're kind of getting a better idea.

You're looking at the blood vessels, right?

Okay, that's close to it. So that's closer to what we'd like, right? We're not looking at blood flow. We're looking at, is there plaque? Here's the problem with the calcium score. It only detects the calcified plaque. The, the, the plaque will always start out as lava. Mm-hmm. Just like a volcano.

The dangerous stuff.

And then it will eventually cool down and form the calcified plaque.

And calcified— the calcified plaque cause you, cause you a heart attack or stroke? No. So stable. Knowing your calcium score, you knowing your calcium score doesn't really tell you what your risk of heart attack and stroke is or tell you if you have soft plaque.

Because it's seeing the wrong plaque.

Yeah.

Now I can tell you if you have a calcium score and it's not zero, and unfortunately we're, we're doing more calcium scores, which is good. They're cheap. They're, It's a non-contrast study. It's cheap, but they're ubiquitous. Lots and lots of places offer, and it's great. However, here's the caveats. A, with a calcium score, I can't see blockages, right? You could have blockages. It could be all on the wall. No idea. More importantly, I can't see the lipid-rich plaque, the lava, the softer cholesterol-rich plaque.

That's what kills you.

That is invisible. It's a calcium score. All I can see is calcium.

Okay.

The other mistake that I find, unfortunately, all the time is that people get a calcium score, And they'll get the results back and they'll say it's low. Well, there's no such thing as low. It's either zero or you have plaque. If you have a positive calcium score, my friend, you have plaque. What you do not know, are there blockages, which you can't tell from calcium score? And most importantly, what about the lava? I can see the cinder cone. I can see the extinct volcano. I don't know anything about how much lava there is or if there's lava.

Where it is, how much it is. Right.

No idea.

Okay.

Right. So it's a good place to start, right? I would sort of, the way I use this analogy is think of the calcium score like a mammogram, right? So on a mammogram, we put women through this. By the way, the radiation exposure with calcium scores or cardiac CT with the kind of equipment we use is about the same as mammogram.

So really low.

Yeah, pretty low, right? Particularly for disease that kills almost half of us.

Yeah, it's worth it.

Yeah, right. So, and by the way, the radiation exposure is very similar. So Why don't you get a cardiac CT with AI and it be done with instead of getting a calcium score, then a cardiac CT? Now you got double the radiation.

Just do one. Just do one and get all the, and all the information about the vessels. And you're done.

That's it. Right. It's there. Not there.

So for, for, for the listeners and watchers today, Dr.

Osborne, nothing but calcium score. Again, nope. We can't see the invisible plaque, which is—

well, that's what I was just gonna ask you.

Yeah. Invisible. I was gonna ask you, 'cause it's calcium score.

Yeah. So can you have a zero calcium score? Yes. And, and every, and pass your stress test and EKGs and everything. All that looks good. Zero calcium score, but still have substantial dangerous low-density plaque that can cause a heart attack or stroke.

Yeah. Only 25 to 30% of the time.

That's a lot. So it's like up to 30%, a third of the time you could have a zero calcium score, right?

And have lots of lipid-rich, dangerous plaque, cholesterol-rich and soft plaque that is invisible on a calcium score and be on the road to a heart attack or stroke. Right.

Okay. So why would you bother? Why bother? Just go directly to that. And I know this sounds like a little bit of a commercial, guys, but The facts are the facts. And, you know, when you, when you really dig down and pull back the, you know, what is it? Peel the onion, pull back the curtain, right? Whatever analogy you wanna say, open up the kimono and look at this. You know, the facts are the facts. And so why wouldn't you just go directly to that? Right.

And that's what we do.

Yeah.

Right. And that's why we have people earlier today. We talked to Jerome Bettis. Be sure to check out that podcast. Great.

Oh, that was awesome, guys.

He was fantastic. Right. We talked to the bus.

Yeah.

The bus was In really good shape.

Yeah, that was great.

Yeah, despite having a bad family history, he was good, which is fantastic. Love to share this.

You guys got to check that out. You got to really check that out. That was a great podcast.

So check that out. He came all the way from Atlanta and he came in, we did a scan and that was it. Yeah. Right. So, but it was amazing.

The story was just like, yeah, that's right.

No EKG, stress test, immediate heart catheterization, blah, blah, blah, blah, blah. Weeks to months, thousands of dollars done. Yeah. That was it.

And everything else. As a professional athlete, he's been through the wringer. He's been through everything. He's been poked and prodded and scanned and Had insurance on him, the whole, I mean, we, he gave us the whole story. That's a really good podcast. And we won't give it away all in this, like some of the things that we found and didn't find and all that stuff. But you gotta check that out. That was really good.

Yeah.

And he walked away going, no, I don't.

And then that was it.

Yeah.

There's no further testing.

That's it. It's either now you treat it or you don't. Right. Either you have it or you don't.

Right.

Yeah. And we can treat it, right?

Right.

Yeah. We can cure it. Well, this has been fantastic, Dr. Osborne. Once again, I really appreciate you spending the time with our listeners, followers, people that really care about their heart health. Um, and for those of you who've been watching our podcast, thank you for joining us today with Dr. Osborne. Um, Dr. Osborne, before we close, before I close things out.

Yeah.

If you would just say—

I got a good one.

Yeah. Just give one. I got a good one.

Yes. Yeah. I, you know, we're not just gonna save your money.

Yeah.

We're gonna save your life.

Yeah.

Right.

Yeah.

There's no equivocation. There's no could be, maybe, possibly, I don't know. Not sure about this.

Yeah.

Right. We put you in the donut of destiny.

Yeah.

It is there or it's not.

Yeah.

That is it.

Yeah.

Right. One test.

Yeah.

That's it.

Yeah. And you don't have to wait 3 months and get referrals and go to deal with all that stuff. You just give us a call, go to clearcardio.com, give us a call, shoot us an email. We'll have one of our folks reach out to you and get you in and get the chance to meet with Dr. Osborne, and we'll look under the hood.

And lastly, if someone says we need to do a stress test, you gotta run.

Run.

Run.

Run. Run.

Yeah.

Just, you only need one test. That's come see us at Clear Cardio. So, yeah. So thank you guys for watching. If you enjoyed this, hit the like and subscribe button below. And if you have concerns and you want either someone in your family or yourself, you know, give us a call and go to clearcardio.com and check us out. And until next time, you know, thanks. We thank you for watching another episode of Prevention is Power podcast.

Don't miss this other episode right here on the screen where we will reveal the missing answers you need to know about true cardiovascular prevention. And if you're ready for absolute clarity on your arterial risk, click the link in the description to schedule your Clear Cardio patient assessment. We'll look at your specific risk factors and see if our advanced program can help you.