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Series Code: UP
Program Code: UP190120A
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00:01 The following program presents principles designed
00:02 to promote good health 00:04 and is not intended to take the place 00:05 of personalized professional care. 00:07 The opinions and ideas expressed 00:09 are those of the speaker. 00:10 Viewers are encouraged to draw their own conclusions 00:13 about the information presented. 00:15 When you've got an electrical issue with your car, 00:17 it can lead to some problematic situations 00:20 and it's the same with your heart. 00:22 Over two and a half million Americans 00:24 are living with atrial fibrillation. 00:26 And on today's program, we're gonna learn the reasons 00:28 why and what we can do about it. 00:31 Thanks for joining us here for the Ultimate Prescription. 00:54 Thank you for joining us today, I'm your host Nick Evenson 00:56 and we are here with Dr. James Marcum. 00:58 And today we're gonna talk about atrial fibrillation 01:00 which, Dr. Marcum, this is one of your specialties 01:02 as a practicing cardiologist, right? 01:04 Well, I wouldn't say specialty but I'm a general cardiologist, 01:08 I've been practicing for nearly 30 years. 01:11 I practice with the Chattanooga Heart Institute 01:14 and all cardiologists at sometime or another 01:17 has to deal with atrial fibrillation. 01:20 It's the most common rhythm problem 01:23 we have in the world. 01:24 It's very common. 01:26 Lots of people have it 01:27 and unfortunately in today's world, 01:29 there's so much information, you know, 01:32 you can get information from the internet, 01:34 you can get it from your mother-in-law, 01:36 you can get it from TV, you can get it from the radio, 01:39 there's so much information. 01:40 It's hard to know even who or what to believe. 01:43 Right. 01:44 'Cause unfortunately, our health care system, Nick, 01:46 is made up of lot of people that are trying to make money. 01:50 And some of them are trying to make it for your good 01:52 and some of them aren't trying to make it for your good. 01:55 And the reason we name this program 01:58 the Ultimate Prescription 02:00 because the Ultimate Prescription 02:01 is really not a procedure, 02:03 it's really not a lifestyle change, 02:06 the Ultimate Prescription is really a walk with Jesus. 02:09 That's right. 02:10 'Cause that's gonna lead to ultimate healing 02:11 'cause we all have bad genes, we all need a savior. 02:14 None of us last forever, right? Yeah, absolutely. 02:16 We're all gonna wear out and when we do wear out, 02:19 whether it's a rhythm problem 02:21 or blockage in the artery problem 02:23 or some of the other part, 02:24 we know that in the twinkling of an eye, 02:26 God's gonna heal us as we walk with Him 02:28 and that's hope for today and hope for eternity. 02:31 I don't know how people do it that don't have faith, Nick, 02:34 I just don't know how they do it. 02:35 Yeah. 02:36 But atrial fibrillation, right? Yep. 02:38 So that's today's topic, 02:39 so let's just get into it little bit. 02:41 What is atrial fibrillation and where does it take place? 02:43 Okay. 02:44 Well, atrial fibrillation, there's a part, 02:47 the top part of the heart is called the atrium, 02:49 okay, and it pumps blood 02:51 to the bottom part of the heart, 02:52 on both sides of the heart. 02:54 The right side of the heart pumps blood to the lungs 02:57 where it gets oxygen and then it comes back 03:00 to the left side of the heart 03:01 which pumps it to the entire body. 03:03 Okay. 03:04 Well, basically, our electrical system 03:06 consist of a battery of the heart 03:08 called the sinoatrial node, 03:11 and then there's little wires that go down 03:13 to the atrial ventricular node, the AV node 03:16 and then it goes down 03:17 to specialized conduction systems 03:19 and this electrical current which consists of ions 03:22 that change positions, 03:24 fancy names called 'Action Potentials' 03:26 but eventually it causes the heart to contract, 03:29 it squeezes. 03:31 And when it squeezes, it generates pressure 03:33 that pumps the blood 03:35 whether it has oxygen or no oxygen 03:37 throughout the entire body. 03:39 So the electrical system is key 03:42 to getting the heart to pump. 03:44 So the electrical system is sort of different 03:47 than what we talked about before which is the arteries, 03:50 which is sort of like the plumbing of the heart 03:52 which gives us the nutrients, 03:54 but the wires is actually what does the squeezing. 03:56 Now the wires need nutrients too. 03:58 So the wires are depended 04:00 on the blood supply and the oxygen, 04:02 but when the wires can malfunction separately 04:06 from the plumbing system. 04:08 So the electrical system like a heart, 04:10 we need the electrical system to get that heart to pump, 04:13 to generate pressure. 04:14 Well, there's many different conditions 04:17 where the electrical system malfunctions. 04:19 Okay. 04:20 Okay. 04:22 One of them and the most common is the atrial fibrillation. 04:24 That's that top chamber, it fibrillates 04:27 and this is what fibrillation might look like. 04:29 It's just bunch of signals coming onto, 04:31 there's not a symmetric contraction. 04:33 It's fibrillating and when it fibrillates, 04:36 the blood doesn't move through as well. 04:39 So when it fibrillates, 04:40 it's at a higher risk of having a blood clot. 04:43 Also when it fibrillates, 04:44 you lose efficiency of the heart 04:47 'cause the blood doesn't move from one chamber 04:49 to the other as efficiently. 04:51 Now you mentioned a blood clot could happen during A fib. 04:54 Is that because when it's not moving correctly, 04:56 the blood may not pump through, 04:58 it may get stuck in there and then turn into a clot? 04:59 Yes, and there's a certain area called the appendage 05:03 which is a part, like a pocket 05:06 that's connected to this, 05:07 that's more prone to have the blood 05:09 that doesn't move as well. 05:11 Okay. 05:12 And when the blood doesn't move, they clot. 05:14 And if you had a blood clot in your atrium 05:17 and it happened to pump out to the body, 05:19 you could have a stroke. 05:20 Right. 05:22 It's been estimated that of all people that had stroke, 05:25 one in three people have atrial fibrillation 05:28 as the cause of their stroke. 05:30 So just recognizing 05:32 atrial fibrillation is important 05:34 'cause you could lower the risk of stroke 05:36 and we can do that with medicines 05:38 and sometimes we can put the heart 05:40 back in rhythm as well. 05:41 So atrial fibrillation 05:43 is the most common rhythm abnormality 05:45 of the heart. 05:46 It's when the top part is going very, very fast, 05:49 that's why it's fibrillating and it's atrium 05:51 because it's fibrillating 05:52 and the dangerous things about it 05:54 is one a blood clot could form 05:56 and two it could make the heart go really, really fast. 06:00 And if a heart goes really, really fast, 06:02 it sometimes cannot generate blood pressure 06:04 and sometimes it can malfunction 06:07 and we can call... 06:08 When heart malfunctions and can't get blood everywhere, 06:10 we call that heart failure. 06:12 Okay. 06:13 So the most serious things 06:14 that happen in atrial fibrillation are: 06:16 A, blood clots. 06:17 B, it can lead to heart failure. 06:21 So if we were to talk about this 06:23 in terms of an automobile per se... 06:24 Yes, okay. 06:26 If there's a number of cylinders, 06:27 they have to fire in the right sequence, 06:29 and if they don't the timing of the vehicle is off 06:30 and the car won't run. 06:32 Is this kind of similar to atrial fibrillation 06:33 different parts of the atrium 06:35 are being fired in the wrong time... 06:37 That's right. That's right. It's just out of sequence? 06:39 Remember we talked early, 06:41 normally it's the battery part of the heart 06:43 generates a signal, it goes down a wire, 06:45 there's a sort of a place called AV node where, you know, 06:49 the top part has those delay, then it goes down this tissue. 06:53 Well, in atrial fibrillation, 06:55 it's not going that normal route. 06:56 We're having signals come from everywhere. 06:58 Okay. Okay. 06:59 So you know, lots of them are getting through 07:01 to the bottom part of the heart 07:02 sometimes you ask, sometimes you don't, 07:04 but it's not going there, 07:05 it's not travelling through regular highway. 07:07 Now someone's experiencing this. 07:09 Is this something they could physically feel happening? 07:11 Is it painful or it's just out... 07:13 No. 07:14 It could be painful 07:15 and some people feel like their heart's just quivering, 07:17 and quivering would be good word for it... 07:18 Okay. Yeah. 07:20 But some people, they don't even feel it at all. 07:22 They don't even know they have it. 07:25 It's a condition that has a lot of different expressions. 07:29 Now some people feel 07:30 short of breath when they have it. 07:31 I run into some people, 07:33 we don't even know they have it till they show up 07:34 in the emergency room with a stroke. 07:36 "Oh, you've had a stroke. 07:38 Oh, did you know you had A fib?" 07:39 "Oh, no, I didn't know I have it." 07:41 Well, they could had A fib for years not noted, 07:44 eventually formed a clot, the clot pumped to the brain, 07:48 then they find out they have a stroke. 07:50 Usually the people that don't know it 07:52 are people that have a pretty strong heart 07:54 and the rhythm doesn't go too fast. 07:56 Okay, yeah. 07:58 So how does this affect? 07:59 You mentioned that people might have a clot, 08:02 but does it affect blood pressure or how... 08:04 What are the other dangers of A fib? 08:08 Well, the main, I say the main danger, 08:10 in my opinion is blood clot. 08:12 The second is the heart loses efficiency 08:14 so... 08:16 So it over uses that part of the heart muscle? 08:17 The heart doesn't contract normally, 08:19 so blood when it's contracting, 08:21 it doesn't move from one chamber 08:22 to another as efficiently. 08:24 Right. 08:25 They have estimated that you lose maybe 08:26 up to one-third of the efficiency of the heart 08:29 when you're out of rhythm like this, 08:31 atrial fibrillation. 08:32 So, and if it loses efficiency, 08:34 and the heart's weak to begin with, 08:36 it makes things worse, 08:37 you can't pump blood everywhere you need to. 08:40 You could actually go into condition 08:42 called heart failure. 08:44 So that's what it is. 08:45 Now lot of people interested in all the different causes of it. 08:50 And that's very interesting 08:51 'cause if you can sometimes find the cause, 08:54 sometimes you can prevent it from happening. 08:56 You definitely know 08:57 how to treat it more effectively. 08:58 Sure, yeah. 09:00 Sometimes it can happen just because the wires get old, 09:02 just things wear out. 09:04 Just like you have hearing prompts, 09:05 eye prompts, things just wear out. 09:07 One of the most common though is the arteries, 09:10 the arteries feed the heart blood, 09:12 if the arteries get blocked up, 09:13 the conduction system can be affected. 09:15 It can trigger atrial fibrillation. 09:17 Okay. 09:18 If any of the heart malfunctions, 09:19 it can trigger atrial fibrillation. 09:21 The valves leak a lot. 09:22 The chambers get enlarged. 09:24 That could trigger. 09:26 We see it frequently 09:27 after people have bypass surgery 09:29 'cause they manipulate the atrium. 09:31 Right. 09:32 Certain hormonal situations 09:34 like thyroid disease can cause it. 09:36 Some people if they get dehydrated, 09:38 that can trigger. 09:40 And if you run low on potassium or magnesium 09:43 and genetically vulnerable heart, 09:45 that can trigger atrial fibrillation. 09:47 So lots of things can cause it. 09:49 A weak heart can trigger atrial fibrillation. 09:52 So when someone comes in with atrial fibrillations, 09:54 we wanna make sure they're on a blood thinner, 09:56 we wanna make sure it's not going fast, 09:59 we wanna investigate the cause of it. 10:01 What's causing it? 10:02 We do it with all sorts of tests, 10:04 echocardiograms, we look at the arteries, 10:07 we look a monitors, we check the blood work. 10:09 Once we find out the cause of it, 10:11 we try to work on the cause 10:13 and sometimes we even put the heart 10:15 back in rhythm. 10:16 And that, we can do that with many different ways. 10:19 Sometimes we cardiovered it or shock it back into rhythm. 10:22 Right. 10:23 Sometimes you can use medicines to put it back in rhythm. 10:26 And now there's a procedure 10:28 that we can actually destroy this rhythm in some cases 10:31 and that's called an ablation. 10:33 We haven't always had that procedure, 10:35 but now we can go up actually 10:37 and find out where those abnormal circuits are 10:39 in certain situations 10:41 and destroy that with an ablation. 10:43 So explain the ablation to us a little bit? 10:45 How does that happen? 10:46 What's the actual procedure like? 10:47 Well, the procedure is very complicated 10:50 but you actually basically put catheters into the groin 10:53 and you go up into the atrium, the part of the heart 10:56 where most of these signals come from, 10:57 they're the pulmonary veins 10:59 and you sort of destroy in a pattern 11:02 all the different things, 11:03 the pathways of these rhythms 11:05 and that's why we called ablation 11:07 'cause we destroy it. 11:08 It's quite a long procedure. 11:10 We don't do it on everybody. 11:12 So mainly we do it on people 11:14 that are having lots of symptoms, 11:15 they can't be on the blood thinners, 11:18 that are of the appropriate criteria, 11:19 they don't have a lot of co morbid conditions 11:21 or things but it's a pretty... 11:23 But we haven't had this forever. 11:25 When I first started my career, 11:27 we did not have atrial ablation. 11:30 It was very limited what we could do, 11:31 but now we have all sorts of options 11:33 for all the millions of people now 11:35 that have atrial fibrillation. 11:37 And as the population ages, more and more people 11:40 will experience this rhythm problem. 11:42 Yeah, so the ablation, who should have an ablation? 11:45 Who's the right candidate for that procedure? 11:48 Well, first of all if a person has atrial fibrillation, 11:51 we wanna know the cause. 11:53 If we're gonna fix the cause, that's great. 11:55 Well, let's say a person comes in, 11:57 78 years old with atrial fibrillation, 11:59 it's going fast. 12:00 The first thing we would do 12:02 would be to try to restore rhythm 12:04 if we didn't know how long. 12:05 We make sure there's no blood clots. 12:07 And if there's no blood clots, 12:09 we can put the heart back in rhythm. 12:11 And the way we do that 12:12 in an emergency situation is we go and look. 12:15 We have a tube that we can place down the esophagus 12:18 right behind the atrium. 12:20 We can see if they have a blood clot 12:21 that's called a ransesophageal echocardiogram. 12:24 They didn't have the blood clot, 12:26 we can put it back in rhythm. 12:27 Okay. 12:28 And then we investigate all the other causes. 12:30 If a person has lots of symptoms 12:32 and they keep going to atrial fibrillation 12:35 and either can't take medicines or medicines are too risky, 12:38 then that person might be a candidate. 12:41 A younger person might be a candidate 12:43 'cause we don't want to have a lifelong medicines 12:46 are coming in and out of the hospital. 12:48 So it's really variable from person to person. 12:50 The specialists that deals with this in my group 12:53 are called electrophysiologists. 12:55 And they've gone to school for prolong periods of time 12:57 just to learn how to handle this. 12:59 We have some medicines that we use 13:01 to help put the heart back in rhythm, 13:03 of course cardioversion 13:04 will put it in rhythm short term, 13:06 but won't necessarily hold it for long term. 13:09 So this is the rhythm that's very complicated. 13:12 It's something that all people need to know 13:15 about how to handle it 13:17 and what are all the different options 13:18 we might choose to treat it. 13:20 Yeah. 13:21 Well we're gonna take a break in just a moment but, 13:24 Dr. Marcum, why don't you just tell us a little bit 13:25 about this atrial fibrillation? 13:27 What is the one best thing that you can do 13:30 to prevent something like that? 13:31 Is there any options as far as lifestyle? 13:32 Well, you know in general, 13:34 you know like I said if it's genetic thing, 13:38 we might be able to turn off the expression of genes 13:41 by living healthy 13:42 and any type of stressor on the body 13:44 can age the electrical system. 13:46 You know, hydration, eating greens, 13:49 you know all those things, getting enough rest, 13:51 you know, just being healthy in general 13:53 might slow the progression 13:54 but some people do all of this, Nick, 13:56 and still show up with atrial fibrillation 13:58 at some point in their life. 13:59 All right. 14:01 I tell you what, I'm gonna talk to you more about that, 14:02 but we're gonna take a quick break 14:03 and the Ultimate Prescription will be back in just a moment. 14:05 Stay with us. |
Revised 2020-01-30