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Series Code: UP
Program Code: UP190123A
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00:15 Each day a healthy heart beats about 100, 000 times
00:18 at a rate anywhere from 60 to 100 beats per minute. 00:21 Physical activity, diet, medication and age 00:24 are all common factors that can affect heart rate, 00:27 but what causes the heart to sometimes beat too slow. 00:30 Today, we'll learn about rhythms of the heart 00:32 and what we can do about them 00:34 right here on the Ultimate Prescription. 00:56 And thank you for joining us today 00:58 for the Ultimate Prescription. 00:59 I'm your host, Nick Evenson here with Dr. James Marcum, 01:01 and today we're talking about slow rhythms of the heart. 01:04 Dr. Marcum, welcome to the program. 01:06 Yeah, it's my pleasure to be here, Nick, 01:08 and I must compliment you on that tie. 01:10 Oh, thank you. 01:12 This is actually a tie I got from my grandfather. 01:13 So it's a special tie. 01:15 You know, I in my younger days used to wear ties. 01:18 But now as I've gotten older, 01:20 it's more important to be comfortable, you know. 01:22 Yeah. 01:23 Well, you know, you've got a stressful job. 01:24 So comfort, 01:26 comfortable attire is important. 01:27 Yeah, well, I've got... 01:29 Well, I can wear the tie occasionally but, 01:30 you know, the casual look, it makes more comforable. 01:34 Hey, what are we talking about today? 01:36 So we're gonna talk about slow rhythms, 01:38 and also maybe a few fast rhythms, 01:40 but let's talk about you for a second 01:41 because some people, 01:42 we may have some new viewers 01:44 that don't know who Dr. Marcum is. 01:45 You are a practicing cardiologist 01:47 with the Chattanooga Heart Institute 01:48 and also speaker/director of Heartwise Ministries. 01:49 Yeah. 01:51 And I've been practicing, 01:52 I guess one of the things 01:54 that I can say I've been practicing now 01:55 for quite a while and I wish all the things 01:59 I've learned through the years 02:01 I knew back when I started back in the early 1990s. 02:05 You know, 02:06 when you're younger you wish you know, 02:08 and I wish I had the energy I had back then now. 02:10 So now we in Chattanooga Heart Institute, 02:13 we have a group of 50 now, 02:16 30 cardiologists and surgeons and then 20 providers. 02:20 And now that I'm the fifth or sixth oldest in the group, 02:24 I, you know, 02:25 I've almost outsourced myself out of a job. 02:28 Years ago in the practice of cardiology, 02:30 cardiologists used to do a little bit of everything. 02:33 But now, every 10 years everything changes, 02:36 you have to learn everything over again, 02:37 including cardiology, 02:39 but I've also found that, Nick, 02:41 it not only changes in the technology part, 02:43 but also I've looked at the lifestyle part, 02:46 that's changed quite a bit too. 02:47 You know, 02:49 we used to focus a lot on nutrition 02:51 and I think all that's important. 02:52 Then for a while we started on movement 'cause 02:55 we noticed that people weren't moving very much and now, 02:58 the big emphasis lately on preventing and reversing 03:01 disease has been on mental health 03:03 and bowel flora. 03:06 So everything changes. 03:07 But, you know, one thing that hasn't changed 03:09 is the most important thing and that's the spiritual walk. 03:14 Because all of us have bad genes, 03:16 we all need a Savior, 03:17 we're all gonna break down. 03:19 And when we do break down, when we have Him in our heart, 03:22 we know that in the twinkling of an eye, 03:25 our genes are gonna be made good again, 03:26 we're gonna be healed. 03:28 And that's sort of what keeps me going day to day 03:30 is that I have opportunities to give that hope to people 03:34 that might not do so well. 03:36 And not everyone does well 03:38 with these modern medicine and procedures, 03:40 you know, sooner or later, 03:41 we run out of things that we can help people with. 03:43 Right. 03:44 So we're gonna talk about slow heart rhythms. 03:46 Do you know what a heart rhythm is, Nick? 03:48 I'm gonna quiz you a little bit. 03:49 The heart rhythm goes bump bump, 03:51 and that's a rhythm, right? 03:52 Right. 03:53 But do you know how you can check the speed of your heart? 03:56 Well, I do know a little bit. 03:58 You can check a pulse, 03:59 the radial pulse on the wrist here. 04:01 And it's a little difficult to feel, 04:03 takes a little practice but you can feel there. 04:04 Or right here on the carotid artery 04:06 and you can count for... 04:07 watch the clock and count for a minute 04:09 and then that's your heart rate. 04:11 And I think that's a good thing 04:12 for everyone to learn how to do 04:14 because if you're sick, guess what? 04:16 Naturally your heart's gonna go fast. 04:18 Yeah. 04:19 So, you know, if you're infected 04:20 or you have a losing blood, if you're having pain, 04:23 your heart's naturally gonna go fast 04:25 because it wants to pump blood to every organ that needs it. 04:28 Now we talked about well, 04:30 what would cause a heart rhythm to go slow? 04:33 And what's dangerous slow, okay? 04:36 Well, dangerously slow is any heart beat that so slow, 04:41 that it can't generate a blood pressure. 04:43 Now some highly tuned athletes which I am not, okay? 04:49 Their hearts can pump 40 beats a minute 04:51 and they get plenty of blood flow 04:52 and it's not a big deal. 04:54 This is normal slow. 04:55 This is their resting heart rate? 04:56 Say like in the evening when they're sleeping 04:58 or the first thing in the morning. 04:59 'Cause their heart is so efficient. 05:00 Yeah. 05:02 And their vascular system is all very healthy. 05:04 Very healthy, very efficient. 05:06 So their heart can go for in 40 and they get blood everywhere. 05:09 But some people, they go slow 05:11 and it's what we call pathologic 05:14 where it's dangerous. 05:16 And there's some medical conditions 05:18 that can make the heart go slow. 05:20 For instance, an underactive thyroid. 05:23 Remember, the thyroid is the organ 05:24 that keeps us regulated. 05:26 So if you run out of thyroid, your heart's gonna go slow. 05:29 Make sense? Yeah. 05:31 I had one lady once that took a medicine 05:34 called a beta blocker, 05:35 which slowed the heart rate down 05:37 and helped the heart strength. 05:39 And every time she felt like she was having a heart problem, 05:41 she says, "Well, my heart's not doing good. 05:43 I'll take a beta blocker." 05:44 And it made her heart go slow. 05:46 Slow it down some more, right? 05:47 So one day she says, 05:49 "Yeah, I don't feel good. 05:50 I'm taking a beta blocker. 05:51 I still don't feel good. 05:53 I'm gonna take another one." 05:54 A lot of times you got to the emergency room 05:55 her heart rate is going 20 and her blood pressure was 70. 05:58 She wasn't feeling very good. 05:59 So medications can also make the heart go slow. 06:03 There are certain herbs and plants 06:06 that can make the hearts go slow. 06:08 One of the biggest ones through the years 06:10 that people have heard of is one called digitalis. 06:13 That's a medicine or herb 06:15 that can make the heart go slow. 06:17 So medicines can make it go slow, 06:18 thyroid can make it go slow, 06:20 if you lack oxygen, 06:22 sometimes the heart can go slow. 06:25 People with the condition called sleep apnea. 06:27 Do you know what that is? 06:29 Tell me what that is. 06:30 I wanna quiz you again, make sure you know. 06:31 Sleep apnea is when you're asleep, 06:34 you don't get good oxygen therefore 06:37 your body doesn't work well, 06:40 I don't know why. 06:42 Why sleep apnea occur? 06:43 Is that something to do with weight? 06:44 Well, there's two different reasons. 06:46 One is obstructive sleep apnea 06:48 where you have too much tissue heavy, 06:50 you know, you obstruct the airway. 06:52 The other one's called central sleep apnea, 06:54 it happens in the brain. 06:56 So the brain doesn't sleep well and usually the brain part 06:59 usually has to do with your circadian rhythms 07:01 being disrupted from different things. 07:04 Your oxygen goes down, 07:05 but when your oxygen goes down at night, 07:07 your heart can slow down. 07:08 So I see person on a monitor, 07:10 that's how we see if the heart's going 07:12 slow or fast. 07:13 We put these 24 hour monitors on people. 07:16 We have three day monitors we put, 07:20 we can hook people up to the internet 07:21 and see their heart how fast it goes. 07:24 We also now have chip implants 07:26 that we can do to see if a heart goes too slow. 07:28 Wow. 07:30 So if a heart's going too slow and is pathologic though, 07:33 usually a person will have a symptom. 07:35 Okay. 07:36 They won't feel right. 07:37 So they won't feel right. 07:39 I would imagine maybe 07:40 if you have a slow heart rhythm, 07:41 maybe you feel chronic fatigue. 07:44 That could be one. 07:45 What are some of the other symptoms? 07:46 Oh, the blood pressure might go low. 07:49 But probably the most common one, Nick, 07:51 is when it goes too slow. 07:53 The blood pressure goes low 07:54 and a person gets dizzy or passing out. 07:57 So almost everyone that gets dizzy or passes out, 08:00 the first thing a cardiologist says 08:02 "Could it be related to the rhythm going to slow?" 08:05 And if we don't know, 08:06 what we end up doing is putting in some type of monitor 08:09 on the person. 08:11 A short term, a long term monitor. 08:13 And then if they pass out again, 08:15 we have that monitor to see 08:17 if it was related to the rhythm of the heart. 08:18 So you can then go and analyze the rhythm 08:21 what was happening over the last week 08:23 or several days leading right up to the event? 08:25 Yeah. I had a person that worked. 08:27 He wasn't a pilot, 08:29 but he was an airline attendant once 08:30 that was having passing out spells. 08:33 So I was concerned that it could be a slow heart rate. 08:38 Thyroid was good, electrolytes were good, 08:40 didn't have anything that would do it other 08:42 than the wires just getting old. 08:45 So six months after we put in a loop monitor, 08:47 that's a continuous monitor. 08:49 He had a spell, 08:50 and it was like at 4:30 afternoon 08:52 he got dizzy and passed out. 08:54 We were able to dig out that and we noticed 08:56 that his heart stopped for six seconds, 08:59 did not beat, going to slow. 09:01 We figured out what he now meets criteria 09:04 to have treatment for that. 09:06 And the treatment for that slow heart rate is a pacemaker. 09:09 Yeah. 09:11 So what causes... 09:12 You said his heart stopped for six seconds. 09:14 What caused that condition? 09:16 On him, we call that a sick sinus syndrome. 09:21 The sinus node is the battery that has, 09:23 that sort of like any battery, you know, 09:26 sometimes lithium batteries last forever. 09:29 They keep on ticking, 09:30 they take a licking, you know, 09:31 sometimes they run out of juice. 09:34 And that's sort of genetically determined. 09:36 Now the brain and what's the brain hold. 09:38 Well, the brain can determine, 09:40 tell the battery to speed up 09:41 and use more energy, 09:43 you know, you're sick, 09:44 you're running, you're scared like that, 09:46 your heart's gonna go fast, right? 09:47 So your heart went fast when I did that, right? 09:49 Yeah, woke me up a little bit. 09:50 Right. 09:51 And now that you're relaxing, the heart's gonna slow down. 09:53 Now the brain does that. 09:55 But there's the battery part of your heart 09:57 that it spits out the energy. 09:59 Right, yeah. 10:00 But sooner or later, the energy can run out, 10:02 and it can go slow and stop. 10:04 Just like other parts of the body get old 10:06 and wear out. 10:07 And when we go wear out, 10:09 technology many times can replace things. 10:12 If you can't see good, we have glasses. 10:14 Can't hear good, we have hearing aids. 10:16 Well, if your wires wear out, 10:18 we have pacemakers. 10:19 So for this patient, it was a pacemaker that you put in? 10:21 Right. 10:22 And he had a pacemaker 10:24 and he's actually had it replaced twice 10:25 since I've known him now. 10:27 Pacemakers don't last forever, 10:28 it's a battery that replaces your battery 10:31 that ran out of juice. 10:33 So it doesn't totally fix things. 10:35 It is never quite as good as your own battery, 10:37 but it's better than the alternative. 10:39 Yeah. 10:40 Now you have a couple of different devices here. 10:42 One of this is a pacemaker? Yes. 10:43 What have we got? 10:44 Why don't you hold this one up? 10:46 Sure. Yeah. 10:47 That is a pacemaker. 10:50 And it's a very small pacemaker, 10:52 and we implant that in the body. 10:55 And then we hook two leads up that, 10:57 one lead goes into the heart, usually the atrium, 11:01 another one goes into the ventricle. 11:03 And these leads both make the heart beat, 11:06 as well as monitor what the heart rhythms doing. 11:09 So sometimes it might be going fast enough 11:11 that it doesn't need the pacemaker, right? 11:14 So you don't need it so why use up the battery. 11:16 So it just senses it and doesn't fire. 11:19 Now, some people are 11:20 what we call pacemaker dependent, 11:23 that if they didn't have a pacemaker at all, 11:24 they wouldn't have any rhythm. 11:26 They use up the battery quite often. 11:28 And we have devices where we can monitor 11:31 how well the pacemaker's doing, 11:33 how long that's gonna last, 11:34 when we need to put another battery in. 11:37 And they have leads that actually go through 11:39 the blood vessels into the heart 11:41 that stay there permanently. 11:43 Yeah, so a device like this about how long might it last? 11:46 How often do the patients have to have them checked? 11:49 Well, we check them usually on the month remotely. 11:52 Okay. 11:53 Yearly, we do a full what we call interrogation. 11:57 And the technology has improved so much, 11:59 we can just put something over it, 12:00 we can tell, you know, 12:01 what it's doing, 12:03 we can actually tell this has a monitoring device. 12:05 If you have a funny feeling three days ago, 12:08 I can look that up and see 12:09 if the pacemaker or a funny heart rhythm was involved. 12:13 So it's a smart machine. 12:15 And also, 12:16 if you use it every single beat of course, 12:18 the battery wears out quicker, 12:20 six to eight years, 12:22 but I've had some last as long as ten years, 12:24 some as long as six to eight years. 12:26 But we monitor that when the battery runs low, 12:29 we replace it well ahead of time. 12:31 And we put a new battery in it. 12:33 It's sort of like a car battery, 12:34 you know, go in there through the incision, 12:36 put a new one in, 12:37 hook up the leads so yep, and he gets to go home. 12:39 Yeah, now I've heard you talk 12:40 a little bit in the past in our conversations 12:42 about some folks not wanting to have a pacemaker put in 12:45 and what are some of the objections? 12:48 And are they... 12:49 What are your thoughts on it? 12:51 Well, some people think that that 12:52 their heart will start speeding up by natural things. 12:55 They don't feel too bad, 12:56 you know, man had one spell, 12:58 but today they feel good 12:59 and I tell them well, 13:01 you know, 13:02 you know, some people just wear out, 13:04 the battery wears out, 13:05 now how fast it wears out 13:06 when an episode will happen again, 13:08 no one knows. 13:09 But sometimes it's like you have a spell 13:11 and it doesn't happen for two or three months. 13:13 But what if you had a spell of slow heart rhythm 13:16 that didn't generate a blood pressure 13:18 when you are driving. 13:19 It'll be dangerous. 13:21 Or when you're doing a dangerous activity? 13:22 Yeah. 13:24 And you fell down and hurt yourself. 13:25 So once we've documented that you had a slow heart rate. 13:28 If you don't have something done, 13:30 you're not gonna be driving your car safely. 13:32 You're not gonna be, you know, 13:33 doing some dangerous things safely. 13:35 So we usually recommend a pacemaker, 13:38 and nowadays the ability to put them in, 13:41 they've gotten safer and safer and safer. 13:43 And if we don't have them, 13:44 not only you're in danger of an accident, 13:47 but your danger of the heart gradually slowing down, 13:50 and eventually going so slow 13:52 that it doesn't support your organs anymore. 13:54 All right. 13:55 That answers my questions pretty well there. 13:57 There's more to come. 13:58 Stay with us on the Ultimate Prescription. 14:00 We'll be back in just a moment. |
Revised 2020-02-24