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Series Code: UP
Program Code: UP190123B
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00:01 Welcome back to the Ultimate Prescription.
00:02 I'm Nick Evenson, your host here 00:04 with Dr. James Marcum, 00:05 and today we are talking about slow rhythms of the heart. 00:07 And before the break, 00:08 we were talking some about pacemakers 00:10 and what they can be good for and how you can monitor them. 00:14 But let's talk about some of the symptoms 00:16 and how you manage 00:18 slow rhythms acutely, Dr. Marcum? 00:20 Well, modern medicine is great at treating acute problems. 00:24 And sometimes, like, we mentioned that 00:27 my patient that took too many medicines, 00:29 overdosed on a beta blocker 00:31 made the heart go slow. 00:34 So if you did that, or took an herb that made 00:36 your heart go too slow and came in, 00:38 I wouldn't put in a pacemaker for that. 00:40 Because once the medicine wears out, 00:43 you would do fine. 00:44 So in those cases, when they acutely come in 00:47 with the slow heart rate, we have couple of options. 00:49 Sometimes we can put them on medicines 00:51 and speed up the heart. 00:53 Dopamine is one that we sometimes use, 00:56 isoproterenol is another one. 00:58 Sometimes it's going 01:00 so what we can put in a temporary pacemaker. 01:02 So we insert a temporary pacemaker, 01:04 temporary wire to the heart, that keeps it going 01:07 until the normal rhythm returns, 01:09 and then we take it out 01:10 and they don't have to have a permanent pacemaker. 01:13 Sometimes when a person's having a heart attack, 01:16 the wires that go to that part of the heart 01:18 don't get enough blood 01:20 so the heart goes slow temporarily. 01:21 Well, sometimes restoring blood flow to the heart 01:24 can help the wires do better. 01:26 Okay. Yeah. 01:27 Sometimes until they heal up, we need to put a pacemaker in. 01:30 And sometimes we put in a temporary pacemaker too. 01:33 Sometimes we can give medicines 01:34 until we can get that pacemaker in, 01:36 to keep people going. 01:38 Nowadays, we even have a pacemaker 01:41 that we can put on the outside of the body. 01:44 That's called an external pacemaker. 01:47 So we have pads we can place on people, 01:50 and we can literally pace from the outside 01:53 until we could put an internal. 01:55 That's a little painful, 'cause... 01:58 But it does keep the blood pressure up, 02:00 and it keeps the heart contracting 02:02 to keep people going until we can do 02:05 something more permanent. 02:06 That sounds like the equivalent of when the doctor 02:08 grabs the paddles and everything is just clear. 02:10 Well, no, no, no, that's a different one. 02:12 Okay. 02:13 That's one for the dangerous fast heart rates. 02:16 And when they shock them like that, 02:17 that just disrupts the fast heart rate, 02:19 so the normal rhythm can come back. 02:21 Now, if we shock a fast one, 02:23 and a normal one comes back that's too slow, 02:26 then it needs either medicines to speed it up or pacing. 02:30 So rhythms of the heart are very, very interesting, 02:33 but it's something that we have a lot of ability 02:36 to help technologically, 02:37 you know, we can get the pacemakers, 02:39 temporary, long term, with external pacemakers. 02:43 And usually the external ones are ones we put on 02:46 until we can put either a temporary 02:48 or a permanent pacemaker in. 02:51 But lots of people now that were aging, 02:53 the wires of the heart just get old. 02:56 You know, they just get old, they get calcified, 02:58 just like any wire gets old. 02:59 And sometimes it just... 03:01 Sometimes the battery wears out, 03:03 sometimes the wires wear out. 03:05 And if the wires wear out, 03:06 sometimes the pacemaker will help with that as well. 03:09 Okay. 03:10 'Cause remember, the pacemakers obviate the need for the wires, 03:13 'cause the pacemaker causes the heart to contract 03:16 on its own without the wires. 03:18 So let's say one of the wires is messed up, 03:21 then we could put in a pacemaker for that. 03:23 So a pacemaker, if the batteries got old, 03:25 if a wire's got old, a pacemaker would help 03:28 in each one of those situations 03:30 where the conduction system has just gotten old, 03:33 so the heart can't squeeze. 03:34 Pretty cool, huh? 03:36 Very cool. 03:37 Now this leads me to the next question is 03:39 what is involved in placing a pacemaker? 03:42 Where does it go physically and what's involved in 03:44 putting it there? 03:45 Well, it used to be... 03:47 One of the first pacemakers was by Alfred Hitchcock. 03:51 I don't know if you remember... 03:52 You're probably too young to remember him. 03:54 The guy who made the movies. 03:55 Yeah. Same guy? 03:56 He had a gigantic pacemaker, really big, 03:58 placed in his abdomen. 04:00 That was, remember even 100 years ago, 04:03 we didn't have this technology. 04:04 People would just die, 04:06 their heart would go slow and they pass away years ago 04:08 where they bonked their head or hurt themselves 04:10 or something bad would happen, 04:11 where they'd be in their Model T in wreck 04:13 and no one would know why, 04:14 you know, it was a slow heart rate. 04:16 But now we have all this technology 04:18 and it continues to get smaller and smaller. 04:21 We have devices, pacemakers that are as small as ticks 04:25 that we can implant in the heart now, 04:28 that they have no leads. 04:29 That they're all like a battery driven... 04:31 Now, they're not as good as these type of pacemakers 04:34 but, you know, you asked me the question. 04:37 It wasn't a true or false question. 04:39 But what was the question again? 04:40 Do you remember what it was? What's involved in placing? 04:42 Okay, placing. The pacemaker. 04:43 So what we would do is we would make a small incision, okay? 04:49 First we would get the leads placed in the heart. 04:52 We'd make a small incision, 04:53 put this pacemaker under the skin, 04:55 hook the leads up, make sure it's well positioned 04:58 and then just sew up the skin and then test it, 05:00 make sure it works good. 05:01 So are there any risks of it 05:03 becoming detached from the leads or... 05:05 We want to have a good safe position. 05:08 The real risk are infection, 05:10 because anytime you cut the skin, 05:11 there's infection, 05:13 there's a small risk of bleeding. 05:15 But the alternatives to the pacemaker, 05:17 the risk of not having it is dying. 05:20 So I think most people say 05:21 the risks are worth the benefits 05:23 and nowadays, technology's improved so much. 05:26 It's almost a one day procedure now. 05:28 They come in and get it, they go home the next day, 05:31 the batteries replacements are one day procedure. 05:34 They come and get the battery, we zip it, 05:37 put a new one in, go home the same day. 05:39 The ones we put the leads in, 05:40 we usually like to watch them at least overnight. 05:43 But we put pacemakers in 95 year old sometimes 05:46 that are very active with no other medical problems. 05:49 So pacemakers are just a place 05:51 where modern medicine technology 05:53 has really helped tremendously in people's care. 05:57 Yeah. 05:58 Now we've got a larger device here. 05:59 This was the pacemaker that we were talking about 06:01 just a minute ago and this is... 06:03 Which is twice the size. 06:04 And this is something different. 06:06 Tell us what is this? 06:07 Well, pacemakers are good for slow rhythms, okay? 06:10 But there are a lot of fast rhythms 06:12 that come from the heart. 06:14 Fast rhythms from the bottom part of the heart, 06:17 we give them names ventricular, 06:18 'cause that's the bottom chamber, 06:20 ventricular tachycardia. 06:22 That means going real fast. 06:24 There's another rhythm called ventricular fibrillation, 06:27 where it's unstable. 06:29 Well, that is a device called a defibrillator 06:32 that we implant internally 06:34 that would see that dangerous rhythm 06:35 and shock the heart back into rhythm. 06:37 Or it can do some fancy things on the bottom 06:41 to restore the rhythm, the bottom part of the heart. 06:43 So fast rates 06:45 from the bottom part of the heart 06:46 can be treated with that. 06:47 Sometimes we've talked about ablations 06:49 where we can destroy the fast rhythms. 06:52 Sometimes in the bottom part, we can destroy these rhythms, 06:55 but we can also have dangerous fast rhythms 06:57 from the top part of the heart. 06:59 Now we talk before about atrial fibrillation, 07:02 but there's some congenital rhythms, 07:04 one of them is called supraventricular tachycardia. 07:08 That's sort of like a short circuit in the heart 07:11 where we can go up and ablate that one. 07:13 And there's several different genetic, 07:15 abnormal rhythms that we could also ablate or destroy. 07:19 One that we see fairly common 07:21 is called Wolff-Parkinson-White. 07:23 It was named after the person that developed that. 07:26 But that would be a rhythm that we could ablate. 07:29 But these are very good for people 07:31 that have weak hearts, 07:32 that are more likely 07:34 to have these dangerous heart rhythms from the bottom. 07:36 They might not ever have it, but it's insurance, Nick. 07:40 We know that people that have a weak heart, 07:43 and we define that by a term called ejection fraction. 07:47 If it's below a certain number, 07:49 they have a higher risk of this dangerous heart rhythms 07:52 from the bottom part. 07:53 So as insurance against these rhythms 07:55 'cause that's what they die from. 07:57 For insurance we put these in to the heart 08:00 and it might not ever fire, but if it does fire, 08:03 it keeps you alive. 08:04 It's like having an ambulance in you 24/7. 08:08 Just in case. Yeah. 08:09 Now you've seen at airports the defibrillators, right? 08:12 Those are external defibrillators, 08:14 and that's the same thing inside you. 08:16 The internal version. 08:18 Yeah. Okay. 08:19 Well, what about limitations? 08:20 What limitations do patients 08:22 with pacemakers and defibrillators...? 08:24 What limitations are there? 08:25 Well, in the old days some of these you... 08:27 Because they were the device they're made them 08:29 they couldn't be under MRIs. 08:31 You know, that's that, you know, is a magnet. 08:34 But nowadays, we have these devices 08:36 that are MRI compatible. 08:39 Now we do ask people that have pacemakers, 08:41 you know, when they're first put in to avoid 08:43 extraneous activities in the upper extremity, 08:46 because we don't want them to jard or tear it loose, 08:49 but after it heals in, 08:50 they cannot do pretty much everything. 08:53 We advise them not to get in microwaves, 08:55 you know, that kind of stuff that would deactivate it 08:57 and certain radio waves but really, 08:59 they live a full and healthy life, 09:02 you know, they might not be able to play football 09:04 or do some things like that, 09:05 but they can just pretty much do just about everything 09:08 they would like to do. 09:09 Yeah. How about alternatives? 09:10 What kind of alternatives are there for pacemakers? 09:13 Well, if you choose not to have a pacemaker, 09:16 eventually the battery of your heart 09:19 or the wires are gonna stop. 09:21 And when they do stop, 09:23 you're not gonna generate a blood pressure 09:25 and then you're gonna go to sleep in Jesus. 09:27 Now how long that takes to happen, no one knows. 09:31 So there's not really great treatments alternatives. 09:34 I don't know if any natural remedy 09:36 that would replace the wires of the heart. 09:39 We don't have that. 09:40 But that's a great place for modern medicine. 09:42 Before we had pacemakers 09:43 people would whose heart would go slower 09:45 and slower and slower, and they get tired or dizzy, 09:48 passing out, until their heart stopped. 09:50 Yeah. 09:52 Well, that seems like a great place 09:53 for modern medicine, 09:55 Dr. Marcum, thank you for sharing with us 09:56 about the pacemaker. 09:58 Yeah. 09:59 And I think it's time in the program 10:00 where we want to talk about a biblical prescription. 10:02 Did you have a verse you want to share with us today? 10:03 Yes, I do. 10:04 And that is from Philippians 10:07 on a biblical prescription and it says, 10:09 "Be careful for nothing, 10:11 but in everything by prayer and supplication 10:14 with thanksgiving let your requests 10:17 be made known unto God." 10:19 So what that text is really telling us is 10:21 it doesn't want us to be anxious about anything. 10:24 We don't need to be stressed. 10:26 We know that bodies that live under stress and fear, 10:30 it turns on adrenaline, cortisol, syndecans, 10:34 all these natural chemicals that are good 10:36 if we're running from danger, 10:39 but not so good chronically. 10:41 It causes processes called genetic aging, oxidation, 10:44 makes us get older quicker. 10:47 So stress and fear causes our bodies to get older. 10:50 So let's say the wires of the heart 10:52 would normally get old at 80. 10:54 And if you're under a lot of stress and fear, 10:55 it might get older sooner. 10:58 So we want to stay away from this. 10:59 Science has shown that people that are less anxious, 11:02 less fear, live longer, do better. 11:05 Now, when we think about different types of fear, 11:07 the worst type, I took care of a fellow the other day 11:09 that had posttraumatic stress syndrome. 11:13 And just the stress that he had seen, 11:15 some of the war things, 11:16 that is the highest ramp stress I've seen. 11:19 He was making so much adrenaline and cortisol, 11:22 that his body was getting older real quick, 11:25 almost in front of our eyes. 11:27 In the heart business, 11:29 we have something called the broken heart syndrome, 11:31 where people are under extreme stress, 11:33 it's usually when they lose a loved one, 11:36 that the body makes so much stress chemistry, 11:38 that it actually causes the heart not to work. 11:41 And that we had called that stress induced cardiomyopathy 11:44 or a broken heart syndrome. 11:47 So stress is a real evil. 11:49 And in this test, it tells us not to do that, 11:52 but it gives us a prescription. 11:54 Prayer, supplication, and guess what? 11:58 Thanksgiving. 12:00 Turn to God, when we have this, 12:02 let Him take all the stress off of our bodies 12:05 turn to Him, prayer, thanksgiving, 12:07 and that is a biblical prescription 12:09 that doesn't have lots of side effects, 12:11 doesn't cost us a lot of money, gives us a plan 12:14 when the stresses of life just seem to be overcoming us. 12:17 Yeah. 12:18 Well, thank you for sharing that text. 12:19 And, Dr. Marcum, if folks want to learn more 12:21 about where they can find 12:22 biblical prescriptions for their life, 12:23 where should they go? 12:25 Yeah, a couple ways they can get a hold of us 12:26 is our website, HeartWiseMinistries.org, 12:30 and on that we have a prayer page, 12:33 you can ask the doctor questions, lots of resources. 12:37 It's just a... 12:38 And we have a worship app they can use as well. 12:39 That's right. 12:41 We want to send people to download 12:42 the Biblical Prescriptions worship app 12:44 on their Android or iOS device. 12:46 And it's a free download 12:48 and you can send reminders to yourself 12:50 to get into scripture from God's Word, 12:52 multiple times a day, and it's a great tool 12:54 that I found to help remind me to stay faithful 12:56 and get those biblical prescriptions 12:58 applied in my life. 13:00 Thank you so much for joining us today. 13:01 Dr. Marcum is gonna be right back with a prayer 13:03 to close the program in just a moment. 13:10 I hope you've learned today 13:11 a little bit about slow heart rates 13:13 and a little about rhythms of the heart. 13:16 But whether your hearts going slow or fast 13:18 we have a savior that's interested 13:20 in every heartbeat that we have. 13:23 Let's end our program today with prayer. 13:26 Father God, we thank You for giving us life 13:29 and breath and a heartbeat where we can serve You, Father, 13:32 and there are some might be needing You 13:34 especially this day. 13:36 We want to pray for blessings. 13:38 We want to pray for Your strength 13:39 and we want to thank You and praise you for being a God 13:41 that loves and saves us. 13:43 Please go with us is our prayer. 13:45 Amen. 13:47 I want to thank you for joining us. 13:49 If you have questions go to our website 13:51 HeartWiseMinistries.org. 13:53 I'm Dr. James Marcum wishing you the best of health. |
Revised 2020-02-21