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Series Code: UP
Program Code: UP190127A
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00:01 The following program presents principles designed
00:02 to promote good health and is not intended 00:04 to take the place of personalized 00:06 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 The heart is a complex organ with many moving parts. 00:18 On today's program, 00:19 we'll take a look at the valves of the heart 00:21 and discover what can be done 00:22 when there's a problem with a heart valve. 00:24 Thanks for joining us today 00:26 right here on the Ultimate Prescription. 00:48 Welcome to the Ultimate Prescription. 00:50 I'm your host Nick Evenson here with Dr. James Marcum, 00:53 practicing Cardiologist 00:55 with the Chattanooga Heart Institute. 00:56 Welcome, Dr. Marcum. It's nice to be here, Nick. 00:59 And I was thinking, you know, I've been doing 01:01 television programs for a few years, 01:03 but I really enjoy meeting patients 01:06 every day, and talking to them 01:08 about their different problems 01:09 and sort of coming up with a plan. 01:11 And, of course, I mainly work with hearts, 01:13 but, you know, time goes by, quickly, 01:17 you know, and I think there's an advantage 01:19 of being able to look at things over time. 01:23 And you see what things don't work 01:25 and I have to relearn everything 01:27 in medicine about every 10 years. 01:29 How about that in your field? 01:31 Yeah, technology is always changing, 01:33 and it got to keep up with it year-over-year, 01:35 otherwise, you're gonna fall behind 01:37 and five years down the road, 01:38 I might not be able to do my job. 01:39 You know, now a lot of people, you know, they see you, 01:42 and they think you're a host, 01:43 but in reality, you know, you have your own company 01:47 that does video and that kind of stuff. 01:50 And, you know, you've worked with Heartwise Ministries 01:52 doing just about everything. 01:54 And you can agree with me that your field 01:56 is constantly changing. 01:58 Yeah, yeah. 01:59 In video production, obviously, we've got television, 02:02 but we've also got digital media, 02:03 and then there's YouTube 02:05 and all kinds of outlets for video now. 02:06 And so it's a really, you know, 02:07 the landscape has changed over the last 10 years, 02:10 even significantly, in the way that 02:11 we format videos and write videos, 02:13 it can all change and vary. 02:15 And it's amazing how the world is changing. 02:18 And one constant that we do have is change. 02:22 And I've been amazed at watching back 02:24 over my career in cardiology, you know, 02:28 when my kids were little Jake and Kelly, you know, 02:30 I was doing things much differently, 02:32 and now that they're grown. 02:33 Now you have a couple little kids too, right? 02:34 I do. 02:36 I've got a wonderful wife Leslie, 02:37 and we got two little boys, Hayden and Corbin. 02:39 They're four and five. 02:41 And they are full of energy and they keep us hopping. 02:43 So we do our best to keep up. 02:45 I remember those days, Nick, 02:47 and all those out there with kids. 02:48 You know, we're empty nesters now, 02:50 and that's a whole different stage of life, too. 02:52 Yeah. 02:54 You know, despite all the change that happens, 02:57 I'm reminded that God's Word is constant. 03:00 And I really appreciate the Biblical Prescriptions app 03:02 that we've developed. 03:04 Now if we could talk about that for a minute, 03:06 it's available for Android and iOS devices. 03:08 And it's a free download. 03:10 You can have it on your phone or your tablet. 03:11 And it's designed to just remind you every day 03:14 to spend 10 minutes. 03:16 And, Dr. Marcum, 03:17 you've done a specific worship routine 03:19 that's in the app. 03:20 Yeah. It takes about 10 minutes. 03:22 And it really helps people retain that scripture 03:24 and apply the biblical prescription 03:25 in their lives. 03:27 Can you just describe that for us? 03:28 Yeah. 03:29 And the reason we use 10 minutes 03:31 is because the studies on how our brain changes, 03:33 our physiology changes have studied 03:36 just 10 minutes of biblical worship. 03:38 We know that the part of the brain 03:40 called the anterior cingulate cortex gets bigger. 03:43 The stress chemistry comes down just from studying 10 minutes. 03:47 And in this app, you know, you warm-up to exercise, 03:50 we have some things 03:51 that we do to warm-up to worship. 03:53 Okay, hold on. 03:54 We're talking about some physical activities 03:56 to warm-up that help your brain 03:58 get some better blood flow maybe. 03:59 Well, when we worship, 04:01 we don't wanna be stressed out, 04:02 we wanna be focused on that relationship. 04:04 And there are some things that we can do to breathing, 04:07 stretching, moving different parts of our body 04:09 that can turn on the upper part of the brain 04:11 and sort of turn down the stress part of the brain 04:14 and get us focused on worshiping God. 04:17 And there's some prayers that help bring us 04:19 into God's presence that cleanses us, 04:21 just as a good 10-minute study for people to stay on track 04:25 in that relationship with Jesus. 04:27 Yeah, you know, I think it's a great approach. 04:29 I've discovered in my own life, 04:30 that I have some of my most creative 04:32 and best thinking moments when I'm exercising. 04:34 Yeah. 04:36 And so doing a little exercise to warm-up 04:37 before we study something as important as God's Word, 04:39 it's a great strategy. 04:40 And physiologically what that does, Nick, 04:42 as you make a chemical 04:43 when you exercise called endorphin. 04:46 Endorphin turns down stress chemistry. 04:48 So this gets more of your brain 04:50 working up in the prefrontal cortex 04:52 where you communicate with God. 04:54 So there's real physiology behind some of these things. 04:57 And it's just fascinating that 04:58 now we have the technology to prove God's Word 05:01 once again is true. 05:03 That's right. 05:04 Now so when we talked about change, 05:08 and in medicine, it's changed so much 05:10 just how we handle every part of the heart, 05:12 bypass has improved, 05:14 we have all these technologies for rhythms of the heart, 05:16 but today I want to focus on some of the changes 05:19 on our heart valves. 05:21 Okay. Okay. 05:23 Describe, I was gonna say 05:24 describe for us, the heart valves. 05:25 Yeah. 05:27 Some people may have no idea 05:28 what they do, where they're located, 05:29 kind of give us an overview? 05:31 Well, the heart is a pump 05:33 that pumps to the cardiovascular system, 05:35 all the blood vessels throughout the body. 05:37 And within that pump, we have a left side 05:40 that pumps to the body and a right side 05:42 that smaller doesn't have to be 05:44 as strong that pumps to the lungs. 05:46 When the blood gets... 05:47 Usually, when the blood comes, 05:49 gets to the lungs, it's filled with oxygen. 05:51 It's filled with oxygen and it comes back 05:54 into the top chamber 05:55 called the left atrium with blood on it. 05:57 It goes to the left ventricle, 05:59 and then it's pumped through the entire body, 06:01 it goes through the entire body 06:03 carrying oxygen and nutrients, 06:05 and then it's distributed to the organs. 06:08 So all the organs 06:09 needed good cardiovascular system, 06:12 then the organ say, 06:13 "Hey, I've got to get rid of my wastes." 06:15 And it gets rid of the waste, 06:16 and the vascular system helps get rid 06:18 of some of the waste of the body 06:19 that comes back to the heart 06:21 with less oxygen 06:23 then it got to repeat the cycle again. 06:25 So these valves help blood 06:28 go from one chamber to another chamber 06:30 in the heart. 06:31 Okay. 06:32 And we have four major heart valves. 06:34 The ones we're gonna focus on today is the aortic valve. 06:37 That's the valve that leaves the heart and the mitral valve, 06:41 that's the valve that separates the left atrium 06:44 from the left ventricle. 06:46 Now sometimes these valves have problems, 06:49 okay, they don't work as good. 06:51 And different things can cause those problems. 06:55 Sometimes it can be an infection, 06:57 gets on the valve, we call that endocarditis. 07:00 Years ago, they used to have a condition called 07:04 rheumatic fever 07:05 where you were exposed to an infection 07:07 and that damaged the heart valve 07:08 cause it to wear. 07:10 Some people, they're born with valves 07:12 that are congenitally abnormal 07:15 and we can help those valves out. 07:17 Sometimes the valves just get old and wear out, 07:19 we call that degenerative heart disease. 07:22 So there's many different things 07:24 that can cause the valves to get older to malfunction. 07:27 Sometimes, Nick, the heart itself gets weak, 07:31 usually from blockages in the arteries of the heart. 07:34 When a heart gets weak, 07:36 the heart gets enlarged 07:38 so the valves normally would close 07:39 here are spread apart. 07:41 So the door hinge leaks. Yeah. 07:44 So the valve leaks blood backwards 07:45 instead of going forward, 07:47 the blood's going in the wrong direction. 07:49 That's not good. 07:51 Sometimes the valves don't open 07:53 so the blood can't change from chamber to the other. 07:57 We call that... 07:58 If a valve doesn't open, we call that stenosis, okay? 08:03 If it leaks, we call that regurgitation. 08:07 So for each valve, sometimes it has, 08:09 a valve can be stenotic or it can be regurgitant. 08:13 So once we determine that, 08:15 and there's a test that we do, 08:16 the most common one is called an echocardiogram, 08:19 where we look at the arteries, 08:21 we can see it with sound wave, 08:22 we can actually see how the valves open and close 08:25 and open and close. 08:26 We can see how much bloods going backwards. 08:28 And sometimes we can find out 08:30 what what's causing it to malfunction. 08:32 Right. 08:33 If it's an infection, we want to treat the infection. 08:36 If the valves worn out, 08:37 sometimes we have to replace the valve. 08:40 So how would I know, you know, a valve is a problem? 08:44 Yeah, what kind of symptom? 08:45 Would you feel something? Yeah. 08:47 Well usually, the first symptom 08:48 the person has is either shortness of breath 08:50 when they do things because the, 08:52 you know, shortness of breath 08:53 because either the back pressure 08:54 of a leaky valve, 08:56 or sometimes the blood doesn't lead the heart 08:59 from a stenotic valve, and they can have symptoms. 09:02 It can be shortness of breath, dizzy passing out. 09:05 Sometimes it can be pain, 09:07 sometimes it can be palpitations. 09:09 So when a person has a symptom, 09:11 they would go to their doctor and their doctor, 09:14 "That might be a symptom of the heart." 09:16 It sounds like there's a lot of symptoms 09:18 that are heart related that could all be the same. 09:19 That's correct. 09:21 Shortness of breath, 09:22 doesn't mean it's a valve problem. 09:23 But something with the heart it's like... 09:25 But it could be a heart, 09:26 shortness of breath could be a heart problem. 09:28 It could be a lung problem. It could be anemia problem. 09:31 So lots of things can cause the symptom. 09:33 We know the symptom is something not right. 09:35 So you go to your doctor, 09:37 he might ask you some questions, 09:38 and they probably have to do some testing 09:41 to see what was wrong. 09:42 So I had a patient come to me that was about 82 years old, 09:46 and she was shortness of breath. 09:48 And she says, 09:49 "I normally didn't do this way." 09:51 So I did some testing on her. 09:52 She wasn't anemic. I didn't think she... 09:55 I listened to her heart. 09:56 And guess what I heard, a murmur. 09:58 Yeah. And it sound like this. 10:03 Normally, you listen to the heart 10:04 and you can hear the valves opening and closing, 10:06 you're not supposed to hear that sound. 10:09 Well, that was a sound 10:11 that's characteristic of the blood 10:12 not leaving the heart very well. 10:13 Okay. 10:15 That was a characteristic of a valve 10:16 abnormality that people get called aortic stenosis. 10:20 Well, I talked to her 10:21 she'd never been exposed to an infection. 10:24 She never had problems with other things in life. 10:27 Her genetic history was really negative. 10:30 But, you know, things wear out, okay? 10:32 So we did the next test, I figured something was wrong. 10:35 The shortness of breath could be 10:37 coming from the valve. 10:38 So I ordered the echocardiogram, 10:40 and sure enough, Nick, 10:41 the valve wasn't opening and closing very well. 10:44 We call that aortic stenosis. Okay. 10:47 So the valve wasn't opening and she was short of breath 10:50 because the pressure was backing up. 10:51 She was short of breath. 10:53 She couldn't do very much 10:54 'cause the blood wasn't flowing out 10:55 of the heart good. 10:57 It was backing up the pressure. 10:58 She was getting shorter breath. 10:59 Right. So she said, "Well, you know." 11:01 I said, "This is something that causes 11:03 and probably just because of aging." 11:05 We call that, you know, the valve is oxidizing, 11:08 it's getting old, it's calcified, 11:10 it doesn't open good. 11:11 And we measured that by how much pressure it took 11:14 to open the valve, 11:15 low would be 10, high would be 50. 11:18 Hers was 60. 11:19 So a lot of pressure to open that valve. 11:21 Right. 11:22 And we talked about all the different options, 11:24 including open-heart surgery. 11:26 But on this lady, we had a new procedure 11:29 that's only been around a few years 11:30 now called trans aortic valvular replacement. 11:35 And this is one way that we can help people 11:37 with aortic stenosis. 11:39 All right, well, we've got a clip here 11:41 that I'd like you to talk us through that shows 11:43 the actual procedure. 11:45 Let's see. 11:46 So there's much that can be done 11:47 to help the valves. 11:49 And this is one that we don't have 11:50 to cut a person open. 11:51 And what we do is the valve doesn't open very good. 11:53 First, we squished some of the calcium 11:55 with the balloon so we open up and then we can 11:58 actually go in there and put a new valve in 12:01 through the blood vessels. 12:02 And this is a certain type of valve 12:04 called a trans aortic valve and we expand it. 12:07 So we squish the calcium. 12:09 And now we're left with an open valve. 12:11 Now this is the alternative of that 12:13 and that would be open-heart surgery. 12:15 We can also depending on the patient, 12:17 we can put a new heart valve in. 12:19 So when valves wear out from old age, 12:21 and the aortic valve 12:22 is probably the most common one, 12:24 we can replace that valve, 12:26 either trans aortic valve replacement, 12:28 or we can do an open-heart surgery. 12:30 This is a place where modern medicine 12:32 is very helpful. 12:34 If we're having a symptom, 12:35 if something parts wearing out, we can replace that part. 12:39 Before we had this person might die a few years younger 12:42 because the part wear out. 12:44 So my patient got a trans aortic valve replacement. 12:47 She's not a short of breath. 12:48 We talked to her about the risk of having it done 12:51 and the benefits of it 12:53 and she decided to move forward with it. 12:55 Not everyone decides that's the way they want to do, 12:57 but at 82 she has a new value. 13:00 That's working well, she's less short of breaths 13:02 so she can play with her grandchildren 13:04 do a lot more, she's much more active. 13:07 So a synthetic valve, is that a synthetic valve? 13:09 Well, this would be considered a synthetic valve 13:12 because it's extra cardiac tissue 13:14 that's put in the body. 13:16 It's not from a cadaver. 13:17 It's not necessarily yes, we put it in. 13:20 And how long could you expect one of those to last? 13:22 It depends on whether the body wears out, okay? 13:26 Now younger people, we would probably 13:28 put in a longer lasting valve on the metal valve, 13:31 but now we have newer valves that come in 13:34 that actually even have coating on the valves 13:37 that are bioprosthetic valve 13:39 that keep it from aging as quick. 13:41 So now we have valves that are bioprosthetic 13:43 that lasts longer and longer. 13:45 Now these valves are never 13:46 as good as the valves God gave us. 13:48 Right. But they are... 13:50 They do help us to slow down this aging process. 13:53 And I've had patients now that their valves 13:56 are now five and six years old. 13:57 Remember, they haven't been around that long. 13:59 So we don't have a longevity track. 14:01 But we know when the aortic stenosis reaches 14:04 a certain place that if we don't do something soon, 14:07 the patient's gonna gradually get older. 14:09 All right. 14:10 Well, we've got to stop there for just a moment 14:12 and take a break. 14:13 There's more to come with heart valves 14:14 on the Ultimate Prescription in just a moment. |
Revised 2020-02-15