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Series Code: UP
Program Code: UP190128A
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00:14 Shortness of breath, fatigue, swelling in your legs,
00:18 ankles and feet, 00:19 and a rapid or irregular heartbeat 00:21 are just a few of the symptoms that might indicate 00:24 an issue with your heart. 00:26 Stay with us, and learn more about 00:27 how doctors diagnose a weak heart today 00:30 on the Ultimate Prescription. 00:53 Welcome to the Ultimate Prescription. 00:54 I'm your host Nick Evenson, here with Dr. James Marcum, 00:57 Speaker and Director of Heartwise Ministries 01:00 and practicing physician, 01:02 Cardiologist with Chattanooga Heart. 01:03 Yes. 01:04 Dr. Marcum, welcome to the program. 01:06 Well, thank you, Nick. 01:07 And we have a very interesting and important topic today. 01:11 We're gonna be talking about weak hearts. 01:14 But before we explore that, in general, you know, 01:17 in a short period of time, 01:19 it's hard to get anything into in depth. 01:22 But we just wanna give broad brushstroke 01:25 so people can understand their health is important 01:28 little things that we can do to get more information. 01:31 And if nothing else, 01:32 we can always go to the website, 01:34 HeartWiseMinistries.org 01:37 and ask our specific questions. 01:38 That's right. 01:39 We have a number of resources there, 01:41 health articles, radio program, television programs. 01:44 We also have an app that there's information 01:46 on the website that you can find out about 01:48 to find daily worship routines that you can take part in, 01:51 and we just wanna help people learn 01:53 where they can find good advice, 01:55 where they can get more connected 01:56 with our Creator and live more in harmony 01:58 with God's design for our lives. 02:00 Yeah, and unfortunately, every day, 02:03 all of us get a little bit older, 02:05 more chance that our parts might malfunction, 02:08 develop a symptom like you talked about. 02:10 And then we need help. 02:12 But I wanna focus a little bit on it's very important 02:15 that as we go through life, we understand the reason why. 02:19 Right. 02:21 Do you ever ask yourself that question, why? 02:22 Yeah, yeah, sure do. 02:24 Now people like scientists, explorers, doctors, 02:26 theologians, everyone, 02:29 that's a key question 02:30 'cause if you understand the reason why, 02:33 you're more likely to have a successful solution. 02:36 So if a person comes in with high blood pressure 02:39 or high blood pressure is a number. 02:41 I wanna know why the blood pressure is high. 02:43 Right. Is it 'cause of stress? 02:46 Is it too much salt in the diet? 02:48 Is it because of lack of exercise? 02:51 Is there a problem with stress on the body 02:53 causing to be high like sleep apnea, 02:56 problems with the kidney, problems with the thyroid? 02:58 Why is important? 03:01 Someone carries extra weight, okay? 03:03 And they wanna lose weight. 03:04 Well, I wanna say that, 03:06 "Well, why do they carry extra weight?" 03:07 Is it a metabolic problem? 03:09 Is a problem of too much calories? 03:11 Understanding the reason why is very important. 03:13 Right, right. 03:15 So when it comes to weak hearts, 03:16 you're saying, 03:18 we need to not just treat the symptoms, 03:19 not just take a pill, but really figure out 03:21 what's going on 03:23 and treat the underlying cause of the problem? 03:25 And that goes with really every problem in life, 03:27 you know, you have a relationship problem. 03:29 Well, you wanna know 03:30 why you have a relationship problem, 03:32 whether that be with a friend, a spouse, a loved one, a doc... 03:36 Well, why do we have the problem? 03:38 'Cause if we can understand why, 03:40 we can get at the core of existence. 03:41 Right. 03:42 So if you think about that for a second, 03:45 you know, we've talked a lot about... 03:47 And I'm very interested in genetics. 03:49 Okay, we call that genomic medicine. 03:51 Why does our DNA get old? Why does it mutate? 03:54 Why do we have disease in the first place, you know? 03:58 Because we have bad genes, okay? 04:00 Well, why do we have bad genes? 04:03 You know, why do we have bad genes? 04:04 Because we've reproduced 04:06 from parents that had bad genes. 04:07 So it goes back far enough. 04:09 And it ultimately it gets back to well, 04:11 who had perfect genetics? 04:13 Adam and Eve, right? God's original creation. 04:16 Until they put stress on those genes 04:18 by turning away from God, then the mutation started, 04:22 and then eventually, 04:23 we started to have more and more problems, right? 04:24 Right. 04:26 So understanding the reason why it's very important. 04:28 Yeah, not something we can undervalue. 04:30 You know, too often, we just want the easy route. 04:33 As patients, we want the easy route. 04:34 We don't wanna necessarily do the hard work sometimes, 04:37 but sometimes the hard work is necessary. 04:39 Now what's difficult is my son, Jake, was Jake and Kelly. 04:43 And they always ask why? Why? Why? 04:46 Oh, yeah. Why? 04:48 It's like the first thing out of their mouth. 04:49 Why? Why? Yeah. 04:50 But as we get older, 04:52 I don't think we asked that question as much. 04:54 We accept things. This is the way things are. 04:57 I'm not gonna ask why. Why is that world broken? 05:01 You know, why is this going on? 05:02 Because, you know, it's tough to ask, 05:05 to answer those questions. 05:06 So we're gonna understand the reason why, 05:08 why heart is weak. 05:10 Yeah. 05:11 So let's start with heart failure. 05:12 Yeah. What does heart failure mean? 05:14 Well, heart failure just means just what it says. 05:17 The heart is not doing its job. It's failing, okay? 05:21 Just like if you were sitting there, Nick, 05:23 and all of a sudden you quit talking. 05:25 And, you know, didn't do anything. 05:27 I'd say this is Nick failure. Nick failure. 05:29 Yeah. Let's not do that. 05:30 We don't want Nick failure. 05:32 If the people that are operating 05:33 the sound and the cameras, 05:35 if all of a sudden everything went black, 05:36 I would say, "This is production failure." 05:38 Right. Right. 05:39 So all it means is the heart failure. 05:42 Does this tell us why? Tells me nothing about why? 05:45 Got it. 05:46 But the heart is not doing its job, okay? 05:48 Just like if you quit doing your job, 05:51 I would say, "Well, you quit doing it, but why?" 05:53 You know, is he sick in his stomach, 05:54 you know, does the mind go blank? 05:56 Did he eat too much for lunch? Does he feeling bad? 05:58 Is he having pain? Why? Well, that's what I... 06:00 The approach we take with the heart. 06:02 So what heart failure 06:03 is the heart's not doing its job. 06:06 When it doesn't do its job, the organs malfunction, right? 06:09 'Cause the heart is in charge of getting oxygen, 06:11 nutrients of blood, 06:13 and different organs might malfunction. 06:14 So we might have a symptom first, 06:16 like shortness of breath, swelling, palpitations, 06:20 kidneys not working as well, 06:22 fatigue that just means the heart's not doing its job. 06:25 Sometimes, when we say the word heart failure, 06:28 because it's not pumping enough blood, 06:30 that's the strength of the heart, 06:32 the strength of heart goes down, 06:33 it malfunctions 'cause it's not as strong 06:35 as it should be, right? 06:37 The other time is sometimes it's perfectly strong, 06:40 but it doesn't know how to relax, okay? 06:43 It's a stiff heart. Right. 06:45 You know, everything gets stiff if it's not used. 06:48 So sometimes hearts even though they're strong, they get stiff, 06:52 they lose efficiency, and pressure backs up 06:54 and you can have a completely normal strength of the heart, 06:57 but it malfunctions because it's too stiff 07:00 or it's going too fast. 07:01 If you have a fast heart rhythm 300 beats a minute, 07:03 200 beats a minute, right? 07:05 The heart's strong enough, but it's not efficient. 07:08 Right. 07:09 And then it so it can't pump blood the way 07:11 even though it's perfectly strong. 07:12 So that makes sense to you? 07:14 Yeah. So we got that. 07:15 We understand why something's occurring. 07:17 And heart failure... 07:19 This means the heart's not doing its job. 07:20 Yeah. 07:22 So once a person comes with those symptoms, 07:24 and I say, "Wow, they have heart failure." 07:26 Then we start understanding why. 07:28 And that takes us to testing. Yeah. 07:30 Now a couple of years ago, 07:31 I had the opportunity to come to your office, 07:33 and we discussed a little bit 07:34 about how you diagnose heart failure. 07:36 Let's take a look at the clip from that visit, 07:38 and you can talk through some of the visits 07:40 that you diagnose. 07:41 Most of these tests that we use, 07:43 this is an echocardiogram, 07:44 it shows the heart beating, and the valves opening, 07:46 and that would tell us if the heart's weak, 07:48 if the valves might be clogged. 07:50 This is an electrocardiogram. 07:51 It looks at the electrical system of the heart 07:54 that might give us clues 07:55 to if the hearts going slow or fast. 07:59 There's others tests that we can use, 08:01 we can look and see if the hearts enlarged 08:03 or if there's fluid in the lungs, 08:05 that would give us a clue. 08:06 And here I am looking at a pacemaker 08:08 seeing whether the pacemaker might not be working. 08:10 Right. 08:11 There's the heart's going too slow, 08:13 it can't pump well, 08:14 that's a reason that the heart might fail 08:16 and the rhythm's too slow. 08:18 This is a nuclear stress test it looks to see 08:21 if the arteries might be causing it. 08:23 This is probably the most common cause of heart failure 08:25 is the arteries become blocked, 08:27 they don't work well, 08:29 we don't get enough oxygen through it. 08:31 So we want to know if that's the reason for heart failure. 08:34 We have fancy nuclear test, 08:36 we actually can see how much the heart squeezes 08:39 in every segment of the heart so we can diagnose exactly 08:43 which artery might be causing the problem 08:45 or which artery might be contributed to heart failure. 08:48 So there are many different reasons. 08:49 these are just a few of them. 08:51 We have more besides that, we got angiograms. 08:54 We have CAT scans, we've PET scans, 08:57 we've MRIs. 08:58 Sometimes we can actually do a biopsy of the heart 09:01 to see if the heart might have 09:03 some type of disease in the heart. 09:05 And there are certain conditions 09:06 like amyloid, 09:07 sarcoidosis that these diseases 09:10 have infiltrated the heart 09:12 and made the heart not function leading to heart failure. 09:15 So there's many different diagnostic tools 09:18 to look why a heart might be weak 09:20 and leading to heart failure. 09:23 Now you've already covered some of what causes a weak heart. 09:26 You mentioned rabbit heartbeats and things like that. 09:28 But what are some of the common things 09:29 we need to know about causation for a weak heart? 09:32 So if a person comes in, and they've had heart failure. 09:36 Let's say they're in the hospital. 09:37 And they had a symptom. 09:38 And we say, "Well, the heart wasn't working well." 09:40 And one of the most common ways we measure 09:42 it is fluid in the lungs, okay? 09:45 Fluid backup, we have a measurement 09:46 we can do called a proBNP 09:49 which is a hormone that goes up 09:51 when the heart's malfunctioning. 09:53 So we had that diagnosis that, 09:54 yes, you indeed have heart failure. 09:56 So the heart condition actually causes this BND... 10:00 proBNP, it's a hormone to go up in the bloodstream. 10:03 And that causes fluid in the lungs because... 10:05 No, it's a marker of heart failure. 10:07 Okay. Okay. 10:08 Now when fluid gets in the lung, 10:09 that's a marker that the heart's not doing its job 10:11 'cause normally fluid should not get in the lung. 10:13 Right. Fluid should be pumped out of the body. Right. 10:14 But when fluid backs up in the lungs, in the legs, 10:19 you know that could be a sign 10:21 that you're developing heart failure. 10:22 Just basically a sign of the circular system, 10:24 just not doing the job. 10:26 Malfunctioning, right? Malfunctioning. 10:27 If we have kidneys that are failing, 10:29 if we have no energy, those are all signs 10:31 that the hearts getting weaker, 10:33 and sometimes it can lead to failure. 10:34 One of the markers that go up sort of clue us, 10:38 when a heart failure makes one of these pro BNP. 10:41 So these are all clues. 10:42 It tells me, "Yes, you do have heart failure." 10:44 'Cause sometimes people have symptoms, 10:46 shortness of breath, tired 10:47 that are unrelated to heart failure. 10:49 Right. 10:50 And we wanna check that one off the list, right? 10:52 So once you have it, 10:54 then we do these diagnostic tests, 10:56 and then we say, "Well, I go through the list. 10:57 Well, we determined it's the heart. 10:59 What are the many causes of it? 11:01 And we talked about these before." 11:04 Probably the most common cause of a weak heart 11:07 are blockages in the arteries. 11:09 Fat gets in the arteries. They get clogged up. 11:11 If that's the case, we wanna help the arteries 11:14 as much as we could, if possible a bypass surgery, 11:17 if possible stents, 11:19 medicines that make the heart not have to work as hard, 11:22 different things that would help 11:24 if they had blockages in the arteries. 11:25 We've talked about rhythms going too slow, 11:28 that could lead to heart failure. 11:29 Rhythms going too fast 11:31 the electrical system could cause heart failure. 11:34 Remember, the heart muscles fine, 11:35 but the electrical system is messed up. 11:38 The valves of the heart malfunction 11:41 that could lead to heart failure. 11:42 The echocardiogram usually tells us that. 11:45 Sometimes it can be just stress in general, 11:48 we have too much stress in our life. 11:49 We call that the broken heart syndrome, 11:52 you know that can cause it. 11:54 And we just... 11:55 We would measure that by looking at everything 11:57 and we see that frequently in females 12:00 that have sudden stress usually, the loss of life, 12:04 you know, the grief sometimes. 12:06 Sometimes it could be hormones that cause it. 12:08 Sometimes the thyroid can be too low, 12:11 that can lead to heart failure. 12:13 Sometimes infections can cause inflammation. 12:16 You know, how sometimes when you get the flu, 12:18 your muscles get weak? 12:19 Well, sometimes in genetically predisposed heart, 12:22 the heart can get weak as well. 12:25 Sometimes other diseases can also affect the heart. 12:28 Sometimes it can be medicines like chemotherapy 12:30 or certain medications can make a heart weak. 12:33 So once we diagnose heart failure, 12:36 we start looking at the tests 12:37 because we want to understand the reason why? 12:41 And these are just a few of the many different 12:43 causes that can look nutritional deficiencies, 12:47 lots of things can make and we base it on a history 12:50 physical in our initial diagnostic test 12:52 to determine what might be the cause 12:55 if we can get cause 12:56 treatment's going to be much more successful. 12:59 Now sometimes we never find out the reason why. 13:01 And that's usually a genetics remote infection. 13:04 And we call that a weak heart. 13:07 We don't know why. Yeah. 13:09 So it sounds like a lot of times the quick fix 13:12 for emergency care will be a procedure, 13:14 but then you really get down to the reason why. 13:16 And that often comes down 13:17 to either genes or lifestyle choices. 13:20 Is that way? Well, not necessarily. 13:22 It could be a genetic problem. Right. 13:24 It could be a part just wearing out of the body. 13:27 It could be an infection of the heart. 13:29 It could be someone was experimenting 13:31 with medications they shouldn't be. 13:33 It could be a nutritional deficiency. 13:35 It could be lots of different things, 13:37 including what you said. 13:38 So everything, it's sort of like 13:40 when you look at weak hearts, 13:41 you almost like an investigator, 13:44 you wanna understand the reason 13:45 why so you got to get looking 13:47 'cause if you understand why treatment 13:49 becomes much more successful. 13:51 All right, we're gonna talk about 13:52 more about treatments in just a moment. 13:54 So stay with us here on the Ultimate Prescription. 13:56 We will be back right after the break. |
Revised 2020-02-17