The following
program presents principles
00:00:01.36\00:00:02.70
designed to promote good health
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and is not
intended to take the place
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of personalized
professional care.
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The opinions and ideas expressed
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are those of the speaker.
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Viewers are encouraged to
draw their own conclusions
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about the information presented.
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Did you know that
coronary artery disease
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is the most common
type of heart disease
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found in the United States?
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Unfortunately for some people,
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the first sign of this
disease could be a heart attack.
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On today's program,
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you'll learn how
you can reduce your risk
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of coronary artery disease,
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and thank you for joining us,
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the Ultimate
Prescription starts now.
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Welcome and thank
you for joining us today
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on the Ultimate Prescription.
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I'm your host Nick Evenson
here with Dr. James Marcum,
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speaker and director
of Heartwise Ministries,
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and also a practicing physician.
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Yeah, Nick, I see
patients every day
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in the office at the
Chattanooga Heart Institute,
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and I've had now quit a
few years of experience.
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And you know there's a
place for modern medicine,
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can't fix everything, you know?
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Right, yeah.
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And there's a
place for lifestyle,
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that can't fix everything.
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But I've learned
the key in health
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is to walk with our
Lord through worship
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and that helps us
understand where to go.
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And today we've
got an exciting topic.
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That's right. That's right.
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For viewers who've watched
this program for a long time,
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you'll know that we talked
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about a lot of
different health topics,
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not just related
to your specialty,
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but today we're talking about
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one of your
specialties which is...
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Coronary artery
disease. That's right.
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And we think about
the cardiovascular system.
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You know the heart
and all the blood vessels,
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but today we're just gonna focus
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on one aspect of that.
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And that's the
coronary arteries.
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You know,
arteries supply the heart
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with blood, nutrients, oxygen.
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When something
happens to this artery
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or any of the
arteries that supply the heart,
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the heart malfunctions.
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When the heart
malfunctions, guess what?
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The organs suffer.
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Right.
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Blood pressure goes down.
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When it doesn't get the
oxygen and the nutrients,
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bad things happen very quickly.
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So our listeners
today are gonna learn things
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about what to do
about heart attack,
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what to do in
emergency situation,
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what are the modern
medical things we have,
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how to prevent
it from happening,
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all these good things
that people want to know
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and, you know, everyone wants
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to prevent a heart
attack, right, Nick?
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Absolutely, that's right.
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You know, heart
attacks are scary things.
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Yeah, absolutely.
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You know, and I'm surprised
the youngest heart attack
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I've ever seen was a
person in their early 20s, okay?
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And the oldest one was
a guy, was 101 years old.
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So you can have a
heart attack any time,
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and that's a problem with
the arteries of the heart.
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So what a heart attack means
is the artery doesn't get blood
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to that part of the
heart, the heart dies,
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sorts of die
and it malfunctions.
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Often time it ends up
in a funny heart rhythm
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because the heart
doesn't get enough blood
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as electrical instability.
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Those are the type of situation
we'll have a heart attack,
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the heart goes crazy,
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and you see people
running to shock the heart.
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Right, yeah.
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Other times
it's just chest pain.
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There's no funny rhythms
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and then bad things
happen from that as well.
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So that's all
the different things
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we're gonna talk about today.
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Yeah, well, let's
go and get into it.
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We've got a short video
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that'll like us
to take a look at
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and you can kind of comment
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on what's
happening here in this,
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regarding to what happens...
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Well, here is our
cardiovascular system, Nick,
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and there's the
heart right in the center,
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pumping blood everywhere.
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Pumping blood
throughout the arteries,
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through legs, to every aspect,
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then it goes to the capillaries,
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then it comes back to the heart.
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The right side
of the heart pumps
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through lungs which gets oxygen.
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The veins bring
it back to the heart,
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we're seeing that right now.
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And if you notice,
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all the blood
vessels on the heart,
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those are the coronaries.
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That's what we're
going to talk about today.
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Those red streaks on the heart
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and inside all sorts
of things are going on.
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And this is a
picture of an artery
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that supplies the heart
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and in it we're going to
notice it's getting bigger
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and it's picking
up different things,
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it's getting bigger
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because it's
becoming fatty, fat filled.
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Okay.
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That's probably
the most common cause
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of a coronary problem
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that is stored in the artery,
more and more it gets stored,
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so the blood can't flow,
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then a symptom develops,
that's one type of problem.
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But sometimes that
plaque becomes unstable.
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And when that
plaque becomes unstable,
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it can explode or
rupture like a volcano.
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And when something
ruptures inside an artery,
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the body says, "Oh,
no, I've a problem."
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So the body
wants to clot it off.
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Even if you just
have a small plaque,
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a small amount of
fat that ruptures,
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you don't even know, it doesn't,
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and then one day it
gets unstable, it ruptures,
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the body wants to clot
it off, it clots it off,
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no blood makes it
down that pathway,
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and the heart has a malfunction.
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Yeah.
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Now the way I
like to think of it is,
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is these are plaques, or
fatty streaks in our heart,
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and it becomes...
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We heard this
term called oxidation.
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Have you ever heard that? Yep.
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Oxidation, things are rusting,
getting old, getting unstable.
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So the thing, sort of helps that
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is things called antioxidants.
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So when these
things start happening,
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the heart can get filled up
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so the blood
doesn't make it downstream.
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Don't get nutrients,
you have a heart attack,
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and that's one type
of heart attack, okay,
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or one type of coronary problem,
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but there's other
one's that's happened too.
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Lot of people don't realize
that sometimes these tubes
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that feed the
heart, the nourishment
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can spasm like that.
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You know, we talked
about the little plaques
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that get inside
that disrupt flow,
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but sometimes artery
itself can do like that.
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Now what is it that
it causes the artery
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to kind of
contract and retreat blood?
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Yeah, many different things,
some of the more common causes,
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extreme cold can
cause constriction.
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Okay.
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Now people are usually
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genetically predisposed to that.
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Other things that
can cause it is drugs.
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We've seen it quite a bit
in people that take cocaine,
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sometimes med and vitamins
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causes the
arteries to constrict.
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There's powerful
medicines that we use
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to raise the blood pressure
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that can sometimes
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cause the arteries to constrict.
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So, many different
things can cause these arteries
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to do constrict suddenly.
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Too much caffeine can cause
it to constrict a little bit,
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but it's usually
multiple factors.
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So I have one patient
that came at one time,
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that he was skiing
way up at a high altitude.
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So he had the cold,
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but he had low oxygen levels
which can cause it constrict.
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And he's drinking a lot
of energy drinks in caffeine.
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That mixture on
predisposed genetics
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caused his artery to constrict.
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So he had constricted,
he had a heart attack,
00:07:03.52\00:07:06.22
then when we looked at
the arteries diagnostically
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we found out
there was no blockage,
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there was no fat.
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It was a
constriction of the artery.
00:07:11.83\00:07:13.43
So we sort of
make that diagnosis
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based on diagnostic testing.
00:07:15.80\00:07:18.73
So the different
types of heart attacks
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are one the plaque,
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the pimple ruptures suddenly.
00:07:22.34\00:07:25.07
One it gradually
gets clogged up over time,
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the third it spasms
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and then the fourth
type of coronary heart attack
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is sometimes a
clot can float down
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into those
arteries and clog them up.
00:07:35.18\00:07:37.12
Just cause a blockage?
Yeah, from somewhere else.
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That's a little bit rare.
00:07:39.12\00:07:40.46
For instance,
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sometimes the heart
muscle is very weak,
00:07:41.86\00:07:44.46
and you get a lot
of blood clot in there.
00:07:44.49\00:07:46.46
Well, that blood
clot could be pumped out
00:07:46.49\00:07:48.50
and it could
actually flow down in artery
00:07:48.53\00:07:50.60
and cause a heart attack.
00:07:50.63\00:07:51.97
That is probably the most
rare type of heart attack.
00:07:52.00\00:07:55.44
The most common one
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unfortunately is one
that we can't really predict.
00:07:56.84\00:08:00.41
'Cause everyone
is walking around
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with disease
based on their genetics,
00:08:01.98\00:08:04.88
some people
experience the symptoms,
00:08:04.91\00:08:06.48
some people don't.
00:08:06.51\00:08:07.88
So everyone that I see,
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I assume that
they have some element
00:08:09.72\00:08:12.75
of coronary artery disease.
00:08:12.79\00:08:15.79
Okay, so that means
damage to the arteries,
00:08:15.82\00:08:18.06
a little plaque, a little fat
00:08:18.09\00:08:20.00
that's stored
damaging that inside lining
00:08:20.03\00:08:23.03
which is called the endothelium.
00:08:23.06\00:08:25.77
Now let's take a look here.
00:08:25.80\00:08:27.34
We're, kind of, gonna
get into the diagnosis
00:08:27.37\00:08:29.30
of how this is discovered.
00:08:29.34\00:08:31.37
But let's take a
little video here
00:08:31.41\00:08:32.74
and talk to us, Dr. Marcum,
00:08:32.77\00:08:34.11
about how coronary
artery disease is diagnosed?
00:08:34.14\00:08:36.71
Okay, we'll do that.
00:08:36.75\00:08:38.11
We hear it sometimes,
00:08:38.15\00:08:39.48
if a person doesn't
know he's having symptoms,
00:08:39.51\00:08:41.18
he can walk on a treadmill.
00:08:41.22\00:08:42.82
And when you're
walking on a treadmill,
00:08:42.85\00:08:44.49
we can hook you up to EKG's
00:08:44.52\00:08:46.55
and different
monitoring and we can do that,
00:08:46.59\00:08:50.76
see if you have a symptom.
00:08:50.79\00:08:52.13
This is a picture of
a nuclear stress test
00:08:52.16\00:08:54.43
where we can actually
measure the blood flow
00:08:54.46\00:08:57.40
in your heart after exercise.
00:08:57.43\00:08:59.57
We can see if the
heart's getting enough blood.
00:08:59.60\00:09:01.84
We can check on
the symptoms to see.
00:09:01.87\00:09:04.01
So this gentleman
walked on a treadmill,
00:09:04.04\00:09:05.91
we're looking at the
blood flow in the heart
00:09:05.94\00:09:07.91
to see if the blood is
going everywhere it should.
00:09:07.94\00:09:10.45
Sometimes we can look
00:09:10.48\00:09:11.81
and see a part of the
heart doesn't squeeze good.
00:09:11.85\00:09:14.02
And if it doesn't squeeze good,
it's getting not enough blood.
00:09:14.05\00:09:17.02
We know that they do have
the diagnosis of coronaries.
00:09:17.05\00:09:20.12
And here is a
diagnostic angiogram
00:09:20.16\00:09:22.22
where we actually
put dye into the arteries
00:09:22.26\00:09:24.96
looking for obstruction.
00:09:24.99\00:09:26.90
Once we find out
that they have this
00:09:26.93\00:09:28.63
and we can talk
about the best way to treat
00:09:28.66\00:09:30.73
both the symptoms,
00:09:30.77\00:09:32.33
and we could make a diagnosis
00:09:32.37\00:09:33.80
so we can talk
about what are the things
00:09:33.84\00:09:35.64
that we can do to
reverse the disease.
00:09:35.67\00:09:38.07
Now these are just a few
00:09:38.11\00:09:39.44
of the many
diagnostic tests we have.
00:09:39.47\00:09:41.91
I mean other test
that's popular to see
00:09:41.94\00:09:44.05
if the arteries are aging now
00:09:44.08\00:09:46.25
is called a CAT
scan of the heart
00:09:46.28\00:09:48.45
where we look for
coronary calcifications.
00:09:48.48\00:09:51.65
Where we can look at
the arteries from outside
00:09:51.69\00:09:54.12
with a CAT scan
00:09:54.16\00:09:55.49
and we can see if
the arteries are aging,
00:09:55.52\00:09:57.63
it doesn't
necessary look at the inside.
00:09:57.66\00:10:00.26
So the tests
like the stress test
00:10:00.30\00:10:02.36
where we exercise and do things,
00:10:02.40\00:10:04.13
that's trying to
provoke the symptoms.
00:10:04.17\00:10:06.84
And we measure the blood flow
and indirectly we can assume
00:10:06.87\00:10:10.14
that the arteries not
getting enough blood flow.
00:10:10.17\00:10:12.41
So we know we have a problem.
00:10:12.44\00:10:14.54
Then we have to diagnose, well,
what type of problem it is.
00:10:14.58\00:10:17.48
And usually it's
fat in the arteries
00:10:17.51\00:10:19.48
that developed over
a long period of time.
00:10:19.51\00:10:21.82
And that is a way we
sort of diagnose this.
00:10:21.85\00:10:24.55
Now in the original
video that we looked at,
00:10:24.59\00:10:26.79
it looked like there was
a lot of different arteries
00:10:26.82\00:10:29.06
going to different
parts of the heart.
00:10:29.09\00:10:30.43
The heart looks very complex.
00:10:30.46\00:10:31.96
Is there a reason
like these arteries
00:10:31.99\00:10:33.86
are particularly
susceptible to disease?
00:10:33.90\00:10:36.46
Well, the arteries of the heart
feed the heart what it needs.
00:10:36.50\00:10:40.60
And it's based a lot
on our genetic tendencies
00:10:40.64\00:10:44.17
to store fat.
00:10:44.21\00:10:45.54
You know we can store
fat in many other organs
00:10:45.57\00:10:47.48
and we have other supplies,
it's not that important.
00:10:47.51\00:10:50.35
But when the heart
which pumps everything
00:10:50.38\00:10:52.41
to every part of the body,
00:10:52.45\00:10:54.18
when it gets
disease we've problems.
00:10:54.22\00:10:56.48
Now we mentioned heart
attacks of the arteries,
00:10:56.52\00:10:59.02
we mentioned spasms,
00:10:59.05\00:11:00.62
but sometimes you can
have genetic problems as well.
00:11:00.66\00:11:03.59
Right.
00:11:03.63\00:11:04.96
And sometimes,
the arteries are going
00:11:04.99\00:11:06.33
in the wrong directions
and things squeeze the artery,
00:11:06.36\00:11:09.73
that can be a fatal thing
that can cause artery problems.
00:11:09.76\00:11:13.57
Sometimes we
can have a condition
00:11:13.60\00:11:14.94
called a bridging situation
00:11:14.97\00:11:16.67
where the muscle
squeezes the artery,
00:11:16.71\00:11:18.64
so it doesn't
get enough symptoms.
00:11:18.67\00:11:20.38
And these basically are made
00:11:20.41\00:11:21.94
based on a
person having a symptom.
00:11:21.98\00:11:24.58
Us doing a
diagnostic test finding out,
00:11:24.61\00:11:26.88
well, what the cause is.
00:11:26.92\00:11:28.58
And then we look back and say,
00:11:28.62\00:11:29.95
well, do we need
to treat an emergency,
00:11:29.98\00:11:32.19
or do we need to
do something lifestyle
00:11:32.22\00:11:34.86
or some other aspect
00:11:34.89\00:11:36.66
to help the
artery to not progress
00:11:36.69\00:11:38.63
to the point where it needs it.
00:11:38.66\00:11:40.00
And sometimes we
can use medicines
00:11:40.03\00:11:41.53
to treat the arteries,
00:11:41.56\00:11:43.40
sometimes we can give nitrates
00:11:43.43\00:11:44.77
which makes the arteries bigger,
00:11:44.80\00:11:46.33
sometimes blood thinners,
00:11:46.37\00:11:48.17
sometimes we can
stabilize plaques
00:11:48.20\00:11:50.41
with different types of
medications called statins.
00:11:50.44\00:11:54.08
Sometimes if the blood pressure
00:11:54.11\00:11:55.61
is too high
damaging the arteries,
00:11:55.64\00:11:57.95
we can lower the blood pressure.
00:11:57.98\00:11:59.58
So there's lots
of things we can do
00:11:59.61\00:12:01.08
to slow down the disease
in the arteries of the heart.
00:12:01.12\00:12:04.55
So let's talk a little
about some of the symptoms
00:12:04.59\00:12:06.45
that you've mentioned,
00:12:06.49\00:12:07.82
you talked about a heart attack.
00:12:07.86\00:12:09.19
Obviously lot of people
knows the symptoms of that,
00:12:09.22\00:12:10.73
but what are the symptoms
people need to be aware of?
00:12:10.76\00:12:12.86
Any spot of the
body above the waist
00:12:12.89\00:12:15.53
that won't go away,
that could be a heart attack.
00:12:15.56\00:12:17.63
Any kind of pain
above, above the waist?
00:12:17.67\00:12:19.33
Yes, and pain that
won't go away, Nick,
00:12:19.37\00:12:21.47
it means it that you could
have a blockage in an artery.
00:12:21.50\00:12:24.74
The fact that it's
not going away means
00:12:24.77\00:12:26.37
that artery is
completely blocked.
00:12:26.41\00:12:28.41
And if we don't do
something right away
00:12:28.44\00:12:30.75
the heart could have
a dangerous malfunction,
00:12:30.78\00:12:33.58
the heart muscle could die,
it could go into heart failure.
00:12:33.62\00:12:36.79
When the muscle
doesn't work well,
00:12:36.82\00:12:38.42
you can't
generate blood pressure
00:12:38.45\00:12:40.26
and all of the organs suffer.
00:12:40.29\00:12:42.22
So any symptom
that won't go away
00:12:42.26\00:12:44.16
needs the care right now
and get to the emergency room.
00:12:44.19\00:12:46.63
Yeah.
00:12:46.66\00:12:48.00
And then what
if it does go away?
00:12:48.03\00:12:49.36
You feel the pain,
but it does go away,
00:12:49.40\00:12:51.00
is that something
to get checked out
00:12:51.03\00:12:52.37
or you need to
complain on right away?
00:12:52.40\00:12:53.74
Yes, yes, well you know
if it's a dramatic symptom
00:12:53.77\00:12:55.64
I would get help right away,
00:12:55.67\00:12:57.17
but let's say
you're walking every day,
00:12:57.21\00:12:59.14
you can't make that walk
'cause of a funny feeling.
00:12:59.17\00:13:01.58
Well, that would be
a call to your doctor
00:13:01.61\00:13:03.31
and he would might wanna confirm
00:13:03.35\00:13:04.68
that it is the
arteries with one of these tests
00:13:04.71\00:13:07.08
we talked about,
00:13:07.12\00:13:08.45
and talk about all of the
different treatment options
00:13:08.48\00:13:10.89
as well as ways we can
reverse coronary artery disease.
00:13:10.92\00:13:14.49
So remember,
coronary artery disease
00:13:14.52\00:13:16.93
is disease that
affects the arteries
00:13:16.96\00:13:18.59
that feed the heart.
00:13:18.63\00:13:19.96
When the heart doesn't
get enough oxygen and blood,
00:13:20.00\00:13:22.23
it malfunctions.
00:13:22.26\00:13:23.60
That can lead to
a dangerous rhythm
00:13:23.63\00:13:25.63
or low blood pressure
00:13:25.67\00:13:27.00
and unfortunately
that can kill someone
00:13:27.04\00:13:29.00
right away with little warning.
00:13:29.04\00:13:30.94
Some people never had
a problem in their life
00:13:30.97\00:13:32.51
till they have
their heart attack.
00:13:32.54\00:13:33.88
Yeah.
00:13:33.91\00:13:35.24
Well, I think I understand,
I think I get the picture now,
00:13:35.28\00:13:36.61
thank you for
making that clear for me.
00:13:36.64\00:13:37.98
Okay.
00:13:38.01\00:13:39.35
We're gonna talk
more about the diagnosis
00:13:39.38\00:13:40.72
and also the treatment
of coronary artery disease
00:13:40.75\00:13:42.92
when the Ultimate
Prescription returns.
00:13:42.95\00:13:44.59