The following program
presents principles designed
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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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When you've got an
electrical issue with your car,
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it can lead to some
problematic situations
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and it's the
same with your heart.
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Over two and a
half million Americans
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are living with
atrial fibrillation.
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And on today's program,
we're gonna learn the reasons
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why and what we can do about it.
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Thanks for joining us here
for the Ultimate Prescription.
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Thank you for joining us today,
I'm your host Nick Evenson
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and we are here
with Dr. James Marcum.
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And today we're gonna
talk about atrial fibrillation
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which, Dr. Marcum, this
is one of your specialties
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as a practicing
cardiologist, right?
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Well, I wouldn't say specialty
but I'm a general cardiologist,
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I've been
practicing for nearly 30 years.
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I practice with the
Chattanooga Heart Institute
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and all cardiologists
at sometime or another
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has to deal with
atrial fibrillation.
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It's the most
common rhythm problem
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we have in the world.
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It's very common.
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Lots of people have it
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and
unfortunately in today's world,
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there's so much
information, you know,
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you can get
information from the internet,
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you can get it
from your mother-in-law,
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you can get it from TV,
you can get it from the radio,
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there's so much information.
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It's hard to know even
who or what to believe.
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Right.
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'Cause unfortunately,
our health care system, Nick,
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is made up of lot of people
that are trying to make money.
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And some of them are
trying to make it for your good
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and some of them aren't
trying to make it for your good.
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And the reason
we name this program
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the Ultimate Prescription
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because the
Ultimate Prescription
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is really not a procedure,
00:02:01.48\00:02:03.65
it's really not
a lifestyle change,
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the Ultimate Prescription
is really a walk with Jesus.
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That's right.
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'Cause that's gonna
lead to ultimate healing
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'cause we all have bad
genes, we all need a savior.
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None of us last forever,
right? Yeah, absolutely.
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We're all gonna wear
out and when we do wear out,
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whether it's a rhythm problem
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or blockage in
the artery problem
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or some of the other part,
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we know that in the
twinkling of an eye,
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God's gonna heal
us as we walk with Him
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and that's hope for
today and hope for eternity.
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I don't know how people do
it that don't have faith, Nick,
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I just don't
know how they do it.
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Yeah.
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But atrial
fibrillation, right? Yep.
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So that's today's topic,
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so let's just get
into it little bit.
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What is atrial fibrillation
and where does it take place?
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Okay.
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Well, atrial
fibrillation, there's a part,
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the top part of the
heart is called the atrium,
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okay, and it pumps blood
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to the bottom part of the heart,
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on both sides of the heart.
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The right side of the
heart pumps blood to the lungs
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where it gets oxygen
and then it comes back
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to the left side of the heart
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which pumps it
to the entire body.
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Okay.
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Well, basically,
our electrical system
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consist of a
battery of the heart
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called the sinoatrial node,
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and then there's
little wires that go down
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to the atrial
ventricular node, the AV node
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and then it goes down
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to specialized
conduction systems
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and this electrical
current which consists of ions
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that change positions,
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fancy names called
'Action Potentials'
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but eventually it
causes the heart to contract,
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it squeezes.
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And when it
squeezes, it generates pressure
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that pumps the blood
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whether it has
oxygen or no oxygen
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throughout the entire body.
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So the electrical system is key
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to getting the heart to pump.
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So the electrical
system is sort of different
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than what we talked about
before which is the arteries,
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which is sort of like
the plumbing of the heart
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which gives us the nutrients,
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but the wires is actually
what does the squeezing.
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Now the wires
need nutrients too.
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So the wires are depended
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on the blood
supply and the oxygen,
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but when the wires
can malfunction separately
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from the plumbing system.
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So the electrical
system like a heart,
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we need the electrical system
to get that heart to pump,
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to generate pressure.
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Well, there's many
different conditions
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where the
electrical system malfunctions.
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Okay.
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Okay.
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One of them and the most common
is the atrial fibrillation.
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That's that top
chamber, it fibrillates
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and this is what
fibrillation might look like.
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It's just bunch of
signals coming onto,
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there's not a
symmetric contraction.
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It's fibrillating
and when it fibrillates,
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the blood doesn't
move through as well.
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So when it fibrillates,
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it's at a higher risk
of having a blood clot.
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Also when it fibrillates,
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you lose efficiency of the heart
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'cause the blood
doesn't move from one chamber
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to the other as efficiently.
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Now you mentioned a blood
clot could happen during A fib.
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Is that because when
it's not moving correctly,
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the blood may not pump through,
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it may get stuck in there
and then turn into a clot?
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Yes, and there's a certain
area called the appendage
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which is a part, like a pocket
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that's connected to this,
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that's more
prone to have the blood
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that doesn't move as well.
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Okay.
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And when the blood
doesn't move, they clot.
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And if you had a
blood clot in your atrium
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and it happened to
pump out to the body,
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you could have a stroke.
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Right.
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It's been estimated that
of all people that had stroke,
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one in three people
have atrial fibrillation
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as the cause of their stroke.
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So just recognizing
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atrial fibrillation is important
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'cause you could
lower the risk of stroke
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and we can do
that with medicines
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and sometimes we
can put the heart
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back in rhythm as well.
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So atrial fibrillation
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is the most
common rhythm abnormality
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of the heart.
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It's when the top part
is going very, very fast,
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that's why it's
fibrillating and it's atrium
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because it's fibrillating
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and the
dangerous things about it
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is one a blood clot could form
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and two it could make the
heart go really, really fast.
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And if a heart goes
really, really fast,
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it sometimes cannot
generate blood pressure
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and sometimes it can malfunction
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and we can call...
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When heart malfunctions
and can't get blood everywhere,
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we call that heart failure.
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Okay.
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So the most serious things
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that happen in
atrial fibrillation are:
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A, blood clots.
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B, it can lead to heart failure.
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So if we were to talk about this
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in terms of an
automobile per se...
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Yes, okay.
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If there's a
number of cylinders,
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they have to fire
in the right sequence,
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and if they don't the
timing of the vehicle is off
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and the car won't run.
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Is this kind of
similar to atrial fibrillation
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different parts of the atrium
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are being fired
in the wrong time...
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That's right. That's right.
It's just out of sequence?
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Remember we talked early,
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normally it's the
battery part of the heart
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generates a signal,
it goes down a wire,
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there's a sort of a place
called AV node where, you know,
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the top part has those delay,
then it goes down this tissue.
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Well, in atrial fibrillation,
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it's not going
that normal route.
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We're having signals
come from everywhere.
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Okay. Okay.
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So you know, lots of
them are getting through
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to the bottom part of the heart
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sometimes you ask,
sometimes you don't,
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but it's not going there,
00:07:04.35\00:07:05.69
it's not travelling
through regular highway.
00:07:05.72\00:07:07.89
Now someone's experiencing this.
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Is this something they
could physically feel happening?
00:07:09.29\00:07:11.63
Is it painful
or it's just out...
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No.
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It could be painful
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and some people feel like
their heart's just quivering,
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and quivering would
be good word for it...
00:07:17.53\00:07:18.93
Okay. Yeah.
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But some people, they
don't even feel it at all.
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They don't even
know they have it.
00:07:22.60\00:07:25.57
It's a condition that has a
lot of different expressions.
00:07:25.61\00:07:29.01
Now some people feel
00:07:29.04\00:07:30.38
short of breath
when they have it.
00:07:30.41\00:07:31.75
I run into some people,
00:07:31.78\00:07:33.11
we don't even know they
have it till they show up
00:07:33.15\00:07:34.82
in the emergency
room with a stroke.
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"Oh, you've had a stroke.
00:07:36.42\00:07:38.12
Oh, did you know you had A fib?"
00:07:38.15\00:07:39.62
"Oh, no, I
didn't know I have it."
00:07:39.65\00:07:41.69
Well, they could had A
fib for years not noted,
00:07:41.72\00:07:44.86
eventually formed a clot,
the clot pumped to the brain,
00:07:44.89\00:07:48.13
then they find out
they have a stroke.
00:07:48.16\00:07:50.13
Usually the
people that don't know it
00:07:50.17\00:07:52.10
are people that have
a pretty strong heart
00:07:52.13\00:07:54.60
and the rhythm
doesn't go too fast.
00:07:54.64\00:07:56.74
Okay, yeah.
00:07:56.77\00:07:58.27
So how does this affect?
00:07:58.31\00:07:59.91
You mentioned that
people might have a clot,
00:07:59.94\00:08:02.44
but does it affect
blood pressure or how...
00:08:02.48\00:08:04.45
What are the
other dangers of A fib?
00:08:04.48\00:08:08.28
Well, the main, I
say the main danger,
00:08:08.32\00:08:10.59
in my opinion is blood clot.
00:08:10.62\00:08:12.35
The second is the
heart loses efficiency
00:08:12.39\00:08:14.72
so...
00:08:14.76\00:08:16.09
So it over uses that
part of the heart muscle?
00:08:16.12\00:08:17.49
The heart doesn't
contract normally,
00:08:17.53\00:08:19.76
so blood when it's contracting,
00:08:19.79\00:08:21.23
it doesn't move from one chamber
00:08:21.26\00:08:22.60
to another as efficiently.
00:08:22.63\00:08:23.97
Right.
00:08:24.00\00:08:25.33
They have
estimated that you lose maybe
00:08:25.37\00:08:26.74
up to one-third of the
efficiency of the heart
00:08:26.77\00:08:29.37
when you're out
of rhythm like this,
00:08:29.40\00:08:30.97
atrial fibrillation.
00:08:31.01\00:08:32.44
So, and if it loses efficiency,
00:08:32.47\00:08:34.38
and the heart's
weak to begin with,
00:08:34.41\00:08:36.38
it makes things worse,
00:08:36.41\00:08:37.85
you can't pump blood
everywhere you need to.
00:08:37.88\00:08:39.98
You could
actually go into condition
00:08:40.02\00:08:42.28
called heart failure.
00:08:42.32\00:08:43.99
So that's what it is.
00:08:44.02\00:08:45.75
Now lot of people interested in
all the different causes of it.
00:08:45.79\00:08:50.29
And that's very interesting
00:08:50.33\00:08:51.76
'cause if you can
sometimes find the cause,
00:08:51.79\00:08:54.36
sometimes you can
prevent it from happening.
00:08:54.40\00:08:56.13
You definitely know
00:08:56.16\00:08:57.50
how to treat it
more effectively.
00:08:57.53\00:08:58.87
Sure, yeah.
00:08:58.90\00:09:00.24
Sometimes it can happen
just because the wires get old,
00:09:00.27\00:09:02.60
just things wear out.
00:09:02.64\00:09:03.97
Just like you
have hearing prompts,
00:09:04.01\00:09:05.34
eye prompts,
things just wear out.
00:09:05.37\00:09:07.44
One of the most common
though is the arteries,
00:09:07.48\00:09:10.21
the arteries
feed the heart blood,
00:09:10.25\00:09:12.01
if the arteries get blocked up,
00:09:12.05\00:09:13.68
the conduction
system can be affected.
00:09:13.72\00:09:15.75
It can trigger
atrial fibrillation.
00:09:15.78\00:09:17.12
Okay.
00:09:17.15\00:09:18.49
If any of the
heart malfunctions,
00:09:18.52\00:09:19.85
it can trigger
atrial fibrillation.
00:09:19.89\00:09:21.22
The valves leak a lot.
00:09:21.26\00:09:22.82
The chambers get enlarged.
00:09:22.86\00:09:24.26
That could trigger.
00:09:24.29\00:09:25.99
We see it frequently
00:09:26.03\00:09:27.36
after people have bypass surgery
00:09:27.40\00:09:29.33
'cause they
manipulate the atrium.
00:09:29.36\00:09:31.03
Right.
00:09:31.07\00:09:32.40
Certain hormonal situations
00:09:32.43\00:09:34.17
like thyroid
disease can cause it.
00:09:34.20\00:09:36.74
Some people if
they get dehydrated,
00:09:36.77\00:09:38.67
that can trigger.
00:09:38.71\00:09:40.31
And if you run low on
potassium or magnesium
00:09:40.34\00:09:43.14
and genetically
vulnerable heart,
00:09:43.18\00:09:45.41
that can trigger
atrial fibrillation.
00:09:45.45\00:09:47.65
So lots of things can cause it.
00:09:47.68\00:09:49.48
A weak heart can
trigger atrial fibrillation.
00:09:49.52\00:09:52.09
So when someone comes in
with atrial fibrillations,
00:09:52.12\00:09:54.39
we wanna make sure
they're on a blood thinner,
00:09:54.42\00:09:56.93
we wanna make sure
it's not going fast,
00:09:56.96\00:09:59.09
we wanna
investigate the cause of it.
00:09:59.13\00:10:01.43
What's causing it?
00:10:01.46\00:10:02.80
We do it with
all sorts of tests,
00:10:02.83\00:10:04.33
echocardiograms, we
look at the arteries,
00:10:04.37\00:10:07.14
we look a monitors,
we check the blood work.
00:10:07.17\00:10:09.57
Once we find
out the cause of it,
00:10:09.60\00:10:11.21
we try to work on the cause
00:10:11.24\00:10:12.97
and sometimes we
even put the heart
00:10:13.01\00:10:15.14
back in rhythm.
00:10:15.18\00:10:16.51
And that, we can do that
with many different ways.
00:10:16.54\00:10:19.51
Sometimes we cardiovered it
or shock it back into rhythm.
00:10:19.55\00:10:22.38
Right.
00:10:22.42\00:10:23.75
Sometimes you can use medicines
to put it back in rhythm.
00:10:23.79\00:10:26.76
And now there's a procedure
00:10:26.79\00:10:28.12
that we can actually destroy
this rhythm in some cases
00:10:28.16\00:10:31.39
and that's called an ablation.
00:10:31.43\00:10:33.60
We haven't always
had that procedure,
00:10:33.63\00:10:35.36
but now we can go up actually
00:10:35.40\00:10:37.27
and find out where
those abnormal circuits are
00:10:37.30\00:10:39.60
in certain situations
00:10:39.63\00:10:41.17
and destroy that
with an ablation.
00:10:41.20\00:10:43.41
So explain the
ablation to us a little bit?
00:10:43.44\00:10:45.01
How does that happen?
00:10:45.04\00:10:46.37
What's the
actual procedure like?
00:10:46.41\00:10:47.74
Well, the
procedure is very complicated
00:10:47.78\00:10:50.01
but you actually basically
put catheters into the groin
00:10:50.05\00:10:53.82
and you go up into the
atrium, the part of the heart
00:10:53.85\00:10:56.32
where most of
these signals come from,
00:10:56.35\00:10:57.89
they're the pulmonary veins
00:10:57.92\00:10:59.25
and you sort of
destroy in a pattern
00:10:59.29\00:11:02.19
all the different things,
00:11:02.22\00:11:03.86
the pathways of these rhythms
00:11:03.89\00:11:05.69
and that's why
we called ablation
00:11:05.73\00:11:07.06
'cause we destroy it.
00:11:07.10\00:11:08.43
It's quite a long procedure.
00:11:08.46\00:11:10.47
We don't do it on everybody.
00:11:10.50\00:11:12.67
So mainly we do it on people
00:11:12.70\00:11:14.04
that are having
lots of symptoms,
00:11:14.07\00:11:15.80
they can't be on
the blood thinners,
00:11:15.84\00:11:18.04
that are of the
appropriate criteria,
00:11:18.07\00:11:19.61
they don't have a lot
of co morbid conditions
00:11:19.64\00:11:21.81
or things but it's a pretty...
00:11:21.84\00:11:23.81
But we haven't had this forever.
00:11:23.85\00:11:25.85
When I first started my career,
00:11:25.88\00:11:27.52
we did not have atrial ablation.
00:11:27.55\00:11:29.98
It was very
limited what we could do,
00:11:30.02\00:11:31.42
but now we have
all sorts of options
00:11:31.45\00:11:33.46
for all the
millions of people now
00:11:33.49\00:11:35.56
that have atrial fibrillation.
00:11:35.59\00:11:37.19
And as the population
ages, more and more people
00:11:37.23\00:11:40.26
will experience
this rhythm problem.
00:11:40.30\00:11:42.90
Yeah, so the ablation,
who should have an ablation?
00:11:42.93\00:11:45.70
Who's the right
candidate for that procedure?
00:11:45.73\00:11:48.14
Well, first of all if a
person has atrial fibrillation,
00:11:48.17\00:11:51.57
we wanna know the cause.
00:11:51.61\00:11:53.21
If we're gonna fix
the cause, that's great.
00:11:53.24\00:11:55.48
Well, let's say
a person comes in,
00:11:55.51\00:11:57.15
78 years old with
atrial fibrillation,
00:11:57.18\00:11:59.28
it's going fast.
00:11:59.31\00:12:00.88
The first thing we would do
00:12:00.92\00:12:02.28
would be to try
to restore rhythm
00:12:02.32\00:12:04.39
if we didn't know how long.
00:12:04.42\00:12:05.75
We make sure
there's no blood clots.
00:12:05.79\00:12:07.72
And if there's no blood clots,
00:12:07.76\00:12:09.09
we can put the
heart back in rhythm.
00:12:09.12\00:12:11.13
And the way we do that
00:12:11.16\00:12:12.49
in an emergency
situation is we go and look.
00:12:12.53\00:12:15.43
We have a tube that we
can place down the esophagus
00:12:15.46\00:12:18.27
right behind the atrium.
00:12:18.30\00:12:20.14
We can see if
they have a blood clot
00:12:20.17\00:12:21.70
that's called a
ransesophageal echocardiogram.
00:12:21.74\00:12:24.64
They didn't have the blood clot,
00:12:24.67\00:12:26.01
we can put it back in rhythm.
00:12:26.04\00:12:27.38
Okay.
00:12:27.41\00:12:28.74
And then we investigate
all the other causes.
00:12:28.78\00:12:30.41
If a person has lots of symptoms
00:12:30.45\00:12:32.95
and they keep going
to atrial fibrillation
00:12:32.98\00:12:35.32
and either can't take medicines
or medicines are too risky,
00:12:35.35\00:12:38.89
then that person
might be a candidate.
00:12:38.92\00:12:41.22
A younger person
might be a candidate
00:12:41.26\00:12:43.22
'cause we don't want to
have a lifelong medicines
00:12:43.26\00:12:46.06
are coming in and
out of the hospital.
00:12:46.09\00:12:48.03
So it's really
variable from person to person.
00:12:48.06\00:12:50.53
The specialists that
deals with this in my group
00:12:50.57\00:12:53.20
are called electrophysiologists.
00:12:53.23\00:12:55.44
And they've gone to school
for prolong periods of time
00:12:55.47\00:12:57.81
just to learn
how to handle this.
00:12:57.84\00:12:59.87
We have some
medicines that we use
00:12:59.91\00:13:01.68
to help put the
heart back in rhythm,
00:13:01.71\00:13:03.55
of course cardioversion
00:13:03.58\00:13:04.91
will put it in
rhythm short term,
00:13:04.95\00:13:06.58
but won't necessarily
hold it for long term.
00:13:06.61\00:13:09.18
So this is the rhythm
that's very complicated.
00:13:09.22\00:13:12.95
It's something that
all people need to know
00:13:12.99\00:13:15.66
about how to handle it
00:13:15.69\00:13:17.03
and what are all
the different options
00:13:17.06\00:13:18.39
we might choose to treat it.
00:13:18.43\00:13:20.33
Yeah.
00:13:20.36\00:13:21.70
Well we're gonna take a
break in just a moment but,
00:13:21.73\00:13:24.20
Dr. Marcum, why don't
you just tell us a little bit
00:13:24.23\00:13:25.57
about this atrial fibrillation?
00:13:25.60\00:13:27.87
What is the one best
thing that you can do
00:13:27.90\00:13:30.01
to prevent something like that?
00:13:30.04\00:13:31.47
Is there any
options as far as lifestyle?
00:13:31.51\00:13:32.84
Well, you know in general,
00:13:32.87\00:13:34.58
you know like I said
if it's genetic thing,
00:13:34.61\00:13:37.98
we might be able to turn
off the expression of genes
00:13:38.01\00:13:40.98
by living healthy
00:13:41.02\00:13:42.35
and any type of
stressor on the body
00:13:42.38\00:13:44.02
can age the electrical system.
00:13:44.05\00:13:46.76
You know,
hydration, eating greens,
00:13:46.79\00:13:49.19
you know all those
things, getting enough rest,
00:13:49.22\00:13:51.39
you know, just
being healthy in general
00:13:51.43\00:13:53.13
might slow the progression
00:13:53.16\00:13:54.50
but some people
do all of this, Nick,
00:13:54.53\00:13:56.40
and still show up
with atrial fibrillation
00:13:56.43\00:13:58.33
at some point in their life.
00:13:58.37\00:13:59.70
All right.
00:13:59.73\00:14:01.07
I tell you what, I'm gonna
talk to you more about that,
00:14:01.10\00:14:02.44
but we're gonna
take a quick break
00:14:02.47\00:14:03.81
and the Ultimate Prescription
will be back in just a moment.
00:14:03.84\00:14:05.21
Stay with us.
00:14:05.24\00:14:06.57