Welcome back to the
Ultimate Prescription.
00:00:01.36\00:00:02.70
I'm Nick Evenson here
with Dr. James Marcum,
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and today we are talking
about atrial fibrillation
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and some of the
ways that can be treated.
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And, Dr. Marcum,
before the break we talked
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about an ablation a bit.
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What are some
of the other things
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we need to know
about treating A fib.
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Yeah.
00:00:14.54\00:00:15.88
Well, you know,
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atrial
fibrillation is very complex
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and the take
home message is today,
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if you have atrial fibrillation,
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get it
evaluated by cardiologist.
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Okay.
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The subset of cardiology
as in electrophysiologist,
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they'll talk to you
00:00:30.43\00:00:31.76
about slowing it
down blood thinners
00:00:31.79\00:00:34.20
and what caused it.
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That's the key.
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If you have symptoms
in atrial fibrillation,
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they can talk to
you about medicines
00:00:39.50\00:00:41.04
that can restore
the rhythm or ablations.
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Now sometimes in some people,
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we have a surgical
procedure that we do frequently
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specially when people having
other surgeries in the heart.
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Let's say you have
a leaky heart valve
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and atrium gets big from that
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or you had bypass surgery.
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Well, there's a procedure
that we can do intraoperatively
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called the "maze procedure."
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That's where intraoperatively,
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you know, we
talked how we destroy it
00:01:06.53\00:01:08.46
with a catheter from the groin,
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they can do it
inside with the catheter
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and that's called the maze.
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And we have an
example of that...
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Yeah, we've got a video clip,
let's just talk through that.
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And this is where,
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this is actually
the ablation catheter
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that's going in
inside the heart, okay.
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This is the area
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where atrial
fibrillation usually comes from
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and they're actually going
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and mapping out
that part of the heart,
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and what they're gonna do is
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this is sort of
gross estimate of,
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you know, the pulmonary
veins is where they're around
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and they actually do
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where they destroy
where that comes from.
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That's actually the
picture of an ablation.
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Okay.
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The maze
procedure is where actually,
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they don't use with a catheter,
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they actually
do that physically.
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Okay.
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You know, they do it
as a part of an operation,
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of course, it's a
little more accurate
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'cause you're right
there holding the heart.
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Okay, right.
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So it's a lot more accurate,
but those are the ways we deal
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with atrial
fibrillation chronically
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if we want to give it
a chance of destroying.
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Is this a 100%?
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No, 'cause you know
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they can't
sometimes get all the spots
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where atrial
fibrillation's coming from.
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But as we
progress with technology,
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this is more and more effective.
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What's the advantage of
having an atrial fibrillation
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or maze procedure?
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Well, the atrial
fibrillation might be gone,
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okay, and there's
a chance you might be
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off blood thinner someday...
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Okay.
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You can restore the rhythm,
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so the heart works
more functionally well.
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And if the heart
happens to be weak,
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and it's out of rhythm,
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that's sort of a double ramming,
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Nick, it's not good for you.
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Yeah.
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So I think that sort of the way
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we approach atrial fibrillation.
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So when a person
comes in an emergency,
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let's say they have it,
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they never know
they had it before.
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So they come in
emergency room there.
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The first thing they do
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is slow it down
with some medicines.
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We slow it down, we
put him on blood thinners
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and then we
assess whether we need
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to put him back
in rhythm quickly.
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Let me
interrupt you there. Yeah.
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What do blood thinners
do to help the situation?
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Is it to just take off
some of the load from the heart?
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No, no. Or what does it do?
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Blood thinners take...
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Remember, we talked
about the risk of blood clots.
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Every second you're
in atrial fibrillation,
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there's a risk of a blood clot.
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The longer you're
in atrial fibrillation,
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the higher the
risk of blood clot.
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Okay.
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So the real
danger I think of A Fib
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is the blood clot.
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If you have a stroke, you know,
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it's hard to
get back after that.
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Yeah. Yeah, yeah.
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And so the blood thinner is
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to help lower the risk of stroke
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and then slowing down the
heart helps the efficiency.
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Once that's done,
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some people feel great like that
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and they don't
need anything more done,
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of course, we
explore the reasons why,
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we do the blood work,
we look at the thyroid,
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we make sure they're not have
a concomitant medical problem,
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low potassium or magnesium,
make sure the heart's strong,
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make sure there's not a
coronary disease problem.
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And then after all that's done,
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we assess how
they're feeling in it.
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If they're feeling bad,
we can put it in rhythm.
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Let's say they go
out of rhythm again,
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and again and again.
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We can put him
on some medicines,
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there's some frequently
used medicines that I use,
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one called flecainide,
one called propafenone,
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one called sotalol, we
use ones called amiodarone,
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there's a new one
out called dofetilide
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that works good.
00:04:12.51\00:04:13.85
And sometimes those are
needed to control the rhythm.
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Sometimes those still
can't control the rhythm
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and the people feel terrible.
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Then we move up the track
to ablation or maze procedure.
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Okay.
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So that's how we treated sort
of short term and long term,
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but usually the
big questions I get
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are on blood thinners.
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Right.
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A lot of people
don't necessarily wanna be
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on blood thinners, right?
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No, 'cause everyone is
afraid of blood thinners,
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you know, do blood
thinners cause you to bleed?
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No, they don't cause bleeding,
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but if you have a
little bit of bleeding,
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it becomes a lot of bleeding.
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Yeah.
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I found more
cancers from starting people
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on blood thinners
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then I would care to mention
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'cause a little bit of blood,
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they might
notice in their bowel,
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and it becomes a lot of blood,
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we'd say, oh,
you've a lot of blood,
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let's investigate that.
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We find out that
they have a small cancer
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in their colon or one
in the urinary system.
00:05:05.57\00:05:09.27
So, but if you do bleed,
it accentuates the bleed.
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And there's lots of
different blood thinners
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on the market.
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The one that's
been around forever
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is called Warfarin.
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Okay.
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Or Coumadin, that's
another name for that.
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There's some new ones
out now, one called Pradaxa,
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one called Eliquis that I
like, and one called Xarelto.
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The advantage of the new ones
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is they don't have to
have blood work every month
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or so often to
keep it monitored.
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Okay, so it's little easier
for the patient to manage.
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The other ones the
Coumadin, the Warfarin,
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you have to be careful
with eating green foods
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because they could
interact with the blood thinner.
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Okay.
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So you had to be a
little bit more careful
00:05:50.85\00:05:52.18
on the food you ate.
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So lot of
people that were trying
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to eat super healthy
didn't like that medicine.
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But the new ones,
the advantage of that,
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you can eat as
much greens as you want,
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you don't have to check.
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The disadvantages,
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we really have to
depend on the patient
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to take the medicines.
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And it's dosed base
on the kidney function.
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And unfortunately right
now it can be rather expensive.
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So we always talk to
them about every day.
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Now can a person
that's had atrial fibrillation
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be off the medicine?
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That's a
question I frequently get.
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Well, they can but
there's a risk of this.
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We never know for sure
00:06:28.48\00:06:30.09
whether that
rhythm's going to recur.
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It's just like, would
you be comfortable, Nick,
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driving your car
without car insurance?
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It's not a very smart idea.
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Well, right, it's not worth.
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Yeah.
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So most patients,
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once you
understand the reason why,
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we have this score
where we measure the risk
00:06:46.47\00:06:49.20
of getting a blood clot,
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we call that a CHAD score
00:06:50.61\00:06:52.51
where we measure things
like underlying heart disease,
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age, high blood pressure,
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and if they get so many points,
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we say, listen,
your risk is pretty high.
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Your benefit on
being on a blood thinner
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outweighs the risk.
00:07:02.48\00:07:04.35
Now another thing that
comes up very frequently
00:07:04.39\00:07:06.89
is people start bleeding.
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What do we do about that?
00:07:08.39\00:07:10.43
You know, well sometimes
00:07:10.46\00:07:11.93
we just have to stop it and say,
00:07:11.96\00:07:13.29
listen, the risk of
bleeding outweighs the benefit
00:07:13.33\00:07:16.87
of the blood thinner.
00:07:16.90\00:07:18.23
Just because you're
in atrial fibrillation
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and that doesn't mean
you're gonna have a stroke
00:07:20.40\00:07:22.64
but you're just at a higher risk
00:07:22.67\00:07:24.21
of having a stroke.
00:07:24.24\00:07:26.88
There's a new procedure
00:07:26.91\00:07:28.24
that we now have
recently called a "Watchman".
00:07:28.28\00:07:32.01
And remember, we talked
early about that little sac
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where most of the clots develop.
00:07:34.82\00:07:36.32
Right.
00:07:36.35\00:07:37.69
Well, now we can close off that
00:07:37.72\00:07:39.19
with a procedure
that's called a Watchman.
00:07:39.22\00:07:41.72
And so people that
can't take blood thinners
00:07:41.76\00:07:43.69
or at high risk,
00:07:43.73\00:07:45.06
sometimes we can now
offer them that procedure
00:07:45.09\00:07:47.63
which is called a
Watchman procedure.
00:07:47.66\00:07:50.07
And that's basically
limiting off that one area
00:07:50.10\00:07:52.30
that's highly
productive of clots
00:07:52.33\00:07:53.94
when you have
atrial fibrillation.
00:07:53.97\00:07:56.24
But all the time I
get other question,
00:07:56.27\00:07:58.67
is there natural products
that lower the risk of stroke?
00:07:58.71\00:08:01.98
Right.
00:08:02.01\00:08:03.35
Well, none that's
been scientifically proved.
00:08:03.38\00:08:05.51
Now certain things
like Aspirin, Plavix,
00:08:05.55\00:08:08.62
other blood
thinners lower incrementally,
00:08:08.65\00:08:11.79
but never to the level
00:08:11.82\00:08:13.56
that these other blood
thinners have been measured.
00:08:13.59\00:08:16.99
Coumadin,
Eliquis, Xarelto, Pradaxa,
00:08:17.03\00:08:19.49
they lower it the most.
00:08:19.53\00:08:21.36
Okay.
00:08:21.40\00:08:22.73
You know, I'm gonna
change gear just for a second.
00:08:22.76\00:08:24.10
From time to time, we
have viewers that call in
00:08:24.13\00:08:26.00
or write in with questions.
00:08:26.03\00:08:27.44
And somebody's
written and asked,
00:08:27.47\00:08:28.80
"How do I know if I
need to take a supplement?"
00:08:28.84\00:08:31.54
You mentioned
earlier about being able
00:08:31.57\00:08:33.01
to measure folk's blood
00:08:33.04\00:08:34.41
and see for
deficiencies as such,
00:08:34.44\00:08:36.21
but is that necessary to know
00:08:36.24\00:08:37.88
if you need a supplement
or what's the best way?
00:08:37.91\00:08:39.25
Now that is an
important question
00:08:39.28\00:08:41.12
as it relates to
atrial fibrillation
00:08:41.15\00:08:43.72
because all the supplements,
00:08:43.75\00:08:45.49
some of them interact
00:08:45.52\00:08:46.86
with the
medicines you're taking.
00:08:46.89\00:08:48.22
Right.
00:08:48.26\00:08:49.59
So if you are
taking a supplement,
00:08:49.62\00:08:51.19
no matter what it is,
00:08:51.23\00:08:52.56
you need to let
your doctor know,
00:08:52.59\00:08:54.10
especially if you're
on other pharmaceuticals.
00:08:54.13\00:08:57.03
So people, the
way I answer that,
00:08:57.07\00:08:59.07
people that need supplements
are people with deficiencies.
00:08:59.10\00:09:02.27
Okay.
00:09:02.30\00:09:03.64
The world's been
around a long time
00:09:03.67\00:09:05.44
and we haven't had
supplements for many years.
00:09:05.47\00:09:07.28
You got it from
the food you eat.
00:09:07.31\00:09:08.64
Right.
00:09:08.68\00:09:10.01
And people that
eat plant-based diets
00:09:10.05\00:09:11.65
usually don't need
much supplementation.
00:09:11.68\00:09:14.38
Now we can always
measure the blood,
00:09:14.42\00:09:16.02
we can measure the magnesium
00:09:16.05\00:09:17.85
or the potassium,
things of the nature.
00:09:17.89\00:09:19.82
Some people that don't get out
in the sunshine need vitamin D.
00:09:19.85\00:09:23.12
Okay, yeah.
00:09:23.16\00:09:24.56
And some people that
eat a plant-based vegan diet
00:09:24.59\00:09:27.33
need the B vitamins.
00:09:27.36\00:09:28.70
Okay.
00:09:28.73\00:09:30.07
So they might
need that supplement,
00:09:30.10\00:09:31.43
but usually
they don't need a lot
00:09:31.47\00:09:32.80
of other supplementations.
00:09:32.83\00:09:34.90
Sometimes when
you take supplements,
00:09:34.94\00:09:37.67
you can, it's like if
you have an orchestra,
00:09:37.71\00:09:40.91
and let's say
you have an orchestra
00:09:40.94\00:09:42.94
with 40 French horns.
00:09:42.98\00:09:45.11
French horns are great,
00:09:45.15\00:09:46.61
but if you have
too many French horns,
00:09:46.65\00:09:47.98
they might drown
off the trumpets.
00:09:48.02\00:09:49.88
And overpowers the
rest of the orchestra.
00:09:49.92\00:09:51.25
Right. Yeah.
00:09:51.29\00:09:52.62
So some people
sort of get overboard
00:09:52.65\00:09:53.99
on a supplement
that they don't need
00:09:54.02\00:09:56.39
and it comes into the body
00:09:56.42\00:09:57.79
and it binds receptors
00:09:57.83\00:09:59.59
that you know
that they're needed
00:09:59.63\00:10:01.00
for other things
00:10:01.03\00:10:02.36
and it sort of drowns
out the other good things
00:10:02.40\00:10:04.33
that could be
going on in the body.
00:10:04.37\00:10:06.00
So that sort of my
answer to that question,
00:10:06.03\00:10:07.94
but it's very important
00:10:07.97\00:10:09.30
no matter what your
cardiovascular system is
00:10:09.34\00:10:11.54
to let your doctor know
00:10:11.57\00:10:12.91
if you are
taking these supplements
00:10:12.94\00:10:14.48
as it might
interact with medicines,
00:10:14.51\00:10:16.44
and especially it's important
for your blood thinners
00:10:16.48\00:10:18.55
'cause if the blood
thinner gets way too thin,
00:10:18.58\00:10:21.22
just a little
scratch can lead to a gusher.
00:10:21.25\00:10:24.09
Yeah, that's right.
00:10:24.12\00:10:25.45
Yeah. I tell you what?
00:10:25.49\00:10:26.82
We wanna hear the
biblical prescription
00:10:26.86\00:10:29.12
for this program today,
00:10:29.16\00:10:30.49
and why don't you
share that with us now?
00:10:30.53\00:10:32.53
Well, first of all, you know,
I like a biblical prescription
00:10:32.56\00:10:36.26
'cause these are
words that God has given us
00:10:36.30\00:10:39.17
that we now had evidence
00:10:39.20\00:10:40.80
that it changes your physiology.
00:10:40.84\00:10:42.40
Right.
00:10:42.44\00:10:43.77
Just like a pill
changes one chemical pathway,
00:10:43.81\00:10:45.67
a biblical prescription
usually affects the whole body,
00:10:45.71\00:10:49.44
helps your body do better.
00:10:49.48\00:10:50.88
So that's what I call
biblical prescription.
00:10:50.91\00:10:53.01
So a biblical
prescription for today
00:10:53.05\00:10:55.85
is found in Psalms 46:10.
00:10:55.88\00:11:00.16
It's, "Be still, take
it easy, rest, and know,
00:11:00.19\00:11:04.73
have certainty
without doubt that I am God:
00:11:04.76\00:11:08.33
I will be exalted
among the heathen,
00:11:08.36\00:11:10.37
I will be exalted in the earth."
00:11:10.40\00:11:13.44
Science says that when we rest,
00:11:13.47\00:11:17.14
when we get enough rest,
00:11:17.17\00:11:18.51
the physical
rest, the mental rest,
00:11:18.54\00:11:21.31
the spiritual rest,
and the social rest,
00:11:21.34\00:11:24.55
our body does better.
00:11:24.58\00:11:25.91
Yeah.
00:11:25.95\00:11:27.28
You know, it rest,
it doesn't malfunction,
00:11:27.32\00:11:29.25
it doesn't put
stress on the system.
00:11:29.28\00:11:31.29
In this story says,
00:11:31.32\00:11:33.66
you know maybe God knew
00:11:33.69\00:11:35.02
that we were gonna
be too busy someday.
00:11:35.06\00:11:38.03
And he says, "Listen,
be still, quit moving,
00:11:38.06\00:11:41.03
turn down the stress chemistry
00:11:41.06\00:11:42.90
that might
activate the development
00:11:42.93\00:11:45.53
of these rhythms that we get
00:11:45.57\00:11:47.24
when we're older
like atrial fibrillation."
00:11:47.27\00:11:48.70
Yeah.
00:11:48.74\00:11:50.07
So maybe if we rest more,
00:11:50.11\00:11:51.44
we were never
designed to go 24/7.
00:11:51.47\00:11:54.58
So being still,
rest or worship, know,
00:11:54.61\00:11:58.35
not only it says
be still and rest,
00:11:58.38\00:12:00.35
but know that I am God.
00:12:00.38\00:12:02.55
Not other things that are God.
00:12:02.58\00:12:04.55
You know not our cell
phones, that's not God.
00:12:04.59\00:12:06.32
Right.
00:12:06.35\00:12:07.69
But know that I am God
to our worship being still,
00:12:07.72\00:12:09.86
turning to Him,
there's physiologic benefits
00:12:09.89\00:12:12.86
in slowing down aging
00:12:12.89\00:12:14.23
and treating chronic
disease happens when we do this.
00:12:14.26\00:12:16.80
Sounds like this
biblical prescription
00:12:16.83\00:12:18.40
might be the best
supplement there is out there?
00:12:18.43\00:12:20.74
Oh, it's better
than a supplement.
00:12:20.77\00:12:22.24
Better than a supplement.
00:12:22.27\00:12:23.61
Yeah. All right.
00:12:23.64\00:12:24.97
Well, Dr. Marcum,
thank you very much.
00:12:25.01\00:12:26.34
I think I understand
00:12:26.37\00:12:27.71
atrial
fibrillation a little better
00:12:27.74\00:12:29.08
and hopefully our
viewers at home do as well.
00:12:29.11\00:12:30.68
And, Dr. Marcum,
we're going to learn more
00:12:30.71\00:12:33.58
at Heartwise Ministries, right?
00:12:33.62\00:12:35.12
Yes, and if you've questions,
we didn't cover everything.
00:12:35.15\00:12:38.22
Go to HeartwiseMinistries.org.
00:12:38.25\00:12:40.82
We'd happy to
answer your questions
00:12:40.86\00:12:42.89
on atrial fibrillation
00:12:42.92\00:12:44.26
and steer you in
the right direction.
00:12:44.29\00:12:45.63
Dr. Marcum, thank you
00:12:45.66\00:12:47.00
for sharing with us
on atrial fibrillation.
00:12:47.03\00:12:48.36
And, viewers, I hope
00:12:48.40\00:12:49.73
that you have
learned something as well
00:12:49.76\00:12:51.10
that will be valuable to you.
00:12:51.13\00:12:52.47
And thank you for joining us,
00:12:52.50\00:12:53.84
Dr. Marcum is gonna
close the program in prayer
00:12:53.87\00:12:55.24
in just a moment.
00:12:55.27\00:12:56.60
Atrial fibrillation
00:13:01.61\00:13:02.94
is a very complex
medical situation.
00:13:02.98\00:13:06.21
I hope you have
learned a few tips
00:13:06.25\00:13:07.65
that will help you today,
00:13:07.68\00:13:09.02
but as we end our time together,
00:13:09.05\00:13:10.72
let's pray for one another.
00:13:10.75\00:13:13.56
Heavenly Father, thank You
00:13:13.59\00:13:14.92
for each person
that's viewing this program.
00:13:14.96\00:13:17.09
We just want to
pray for your blessings
00:13:17.13\00:13:19.53
and your ultimate
healing in our lives,
00:13:19.56\00:13:21.40
and please lead us to Your will.
00:13:21.43\00:13:24.03
Please be with our health
00:13:24.07\00:13:25.40
and help us to improve
daily is our humble prayer.
00:13:25.43\00:13:27.54
Amen.
00:13:27.57\00:13:28.90
I wanna thank you for joining us
00:13:28.94\00:13:30.27
on the Ultimate Prescription.
00:13:30.31\00:13:31.64
If you might have questions,
00:13:31.67\00:13:33.01
please feel free
to go to our website.
00:13:33.04\00:13:35.41
Ask us a question
about atrial fibrillation,
00:13:35.44\00:13:37.68
that's HeartwiseMinistries.org.
00:13:37.71\00:13:40.72
Until next time,
I'm Dr. James Marcum,
00:13:40.75\00:13:43.02
wishing you the best of health.
00:13:43.05\00:13:44.89