Each day a healthy heart
beats about 100, 000 times
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at a rate anywhere from
60 to 100 beats per minute.
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Physical activity,
diet, medication and age
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are all common factors
that can affect heart rate,
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but what causes the heart
to sometimes beat too slow.
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Today, we'll learn
about rhythms of the heart
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and what we can do about them
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right here on the
Ultimate Prescription.
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And thank you
for joining us today
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for the Ultimate Prescription.
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I'm your host, Nick Evenson
here with Dr. James Marcum,
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and today we're talking
about slow rhythms of the heart.
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Dr. Marcum,
welcome to the program.
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Yeah, it's my
pleasure to be here, Nick,
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and I must
compliment you on that tie.
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Oh, thank you.
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This is actually a tie
I got from my grandfather.
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So it's a special tie.
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You know, I in my
younger days used to wear ties.
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But now as I've gotten older,
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it's more important to
be comfortable, you know.
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Yeah.
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Well, you know,
you've got a stressful job.
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So comfort,
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comfortable attire is important.
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Yeah, well, I've got...
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Well, I can wear the
tie occasionally but,
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you know, the casual
look, it makes more comforable.
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Hey, what are we
talking about today?
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So we're gonna
talk about slow rhythms,
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and also maybe a
few fast rhythms,
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but let's talk
about you for a second
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because some people,
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we may have some new viewers
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that don't know
who Dr. Marcum is.
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You are a
practicing cardiologist
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with the
Chattanooga Heart Institute
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and also speaker/director
of Heartwise Ministries.
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Yeah.
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And I've been practicing,
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I guess one of the things
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that I can say
I've been practicing now
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for quite a while
and I wish all the things
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I've learned through the years
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I knew back when I
started back in the early 1990s.
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You know,
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when you're
younger you wish you know,
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and I wish I had the
energy I had back then now.
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So now we in
Chattanooga Heart Institute,
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we have a group of 50 now,
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30 cardiologists and
surgeons and then 20 providers.
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And now that I'm the fifth
or sixth oldest in the group,
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I, you know,
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I've almost
outsourced myself out of a job.
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Years ago in the
practice of cardiology,
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cardiologists used to do
a little bit of everything.
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But now, every 10
years everything changes,
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you have to learn
everything over again,
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including cardiology,
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but I've also found that, Nick,
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it not only changes
in the technology part,
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but also I've looked
at the lifestyle part,
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that's changed quite a bit too.
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You know,
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we used to focus
a lot on nutrition
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and I think all
that's important.
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Then for a while we
started on movement 'cause
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we noticed that people weren't
moving very much and now,
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the big emphasis lately
on preventing and reversing
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disease has
been on mental health
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and bowel flora.
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So everything changes.
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But, you know, one
thing that hasn't changed
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is the most important thing
and that's the spiritual walk.
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Because all of
us have bad genes,
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we all need a Savior,
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we're all gonna break down.
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And when we do break down,
when we have Him in our heart,
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we know that in the
twinkling of an eye,
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our genes are
gonna be made good again,
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we're gonna be healed.
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And that's sort of what
keeps me going day to day
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is that I have opportunities
to give that hope to people
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that might not do so well.
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And not everyone does well
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with these modern
medicine and procedures,
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you know, sooner or later,
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we run out of things
that we can help people with.
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Right.
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So we're gonna talk
about slow heart rhythms.
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Do you know what a
heart rhythm is, Nick?
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I'm gonna quiz you a little bit.
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The heart rhythm goes bump bump,
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and that's a rhythm, right?
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Right.
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But do you know how you can
check the speed of your heart?
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Well, I do know a little bit.
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You can check a pulse,
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the radial pulse
on the wrist here.
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And it's a little
difficult to feel,
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takes a little
practice but you can feel there.
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Or right here on
the carotid artery
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and you can count for...
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watch the clock
and count for a minute
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and then that's your heart rate.
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And I think that's a good thing
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for everyone to learn how to do
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because if
you're sick, guess what?
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Naturally your
heart's gonna go fast.
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Yeah.
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So, you know, if you're infected
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or you have a losing
blood, if you're having pain,
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your heart's
naturally gonna go fast
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because it wants to pump blood
to every organ that needs it.
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Now we talked about well,
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what would cause a
heart rhythm to go slow?
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And what's dangerous slow, okay?
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Well, dangerously slow is
any heart beat that so slow,
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that it can't
generate a blood pressure.
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Now some highly tuned
athletes which I am not, okay?
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Their hearts can
pump 40 beats a minute
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and they get
plenty of blood flow
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and it's not a big deal.
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This is normal slow.
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This is their
resting heart rate?
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Say like in the
evening when they're sleeping
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or the first
thing in the morning.
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'Cause their
heart is so efficient.
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Yeah.
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And their vascular
system is all very healthy.
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Very healthy, very efficient.
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So their heart can go for in 40
and they get blood everywhere.
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But some people, they go slow
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and it's what we call pathologic
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where it's dangerous.
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And there's some
medical conditions
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that can make the heart go slow.
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For instance, an
underactive thyroid.
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Remember, the
thyroid is the organ
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that keeps us regulated.
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So if you run out of thyroid,
your heart's gonna go slow.
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Make sense? Yeah.
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I had one lady once
that took a medicine
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called a beta blocker,
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which slowed the heart rate down
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and helped the heart strength.
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And every time she felt like
she was having a heart problem,
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she says, "Well, my
heart's not doing good.
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I'll take a beta blocker."
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And it made her heart go slow.
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Slow it down some more, right?
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So one day she says,
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"Yeah, I don't feel good.
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I'm taking a beta blocker.
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I still don't feel good.
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I'm gonna take another one."
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A lot of times you
got to the emergency room
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her heart rate is going 20
and her blood pressure was 70.
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She wasn't feeling very good.
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So medications can
also make the heart go slow.
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There are
certain herbs and plants
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that can make
the hearts go slow.
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One of the biggest
ones through the years
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that people have heard
of is one called digitalis.
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That's a medicine or herb
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that can make the heart go slow.
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So medicines
can make it go slow,
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thyroid can make it go slow,
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if you lack oxygen,
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sometimes the heart can go slow.
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People with the
condition called sleep apnea.
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Do you know what that is?
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Tell me what that is.
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I wanna quiz you
again, make sure you know.
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Sleep apnea is
when you're asleep,
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you don't get
good oxygen therefore
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your body doesn't work well,
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I don't know why.
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Why sleep apnea occur?
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Is that something
to do with weight?
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Well, there's two
different reasons.
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One is obstructive sleep apnea
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where you have
too much tissue heavy,
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you know, you
obstruct the airway.
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The other one's
called central sleep apnea,
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it happens in the brain.
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So the brain doesn't sleep
well and usually the brain part
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usually has to do
with your circadian rhythms
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being disrupted
from different things.
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Your oxygen goes down,
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but when your
oxygen goes down at night,
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your heart can slow down.
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So I see person on a monitor,
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that's how we see
if the heart's going
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slow or fast.
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We put these 24
hour monitors on people.
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We have three
day monitors we put,
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we can hook
people up to the internet
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and see their
heart how fast it goes.
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We also now have chip implants
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that we can do to see
if a heart goes too slow.
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Wow.
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So if a heart's going too
slow and is pathologic though,
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usually a person
will have a symptom.
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Okay.
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They won't feel right.
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So they won't feel right.
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I would imagine maybe
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if you have a slow heart rhythm,
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maybe you feel chronic fatigue.
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That could be one.
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What are some of
the other symptoms?
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Oh, the blood
pressure might go low.
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But probably the
most common one, Nick,
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is when it goes too slow.
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The blood pressure goes low
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and a person gets
dizzy or passing out.
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So almost everyone that
gets dizzy or passes out,
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the first thing
a cardiologist says
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"Could it be related to
the rhythm going to slow?"
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And if we don't know,
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what we end up doing is
putting in some type of monitor
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on the person.
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A short term, a
long term monitor.
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And then if they pass out again,
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we have that monitor to see
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if it was related to
the rhythm of the heart.
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So you can then go
and analyze the rhythm
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what was
happening over the last week
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or several days
leading right up to the event?
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Yeah. I had a
person that worked.
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He wasn't a pilot,
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but he was an
airline attendant once
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that was having
passing out spells.
00:08:30.74\00:08:33.38
So I was concerned that it
could be a slow heart rate.
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Thyroid was good,
electrolytes were good,
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didn't have anything
that would do it other
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than the wires just getting old.
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So six months after
we put in a loop monitor,
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that's a continuous monitor.
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He had a spell,
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and it was like
at 4:30 afternoon
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he got dizzy and passed out.
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We were able to dig
out that and we noticed
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that his heart
stopped for six seconds,
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did not beat, going to slow.
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We figured out what
he now meets criteria
00:09:01.57\00:09:04.51
to have treatment for that.
00:09:04.54\00:09:06.27
And the treatment for that
slow heart rate is a pacemaker.
00:09:06.31\00:09:09.71
Yeah.
00:09:09.74\00:09:11.08
So what causes...
00:09:11.11\00:09:12.45
You said his heart
stopped for six seconds.
00:09:12.48\00:09:14.05
What caused that condition?
00:09:14.08\00:09:16.28
On him, we call that
a sick sinus syndrome.
00:09:16.32\00:09:21.19
The sinus node is
the battery that has,
00:09:21.22\00:09:23.86
that sort of like
any battery, you know,
00:09:23.89\00:09:26.13
sometimes lithium
batteries last forever.
00:09:26.16\00:09:28.96
They keep on ticking,
00:09:29.00\00:09:30.33
they take a licking, you know,
00:09:30.37\00:09:31.87
sometimes they run out of juice.
00:09:31.90\00:09:34.24
And that's sort of
genetically determined.
00:09:34.27\00:09:36.71
Now the brain and
what's the brain hold.
00:09:36.74\00:09:38.67
Well, the brain can determine,
00:09:38.71\00:09:40.24
tell the battery to speed up
00:09:40.28\00:09:41.88
and use more energy,
00:09:41.91\00:09:43.24
you know, you're sick,
00:09:43.28\00:09:44.61
you're running,
you're scared like that,
00:09:44.65\00:09:46.35
your heart's
gonna go fast, right?
00:09:46.38\00:09:47.72
So your heart went
fast when I did that, right?
00:09:47.75\00:09:49.08
Yeah, woke me up a little bit.
00:09:49.12\00:09:50.45
Right.
00:09:50.49\00:09:51.82
And now that you're relaxing,
the heart's gonna slow down.
00:09:51.85\00:09:53.66
Now the brain does that.
00:09:53.69\00:09:55.29
But there's the
battery part of your heart
00:09:55.32\00:09:57.23
that it spits out the energy.
00:09:57.26\00:09:59.13
Right, yeah.
00:09:59.16\00:10:00.50
But sooner or later,
the energy can run out,
00:10:00.53\00:10:02.33
and it can go slow and stop.
00:10:02.36\00:10:04.53
Just like other
parts of the body get old
00:10:04.57\00:10:06.37
and wear out.
00:10:06.40\00:10:07.74
And when we go wear out,
00:10:07.77\00:10:09.10
technology many
times can replace things.
00:10:09.14\00:10:12.17
If you can't see
good, we have glasses.
00:10:12.21\00:10:14.28
Can't hear good,
we have hearing aids.
00:10:14.31\00:10:16.14
Well, if your wires wear out,
00:10:16.18\00:10:18.41
we have pacemakers.
00:10:18.45\00:10:19.78
So for this patient, it was
a pacemaker that you put in?
00:10:19.81\00:10:21.52
Right.
00:10:21.55\00:10:22.88
And he had a pacemaker
00:10:22.92\00:10:24.25
and he's actually
had it replaced twice
00:10:24.29\00:10:25.92
since I've known him now.
00:10:25.95\00:10:27.39
Pacemakers don't last forever,
00:10:27.42\00:10:28.76
it's a battery that
replaces your battery
00:10:28.79\00:10:31.19
that ran out of juice.
00:10:31.23\00:10:33.23
So it doesn't
totally fix things.
00:10:33.26\00:10:34.96
It is never quite as
good as your own battery,
00:10:35.00\00:10:37.73
but it's better
than the alternative.
00:10:37.77\00:10:39.17
Yeah.
00:10:39.20\00:10:40.54
Now you have a couple
of different devices here.
00:10:40.57\00:10:42.20
One of this is a pacemaker? Yes.
00:10:42.24\00:10:43.57
What have we got?
00:10:43.61\00:10:44.94
Why don't you hold this one up?
00:10:44.97\00:10:46.31
Sure. Yeah.
00:10:46.34\00:10:47.68
That is a pacemaker.
00:10:47.71\00:10:50.25
And it's a very small pacemaker,
00:10:50.28\00:10:52.65
and we implant that in the body.
00:10:52.68\00:10:55.08
And then we hook
two leads up that,
00:10:55.12\00:10:57.45
one lead goes into the
heart, usually the atrium,
00:10:57.49\00:11:01.32
another one goes
into the ventricle.
00:11:01.36\00:11:03.19
And these leads
both make the heart beat,
00:11:03.22\00:11:06.36
as well as monitor what
the heart rhythms doing.
00:11:06.39\00:11:09.36
So sometimes it
might be going fast enough
00:11:09.40\00:11:11.43
that it doesn't need
the pacemaker, right?
00:11:11.47\00:11:14.10
So you don't need it
so why use up the battery.
00:11:14.14\00:11:16.71
So it just senses
it and doesn't fire.
00:11:16.74\00:11:19.37
Now, some people are
00:11:19.41\00:11:20.74
what we call
pacemaker dependent,
00:11:20.78\00:11:22.98
that if they didn't
have a pacemaker at all,
00:11:23.01\00:11:24.75
they wouldn't have any rhythm.
00:11:24.78\00:11:26.31
They use up the
battery quite often.
00:11:26.35\00:11:28.88
And we have devices
where we can monitor
00:11:28.92\00:11:31.42
how well the pacemaker's doing,
00:11:31.45\00:11:33.52
how long that's gonna last,
00:11:33.56\00:11:34.96
when we need to
put another battery in.
00:11:34.99\00:11:37.13
And they have leads
that actually go through
00:11:37.16\00:11:39.29
the blood vessels into the heart
00:11:39.33\00:11:41.76
that stay there permanently.
00:11:41.80\00:11:43.13
Yeah, so a device like this
about how long might it last?
00:11:43.16\00:11:46.87
How often do the patients
have to have them checked?
00:11:46.90\00:11:49.70
Well, we check them
usually on the month remotely.
00:11:49.74\00:11:52.57
Okay.
00:11:52.61\00:11:53.94
Yearly, we do a full
what we call interrogation.
00:11:53.98\00:11:56.98
And the technology
has improved so much,
00:11:57.01\00:11:59.01
we can just put
something over it,
00:11:59.05\00:12:00.42
we can tell, you know,
00:12:00.45\00:12:01.78
what it's doing,
00:12:01.82\00:12:03.15
we can actually tell
this has a monitoring device.
00:12:03.18\00:12:05.79
If you have a funny
feeling three days ago,
00:12:05.82\00:12:08.02
I can look that up and see
00:12:08.06\00:12:09.39
if the pacemaker or a
funny heart rhythm was involved.
00:12:09.42\00:12:13.03
So it's a smart machine.
00:12:13.06\00:12:15.06
And also,
00:12:15.10\00:12:16.77
if you use it every
single beat of course,
00:12:16.80\00:12:18.87
the battery wears out quicker,
00:12:18.90\00:12:20.64
six to eight years,
00:12:20.67\00:12:22.00
but I've had some
last as long as ten years,
00:12:22.04\00:12:24.14
some as long as
six to eight years.
00:12:24.17\00:12:26.78
But we monitor that
when the battery runs low,
00:12:26.81\00:12:29.41
we replace it
well ahead of time.
00:12:29.44\00:12:31.88
And we put a new battery in it.
00:12:31.91\00:12:33.25
It's sort of like a car battery,
00:12:33.28\00:12:34.62
you know, go in
there through the incision,
00:12:34.65\00:12:36.02
put a new one in,
00:12:36.05\00:12:37.39
hook up the leads so
yep, and he gets to go home.
00:12:37.42\00:12:39.42
Yeah, now I've heard you talk
00:12:39.45\00:12:40.79
a little bit in the
past in our conversations
00:12:40.82\00:12:42.49
about some folks not wanting
to have a pacemaker put in
00:12:42.52\00:12:45.56
and what are some
of the objections?
00:12:45.59\00:12:48.36
And are they...
00:12:48.40\00:12:49.73
What are your thoughts on it?
00:12:49.76\00:12:51.10
Well, some
people think that that
00:12:51.13\00:12:52.63
their heart will start
speeding up by natural things.
00:12:52.67\00:12:55.37
They don't feel too bad,
00:12:55.40\00:12:56.74
you know, man had one spell,
00:12:56.77\00:12:58.11
but today they feel good
00:12:58.14\00:12:59.47
and I tell them well,
00:12:59.51\00:13:01.38
you know,
00:13:01.41\00:13:02.74
you know, some
people just wear out,
00:13:02.78\00:13:04.11
the battery wears out,
00:13:04.15\00:13:05.48
now how fast it wears out
00:13:05.51\00:13:06.85
when an episode
will happen again,
00:13:06.88\00:13:08.58
no one knows.
00:13:08.62\00:13:09.95
But sometimes it's
like you have a spell
00:13:09.98\00:13:11.89
and it doesn't happen
for two or three months.
00:13:11.92\00:13:13.89
But what if you had a
spell of slow heart rhythm
00:13:13.92\00:13:16.22
that didn't
generate a blood pressure
00:13:16.26\00:13:18.49
when you are driving.
00:13:18.53\00:13:19.86
It'll be dangerous.
00:13:19.89\00:13:21.23
Or when you're doing
a dangerous activity?
00:13:21.26\00:13:22.60
Yeah.
00:13:22.63\00:13:23.97
And you fell down
and hurt yourself.
00:13:24.00\00:13:25.33
So once we've documented
that you had a slow heart rate.
00:13:25.37\00:13:28.60
If you don't
have something done,
00:13:28.64\00:13:29.97
you're not gonna be
driving your car safely.
00:13:30.01\00:13:32.17
You're not gonna be, you know,
00:13:32.21\00:13:33.54
doing some
dangerous things safely.
00:13:33.58\00:13:35.68
So we usually
recommend a pacemaker,
00:13:35.71\00:13:37.98
and nowadays the
ability to put them in,
00:13:38.01\00:13:41.22
they've gotten
safer and safer and safer.
00:13:41.25\00:13:43.55
And if we don't have them,
00:13:43.59\00:13:44.92
not only you're in
danger of an accident,
00:13:44.95\00:13:47.19
but your danger of the
heart gradually slowing down,
00:13:47.22\00:13:50.16
and eventually going so slow
00:13:50.19\00:13:52.06
that it doesn't
support your organs anymore.
00:13:52.09\00:13:54.50
All right.
00:13:54.53\00:13:55.86
That answers my
questions pretty well there.
00:13:55.90\00:13:57.23
There's more to come.
00:13:57.27\00:13:58.60
Stay with us on the
Ultimate Prescription.
00:13:58.63\00:13:59.97
We'll be back in just a moment.
00:14:00.00\00:14:01.34