Welcome back to the
Ultimate Prescription.
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I'm Nick Evenson, your host here
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with Dr. James Marcum,
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and today we are talking
about slow rhythms of the heart.
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And before the break,
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we were talking
some about pacemakers
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and what they can be good for
and how you can monitor them.
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But let's talk
about some of the symptoms
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and how you manage
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slow rhythms
acutely, Dr. Marcum?
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Well, modern medicine is great
at treating acute problems.
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And sometimes,
like, we mentioned that
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my patient that
took too many medicines,
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overdosed on a beta blocker
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made the heart go slow.
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So if you did that,
or took an herb that made
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your heart go
too slow and came in,
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I wouldn't put in
a pacemaker for that.
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Because once the
medicine wears out,
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you would do fine.
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So in those cases,
when they acutely come in
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with the slow heart rate,
we have couple of options.
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Sometimes we can
put them on medicines
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and speed up the heart.
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Dopamine is one
that we sometimes use,
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isoproterenol is another one.
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Sometimes it's going
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so what we can put in
a temporary pacemaker.
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So we insert a
temporary pacemaker,
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temporary wire to the
heart, that keeps it going
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until the normal rhythm returns,
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and then we take it out
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and they don't have to
have a permanent pacemaker.
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Sometimes when a
person's having a heart attack,
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the wires that go to
that part of the heart
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don't get enough blood
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so the heart
goes slow temporarily.
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Well, sometimes restoring
blood flow to the heart
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can help the wires do better.
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Okay. Yeah.
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Sometimes until they heal up,
we need to put a pacemaker in.
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And sometimes we put in
a temporary pacemaker too.
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Sometimes we can give medicines
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until we can get
that pacemaker in,
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to keep people going.
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Nowadays, we
even have a pacemaker
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that we can put on
the outside of the body.
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That's called an
external pacemaker.
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So we have pads we
can place on people,
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and we can literally
pace from the outside
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until we could put an internal.
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That's a little
painful, 'cause...
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But it does keep
the blood pressure up,
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and it keeps the
heart contracting
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to keep people
going until we can do
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something more permanent.
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That sounds like the
equivalent of when the doctor
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grabs the paddles and
everything is just clear.
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Well, no, no, no,
that's a different one.
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Okay.
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That's one for the
dangerous fast heart rates.
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And when they
shock them like that,
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that just disrupts
the fast heart rate,
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so the normal
rhythm can come back.
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Now, if we shock a fast one,
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and a normal one
comes back that's too slow,
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then it needs either medicines
to speed it up or pacing.
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So rhythms of the heart
are very, very interesting,
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but it's something that
we have a lot of ability
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to help technologically,
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you know, we can
get the pacemakers,
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temporary, long term,
with external pacemakers.
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And usually the
external ones are ones we put on
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until we can put
either a temporary
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or a permanent pacemaker in.
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But lots of people
now that were aging,
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the wires of the
heart just get old.
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You know, they just get
old, they get calcified,
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just like any wire gets old.
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And sometimes it just...
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Sometimes the battery wears out,
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sometimes the wires wear out.
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And if the wires wear out,
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sometimes the pacemaker
will help with that as well.
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Okay.
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'Cause remember, the pacemakers
obviate the need for the wires,
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'cause the pacemaker
causes the heart to contract
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on its own without the wires.
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So let's say one of
the wires is messed up,
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then we could put in
a pacemaker for that.
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So a pacemaker, if
the batteries got old,
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if a wire's got old,
a pacemaker would help
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in each one of those situations
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where the conduction
system has just gotten old,
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so the heart can't squeeze.
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Pretty cool, huh?
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Very cool.
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Now this leads me
to the next question is
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what is involved in
placing a pacemaker?
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Where does it go physically
and what's involved in
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putting it there?
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Well, it used to be...
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One of the first pacemakers
was by Alfred Hitchcock.
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I don't know if you remember...
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You're probably too
young to remember him.
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The guy who made the movies.
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Yeah. Same guy?
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He had a gigantic
pacemaker, really big,
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placed in his abdomen.
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That was, remember
even 100 years ago,
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we didn't have this technology.
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People would just die,
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their heart would go slow
and they pass away years ago
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where they bonked
their head or hurt themselves
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or something bad would happen,
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where they'd be in
their Model T in wreck
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and no one would know why,
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you know, it was
a slow heart rate.
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But now we have
all this technology
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and it continues to
get smaller and smaller.
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We have devices, pacemakers
that are as small as ticks
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that we can
implant in the heart now,
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that they have no leads.
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That they're all
like a battery driven...
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Now, they're not as good
as these type of pacemakers
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but, you know, you
asked me the question.
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It wasn't a true
or false question.
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But what was the question again?
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Do you remember what it
was? What's involved in placing?
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Okay, placing. The pacemaker.
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So what we would do is we would
make a small incision, okay?
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First we would get the
leads placed in the heart.
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We'd make a small incision,
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put this
pacemaker under the skin,
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hook the leads up, make
sure it's well positioned
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and then just sew up
the skin and then test it,
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make sure it works good.
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So are there any risks of it
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becoming detached
from the leads or...
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We want to have a
good safe position.
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The real risk are infection,
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because anytime
you cut the skin,
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there's infection,
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there's a small
risk of bleeding.
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But the
alternatives to the pacemaker,
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the risk of not
having it is dying.
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So I think most people say
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the risks are worth the benefits
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and nowadays,
technology's improved so much.
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It's almost a one
day procedure now.
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They come in and get it,
they go home the next day,
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the batteries replacements
are one day procedure.
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They come and get
the battery, we zip it,
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put a new one in,
go home the same day.
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The ones we put the leads in,
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we usually like to
watch them at least overnight.
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But we put pacemakers
in 95 year old sometimes
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that are very active with
no other medical problems.
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So pacemakers are just a place
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where modern medicine technology
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has really helped
tremendously in people's care.
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Yeah.
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Now we've got a
larger device here.
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This was the pacemaker
that we were talking about
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just a minute ago and this is...
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Which is twice the size.
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And this is something different.
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Tell us what is this?
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Well, pacemakers are
good for slow rhythms, okay?
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But there are a
lot of fast rhythms
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that come from the heart.
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Fast rhythms from the
bottom part of the heart,
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we give them names ventricular,
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'cause that's
the bottom chamber,
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ventricular tachycardia.
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That means going real fast.
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There's another rhythm
called ventricular fibrillation,
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where it's unstable.
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Well, that is a
device called a defibrillator
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that we implant internally
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that would see
that dangerous rhythm
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and shock the
heart back into rhythm.
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Or it can do some
fancy things on the bottom
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to restore the rhythm,
the bottom part of the heart.
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So fast rates
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from the bottom
part of the heart
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can be treated with that.
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Sometimes we've
talked about ablations
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where we can
destroy the fast rhythms.
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Sometimes in the bottom part,
we can destroy these rhythms,
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but we can also have
dangerous fast rhythms
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from the top part of the heart.
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Now we talk before
about atrial fibrillation,
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but there's some
congenital rhythms,
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one of them is called
supraventricular tachycardia.
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That's sort of like a
short circuit in the heart
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where we can go up
and ablate that one.
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And there's
several different genetic,
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abnormal rhythms that we
could also ablate or destroy.
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One that we see fairly common
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is called Wolff-Parkinson-White.
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It was named after the
person that developed that.
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But that would be a
rhythm that we could ablate.
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But these are
very good for people
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that have weak hearts,
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that are more likely
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to have these dangerous
heart rhythms from the bottom.
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They might not ever have
it, but it's insurance, Nick.
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We know that people
that have a weak heart,
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and we define that by a
term called ejection fraction.
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If it's below a certain number,
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they have a higher risk of
this dangerous heart rhythms
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from the bottom part.
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So as insurance
against these rhythms
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'cause that's
what they die from.
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For insurance we put
these in to the heart
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and it might not ever
fire, but if it does fire,
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it keeps you alive.
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It's like having an
ambulance in you 24/7.
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Just in case. Yeah.
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Now you've seen at airports
the defibrillators, right?
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Those are
external defibrillators,
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and that's the
same thing inside you.
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The internal version.
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Yeah. Okay.
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Well, what about limitations?
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What limitations do patients
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with pacemakers
and defibrillators...?
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What limitations are there?
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Well, in the old
days some of these you...
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Because they were the
device they're made them
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they couldn't be under MRIs.
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You know, that's
that, you know, is a magnet.
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But nowadays, we
have these devices
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that are MRI compatible.
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Now we do ask people
that have pacemakers,
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you know, when
they're first put in to avoid
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extraneous activities
in the upper extremity,
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because we don't want
them to jard or tear it loose,
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but after it heals in,
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they cannot do
pretty much everything.
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We advise them not
to get in microwaves,
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you know, that kind of
stuff that would deactivate it
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and certain
radio waves but really,
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they live a full
and healthy life,
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you know, they might
not be able to play football
00:09:02.07\00:09:04.14
or do some things like that,
00:09:04.17\00:09:05.51
but they can just pretty
much do just about everything
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they would like to do.
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Yeah. How about alternatives?
00:09:09.44\00:09:10.78
What kind of alternatives
are there for pacemakers?
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Well, if you choose
not to have a pacemaker,
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eventually the
battery of your heart
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or the wires are gonna stop.
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And when they do stop,
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you're not gonna
generate a blood pressure
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and then you're
gonna go to sleep in Jesus.
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Now how long that takes
to happen, no one knows.
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So there's not really
great treatments alternatives.
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I don't know if
any natural remedy
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that would replace
the wires of the heart.
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We don't have that.
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But that's a great
place for modern medicine.
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Before we had pacemakers
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people would whose
heart would go slower
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and slower and slower,
and they get tired or dizzy,
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passing out, until
their heart stopped.
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Yeah.
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Well, that seems
like a great place
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for modern medicine,
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Dr. Marcum, thank
you for sharing with us
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about the pacemaker.
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Yeah.
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And I think it's
time in the program
00:09:59.39\00:10:00.73
where we want to talk
about a biblical prescription.
00:10:00.76\00:10:02.10
Did you have a verse you
want to share with us today?
00:10:02.13\00:10:03.47
Yes, I do.
00:10:03.50\00:10:04.83
And that is from Philippians
00:10:04.87\00:10:07.20
on a biblical
prescription and it says,
00:10:07.24\00:10:09.40
"Be careful for nothing,
00:10:09.44\00:10:11.51
but in everything by
prayer and supplication
00:10:11.54\00:10:14.54
with
thanksgiving let your requests
00:10:14.58\00:10:17.05
be made known unto God."
00:10:17.08\00:10:19.08
So what that text
is really telling us is
00:10:19.11\00:10:21.38
it doesn't want us to
be anxious about anything.
00:10:21.42\00:10:24.35
We don't need to be stressed.
00:10:24.39\00:10:26.19
We know that bodies that
live under stress and fear,
00:10:26.22\00:10:30.16
it turns on
adrenaline, cortisol, syndecans,
00:10:30.19\00:10:34.43
all these natural
chemicals that are good
00:10:34.46\00:10:36.83
if we're running from danger,
00:10:36.87\00:10:39.17
but not so good chronically.
00:10:39.20\00:10:41.00
It causes processes
called genetic aging, oxidation,
00:10:41.04\00:10:44.94
makes us get older quicker.
00:10:44.97\00:10:47.14
So stress and fear
causes our bodies to get older.
00:10:47.18\00:10:50.05
So let's say the
wires of the heart
00:10:50.08\00:10:52.18
would normally get old at 80.
00:10:52.21\00:10:54.02
And if you're under a
lot of stress and fear,
00:10:54.05\00:10:55.88
it might get older sooner.
00:10:55.92\00:10:58.22
So we want to
stay away from this.
00:10:58.25\00:10:59.95
Science has shown that
people that are less anxious,
00:10:59.99\00:11:02.42
less fear, live
longer, do better.
00:11:02.46\00:11:05.16
Now, when we think
about different types of fear,
00:11:05.19\00:11:07.53
the worst type, I took
care of a fellow the other day
00:11:07.56\00:11:09.90
that had
posttraumatic stress syndrome.
00:11:09.93\00:11:13.13
And just the
stress that he had seen,
00:11:13.17\00:11:15.17
some of the war things,
00:11:15.20\00:11:16.94
that is the highest
ramp stress I've seen.
00:11:16.97\00:11:19.77
He was making so much
adrenaline and cortisol,
00:11:19.81\00:11:22.71
that his body was
getting older real quick,
00:11:22.74\00:11:25.88
almost in front of our eyes.
00:11:25.91\00:11:27.82
In the heart business,
00:11:27.85\00:11:29.18
we have something called
the broken heart syndrome,
00:11:29.22\00:11:31.79
where people are
under extreme stress,
00:11:31.82\00:11:33.89
it's usually when
they lose a loved one,
00:11:33.92\00:11:36.02
that the body makes
so much stress chemistry,
00:11:36.06\00:11:38.76
that it actually
causes the heart not to work.
00:11:38.79\00:11:41.43
And that we had called that
stress induced cardiomyopathy
00:11:41.46\00:11:44.63
or a broken heart syndrome.
00:11:44.67\00:11:47.00
So stress is a real evil.
00:11:47.04\00:11:49.30
And in this test, it
tells us not to do that,
00:11:49.34\00:11:52.24
but it gives us a prescription.
00:11:52.27\00:11:54.61
Prayer,
supplication, and guess what?
00:11:54.64\00:11:58.41
Thanksgiving.
00:11:58.45\00:12:00.32
Turn to God, when we have this,
00:12:00.35\00:12:02.32
let Him take all the
stress off of our bodies
00:12:02.35\00:12:05.22
turn to Him,
prayer, thanksgiving,
00:12:05.25\00:12:07.02
and that is a
biblical prescription
00:12:07.06\00:12:09.02
that doesn't have
lots of side effects,
00:12:09.06\00:12:11.26
doesn't cost us a lot
of money, gives us a plan
00:12:11.29\00:12:14.46
when the stresses of life
just seem to be overcoming us.
00:12:14.50\00:12:17.10
Yeah.
00:12:17.13\00:12:18.47
Well, thank you
for sharing that text.
00:12:18.50\00:12:19.83
And, Dr. Marcum, if
folks want to learn more
00:12:19.87\00:12:21.20
about where they can find
00:12:21.24\00:12:22.57
biblical
prescriptions for their life,
00:12:22.60\00:12:23.94
where should they go?
00:12:23.97\00:12:25.31
Yeah, a couple ways
they can get a hold of us
00:12:25.34\00:12:26.68
is our website,
HeartWiseMinistries.org,
00:12:26.71\00:12:30.48
and on that we
have a prayer page,
00:12:30.51\00:12:33.15
you can ask the doctor
questions, lots of resources.
00:12:33.18\00:12:36.99
It's just a...
00:12:37.02\00:12:38.35
And we have a worship
app they can use as well.
00:12:38.39\00:12:39.72
That's right.
00:12:39.75\00:12:41.09
We want to send
people to download
00:12:41.12\00:12:42.46
the Biblical
Prescriptions worship app
00:12:42.49\00:12:44.49
on their Android or iOS device.
00:12:44.53\00:12:46.90
And it's a free download
00:12:46.93\00:12:48.26
and you can send
reminders to yourself
00:12:48.30\00:12:50.60
to get into
scripture from God's Word,
00:12:50.63\00:12:52.77
multiple times a
day, and it's a great tool
00:12:52.80\00:12:54.44
that I found to help
remind me to stay faithful
00:12:54.47\00:12:56.84
and get those
biblical prescriptions
00:12:56.87\00:12:58.57
applied in my life.
00:12:58.61\00:12:59.97
Thank you so much
for joining us today.
00:13:00.01\00:13:01.34
Dr. Marcum is gonna be
right back with a prayer
00:13:01.38\00:13:03.14
to close the
program in just a moment.
00:13:03.18\00:13:04.51
I hope you've learned today
00:13:10.12\00:13:11.65
a little bit
about slow heart rates
00:13:11.69\00:13:13.82
and a little about
rhythms of the heart.
00:13:13.86\00:13:16.62
But whether your
hearts going slow or fast
00:13:16.66\00:13:18.93
we have a savior
that's interested
00:13:18.96\00:13:20.83
in every heartbeat that we have.
00:13:20.86\00:13:23.03
Let's end our
program today with prayer.
00:13:23.06\00:13:26.87
Father God, we thank
You for giving us life
00:13:26.90\00:13:29.37
and breath and a heartbeat
where we can serve You, Father,
00:13:29.40\00:13:32.41
and there are some
might be needing You
00:13:32.44\00:13:34.84
especially this day.
00:13:34.88\00:13:36.21
We want to pray for blessings.
00:13:36.24\00:13:38.18
We want to pray
for Your strength
00:13:38.21\00:13:39.55
and we want to thank You
and praise you for being a God
00:13:39.58\00:13:41.95
that loves and saves us.
00:13:41.98\00:13:43.69
Please go with us is our prayer.
00:13:43.72\00:13:45.45
Amen.
00:13:45.49\00:13:47.76
I want to thank
you for joining us.
00:13:47.79\00:13:49.19
If you have
questions go to our website
00:13:49.22\00:13:51.03
HeartWiseMinistries.org.
00:13:51.06\00:13:53.83
I'm Dr. James Marcum
wishing you the best of health.
00:13:53.86\00:13:56.83