Praise God for I am
fearfully and wonderfully made!
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This is a beautiful quotation
that's found in the Psalms.
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Welcome to "Wonderfully Made"
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I'm so glad you took time
out of your busy and hectic
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schedules to join us.
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Today, we're going to talk about
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the important
topic of heart rhythms.
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My name is Dr. Jim
Marcum, and I'm a cardiologist
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with the
"Chattanooga Heart Institute"
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and with me today is Dan Miller
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Dan Miller is a businessman
from Chattanooga as well
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but he's also a consumer
advocate of healthcare...
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and I'm so glad he's here
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And our goal today is to
talk to you as if we were
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right there in
the house with you.
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We've collected questions
from ALL over the world
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dealing with this important
topic of heart rhythms.
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What we've done is...
hopefully, we can cover
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everything of
interest, and Dan is going to,
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if we talk a little bit
too technical, Dan is going to
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sort of correct us, and
slow us down a little bit
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and he's going to make
this so everyone feels like
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we're right in your
living room today talking.
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So Dan, with that introduction,
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let's get going
with the questions!
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Okay, thank you, Jim.
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The first
question is from Brenda.
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She lives in Atlanta,
and she's 38 years old.
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She works as an
executive secretary...
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and her question is this...
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She has noticed that her
heart pounds and races at times.
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It usually happens when
she's preparing to go to bed
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and it really bothers her.
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What could be causing this?
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Well, Brenda, that is
an excellent question.
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Many people,
especially in your age group,
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have this problem
with pounding hearts...
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Dan, have you ever had a
problem with a pounding heart?
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Yes I have...
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Now, have you ever
noticed any time of the day
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when this
pounding usually occurs?
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Generally in the evenings.
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Generally in the evening...
Well that's a common time
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when pounding does occur...
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And the reason the
pounding occurs then is
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there's some much stimuli
that goes on during the day
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and at the evening
time, people start to notice
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and slow down a little
bit, and then they start feeling
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things that they
normally wouldn't feel
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when they're too
busy during the day.
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Well, Brenda... The
most common cause of
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this in your age group would
be something that's called...
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"premature
ventricular contractions"
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Sometimes we
just call this "PVCs"
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This is very frequently...
Now how do I know that
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without testing? Well, I don't
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But, the way we would
test is put a fancy device
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called a "Holter
monitoring device"
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Have you ever heard of a
Holter monitor yet? No I haven't
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Well, let me explain
a little bit about what
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Holter monitoring is...
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That's a special
device... we put on electrodes
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and we can tell every beat of
your heart for X-amount of time.
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We can measure
from 24 to 48 hours
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and this is one of the
most useful tools that we have
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to detect rhythms of the heart.
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Let's put up our
first graphic regarding
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premature ventricular
contractions, or PVCs.
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Many different
things can cause these PVCs.
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It can be a structural
abnormality within the heart.
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That is... the
heart doesn't work well.
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It's either too
weak, or valves messed up,
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or some other problem.
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Caffeine in the United States...
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Caffeine is a
frequent cause of PVCs.
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There are certain
over-the-counter drugs
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that can cause it,
especially those for
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cold medications that
have a substance called
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"pseudoephedrine"
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STRESS is a cause of PVCs.
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And there is a host of medical
problems that cause these
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premature
ventricular contractions.
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So, this is a very
common problem, Brenda
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And, getting
back to your question,
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I would be very
curious, if you were my patient,
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whether you did have a
structurally normal heart
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And I would ask you a
bunch of questions about the
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stress and
medications you were on,
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and we'd probably want
to put a monitor on you.
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Does Brenda's age put
any bearing on any of this?
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Well, in pregnant
years, okay we think of PVCs as
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something that's
causing stress to the heart.
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And that stress
can come from anywhere.
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It can come from the job...
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Not sleeping well at night...
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It can be caused
from a substance like
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nicotine or caffeine.
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It could come from being scared.
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If I scared you,
Dan... today if I go BOO!
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...you would jump
and you might have a PVC
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Well all these things
can cause the heart to skip.
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In this age group,
another thing that we have
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to keep in the
back of our mind is
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...Could this
person be pregnant?
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That would put definitely
a stress on the heart.
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What happens, physiologically,
when you're under stress,
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you make a hormone, and that
hormone is called "epinephrine"
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And that epinephrine
is usually what causes
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the heart to skip and beat...
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And one of the treatments
that we do if it skips,
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or just unbearable,
and we can't do anything,
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is we try to block that
receptor with medications.
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So Brenda, what
could be causing this?
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Well, back to your question...
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it could be the
medicines you take...
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It could be... a RARE
cause would be a structural
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abnormality, but
usually in your age group,
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it's just the
stress of everyday life
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that's causing
the skipped beats...
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and that could cause
from many things. Right
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All righty... let's go to
our second question then...
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This comes from Mel in Toronto.
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The speed of his heart is
about 38 to 42 beats per minute.
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He takes Atenolol
for high blood pressure
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and it's making him very tired.
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Do you think that he
needs a pacemaker? Oh... okay
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Mel, that's a
question we hear a lot of,
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and before I
answer your question,
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a lot of people don't
even know what a pacemaker is.
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Have you ever seen a
pacemaker? I have not...
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Okay, well I brought a
pacemaker with me today
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and this is a pacemaker,
and this keeps the heart going
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when it's not
beating strong enough.
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And the way we have
this pacemaker, is inserted
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right here under the
skin, and here is the lead
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that goes inside the
right ventricular chamber
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and sometimes we put a
lead in the top chamber which is
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the right atrium, and
this not only beats the heart,
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but every single beat that the
heart does, it can monitor it.
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And we have ways on a pacemaker,
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we can tell everything that's
happening within the heart.
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Now what is this made out of?
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Okay... this pacemaker is
made of a substance, an element
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called "titanium" which
is very stable in the body
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and these are special
plastics that go in the body
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that the body doesn't
react to it, so you don't have a
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bad reaction, or
anything like that.
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Pacemakers are one of
the most frequent treatments
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we have for heart disease.
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Before we had
pacemakers, when the heart went
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slower and slower and slower...
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it would just STOP!
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And if a heart is not beating,
we have no blood pressure.
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And one of the first
pacemakers that went in...
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I don't know if
people realize this, was...
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Did you ever hear of
Alfred Hitchcock? Yes sir
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Okay, well Alfred Hitchcock
had one of the first pacemakers
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And back in those
days, the pacemakers were
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about the size of my hand,
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and it went in the belly.
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And that's what it took
to keep his heart going...
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But through the years, as you
see, the pacemakers have gotten
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smaller and smaller
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and it's my prediction that
some day, they're going to be
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on the size of a computer chip.
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Now, can these be
monitored any other way than
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...how does the
monitoring process work?
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Well, we have a couple of
ways we can monitor it, Dan
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One of the ways we can do it
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is with a
handheld device over it...
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that we can tell every
beat that the heart has.
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Another way, nowadays,
we can actually download
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the information that's
stored in these computer chips
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on the internet... Right
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And I can actually see
every beat of a patient's heart
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for a long period of time,
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in addition to see how
often the pacemaker is used
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...To see when it's wearing out
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...To see when the battery
might need to be replaced.
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So you're saying I
can be traveling somewhere
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and you could monitor me
from long distance anyway...
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Totally mobile
with the pacemaker...
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You know, another thing
that people don't realize is
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...Some people ask me
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"Can I get into
MRIs, and magnetic fields?"
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Well usually, we advise
not to get in an MRI machine.
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Now, an MRI machine
is a fancy machine that
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takes pictures of you
because it's got such a strong
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magnet, it can pull on that.
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We don't want it to be
pulling on someone's heart.
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It's like in
airports, and restaurants,
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and stuff like
that... that have the signs
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Right, you can still go
there but it would detect metal
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in you and the
alarms would go off...
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So it's
frequently the cause of...
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especially now with
all the problems we've had
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at the airports, it's a very
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frequent
problem... But you know what?
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We forgot to answer Mel's
question here... Yes we did
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Mel... Making you tired.
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Well, could the
rhythm be making you tired?
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It's going 38 to
42 beats per minute.
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A normal heart runs
about 70 beats per minute.
00:09:08.31\00:09:11.22
So the rhythm itself
might be making you tired.
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OR, it might be the Atenolol
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Atenolol is a medication
which slows down the heart.
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It slows down the
wiring of the heart,
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so that could be
making you tired.
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Do you need a pacemaker?
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A pacemaker is needed
usually when the heart can't
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generate enough blood
pressure to supply the brain.
00:09:29.12\00:09:32.15
So, you might feel
dizzy, you might pass out
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...you might feel weak... Those
are symptoms that would say...
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"Hey! I think you
might need a pacemaker"
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Let's go up to
our second graphics
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that has to do with when a
person might need a pacemaker
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and here are the
indications for a pacemaker...
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The heart is too slow, okay,
but, well Mel's going too slow
00:09:49.85\00:09:53.93
and he's tired.
00:09:53.96\00:09:55.13
Well so, he's
having some symptoms...
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Usually we see dizziness,
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so that might be a reason.
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Conduction disease...
what that means is the
00:10:00.36\00:10:02.38
actual wires of the
heart... the batteries,
00:10:02.39\00:10:04.69
the thing that keeps the
heart going are diseased.
00:10:04.72\00:10:07.93
And the last thing, is
sometimes people need to
00:10:07.96\00:10:11.51
take the medications
to slow the heart down.
00:10:11.54\00:10:14.51
The medications are so
important to slow the heart rate
00:10:14.54\00:10:17.22
that we put a pacemaker in
00:10:17.25\00:10:19.31
just so the patient
can take the medications.
00:10:19.34\00:10:22.16
So sometimes, in that instance,
00:10:22.19\00:10:23.47
those people
also need a pacemaker.
00:10:23.50\00:10:25.95
But Mel is taking a medication
which could slow his heart.
00:10:25.98\00:10:29.73
So the first thing that
I would do with Mel here,
00:10:29.76\00:10:32.29
is, Mel, I would
stop your Atenolol,
00:10:32.32\00:10:34.69
and use a different medication
to treat your blood pressure...
00:10:34.72\00:10:38.69
And then, I would
put a monitor on you...
00:10:38.72\00:10:43.08
one of these Holter monitors
and see what the rhythm is doing
00:10:43.11\00:10:45.27
and see if
anymore symptoms occur.
00:10:45.30\00:10:47.18
If more symptoms don't occur,
00:10:47.21\00:10:49.31
I don't think I
would worry a lot.
00:10:49.32\00:10:52.05
Another thing,
Dan, I might do...
00:10:52.08\00:10:53.61
is I would watch Mel's
heart rate when he walked.
00:10:53.64\00:10:56.60
Lots of people...
athletes go very, very slow
00:10:56.61\00:10:59.10
when they're not doing anything,
00:10:59.13\00:11:00.21
but if it speeds
up when you do things,
00:11:00.24\00:11:02.20
that's a great sign. Right
00:11:02.23\00:11:04.33
Now let me ask YOU a question...
00:11:04.36\00:11:06.42
Do you know... many
people don't realize this
00:11:06.43\00:11:10.81
What part of the day do
you think your heart goes
00:11:10.84\00:11:13.00
the slowest, and what part
do you think it goes the fastest
00:11:13.03\00:11:17.93
I would say slowest would
probably be in my sleep...
00:11:17.96\00:11:23.20
That's correct!
00:11:23.23\00:11:24.28
Fastest would probably
be when I first wake up?
00:11:24.31\00:11:28.39
That's right! That's great Dan!
00:11:28.42\00:11:30.50
You're on top of this.
00:11:30.53\00:11:32.03
If you don't have a
lot of stress on you,
00:11:32.06\00:11:34.87
or other outside stimuli,
00:11:34.90\00:11:36.44
like you're getting cut or hit,
00:11:36.47\00:11:38.58
your heart is going to
go fastest in the mornings
00:11:38.61\00:11:41.71
because the hormonal system
00:11:41.74\00:11:42.98
starts kicking in,
and slowest at night
00:11:43.01\00:11:44.47
In fact, I've seen people's
hearts on these monitors
00:11:44.51\00:11:46.95
run, with no problems at all,
run in the 20s to 30s at night.
00:11:46.98\00:11:50.70
It goes pretty slow... Right
00:11:50.73\00:11:52.28
And that's when
the body is resting.
00:11:52.31\00:11:53.43
The heart has a time
to catch up from the day.
00:11:53.46\00:11:55.65
So, Mel, good luck with
your heart, and I hope that
00:11:55.68\00:11:59.35
answered your question.
00:11:59.38\00:12:02.13
All right, let's
go to question #3...
00:12:02.16\00:12:05.48
It's from
Robert in Pennsylvania.
00:12:05.51\00:12:08.78
He says, "I'm a minister
of a 1,500 member congregation
00:12:08.81\00:12:13.74
in Pennsylvania... we
recently had a parishioner die
00:12:13.77\00:12:18.26
after the morning services. "
00:12:18.29\00:12:20.69
"What are your
thoughts on getting an automatic
00:12:20.72\00:12:23.84
external defibrillator?" Okay
00:12:23.87\00:12:27.10
And most of his congregation
is elderly, so this is really
00:12:27.13\00:12:31.16
something that concerns him.
00:12:31.19\00:12:33.06
Well, this defibrillator issue
is coming up more and more.
00:12:33.09\00:12:38.54
In the
Chattanooga area recently,
00:12:38.57\00:12:40.54
we had a young person that
actually died from one of these
00:12:40.57\00:12:44.73
dangerous heart rhythms.
00:12:44.76\00:12:46.44
It's very rare for a
young person to have these,
00:12:46.47\00:12:48.98
and every year, you hear
about a football player that has
00:12:49.01\00:12:52.08
one of these
abnormal rhythms that was
00:12:52.11\00:12:53.87
otherwise undetectable.
00:12:53.88\00:12:57.58
So the issue is... is should
everyone, in different places,
00:12:57.61\00:13:01.20
carry these defibrillators?
00:13:01.23\00:13:02.39
Because if you can get a
defibrillator to a person
00:13:02.42\00:13:04.64
quickly, you can
literally save many lives. Right
00:13:04.67\00:13:08.63
And the economics of it is...
00:13:08.66\00:13:10.64
you know, should these
big churches where there are
00:13:10.67\00:13:14.08
lots of people that could
potentially have an arrhythmia
00:13:14.11\00:13:17.24
from a heart problem die...
00:13:17.27\00:13:18.82
Now before I
answer this question,
00:13:18.85\00:13:20.64
I just want to go
over, out of all the causes
00:13:20.67\00:13:23.33
of death in America, the
most likely cause of death is
00:13:23.36\00:13:26.48
going to be
cardiovascular disease
00:13:26.51\00:13:28.00
And a lot of people don't
realize that 43% of all deaths
00:13:28.03\00:13:31.83
in the United States, is
due to cardiovascular disease.
00:13:31.86\00:13:35.55
And that's greater
than wars, and cancers,
00:13:35.58\00:13:38.25
and infections,
than everything combined.
00:13:38.28\00:13:40.71
An interesting statistic is
... if you have a heart attack,
00:13:40.74\00:13:44.15
guess how many people,
guess what percentage dies
00:13:44.18\00:13:46.88
before they even make it to the
hospital from a heart attack?
00:13:46.91\00:13:49.07
I have no idea. ... 33%
00:13:49.10\00:13:52.42
Most people don't
think it's that high.
00:13:52.45\00:13:53.89
But if you have a heart attack,
00:13:53.92\00:13:55.41
there's a 1 in 3 chance
that you're going to die before
00:13:55.44\00:13:57.65
you even make
it to the hospital.
00:13:57.68\00:13:58.94
That's why these defibrillators
are so much in the news
00:13:58.97\00:14:02.96
and so much... you
know, everyone is wanting to
00:14:02.99\00:14:05.34
talk about them.
00:14:05.37\00:14:06.63
So, thoughts on an
automatic external defibrillator
00:14:06.66\00:14:10.84
I think this
would be an excellent
00:14:10.87\00:14:13.25
thing for your congregation.
00:14:13.29\00:14:14.75
And the training
involved really is very simple
00:14:14.78\00:14:17.73
In fact, we brought a
defibrillator with us today
00:14:17.76\00:14:20.75
It is at this point in time,
let me put this on you, Jim
00:14:20.78\00:14:27.54
We're going to
sort of pretend that...
00:14:27.57\00:14:30.30
and the first thing
we do is, we turn it on
00:14:30.33\00:14:31.95
to show everybody
how it actually works.
00:14:31.98\00:14:33.61
It's not that hard to
work, and you'd be surprised how
00:14:33.64\00:14:35.90
easy it is to work,
and if you're looking at
00:14:35.93\00:14:38.55
Robert, if you're looking
at the show this evening,
00:14:38.58\00:14:40.85
I want you to sort of put
this in the back of your mind
00:14:40.88\00:14:43.50
for your congregation
00:14:43.51\00:14:45.97
A lot of people
think it's hard to work,
00:14:46.00\00:14:47.78
but it's not... very easy!
00:14:47.79\00:14:48.93
Okay, is the device on?
00:14:48.96\00:14:50.26
You turn it on. Okay
00:14:50.29\00:14:51.91
And we're going to get
things going here. Okay
00:14:51.94\00:14:58.56
I think it's ready to open up.
00:14:58.59\00:15:01.14
You push the button on
the front of the machine.
00:15:01.17\00:15:03.25
The device opens up...
and you have to hit it again
00:15:03.28\00:15:08.58
Push it one more time. Okay...
00:15:08.61\00:15:15.51
This device, we're going
to have to get it going here.
00:15:15.54\00:15:19.94
It's supposed to come on here.
00:15:19.95\00:15:21.65
It talks to you, actually,
when it comes on. Correct
00:15:21.68\00:15:25.53
Now, we have a
trainer with me today,
00:15:25.56\00:15:27.61
so let's back
up... "CALL FOR HELP NOW"
00:15:27.64\00:15:30.81
Here it goes... So at this
point is where I call for help
00:15:30.84\00:15:33.12
"REMOVE CLOTHING FROM CHEST"
00:15:33.15\00:15:34.72
So I would
remove my clothes. Right
00:15:34.75\00:15:36.65
At this time, you'd
be laying on the ground,
00:15:36.66\00:15:37.80
and I'd take your
clothing away from your chest.
00:15:37.83\00:15:40.69
We're going to
install this on your shirt,
00:15:40.72\00:15:43.92
so you'll need to
take your jacket off.
00:15:43.95\00:15:45.38
"PULL RED HANDLE TO OPEN BAG"
00:15:45.41\00:15:48.03
So I would pull this out...
00:15:48.06\00:15:49.82
"PEEL EACH PAD AT THE PLASTIC"
00:15:49.85\00:15:53.07
"AND APPLY PAD TO EXPOSED CHEST"
00:15:53.08\00:15:57.54
You'll tear the
2 pads in half...
00:15:57.55\00:16:03.57
"REMOVE CLOTHING FROM CHEST"
00:16:03.60\00:16:06.19
So it repeats it if you
don't do something right...
00:16:06.22\00:16:09.07
or you can't...
This one actually has a
00:16:09.10\00:16:10.56
picture showing us
where to put the pad
00:16:10.59\00:16:13.87
So I would apply
that one at that point...
00:16:13.90\00:16:16.58
"PULL RED HANDLE TO OPEN
BAG" I would pull this off...
00:16:16.61\00:16:21.35
"PEEL EACH AT THE PLASTIC"
00:16:21.38\00:16:23.24
This one goes under your arm...
00:16:24.43\00:16:25.42
"AND APPLY PAD TO EXPOSED CHEST"
00:16:25.45\00:16:28.34
"DO NOT TOUCH PATIENT"
00:16:28.37\00:16:31.21
"EVALUATING HEART RHYTHM"
00:16:31.24\00:16:34.93
And at this point in time,
it automatically evaluates...
00:16:34.96\00:16:38.11
"STAND BY" Okay
00:16:38.14\00:16:40.26
"PREPARING TO SHOCK"
00:16:40.29\00:16:41.85
"EVERYONE CLEAR" I
would get out of the way...
00:16:41.89\00:16:44.33
"DO NOT TOUCH PATIENT"
00:16:44.36\00:16:45.52
"DELIVERING
SHOCK" ... alarm beeps...
00:16:45.55\00:16:50.42
Okay! Well, as you can see...
00:16:50.45\00:16:53.49
Was that the first time you've
every done this? Yes it is
00:16:53.52\00:16:56.82
Now that was not
too hard to put on...
00:16:56.85\00:16:58.97
And yet, if I really would have
had a dangerous heart rhythm,
00:16:59.00\00:17:02.60
that potentially
could have saved my life.
00:17:02.63\00:17:05.24
I would have really
wanted this on that young person
00:17:05.27\00:17:08.40
that day... You
know, that happened to
00:17:08.43\00:17:10.65
collapse in a gym.
00:17:10.68\00:17:12.62
I would really want
this on, because if someone
00:17:12.63\00:17:14.96
could have been trained
to put this on immediately,
00:17:14.99\00:17:17.16
it would have
saved his life. Correct
00:17:17.19\00:17:18.53
Now, a question
we might get is...
00:17:18.56\00:17:21.20
"Can you mess up
with one of these?"
00:17:21.23\00:17:22.75
I mean, can... Can you
be shocked accidentally?
00:17:22.78\00:17:26.67
I've never heard it happening...
00:17:26.70\00:17:27.97
And the reason it
didn't shock me is because
00:17:28.00\00:17:30.04
my heart rhythm was normal.
00:17:30.05\00:17:31.98
It's trained to only
shock that abnormal heart rhythm
00:17:32.01\00:17:34.96
which is called
"ventricular fibrillation"
00:17:34.99\00:17:37.27
or "ventricular tachycardia"
00:17:37.30\00:17:38.92
That's the ones you see
people over people's heart
00:17:38.95\00:17:41.15
shocking it, you
know, dramatically...
00:17:41.18\00:17:43.17
...like in the hospital.
00:17:43.20\00:17:44.71
So, Robert,
that's how you use these,
00:17:44.72\00:17:47.40
and the price of
these defibrillators are
00:17:47.41\00:17:49.69
coming down every year.
00:17:49.70\00:17:51.44
One of the
questions that comes up is...
00:17:51.47\00:17:53.77
"What about the
liability issues?"
00:17:53.80\00:17:55.95
You know, are you
liable if you have one?
00:17:55.98\00:17:58.36
Are you liable if
you DON'T have one? Right
00:17:58.37\00:18:00.83
And these are being
worked through right now,
00:18:00.86\00:18:02.88
but most people have a
short training course...
00:18:02.91\00:18:05.48
They have to be
Basic Life Service Support.
00:18:05.51\00:18:08.17
But when I talk to people about
whether they need one of these,
00:18:08.20\00:18:11.55
I say, "Well, you
just don't choose not to
00:18:12.21\00:18:15.69
for the legal reasons. "
00:18:15.72\00:18:17.13
I mean, you want to have
this to save lives. Correct
00:18:17.16\00:18:20.23
And if you didn't have
it" What would happen? Right
00:18:20.26\00:18:22.67
And what's the worse thing
that can happen if you mess up?
00:18:22.70\00:18:25.31
Do it over... I
would suppose. Right
00:18:25.34\00:18:28.11
But if you don't even have the
00:18:28.14\00:18:29.17
machine, you know,
if someone is going...
00:18:29.20\00:18:30.51
You don't even have
that chance... Exactly
00:18:30.54\00:18:32.19
And if you don't get
the paramedics there within
00:18:32.23\00:18:33.94
5 minutes and
deliver that shock,
00:18:33.97\00:18:35.85
that patient has very
little ability of having
00:18:35.88\00:18:38.76
significant long-term recovery.
00:18:38.79\00:18:41.43
So, Robert, there it
is. That's a defibrillator
00:18:41.46\00:18:44.21
and we hope you
consider getting it...
00:18:44.24\00:18:46.83
And if there are
any more questions,
00:18:46.84\00:18:49.36
the people that run
these defibrillator companies
00:18:49.39\00:18:52.16
they're on the websites.
00:18:52.19\00:18:53.96
This one happens to be one done
by a company called "Medtronic"
00:18:53.99\00:18:57.99
They are more than happy to
give you information on this.
00:18:58.02\00:19:01.51
Beep-beep... It's extremely easy
00:19:01.54\00:19:03.17
Okay, well we stopped it...
I hope it doesn't go off again!
00:19:03.21\00:19:05.53
Let's not... Okay, we
don't want it to start talking
00:19:05.56\00:19:07.81
We've got to finish
this show, Dan... ha, ha, ha
00:19:07.82\00:19:09.21
So with that, let's
go to the next question.
00:19:09.24\00:19:11.15
Beep-beep... okay,
let's leave that closed there.
00:19:11.18\00:19:16.58
And the next question will
be from Lynette in Tennessee.
00:19:16.61\00:19:20.88
"The speed of my
heart races at times. "
00:19:20.91\00:19:24.44
"I was at Disney World a
few years ago, and nearly
00:19:24.47\00:19:27.26
fainted from this rhythm. "
00:19:27.29\00:19:29.37
"I have 2 small children
and live an active lifestyle. "
00:19:29.40\00:19:33.47
"This RARELY occurs...
Should I be concerned?"
00:19:33.50\00:19:37.90
Well, yeah, the
speed of the heart races.
00:19:37.93\00:19:41.18
You can go ahead and
put that up if we need to.
00:19:41.21\00:19:43.70
Lynette, this
is a good question.
00:19:43.73\00:19:45.38
In the heart, there are
sometimes groups of cells that
00:19:45.41\00:19:49.09
become very, very unhappy.
00:19:49.12\00:19:51.50
And these cells can
generate a fast rhythm,
00:19:51.53\00:19:54.08
and sort of a generic name
we gave for that is a big name.
00:19:54.11\00:19:57.64
It's called
"supraventricular tachycardia"
00:19:57.67\00:20:00.49
where the heart goes real fast.
00:20:00.52\00:20:02.49
And sometimes when the
heart goes fast like this,
00:20:02.52\00:20:04.69
you don't get blood
pressure to your head...
00:20:04.72\00:20:06.66
and that's what
makes you feel so poorly.
00:20:06.69\00:20:09.75
One of the things we
say when it happens...
00:20:09.78\00:20:12.66
Okay, "Lay down
and put your feet up"
00:20:12.67\00:20:15.05
And you can sometimes
rub on this part of your neck
00:20:15.08\00:20:18.53
and sometimes this will actually
slow your heart down enough
00:20:18.56\00:20:21.39
until you can catch your breath.
00:20:21.42\00:20:23.19
If it continues for
a long period of time,
00:20:23.22\00:20:25.82
YOU REALLY need to
go to the hospital,
00:20:25.85\00:20:28.17
so we can either put a
monitor on you, or get an EKG
00:20:28.20\00:20:31.47
to see what this
rhythm is about...
00:20:31.50\00:20:34.32
Because you don't want
to be having this rhythm
00:20:34.35\00:20:36.95
when you go down with your kids.
00:20:36.98\00:20:38.64
Could a ride at Disney
World have brought that about?
00:20:38.67\00:20:43.76
Yeah, I guess it's possible,
but usually these rhythms
00:20:43.79\00:20:47.13
are triggered on their own.
00:20:47.16\00:20:49.22
I mean... most people
have these that they're doing
00:20:49.25\00:20:51.77
nothing, and
then it just comes on!
00:20:51.80\00:20:53.82
Now we do know that
there are some triggers
00:20:53.85\00:20:55.40
that make it worse -
- if you're dehydrated
00:20:55.43\00:20:57.95
Sometimes you can take
a stimulant from the heart
00:20:57.98\00:21:00.55
and some of the more common
stimulants that you might see
00:21:00.58\00:21:02.69
at a theme park
would be stress from
00:21:02.70\00:21:04.69
2 small kids all
day... Standing in line
00:21:04.72\00:21:06.61
Yes, if you don't
have the fast passes...
00:21:06.64\00:21:08.39
you'll have to stand in line
a lot at Disney World. Exactly!
00:21:08.42\00:21:11.06
Another thing, we
talked about caffeine.
00:21:11.09\00:21:13.55
If you get dehydrated, if
you're not drinking all day,
00:21:13.58\00:21:16.25
you don't have enough
fluid, those are some other
00:21:16.28\00:21:17.85
things that could
trigger this rhythm.
00:21:17.88\00:21:19.56
In people that just
have it rarely, I'd recommend
00:21:19.59\00:21:21.98
no treatment, just monitor.
00:21:22.01\00:21:23.28
But if it happens on a
regular basis, more frequently
00:21:23.29\00:21:26.02
We can actually go up
inside a body and destroy
00:21:26.05\00:21:29.64
these dangerous
heart rhythms now with a
00:21:29.67\00:21:31.21
small amount of energy. Right
00:21:31.24\00:21:32.86
And if people don't
want to do that, we can also
00:21:32.87\00:21:34.81
take medications.
00:21:34.84\00:21:35.82
Now, is it a person's
fault that they have this?
00:21:35.85\00:21:38.74
No, not really... most people
are just sort of born that way
00:21:38.77\00:21:41.82
and they have
these abnormal pathways,
00:21:41.85\00:21:43.40
and they have to
just live with that.
00:21:43.43\00:21:45.24
So Lynette, good
luck with your rhythm,
00:21:45.27\00:21:46.96
and if it keeps coming on,
00:21:46.99\00:21:48.30
I would go see your
healthcare provider.
00:21:48.33\00:21:51.35
All righty, next question
is from Earl in Minnesota. Okay
00:21:51.36\00:21:57.88
He says, "Atrial fibrillation
runs in my family. "
00:21:57.91\00:22:03.89
"I am 86, my doctor says
I have arterial fibrillation
00:22:03.92\00:22:09.89
and he wants to put me
on a blood thinner. " Ooo
00:22:09.90\00:22:12.60
"I don't want to. " Okay
00:22:12.63\00:22:14.84
"What do you think?"
00:22:14.87\00:22:15.97
Atrial fibrillation is
another one of these rhythms
00:22:16.00\00:22:20.65
of the heart.
00:22:20.66\00:22:21.85
Now we didn't talk
much about it earlier, but
00:22:21.88\00:22:23.94
the normal rhythm is
called "sinus rhythm"
00:22:23.97\00:22:26.52
That means each rhythm is
generated from the special
00:22:26.55\00:22:29.31
battery that God gave
us called "the sinus node"
00:22:29.34\00:22:32.53
...that's a normal rhythm
00:22:32.56\00:22:33.79
So, if it's going too slow,
we call that "sinus bradycardia"
00:22:33.82\00:22:37.62
or too slow of a heart rhythm.
00:22:37.65\00:22:39.01
If it's going fast,
we call it "tachycardia"
00:22:39.04\00:22:41.68
Those are normal
rhythms of the heart,
00:22:41.69\00:22:43.33
but just going slow
for another reason. Right
00:22:43.36\00:22:45.98
Sometimes you have, sort of,
00:22:46.01\00:22:48.33
these misconnections
that we talk about...
00:22:48.37\00:22:50.76
And if it's coming from
the TOP part of the heart,
00:22:50.79\00:22:52.80
this abnormal faring
from all sorts of FUNNY spots,
00:22:52.83\00:22:56.02
we call that
"atrial fibrillation"
00:22:56.05\00:22:58.50
And that's where the top part
is literally going like this...
00:22:58.53\00:23:01.40
It's just squeezing all over.
00:23:01.43\00:23:02.69
It's not working symmetrically
00:23:02.72\00:23:05.19
with the bottom
part of the heart.
00:23:05.22\00:23:07.16
And guess what happens
to blood if the heart is
00:23:07.19\00:23:10.00
squeezing like a...
worm when it comes through?
00:23:10.01\00:23:11.98
Squeezed out?
00:23:12.01\00:23:13.68
Well, some of it is squeezed
out but not as much as normal.
00:23:13.69\00:23:16.13
But actually, when
it's moving like THIS,
00:23:16.16\00:23:18.18
you can get blood
clots because the blood
00:23:18.21\00:23:20.40
doesn't pass through.
00:23:20.43\00:23:21.77
And if a blood clot gets
in there and passes through
00:23:21.80\00:23:24.24
from the upper
chamber to the lower chamber,
00:23:24.27\00:23:26.19
and the lower chamber
pumps that blood clot somewhere,
00:23:26.22\00:23:29.01
it could go to the
head, and cause a stroke.
00:23:29.04\00:23:32.22
In fact, about 15% of all
strokes in the United States,
00:23:32.25\00:23:37.96
are caused by this
rhythm atrial fibrillation.
00:23:37.99\00:23:41.10
So, Earl, that's
why your doctor wants to
00:23:41.13\00:23:45.02
put you on a blood thinner...
00:23:45.05\00:23:46.21
He wants to lower your
risk of having a stroke.
00:23:46.25\00:23:49.39
Now, is there some people
that don't get a blood thinner?
00:23:49.42\00:23:52.72
You know, um... Yeah, if
the risk of bleeding outweighs
00:23:52.75\00:23:57.34
the risk of the blood thinner
then you wouldn't get it.
00:23:57.37\00:24:00.16
And, you have to
have frequent monitoring
00:24:00.19\00:24:02.09
when you're on Coumadin.
00:24:02.12\00:24:03.17
Now, do you know
what Coumadin really is?
00:24:03.20\00:24:04.52
I do not... What is that?
00:24:04.55\00:24:06.16
Coumadin is rat poison!
00:24:06.17\00:24:08.58
A lot of people
don't like to realize
00:24:08.61\00:24:10.13
that it's just rat poison.
00:24:10.16\00:24:11.19
A lot of people don't like to
take it because it's rat poison
00:24:11.22\00:24:14.33
But it has lowered the risk of
having a blood clot in the body.
00:24:14.36\00:24:17.97
And in atrial fibrillation,
you have to evaluate the
00:24:18.00\00:24:21.23
risk of being on
the blood thinners,
00:24:21.26\00:24:22.81
whether you can
take in the monitoring,
00:24:22.84\00:24:24.52
versus the risk of
falling, and bleeding.
00:24:24.55\00:24:27.61
These are all
very important things
00:24:27.64\00:24:29.30
to think about when
you're on Coumadin...
00:24:29.33\00:24:31.06
But Earl, if you came to me
and you had atrial fibrillation,
00:24:31.10\00:24:34.18
first of all, I would say,
Coumadin needs to be considered,
00:24:34.21\00:24:39.50
The next thing I'd want to look
at is the different causes...
00:24:39.53\00:24:41.78
You know, why do you...
It's a very common rhythm
00:24:41.81\00:24:44.81
and with that in mind,
let's bring up the next graph
00:24:44.84\00:24:46.76
about the causes of
atrial fibrillation...
00:24:46.79\00:24:49.92
Okay, remember this is
where the top part is going
00:24:49.95\00:24:52.45
faster than the bottom part.
00:24:52.48\00:24:53.95
Sometimes it can again
be because there's something
00:24:53.98\00:24:56.15
wrong with the heart itself.
00:24:56.16\00:24:57.62
That is, there's a
structural heart problem.
00:24:57.65\00:25:00.27
It might be that
it's stretched out...
00:25:00.30\00:25:02.81
It might be the
valves that's bad.
00:25:02.84\00:25:04.82
There might be
an old heart attack.
00:25:04.85\00:25:06.43
Something's wrong with the
heart itself that's causing it.
00:25:06.46\00:25:08.79
Sometimes you can
have a thyroid condition
00:25:08.82\00:25:11.09
Remember the thyroid
regulates these rhythms.
00:25:11.12\00:25:13.28
You can have a
thyroid abnormality
00:25:13.31\00:25:14.98
Sometimes high blood
pressure can actually cause this
00:25:15.01\00:25:18.92
rhythm, atrial fibrillation,
because it stretches it out.
00:25:18.95\00:25:20.91
And there is a
host of other causes.
00:25:20.94\00:25:23.29
And Earl, I want to, sort
of go through some of those
00:25:23.32\00:25:25.73
other causes
with you, just in case
00:25:25.74\00:25:28.08
you might have one of these.
00:25:28.09\00:25:29.97
Again, we talked about
being dehydrated. Right
00:25:30.00\00:25:33.16
Having an infection.
00:25:33.19\00:25:35.08
Certain medications
can sort of cause it to be
00:25:35.11\00:25:37.77
more likely to happen.
00:25:37.81\00:25:39.01
Just being sick can
cause it to happen... Correct
00:25:39.05\00:25:42.15
Now, one of the things that
the heart likes most is oxygen!
00:25:42.18\00:25:44.23
We found that people
that don't get enough oxygen
00:25:45.16\00:25:48.51
So if Earl has a
lot of lung disease...
00:25:48.54\00:25:50.50
THAT could be a trigger
for this atrial fibrillation.
00:25:50.53\00:25:54.31
And in this rhythm,
you feel pretty bad,
00:25:54.34\00:25:56.33
if the heart is going too fast.
00:25:56.36\00:25:57.99
So atrial fibrillation is
one that usually you have to go
00:25:58.02\00:26:01.47
in the hospital
to get it treated...
00:26:01.50\00:26:02.79
so it's a pretty
tough thing to have.
00:26:02.82\00:26:05.46
So I think
Coumadin is reasonable
00:26:05.49\00:26:07.14
And the other thing, you know,
00:26:07.15\00:26:08.32
if we can fix
the underlying cause.
00:26:08.35\00:26:10.38
You know, Earl, if you
have problems with your lungs,
00:26:10.41\00:26:12.84
if there is an infection,
you're not getting enough
00:26:12.85\00:26:14.30
oxygen, let's fix that. Right
00:26:14.31\00:26:16.41
Now, do you have
to do tests to balance
00:26:16.44\00:26:20.53
the amount of
Coumadin that you're getting...
00:26:20.56\00:26:22.16
Can you get too much
Coumadin? Yes you can...
00:26:22.19\00:26:24.10
And we have to frequently
check the blood to see
00:26:24.11\00:26:27.03
if the blood is TOO thick, or
too thin while on your Coumadin
00:26:27.06\00:26:29.59
...Because if it's too
thin, and you bonk your head,
00:26:29.62\00:26:31.53
you could have a very,
very serious problem... Right
00:26:31.56\00:26:37.09
You know, in the
slide, you also mentioned that
00:26:37.12\00:26:41.69
the thyroid has a
lot of problems...
00:26:41.72\00:26:44.00
There are a lot of
people with thyroid problems
00:26:44.03\00:26:46.37
in the United States today,
it seems like... There are!
00:26:46.38\00:26:49.10
I, personally, have
some problems with mine
00:26:49.13\00:26:52.15
and so that's something even
beneficial for me to remember.
00:26:52.16\00:26:57.93
Right... it can go,
you know, too low, too high
00:26:57.96\00:27:00.21
Thyroid is a very
common regulator of the heart.
00:27:00.24\00:27:02.52
It regulates the heart's speed.
00:27:02.53\00:27:03.71
And actually, a lot
of people don't realize,
00:27:03.74\00:27:05.25
but a low heart RATE can
cause you to have a slow heart.
00:27:05.28\00:27:10.05
Now before we close today,
I wanted to show the people
00:27:10.08\00:27:13.36
we talked about rhythms...
00:27:13.39\00:27:14.44
we talked a little bit
about the slow ones... Right
00:27:14.47\00:27:16.84
a little bit about the fast ones
00:27:16.87\00:27:18.23
And today, I just want
you to get INTERESTED in
00:27:18.26\00:27:20.19
your heart rhythm.
00:27:20.22\00:27:21.25
One other thing I'd like to
00:27:21.26\00:27:22.44
show you that we
brought with us today...
00:27:22.47\00:27:24.02
This is a defibrillator!
00:27:24.06\00:27:25.96
Remember earlier in the show
we had an external defibrillator
00:27:26.00\00:27:29.75
Now what an
external defibrillator is...
00:27:29.78\00:27:31.89
is a device that
we put on IMMEDIATELY
00:27:31.92\00:27:34.72
when someone is having a
sudden problem with their heart.
00:27:34.75\00:27:38.11
Now this device, in
people with weak hearts
00:27:38.14\00:27:40.20
or people who
have diseased hearts
00:27:40.23\00:27:41.62
that need this
technology all the time.
00:27:41.63\00:27:43.88
This can be inserted under
the skin, and it can deliver
00:27:43.91\00:27:46.72
a shock, and this one
can actually pace the heart
00:27:46.75\00:27:49.07
any time it might be needed.
00:27:49.10\00:27:50.96
Well we're almost
out of time today, Dan
00:27:50.99\00:27:53.10
I want to thank
you for joining us.
00:27:53.13\00:27:54.66
I hope that the audience
has learned something about
00:27:54.69\00:27:57.18
the rhythms of the heart...
00:27:57.21\00:27:58.21
The fast ones, the slow ones...
00:27:58.24\00:27:59.95
a little bit more
knowledge about what to do.
00:27:59.98\00:28:02.09
And we hope that ALL of
you can have hearts that
00:28:02.12\00:28:05.20
NEVER go out of rhythm.
00:28:05.23\00:28:06.86
And we hope that God will
create in you, a new heart
00:28:06.89\00:28:09.71
one that depends on Him
daily to keep your heart
00:28:09.74\00:28:12.73
running smoothly.
00:28:12.77\00:28:14.73