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Series Code: UP
Program Code: UP190120B
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00:01 Welcome back to the Ultimate Prescription.
00:02 I'm Nick Evenson here with Dr. James Marcum, 00:04 and today we are talking about atrial fibrillation 00:06 and some of the ways that can be treated. 00:08 And, Dr. Marcum, before the break we talked 00:10 about an ablation a bit. 00:11 What are some of the other things 00:13 we need to know about treating A fib. 00:14 Yeah. 00:15 Well, you know, 00:17 atrial fibrillation is very complex 00:19 and the take home message is today, 00:21 if you have atrial fibrillation, 00:23 get it evaluated by cardiologist. 00:25 Okay. 00:27 The subset of cardiology as in electrophysiologist, 00:30 they'll talk to you 00:31 about slowing it down blood thinners 00:34 and what caused it. 00:35 That's the key. 00:36 If you have symptoms in atrial fibrillation, 00:39 they can talk to you about medicines 00:41 that can restore the rhythm or ablations. 00:44 Now sometimes in some people, 00:46 we have a surgical procedure that we do frequently 00:49 specially when people having other surgeries in the heart. 00:52 Let's say you have a leaky heart valve 00:54 and atrium gets big from that 00:56 or you had bypass surgery. 00:58 Well, there's a procedure that we can do intraoperatively 01:02 called the "maze procedure." 01:04 That's where intraoperatively, 01:06 you know, we talked how we destroy it 01:08 with a catheter from the groin, 01:10 they can do it inside with the catheter 01:13 and that's called the maze. 01:14 And we have an example of that... 01:15 Yeah, we've got a video clip, let's just talk through that. 01:17 And this is where, 01:19 this is actually the ablation catheter 01:22 that's going in inside the heart, okay. 01:24 This is the area 01:26 where atrial fibrillation usually comes from 01:28 and they're actually going 01:29 and mapping out that part of the heart, 01:32 and what they're gonna do is 01:34 this is sort of gross estimate of, 01:36 you know, the pulmonary veins is where they're around 01:39 and they actually do 01:41 where they destroy where that comes from. 01:43 That's actually the picture of an ablation. 01:45 Okay. 01:47 The maze procedure is where actually, 01:48 they don't use with a catheter, 01:50 they actually do that physically. 01:52 Okay. 01:53 You know, they do it as a part of an operation, 01:55 of course, it's a little more accurate 01:56 'cause you're right there holding the heart. 01:58 Okay, right. 01:59 So it's a lot more accurate, but those are the ways we deal 02:01 with atrial fibrillation chronically 02:04 if we want to give it a chance of destroying. 02:06 Is this a 100%? 02:08 No, 'cause you know 02:09 they can't sometimes get all the spots 02:11 where atrial fibrillation's coming from. 02:13 But as we progress with technology, 02:15 this is more and more effective. 02:17 What's the advantage of having an atrial fibrillation 02:19 or maze procedure? 02:21 Well, the atrial fibrillation might be gone, 02:23 okay, and there's a chance you might be 02:26 off blood thinner someday... 02:27 Okay. 02:29 You can restore the rhythm, 02:30 so the heart works more functionally well. 02:32 And if the heart happens to be weak, 02:34 and it's out of rhythm, 02:36 that's sort of a double ramming, 02:37 Nick, it's not good for you. 02:39 Yeah. 02:40 So I think that sort of the way 02:41 we approach atrial fibrillation. 02:43 So when a person comes in an emergency, 02:46 let's say they have it, 02:47 they never know they had it before. 02:48 So they come in emergency room there. 02:50 The first thing they do 02:51 is slow it down with some medicines. 02:53 We slow it down, we put him on blood thinners 02:55 and then we assess whether we need 02:57 to put him back in rhythm quickly. 02:59 Let me interrupt you there. Yeah. 03:00 What do blood thinners do to help the situation? 03:02 Is it to just take off some of the load from the heart? 03:03 No, no. Or what does it do? 03:04 Blood thinners take... 03:06 Remember, we talked about the risk of blood clots. 03:08 Every second you're in atrial fibrillation, 03:10 there's a risk of a blood clot. 03:12 The longer you're in atrial fibrillation, 03:14 the higher the risk of blood clot. 03:15 Okay. 03:16 So the real danger I think of A Fib 03:18 is the blood clot. 03:19 If you have a stroke, you know, 03:21 it's hard to get back after that. 03:23 Yeah. Yeah, yeah. 03:24 And so the blood thinner is 03:25 to help lower the risk of stroke 03:28 and then slowing down the heart helps the efficiency. 03:31 Once that's done, 03:32 some people feel great like that 03:33 and they don't need anything more done, 03:35 of course, we explore the reasons why, 03:37 we do the blood work, we look at the thyroid, 03:39 we make sure they're not have a concomitant medical problem, 03:43 low potassium or magnesium, make sure the heart's strong, 03:46 make sure there's not a coronary disease problem. 03:49 And then after all that's done, 03:51 we assess how they're feeling in it. 03:52 If they're feeling bad, we can put it in rhythm. 03:54 Let's say they go out of rhythm again, 03:57 and again and again. 03:58 We can put him on some medicines, 03:59 there's some frequently used medicines that I use, 04:02 one called flecainide, one called propafenone, 04:06 one called sotalol, we use ones called amiodarone, 04:10 there's a new one out called dofetilide 04:12 that works good. 04:13 And sometimes those are needed to control the rhythm. 04:16 Sometimes those still can't control the rhythm 04:19 and the people feel terrible. 04:20 Then we move up the track to ablation or maze procedure. 04:24 Okay. 04:26 So that's how we treated sort of short term and long term, 04:29 but usually the big questions I get 04:32 are on blood thinners. 04:34 Right. 04:35 A lot of people don't necessarily wanna be 04:37 on blood thinners, right? 04:38 No, 'cause everyone is afraid of blood thinners, 04:41 you know, do blood thinners cause you to bleed? 04:44 No, they don't cause bleeding, 04:46 but if you have a little bit of bleeding, 04:48 it becomes a lot of bleeding. 04:50 Yeah. 04:51 I found more cancers from starting people 04:53 on blood thinners 04:54 then I would care to mention 04:56 'cause a little bit of blood, 04:58 they might notice in their bowel, 04:59 and it becomes a lot of blood, 05:01 we'd say, oh, you've a lot of blood, 05:02 let's investigate that. 05:03 We find out that they have a small cancer 05:05 in their colon or one in the urinary system. 05:09 So, but if you do bleed, it accentuates the bleed. 05:13 And there's lots of different blood thinners 05:15 on the market. 05:16 The one that's been around forever 05:18 is called Warfarin. 05:19 Okay. 05:20 Or Coumadin, that's another name for that. 05:22 There's some new ones out now, one called Pradaxa, 05:26 one called Eliquis that I like, and one called Xarelto. 05:31 The advantage of the new ones 05:33 is they don't have to have blood work every month 05:35 or so often to keep it monitored. 05:37 Okay, so it's little easier for the patient to manage. 05:41 The other ones the Coumadin, the Warfarin, 05:43 you have to be careful with eating green foods 05:46 because they could interact with the blood thinner. 05:49 Okay. 05:50 So you had to be a little bit more careful 05:52 on the food you ate. 05:53 So lot of people that were trying 05:55 to eat super healthy didn't like that medicine. 05:57 But the new ones, the advantage of that, 05:59 you can eat as much greens as you want, 06:01 you don't have to check. 06:03 The disadvantages, 06:04 we really have to depend on the patient 06:06 to take the medicines. 06:08 And it's dosed base on the kidney function. 06:11 And unfortunately right now it can be rather expensive. 06:15 So we always talk to them about every day. 06:17 Now can a person that's had atrial fibrillation 06:20 be off the medicine? 06:22 That's a question I frequently get. 06:25 Well, they can but there's a risk of this. 06:28 We never know for sure 06:30 whether that rhythm's going to recur. 06:33 It's just like, would you be comfortable, Nick, 06:35 driving your car without car insurance? 06:38 It's not a very smart idea. 06:40 Well, right, it's not worth. 06:41 Yeah. 06:43 So most patients, 06:44 once you understand the reason why, 06:46 we have this score where we measure the risk 06:49 of getting a blood clot, 06:50 we call that a CHAD score 06:52 where we measure things like underlying heart disease, 06:54 age, high blood pressure, 06:56 and if they get so many points, 06:57 we say, listen, your risk is pretty high. 07:00 Your benefit on being on a blood thinner 07:02 outweighs the risk. 07:04 Now another thing that comes up very frequently 07:06 is people start bleeding. 07:08 What do we do about that? 07:10 You know, well sometimes 07:11 we just have to stop it and say, 07:13 listen, the risk of bleeding outweighs the benefit 07:16 of the blood thinner. 07:18 Just because you're in atrial fibrillation 07:20 and that doesn't mean you're gonna have a stroke 07:22 but you're just at a higher risk 07:24 of having a stroke. 07:26 There's a new procedure 07:28 that we now have recently called a "Watchman". 07:32 And remember, we talked early about that little sac 07:34 where most of the clots develop. 07:36 Right. 07:37 Well, now we can close off that 07:39 with a procedure that's called a Watchman. 07:41 And so people that can't take blood thinners 07:43 or at high risk, 07:45 sometimes we can now offer them that procedure 07:47 which is called a Watchman procedure. 07:50 And that's basically limiting off that one area 07:52 that's highly productive of clots 07:53 when you have atrial fibrillation. 07:56 But all the time I get other question, 07:58 is there natural products that lower the risk of stroke? 08:02 Right. 08:03 Well, none that's been scientifically proved. 08:05 Now certain things like Aspirin, Plavix, 08:08 other blood thinners lower incrementally, 08:11 but never to the level 08:13 that these other blood thinners have been measured. 08:17 Coumadin, Eliquis, Xarelto, Pradaxa, 08:19 they lower it the most. 08:21 Okay. 08:22 You know, I'm gonna change gear just for a second. 08:24 From time to time, we have viewers that call in 08:26 or write in with questions. 08:27 And somebody's written and asked, 08:28 "How do I know if I need to take a supplement?" 08:31 You mentioned earlier about being able 08:33 to measure folk's blood 08:34 and see for deficiencies as such, 08:36 but is that necessary to know 08:37 if you need a supplement or what's the best way? 08:39 Now that is an important question 08:41 as it relates to atrial fibrillation 08:43 because all the supplements, 08:45 some of them interact 08:46 with the medicines you're taking. 08:48 Right. 08:49 So if you are taking a supplement, 08:51 no matter what it is, 08:52 you need to let your doctor know, 08:54 especially if you're on other pharmaceuticals. 08:57 So people, the way I answer that, 08:59 people that need supplements are people with deficiencies. 09:02 Okay. 09:03 The world's been around a long time 09:05 and we haven't had supplements for many years. 09:07 You got it from the food you eat. 09:08 Right. 09:10 And people that eat plant-based diets 09:11 usually don't need much supplementation. 09:14 Now we can always measure the blood, 09:16 we can measure the magnesium 09:17 or the potassium, things of the nature. 09:19 Some people that don't get out in the sunshine need vitamin D. 09:23 Okay, yeah. 09:24 And some people that eat a plant-based vegan diet 09:27 need the B vitamins. 09:28 Okay. 09:30 So they might need that supplement, 09:31 but usually they don't need a lot 09:32 of other supplementations. 09:34 Sometimes when you take supplements, 09:37 you can, it's like if you have an orchestra, 09:40 and let's say you have an orchestra 09:42 with 40 French horns. 09:45 French horns are great, 09:46 but if you have too many French horns, 09:48 they might drown off the trumpets. 09:49 And overpowers the rest of the orchestra. 09:51 Right. Yeah. 09:52 So some people sort of get overboard 09:54 on a supplement that they don't need 09:56 and it comes into the body 09:57 and it binds receptors 09:59 that you know that they're needed 10:01 for other things 10:02 and it sort of drowns out the other good things 10:04 that could be going on in the body. 10:06 So that sort of my answer to that question, 10:07 but it's very important 10:09 no matter what your cardiovascular system is 10:11 to let your doctor know 10:12 if you are taking these supplements 10:14 as it might interact with medicines, 10:16 and especially it's important for your blood thinners 10:18 'cause if the blood thinner gets way too thin, 10:21 just a little scratch can lead to a gusher. 10:24 Yeah, that's right. 10:25 Yeah. I tell you what? 10:26 We wanna hear the biblical prescription 10:29 for this program today, 10:30 and why don't you share that with us now? 10:32 Well, first of all, you know, I like a biblical prescription 10:36 'cause these are words that God has given us 10:39 that we now had evidence 10:40 that it changes your physiology. 10:42 Right. 10:43 Just like a pill changes one chemical pathway, 10:45 a biblical prescription usually affects the whole body, 10:49 helps your body do better. 10:50 So that's what I call biblical prescription. 10:53 So a biblical prescription for today 10:55 is found in Psalms 46:10. 11:00 It's, "Be still, take it easy, rest, and know, 11:04 have certainty without doubt that I am God: 11:08 I will be exalted among the heathen, 11:10 I will be exalted in the earth." 11:13 Science says that when we rest, 11:17 when we get enough rest, 11:18 the physical rest, the mental rest, 11:21 the spiritual rest, and the social rest, 11:24 our body does better. 11:25 Yeah. 11:27 You know, it rest, it doesn't malfunction, 11:29 it doesn't put stress on the system. 11:31 In this story says, 11:33 you know maybe God knew 11:35 that we were gonna be too busy someday. 11:38 And he says, "Listen, be still, quit moving, 11:41 turn down the stress chemistry 11:42 that might activate the development 11:45 of these rhythms that we get 11:47 when we're older like atrial fibrillation." 11:48 Yeah. 11:50 So maybe if we rest more, 11:51 we were never designed to go 24/7. 11:54 So being still, rest or worship, know, 11:58 not only it says be still and rest, 12:00 but know that I am God. 12:02 Not other things that are God. 12:04 You know not our cell phones, that's not God. 12:06 Right. 12:07 But know that I am God to our worship being still, 12:09 turning to Him, there's physiologic benefits 12:12 in slowing down aging 12:14 and treating chronic disease happens when we do this. 12:16 Sounds like this biblical prescription 12:18 might be the best supplement there is out there? 12:20 Oh, it's better than a supplement. 12:22 Better than a supplement. 12:23 Yeah. All right. 12:25 Well, Dr. Marcum, thank you very much. 12:26 I think I understand 12:27 atrial fibrillation a little better 12:29 and hopefully our viewers at home do as well. 12:30 And, Dr. Marcum, we're going to learn more 12:33 at Heartwise Ministries, right? 12:35 Yes, and if you've questions, we didn't cover everything. 12:38 Go to HeartwiseMinistries.org. 12:40 We'd happy to answer your questions 12:42 on atrial fibrillation 12:44 and steer you in the right direction. 12:45 Dr. Marcum, thank you 12:47 for sharing with us on atrial fibrillation. 12:48 And, viewers, I hope 12:49 that you have learned something as well 12:51 that will be valuable to you. 12:52 And thank you for joining us, 12:53 Dr. Marcum is gonna close the program in prayer 12:55 in just a moment. 13:01 Atrial fibrillation 13:02 is a very complex medical situation. 13:06 I hope you have learned a few tips 13:07 that will help you today, 13:09 but as we end our time together, 13:10 let's pray for one another. 13:13 Heavenly Father, thank You 13:14 for each person that's viewing this program. 13:17 We just want to pray for your blessings 13:19 and your ultimate healing in our lives, 13:21 and please lead us to Your will. 13:24 Please be with our health 13:25 and help us to improve daily is our humble prayer. 13:27 Amen. 13:28 I wanna thank you for joining us 13:30 on the Ultimate Prescription. 13:31 If you might have questions, 13:33 please feel free to go to our website. 13:35 Ask us a question about atrial fibrillation, 13:37 that's HeartwiseMinistries.org. 13:40 Until next time, I'm Dr. James Marcum, 13:43 wishing you the best of health. |
Revised 2020-01-30