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0:09
Hello everybody and thank you for joining us. Hope you had a wonderful vacation and holiday. Well, I certainly did. I'm looking forward to sharing the message with you today. Good to see so many of you on. All right, well the heart is an incredible organ of the body and it affects everything. I'm super excited to talk to you about the heart today. Let's jump right in. We've got a lot of material to cover today and I would love to share it with you.
0:41
Hopefully everybody has seen my screen, Heart to Heart. We're going to jump in and first of all just define a little bit about what is the purpose of the human heart. What does it do? We, of course, have a lot of other ways of thinking about the heart. We're going to talk primarily about the physical function of the heart, but we will discuss a little bit about the emotional and psychological aspect of the heart. Its primary purpose, is transportation. It is
1:13
the pump and the organ that moves fluids through our body and transport things. We can break them down into pretty much three different categories. The first category is materials that are entering into the body. So for example, everybody right now just takes a nice deep breath in. You take a deep breath in, you just brought a mixture of oxygen and nitrogen and other inert gases into our lungs. And in our lungs, we have these little sacs that are called alveoli.
1:43
And in those alveoli sacs, they exchange the gases with the vascular system that then sends the new blood back into the heart and gets pumped out to the body. So it transports oxygen, it transports nutrients. So it also is connected to a lot of our other organs, particularly the digestive system, and it receives the different nutrients from our diet, things that we eat, and it transports those around the body to be able to provide cell health and the other things that we need.
2:16
It also is responsible for transportation of materials that move from cell to cell. So I'll show you some pictures in a minute, but the idea is that the blood system, the vascular system, is moving these nutrients around the body. So it moves things like waste. So when a cell is done with certain nutrients, it excretes waste. That waste goes into the vascular system. It then gets moved into filtration systems like kidneys and livers and is eliminated from the body.
2:47
It also transports our immune system. So when you think about antibodies, we talk about this a lot with COVID, that it is moving the white blood cells, the antibodies, the B plasma cells, T cells, it moves them around the body to the site of where the infection is. And so it tries to protect us and get that, get those cells to the right place. It also moves proteins that necessary for healing. So if we cut ourselves or have an injury,
3:15
the vascular system is going to move the blood there to be able to clot and to clean out the wound. Hormones, we think of our pituitary gland and our hormone glands, the thyroid gland, the adrenal glands that are secreting hormones that are signals to the rest of the body to do certain activities. That gets transported again, cell to cell by the vascular system. And then the last thing is that it excretes, it removes waste products, so metabolic waste.
3:47
It removes heat by moving blood when we get hot. It'll make our skin flush, and that is a way of eliminating heat when we get too hot. It also, through the lungs, eliminates carbon dioxide as the waste gas of the human being. So those are really, when we think about it, its primary purpose is transportation. Now the heart is an amazing organ, and I think it's important for us to give a lot of credit and awe to the heart. So it's more than just a pump.
4:17
In ancient civilizations, they thought of the heart as being much more than a pump, and often we talk about it in the same way. We talk about feelings of our heart, we talk about
4:28
different things, a broken heart, when things go wrong. The ancient Egyptians thought it was the seat of the mind, and so they preserved the heart when they would mummify their leadership. And that heart was where they felt that the mind sat, that that was where the soul of the body was, and that the heart was responsible for that life, light of the mind. And that's not far from the truth. We'll
4:58
look at how blood gets distributed and the brain and the mind has a priority set in the body to make sure that oxygen is getting to our brain and to our heart muscle before it goes anywhere else, to be able to make sure that we maintain our brain health and that we maintain our heart health. Aristotle thought it was the seat of intelligence. So again, thinking of our mind now more from an intellectual rather than anything else is that it was the place where our intelligence sat.
5:30
That's where it resided. The heart basically is a workhorse of the body. It's a muscle, it contracts continually, resting only in the millisecond long pause between beats. So it literally is just beating all the time. And I saw this one quote. It said, in one minute, the heart performs work equivalent to lifting a five-pound weight up one foot off the ground. So just imagine the size of your heart and that in one minute, the amount of work that it does is
6:01
like lifting a five-pound weight, doing a bicep curl, or something like that. Pretty cool stuff.
6:09
When we look at the heart muscle, we often compare it to skeletal muscle, or striated muscle, or smooth muscle. And it is unique in the way that it works. I won't go too deep into this, but the reality is that it is in a series contraction. So series means one muscle fiber contracts and it sends a signal to the other signal to contract. Where in the striatum muscle, or if we're thinking of skeletal muscle, there is a nerve impulse that comes and will contract
6:39
multiple muscle fibers. So in the heart, it's one fiber at a time in linear and it's going to cause that muscle fiber to, and we can see it right here, it goes from one nucleic to the next nucleic. So it's continually contracting along, and I'll explain why that's so important. So the heart is made up, 99% of it is cardiac muscle, this muscle we're talking about here. Only 1% is what we call the pacemaker cells. Now the pacemaker cells, super cool.
7:11
When you see those movies and somebody pulls somebody's heart out, and it's a horror movie and that heart is still bumping, that's true. So as long as there is oxygen in the heart muscle, it will continue to beat on its own. It doesn't need the brain, it doesn't need anything else. It will beat on its own as long as it has oxygen until the oxygen depletes and then the muscles will infarct
7:33
or die. So that is a true phenomena of the heart, that it continues to beat. And that is because of these pacemaker cells that reside in the SA node. And the SA node is where the impulse of the heart contraction starts every single time. So continually beats independently, and it's influenced by the autonomic nervous system. So when you hear sympathetic or parasympathetic system, what will happen is if the blood pressure or the heart rate is too slow,
8:06
then the sympathetic, the one about excitement, will stimulate that SA node and tell the automatic pacemaker cells to increase their speed. And vice versa, if it's beating too fast, the parasympathetic, or the more passive part of our nervous system, will tell it to slow down.
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But it will always beat. It will always beat relatively on time.
8:33
All right. So let's jump in and take a look at the heart here.
8:38
So if we do it from the traveling of the heart, like where things come in from. And I like to start with the blood coming into the right atrium. So here we have the inferior vena cava bringing blood into the right atrium and the superior vena cava from the brain and the neck bringing blood into the vena into the right atrium. Now from the right atrium that blood is going to pass through the tricuspid valve and by the way it is the closing of the tricuspid
9:07
or mitral valves that causes the first heart sound the lub of the lub dub. So when that valve closes, that's the lub sound. So this blood is coming from the right atrium, goes into the right ventricle, the big part of the heart, and then this blood that is low in oxygen
9:28
is pumped out and it goes through these right pulmonary and left pulmonary arteries into the lungs. And it's in the lungs that this blood then gets transfused, right, it becomes now oxygenated and the CO2 comes off and we breathe that out, that's part of the purpose of the heart. And now that blood comes back in fresh through the pulmonary veins. And the pulmonary veins are going to bring that blood, that oxygenated blood into the left atrium.
10:06
From the left atrium, it will pass through the mitral valve. Again, that's part of the lub sound. And then the ventricle, the left ventricle, is that big, nice, thick one. It's gonna push the blood into the aortic arch, and then that oxygenated blood is gonna go through our arteries, our arterioles, and then go through the rest of the body and come back as the venous return. So basically, venous return comes in, deoxygenated, full of CO2, gets pumped by
10:35
the right side of the heart into the lungs, gets oxygenated, gets pumped back into the left atrium, down in the left ventricle, and then pumped out into the body. And it does that 72 times a minute, it's pumping that blood, okay? Couple other things to be aware of is the semilunar valves are the valves going from the ventricles. The ventricles going into either the lungs or going into the aorta. And when that door closes or that valve closes, that is responsible for the
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dub sound. So if you were to put a stethoscope on your heart and listen, the sounds you would hear would be lub dub, lub dub, lub dub, lub dub, lub dub. And what that represents is the different chambers of the heart filling and closing as they push the blood through. So what happens is this SA node sits up here above the atrium. And what it's gonna cause is it's gonna cause a depolarization of the atrium that's gonna cause a contraction of the atrium, the atrial node.
11:40
And then it's going to send an electrical impulse down what's called the bundle of His that's in the septum. It's going to come all the way down to the tip of the heart. And then the Purkinje fibers are going to send an impulse that will create a sequential kind of pumping of the heart to push the blood out. So it closes at the apex of the heart and then works its way up. And about 60 or 50% of the blood inside that valve stays inside that,
12:12
or not the valve, but inside of the ventricle, stays in the ventricle.
12:18
And then it gets refilled, pressurized, squeezes out another 70 or so milliliters of blood. And that's how we calculate something. So let's take a look at another slide that will help us with that.
12:30
So if we look here, we said that the lungs, basically that right, the old body blood will come into the right atrium, goes into the right ventricle, and then gets pumped into the lungs. The lungs get rid of the CO2, pick up the O2, bring it back into the left atrium, gets pushed into the left ventricle, left ventricle pushes it back out to the body. That's the basic flow of the blood and its oxygenation. We'll keep it nice and simple. When we look at this next slide,
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now we can sort of see where it's going, right? So as the fresh blood gets pumped out of the ventricle into the aortic arch, some of that blood is going to go up into the head and brain and the arms. That's the superior vascular system. Some of it's gonna come down to different organs, the trunk, the hepatic artery into the liver, the digestive tract, the kidneys, and the pelvis and legs. What you see here is where the capillary beds
13:37
meet with the venules. So you have the arterioles going into capillaries and capillaries going into the actual venules coming on this side. So oxygen goes to the cells represented here in these areas in the middle. That is where the oxygenation and the cleansing of the cell takes place. This is the communication directly between the epithelial cell of the capillary and the cell membrane of all the
14:08
cells of our body. And they all need blood because the blood carries the oxygen, and they all need the blood because the blood also takes away the waste product or metabolic waste of that cell. This is essential for all of us. Now what's interesting is, let's say that I want to go for a run, right? Or let's say even more scary, because let's say that we're being chased and somebody is chasing us and we're running and we're running down the streets and trying to get away
14:36
from somebody that potentially represents danger to us. What will happen is the sympathetic system kicks in. Now I said already, the sympathetic system is going to hit that SA node right here. And what's it going to do? Speed up the heart, right? So the heart's gonna start beating faster. So it's gonna beat faster, it's gonna move more blood through the body. And that blood's gonna always have a priority to go to the blood of the heart,
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because if the heart doesn't work, there's no pump. And it's also gonna prioritize the brain. So those two get prioritized first, the brain doesn't take a whole lot of blood, it stays pretty much the same, except for when I'm trying to get ready for my podcast. But the brain stays pretty much the same. The heart changes with the intensity of the heart beating and the demand on the body. What's interesting, though, is that the body has a
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way of going, well, we don't need so much blood in our digestive system right now, or in our liver, or in our kidneys. So I'm going to close those areas up and make it so that that blood gets redirected to my legs so that my legs can run and help me get away into my brain so I can be smart to know how to get away from that potential risk. Now as soon as I get away and I'm safe and I go to the restaurant and I'm sitting down to eat, I'm relaxing,
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maybe you had a glass of wine or something, all of a sudden parasympathetic comes in. Now the same amount of blood still goes to the brain, but the amount that the heart needs is much less because now instead of beating 130 beats per minute, you're beating 68 beats per minute. So it doesn't need as much blood and neither do your legs or your arms. So what happens? Blood gets redirected to the digestive tract, the filtration tract, reproduction
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tracts. The body knows how to redirect the blood based on what we're experiencing. Now, sometimes when there is extreme cold, the body will always try to make sure that it's keeping the main organs healthy, the brain and the heart, and maybe some of the other organs, at the expense maybe of losing blood down in the peripheral body. So you might lose a toe to frostbite or a finger. But that's because the body knows and is prioritizing where that blood
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goes. I find this fascinating that based on our psychology and our fears or our beliefs that the heart will respond accordingly. So if we think of this as being a benefit of Pilates, Pilates often puts people into a parasympathetic mode. It doesn't mean they're not exercising, but it makes them mindful. And mindfulness is a great way of managing blood flow and blood health and blood pressure. It puts us into more of a parasympathetic mode. Another term for this
17:28
is when we talk about being parasympathetic or sympathetic, we often refer to it as limbic, like survival mode in the sympathetic mode. So in sympathetic mode, the heart's gonna beat too fast and the cortisol squirting out of the adrenal gland and we're in a major stress. And that stress is okay if it lasts for a little while because it's built and designed to help us survive. But in today's world, sometimes we are in that sympathetic mode or limbic mode all the time.
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And so we don't spend enough time inside of the parasympathetic mode, which affects things like liver puration and kidney filtration and digestive to be able to get the proper nutrients. And so our digestive system doesn't work so well. So we might find that we're constipated or we have diarrhea or we're not absorbing the minerals that we need to absorb. We really don't want to be in survival mode. That's the key thing. So a Pilates class a
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day keeps the disease away, right? So if we're meditating, moving, that helps a lot. I've got a couple questions or comments. Let me address those before we go to the next section. From Heather, she said, what effect can breath work have on cardiovascular health? Western Massachusetts. Heather, thank you for asking that question because we know that we can control even our heart rate, especially practicing things like yoga breath, we can control our heart rate
18:54
where we can either excite it or slow it down. We can relax the body, we can refocus the body just using breath. If we breathe too much, we are hyperventilating. And hyperventilating will cause the vascular constriction which causes us to pass out. If you've ever done that as a kid, we used to do this dumb thing where we would hyperventilate and then one of our buddies would come give us a big bear hug and then we would pass out and we thought that the waking up with a
19:24
buzzing feeling was really the cool thing, right? But that I learned is what is hyperventilation, right? So our breath techniques, what we do in Pilates can greatly affect heart rate, blood pressure, and staying out of the sympathetic mode too much or getting out of the limbic mode. Great question, Heather. Sarah, good to hear from you. It says here, hi, Brent. Presumably that threat that triggers the heart to beat faster can be real or perceived. That way those that suffer
19:55
anxiety can have sustained levels of high blood pressure, cortisol, and you're just ahead of me. So you're exactly right. So when we have fear, whether it's justified or not, this is where for example individuals who suffer from anxiety, anxiety puts them into limbic mode. Limbic mode does things like survival, so it's going to shut down metabolism, it's going to try to go into saving mode, it changes the heart rate, the blood pressure,
20:26
the cortisol levels, all things that long-term can cause disease and impairment in the body. So that's very important to understand. And that's why we as Pilates teachers, when a healthy individual that might be dealing with anxiety, a Pilates class a day or a Pilates lesson or some philosophy on how to manage stress can make all the difference in their long-term health. Because stress is one of the big challenges that we all face in
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today's world, especially with things going on internationally, things going on with health, things going on with pandemics and financial and the different challenges that we're gonna be facing over the next number of years. So again, having somewhere in our day, Deepak Chopra also said this, he said that the research, and I've seen this research, that 15 minutes of meditation a day is enough to keep us out of limbic mode. Limbic mode, if
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we let it go three, four days in a row, you know what that feels like. It feels horrible. We feel depleted. Our eyes are recessed in our head. We're tired. We don't have energy. We're not absorbing the nutrients that we should be absorbing. And we just have stress. And we don't even know where that stress comes from after the second or third day. It just is stressed and we want to try to manage that. And that's why movement and breath and mindfulness are so powerful.
21:46
Thank you for that comment, Sarah. Let's move into the next slide where we're looking at this idea of blood pressure, right? Now, a lot of times when we look at blood pressure rates, and I'm gonna show you some in a minute of what are some normal healthy blood pressure rates, and what are some good resting heart rates for us. What this shows us is that coming out of the heart right here, this is the aorta pumping the blood out, we typically talk
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about blood pressure being between 120 and 80. The systolic at 120 and the diastolic at 80. When you go in the hospital to visit a friend, if you look up on the screen, what it's really looking at is this mean arterial pressure. That's looking at the average pressure in the arterial part of the vascular system. It's not measuring it anywhere else. It has to be an artery to be able to measure
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that blood pressure, right? So typically we put a cuff around the arm, and we're basically listening for the sounds of it opening and closing, and we can pump it up and anything above 120, there would be no blood flow through that artery. And as soon as it comes lower, you would hear the heart start beating, bump, bump, bump, bump, bump, bump. And the low end of it, when it gets down lower than 80, it goes quiet again because now the valve of that artery is all the way open and the
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blood's flowing through without any obstruction. And so this is where we see the measurement that we use today for healthcare is our blood pressure. In the hospital, we look at the mean arterial pressure, but I want you to look at what happens in this pressure gradients, right? So it's gonna go from being at around a mean arterial of 92, it's gonna start dropping down when it gets into the arterials. You can see the arterial here is now coming down into the 50s and
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40s. By the time it gets into the capillaries, it's in the high teens, and then it continues to flow into the venous system and back up to the vena cava at somewhere around 4 millimeters of mercury pressure. So it's sort of a cool thing because this is coming down here, comes down, and the heart pumps it back up through the lungs, and it comes back out through the arteries again and comes back down. So blood flows from high pressure to low pressure.
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If we have too much resistance in our arteries, that causes increased blood pressure.
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And tension inside of the artery can come from two things. It can come from obstruction, like we talked about coronary artery disease, atherosclerosis, we'll talk about that at the very end. Or we could be talking about vasoconstriction. So there are times where we just have too much stress, too much vasoconstriction, too much pressure, right? And that vasoconstriction can drive our blood pressure up to as high as 250.
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Over 90, I've seen blood pressure that high, right? That's a disaster waiting to happen with blood pressure that high. That typically can lead to diseases like stroke, brain stroke, or brain infarct. It can lead to heart disease. It can lead to other types of problems in the peripheral vascular system. So we really want to target this area. Let's take a look at a couple scales that we can look at regarding heart rate and blood pressure. So this is heart
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rate. So if you are male, and this is because the data collected has always been collected, not as a political gender identity but as how medicine has identified individuals as male or female and what their activity rate is and women and their activity rate. So for example for me I come down and I think that I'm in good health and I go out to my age bracket, and it says 56 to 65 should be 68 to 71 beats per minute. And I'm right about 68 is my resting 62 to 68.
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So I'm doing okay. I might even be in great health according to this chart. So you can take a second and just look at it, identify yourself, identify your age bracket. And the last time you took your heart rate, you can measure and see where you fall in line with this resting heart rate.
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Good to move on. So if we look next at blood pressure, resting blood pressure, this is looking at age. It does not break it into male or female. But if we look again for my age bracket, 55 to 59, right? I should not be below 118 over 82 and I should not be over 144 over 90. So I'm 132 over 79 is my blood pressure. So somewhere in here is where I reside. So normal blood pressure. And I always like to know what people's blood pressure
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is because it tells me a lot of things about them. And if they're on blood pressure medicine, then I need to know that they might, if they take medicine in the morning and they come in to do an early morning Pilates session with you, that medicine might drop their blood pressure too low. Right? So if they're getting up quick from doing supine exercises and they get lightheaded on you, you have to recognize that that, you would want to know that ahead of time that they're
27:12
taking blood pressure medicine or that they have occasional dizziness or lightheadedness when they make quick movements. That's telling me their blood pressure is too low. If they're dealing with a pretty severe headache, right? That might mean that their blood pressure is above the max, right? That's often a good sign that their headache is just pounding and they feel like there's pressure in their head. That often can be associated and that we have to be careful is we
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wouldn't want to do hanging series with somebody that's having a high blood pressure headache. So again, being careful and being smart is you wouldn't want to put more blood pressure, more gravity of the blood into the head by doing inverted exercise. You'd want to do things with them sitting up or them standing and picking different exercises based on what they're experiencing that day. The Pilates still would probably be the best
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thing to help them reduce their blood pressure that you could do for them as a Pilates teacher. Saying that if their blood pressure's too low and they get up too fast and they get faint, if you just sit them down within 30 seconds, they're gonna be fine. Or if they start to get a headache and the headache gets worse, stop the session. If it starts to get really worse, they have severe pain, call 911. It's not for us to make the decision,
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right? It's just to get them to where they have the appropriate recovery time. All right. And we have to think about this all the time as physical therapists. We do not diagnose in and of ourselves cardiovascular disease, but we have to be aware of its symptoms for somebody who is doing therapy, or in our case, doing Pilates, that might have some heart disease and might be managing it with pharmaceutical. And we don't have to be
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a diagnostician, we just have to be aware of the signs. We have to communicate with the client, and we have to make sure that if anything seems too severe, that we would send them to the hospital. All right, let's talk about heart sounds.
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So remember how I said when the blood comes in through the atrium, so here is the right atrium, here is the left atrium. These are the mitral valve and the tricuspid valve, right? That's the valve they go through. When the blood comes through them into the ventricles and the pressure closes it, that is the lub sound. That's the first heart sound, right? S1, sound one. When the blood goes through the pulmonary valve and goes through the aortic
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valve or the semi-lunar valves and those doors close, that is the second heart sound, dub. So that's why physicians listen to our heart sounds to see if they are in rhythm, right? If they are in rhythm. So we should be consistent, lub-dub, lub-dub, lub-dub. If the heart beats faster it's going to be lub-dub, lub-dub, lub-dub, but it is still going to be lub-dub and it is going to be the paired sound representing the atrium closing, representing the ventricle closing. The right
30:12
and left atrium close at the same time and the right and left ventricle close at the same time, or should. Sometimes when doctors say there is a murmur or there is something strange, it might mean that one of the valves is not in sync with the other valves of the heart. Speaking of that, we can look next at an EKG rhythm, right?
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So this is a electrical cardiogram and what the doctors do, and I'm sure a number of you have probably had an EKG somewhere in your life. Anytime you go in the hospital, they put the electrodes on your chest and they just want to make sure your heart's okay. If you've ever had a surgery, the EKG was running the whole time through the surgery. They're looking to see if there's any problems with the anesthesia that might cause a problem
30:59
with your heart. So they're always monitoring it, right? So the P wave represents the depolarization of the atrium. So depolarization means there's a signal that tells that muscle to contract. Right now if we look at the P wave right here, this is the depolarization of the ventricles. The QRS wave, the big one, is the depolarization of the ventricles. If I put the heart sounds on it, it would be lub-dub, lub-dub. We have the contraction of the atrium we have the
31:38
depolarization and contraction of the ventricles and Then this is what's called the repolarization of the ventricle we don't see the repolarization of the atrium because it's happening the same time as The depolarization of the ventricle so it happens the same time. So that's why you would see ventricle can our atrium contract ventricle contract atrium contract ventricle contract,
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atrium contract, ventricle contract, atrium, ventricle. If you think back of what we talked about with how that electrical signal goes, the pacemaker cells send the signal to the atrium node first, the AV node. And that AV node is going to be depolarized. That's the P wave. Then it goes down that bundle of His in the septum, and then it comes up with the Purkinje fibers. And that depolarization is
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the QRS wave. Then it contracts, and then the repolarization ready for the next contraction. So this would repeat itself over and over again. You'd look at a chart, and you would see your PQRST P wave over and over again. You would see that repeating itself.
32:54
Let's see. I have Prudence Hutton said, mitral valve prolapse, seemingly common. What should Pilates world consider? With a prolapse, most people that have that are aware of what their limitations are in exercise. And what that typically means is that they don't get a complete closing of the valve. So there's a little bit of leakage. The question is how much leakage? And so they typically will know how strenuous they can exercise.
33:24
If they exercise too strenuously and they're not getting enough blood, oxygenated blood out of the body, it can actually cause the heart to struggle and possibly even have angina or an infarction. So they are aware of those limitations. If they've been diagnosed with MVP, and if they know that they have a lot of leakage in there, that some people have minimal leakage, and the doctor says, don't worry about it, your ejection fraction, or the amount, the stroke
33:54
volume, still seems to be fine. They measure that with the ultrasound that they do on the heart.
34:00
They can measure that stroke volume. That's a great question. I would just ask them if they have any limitations from their physician on how strenuous their exercise can be. And that's a good point for us as well as to think, you know, are we gonna have them doing hundreds, you know, for the full hundred with their legs out at 20 degrees and their body up and having them breathing fast, is that gonna be too much for them? So you might
34:24
think of how you would modify that exercise based on how much strain they can handle. Marie Trigg says, I have a client with ascending aortic aneurysm. Please explain what this is and the possible dangers. I'm going to talk about pathology at the end. And it's very interesting, Marie, that you bring this up because I have an atrial aneurysm. We will talk about what an aneurysm is and why we have to be careful with aneurysms. If you just be patient with me,
34:57
I will talk about that in a little bit. So here is looking at that combination of heart sound and EKG. If you remember, we said that there would be the P wave and then we have the P and then the QRS wave and the T wave over here. And the lub-dub is basically lub is the contraction of the atrium, dub is the contraction of the ventricle. So you can sort of see that relationship between the EKG sign that I'm showing here. And that's what doctors look for. They
35:33
want to know that the sound and the EKG match. That's really important to them.
35:41
So what influences the heart? So mechanoreceptors, these are stretch receptors,
35:49
reside in different parts of the heart in the aortic arch. And they provide signals that can change blood pressure and heart rate. So remember that we have two parts of the nervous system. We're going to talk about this next week because I'm gonna talk about the nervous system, both the peripheral and the internal nervous system. And we're going to look at how sensory comes into the central nervous system and output leaves the central nervous system.
36:20
So here we have mechanoreceptors that are sensing increased pressure or stretch. The baroreceptors are pressure, the stretch receptors are the mechanoreceptors. So when they get stretched or they feel pressure, they send a signal to the brain, the brainstem. And in that brainstem, that's where the autonomic nervous system resides and it's going to act accordingly. So if those mechanoreceptors and baroreceptors show too much pressure, then it's going to send a
36:54
message to decrease the pressure. That decision is made in the brain. The brain then sends to the autonomic nervous system that if the blood pressure is too high, it's going to cause the heart rate to slow down and vasodilation. If the blood pressure decreases too low, the sympathetic system is going to stimulate the heart to beat faster and cause vasoconstriction. So it's going to bring the blood pressure up. And there's some very important reasons for this.
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Some of the organs, especially the ones like the kidneys, require that there is a certain amount of blood pressure to be able to push the blood through the glomerular filtration system of the kidney. You might've heard of that before, but if the kidney, if there's not enough blood pressure, there's no filtration and the waste products and metabolic waste does not get removed and it stays in the body. If there's too much waste in the blood or too much solute in the blood, that also
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results in what we call an osmoreceptor, right? So osmolarity has to do with the percentage of solutes or solids inside the blood. If there's too much solid in the blood, that is gonna minimize oxygen exchange. And so we're gonna have problems. You can think about this with metabolic disorders, diabetes, other problems, but if that blood pressure is too low, then we often might see that there's too much solute in the blood. And the brain has receptors for that,
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the osmoreceptor up around the pituitary gland that is gonna tell the body, hey, you need water, you need to drink water, you need to drink a lot of water, you need to decrease your salt, we need to get rid of all this solute. So if you drink the water, the water is going to increase the volume, you increase the heart rate and the vasoconstriction, the pressure is going to come up and the kidneys will filter again. So it's this continual cycle,
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the body is always adjusting, always adapting to be able to make sure that our heart has the right pressure and it has the right volume coming out to be able to be healthy. So the fact that we do as well as we do in itself is a miracle.
39:01
All right, we got a few more minutes. I wanted to jump into some common cardiovascular diseases.
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This is a cartoon of an infarction right here. The inside part of this is the infarction. This would be more like an angina or ischemia that we might see in heart muscle, it's not getting enough oxygen. So we're gonna talk about both angina and infarction. We're also gonna talk about atherosclerosis and we'll talk about atrial fibrillation. And now I'll also talk a little bit about an aneurysm. So atherosclerosis is actually, there's a lot of
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confusion in this. A lot of people think that if you have a high LDL count, so when you go to get your blood test, the high LDL count is what causes atherosclerosis, so you can't eat foods that have fats in them. Actually, the biggest challenges to atherosclerosis are like high fructose corn syrups and certain types of vegetable oils. Those are the two big no-no's that cause a lot of damage in the system. What we eat doesn't always directly correlate with this. Like a lot of times
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we said, oh, you can't have fat, so you should be using margarine or processed oils or things that are not, that are fake, right? That we did for 50 years after World War II. And now we're learning that that's the worst thing you could do, right? So we don't wanna have a lot of processed foods. So high fructose corn syrups and hydrogenated oils or also some of the vegetable oils, canola,
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soy, soybean oil, sunflower oil, grapeseed oil, all of those have a high risk of leading to chronic atherosclerosis. So what happens is the inflammation happens in between the muscle and the epithelial cell of the vessel. And it starts to build cholesterol. That's why people get freaked out about it. The reality is we need cholesterol. We need a balance of high lipo cholesterol and low to be able to be healthy. It transports a lot of things for us. It's very essential
41:07
for us to have that, especially for brain health. That's why you hear people saying fish oils and omega-3 oils, right? They're very healthy for us. We don't want to not have them. The problem here is that the wrong kind causes an inflammation and it starts to close the vessel. So when you hear about people with coronary heart disease and they need to have a stent or they need to have bypass surgery, this is typically the disease we're talking about. It can also happen
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in the carotid arteries where they get clogged up and can cause things like thrombosis or a clot that gets thrown and causes a stroke in the brain or an embolism in the lungs or the heart, right? This is probably one of the number one killers in our country today, heart disease. This is the main one of heart disease. I do think it's a lack of movement and the abundance of processed foods that we have that are the main causes of atherosclerosis. I will
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share a lead of a book, a couple of books that I think are very good. They can be a little too technical at times, but they're written by very good physicians that are not buying into a lot of the pharmaceutical and the processed food industries that seem to influence us so much.
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We look at this first one, angina pectoris, this is where there is ischemia in the heart. What does ischemia mean? Ischemia means that there is not enough oxygen getting to the muscle. If the muscle does not get oxygen, it becomes ischemic. If it becomes ischemic too long, it infarcts. Infarction means death. That's what infarction means. So the cells die. Angina is not killing them, but they're ischemic. So quite often ischemic pain,
42:52
they will have chest pain, arm pain, particularly the left arm, left jaw pain, maybe a little bit of a headache. They might have shortness of breath. They might also feel the signs of a heart attack where they might feel nauseous, or they might feel like an elephant is sitting on their chest. Anytime we hear any of our clients making these kind of claims or complaints, we need to take them
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serious. Now, some people are so used to having angina, they might have nitroglycerin pills in their pocket. And when they start to have angina, they take a nitro pill and it causes vasodilation and the blood gets to the heart and they're okay. They know how to manage it. Others are stubborn and they don't. So we want to be careful that if we are doing an exercise that is increasing the heart demand and increasing vascular flow and they know that they have atherosclerosis,
43:50
we want to be careful that we're not the cause of causing that angina pectoris. So again, it's important for us to gather information. Even if we're not making diagnoses, we just need to know, what would you want me to do? How do you want to manage this if you have a problem with your angina that's in your medical records? Do you have medicine for it? Who do you want me to call? Do you ever have major problems with it? How would you know if it's gonna be an infarction
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or an angina attack? They don't always know. When we look at the difference between angina and infarction, infarction typically is gonna be a complete blockage and it's gonna cause death to the cell, right? And that's where you hear somebody said, I had a heart attack, I went to the hospital, I now have an ejection fraction of 30%, right? Of what they should be, 54% would be normal. They might be at 30%. So what that means is,
44:48
they cannot be involved anymore in highly rigorous activities because they cannot get enough blood or oxygen to their heart. They also lose some of that electrocardio pulse in the area that the cells are dead. Remember I said the cells fire in series. So it goes from cell number one to cell number two to cell number three to four as it works its way up the heart to cause a contraction. If there's a major portion here that's dead now, that signal coming from here up now is
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impaired here and it has to go around. So the signal changes, that means some of the blood in that ventricle is not gonna get squeezed out. And that is the stroke volume that's gonna be decreased or the ejection fraction that gets down below 50%. And that's a problem, right?
45:38
So again, rather than talking about what to do, I just want to make sure we understand what it is. If we look at atrial fibrillation, now this is something that I struggle with. I've had two episodes with atrial fibrillation in my life. One was induced by a high dose of caffeine and the other was induced by sleep apnea about 10 years apart. When I go into sleep apnea, or I'm sorry, when I go into atrial fibrillation, this is where the heart beats very irregularly.
46:06
So apparently there are, from congenital times, development where some of these autonomic cells that sort of stimulate the nervous impulse are above the atrium. And so you might hear somebody that had an ablation surgery where they went in and they ablated these cells. They did an electrical burning of those cells to stop them from causing irregular heartbeats because they're interfering with the pacemaker cells. That's what
46:38
you're getting here. Now, in my case, the atrial fibrillation caused me to go into tachycardia. Tachycardia means that it's fast. So my heart rate was getting upwards of 190, 199 beats per minute. Now some hearts can handle that just fine, but I have another anomaly in my heart. So in my heart I have a very thick atrial wall. They call that an athletic heart. I don't think it has to do with being athletic. It's just it's a thick wall, and I think that's more congenital. So
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what happens? Think about it mechanically, if the heart rate goes up, the blood cannot get through a thicker wall to the inner cells of that wall. That can lead to a massive heart attack. For me, atrial fibrillation could be a life-threatening thing if I go into tachycardia with my thickened left ventricular wall. Everybody has a little different thing, and there's so much pathology. I mean, think about what these cardiologists and cardiac surgeons have to know to be able to help
47:45
us. There's just so much to know. But for us, what we need to know is that if somebody feels an irregular heartbeat and they're not familiar with it, they need to go to the hospital, right? Sometimes they can get by with even in the first 24 hours going there, but the big risk of atrial fibrillation is two things. A blood clot in the atrium, that the blood clot then can go into the heart or the brain and cause a stroke, or you go into tachycardia, and
48:12
if you're like me and you can't handle a really fast heart rate, they can have a massive heart attack and die. So those are important things, and this is pretty common. You'll be surprised at how many of our clients have atrial fibrillation. It's not uncommon. The last thing I wanted to talk about was the idea of an aneurysm. So an aneurysm means a weakened wall. So an ascending or descending aorta that goes into the heart or out of the heart, those have
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tremendous pressure on them. And if there's an aneurysm, that means it's sort of like a balloon inside of the inner tube tire of your bike. So if the tube is weakened, what that means is if something rubs up against her, the pressure is too high,
48:58
it can actually rupture. So if the pressure gets too high, it can actually rupture and you have a bleed. When people go to the hospital for a potential stroke, the first thing they have to determine is, is this a blood clot or is this a bleed? Right? So, typically aneurysms lead to bleeds and things like atrial fibrillation or congestion or things like that where the heart has irregular beats or mitral valve prolapse that the blood is circulating can be causing a clot
49:34
and the clot can also cause a stroke. So they have to determine if they have to use a blood thinner on a clot, but if they use a blood thinner on a bleed, that would make the bleed worse. So they have to do a CT scan, and most emergency rooms now are equipped to differentiate immediately if a stroke is a bleed or if it is a clot. And so that's always the risk when we have clients that come in that we know have aneurysm, the first thing we want to know is how bad is it?
50:03
And has the doctor given them any limitations? So for example, I would not have them doing inverted exercises if I knew that they had a superior aortic aneurysm, because that would be increasing the blood pressure in the area of the aneurysm by having them do inverted work. Right? The opposite would be true is if they're doing work upright even not laying down You're going to minimize the pressure that is coming up into the superior aortic arch All right last slide here, and we'll
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finish up is For us as Pilates practitioners. What do we do so here's a couple questions? And you can just answer them in the chat if you want, but is it important to know a client's medical history after us talking about cardiac client's medical history after us talking about cardiovascular work? Do you think that a Pilates teacher should be responsible to understand a little bit about cardiac health? What do you think?
51:06
Looking to see your answers in the chat. I see a yes out of 82 people, there we go, good. I do think we have a responsibility to take a history. We do not diagnose as Pilates teachers, we do not prescribe, we do not tell them what pharmaceuticals to take, we don't tell them or make a judgment call on these things, but I think it's very important for us to understand. And if we have a client and they have a diagnosis we don't understand, just go look it up. Become
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familiar with it. The question that I always ask my clients is, has your physician given you any limitations regarding your movement or exercise activity? That's really our question for them, no matter what their pathology is. The next question is, how does varying postures affect blood flow and blood pressure? Well, we've talked about it a little bit already, but head going down is going to affect blood pressure and blood flow to the brain,
52:09
right? Laying on your back, there's gonna be more blood flow to your brain than if you're standing up. So the idea is positional orientation does affect things like blood pressure and blood flow. So if you ask your client, what are some of their limitations, or if they ever get dizzy when they stand up too fast, that's a good indicator that you should take precautions on how fast they transition from being supine to standing and changing their positions on an exercise, right?
52:41
The next one is if someone complains of chest pain, left arm pain, shortness of breath, what do we do? What would you do? Write it in the chat. What would you do?
52:55
Thank you. You call 911. You don't mess around with it. Even if it's heartburn or a pulled pectoral muscle, which it could be or it could be anxiety, that's not our call. It is never our call. As Pilates teachers, exercise teachers, even physical therapists, we do not make that diagnosis. We call emergency services. So most adult patients have high blood pressure. You know, what should we know, right? And thank
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you for that, Evie, for the 144 in Austria, right? Every country knows what their emergency numbers are. So make sure you know them and you have them close, right? Most adult patients have high blood pressure. So what should we know? And what signs should we be looking for? So I've talked about this a little bit already, is if we see lightheadedness or headaches, that often is an indicator of blood pressure issues either being too low or too high. I think we just are sensitive
53:54
to it. Sometimes sitting up, having a glass of water, if their blood pressure is too low, can make all the difference. Maybe they're dehydrated and their blood pressure is just too low. The one I worry about more is if their blood pressure is too high and they're complaining of a headache. And if it's bad enough and they're having a hard time seeing or functioning, it's not a normal headache they deal with, I'm calling 911 as well or making sure that whoever brought
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them might take them to the hospital immediately. Because you don't want to wait too long. Here's a couple signs that I always look for. If they're having a hard time articulating their words, if they're having a hard time seeing things, if they're having severe headaches, if they feel numbness in their fingers or another part of their body, those are all signs of stroke. And even if it is not a stroke, you don't wanna be making the wrong decision. Years ago,
54:47
we were in our office in Coral Gables, Miami, and we had a patient or a client that was just doing our normal Pilates, and Shelly was walking by, and she noticed that this particular client's legs were moving all over the place. And it wasn't her normal routine, wasn't controlled, and she realized that that patient was also having a hard time with her speech. She went over to one of our physical therapists, Anna Tishenko at the time,
55:12
that was a specialist in neurorehabilitation. And she took the immediate steps to call 911. Now it turned out she wasn't having a stroke, but she did have brain cancer. And the first signs of brain cancer happened in her Pilates class that Shelly observed, told the therapist, got her in. Unfortunately, she did not survive that glia cell carcinoma, this particular patient, but it was first depicted in a Pilates class. So a lot of times our ability to watch people
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move and we see something that is different than what we normally see. A client that comes in and moves well and all of a sudden they're not moving well, they're not speaking well, they're not making sense with their words, you need to call 911, right? Somebody that's having chest pain, arm pain that's coming from this related to increased stress in their exercises, you need to call 911. You need to address that. Now I have clients that have chronic heart disease, they have
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medication that they carry with them, they know how to manage it, and we talk about it before they start their Pilates so that we know what we need to do if they start to have an event. And they typically will not go to the ER if they can resolve it with their nitroglycerin.
56:34
And I think that's all I have for you today. Again, it's not, it's just education, education, education. The more we know about our body, the more we understand how the body moves. And Joseph Pilates certainly talked about this. He talked about how important it is for us to have vigorous breath and blood flow in our body to clean out the waste, to make us strong, to make us clear-headed. There's so much truth to that. For our children
57:00
and our adolescent and our young adults, they need to exercise so much more. They need to move so much more. We are in a very sedentary world for that population,
57:13
and that is going to lead to a lot of heart disease and metabolic disorders that we're going to see in the next 20, 30 years. So do keep your eye open for that. There are two questions. Inversion OK for someone with a stent? Theoretically, yes. If the stent is working, their blood is flowing fine. I would not have a problem with that. The next one, Marie Trigg said, if a person has bleed from an aortic aneurysm, what are the symptoms? Usually they'll have
57:42
pretty severe pain and lightheadedness or pass out. I think that the key thing is just to be aware of any sudden changes. So a bleed will cause a sudden change. And typically you would see things like some loss of speech and be able to put words together, especially if it's a bleed up in the brain or in the carotid or the superior aorta. So just keeping that at well. I think that's it. I want to express my gratitude for you
58:12
guys coming back. Next week we have an exciting lecture on the central and peripheral nervous system. Keep your minds open, keep looking for things, learning, tell friends about the free webinar. We want everybody to be able to participate on these webinars and to learn. You can always share it with them as well. You can give them the link to be able to watch it and then maybe they'll join us in the future and sign up for future webinars. We have
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a really exciting schedule in the beginning of the year. Next week, as I mentioned, I'll be talking about specifically the central and peripheral nervous system, talking about how our sensory and our motor react and how it ties into the autonomic nervous system. So I hope you'll join me next week and above all things, be kind and see you next Thursday.
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