{"version":"1.0.0","segments":[{"startTime":0.289,"endTime":3.122,"body":"(swooshing music)"},{"startTime":4.89,"endTime":7.59,"body":"- This evening I'm going to talk about"},{"startTime":7.59,"endTime":9.693,"body":"one of the major groups of things"},{"startTime":9.693,"endTime":11.73,"body":"that can go wrong with the heart,"},{"startTime":11.73,"endTime":15.183,"body":"and that is the heart"},{"startTime":11.73,"endTime":15.183,"body":"rhythm becoming abnormal."},{"startTime":17.28,"endTime":18.49,"body":"Now the heart"},{"startTime":19.38,"endTime":21.03,"body":"in every mammal,"},{"startTime":21.03,"endTime":24.69,"body":"and indeed birds beats with"},{"startTime":21.03,"endTime":24.69,"body":"extraordinary regularity."},{"startTime":24.69,"endTime":28.323,"body":"It's a quite extraordinary"},{"startTime":24.69,"endTime":28.323,"body":"mechanism by which it does that."},{"startTime":29.58,"endTime":32.94,"body":"And in humans it has a very steady beat,"},{"startTime":32.94,"endTime":34.383,"body":"usually somewhere between 60"},{"startTime":34.383,"endTime":37.71,"body":"and 100 beats per minute, at rest."},{"startTime":37.71,"endTime":40.17,"body":"If people are extremely fit athletes,"},{"startTime":40.17,"endTime":41.46,"body":"it'll go slower than that."},{"startTime":41.46,"endTime":44.553,"body":"So there's a variety of possibilities,"},{"startTime":45.39,"endTime":48.36,"body":"but it can be designed in nature"},{"startTime":48.36,"endTime":50.22,"body":"to be quite different points."},{"startTime":50.22,"endTime":52.89,"body":"So for example, blue whales,"},{"startTime":50.22,"endTime":52.89,"body":"which are very large,"},{"startTime":52.89,"endTime":56.76,"body":"can go down to four beats per"},{"startTime":52.89,"endTime":56.76,"body":"minute when they're diving,"},{"startTime":56.76,"endTime":61.44,"body":"whereas this Etruscan pygmy"},{"startTime":56.76,"endTime":61.44,"body":"shrew on the lower part of this"},{"startTime":61.44,"endTime":63.24,"body":"can have a beats per minute,"},{"startTime":63.24,"endTime":66.09,"body":"which are over 1,000"},{"startTime":63.24,"endTime":66.09,"body":"beats per minute at rest."},{"startTime":66.09,"endTime":68.91,"body":"So the heart can essentially set its rate"},{"startTime":68.91,"endTime":70.41,"body":"to the animal it's in,"},{"startTime":70.41,"endTime":73.02,"body":"but the animal it's in in"},{"startTime":70.41,"endTime":73.02,"body":"us is obviously humans,"},{"startTime":73.02,"endTime":77.733,"body":"so that's the rate we have,"},{"startTime":73.02,"endTime":77.733,"body":"between 60 and 100, at rest."},{"startTime":79.32,"endTime":83.04,"body":"Now this series of lectures"},{"startTime":79.32,"endTime":83.04,"body":"I've been giving this year"},{"startTime":83.04,"endTime":84.84,"body":"are the major conditions,"},{"startTime":84.84,"endTime":88.53,"body":"which lead to heart disease in humans."},{"startTime":88.53,"endTime":90.72,"body":"And the first group, which"},{"startTime":88.53,"endTime":90.72,"body":"I've talked about already"},{"startTime":90.72,"endTime":93.15,"body":"are diseases of the coronary arteries,"},{"startTime":93.15,"endTime":96.06,"body":"things that lead to angina, heart attacks,"},{"startTime":96.06,"endTime":97.86,"body":"and problems of that sort."},{"startTime":97.86,"endTime":99.42,"body":"In this lecture I'm going to be talking"},{"startTime":99.42,"endTime":100.56,"body":"about rhythm problems,"},{"startTime":100.56,"endTime":104.19,"body":"the heart going too fast"},{"startTime":100.56,"endTime":104.19,"body":"or going too slowly."},{"startTime":104.19,"endTime":105.51,"body":"And then in the last lecture,"},{"startTime":105.51,"endTime":106.917,"body":"I'm going to talk about the"},{"startTime":105.51,"endTime":106.917,"body":"structures of the heart,"},{"startTime":106.917,"endTime":111.543,"body":"the heart valves, the heart"},{"startTime":106.917,"endTime":111.543,"body":"muscle, and the structures."},{"startTime":114.63,"endTime":119.63,"body":"Now to understand how the rhythm"},{"startTime":114.63,"endTime":119.63,"body":"works and what goes wrong,"},{"startTime":120.3,"endTime":123.21,"body":"it is important to go"},{"startTime":120.3,"endTime":123.21,"body":"back for those of you"},{"startTime":123.21,"endTime":124.86,"body":"who are a little bit away from it"},{"startTime":124.86,"endTime":128.4,"body":"to school biology, anatomy,"},{"startTime":128.4,"endTime":132.54,"body":"because the anatomy helps"},{"startTime":128.4,"endTime":132.54,"body":"to explain what goes wrong."},{"startTime":132.54,"endTime":136.68,"body":"And the heart is essentially"},{"startTime":132.54,"endTime":136.68,"body":"two pumps smashed together,"},{"startTime":136.68,"endTime":138.63,"body":"there's a left side and"},{"startTime":136.68,"endTime":138.63,"body":"there's a right side,"},{"startTime":138.63,"endTime":139.95,"body":"but in terms of the timing"},{"startTime":139.95,"endTime":143.31,"body":"they work together at the same time."},{"startTime":143.31,"endTime":144.84,"body":"You have four chambers,"},{"startTime":144.84,"endTime":147.453,"body":"the upper two chambers"},{"startTime":144.84,"endTime":147.453,"body":"are called the atrium,"},{"startTime":148.29,"endTime":152.04,"body":"and that beats first, go through"},{"startTime":148.29,"endTime":152.04,"body":"the sequence several times."},{"startTime":152.04,"endTime":153.51,"body":"And then below that is the ventricle,"},{"startTime":153.51,"endTime":154.92,"body":"which is a large muscle,"},{"startTime":154.92,"endTime":158.31,"body":"which actually when it"},{"startTime":154.92,"endTime":158.31,"body":"contracts it then pumps blood,"},{"startTime":158.31,"endTime":160.59,"body":"either around the whole"},{"startTime":158.31,"endTime":160.59,"body":"body on the left side"},{"startTime":160.59,"endTime":162.63,"body":"or around the lungs on the right side."},{"startTime":162.63,"endTime":165.933,"body":"So that's the way that this works."},{"startTime":168.75,"endTime":173.58,"body":"And to make this work in"},{"startTime":168.75,"endTime":173.58,"body":"sequence completely regularly,"},{"startTime":173.58,"endTime":175.41,"body":"and then be able to speed up or slow down"},{"startTime":175.41,"endTime":177.09,"body":"depending on whether you need it,"},{"startTime":177.09,"endTime":179.73,"body":"the heart has what is"},{"startTime":177.09,"endTime":179.73,"body":"for practical purposes"},{"startTime":179.73,"endTime":181.113,"body":"a wiring system,"},{"startTime":183.182,"endTime":185.49,"body":"and several pacemakers."},{"startTime":185.49,"endTime":190.17,"body":"So at the top of the heart"},{"startTime":185.49,"endTime":190.17,"body":"where the number one there"},{"startTime":190.17,"endTime":192.0,"body":"is something called the sinoatrial node,"},{"startTime":192.0,"endTime":193.53,"body":"and that is your principal pacemaker."},{"startTime":193.53,"endTime":195.18,"body":"If everything is going right,"},{"startTime":195.18,"endTime":198.12,"body":"then that will just go"},{"startTime":195.18,"endTime":198.12,"body":"along with a regular rhythm,"},{"startTime":198.12,"endTime":199.86,"body":"as I say, 60 to 100,"},{"startTime":199.86,"endTime":202.893,"body":"and initiates the whole cascade"},{"startTime":199.86,"endTime":202.893,"body":"I'm going to talk about."},{"startTime":203.94,"endTime":206.01,"body":"And what then happens is electrical wave"},{"startTime":206.01,"endTime":209.55,"body":"spreads over the atrium very rapidly,"},{"startTime":209.55,"endTime":211.563,"body":"and the atrium contracts,"},{"startTime":212.46,"endTime":213.42,"body":"and then there's a delay,"},{"startTime":213.42,"endTime":216.15,"body":"and the delay is built-in between it going"},{"startTime":216.15,"endTime":219.03,"body":"from the atrium to the"},{"startTime":216.15,"endTime":219.03,"body":"ventricle to give time"},{"startTime":219.03,"endTime":222.57,"body":"for the blood essentially to"},{"startTime":219.03,"endTime":222.57,"body":"get it to where it needs to be."},{"startTime":222.57,"endTime":224.34,"body":"And then the valves close,"},{"startTime":224.34,"endTime":228.96,"body":"and then it goes through"},{"startTime":224.34,"endTime":228.96,"body":"a very fast set of fibers,"},{"startTime":228.96,"endTime":232.77,"body":"things called Purkinje"},{"startTime":228.96,"endTime":232.77,"body":"fibers in the bundles of His,"},{"startTime":232.77,"endTime":236.31,"body":"so that the whole of the"},{"startTime":232.77,"endTime":236.31,"body":"lower part of the heart,"},{"startTime":236.31,"endTime":238.59,"body":"it suddenly has an electrical impulse"},{"startTime":238.59,"endTime":240.48,"body":"at virtually the same time"},{"startTime":240.48,"endTime":242.01,"body":"because otherwise it'd"},{"startTime":240.48,"endTime":242.01,"body":"be very inefficient."},{"startTime":242.01,"endTime":245.16,"body":"So the wiring system means"},{"startTime":242.01,"endTime":245.16,"body":"that the electrical impulse"},{"startTime":245.16,"endTime":248.25,"body":"goes around the whole"},{"startTime":245.16,"endTime":248.25,"body":"thing incredibly quickly,"},{"startTime":248.25,"endTime":252.27,"body":"then the heart, lower part"},{"startTime":248.25,"endTime":252.27,"body":"contracts, and then it relaxes."},{"startTime":252.27,"endTime":253.947,"body":"That's the sequence, and"},{"startTime":252.27,"endTime":253.947,"body":"you'll have seen that,"},{"startTime":253.947,"endTime":257.313,"body":"and it's all of you, it's"},{"startTime":253.947,"endTime":257.313,"body":"happening all the time."},{"startTime":258.42,"endTime":260.79,"body":"But this delay at the,"},{"startTime":260.79,"endTime":262.667,"body":"what's called the atrioventricular"},{"startTime":262.667,"endTime":265.02,"body":"the AV node is very important"},{"startTime":265.02,"endTime":266.82,"body":"because if that delay didn't happen,"},{"startTime":266.82,"endTime":270.0,"body":"then the atrium wouldn't"},{"startTime":266.82,"endTime":270.0,"body":"beat before the ventricle"},{"startTime":270.0,"endTime":272.043,"body":"in a nice, steady sequence."},{"startTime":276.15,"endTime":279.12,"body":"The SA node, the bit"},{"startTime":276.15,"endTime":279.12,"body":"at the top of the heart"},{"startTime":279.12,"endTime":281.648,"body":"can actually speed up or slow down"},{"startTime":281.648,"endTime":283.53,"body":"under control of your body."},{"startTime":283.53,"endTime":285.39,"body":"And the sympathetic system..."},{"startTime":285.39,"endTime":287.04,"body":"I'll come back to this"},{"startTime":285.39,"endTime":287.04,"body":"again several times,"},{"startTime":287.04,"endTime":287.94,"body":"the sympathetic system,"},{"startTime":287.94,"endTime":292.29,"body":"the flight or fight system speeds it up,"},{"startTime":292.29,"endTime":294.99,"body":"and it also speeds up the"},{"startTime":292.29,"endTime":294.99,"body":"conduction through the AV node,"},{"startTime":294.99,"endTime":298.35,"body":"and the parasympathetic"},{"startTime":294.99,"endTime":298.35,"body":"node system slows it down."},{"startTime":298.35,"endTime":300.48,"body":"So for all of this, its intention,"},{"startTime":300.48,"endTime":302.43,"body":"and we can speed up or slow down."},{"startTime":302.43,"endTime":305.34,"body":"If we have to climb that"},{"startTime":302.43,"endTime":305.34,"body":"mountain, if we're very excited,"},{"startTime":305.34,"endTime":308.22,"body":"if we're very stressed, if we've"},{"startTime":305.34,"endTime":308.22,"body":"lost blood, it'll speed up."},{"startTime":308.22,"endTime":312.423,"body":"If we're at rest to conserve"},{"startTime":308.22,"endTime":312.423,"body":"energy, it'll slow down."},{"startTime":314.13,"endTime":317.01,"body":"But there's also built-in redundancy."},{"startTime":317.01,"endTime":319.8,"body":"The body is unbelievably good at having..."},{"startTime":319.8,"endTime":322.2,"body":"If something goes wrong,"},{"startTime":319.8,"endTime":322.2,"body":"having something else,"},{"startTime":322.2,"endTime":325.56,"body":"which will take over, if necessary."},{"startTime":325.56,"endTime":329.97,"body":"And below the SA node,"},{"startTime":325.56,"endTime":329.97,"body":"the normal pacemaker,"},{"startTime":329.97,"endTime":332.85,"body":"there's another pacemaker"},{"startTime":329.97,"endTime":332.85,"body":"in the AV node as well,"},{"startTime":332.85,"endTime":335.85,"body":"which if the SA node is"},{"startTime":332.85,"endTime":335.85,"body":"not working can take over,"},{"startTime":335.85,"endTime":337.39,"body":"but it beats more slowly"},{"startTime":338.4,"endTime":340.26,"body":"because if it beat at the same speed,"},{"startTime":340.26,"endTime":341.51,"body":"they'd be in competition."},{"startTime":342.42,"endTime":346.53,"body":"So it beats more slowly, but"},{"startTime":342.42,"endTime":346.53,"body":"if the top one is eliminated,"},{"startTime":346.53,"endTime":349.2,"body":"the AV node one would simply take over."},{"startTime":349.2,"endTime":351.42,"body":"And if the AV node doesn't work,"},{"startTime":351.42,"endTime":353.46,"body":"there are other pacemakers"},{"startTime":351.42,"endTime":353.46,"body":"lower down the system"},{"startTime":353.46,"endTime":354.99,"body":"that are slower still,"},{"startTime":354.99,"endTime":356.88,"body":"they're not capable of"},{"startTime":354.99,"endTime":356.88,"body":"allowing you to climb Everest,"},{"startTime":356.88,"endTime":358.53,"body":"but they will keep you alive."},{"startTime":358.53,"endTime":360.21,"body":"So if there's a temporary problem,"},{"startTime":360.21,"endTime":363.54,"body":"they will take over until the"},{"startTime":360.21,"endTime":363.54,"body":"temporary problem is fixed."},{"startTime":363.54,"endTime":366.993,"body":"So it's a very, very clever"},{"startTime":363.54,"endTime":366.993,"body":"bit of built-in redundancy."},{"startTime":370.08,"endTime":371.43,"body":"Now the way that the sympathetic"},{"startTime":371.43,"endTime":373.74,"body":"and the parasympathetic"},{"startTime":371.43,"endTime":373.74,"body":"nervous system work,"},{"startTime":373.74,"endTime":376.02,"body":"normally if you are"},{"startTime":373.74,"endTime":376.02,"body":"just completely at rest,"},{"startTime":376.02,"endTime":378.36,"body":"totally relaxed listening to a lecture,"},{"startTime":378.36,"endTime":380.88,"body":"your parasympathetic system"},{"startTime":378.36,"endTime":380.88,"body":"is actually driving the heart"},{"startTime":380.88,"endTime":383.4,"body":"to go a bit slowly."},{"startTime":383.4,"endTime":385.11,"body":"The first thing that happens"},{"startTime":383.4,"endTime":385.11,"body":"when you start to try"},{"startTime":385.11,"endTime":386.7,"body":"and do some activity"},{"startTime":386.7,"endTime":391.56,"body":"is the parasympathetic"},{"startTime":386.7,"endTime":391.56,"body":"system switches off,"},{"startTime":391.56,"endTime":393.75,"body":"and then the sympathetic"},{"startTime":391.56,"endTime":393.75,"body":"system switches on,"},{"startTime":393.75,"endTime":395.55,"body":"and that speeds the heart up"},{"startTime":395.55,"endTime":397.86,"body":"up to maybe 150 beats per minute."},{"startTime":397.86,"endTime":399.42,"body":"So if you're a sprinter"},{"startTime":397.86,"endTime":399.42,"body":"or something like that,"},{"startTime":399.42,"endTime":402.12,"body":"it'll take off at an"},{"startTime":399.42,"endTime":402.12,"body":"absolutely phenomenal rate."},{"startTime":402.12,"endTime":405.573,"body":"And that's under some degree your control."},{"startTime":407.01,"endTime":408.24,"body":"It's important to know a little bit"},{"startTime":408.24,"endTime":410.22,"body":"about the drugs by which the..."},{"startTime":410.22,"endTime":413.49,"body":"Or the messengers by"},{"startTime":410.22,"endTime":413.49,"body":"which the body does this"},{"startTime":413.49,"endTime":415.26,"body":"because they're important for the drugs"},{"startTime":415.26,"endTime":418.353,"body":"that I'll talk about"},{"startTime":415.26,"endTime":418.353,"body":"later in how you treat it."},{"startTime":422.527,"endTime":426.15,"body":"So the rhythm effects"},{"startTime":422.527,"endTime":426.15,"body":"for speeding things up,"},{"startTime":426.15,"endTime":430.08,"body":"for the adrenal system is the beta system,"},{"startTime":430.08,"endTime":433.11,"body":"that's what the sympathetic system uses."},{"startTime":433.11,"endTime":434.76,"body":"And the reason that's important"},{"startTime":434.76,"endTime":437.19,"body":"is there is a drug class"},{"startTime":434.76,"endTime":437.19,"body":"called beta blockers,"},{"startTime":437.19,"endTime":438.96,"body":"which work directly on this system,"},{"startTime":438.96,"endTime":440.04,"body":"but that's part of the way"},{"startTime":440.04,"endTime":442.29,"body":"in which the body speeds things up."},{"startTime":442.29,"endTime":445.62,"body":"And the parasynthetic system"},{"startTime":442.29,"endTime":445.62,"body":"uses a messenger called"},{"startTime":445.62,"endTime":449.373,"body":"acetylcholine to a slightly"},{"startTime":445.62,"endTime":449.373,"body":"different set of receptors."},{"startTime":453.69,"endTime":454.62,"body":"Now throughout this talk,"},{"startTime":454.62,"endTime":456.87,"body":"I'm going to be talking"},{"startTime":454.62,"endTime":456.87,"body":"quite a lot about ECGs,"},{"startTime":456.87,"endTime":459.75,"body":"so I just want to talk"},{"startTime":456.87,"endTime":459.75,"body":"a little bit about ECGs."},{"startTime":459.75,"endTime":462.69,"body":"An extraordinarily powerful bit of kit"},{"startTime":462.69,"endTime":465.0,"body":"that is fundamentally incredibly simple."},{"startTime":465.0,"endTime":468.03,"body":"All it does is measures"},{"startTime":465.0,"endTime":468.03,"body":"the electrical impulses"},{"startTime":468.03,"endTime":471.09,"body":"on the outside of your body,"},{"startTime":471.09,"endTime":472.59,"body":"but because your heart has got this"},{"startTime":472.59,"endTime":475.233,"body":"electrical conduction"},{"startTime":472.59,"endTime":475.233,"body":"happening, you can read it,"},{"startTime":476.31,"endTime":479.73,"body":"and you can actually tell exactly"},{"startTime":476.31,"endTime":479.73,"body":"which bit of the heartbeat"},{"startTime":479.73,"endTime":482.58,"body":"is happening at any given point in time."},{"startTime":482.58,"endTime":485.49,"body":"It was developed right back"},{"startTime":482.58,"endTime":485.49,"body":"in the 1880s originally,"},{"startTime":485.49,"endTime":487.89,"body":"and they were originally"},{"startTime":485.49,"endTime":487.89,"body":"large bits of equipment,"},{"startTime":487.89,"endTime":489.6,"body":"like the one being demonstrated."},{"startTime":489.6,"endTime":491.88,"body":"This is just from the 1910s on the right,"},{"startTime":491.88,"endTime":493.92,"body":"and the gentleman who is demonstrating it"},{"startTime":493.92,"endTime":496.71,"body":"has one leg in a bucket, and"},{"startTime":493.92,"endTime":496.71,"body":"both hands in the bucket."},{"startTime":496.71,"endTime":499.14,"body":"And those are the ways in"},{"startTime":496.71,"endTime":499.14,"body":"which the electoral conduction"},{"startTime":499.14,"endTime":501.753,"body":"was actually transmitted and measured."},{"startTime":503.61,"endTime":506.43,"body":"But what all of them have in common is"},{"startTime":506.43,"endTime":509.61,"body":"that they just simply measure"},{"startTime":506.43,"endTime":509.61,"body":"the electrical impulses"},{"startTime":509.61,"endTime":511.62,"body":"on the surface of your body,"},{"startTime":511.62,"endTime":513.36,"body":"which actually come from your heart,"},{"startTime":513.36,"endTime":514.2,"body":"which gives you some idea"},{"startTime":514.2,"endTime":517.533,"body":"about how strong these"},{"startTime":514.2,"endTime":517.533,"body":"electrical impulses actually are."},{"startTime":519.84,"endTime":524.07,"body":"Now the ECG has a very standard shape,"},{"startTime":524.07,"endTime":526.47,"body":"and last time in the last lecture"},{"startTime":526.47,"endTime":528.78,"body":"when I was talking about"},{"startTime":526.47,"endTime":528.78,"body":"coronary heart disease,"},{"startTime":528.78,"endTime":532.14,"body":"I was talking about the"},{"startTime":528.78,"endTime":532.14,"body":"right-hand side of the ECG,"},{"startTime":532.14,"endTime":534.75,"body":"which tells you something"},{"startTime":532.14,"endTime":534.75,"body":"about severe heart attacks."},{"startTime":534.75,"endTime":536.91,"body":"For understanding rhythms,"},{"startTime":534.75,"endTime":536.91,"body":"you need to understand"},{"startTime":536.91,"endTime":538.56,"body":"the left hand side of the ECG,"},{"startTime":538.56,"endTime":540.24,"body":"and I'm just going to walk you through it"},{"startTime":540.24,"endTime":542.4,"body":"in two different ways."},{"startTime":542.4,"endTime":546.12,"body":"So first of all, you get a"},{"startTime":542.4,"endTime":546.12,"body":"small contraction, you see,"},{"startTime":546.12,"endTime":548.88,"body":"so you get a small wave called the P wave,"},{"startTime":548.88,"endTime":551.25,"body":"and that's when the electrical impulse"},{"startTime":551.25,"endTime":553.32,"body":"is going across the atrium,"},{"startTime":553.32,"endTime":555.84,"body":"which is a relatively small organ."},{"startTime":555.84,"endTime":558.9,"body":"And that's the initiation of the system."},{"startTime":558.9,"endTime":560.17,"body":"Then there's a delay"},{"startTime":561.18,"endTime":564.03,"body":"because it then is held"},{"startTime":561.18,"endTime":564.03,"body":"essentially at the AV node,"},{"startTime":564.03,"endTime":566.37,"body":"and then it spreads incredibly fast"},{"startTime":566.37,"endTime":567.45,"body":"around the whole heart,"},{"startTime":567.45,"endTime":570.33,"body":"and that's what's cause the QRS thing,"},{"startTime":570.33,"endTime":573.51,"body":"that's the main electrical impulse."},{"startTime":573.51,"endTime":577.32,"body":"Then there's another delay as"},{"startTime":573.51,"endTime":577.32,"body":"the ventricle is contracting,"},{"startTime":577.32,"endTime":578.82,"body":"and then you get the relaxation wave,"},{"startTime":578.82,"endTime":581.04,"body":"which is something called the T wave."},{"startTime":581.04,"endTime":583.2,"body":"For understanding rhythm,"},{"startTime":583.2,"endTime":585.75,"body":"you just need to understand"},{"startTime":583.2,"endTime":585.75,"body":"the P and the QRS,"},{"startTime":585.75,"endTime":588.693,"body":"forget the rest, those are"},{"startTime":585.75,"endTime":588.693,"body":"the only two that matter."},{"startTime":592.23,"endTime":595.59,"body":"And so just to refresh that,"},{"startTime":595.59,"endTime":598.47,"body":"so starting here on the left,"},{"startTime":595.59,"endTime":598.47,"body":"nothing happening at all,"},{"startTime":598.47,"endTime":600.03,"body":"you get the AV node..."},{"startTime":600.03,"endTime":603.72,"body":"So the SA node fires,"},{"startTime":600.03,"endTime":603.72,"body":"spreads over the atrium,"},{"startTime":603.72,"endTime":604.89,"body":"you get the P wave,"},{"startTime":604.89,"endTime":609.33,"body":"then you get contraction"},{"startTime":604.89,"endTime":609.33,"body":"delay at the AV node at,"},{"startTime":609.33,"endTime":611.43,"body":"then it spreads very rapidly"},{"startTime":611.43,"endTime":613.3,"body":"through the ventricle QRS"},{"startTime":614.31,"endTime":616.86,"body":"relaxation to the T wave,"},{"startTime":616.86,"endTime":620.133,"body":"and repeat after a period of a delay."},{"startTime":621.87,"endTime":624.21,"body":"So that's under ordinary circumstances,"},{"startTime":624.21,"endTime":627.33,"body":"and that gives rise to an ECG like this."},{"startTime":627.33,"endTime":628.98,"body":"And if any of you've gone into hospital"},{"startTime":628.98,"endTime":631.17,"body":"or had friends or family in hospital,"},{"startTime":631.17,"endTime":632.79,"body":"there's a high chance you'd"},{"startTime":631.17,"endTime":632.79,"body":"have had one of these,"},{"startTime":632.79,"endTime":635.52,"body":"and have looked to one of these,"},{"startTime":635.52,"endTime":636.81,"body":"and seen what they show."},{"startTime":636.81,"endTime":638.82,"body":"And the ECG show a huge amount,"},{"startTime":638.82,"endTime":641.91,"body":"they're very informative, but"},{"startTime":638.82,"endTime":641.91,"body":"for purposes of this talk,"},{"startTime":641.91,"endTime":644.06,"body":"I'm just going to be"},{"startTime":641.91,"endTime":644.06,"body":"talking about the rhythm."},{"startTime":646.59,"endTime":648.93,"body":"So your heart can then"},{"startTime":646.59,"endTime":648.93,"body":"do one of two things,"},{"startTime":648.93,"endTime":652.86,"body":"which can cause problems for"},{"startTime":648.93,"endTime":652.86,"body":"your ability to function."},{"startTime":652.86,"endTime":656.43,"body":"It can go too fast or too slowly."},{"startTime":656.43,"endTime":658.11,"body":"And ECGs everywhere in the world"},{"startTime":658.11,"endTime":660.21,"body":"run at an exactly standard rate."},{"startTime":660.21,"endTime":662.49,"body":"So the number of squares you see on it,"},{"startTime":662.49,"endTime":663.78,"body":"you can calculate from that"},{"startTime":663.78,"endTime":667.05,"body":"exactly how fast this heart is going."},{"startTime":667.05,"endTime":671.1,"body":"So the heart on the left"},{"startTime":667.05,"endTime":671.1,"body":"is going very slowly,"},{"startTime":671.1,"endTime":675.06,"body":"that's a bradycardia,"},{"startTime":671.1,"endTime":675.06,"body":"it's abnormally slow."},{"startTime":675.06,"endTime":677.52,"body":"The heart on the right is going very fast,"},{"startTime":677.52,"endTime":679.2,"body":"that's a tachycardia."},{"startTime":679.2,"endTime":682.2,"body":"That's again abnormal,"},{"startTime":679.2,"endTime":682.2,"body":"it's going too fast."},{"startTime":682.2,"endTime":684.45,"body":"Either of these will lead to your heart"},{"startTime":684.45,"endTime":686.61,"body":"being much less efficient"},{"startTime":684.45,"endTime":686.61,"body":"than it should be."},{"startTime":686.61,"endTime":690.51,"body":"Remember, it's designed to"},{"startTime":686.61,"endTime":690.51,"body":"go at 60 to 100 normally,"},{"startTime":690.51,"endTime":692.67,"body":"and then you speed up under"},{"startTime":690.51,"endTime":692.67,"body":"certain circumstances."},{"startTime":692.67,"endTime":695.01,"body":"So this is bad news essentially,"},{"startTime":695.01,"endTime":696.45,"body":"not necessarily catastrophic news,"},{"startTime":696.45,"endTime":698.94,"body":"but this is the thing which"},{"startTime":696.45,"endTime":698.94,"body":"I'm going to be talking"},{"startTime":698.94,"endTime":701.463,"body":"about for the next few slides."},{"startTime":703.32,"endTime":705.81,"body":"Now if you have a rhythm problem,"},{"startTime":705.81,"endTime":708.63,"body":"there are a variety of"},{"startTime":705.81,"endTime":708.63,"body":"ways this can be picked up."},{"startTime":708.63,"endTime":711.24,"body":"It may be picked up simply because someone"},{"startTime":711.24,"endTime":713.55,"body":"feels your pulse old-fashioned way,"},{"startTime":713.55,"endTime":715.68,"body":"does an ECG before an operation,"},{"startTime":715.68,"endTime":717.6,"body":"and they notice you"},{"startTime":715.68,"endTime":717.6,"body":"got an abnormal rhythm."},{"startTime":717.6,"endTime":718.74,"body":"Though it wasn't doing you any harm,"},{"startTime":718.74,"endTime":720.39,"body":"you had noticed it yourself,"},{"startTime":720.39,"endTime":722.1,"body":"but they tell there's something going on,"},{"startTime":722.1,"endTime":723.24,"body":"they want to investigate it further."},{"startTime":723.24,"endTime":726.697,"body":"So it may just be you're fine,"},{"startTime":723.24,"endTime":726.697,"body":"the doctor or the nurse says,"},{"startTime":726.697,"endTime":729.48,"body":"\"Hang on a moment, we"},{"startTime":726.697,"endTime":729.48,"body":"need to do something.\""},{"startTime":729.48,"endTime":731.28,"body":"It might be quite minimal symptoms,"},{"startTime":731.28,"endTime":733.35,"body":"people having things called palpitations"},{"startTime":733.35,"endTime":735.21,"body":"where they just feel the"},{"startTime":733.35,"endTime":735.21,"body":"heart skipping beats,"},{"startTime":735.21,"endTime":738.09,"body":"or it's a bit odd, but it can then go on"},{"startTime":738.09,"endTime":742.35,"body":"to have a feeling of"},{"startTime":738.09,"endTime":742.35,"body":"breathlessness, dizziness,"},{"startTime":742.35,"endTime":745.59,"body":"faintness, absolute collapse,"},{"startTime":745.59,"endTime":746.67,"body":"and in the extreme case,"},{"startTime":746.67,"endTime":749.31,"body":"which I'll talk about at"},{"startTime":746.67,"endTime":749.31,"body":"the end, cardiac arrest."},{"startTime":749.31,"endTime":751.431,"body":"To be clear, that's rare,"},{"startTime":751.431,"endTime":752.94,"body":"none of you look as"},{"startTime":752.94,"endTime":754.68,"body":"if you're about to have a cardiac arrest."},{"startTime":754.68,"endTime":755.79,"body":"That's right at the far end,"},{"startTime":755.79,"endTime":759.18,"body":"but the relatively minor"},{"startTime":755.79,"endTime":759.18,"body":"rhythm disturbances"},{"startTime":759.18,"endTime":761.043,"body":"are relatively common."},{"startTime":763.08,"endTime":766.83,"body":"Now for many people,"},{"startTime":763.08,"endTime":766.83,"body":"they will have symptoms"},{"startTime":766.83,"endTime":769.5,"body":"that could be the heart doing that,"},{"startTime":769.5,"endTime":770.88,"body":"or it could be a lot of other things,"},{"startTime":770.88,"endTime":773.31,"body":"including nothing very worrying."},{"startTime":773.31,"endTime":776.82,"body":"And they go to the doctor or"},{"startTime":773.31,"endTime":776.82,"body":"the nurse and they have an ECG,"},{"startTime":776.82,"endTime":779.64,"body":"and at that point in"},{"startTime":776.82,"endTime":779.64,"body":"time the ECG is normal,"},{"startTime":779.64,"endTime":782.04,"body":"but they're also fine at that point."},{"startTime":782.04,"endTime":784.5,"body":"The problem is, you can have runs of"},{"startTime":784.5,"endTime":788.49,"body":"heart going too fast or too"},{"startTime":784.5,"endTime":788.49,"body":"slowly, particularly too fast,"},{"startTime":788.49,"endTime":790.23,"body":"and it's not there at the time"},{"startTime":790.23,"endTime":792.09,"body":"when you present to the doctor."},{"startTime":792.09,"endTime":795.06,"body":"So the way that that is then picked up is"},{"startTime":795.06,"endTime":798.51,"body":"by a mechanism called a Holter monitor."},{"startTime":798.51,"endTime":800.55,"body":"It's named after this"},{"startTime":798.51,"endTime":800.55,"body":"gentleman, Norman Holter,"},{"startTime":800.55,"endTime":802.38,"body":"demonstrating early prototype."},{"startTime":802.38,"endTime":804.785,"body":"This would not be how we"},{"startTime":802.38,"endTime":804.785,"body":"would normally do it now,"},{"startTime":804.785,"endTime":806.092,"body":"(audience laughs)"},{"startTime":806.092,"endTime":809.01,"body":"but engineering improves at all times,"},{"startTime":809.01,"endTime":810.84,"body":"and they're now very, very small,"},{"startTime":810.84,"endTime":812.94,"body":"and you wear them round"},{"startTime":810.84,"endTime":812.94,"body":"your neck or on your belt,"},{"startTime":812.94,"endTime":814.47,"body":"and you just go about"},{"startTime":812.94,"endTime":814.47,"body":"your ordinary business."},{"startTime":814.47,"endTime":815.7,"body":"If you go running, you go running;"},{"startTime":815.7,"endTime":817.35,"body":"if you go to work, you go to work,"},{"startTime":817.35,"endTime":820.41,"body":"and they measure your pulse"},{"startTime":817.35,"endTime":820.41,"body":"rate over a long period of time."},{"startTime":820.41,"endTime":821.85,"body":"They keep a record of it,"},{"startTime":821.85,"endTime":824.16,"body":"and then you can analyze"},{"startTime":821.85,"endTime":824.16,"body":"it subsequently and say,"},{"startTime":824.16,"endTime":827.01,"body":"yes, there are runs where"},{"startTime":824.16,"endTime":827.01,"body":"there's an abnormality,"},{"startTime":827.01,"endTime":829.083,"body":"we need to take that further."},{"startTime":831.51,"endTime":833.43,"body":"Or they will say, \"There's nothing wrong."},{"startTime":833.43,"endTime":834.83,"body":"No, that's not the problem.\""},{"startTime":836.37,"endTime":837.78,"body":"Now if there are, the heart,"},{"startTime":837.78,"endTime":839.67,"body":"I'm going to start off"},{"startTime":837.78,"endTime":839.67,"body":"in terms of the things"},{"startTime":839.67,"endTime":842.37,"body":"which can look abnormal or be abnormal."},{"startTime":842.37,"endTime":843.48,"body":"The first group of things are"},{"startTime":843.48,"endTime":845.643,"body":"when the heart goes too slowly,"},{"startTime":846.51,"endTime":847.86,"body":"and the first of these"},{"startTime":847.86,"endTime":851.01,"body":"is actually when the"},{"startTime":847.86,"endTime":851.01,"body":"heart is going slowly,"},{"startTime":851.01,"endTime":853.05,"body":"possibly abnormally slowly,"},{"startTime":853.05,"endTime":856.113,"body":"but the heart rhythm itself"},{"startTime":853.05,"endTime":856.113,"body":"is completely normal."},{"startTime":857.58,"endTime":860.55,"body":"So if you look at this ECG,"},{"startTime":860.55,"endTime":865.26,"body":"you've got a P wave normally,"},{"startTime":860.55,"endTime":865.26,"body":"a normal interval here,"},{"startTime":865.26,"endTime":867.57,"body":"a normal QRS,"},{"startTime":867.57,"endTime":868.5,"body":"and a normal T wave."},{"startTime":868.5,"endTime":870.93,"body":"This is a normal ECG in that sense,"},{"startTime":870.93,"endTime":872.31,"body":"but it's just going too slowly,"},{"startTime":872.31,"endTime":874.98,"body":"that's what's called sinus bradycardia."},{"startTime":874.98,"endTime":876.3,"body":"And there's lots of reasons for that,"},{"startTime":876.3,"endTime":878.94,"body":"it could be someone who"},{"startTime":876.3,"endTime":878.94,"body":"is an Olympic athlete,"},{"startTime":878.94,"endTime":880.49,"body":"that's just their normal heart."},{"startTime":881.557,"endTime":883.59,"body":"It could be because they've got"},{"startTime":883.59,"endTime":885.39,"body":"a number of reversible causes."},{"startTime":885.39,"endTime":887.25,"body":"For example, they might"},{"startTime":885.39,"endTime":887.25,"body":"have a slightly low"},{"startTime":887.25,"endTime":891.12,"body":"thyroid hormone level,"},{"startTime":887.25,"endTime":891.12,"body":"that tends to lead to this."},{"startTime":891.12,"endTime":894.69,"body":"They might be hypothermic,"},{"startTime":891.12,"endTime":894.69,"body":"if they've got very cold,"},{"startTime":894.69,"endTime":895.95,"body":"that can lead to this."},{"startTime":895.95,"endTime":899.67,"body":"Quite a few drugs can"},{"startTime":895.95,"endTime":899.67,"body":"potentially lead to this,"},{"startTime":899.67,"endTime":901.56,"body":"even some infections, Lyme disease,"},{"startTime":901.56,"endTime":904.08,"body":"for example, can sometimes do this."},{"startTime":904.08,"endTime":905.43,"body":"So there are a variety of things,"},{"startTime":905.43,"endTime":908.103,"body":"which can lead to these"},{"startTime":905.43,"endTime":908.103,"body":"kind of abnormalities."},{"startTime":909.45,"endTime":912.36,"body":"Most of these are reversible,"},{"startTime":912.36,"endTime":914.7,"body":"and then occasionally it"},{"startTime":912.36,"endTime":914.7,"body":"can be more severe things"},{"startTime":914.7,"endTime":916.47,"body":"like a recent relatively small"},{"startTime":916.47,"endTime":918.09,"body":"heart attack can lead to this."},{"startTime":918.09,"endTime":921.873,"body":"So several things can lead"},{"startTime":918.09,"endTime":921.873,"body":"to this kind of presentation."},{"startTime":924.81,"endTime":927.87,"body":"Next thing that can go wrong"},{"startTime":924.81,"endTime":927.87,"body":"is that the first pacemaker,"},{"startTime":927.87,"endTime":931.5,"body":"the key initial pacemaker can get sick,"},{"startTime":931.5,"endTime":933.573,"body":"and this is called sick sinus syndrome."},{"startTime":935.07,"endTime":938.94,"body":"And the node may fire either too fast,"},{"startTime":938.94,"endTime":940.56,"body":"which can cause tachycardia."},{"startTime":940.56,"endTime":941.46,"body":"I'll come back to that."},{"startTime":941.46,"endTime":944.16,"body":"Or too slowly, too slowly being the one"},{"startTime":944.16,"endTime":946.11,"body":"that I'm talking about now."},{"startTime":946.11,"endTime":947.16,"body":"Generally age related,"},{"startTime":947.16,"endTime":950.46,"body":"it's more likely as we"},{"startTime":947.16,"endTime":950.46,"body":"go on in age to happen,"},{"startTime":950.46,"endTime":954.0,"body":"and the heart rhythm then"},{"startTime":950.46,"endTime":954.0,"body":"kind of varies over time"},{"startTime":954.0,"endTime":956.04,"body":"because the pacemaker is not sticking"},{"startTime":956.04,"endTime":960.123,"body":"to its good steady rhythm"},{"startTime":956.04,"endTime":960.123,"body":"under ordinary circumstances."},{"startTime":962.7,"endTime":966.12,"body":"It can be, there have been a"},{"startTime":962.7,"endTime":966.12,"body":"variant, sino-atrial block."},{"startTime":966.12,"endTime":968.52,"body":"This what you see here"},{"startTime":966.12,"endTime":968.52,"body":"is the P waves are normal"},{"startTime":968.52,"endTime":969.57,"body":"all the way along,"},{"startTime":969.57,"endTime":973.26,"body":"but you can see here"},{"startTime":969.57,"endTime":973.26,"body":"between that normal P, QRS,"},{"startTime":973.26,"endTime":975.903,"body":"and this one, there's a long delay."},{"startTime":976.89,"endTime":978.96,"body":"The sino-atrial node has"},{"startTime":976.89,"endTime":978.96,"body":"basically gone to sleep,"},{"startTime":978.96,"endTime":982.65,"body":"it's not doing its job, but"},{"startTime":978.96,"endTime":982.65,"body":"it's not such a long delay"},{"startTime":982.65,"endTime":985.14,"body":"that the rest of the heart takes over."},{"startTime":985.14,"endTime":988.44,"body":"So that's another problem"},{"startTime":985.14,"endTime":988.44,"body":"with the sino-atrial node,"},{"startTime":988.44,"endTime":990.383,"body":"so that's right at the top of the heart."},{"startTime":991.817,"endTime":995.4,"body":"More commonly in terms of"},{"startTime":991.817,"endTime":995.4,"body":"people who got symptoms"},{"startTime":995.4,"endTime":997.23,"body":"is where the problem is a bit lower down."},{"startTime":997.23,"endTime":999.75,"body":"It's what's called the AV node,"},{"startTime":999.75,"endTime":1001.97,"body":"that bit where there's a delay"},{"startTime":1001.97,"endTime":1005.66,"body":"between the atrial contraction"},{"startTime":1005.66,"endTime":1009.86,"body":"and then the ventricular"},{"startTime":1005.66,"endTime":1009.86,"body":"contraction, the AV node,"},{"startTime":1009.86,"endTime":1012.17,"body":"and you can get a block at that point."},{"startTime":1012.17,"endTime":1014.24,"body":"Now there are several"},{"startTime":1012.17,"endTime":1014.24,"body":"different types of block,"},{"startTime":1014.24,"endTime":1015.26,"body":"something called first degree block."},{"startTime":1015.26,"endTime":1016.093,"body":"It doesn't really matter"},{"startTime":1016.093,"endTime":1018.56,"body":"that I'm just telling"},{"startTime":1016.093,"endTime":1018.56,"body":"you for completeness."},{"startTime":1018.56,"endTime":1022.67,"body":"The key ones are second"},{"startTime":1018.56,"endTime":1022.67,"body":"degree heart block,"},{"startTime":1022.67,"endTime":1024.53,"body":"and third and complete heart block."},{"startTime":1024.53,"endTime":1026.93,"body":"So second degree heart block"},{"startTime":1026.93,"endTime":1028.43,"body":"is made up of two different varieties."},{"startTime":1028.43,"endTime":1030.56,"body":"One of which is where the heart,"},{"startTime":1030.56,"endTime":1035.24,"body":"but in a very regular rhythm drops a beat."},{"startTime":1035.24,"endTime":1038.12,"body":"And what actually happens"},{"startTime":1035.24,"endTime":1038.12,"body":"when you look at the ECG is"},{"startTime":1038.12,"endTime":1041.27,"body":"that the P wave gets longer and longer,"},{"startTime":1041.27,"endTime":1043.58,"body":"then there's a drop"},{"startTime":1041.27,"endTime":1043.58,"body":"beat, and then it resets,"},{"startTime":1043.58,"endTime":1045.65,"body":"and it goes back to the beginning again."},{"startTime":1045.65,"endTime":1047.42,"body":"That's not dangerous."},{"startTime":1047.42,"endTime":1051.26,"body":"Dropping one beat completely"},{"startTime":1047.42,"endTime":1051.26,"body":"predictably is not dangerous."},{"startTime":1051.26,"endTime":1053.54,"body":"It's odd, but it's not dangerous,"},{"startTime":1053.54,"endTime":1056.36,"body":"but the more worrying one"},{"startTime":1053.54,"endTime":1056.36,"body":"is where you get a beat"},{"startTime":1056.36,"endTime":1058.25,"body":"that is dropped,"},{"startTime":1058.25,"endTime":1062.51,"body":"doesn't go through the AV"},{"startTime":1058.25,"endTime":1062.51,"body":"node properly, unpredictably."},{"startTime":1062.51,"endTime":1065.33,"body":"And this is second degree heart block,"},{"startTime":1065.33,"endTime":1067.7,"body":"and this is something"},{"startTime":1065.33,"endTime":1067.7,"body":"called Mobitz type II."},{"startTime":1067.7,"endTime":1070.73,"body":"And you can have it either"},{"startTime":1067.7,"endTime":1070.73,"body":"irregularly, like this one,"},{"startTime":1070.73,"endTime":1071.57,"body":"or you can have it regularly,"},{"startTime":1071.57,"endTime":1073.43,"body":"where, for example, this one underneath,"},{"startTime":1073.43,"endTime":1076.31,"body":"you can see the P waves"},{"startTime":1073.43,"endTime":1076.31,"body":"going along a rate,"},{"startTime":1076.31,"endTime":1079.013,"body":"and every other one the beat gets dropped."},{"startTime":1080.6,"endTime":1082.253,"body":"That's second degree heart block."},{"startTime":1083.701,"endTime":1086.54,"body":"And then you get complete heart block,"},{"startTime":1086.54,"endTime":1088.49,"body":"also known as third degree heart block."},{"startTime":1088.49,"endTime":1089.6,"body":"And this is when the P wave is"},{"startTime":1089.6,"endTime":1091.97,"body":"merrily beating along perfectly normally,"},{"startTime":1091.97,"endTime":1094.07,"body":"the atrium is contracting,"},{"startTime":1094.07,"endTime":1095.84,"body":"and unfortunately none of it's going"},{"startTime":1095.84,"endTime":1097.67,"body":"through the AV node at all,"},{"startTime":1097.67,"endTime":1099.62,"body":"so then the ventricle takes over."},{"startTime":1099.62,"endTime":1102.29,"body":"So one of the lower pacemakers takes over,"},{"startTime":1102.29,"endTime":1105.17,"body":"and you have an atrium"},{"startTime":1102.29,"endTime":1105.17,"body":"going along at one rhythm,"},{"startTime":1105.17,"endTime":1107.54,"body":"and you have a ventricle"},{"startTime":1105.17,"endTime":1107.54,"body":"going along at another rhythm"},{"startTime":1107.54,"endTime":1110.24,"body":"much more slowly unrelated to one another."},{"startTime":1110.24,"endTime":1112.37,"body":"That's called complete heart block,"},{"startTime":1112.37,"endTime":1114.35,"body":"and people usually have symptoms with,"},{"startTime":1114.35,"endTime":1116.2,"body":"quite significant symptoms with that."},{"startTime":1117.47,"endTime":1120.38,"body":"So all of these things,"},{"startTime":1117.47,"endTime":1120.38,"body":"secondary heart block,"},{"startTime":1120.38,"endTime":1122.57,"body":"and complete heart block."},{"startTime":1122.57,"endTime":1125.76,"body":"If people who got symptoms,"},{"startTime":1122.57,"endTime":1125.76,"body":"they're likely to need treatment"},{"startTime":1126.8,"endTime":1128.3,"body":"because this can be debilitating."},{"startTime":1128.3,"endTime":1129.98,"body":"And if they're doing things like driving,"},{"startTime":1129.98,"endTime":1131.78,"body":"this can actually be very dangerous."},{"startTime":1132.83,"endTime":1133.82,"body":"They can suddenly collapse,"},{"startTime":1133.82,"endTime":1134.96,"body":"for example, when they're up a ladder,"},{"startTime":1134.96,"endTime":1137.453,"body":"or under ordinary circumstances."},{"startTime":1140.15,"endTime":1143.75,"body":"So the first question always"},{"startTime":1140.15,"endTime":1143.75,"body":"is, is this reversible?"},{"startTime":1143.75,"endTime":1145.25,"body":"Is there some reason"},{"startTime":1145.25,"endTime":1147.47,"body":"that you can simply switch off the reason,"},{"startTime":1147.47,"endTime":1148.58,"body":"and it goes back to normal."},{"startTime":1148.58,"endTime":1152.36,"body":"And there are quite a few"},{"startTime":1148.58,"endTime":1152.36,"body":"where that may be the case."},{"startTime":1152.36,"endTime":1157.36,"body":"So the most common of these is"},{"startTime":1152.36,"endTime":1157.36,"body":"that people are taking drugs,"},{"startTime":1158.9,"endTime":1162.8,"body":"which are designed to block"},{"startTime":1158.9,"endTime":1162.8,"body":"the AV node, that's their job,"},{"startTime":1162.8,"endTime":1165.08,"body":"but they got a bit too much of them."},{"startTime":1165.08,"endTime":1167.33,"body":"And therefore if you"},{"startTime":1165.08,"endTime":1167.33,"body":"ease back on the drugs,"},{"startTime":1167.33,"endTime":1169.28,"body":"the heart goes back to beating normally."},{"startTime":1169.28,"endTime":1173.153,"body":"So that's a doctor-induced block, in fact."},{"startTime":1174.68,"endTime":1177.023,"body":"They may have other reversible causes,"},{"startTime":1178.19,"endTime":1181.64,"body":"but if there's any doubt, if you need to,"},{"startTime":1181.64,"endTime":1184.79,"body":"you can actually either"},{"startTime":1181.64,"endTime":1184.79,"body":"give temporary drugs,"},{"startTime":1184.79,"endTime":1186.17,"body":"which will speed the heart up."},{"startTime":1186.17,"endTime":1188.78,"body":"Adrenaline is one,"},{"startTime":1188.78,"endTime":1190.01,"body":"atropin is another,"},{"startTime":1190.01,"endTime":1190.97,"body":"so there are some drugs you can do,"},{"startTime":1190.97,"endTime":1193.97,"body":"but they only are"},{"startTime":1190.97,"endTime":1193.97,"body":"appropriate to hold the line"},{"startTime":1193.97,"endTime":1194.99,"body":"for a short period of time."},{"startTime":1194.99,"endTime":1196.16,"body":"They're not a long-term drug,"},{"startTime":1196.16,"endTime":1199.103,"body":"you're not going to be taking"},{"startTime":1196.16,"endTime":1199.103,"body":"them for the rest of your days."},{"startTime":1200.18,"endTime":1202.94,"body":"And this is not very"},{"startTime":1200.18,"endTime":1202.94,"body":"comfortable, but it's doable."},{"startTime":1202.94,"endTime":1205.22,"body":"You can use what's called external pacing"},{"startTime":1205.22,"endTime":1207.08,"body":"where you put pacing pads on people,"},{"startTime":1207.08,"endTime":1209.45,"body":"and you basically give them"},{"startTime":1207.08,"endTime":1209.45,"body":"a shock across the chest"},{"startTime":1209.45,"endTime":1213.44,"body":"regularly to fire the heart"},{"startTime":1209.45,"endTime":1213.44,"body":"up at a fast enough rate."},{"startTime":1213.44,"endTime":1215.27,"body":"Now no one is going to"},{"startTime":1213.44,"endTime":1215.27,"body":"thank you for doing it,"},{"startTime":1215.27,"endTime":1217.1,"body":"except you will still be"},{"startTime":1215.27,"endTime":1217.1,"body":"alive at the end of it,"},{"startTime":1217.1,"endTime":1218.3,"body":"which is a good outcome."},{"startTime":1217.1,"endTime":1218.3,"body":"(audience member laughs)"},{"startTime":1218.3,"endTime":1219.353,"body":"But this is not..."},{"startTime":1219.353,"endTime":1222.56,"body":"That is what external pacing is,"},{"startTime":1222.56,"endTime":1224.72,"body":"but in general if you're doing these,"},{"startTime":1224.72,"endTime":1225.553,"body":"what you're saying is,"},{"startTime":1225.553,"endTime":1227.45,"body":"either this is very quickly reversible."},{"startTime":1227.45,"endTime":1228.83,"body":"I'm holding the line just for that,"},{"startTime":1228.83,"endTime":1231.71,"body":"or I'm going straight to a pacemaker."},{"startTime":1231.71,"endTime":1235.82,"body":"And the final outcome for"},{"startTime":1231.71,"endTime":1235.82,"body":"long-term bradycardias"},{"startTime":1235.82,"endTime":1238.22,"body":"is always a pacemaker."},{"startTime":1238.22,"endTime":1240.86,"body":"There aren't drugs you can"},{"startTime":1238.22,"endTime":1240.86,"body":"use to keep the heart going"},{"startTime":1240.86,"endTime":1242.96,"body":"over long periods of time."},{"startTime":1242.96,"endTime":1245.72,"body":"So artificial pacemakers,"},{"startTime":1245.72,"endTime":1248.09,"body":"again rather like the Holter monitor"},{"startTime":1248.09,"endTime":1249.86,"body":"and the ECG I showed you,"},{"startTime":1249.86,"endTime":1251.87,"body":"the miracles of engineering means"},{"startTime":1251.87,"endTime":1254.96,"body":"that these have turned"},{"startTime":1251.87,"endTime":1254.96,"body":"from large external boxes"},{"startTime":1254.96,"endTime":1257.54,"body":"only used under extreme circumstances"},{"startTime":1257.54,"endTime":1260.24,"body":"to smaller and smaller,"},{"startTime":1257.54,"endTime":1260.24,"body":"and longer lasting,"},{"startTime":1260.24,"endTime":1262.52,"body":"and increasingly sophisticated things"},{"startTime":1262.52,"endTime":1264.14,"body":"that are tunneled generally under the skin"},{"startTime":1264.14,"endTime":1266.09,"body":"with wires into the heart."},{"startTime":1266.09,"endTime":1268.4,"body":"So the early pacemakers, one shown here,"},{"startTime":1268.4,"endTime":1271.46,"body":"would only have been used"},{"startTime":1268.4,"endTime":1271.46,"body":"in very severe cases."},{"startTime":1271.46,"endTime":1275.24,"body":"Modern pacemakers are small, very durable,"},{"startTime":1275.24,"endTime":1277.43,"body":"you can knock them about"},{"startTime":1275.24,"endTime":1277.43,"body":"really quite a lot,"},{"startTime":1277.43,"endTime":1280.82,"body":"and their batteries"},{"startTime":1277.43,"endTime":1280.82,"body":"depending which type they are"},{"startTime":1280.82,"endTime":1282.83,"body":"last generally between six and 10 years"},{"startTime":1282.83,"endTime":1284.0,"body":"before they need a change."},{"startTime":1284.0,"endTime":1285.29,"body":"So once they're in,"},{"startTime":1285.29,"endTime":1288.533,"body":"that gives you really quite"},{"startTime":1285.29,"endTime":1288.533,"body":"a long period of support."},{"startTime":1290.33,"endTime":1292.34,"body":"So they come in several types,"},{"startTime":1292.34,"endTime":1296.84,"body":"and it really depends on"},{"startTime":1292.34,"endTime":1296.84,"body":"the problem, or which type."},{"startTime":1296.84,"endTime":1300.77,"body":"If you need one, you would get."},{"startTime":1300.77,"endTime":1302.15,"body":"All of them though do the same thing,"},{"startTime":1302.15,"endTime":1304.52,"body":"which is in a regular way,"},{"startTime":1304.52,"endTime":1306.74,"body":"they give a little electrical impulse,"},{"startTime":1306.74,"endTime":1309.47,"body":"which is rather like the"},{"startTime":1306.74,"endTime":1309.47,"body":"SA node or the AV node"},{"startTime":1309.47,"endTime":1311.48,"body":"initiating a heart contraction."},{"startTime":1311.48,"endTime":1315.77,"body":"So it's essentially taken over"},{"startTime":1311.48,"endTime":1315.77,"body":"from your natural pacemakers,"},{"startTime":1315.77,"endTime":1317.48,"body":"and it's doing the job for them,"},{"startTime":1317.48,"endTime":1319.853,"body":"but the rest of the system works normally."},{"startTime":1320.99,"endTime":1324.8,"body":"Most modern pacemakers now"},{"startTime":1320.99,"endTime":1324.8,"body":"work what's called on-demand."},{"startTime":1324.8,"endTime":1326.24,"body":"So if you're someone of the people"},{"startTime":1326.24,"endTime":1329.27,"body":"who 90% of the time your"},{"startTime":1326.24,"endTime":1329.27,"body":"heart's beating normally,"},{"startTime":1329.27,"endTime":1332.21,"body":"but 10% of the time it"},{"startTime":1329.27,"endTime":1332.21,"body":"goes far too slowly."},{"startTime":1332.21,"endTime":1336.05,"body":"For the 90% it recognizes that"},{"startTime":1332.21,"endTime":1336.05,"body":"and it doesn't beat at all,"},{"startTime":1336.05,"endTime":1338.99,"body":"and it only kicks in at the point"},{"startTime":1338.99,"endTime":1340.73,"body":"when your heart is going too slowly."},{"speaker":"That's got two advantages","startTime":1341.9,"endTime":1344.66,"body":"It's much more efficient,"},{"speaker":"That's got two advantages","startTime":1341.9,"endTime":1344.66,"body":"it's more physiological;"},{"speaker":"That's got two advantages","startTime":1344.66,"endTime":1346.67,"body":"and secondly the batteries last longer"},{"speaker":"That's got two advantages","startTime":1346.67,"endTime":1349.49,"body":"because you're not having"},{"speaker":"That's got two advantages","startTime":1346.67,"endTime":1349.49,"body":"to actually drive it"},{"speaker":"That's got two advantages","startTime":1349.49,"endTime":1350.813,"body":"in between times."},{"speaker":"That's got two advantages","startTime":1352.01,"endTime":1354.08,"body":"Increasingly now they can also sense"},{"speaker":"That's got two advantages","startTime":1354.08,"endTime":1356.54,"body":"if the body is moving or"},{"speaker":"That's got two advantages","startTime":1354.08,"endTime":1356.54,"body":"you're breathing rapidly."},{"speaker":"That's got two advantages","startTime":1356.54,"endTime":1358.61,"body":"And if that's the case, they'll speed up,"},{"speaker":"That's got two advantages","startTime":1358.61,"endTime":1360.62,"body":"and when you calm down,"},{"speaker":"That's got two advantages","startTime":1358.61,"endTime":1360.62,"body":"they'll slow down again,"},{"speaker":"That's got two advantages","startTime":1360.62,"endTime":1363.8,"body":"quite extraordinary really"},{"speaker":"That's got two advantages","startTime":1360.62,"endTime":1363.8,"body":"when you think about it."},{"speaker":"That's got two advantages","startTime":1363.8,"endTime":1365.15,"body":"And as I'll show you in a second,"},{"speaker":"That's got two advantages","startTime":1365.15,"endTime":1367.07,"body":"they can be single chamber,"},{"speaker":"That's got two advantages","startTime":1367.07,"endTime":1368.69,"body":"you put them in just one chamber,"},{"speaker":"That's got two advantages","startTime":1368.69,"endTime":1371.72,"body":"two chambers, left,"},{"speaker":"That's got two advantages","startTime":1368.69,"endTime":1371.72,"body":"above the top and bottom,"},{"speaker":"That's got two advantages","startTime":1371.72,"endTime":1373.25,"body":"or what's called biventricular,"},{"speaker":"That's got two advantages","startTime":1373.25,"endTime":1375.59,"body":"which actually usually"},{"speaker":"That's got two advantages","startTime":1373.25,"endTime":1375.59,"body":"means three chambers."},{"speaker":"That's got two advantages","startTime":1375.59,"endTime":1377.803,"body":"So there's a variety of"},{"speaker":"That's got two advantages","startTime":1375.59,"endTime":1377.803,"body":"ways that can be done."},{"speaker":"That's got two advantages","startTime":1378.83,"endTime":1381.133,"body":"Lot of possible settings"},{"speaker":"That's got two advantages","startTime":1378.83,"endTime":1381.133,"body":"depends on what the problem is."},{"speaker":"That's got two advantages","startTime":1381.133,"endTime":1383.66,"body":"If it's just a problem, for"},{"speaker":"That's got two advantages","startTime":1381.133,"endTime":1383.66,"body":"example, at the SA node,"},{"speaker":"That's got two advantages","startTime":1383.66,"endTime":1386.75,"body":"you might just have one"},{"speaker":"That's got two advantages","startTime":1383.66,"endTime":1386.75,"body":"just in the upper atrium,"},{"speaker":"That's got two advantages","startTime":1386.75,"endTime":1389.06,"body":"and the rest of the system goes normally."},{"speaker":"That's got two advantages","startTime":1389.06,"endTime":1392.78,"body":"For many older people, we"},{"speaker":"That's got two advantages","startTime":1389.06,"endTime":1392.78,"body":"know it's much more common"},{"speaker":"That's got two advantages","startTime":1392.78,"endTime":1396.29,"body":"to have a wire in the top"},{"speaker":"That's got two advantages","startTime":1392.78,"endTime":1396.29,"body":"and a wire in the bottom,"},{"speaker":"That's got two advantages","startTime":1396.29,"endTime":1397.64,"body":"and it takes over the whole system."},{"speaker":"That's got two advantages","startTime":1397.64,"endTime":1399.65,"body":"It provides the atrial thing,"},{"speaker":"That's got two advantages","startTime":1399.65,"endTime":1401.21,"body":"waits the correct amount of time,"},{"speaker":"That's got two advantages","startTime":1401.21,"endTime":1402.92,"body":"and then initiates the ventricular one."},{"speaker":"That's got two advantages","startTime":1402.92,"endTime":1406.313,"body":"So it actually takes over the"},{"speaker":"That's got two advantages","startTime":1402.92,"endTime":1406.313,"body":"whole of the pacing system."},{"speaker":"That's got two advantages","startTime":1407.18,"endTime":1408.53,"body":"And if someone's got heart failure,"},{"speaker":"That's got two advantages","startTime":1408.53,"endTime":1411.17,"body":"you might even have it"},{"speaker":"That's got two advantages","startTime":1408.53,"endTime":1411.17,"body":"in three different areas"},{"speaker":"That's got two advantages","startTime":1411.17,"endTime":1413.69,"body":"to make sure that the"},{"speaker":"That's got two advantages","startTime":1411.17,"endTime":1413.69,"body":"whole heart is contracting"},{"speaker":"That's got two advantages","startTime":1413.69,"endTime":1415.943,"body":"at exactly the right point."},{"speaker":"That's got two advantages","startTime":1417.26,"endTime":1420.71,"body":"The developments of these"},{"speaker":"That's got two advantages","startTime":1417.26,"endTime":1420.71,"body":"are happening the whole time."},{"speaker":"That's got two advantages","startTime":1420.71,"endTime":1423.44,"body":"So a new development is things"},{"speaker":"That's got two advantages","startTime":1420.71,"endTime":1423.44,"body":"called leadless pacemaker,"},{"speaker":"That's got two advantages","startTime":1423.44,"endTime":1424.94,"body":"so they don't actually have a box here"},{"speaker":"That's got two advantages","startTime":1424.94,"endTime":1425.863,"body":"with a lead into your heart,"},{"speaker":"That's got two advantages","startTime":1425.863,"endTime":1429.89,"body":"you put the pacemaker itself"},{"speaker":"That's got two advantages","startTime":1425.863,"endTime":1429.89,"body":"into the heart, it sits there."},{"speaker":"That's got two advantages","startTime":1429.89,"endTime":1432.53,"body":"Those are mainly used as"},{"speaker":"That's got two advantages","startTime":1429.89,"endTime":1432.53,"body":"a way of reducing risks"},{"speaker":"That's got two advantages","startTime":1432.53,"endTime":1435.26,"body":"from infection in people who"},{"speaker":"That's got two advantages","startTime":1432.53,"endTime":1435.26,"body":"are particularly high-risk."},{"speaker":"That's got two advantages","startTime":1435.26,"endTime":1437.42,"body":"And I'm sure whoever is"},{"speaker":"That's got two advantages","startTime":1435.26,"endTime":1437.42,"body":"giving a lecture on this"},{"speaker":"That's got two advantages","startTime":1437.42,"endTime":1439.79,"body":"in 20 years' time, they"},{"speaker":"That's got two advantages","startTime":1437.42,"endTime":1439.79,"body":"would have moved further,"},{"speaker":"That's got two advantages","startTime":1439.79,"endTime":1441.38,"body":"they'll be longer lasting,"},{"speaker":"That's got two advantages","startTime":1439.79,"endTime":1441.38,"body":"they'll be smaller,"},{"speaker":"That's got two advantages","startTime":1441.38,"endTime":1442.64,"body":"and they'll be more sophisticated."},{"speaker":"That's got two advantages","startTime":1442.64,"endTime":1444.83,"body":"So this is a technology"},{"speaker":"That's got two advantages","startTime":1442.64,"endTime":1444.83,"body":"that's already good"},{"speaker":"That's got two advantages","startTime":1444.83,"endTime":1446.813,"body":"and continues to improve."},{"speaker":"That's got two advantages","startTime":1449.48,"endTime":1451.4,"body":"So those are the bradycardias,"},{"speaker":"That's got two advantages","startTime":1451.4,"endTime":1453.83,"body":"I'm now going to move"},{"speaker":"That's got two advantages","startTime":1451.4,"endTime":1453.83,"body":"on to the slow things."},{"speaker":"That's got two advantages","startTime":1453.83,"endTime":1454.663,"body":"I'm going to move on to things"},{"speaker":"That's got two advantages","startTime":1454.663,"endTime":1457.22,"body":"that mainly cause the"},{"speaker":"That's got two advantages","startTime":1454.663,"endTime":1457.22,"body":"heart to go too fast."},{"speaker":"That's got two advantages","startTime":1457.22,"endTime":1459.14,"body":"And the commonest of these,"},{"speaker":"That's got two advantages","startTime":1459.14,"endTime":1461.45,"body":"and this is something which"},{"speaker":"That's got two advantages","startTime":1459.14,"endTime":1461.45,"body":"lots of people will have"},{"speaker":"That's got two advantages","startTime":1461.45,"endTime":1464.09,"body":"by the time they get to their older ages"},{"speaker":"That's got two advantages","startTime":1464.09,"endTime":1466.43,"body":"is atrial fibrillation."},{"speaker":"That's got two advantages","startTime":1466.43,"endTime":1470.33,"body":"So atrial fibrillation is"},{"speaker":"That's got two advantages","startTime":1466.43,"endTime":1470.33,"body":"where the top bit of the heart,"},{"speaker":"That's got two advantages","startTime":1470.33,"endTime":1472.56,"body":"instead of beating in a nice steady way"},{"speaker":"That's got two advantages","startTime":1473.81,"endTime":1477.44,"body":"basically goes rogue, and just"},{"speaker":"That's got two advantages","startTime":1473.81,"endTime":1477.44,"body":"twitches like a kind of bag."},{"speaker":"That's got two advantages","startTime":1477.44,"endTime":1478.52,"body":"It is moving,"},{"speaker":"That's got two advantages","startTime":1478.52,"endTime":1480.92,"body":"but it's not moving in any"},{"speaker":"That's got two advantages","startTime":1478.52,"endTime":1480.92,"body":"kind of coordinated way,"},{"speaker":"That's got two advantages","startTime":1480.92,"endTime":1483.23,"body":"it's not producing an impulse."},{"speaker":"That's got two advantages","startTime":1483.23,"endTime":1485.75,"body":"Now that's got a number of implications."},{"speaker":"That's got two advantages","startTime":1485.75,"endTime":1487.293,"body":"The first of them is"},{"speaker":"That's got two advantages","startTime":1487.293,"endTime":1489.17,"body":"that this means that the ventricle"},{"speaker":"That's got two advantages","startTime":1489.17,"endTime":1490.1,"body":"doesn't know what to do"},{"speaker":"That's got two advantages","startTime":1490.1,"endTime":1492.98,"body":"because sometimes basically the rate,"},{"speaker":"That's got two advantages","startTime":1492.98,"endTime":1496.01,"body":"the atrium is sending impulses through"},{"speaker":"That's got two advantages","startTime":1496.01,"endTime":1497.78,"body":"in a very irregular way,"},{"speaker":"That's got two advantages","startTime":1497.78,"endTime":1500.15,"body":"the way it's actually"},{"speaker":"That's got two advantages","startTime":1497.78,"endTime":1500.15,"body":"getting through the AV node,"},{"speaker":"That's got two advantages","startTime":1500.15,"endTime":1503.33,"body":"and you get what is called an"},{"speaker":"That's got two advantages","startTime":1500.15,"endTime":1503.33,"body":"irregularly irregular pulse."},{"speaker":"That's got two advantages","startTime":1503.33,"endTime":1504.62,"body":"So you actually feel the pulse,"},{"speaker":"That's got two advantages","startTime":1504.62,"endTime":1506.78,"body":"and sometimes it's going fast,"},{"speaker":"That's got two advantages","startTime":1504.62,"endTime":1506.78,"body":"sometimes it's going slowly,"},{"speaker":"That's got two advantages","startTime":1506.78,"endTime":1508.01,"body":"and there's no way you can tell"},{"speaker":"That's got two advantages","startTime":1508.01,"endTime":1509.39,"body":"where the next beat is going to be,"},{"speaker":"That's got two advantages","startTime":1509.39,"endTime":1510.99,"body":"it just goes all over the place."},{"speaker":"That's got two advantages","startTime":1512.12,"endTime":1513.83,"body":"That's quite often quite inefficient,"},{"speaker":"That's got two advantages","startTime":1513.83,"endTime":1515.87,"body":"and it often also goes too quickly."},{"speaker":"That's got two advantages","startTime":1515.87,"endTime":1517.73,"body":"So as I'll come onto,"},{"speaker":"That's got two advantages","startTime":1517.73,"endTime":1520.553,"body":"you often need drugs to"},{"speaker":"That's got two advantages","startTime":1517.73,"endTime":1520.553,"body":"then slow the heart down."},{"speaker":"That's got two advantages","startTime":1521.42,"endTime":1526.42,"body":"But there's a third issue,"},{"speaker":"That's got two advantages","startTime":1521.42,"endTime":1526.42,"body":"which is this twitching bag"},{"speaker":"That's got two advantages","startTime":1526.91,"endTime":1530.45,"body":"allows clots to form on the atrium."},{"speaker":"That's got two advantages","startTime":1530.45,"endTime":1532.79,"body":"And if clots form, the"},{"speaker":"That's got two advantages","startTime":1530.45,"endTime":1532.79,"body":"risk of those is they go on"},{"speaker":"That's got two advantages","startTime":1532.79,"endTime":1533.837,"body":"and they flick off into the system,"},{"speaker":"That's got two advantages","startTime":1533.837,"endTime":1536.6,"body":"and the thing you really"},{"speaker":"That's got two advantages","startTime":1533.837,"endTime":1536.6,"body":"worry about is stroke."},{"speaker":"That's got two advantages","startTime":1536.6,"endTime":1537.65,"body":"And atrial fibrillation,"},{"speaker":"That's got two advantages","startTime":1537.65,"endTime":1540.65,"body":"if you don't treat it with blood thinners,"},{"speaker":"That's got two advantages","startTime":1540.65,"endTime":1542.0,"body":"which we'll come onto,"},{"speaker":"That's got two advantages","startTime":1542.0,"endTime":1544.673,"body":"increase the risk of"},{"speaker":"That's got two advantages","startTime":1542.0,"endTime":1544.673,"body":"stroke quite significantly."},{"speaker":"That's got two advantages","startTime":1545.54,"endTime":1548.51,"body":"So the ECG looks like this,"},{"speaker":"That's got two advantages","startTime":1545.54,"endTime":1548.51,"body":"it's a very irregular rhythm,"},{"speaker":"That's got two advantages","startTime":1548.51,"endTime":1550.52,"body":"and you can't see any P waves"},{"speaker":"That's got two advantages","startTime":1548.51,"endTime":1550.52,"body":"because there aren't any"},{"speaker":"That's got two advantages","startTime":1550.52,"endTime":1553.31,"body":"because it's just the atrium twitching."},{"speaker":"That's got two advantages","startTime":1553.31,"endTime":1556.13,"body":"This graph here simply shows the age,"},{"speaker":"That's got two advantages","startTime":1556.13,"endTime":1557.3,"body":"which this tends to come on."},{"speaker":"That's got two advantages","startTime":1557.3,"endTime":1560.12,"body":"Men get it a bit earlier than"},{"speaker":"That's got two advantages","startTime":1557.3,"endTime":1560.12,"body":"women, generally speaking."},{"speaker":"That's got two advantages","startTime":1560.12,"endTime":1564.68,"body":"By your time you get to 100,"},{"speaker":"That's got two advantages","startTime":1560.12,"endTime":1564.68,"body":"for those of you who do,"},{"speaker":"That's got two advantages","startTime":1564.68,"endTime":1567.05,"body":"it's still only a third"},{"speaker":"That's got two advantages","startTime":1564.68,"endTime":1567.05,"body":"of people will have it,"},{"speaker":"That's got two advantages","startTime":1567.05,"endTime":1569.0,"body":"slightly less than women."},{"speaker":"That's got two advantages","startTime":1569.0,"endTime":1570.14,"body":"So the majority will not have it,"},{"speaker":"That's got two advantages","startTime":1570.14,"endTime":1571.79,"body":"but it gets a lot more common"},{"speaker":"That's got two advantages","startTime":1571.79,"endTime":1573.55,"body":"as you get into your 80s and 90s."},{"speaker":"That's got two advantages","startTime":1573.55,"endTime":1576.923,"body":"It just should be seen as one"},{"speaker":"That's got two advantages","startTime":1573.55,"endTime":1576.923,"body":"of the phenomenon of aging."},{"speaker":"That's got two advantages","startTime":1579.65,"endTime":1582.41,"body":"And atrial fibrillation may be temporary."},{"speaker":"That's got two advantages","startTime":1582.41,"endTime":1583.61,"body":"Quite a lot of people,"},{"speaker":"That's got two advantages","startTime":1583.61,"endTime":1587.12,"body":"if they have particularly an older age,"},{"speaker":"That's got two advantages","startTime":1587.12,"endTime":1590.27,"body":"if they have a big stress to the system,"},{"speaker":"That's got two advantages","startTime":1590.27,"endTime":1593.45,"body":"bad infection like a"},{"speaker":"That's got two advantages","startTime":1590.27,"endTime":1593.45,"body":"pneumonia, a big operation,"},{"speaker":"That's got two advantages","startTime":1593.45,"endTime":1597.56,"body":"the heart may flip into atrial"},{"speaker":"That's got two advantages","startTime":1593.45,"endTime":1597.56,"body":"fibrillation for a few days,"},{"speaker":"That's got two advantages","startTime":1597.56,"endTime":1601.01,"body":"and then just right itself"},{"speaker":"That's got two advantages","startTime":1597.56,"endTime":1601.01,"body":"as the body improves."},{"speaker":"That's got two advantages","startTime":1601.01,"endTime":1603.14,"body":"So it can just be a temporary phenomenon."},{"speaker":"That's got two advantages","startTime":1603.14,"endTime":1605.45,"body":"And one of the key things in"},{"speaker":"That's got two advantages","startTime":1603.14,"endTime":1605.45,"body":"medicine is to make a decision,"},{"speaker":"That's got two advantages","startTime":1605.45,"endTime":1608.093,"body":"are we going to treat this or"},{"speaker":"That's got two advantages","startTime":1605.45,"endTime":1608.093,"body":"are we going to let it run,"},{"speaker":"That's got two advantages","startTime":1609.05,"endTime":1610.43,"body":"protect the heart for a period"},{"speaker":"That's got two advantages","startTime":1610.43,"endTime":1613.043,"body":"and see if it goes back to normal?"},{"speaker":"That's got two advantages","startTime":1613.94,"endTime":1617.33,"body":"Several drugs, including"},{"speaker":"That's got two advantages","startTime":1613.94,"endTime":1617.33,"body":"alcohol, caffeine,"},{"speaker":"That's got two advantages","startTime":1617.33,"endTime":1619.97,"body":"cocaine for those who"},{"speaker":"That's got two advantages","startTime":1617.33,"endTime":1619.97,"body":"take it, amphetamines,"},{"speaker":"That's got two advantages","startTime":1619.97,"endTime":1622.82,"body":"all make it more likely to happen."},{"speaker":"That's got two advantages","startTime":1622.82,"endTime":1623.72,"body":"So there are several things,"},{"speaker":"That's got two advantages","startTime":1623.72,"endTime":1625.28,"body":"which can actually trigger this off,"},{"speaker":"That's got two advantages","startTime":1625.28,"endTime":1628.13,"body":"either on a temporary or"},{"speaker":"That's got two advantages","startTime":1625.28,"endTime":1628.13,"body":"on a more permanent basis."},{"speaker":"That's got two advantages","startTime":1628.13,"endTime":1631.49,"body":"And a hyperactive thyroid"},{"speaker":"That's got two advantages","startTime":1628.13,"endTime":1631.49,"body":"can make this more likely,"},{"speaker":"That's got two advantages","startTime":1631.49,"endTime":1634.04,"body":"as for example some valve diseases are,"},{"speaker":"That's got two advantages","startTime":1634.04,"endTime":1636.77,"body":"which I'll come onto in the next talk."},{"speaker":"That's got two advantages","startTime":1636.77,"endTime":1640.1,"body":"If there's an obvious"},{"speaker":"That's got two advantages","startTime":1636.77,"endTime":1640.1,"body":"cause, you stop the cause."},{"speaker":"That's got two advantages","startTime":1640.1,"endTime":1643.4,"body":"So if the problem is particular"},{"speaker":"That's got two advantages","startTime":1640.1,"endTime":1643.4,"body":"drugs, you stop that."},{"speaker":"That's got two advantages","startTime":1643.4,"endTime":1645.415,"body":"If someone's got too much high thyroid,"},{"speaker":"That's got two advantages","startTime":1645.415,"endTime":1648.08,"body":"you bring the thyroid down,"},{"speaker":"That's got two advantages","startTime":1648.08,"endTime":1650.69,"body":"and it can often revert back to normal."},{"speaker":"That's got two advantages","startTime":1650.69,"endTime":1652.85,"body":"If there's no cause, that's obvious,"},{"speaker":"That's got two advantages","startTime":1652.85,"endTime":1655.16,"body":"and particularly if"},{"speaker":"That's got two advantages","startTime":1652.85,"endTime":1655.16,"body":"someone's got problems,"},{"speaker":"That's got two advantages","startTime":1655.16,"endTime":1658.28,"body":"you can shock it out of"},{"speaker":"That's got two advantages","startTime":1655.16,"endTime":1658.28,"body":"the rhythm very frequently,"},{"speaker":"That's got two advantages","startTime":1658.28,"endTime":1660.5,"body":"at least if you catch it very early."},{"speaker":"That's got two advantages","startTime":1660.5,"endTime":1663.11,"body":"And generally particularly"},{"speaker":"That's got two advantages","startTime":1660.5,"endTime":1663.11,"body":"in younger people."},{"speaker":"That's got two advantages","startTime":1663.11,"endTime":1665.6,"body":"So here is someone where you"},{"speaker":"That's got two advantages","startTime":1663.11,"endTime":1665.6,"body":"can see the atrial rhythm"},{"speaker":"That's got two advantages","startTime":1665.6,"endTime":1667.19,"body":"going along atrial fibrillation,"},{"speaker":"That's got two advantages","startTime":1667.19,"endTime":1669.98,"body":"batting along at really"},{"speaker":"That's got two advantages","startTime":1667.19,"endTime":1669.98,"body":"quite a fast rate here."},{"speaker":"That's got two advantages","startTime":1669.98,"endTime":1673.25,"body":"This spike here is someone"},{"speaker":"That's got two advantages","startTime":1669.98,"endTime":1673.25,"body":"putting pads across them"},{"speaker":"That's got two advantages","startTime":1673.25,"endTime":1676.46,"body":"and pressing the Go button,"},{"speaker":"That's got two advantages","startTime":1676.46,"endTime":1678.65,"body":"shock across the chest,"},{"speaker":"That's got two advantages","startTime":1678.65,"endTime":1681.71,"body":"and the heart is jolted"},{"speaker":"That's got two advantages","startTime":1678.65,"endTime":1681.71,"body":"back into a normal rhythm."},{"speaker":"That's got two advantages","startTime":1681.71,"endTime":1684.26,"body":"So that's a quite common"},{"speaker":"That's got two advantages","startTime":1681.71,"endTime":1684.26,"body":"thing that might be done,"},{"speaker":"That's got two advantages","startTime":1684.26,"endTime":1687.5,"body":"either immediately or after a delay when,"},{"speaker":"That's got two advantages","startTime":1687.5,"endTime":1691.16,"body":"during which people have some"},{"speaker":"That's got two advantages","startTime":1687.5,"endTime":1691.16,"body":"anticoagulation for a period."},{"speaker":"That's got two advantages","startTime":1691.16,"endTime":1694.07,"body":"And you can also try the"},{"speaker":"That's got two advantages","startTime":1691.16,"endTime":1694.07,"body":"same thing with drugs."},{"speaker":"There are two drugs in particular","startTime":1695.663,"endTime":1696.5,"body":"amiodarone and flecainide."},{"speaker":"There are two drugs in particular","startTime":1696.5,"endTime":1698.39,"body":"I've talked about, but there are others."},{"speaker":"There are two drugs in particular","startTime":1698.39,"endTime":1699.32,"body":"So there are ways you can try"},{"speaker":"There are two drugs in particular","startTime":1699.32,"endTime":1702.07,"body":"and basically bounce the"},{"speaker":"There are two drugs in particular","startTime":1699.32,"endTime":1702.07,"body":"heart back into normal rhythm."},{"speaker":"There are two drugs in particular","startTime":1704.69,"endTime":1707.24,"body":"But for many people,"},{"speaker":"There are two drugs in particular","startTime":1704.69,"endTime":1707.24,"body":"particularly in older age,"},{"speaker":"There are two drugs in particular","startTime":1707.24,"endTime":1709.28,"body":"they will just get this,"},{"speaker":"There are two drugs in particular","startTime":1707.24,"endTime":1709.28,"body":"this is a permanent state."},{"speaker":"There are two drugs in particular","startTime":1709.28,"endTime":1711.56,"body":"You might be able to flip"},{"speaker":"There are two drugs in particular","startTime":1709.28,"endTime":1711.56,"body":"them back for a short time,"},{"speaker":"There are two drugs in particular","startTime":1711.56,"endTime":1713.48,"body":"but they're going to go back into it."},{"speaker":"There are two drugs in particular","startTime":1713.48,"endTime":1715.97,"body":"And so for them really the key things"},{"speaker":"There are two drugs in particular","startTime":1715.97,"endTime":1718.55,"body":"are firstly to slow the heart down to,"},{"speaker":"There are two drugs in particular","startTime":1718.55,"endTime":1721.19,"body":"or get the heart to a good rhythm."},{"speaker":"There are two drugs in particular","startTime":1721.19,"endTime":1722.753,"body":"And then, secondly,"},{"speaker":"There are two drugs in particular","startTime":1724.341,"endTime":1727.82,"body":"to make sure they don't have"},{"speaker":"There are two drugs in particular","startTime":1724.341,"endTime":1727.82,"body":"any greater risk of stroke"},{"speaker":"There are two drugs in particular","startTime":1727.82,"endTime":1729.203,"body":"than can be avoided."},{"speaker":"There are two drugs in particular","startTime":1730.22,"endTime":1733.73,"body":"The first person who developed"},{"speaker":"There are two drugs in particular","startTime":1730.22,"endTime":1733.73,"body":"a drug to help do this"},{"speaker":"There are two drugs in particular","startTime":1733.73,"endTime":1736.76,"body":"in atrial fibrillation slow the heart down"},{"speaker":"There are two drugs in particular","startTime":1736.76,"endTime":1740.33,"body":"was a doctor called William"},{"speaker":"There are two drugs in particular","startTime":1736.76,"endTime":1740.33,"body":"Withering in the 1780s."},{"speaker":"There are two drugs in particular","startTime":1740.33,"endTime":1742.1,"body":"So this goes back a long way,"},{"speaker":"There are two drugs in particular","startTime":1742.1,"endTime":1744.5,"body":"and this was derived from foxgloves,"},{"speaker":"There are two drugs in particular","startTime":1744.5,"endTime":1747.11,"body":"and this is actually"},{"speaker":"There are two drugs in particular","startTime":1744.5,"endTime":1747.11,"body":"Withering's own illustration"},{"speaker":"There are two drugs in particular","startTime":1747.11,"endTime":1748.85,"body":"and his monograph on this,"},{"speaker":"There are two drugs in particular","startTime":1748.85,"endTime":1752.45,"body":"quite remarkable bit of science actually."},{"speaker":"There are two drugs in particular","startTime":1752.45,"endTime":1753.71,"body":"Still used today,"},{"speaker":"There are two drugs in particular","startTime":1753.71,"endTime":1756.026,"body":"so this is an old drug,"},{"speaker":"There are two drugs in particular","startTime":1753.71,"endTime":1756.026,"body":"but still in the pharma"},{"speaker":"There are two drugs in particular","startTime":1756.026,"endTime":1758.03,"body":"(indistinct) it's"},{"speaker":"There are two drugs in particular","startTime":1756.026,"endTime":1758.03,"body":"actually a very good drug"},{"speaker":"There are two drugs in particular","startTime":1758.03,"endTime":1759.53,"body":"for the right people,"},{"speaker":"There are two drugs in particular","startTime":1759.53,"endTime":1763.04,"body":"but in general now we tend"},{"speaker":"There are two drugs in particular","startTime":1759.53,"endTime":1763.04,"body":"to use more two drug classes,"},{"speaker":"There are two drugs in particular","startTime":1763.04,"endTime":1765.47,"body":"which I'll talk about in"},{"speaker":"There are two drugs in particular","startTime":1763.04,"endTime":1765.47,"body":"slightly more detail now."},{"speaker":"There are two drugs in particular","startTime":1765.47,"endTime":1768.59,"body":"Beta blockers and calcium channel blockers"},{"speaker":"There are two drugs in particular","startTime":1768.59,"endTime":1770.603,"body":"would do this to slow the heart down."},{"speaker":"There are two drugs in particular","startTime":1771.62,"endTime":1772.91,"body":"And what all of them do"},{"speaker":"There are two drugs in particular","startTime":1772.91,"endTime":1776.3,"body":"is they slow the rate at"},{"speaker":"There are two drugs in particular","startTime":1772.91,"endTime":1776.3,"body":"which conduction occurs"},{"speaker":"There are two drugs in particular","startTime":1776.3,"endTime":1778.91,"body":"between the atrium,"},{"speaker":"There are two drugs in particular","startTime":1776.3,"endTime":1778.91,"body":"which is flickering away,"},{"speaker":"There are two drugs in particular","startTime":1778.91,"endTime":1782.03,"body":"firing off the whole"},{"speaker":"There are two drugs in particular","startTime":1778.91,"endTime":1782.03,"body":"time, and the ventricle,"},{"speaker":"There are two drugs in particular","startTime":1782.03,"endTime":1785.81,"body":"so that the heart rate"},{"speaker":"There are two drugs in particular","startTime":1782.03,"endTime":1785.81,"body":"overall slows down a bit."},{"speaker":"There are two drugs in particular","startTime":1785.81,"endTime":1787.07,"body":"You don't want to slow down too far,"},{"speaker":"There are two drugs in particular","startTime":1787.07,"endTime":1788.51,"body":"and that's the art of this"},{"speaker":"There are two drugs in particular","startTime":1788.51,"endTime":1791.06,"body":"is you want them to slow"},{"speaker":"There are two drugs in particular","startTime":1788.51,"endTime":1791.06,"body":"down a bit, but not too much,"},{"speaker":"There are two drugs in particular","startTime":1791.06,"endTime":1793.34,"body":"and you're going to get"},{"speaker":"There are two drugs in particular","startTime":1791.06,"endTime":1793.34,"body":"the dose of the drug right"},{"speaker":"There are two drugs in particular","startTime":1793.34,"endTime":1794.273,"body":"to achieve that."},{"speaker":"There are two drugs in particular","startTime":1797.63,"endTime":1801.38,"body":"Now I talked about these"},{"speaker":"There are two drugs in particular","startTime":1797.63,"endTime":1801.38,"body":"drugs in a different context,"},{"speaker":"There are two drugs in particular","startTime":1801.38,"endTime":1803.42,"body":"but I think it's worth just refreshing,"},{"speaker":"There are two drugs in particular","startTime":1803.42,"endTime":1806.66,"body":"but those who have not gone"},{"speaker":"There are two drugs in particular","startTime":1803.42,"endTime":1806.66,"body":"to my previous lecture,"},{"speaker":"There are two drugs in particular","startTime":1806.66,"endTime":1808.34,"body":"and also for those who have, to point out,"},{"speaker":"There are two drugs in particular","startTime":1808.34,"endTime":1810.83,"body":"these are drugs you can"},{"speaker":"There are two drugs in particular","startTime":1808.34,"endTime":1810.83,"body":"use for several purposes."},{"speaker":"There are two drugs in particular","startTime":1810.83,"endTime":1812.81,"body":"They're remarkable drugs actually."},{"speaker":"There are two drugs in particular","startTime":1812.81,"endTime":1815.333,"body":"The first class is what's"},{"speaker":"There are two drugs in particular","startTime":1812.81,"endTime":1815.333,"body":"called beta blockers."},{"speaker":"There are two drugs in particular","startTime":1816.35,"endTime":1817.85,"body":"So remembering that adrenaline"},{"speaker":"There are two drugs in particular","startTime":1817.85,"endTime":1819.56,"body":"is the key to fight and flight."},{"speaker":"There are two drugs in particular","startTime":1819.56,"endTime":1824.12,"body":"It speeds up the AV node,"},{"speaker":"There are two drugs in particular","startTime":1819.56,"endTime":1824.12,"body":"it speeds up the SA node,"},{"speaker":"There are two drugs in particular","startTime":1824.12,"endTime":1827.09,"body":"and therefore if you can block it."},{"speaker":"There are two drugs in particular","startTime":1827.09,"endTime":1831.14,"body":"And the main transmitter"},{"speaker":"There are two drugs in particular","startTime":1827.09,"endTime":1831.14,"body":"in the heart is the beta,"},{"speaker":"There are two drugs in particular","startTime":1831.14,"endTime":1833.48,"body":"the beta receptors, if you block it,"},{"speaker":"There are two drugs in particular","startTime":1833.48,"endTime":1836.93,"body":"you reduce the essentially"},{"speaker":"There are two drugs in particular","startTime":1833.48,"endTime":1836.93,"body":"adrenaline like effect,"},{"speaker":"There are two drugs in particular","startTime":1836.93,"endTime":1838.85,"body":"and that slows the heart down."},{"speaker":"There are two drugs in particular","startTime":1838.85,"endTime":1841.25,"body":"So this is a purposefully designed drug"},{"speaker":"There are two drugs in particular","startTime":1841.25,"endTime":1842.3,"body":"unlike the Withering's one,"},{"speaker":"There are two drugs in particular","startTime":1842.3,"endTime":1845.42,"body":"which was an observation from nature."},{"speaker":"There are two drugs in particular","startTime":1845.42,"endTime":1848.03,"body":"This one was designed to"},{"speaker":"There are two drugs in particular","startTime":1845.42,"endTime":1848.03,"body":"do the job it was done."},{"speaker":"There are two drugs in particular","startTime":1848.03,"endTime":1849.47,"body":"Sir James Black on the right,"},{"speaker":"There are two drugs in particular","startTime":1849.47,"endTime":1851.963,"body":"rightly got a Nobel prize for doing this."},{"speaker":"There are two drugs in particular","startTime":1853.01,"endTime":1854.54,"body":"And that can slow the heart down,"},{"speaker":"There are two drugs in particular","startTime":1854.54,"endTime":1856.85,"body":"and you just adjust the"},{"speaker":"There are two drugs in particular","startTime":1854.54,"endTime":1856.85,"body":"dose to the right dose"},{"speaker":"There are two drugs in particular","startTime":1856.85,"endTime":1858.623,"body":"for the person in front of you."},{"speaker":"There are two drugs in particular","startTime":1860.87,"endTime":1863.9,"body":"Another class of drugs"},{"speaker":"There are two drugs in particular","startTime":1860.87,"endTime":1863.9,"body":"unrelated to beta blockers"},{"speaker":"There are two drugs in particular","startTime":1863.9,"endTime":1865.04,"body":"does it a completely different way."},{"speaker":"There are two drugs in particular","startTime":1865.04,"endTime":1868.58,"body":"The way in which many"},{"speaker":"There are two drugs in particular","startTime":1865.04,"endTime":1868.58,"body":"cells in the body signal"},{"speaker":"There are two drugs in particular","startTime":1868.58,"endTime":1872.36,"body":"is via calcium, and by calcium"},{"speaker":"There are two drugs in particular","startTime":1868.58,"endTime":1872.36,"body":"channel switching on and off"},{"speaker":"There are two drugs in particular","startTime":1872.36,"endTime":1875.06,"body":"the physiology, this is"},{"speaker":"There are two drugs in particular","startTime":1872.36,"endTime":1875.06,"body":"extraordinarily sophisticated."},{"speaker":"There are two drugs in particular","startTime":1875.9,"endTime":1877.94,"body":"You'll be pleased to hear, I'm"},{"speaker":"There are two drugs in particular","startTime":1875.9,"endTime":1877.94,"body":"not going to go down there,"},{"speaker":"There are two drugs in particular","startTime":1877.94,"endTime":1879.32,"body":"but just to say that there are"},{"speaker":"There are two drugs in particular","startTime":1879.32,"endTime":1882.02,"body":"multiple forms of calcium channel,"},{"speaker":"There are two drugs in particular","startTime":1882.02,"endTime":1883.34,"body":"and there are different forms of"},{"speaker":"There are two drugs in particular","startTime":1883.34,"endTime":1886.4,"body":"calcium channel blocker drugs,"},{"speaker":"There are two drugs in particular","startTime":1886.4,"endTime":1889.37,"body":"and they are variably useful"},{"speaker":"There are two drugs in particular","startTime":1886.4,"endTime":1889.37,"body":"for different bits of the body."},{"speaker":"There are two drugs in particular","startTime":1889.37,"endTime":1891.35,"body":"If you want to drop the blood pressure,"},{"speaker":"There are two drugs in particular","startTime":1891.35,"endTime":1893.33,"body":"you use one bit of them."},{"speaker":"There are two drugs in particular","startTime":1893.33,"endTime":1896.03,"body":"If you want to slow the"},{"speaker":"There are two drugs in particular","startTime":1893.33,"endTime":1896.03,"body":"heart down, you use another."},{"speaker":"There are two drugs in particular","startTime":1896.03,"endTime":1897.26,"body":"They're very slightly different,"},{"speaker":"There are two drugs in particular","startTime":1897.26,"endTime":1899.15,"body":"but they all work for blocking"},{"speaker":"There are two drugs in particular","startTime":1899.15,"endTime":1902.363,"body":"the calcium channel in the system."},{"speaker":"There are two drugs in particular","startTime":1904.1,"endTime":1905.21,"body":"And some of them are optimized"},{"speaker":"There are two drugs in particular","startTime":1905.21,"endTime":1907.19,"body":"and the two that I'd highlighted,"},{"speaker":"There are two drugs in particular","startTime":1907.19,"endTime":1909.053,"body":"drugs called diltiazem and verapamil."},{"speaker":"There are two drugs in particular","startTime":1911.96,"endTime":1914.48,"body":"So one of those drugs may well be used"},{"speaker":"There are two drugs in particular","startTime":1914.48,"endTime":1915.86,"body":"if someone's heart's going too fast."},{"speaker":"There are two drugs in particular","startTime":1915.86,"endTime":1917.93,"body":"And then second thing which"},{"speaker":"There are two drugs in particular","startTime":1915.86,"endTime":1917.93,"body":"must always be considered,"},{"speaker":"There are two drugs in particular","startTime":1917.93,"endTime":1921.26,"body":"and usually initiated is blood thinning."},{"speaker":"There are two drugs in particular","startTime":1921.26,"endTime":1923.45,"body":"And that is to reduce the risk of stroke,"},{"speaker":"There are two drugs in particular","startTime":1923.45,"endTime":1924.773,"body":"that's the principal risk."},{"speaker":"There are two drugs in particular","startTime":1925.82,"endTime":1927.8,"body":"If you only have atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":1927.8,"endTime":1929.96,"body":"nothing else, no other heart problems,"},{"speaker":"There are two drugs in particular","startTime":1929.96,"endTime":1932.6,"body":"no valve problems, no"},{"speaker":"There are two drugs in particular","startTime":1929.96,"endTime":1932.6,"body":"coronary artery disease,"},{"speaker":"There are two drugs in particular","startTime":1932.6,"endTime":1935.45,"body":"your risk of stroke is"},{"speaker":"There are two drugs in particular","startTime":1932.6,"endTime":1935.45,"body":"actually relatively low,"},{"speaker":"There are two drugs in particular","startTime":1935.45,"endTime":1938.69,"body":"but every single additional"},{"speaker":"There are two drugs in particular","startTime":1935.45,"endTime":1938.69,"body":"thing you get on top of that,"},{"speaker":"There are two drugs in particular","startTime":1938.69,"endTime":1940.7,"body":"the risk of a stroke goes up."},{"speaker":"There are two drugs in particular","startTime":1940.7,"endTime":1943.61,"body":"And there are various"},{"speaker":"There are two drugs in particular","startTime":1940.7,"endTime":1943.61,"body":"scoring systems for this."},{"speaker":"There are two drugs in particular","startTime":1943.61,"endTime":1945.08,"body":"And what this graph here shows"},{"speaker":"There are two drugs in particular","startTime":1945.08,"endTime":1946.55,"body":"is one of the scoring systems."},{"speaker":"There are two drugs in particular","startTime":1946.55,"endTime":1950.21,"body":"This is the rate of stroke"},{"speaker":"There are two drugs in particular","startTime":1950.21,"endTime":1951.62,"body":"along this bit,"},{"speaker":"There are two drugs in particular","startTime":1951.62,"endTime":1953.69,"body":"and the more points you score,"},{"speaker":"There are two drugs in particular","startTime":1953.69,"endTime":1956.36,"body":"the more your risk of stroke goes up."},{"speaker":"There are two drugs in particular","startTime":1956.36,"endTime":1958.4,"body":"So someone will do a"},{"speaker":"There are two drugs in particular","startTime":1956.36,"endTime":1958.4,"body":"scoring system and say,"},{"speaker":"There are two drugs in particular","startTime":1958.4,"endTime":1959.93,"body":"how high is your risk?"},{"speaker":"There are two drugs in particular","startTime":1959.93,"endTime":1961.31,"body":"And then the second question it'll ask is,"},{"speaker":"There are two drugs in particular","startTime":1961.31,"endTime":1963.71,"body":"how high is your risk of bleeding?"},{"speaker":"There are two drugs in particular","startTime":1963.71,"endTime":1965.78,"body":"Are you someone who is"},{"speaker":"There are two drugs in particular","startTime":1963.71,"endTime":1965.78,"body":"constantly falling over,"},{"speaker":"There are two drugs in particular","startTime":1965.78,"endTime":1966.62,"body":"and bashing their head,"},{"speaker":"There are two drugs in particular","startTime":1966.62,"endTime":1969.83,"body":"in which case the risk of"},{"speaker":"There are two drugs in particular","startTime":1966.62,"endTime":1969.83,"body":"bleeding becomes very high,"},{"speaker":"There are two drugs in particular","startTime":1969.83,"endTime":1973.64,"body":"or is this actually something"},{"speaker":"There are two drugs in particular","startTime":1969.83,"endTime":1973.64,"body":"where the risk is manageable?"},{"speaker":"There are two drugs in particular","startTime":1973.64,"endTime":1976.79,"body":"But most people will have"},{"speaker":"There are two drugs in particular","startTime":1973.64,"endTime":1976.79,"body":"treatment with blood thinners,"},{"speaker":"There are two drugs in particular","startTime":1976.79,"endTime":1979.97,"body":"the old-fashioned one was"},{"speaker":"There are two drugs in particular","startTime":1976.79,"endTime":1979.97,"body":"something called warfarin,"},{"speaker":"There are two drugs in particular","startTime":1979.97,"endTime":1980.99,"body":"it's still used."},{"speaker":"There are two drugs in particular","startTime":1980.99,"endTime":1982.94,"body":"At very high doses, it's a rat killer,"},{"speaker":"There are two drugs in particular","startTime":1982.94,"endTime":1985.16,"body":"for those I'm sure you've heard that,"},{"speaker":"There are two drugs in particular","startTime":1985.16,"endTime":1987.2,"body":"but in the kind of doses we're"},{"speaker":"There are two drugs in particular","startTime":1985.16,"endTime":1987.2,"body":"talking about for humans,"},{"speaker":"There are two drugs in particular","startTime":1987.2,"endTime":1990.5,"body":"much, much lower doses,"},{"speaker":"There are two drugs in particular","startTime":1987.2,"endTime":1990.5,"body":"it just thins the blood."},{"speaker":"There are two drugs in particular","startTime":1990.5,"endTime":1994.01,"body":"And here's a study which"},{"speaker":"There are two drugs in particular","startTime":1990.5,"endTime":1994.01,"body":"compares the rate of stroke"},{"speaker":"There are two drugs in particular","startTime":1994.01,"endTime":1996.2,"body":"in red in people on warfarin,"},{"speaker":"There are two drugs in particular","startTime":1996.2,"endTime":1998.48,"body":"and in blue people who"},{"speaker":"There are two drugs in particular","startTime":1996.2,"endTime":1998.48,"body":"do not have warfarin."},{"speaker":"There are two drugs in particular","startTime":1998.48,"endTime":2000.78,"body":"It really pulls down the rate of stroke"},{"speaker":"There are two drugs in particular","startTime":2000.78,"endTime":2002.26,"body":"in people who got atrial fibrillation"},{"speaker":"There are two drugs in particular","startTime":2002.26,"endTime":2003.94,"body":"and other risk factors."},{"speaker":"There are two drugs in particular","startTime":2003.94,"endTime":2006.76,"body":"You don't need it if you got"},{"speaker":"There are two drugs in particular","startTime":2003.94,"endTime":2006.76,"body":"almost no other risk factors,"},{"speaker":"There are two drugs in particular","startTime":2006.76,"endTime":2008.32,"body":"but if you've got other risk factors,"},{"speaker":"There are two drugs in particular","startTime":2008.32,"endTime":2010.84,"body":"that's what it's used for."},{"speaker":"There are two drugs in particular","startTime":2010.84,"endTime":2011.95,"body":"Warfarin had a disadvantage,"},{"speaker":"There are two drugs in particular","startTime":2011.95,"endTime":2013.99,"body":"and many of you may have had to do this,"},{"speaker":"There are two drugs in particular","startTime":2013.99,"endTime":2015.46,"body":"you had to get it checked the whole time"},{"speaker":"There are two drugs in particular","startTime":2015.46,"endTime":2016.9,"body":"because it went up and"},{"speaker":"There are two drugs in particular","startTime":2015.46,"endTime":2016.9,"body":"down the whole time."},{"speaker":"There are two drugs in particular","startTime":2016.9,"endTime":2018.61,"body":"It's a real pain in the neck, frankly."},{"speaker":"There are two drugs in particular","startTime":2018.61,"endTime":2021.91,"body":"So there's a new class of"},{"speaker":"There are two drugs in particular","startTime":2018.61,"endTime":2021.91,"body":"drugs called the DOACs,"},{"speaker":"There are two drugs in particular","startTime":2021.91,"endTime":2024.64,"body":"directly-acting oral anticoagulants."},{"speaker":"There are two drugs in particular","startTime":2024.64,"endTime":2027.25,"body":"And these are much simpler,"},{"speaker":"There are two drugs in particular","startTime":2024.64,"endTime":2027.25,"body":"you just take them,"},{"speaker":"There are two drugs in particular","startTime":2027.25,"endTime":2029.29,"body":"you don't have to be constantly measuring,"},{"speaker":"There are two drugs in particular","startTime":2029.29,"endTime":2031.213,"body":"and that makes it easier to manage."},{"speaker":"There are two drugs in particular","startTime":2033.28,"endTime":2036.7,"body":"Now a new mechanism, which is very useful"},{"speaker":"There are two drugs in particular","startTime":2036.7,"endTime":2038.44,"body":"for some people with atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":2038.44,"endTime":2041.11,"body":"particularly uncontrolled by drugs."},{"speaker":"There are two drugs in particular","startTime":2041.11,"endTime":2043.12,"body":"When I say new, I'm talking newish,"},{"speaker":"There are two drugs in particular","startTime":2043.12,"endTime":2045.46,"body":"but developing the"},{"speaker":"There are two drugs in particular","startTime":2043.12,"endTime":2045.46,"body":"whole time is to stop it"},{"speaker":"There are two drugs in particular","startTime":2045.46,"endTime":2047.26,"body":"with what's called cardiac ablation."},{"speaker":"There are two drugs in particular","startTime":2048.16,"endTime":2050.53,"body":"And in cardiac ablation what happens is,"},{"speaker":"There are two drugs in particular","startTime":2050.53,"endTime":2052.843,"body":"a catheter is put usually into the groin,"},{"speaker":"There are two drugs in particular","startTime":2054.04,"endTime":2055.75,"body":"put up into the heart,"},{"speaker":"There are two drugs in particular","startTime":2055.75,"endTime":2058.54,"body":"they test various bits"},{"speaker":"There are two drugs in particular","startTime":2055.75,"endTime":2058.54,"body":"of the heart to work out"},{"speaker":"There are two drugs in particular","startTime":2058.54,"endTime":2061.06,"body":"which is the very"},{"speaker":"There are two drugs in particular","startTime":2058.54,"endTime":2061.06,"body":"excitable bit of the heart"},{"speaker":"There are two drugs in particular","startTime":2061.06,"endTime":2062.59,"body":"that's triggering this off."},{"speaker":"There are two drugs in particular","startTime":2062.59,"endTime":2065.8,"body":"And they basically blast"},{"speaker":"There are two drugs in particular","startTime":2062.59,"endTime":2065.8,"body":"it with radio frequency"},{"speaker":"There are two drugs in particular","startTime":2065.8,"endTime":2069.223,"body":"to cause a scar to cause"},{"speaker":"There are two drugs in particular","startTime":2065.8,"endTime":2069.223,"body":"that bit of the heart to die."},{"speaker":"There are two drugs in particular","startTime":2070.42,"endTime":2072.13,"body":"And the hope then is that"},{"speaker":"There are two drugs in particular","startTime":2070.42,"endTime":2072.13,"body":"the rest of the heart"},{"speaker":"There are two drugs in particular","startTime":2072.13,"endTime":2073.27,"body":"will go back to normal"},{"speaker":"There are two drugs in particular","startTime":2073.27,"endTime":2076.66,"body":"because this rogue bit of the"},{"speaker":"There are two drugs in particular","startTime":2073.27,"endTime":2076.66,"body":"heart is no longer working."},{"speaker":"There are two drugs in particular","startTime":2076.66,"endTime":2078.91,"body":"It's extremely sophisticated,"},{"speaker":"There are two drugs in particular","startTime":2078.91,"endTime":2081.46,"body":"it's getting better the whole time."},{"speaker":"There are two drugs in particular","startTime":2081.46,"endTime":2083.68,"body":"For people who have atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":2083.68,"endTime":2086.71,"body":"they may need one or"},{"speaker":"There are two drugs in particular","startTime":2083.68,"endTime":2086.71,"body":"more than one go at this."},{"speaker":"There are two drugs in particular","startTime":2086.71,"endTime":2088.57,"body":"Some of the other things"},{"speaker":"There are two drugs in particular","startTime":2086.71,"endTime":2088.57,"body":"I'll talk about later,"},{"speaker":"There are two drugs in particular","startTime":2088.57,"endTime":2092.32,"body":"usually it's much more common,"},{"speaker":"There are two drugs in particular","startTime":2088.57,"endTime":2092.32,"body":"you can do it in just one go."},{"speaker":"There are two drugs in particular","startTime":2092.32,"endTime":2094.45,"body":"It is a relatively crude idea,"},{"speaker":"There are two drugs in particular","startTime":2094.45,"endTime":2096.49,"body":"in one sense, scarring the heart,"},{"speaker":"There are two drugs in particular","startTime":2096.49,"endTime":2100.03,"body":"but fundamentally if the"},{"speaker":"There are two drugs in particular","startTime":2096.49,"endTime":2100.03,"body":"difference is between this"},{"speaker":"There are two drugs in particular","startTime":2100.03,"endTime":2101.92,"body":"or being atrial fibrillation with a heart"},{"speaker":"There are two drugs in particular","startTime":2101.92,"endTime":2105.67,"body":"much less efficient being on"},{"speaker":"There are two drugs in particular","startTime":2101.92,"endTime":2105.67,"body":"drugs, the risk of stroke,"},{"speaker":"There are two drugs in particular","startTime":2105.67,"endTime":2107.5,"body":"this is for many people the right answer,"},{"speaker":"There are two drugs in particular","startTime":2107.5,"endTime":2109.723,"body":"not by any means all."},{"speaker":"There are two drugs in particular","startTime":2110.62,"endTime":2112.6,"body":"And if they get it wrong,"},{"speaker":"There are two drugs in particular","startTime":2112.6,"endTime":2115.36,"body":"and they prang the pacemaker,"},{"speaker":"There are two drugs in particular","startTime":2112.6,"endTime":2115.36,"body":"which is entirely possible,"},{"speaker":"There are two drugs in particular","startTime":2115.36,"endTime":2118.66,"body":"there maybe a need for an"},{"speaker":"There are two drugs in particular","startTime":2115.36,"endTime":2118.66,"body":"artificial pacemaker afterwards"},{"speaker":"There are two drugs in particular","startTime":2118.66,"endTime":2119.56,"body":"to keep the heart going."},{"speaker":"There are two drugs in particular","startTime":2119.56,"endTime":2121.96,"body":"So this is just you have to think"},{"speaker":"There are two drugs in particular","startTime":2121.96,"endTime":2123.853,"body":"about some of these issues."},{"speaker":"There are two drugs in particular","startTime":2125.56,"endTime":2127.507,"body":"Some people don't have"},{"speaker":"There are two drugs in particular","startTime":2125.56,"endTime":2127.507,"body":"steady atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":2127.507,"endTime":2129.49,"body":"but they do flip in and"},{"speaker":"There are two drugs in particular","startTime":2127.507,"endTime":2129.49,"body":"out of it the whole time,"},{"speaker":"There are two drugs in particular","startTime":2129.49,"endTime":2132.64,"body":"this is called paroxysmal"},{"speaker":"There are two drugs in particular","startTime":2129.49,"endTime":2132.64,"body":"atrial fibrillation."},{"speaker":"There are two drugs in particular","startTime":2132.64,"endTime":2135.14,"body":"And there are several ways"},{"speaker":"There are two drugs in particular","startTime":2132.64,"endTime":2135.14,"body":"this can be dealt with."},{"speaker":"There are two drugs in particular","startTime":2136.3,"endTime":2138.64,"body":"They may be given drugs continuously,"},{"speaker":"There are two drugs in particular","startTime":2138.64,"endTime":2139.93,"body":"so that it's much less likely"},{"speaker":"There are two drugs in particular","startTime":2139.93,"endTime":2141.1,"body":"they go into atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":2141.1,"endTime":2144.4,"body":"they just keep a normal"},{"speaker":"There are two drugs in particular","startTime":2141.1,"endTime":2144.4,"body":"rhythm because of the drugs."},{"speaker":"There are two drugs in particular","startTime":2144.4,"endTime":2146.17,"body":"They may, and this is quite common now"},{"speaker":"There are two drugs in particular","startTime":2146.17,"endTime":2148.18,"body":"be given what's called"},{"speaker":"There are two drugs in particular","startTime":2146.17,"endTime":2148.18,"body":"a pill in the pocket."},{"speaker":"There are two drugs in particular","startTime":2148.18,"endTime":2149.8,"body":"They know when they're"},{"speaker":"There are two drugs in particular","startTime":2148.18,"endTime":2149.8,"body":"getting atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":2149.8,"endTime":2151.69,"body":"they feel they're"},{"speaker":"There are two drugs in particular","startTime":2149.8,"endTime":2151.69,"body":"suddenly short of breath,"},{"speaker":"There are two drugs in particular","startTime":2151.69,"endTime":2154.51,"body":"they can maybe feel their"},{"speaker":"There are two drugs in particular","startTime":2151.69,"endTime":2154.51,"body":"own pulse in some cases,"},{"speaker":"There are two drugs in particular","startTime":2154.51,"endTime":2156.28,"body":"they have the antirrhythmic"},{"speaker":"There are two drugs in particular","startTime":2154.51,"endTime":2156.28,"body":"drug in their pocket,"},{"speaker":"There are two drugs in particular","startTime":2156.28,"endTime":2160.303,"body":"they take the pill, that"},{"speaker":"There are two drugs in particular","startTime":2156.28,"endTime":2160.303,"body":"flips things back to normal."},{"speaker":"There are two drugs in particular","startTime":2161.14,"endTime":2164.23,"body":"Or again, we may use ablation as before,"},{"speaker":"There are two drugs in particular","startTime":2164.23,"endTime":2167.08,"body":"and some of them may need"},{"speaker":"There are two drugs in particular","startTime":2164.23,"endTime":2167.08,"body":"anticoagulation, some may not."},{"speaker":"There are two drugs in particular","startTime":2167.08,"endTime":2169.33,"body":"So this is a variant"},{"speaker":"There are two drugs in particular","startTime":2167.08,"endTime":2169.33,"body":"of atrial fibrillation"},{"speaker":"There are two drugs in particular","startTime":2169.33,"endTime":2170.48,"body":"when it's intermittent."},{"speaker":"There are two drugs in particular","startTime":2174.52,"endTime":2176.74,"body":"And then the final group of arrhythmias"},{"speaker":"There are two drugs in particular","startTime":2176.74,"endTime":2177.573,"body":"I want to talk about,"},{"speaker":"There are two drugs in particular","startTime":2177.573,"endTime":2178.45,"body":"and then I want to talk at the end"},{"speaker":"There are two drugs in particular","startTime":2178.45,"endTime":2180.733,"body":"just a bit about cardiac arrest,"},{"speaker":"There are two drugs in particular","startTime":2181.57,"endTime":2186.57,"body":"is the tachycardias, which"},{"speaker":"There are two drugs in particular","startTime":2181.57,"endTime":2186.57,"body":"are not atrial fibrillation."},{"speaker":"There are two drugs in particular","startTime":2186.94,"endTime":2190.39,"body":"And these are from one of two forms,"},{"speaker":"There are two drugs in particular","startTime":2190.39,"endTime":2192.553,"body":"they're either above the AV node,"},{"speaker":"There are two drugs in particular","startTime":2193.42,"endTime":2196.12,"body":"it's called supraventricular tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2196.12,"endTime":2198.07,"body":"and it's driven from the atrium,"},{"speaker":"There are two drugs in particular","startTime":2198.07,"endTime":2199.99,"body":"or it's driven from below the node,"},{"speaker":"There are two drugs in particular","startTime":2199.99,"endTime":2202.09,"body":"and it's called ventricular tachycardia."},{"speaker":"There are two drugs in particular","startTime":2202.09,"endTime":2205.54,"body":"And the treatment for those"},{"speaker":"There are two drugs in particular","startTime":2202.09,"endTime":2205.54,"body":"is importantly different,"},{"speaker":"There are two drugs in particular","startTime":2205.54,"endTime":2207.84,"body":"both of them lead to the"},{"speaker":"There are two drugs in particular","startTime":2205.54,"endTime":2207.84,"body":"heart going too fast."},{"speaker":"There are two drugs in particular","startTime":2209.38,"endTime":2210.61,"body":"Under ordinary circumstances,"},{"speaker":"There are two drugs in particular","startTime":2210.61,"endTime":2212.32,"body":"you might have a sinus tachycardia."},{"speaker":"There are two drugs in particular","startTime":2212.32,"endTime":2214.69,"body":"Sinus tachycardia is rather"},{"speaker":"There are two drugs in particular","startTime":2212.32,"endTime":2214.69,"body":"like a sinus bradycardia."},{"speaker":"There are two drugs in particular","startTime":2214.69,"endTime":2216.4,"body":"The P waves, the QRS,"},{"speaker":"There are two drugs in particular","startTime":2216.4,"endTime":2221.4,"body":"they're all going along"},{"speaker":"There are two drugs in particular","startTime":2216.4,"endTime":2221.4,"body":"in the ordinary sequence,"},{"speaker":"There are two drugs in particular","startTime":2221.44,"endTime":2223.393,"body":"but the rate is too quick."},{"speaker":"There are two drugs in particular","startTime":2224.62,"endTime":2226.33,"body":"Now this can be for lots of reasons."},{"speaker":"There are two drugs in particular","startTime":2226.33,"endTime":2229.54,"body":"It could be, you've just gone"},{"speaker":"There are two drugs in particular","startTime":2226.33,"endTime":2229.54,"body":"on a run and you're just,"},{"speaker":"There are two drugs in particular","startTime":2229.54,"endTime":2231.67,"body":"that's your heart's just batting along."},{"speaker":"There are two drugs in particular","startTime":2231.67,"endTime":2233.23,"body":"You might have had a really exciting time"},{"speaker":"There are two drugs in particular","startTime":2233.23,"endTime":2234.49,"body":"or you might be incredibly stressed,"},{"speaker":"There are two drugs in particular","startTime":2234.49,"endTime":2237.16,"body":"you're having public exams,"},{"speaker":"There are two drugs in particular","startTime":2234.49,"endTime":2237.16,"body":"or something of that sort."},{"speaker":"There are two drugs in particular","startTime":2237.16,"endTime":2239.41,"body":"It also may be things"},{"speaker":"There are two drugs in particular","startTime":2237.16,"endTime":2239.41,"body":"like sepsis or infection,"},{"speaker":"There are two drugs in particular","startTime":2239.41,"endTime":2241.3,"body":"pulse goes up in those situations."},{"speaker":"There are two drugs in particular","startTime":2241.3,"endTime":2244.51,"body":"It might be blood loss, you've"},{"speaker":"There are two drugs in particular","startTime":2241.3,"endTime":2244.51,"body":"dropped your blood pressure,"},{"speaker":"There are two drugs in particular","startTime":2244.51,"endTime":2246.73,"body":"the heart compensates by speeding up."},{"speaker":"There are two drugs in particular","startTime":2246.73,"endTime":2250.54,"body":"There's lots of reasons, and"},{"speaker":"There are two drugs in particular","startTime":2246.73,"endTime":2250.54,"body":"things like hypothyroidism"},{"speaker":"There are two drugs in particular","startTime":2250.54,"endTime":2253.51,"body":"can also do this hormonal changes."},{"speaker":"There are two drugs in particular","startTime":2253.51,"endTime":2257.17,"body":"If you've got sinus tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2257.17,"endTime":2259.09,"body":"then normally there's a cause for it."},{"speaker":"There are two drugs in particular","startTime":2259.09,"endTime":2261.58,"body":"And if there isn't an"},{"speaker":"There are two drugs in particular","startTime":2259.09,"endTime":2261.58,"body":"obvious reason for it,"},{"speaker":"There are two drugs in particular","startTime":2261.58,"endTime":2264.04,"body":"like someone who has just been exercising,"},{"speaker":"There are two drugs in particular","startTime":2264.04,"endTime":2266.65,"body":"then you need to find the"},{"speaker":"There are two drugs in particular","startTime":2264.04,"endTime":2266.65,"body":"cause and treat the cause."},{"speaker":"There are two drugs in particular","startTime":2266.65,"endTime":2268.36,"body":"The problem isn't the heart here,"},{"speaker":"There are two drugs in particular","startTime":2268.36,"endTime":2271.003,"body":"the heart is responding as"},{"speaker":"There are two drugs in particular","startTime":2268.36,"endTime":2271.003,"body":"the heart should respond,"},{"speaker":"There are two drugs in particular","startTime":2272.17,"endTime":2275.02,"body":"the problem is elsewhere, and"},{"speaker":"There are two drugs in particular","startTime":2272.17,"endTime":2275.02,"body":"you need to look elsewhere."},{"speaker":"There are two drugs in particular","startTime":2276.67,"endTime":2280.03,"body":"But sometimes the problem is"},{"speaker":"There are two drugs in particular","startTime":2276.67,"endTime":2280.03,"body":"the heart has gone too fast,"},{"speaker":"There are two drugs in particular","startTime":2280.03,"endTime":2282.43,"body":"and a common one of these"},{"speaker":"There are two drugs in particular","startTime":2282.43,"endTime":2284.83,"body":"is something called atrial flutter."},{"speaker":"There are two drugs in particular","startTime":2284.83,"endTime":2288.58,"body":"In atrial flutter, the atrium"},{"speaker":"There are two drugs in particular","startTime":2284.83,"endTime":2288.58,"body":"is not twitching like a bag,"},{"speaker":"There are two drugs in particular","startTime":2288.58,"endTime":2292.367,"body":"but is beating at typically"},{"speaker":"There are two drugs in particular","startTime":2288.58,"endTime":2292.367,"body":"somewhere between 280"},{"speaker":"There are two drugs in particular","startTime":2292.367,"endTime":2296.143,"body":"and 300 beats per minute,"},{"speaker":"There are two drugs in particular","startTime":2292.367,"endTime":2296.143,"body":"which is very fast for a human."},{"speaker":"There are two drugs in particular","startTime":2297.19,"endTime":2299.29,"body":"And then what you can get in response"},{"speaker":"There are two drugs in particular","startTime":2299.29,"endTime":2301.96,"body":"is the ventricle might go"},{"speaker":"There are two drugs in particular","startTime":2299.29,"endTime":2301.96,"body":"along at the same rate."},{"speaker":"There are two drugs in particular","startTime":2301.96,"endTime":2304.78,"body":"This poor person has got a heartbeat"},{"speaker":"There are two drugs in particular","startTime":2304.78,"endTime":2306.61,"body":"where their heart is going"},{"speaker":"There are two drugs in particular","startTime":2304.78,"endTime":2306.61,"body":"at 300 beats per minute,"},{"speaker":"There are two drugs in particular","startTime":2306.61,"endTime":2308.92,"body":"that's very, very fast."},{"speaker":"There are two drugs in particular","startTime":2308.92,"endTime":2312.46,"body":"Or it might be two to one"},{"speaker":"There are two drugs in particular","startTime":2308.92,"endTime":2312.46,"body":"block, or three to one block,"},{"speaker":"There are two drugs in particular","startTime":2312.46,"endTime":2313.66,"body":"or a four to one block."},{"speaker":"There are two drugs in particular","startTime":2313.66,"endTime":2315.73,"body":"So this one is a four to one block,"},{"speaker":"There are two drugs in particular","startTime":2315.73,"endTime":2318.28,"body":"and what you can see is the"},{"speaker":"There are two drugs in particular","startTime":2315.73,"endTime":2318.28,"body":"atrial flutter going along"},{"speaker":"There are two drugs in particular","startTime":2318.28,"endTime":2321.07,"body":"what's called a sore tooth pattern here."},{"speaker":"There are two drugs in particular","startTime":2321.07,"endTime":2325.15,"body":"And once every four flutters,"},{"speaker":"There are two drugs in particular","startTime":2325.15,"endTime":2326.77,"body":"you get a ventricular tachycardia."},{"speaker":"There are two drugs in particular","startTime":2326.77,"endTime":2330.07,"body":"Sorry, ventricular contraction rather."},{"speaker":"There are two drugs in particular","startTime":2330.07,"endTime":2333.1,"body":"So there are a variety"},{"speaker":"There are two drugs in particular","startTime":2330.07,"endTime":2333.1,"body":"of ways this can present."},{"speaker":"There are two drugs in particular","startTime":2333.1,"endTime":2334.81,"body":"It's usually a lot easier to terminate"},{"speaker":"There are two drugs in particular","startTime":2334.81,"endTime":2335.71,"body":"than atrial fibrillation."},{"speaker":"There are two drugs in particular","startTime":2335.71,"endTime":2337.87,"body":"If you shock someone, you"},{"speaker":"There are two drugs in particular","startTime":2335.71,"endTime":2337.87,"body":"need less electricity;"},{"speaker":"There are two drugs in particular","startTime":2337.87,"endTime":2341.44,"body":"if you use drugs, you often"},{"speaker":"There are two drugs in particular","startTime":2337.87,"endTime":2341.44,"body":"need less powerful drugs."},{"speaker":"There are two drugs in particular","startTime":2341.44,"endTime":2344.62,"body":"And ablation is appropriate for people"},{"speaker":"There are two drugs in particular","startTime":2344.62,"endTime":2345.58,"body":"who get it the whole time"},{"speaker":"There are two drugs in particular","startTime":2345.58,"endTime":2348.1,"body":"or have it lots of times repeatedly."},{"speaker":"There are two drugs in particular","startTime":2348.1,"endTime":2349.66,"body":"It's usually much more effective"},{"speaker":"There are two drugs in particular","startTime":2349.66,"endTime":2351.22,"body":"than an atrial fibrillation."},{"speaker":"There are two drugs in particular","startTime":2351.22,"endTime":2352.84,"body":"So actually treatment to this"},{"speaker":"There are two drugs in particular","startTime":2352.84,"endTime":2354.733,"body":"is more straightforward in general."},{"speaker":"There are two drugs in particular","startTime":2357.04,"endTime":2358.66,"body":"And then a variety of other forms"},{"speaker":"There are two drugs in particular","startTime":2358.66,"endTime":2361.0,"body":"of supraventricular tachycardia"},{"speaker":"There are two drugs in particular","startTime":2361.0,"endTime":2363.973,"body":"when it comes from above the AV node."},{"speaker":"There are two drugs in particular","startTime":2365.05,"endTime":2367.18,"body":"And they normally cause"},{"speaker":"There are two drugs in particular","startTime":2367.18,"endTime":2371.89,"body":"what in medics called a"},{"speaker":"There are two drugs in particular","startTime":2367.18,"endTime":2371.89,"body":"narrow complex tachycardia."},{"speaker":"There are two drugs in particular","startTime":2371.89,"endTime":2374.89,"body":"This basically means that the QRS complex"},{"speaker":"There are two drugs in particular","startTime":2374.89,"endTime":2376.93,"body":"looks completely normal."},{"speaker":"There are two drugs in particular","startTime":2376.93,"endTime":2379.81,"body":"And that's because once it's"},{"speaker":"There are two drugs in particular","startTime":2376.93,"endTime":2379.81,"body":"gone through the AV node,"},{"speaker":"There are two drugs in particular","startTime":2379.81,"endTime":2382.63,"body":"the ventricle contracts"},{"speaker":"There are two drugs in particular","startTime":2379.81,"endTime":2382.63,"body":"completely normally."},{"speaker":"There are two drugs in particular","startTime":2382.63,"endTime":2386.68,"body":"So it's a normal contraction,"},{"speaker":"There are two drugs in particular","startTime":2382.63,"endTime":2386.68,"body":"it's just going far too fast."},{"speaker":"There are two drugs in particular","startTime":2386.68,"endTime":2389.11,"body":"There are lots of reasons for that."},{"speaker":"There are two drugs in particular","startTime":2389.11,"endTime":2392.2,"body":"They include, you can"},{"speaker":"There are two drugs in particular","startTime":2389.11,"endTime":2392.2,"body":"have an area of the atrium"},{"speaker":"There are two drugs in particular","startTime":2392.2,"endTime":2395.89,"body":"that's firing abnormally fast,"},{"speaker":"There are two drugs in particular","startTime":2392.2,"endTime":2395.89,"body":"so it's going too quickly,"},{"speaker":"There are two drugs in particular","startTime":2395.89,"endTime":2399.07,"body":"but there can also be"},{"speaker":"There are two drugs in particular","startTime":2395.89,"endTime":2399.07,"body":"various forms of reentry"},{"speaker":"There are two drugs in particular","startTime":2399.07,"endTime":2401.47,"body":"where instead of going"},{"speaker":"There are two drugs in particular","startTime":2399.07,"endTime":2401.47,"body":"in a stately progression"},{"speaker":"There are two drugs in particular","startTime":2401.47,"endTime":2403.45,"body":"over the atrium delays,"},{"speaker":"There are two drugs in particular","startTime":2403.45,"endTime":2406.06,"body":"it goes through the AV node contraction,"},{"speaker":"There are two drugs in particular","startTime":2406.06,"endTime":2408.01,"body":"and then a long delay."},{"speaker":"There are two drugs in particular","startTime":2408.01,"endTime":2411.2,"body":"The electrical impulse"},{"speaker":"There are two drugs in particular","startTime":2408.01,"endTime":2411.2,"body":"around the ventricle"},{"speaker":"There are two drugs in particular","startTime":2413.77,"endTime":2418.3,"body":"goes back up again into at"},{"speaker":"There are two drugs in particular","startTime":2413.77,"endTime":2418.3,"body":"some part along the pathway"},{"speaker":"There are two drugs in particular","startTime":2418.3,"endTime":2421.0,"body":"back into the atrium"},{"speaker":"There are two drugs in particular","startTime":2418.3,"endTime":2421.0,"body":"and restarts the thing."},{"speaker":"There are two drugs in particular","startTime":2421.0,"endTime":2423.34,"body":"So essentially taking"},{"speaker":"There are two drugs in particular","startTime":2421.0,"endTime":2423.34,"body":"over from the pacemaker"},{"speaker":"There are two drugs in particular","startTime":2423.34,"endTime":2424.603,"body":"in a continuous loop."},{"speaker":"There are two drugs in particular","startTime":2425.98,"endTime":2430.98,"body":"So, and then there's some"},{"speaker":"There are two drugs in particular","startTime":2425.98,"endTime":2430.98,"body":"genetic forms of this as well."},{"speaker":"There are two drugs in particular","startTime":2433.84,"endTime":2437.02,"body":"Treatment can be very"},{"speaker":"There are two drugs in particular","startTime":2433.84,"endTime":2437.02,"body":"simple in some cases,"},{"speaker":"There are two drugs in particular","startTime":2437.02,"endTime":2439.09,"body":"so the simplest thing to do"},{"speaker":"There are two drugs in particular","startTime":2439.09,"endTime":2442.84,"body":"is to make the parasympathetic"},{"speaker":"There are two drugs in particular","startTime":2439.09,"endTime":2442.84,"body":"system cause an AV block."},{"speaker":"There are two drugs in particular","startTime":2442.84,"endTime":2444.64,"body":"And the simplest way to do that is,"},{"speaker":"There are two drugs in particular","startTime":2444.64,"endTime":2447.79,"body":"you get someone to just close their nose"},{"speaker":"There are two drugs in particular","startTime":2447.79,"endTime":2450.01,"body":"and just breathe against resistance,"},{"speaker":"There are two drugs in particular","startTime":2450.01,"endTime":2451.75,"body":"and then suddenly release it."},{"speaker":"There are two drugs in particular","startTime":2451.75,"endTime":2454.36,"body":"And that can give enough"},{"speaker":"There are two drugs in particular","startTime":2451.75,"endTime":2454.36,"body":"of a parasympathetic jolt"},{"speaker":"There are two drugs in particular","startTime":2454.36,"endTime":2456.16,"body":"that you may break the cycle."},{"speaker":"There are two drugs in particular","startTime":2456.16,"endTime":2456.993,"body":"When you do that,"},{"speaker":"There are two drugs in particular","startTime":2456.993,"endTime":2459.088,"body":"it's unbelievably"},{"speaker":"There are two drugs in particular","startTime":2456.993,"endTime":2459.088,"body":"satisfying for the patient,"},{"speaker":"There are two drugs in particular","startTime":2459.088,"endTime":2459.921,"body":"(audience laughs)"},{"speaker":"There are two drugs in particular","startTime":2459.921,"endTime":2462.07,"body":"and pretty satisfying for"},{"speaker":"There are two drugs in particular","startTime":2459.921,"endTime":2462.07,"body":"the doctor or the nurse."},{"speaker":"There are two drugs in particular","startTime":2462.07,"endTime":2463.81,"body":"I have to say it doesn't"},{"speaker":"There are two drugs in particular","startTime":2462.07,"endTime":2463.81,"body":"happen very often,"},{"speaker":"There are two drugs in particular","startTime":2463.81,"endTime":2465.13,"body":"but when it does, it's great."},{"speaker":"There are two drugs in particular","startTime":2465.13,"endTime":2467.71,"body":"No drugs involved, this"},{"speaker":"There are two drugs in particular","startTime":2465.13,"endTime":2467.71,"body":"is normal physiology,"},{"speaker":"There are two drugs in particular","startTime":2467.71,"endTime":2470.17,"body":"it's done the job it should do."},{"speaker":"There are two drugs in particular","startTime":2470.17,"endTime":2472.45,"body":"If that fails, there are"},{"speaker":"There are two drugs in particular","startTime":2470.17,"endTime":2472.45,"body":"quite a lot of drugs,"},{"speaker":"There are two drugs in particular","startTime":2472.45,"endTime":2474.04,"body":"and I'm not going to go through them,"},{"speaker":"There are two drugs in particular","startTime":2474.04,"endTime":2476.74,"body":"but if you are doctors"},{"speaker":"There are two drugs in particular","startTime":2474.04,"endTime":2476.74,"body":"or nurses, paramedics,"},{"speaker":"There are two drugs in particular","startTime":2476.74,"endTime":2478.12,"body":"you deal with this the whole time,"},{"speaker":"There are two drugs in particular","startTime":2478.12,"endTime":2480.58,"body":"which temporarily block the AV node,"},{"speaker":"There are two drugs in particular","startTime":2480.58,"endTime":2484.06,"body":"and essentially break the cycle of this."},{"speaker":"There are two drugs in particular","startTime":2484.06,"endTime":2486.73,"body":"And if you need to,"},{"speaker":"There are two drugs in particular","startTime":2484.06,"endTime":2486.73,"body":"someone's gone into shock,"},{"speaker":"There are two drugs in particular","startTime":2486.73,"endTime":2489.46,"body":"they're in deep trouble, you"},{"speaker":"There are two drugs in particular","startTime":2486.73,"endTime":2489.46,"body":"can't control it any other way,"},{"speaker":"There are two drugs in particular","startTime":2489.46,"endTime":2491.11,"body":"you give them a shock across the heart,"},{"speaker":"There are two drugs in particular","startTime":2491.11,"endTime":2492.91,"body":"and that usually jumps the heart back"},{"speaker":"There are two drugs in particular","startTime":2492.91,"endTime":2494.44,"body":"into an ordinary rhythm."},{"speaker":"There are two drugs in particular","startTime":2494.44,"endTime":2497.17,"body":"So that's kind of the progression"},{"speaker":"There are two drugs in particular","startTime":2497.17,"endTime":2499.93,"body":"down the more and more invasive things."},{"speaker":"There are two drugs in particular","startTime":2499.93,"endTime":2503.35,"body":"And then they might need"},{"speaker":"There are two drugs in particular","startTime":2499.93,"endTime":2503.35,"body":"drugs for the long-term,"},{"speaker":"There are two drugs in particular","startTime":2503.35,"endTime":2504.76,"body":"this might be just a one-off occasion"},{"speaker":"There are two drugs in particular","startTime":2504.76,"endTime":2505.81,"body":"for a particular reason,"},{"speaker":"There are two drugs in particular","startTime":2505.81,"endTime":2507.13,"body":"it's the first time they've taken cocaine,"},{"speaker":"There are two drugs in particular","startTime":2507.13,"endTime":2508.42,"body":"they promise never to do it again."},{"speaker":"There are two drugs in particular","startTime":2508.42,"endTime":2510.43,"body":"It's a whole variety of different things,"},{"speaker":"There are two drugs in particular","startTime":2510.43,"endTime":2512.17,"body":"but if they're getting it repeatedly,"},{"speaker":"There are two drugs in particular","startTime":2512.17,"endTime":2513.49,"body":"they may need ablation"},{"speaker":"There are two drugs in particular","startTime":2513.49,"endTime":2515.32,"body":"where you actually find the area,"},{"speaker":"There are two drugs in particular","startTime":2515.32,"endTime":2516.94,"body":"which is causing the problem"},{"speaker":"There are two drugs in particular","startTime":2516.94,"endTime":2518.95,"body":"and scar it in the way I've talked about."},{"speaker":"There are two drugs in particular","startTime":2518.95,"endTime":2520.57,"body":"So that tends to be"},{"speaker":"There are two drugs in particular","startTime":2520.57,"endTime":2522.823,"body":"the longer term solution for many people."},{"speaker":"There are two drugs in particular","startTime":2524.92,"endTime":2527.32,"body":"And then below the atrium,"},{"speaker":"There are two drugs in particular","startTime":2527.32,"endTime":2528.88,"body":"you then get ventricular tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2528.88,"endTime":2531.19,"body":"and this is coming from the"},{"speaker":"There are two drugs in particular","startTime":2528.88,"endTime":2531.19,"body":"wrong bit of the ventricle,"},{"speaker":"There are two drugs in particular","startTime":2531.19,"endTime":2533.83,"body":"So it's getting conducted the wrong way,"},{"speaker":"There are two drugs in particular","startTime":2533.83,"endTime":2536.11,"body":"and the result is you get that nice QRS,"},{"speaker":"There are two drugs in particular","startTime":2536.11,"endTime":2537.64,"body":"and really, really sharp."},{"speaker":"There are two drugs in particular","startTime":2537.64,"endTime":2539.86,"body":"It's over a much broader area."},{"speaker":"There are two drugs in particular","startTime":2539.86,"endTime":2541.51,"body":"This is generally more dangerous"},{"speaker":"There are two drugs in particular","startTime":2541.51,"endTime":2543.31,"body":"than supraventricular tachycardia."},{"speaker":"There are two drugs in particular","startTime":2543.31,"endTime":2544.75,"body":"The rate may be the same,"},{"speaker":"There are two drugs in particular","startTime":2544.75,"endTime":2548.11,"body":"but the ventricle itself is"},{"speaker":"There are two drugs in particular","startTime":2544.75,"endTime":2548.11,"body":"going in a very inefficient way,"},{"speaker":"There are two drugs in particular","startTime":2548.11,"endTime":2550.873,"body":"and these people tend to need"},{"speaker":"There are two drugs in particular","startTime":2548.11,"endTime":2550.873,"body":"treatment pretty rapidly."},{"speaker":"There are two drugs in particular","startTime":2552.1,"endTime":2557.083,"body":"Sometimes they will be"},{"speaker":"There are two drugs in particular","startTime":2552.1,"endTime":2557.083,"body":"possible to treat with drugs."},{"speaker":"There are two drugs in particular","startTime":2558.55,"endTime":2562.51,"body":"And the most commonly used one still"},{"speaker":"There are two drugs in particular","startTime":2562.51,"endTime":2564.55,"body":"is a drug called amiodarone."},{"speaker":"There are two drugs in particular","startTime":2564.55,"endTime":2565.96,"body":"It's a fantastic drug actually,"},{"speaker":"There are two drugs in particular","startTime":2565.96,"endTime":2568.3,"body":"it works really well against"},{"speaker":"There are two drugs in particular","startTime":2565.96,"endTime":2568.3,"body":"paroxysmal atrial fibrillation"},{"speaker":"There are two drugs in particular","startTime":2568.3,"endTime":2570.1,"body":"against supraventricular tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2570.1,"endTime":2574.75,"body":"against ventricular tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2570.1,"endTime":2574.75,"body":"but it has side effects."},{"speaker":"There are two drugs in particular","startTime":2574.75,"endTime":2576.46,"body":"And some of them come from the fact"},{"speaker":"There are two drugs in particular","startTime":2576.46,"endTime":2578.32,"body":"it's got two iodines here,"},{"speaker":"There are two drugs in particular","startTime":2578.32,"endTime":2580.33,"body":"which mean it causes"},{"speaker":"There are two drugs in particular","startTime":2578.32,"endTime":2580.33,"body":"problems with thyroid gland,"},{"speaker":"There are two drugs in particular","startTime":2580.33,"endTime":2581.8,"body":"it can cause problems with the lung,"},{"speaker":"There are two drugs in particular","startTime":2581.8,"endTime":2584.29,"body":"it can make your skin look"},{"speaker":"There are two drugs in particular","startTime":2581.8,"endTime":2584.29,"body":"a rather strange gray color."},{"speaker":"There are two drugs in particular","startTime":2584.29,"endTime":2587.05,"body":"So it's not a drug, it's"},{"speaker":"There are two drugs in particular","startTime":2584.29,"endTime":2587.05,"body":"a drug you use to care,"},{"speaker":"There are two drugs in particular","startTime":2587.05,"endTime":2588.7,"body":"but it is an incredibly effective drug."},{"speaker":"There are two drugs in particular","startTime":2588.7,"endTime":2593.02,"body":"In an emergency, it's a really"},{"speaker":"There are two drugs in particular","startTime":2588.7,"endTime":2593.02,"body":"good drug if you have time."},{"speaker":"There are two drugs in particular","startTime":2593.02,"endTime":2594.52,"body":"But if you don't have time,"},{"speaker":"There are two drugs in particular","startTime":2594.52,"endTime":2597.1,"body":"and for ventricular tachycardia"},{"speaker":"There are two drugs in particular","startTime":2594.52,"endTime":2597.1,"body":"you often don't have time,"},{"speaker":"There are two drugs in particular","startTime":2597.1,"endTime":2600.49,"body":"it's shock, that's the"},{"speaker":"There are two drugs in particular","startTime":2597.1,"endTime":2600.49,"body":"thing you default to,"},{"speaker":"There are two drugs in particular","startTime":2600.49,"endTime":2604.03,"body":"if things are going wrong,"},{"speaker":"There are two drugs in particular","startTime":2600.49,"endTime":2604.03,"body":"or if all other things fail."},{"speaker":"There are two drugs in particular","startTime":2604.03,"endTime":2605.38,"body":"Shock across the heart,"},{"speaker":"There are two drugs in particular","startTime":2605.38,"endTime":2608.053,"body":"so-called synchronized DC cardioversion."},{"speaker":"There are two drugs in particular","startTime":2610.24,"endTime":2612.22,"body":"Occasionally you do also need pacemakers"},{"speaker":"There are two drugs in particular","startTime":2612.22,"endTime":2614.41,"body":"when people have got a tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2614.41,"endTime":2616.6,"body":"and the situations you do them are,"},{"speaker":"There are two drugs in particular","startTime":2616.6,"endTime":2618.43,"body":"you might do what's called block and pace."},{"speaker":"There are two drugs in particular","startTime":2618.43,"endTime":2622.15,"body":"You give someone a drug"},{"speaker":"There are two drugs in particular","startTime":2618.43,"endTime":2622.15,"body":"to slow the heart down,"},{"speaker":"There are two drugs in particular","startTime":2622.15,"endTime":2625.18,"body":"and you give them a pacemaker"},{"speaker":"There are two drugs in particular","startTime":2622.15,"endTime":2625.18,"body":"in case you go too far."},{"speaker":"There are two drugs in particular","startTime":2625.18,"endTime":2628.57,"body":"So it basically provides"},{"speaker":"There are two drugs in particular","startTime":2625.18,"endTime":2628.57,"body":"a ceiling and a floor"},{"speaker":"There are two drugs in particular","startTime":2628.57,"endTime":2630.583,"body":"on the rate of the heart."},{"speaker":"There are two drugs in particular","startTime":2631.75,"endTime":2633.67,"body":"Sometimes when cardiac ablation"},{"speaker":"There are two drugs in particular","startTime":2633.67,"endTime":2635.683,"body":"hits the wrong bit of the system,"},{"speaker":"There are two drugs in particular","startTime":2636.61,"endTime":2639.97,"body":"the heart may go too slowly,"},{"speaker":"There are two drugs in particular","startTime":2636.61,"endTime":2639.97,"body":"so you may ablate and pace."},{"speaker":"There are two drugs in particular","startTime":2639.97,"endTime":2643.39,"body":"And then some people have a"},{"speaker":"There are two drugs in particular","startTime":2639.97,"endTime":2643.39,"body":"rhythm that needs shocking,"},{"speaker":"There are two drugs in particular","startTime":2643.39,"endTime":2645.79,"body":"and they have an"},{"speaker":"There are two drugs in particular","startTime":2643.39,"endTime":2645.79,"body":"implantable defibrillator."},{"speaker":"There are two drugs in particular","startTime":2645.79,"endTime":2648.79,"body":"They looks actually not"},{"speaker":"There are two drugs in particular","startTime":2645.79,"endTime":2648.79,"body":"particularly different"},{"speaker":"There are two drugs in particular","startTime":2648.79,"endTime":2651.58,"body":"to the untrained eye from"},{"speaker":"There are two drugs in particular","startTime":2648.79,"endTime":2651.58,"body":"an ordinary pacemaker,"},{"speaker":"There are two drugs in particular","startTime":2651.58,"endTime":2652.96,"body":"it has thicker leads in a variety..."},{"speaker":"There are two drugs in particular","startTime":2652.96,"endTime":2655.99,"body":"This is a implantable defibrillator here."},{"speaker":"There are two drugs in particular","startTime":2655.99,"endTime":2657.73,"body":"And that actually when it senses"},{"speaker":"There are two drugs in particular","startTime":2657.73,"endTime":2659.95,"body":"that someone's going into"},{"speaker":"There are two drugs in particular","startTime":2657.73,"endTime":2659.95,"body":"ventricular tachycardia,"},{"speaker":"There are two drugs in particular","startTime":2659.95,"endTime":2662.44,"body":"it gives them a shock"},{"speaker":"There are two drugs in particular","startTime":2659.95,"endTime":2662.44,"body":"straight into the heart,"},{"speaker":"There are two drugs in particular","startTime":2662.44,"endTime":2664.24,"body":"and terminates it."},{"speaker":"There are two drugs in particular","startTime":2664.24,"endTime":2665.8,"body":"So those are a variety of ways"},{"speaker":"There are two drugs in particular","startTime":2665.8,"endTime":2669.763,"body":"pacemakers can be useful"},{"speaker":"There are two drugs in particular","startTime":2665.8,"endTime":2669.763,"body":"even in a tachycardia."},{"speaker":"There are two drugs in particular","startTime":2672.79,"endTime":2674.02,"body":"Finally in terms of the rhythms,"},{"speaker":"There are two drugs in particular","startTime":2674.02,"endTime":2677.56,"body":"I'd just like to obviously go"},{"speaker":"There are two drugs in particular","startTime":2674.02,"endTime":2677.56,"body":"onto the most severe of these,"},{"speaker":"There are two drugs in particular","startTime":2677.56,"endTime":2678.943,"body":"which is cardiac arrest."},{"speaker":"There are two drugs in particular","startTime":2679.84,"endTime":2682.63,"body":"And cardiac arrest can"},{"speaker":"There are two drugs in particular","startTime":2679.84,"endTime":2682.63,"body":"happen for multiple reasons."},{"speaker":"There are two drugs in particular","startTime":2682.63,"endTime":2685.63,"body":"Not all of them coming in fact in practice"},{"speaker":"There are two drugs in particular","startTime":2685.63,"endTime":2686.86,"body":"from the heart itself,"},{"speaker":"There are two drugs in particular","startTime":2686.86,"endTime":2689.62,"body":"but when it does coming from the heart,"},{"speaker":"There are two drugs in particular","startTime":2689.62,"endTime":2691.96,"body":"what people have is they collapse,"},{"speaker":"There are two drugs in particular","startTime":2691.96,"endTime":2694.12,"body":"and you feel their pulse"},{"speaker":"There are two drugs in particular","startTime":2691.96,"endTime":2694.12,"body":"and they have no pulse,"},{"speaker":"There are two drugs in particular","startTime":2694.12,"endTime":2695.5,"body":"and you can actually"},{"speaker":"There are two drugs in particular","startTime":2694.12,"endTime":2695.5,"body":"see them walking along"},{"speaker":"There are two drugs in particular","startTime":2695.5,"endTime":2697.54,"body":"and suddenly they collapse,"},{"speaker":"There are two drugs in particular","startTime":2697.54,"endTime":2701.08,"body":"or they're often in ICCU if"},{"speaker":"There are two drugs in particular","startTime":2697.54,"endTime":2701.08,"body":"they just had a heart attack"},{"speaker":"There are two drugs in particular","startTime":2701.08,"endTime":2703.73,"body":"because heart attacks are"},{"speaker":"There are two drugs in particular","startTime":2701.08,"endTime":2703.73,"body":"one of the commonest causes"},{"speaker":"There are two drugs in particular","startTime":2704.65,"endTime":2706.96,"body":"that precede cardiac arrest."},{"speaker":"There are two drugs in particular","startTime":2706.96,"endTime":2709.84,"body":"And they may well have what's"},{"speaker":"There are two drugs in particular","startTime":2706.96,"endTime":2709.84,"body":"called a shockable rhythm,"},{"speaker":"There are two drugs in particular","startTime":2709.84,"endTime":2712.12,"body":"and the shockable rhythms are usually"},{"speaker":"There are two drugs in particular","startTime":2712.12,"endTime":2714.31,"body":"either something called a"},{"speaker":"There are two drugs in particular","startTime":2712.12,"endTime":2714.31,"body":"ventricular fibrillation."},{"speaker":"There are two drugs in particular","startTime":2714.31,"endTime":2716.77,"body":"It's like atrial fibrillation,"},{"speaker":"There are two drugs in particular","startTime":2714.31,"endTime":2716.77,"body":"but on a grand scale."},{"speaker":"There are two drugs in particular","startTime":2716.77,"endTime":2719.29,"body":"Now the ventricle is twitching like a bag,"},{"speaker":"There are two drugs in particular","startTime":2719.29,"endTime":2723.07,"body":"so the whole system is no"},{"speaker":"There are two drugs in particular","startTime":2719.29,"endTime":2723.07,"body":"longer working properly."},{"speaker":"There are two drugs in particular","startTime":2723.07,"endTime":2724.69,"body":"Or they might have what's called"},{"speaker":"There are two drugs in particular","startTime":2724.69,"endTime":2726.67,"body":"pulseless ventricular tachycardia."},{"speaker":"There are two drugs in particular","startTime":2726.67,"endTime":2728.98,"body":"It is beating along, but there isn't a..."},{"speaker":"There are two drugs in particular","startTime":2728.98,"endTime":2730.45,"body":"It is not, it's so inefficient"},{"speaker":"There are two drugs in particular","startTime":2730.45,"endTime":2732.28,"body":"that there isn't a pulse to feel."},{"speaker":"There are two drugs in particular","startTime":2732.28,"endTime":2733.81,"body":"In either of those situations,"},{"speaker":"There are two drugs in particular","startTime":2733.81,"endTime":2735.94,"body":"a paramedic or a doctor or a nurse"},{"speaker":"There are two drugs in particular","startTime":2735.94,"endTime":2737.59,"body":"is going to put a shock across the heart."},{"speaker":"There are two drugs in particular","startTime":2737.59,"endTime":2741.58,"body":"That's basically the way"},{"speaker":"There are two drugs in particular","startTime":2737.59,"endTime":2741.58,"body":"you try and terminate this."},{"speaker":"There are two drugs in particular","startTime":2741.58,"endTime":2742.66,"body":"It doesn't always work,"},{"speaker":"There are two drugs in particular","startTime":2742.66,"endTime":2746.02,"body":"but it does in a"},{"speaker":"There are two drugs in particular","startTime":2742.66,"endTime":2746.02,"body":"significant number of cases,"},{"speaker":"There are two drugs in particular","startTime":2746.02,"endTime":2747.073,"body":"if it's caught early."},{"speaker":"There are two drugs in particular","startTime":2748.48,"endTime":2750.01,"body":"So what you do if you come across this?"},{"speaker":"There are two drugs in particular","startTime":2750.01,"endTime":2752.41,"body":"Well, the key skill is CPR."},{"speaker":"There are two drugs in particular","startTime":2752.41,"endTime":2755.443,"body":"This is a first aid skill,"},{"speaker":"There are two drugs in particular","startTime":2752.41,"endTime":2755.443,"body":"is actually pretty easy."},{"speaker":"There are two drugs in particular","startTime":2756.28,"endTime":2758.11,"body":"And I would strongly recommend anybody,"},{"speaker":"There are two drugs in particular","startTime":2758.11,"endTime":2761.56,"body":"you can go on a St. John's"},{"speaker":"There are two drugs in particular","startTime":2758.11,"endTime":2761.56,"body":"ambulance or other course,"},{"speaker":"There are two drugs in particular","startTime":2761.56,"endTime":2763.12,"body":"and learn the basics of CPR"},{"speaker":"There are two drugs in particular","startTime":2763.12,"endTime":2764.2,"body":"because if someone collapses,"},{"speaker":"There are two drugs in particular","startTime":2764.2,"endTime":2766.21,"body":"this can be literally lifesaving."},{"speaker":"There are two drugs in particular","startTime":2766.21,"endTime":2767.043,"body":"There are relatively few things"},{"speaker":"There are two drugs in particular","startTime":2767.043,"endTime":2769.483,"body":"that are literally lifesaving,"},{"speaker":"There are two drugs in particular","startTime":2767.043,"endTime":2769.483,"body":"this is one of them."},{"speaker":"There are two drugs in particular","startTime":2770.68,"endTime":2773.41,"body":"And what you do is you"},{"speaker":"There are two drugs in particular","startTime":2770.68,"endTime":2773.41,"body":"are pumping the chest"},{"speaker":"There are two drugs in particular","startTime":2773.41,"endTime":2776.62,"body":"as a way of causing"},{"speaker":"There are two drugs in particular","startTime":2773.41,"endTime":2776.62,"body":"enough blood to circulate"},{"speaker":"There are two drugs in particular","startTime":2776.62,"endTime":2778.93,"body":"around the body to keep"},{"speaker":"There are two drugs in particular","startTime":2776.62,"endTime":2778.93,"body":"the brain, the kidneys,"},{"speaker":"There are two drugs in particular","startTime":2778.93,"endTime":2782.11,"body":"the vital organs alive"},{"speaker":"There are two drugs in particular","startTime":2778.93,"endTime":2782.11,"body":"whilst waiting for help."},{"speaker":"There are two drugs in particular","startTime":2782.11,"endTime":2784.24,"body":"So stage one call for help"},{"speaker":"There are two drugs in particular","startTime":2784.24,"endTime":2786.13,"body":"or call to someone else to call for help."},{"speaker":"There are two drugs in particular","startTime":2786.13,"endTime":2789.16,"body":"Stage two, you start pumping on the chest."},{"speaker":"There are two drugs in particular","startTime":2789.16,"endTime":2791.08,"body":"And if you've recently"},{"speaker":"There are two drugs in particular","startTime":2789.16,"endTime":2791.08,"body":"done your refresher course,"},{"speaker":"There are two drugs in particular","startTime":2791.08,"endTime":2792.64,"body":"and you feel confident,"},{"speaker":"There are two drugs in particular","startTime":2792.64,"endTime":2795.46,"body":"you can do what we used to"},{"speaker":"There are two drugs in particular","startTime":2792.64,"endTime":2795.46,"body":"call \"The Breath of Life\""},{"speaker":"There are two drugs in particular","startTime":2795.46,"endTime":2797.8,"body":"where you breathe in and out of the chest,"},{"speaker":"There are two drugs in particular","startTime":2797.8,"endTime":2799.54,"body":"but I wouldn't recommend"},{"speaker":"There are two drugs in particular","startTime":2797.8,"endTime":2799.54,"body":"that if you've never done it"},{"speaker":"There are two drugs in particular","startTime":2799.54,"endTime":2801.25,"body":"except watching a YouTube video."},{"speaker":"There are two drugs in particular","startTime":2801.25,"endTime":2803.17,"body":"Pumping the chest is easy,"},{"speaker":"There are two drugs in particular","startTime":2803.17,"endTime":2807.463,"body":"coordinating it with the"},{"speaker":"There are two drugs in particular","startTime":2803.17,"endTime":2807.463,"body":"breathing is a bit more difficult."},{"speaker":"There are two drugs in particular","startTime":2808.6,"endTime":2812.23,"body":"But the CPR is really critical"},{"speaker":"There are two drugs in particular","startTime":2808.6,"endTime":2812.23,"body":"and can keep people alive"},{"speaker":"There are two drugs in particular","startTime":2812.23,"endTime":2814.0,"body":"for really quite a long period of time."},{"speaker":"There are two drugs in particular","startTime":2814.0,"endTime":2817.453,"body":"So it's a very effective holding maneuver."},{"speaker":"There are two drugs in particular","startTime":2818.53,"endTime":2821.2,"body":"And then what we are"},{"speaker":"There are two drugs in particular","startTime":2818.53,"endTime":2821.2,"body":"holding for in most cases"},{"speaker":"There are two drugs in particular","startTime":2821.2,"endTime":2825.487,"body":"is a combination of drugs,"},{"speaker":"There are two drugs in particular","startTime":2821.2,"endTime":2825.487,"body":"in some cases and shocking."},{"speaker":"There are two drugs in particular","startTime":2825.487,"endTime":2827.71,"body":"Now if a paramedic turns"},{"speaker":"There are two drugs in particular","startTime":2825.487,"endTime":2827.71,"body":"up in an ambulance,"},{"speaker":"There are two drugs in particular","startTime":2827.71,"endTime":2829.39,"body":"if you're in a hospital and"},{"speaker":"There are two drugs in particular","startTime":2827.71,"endTime":2829.39,"body":"you're dealing with doctors"},{"speaker":"There are two drugs in particular","startTime":2829.39,"endTime":2832.69,"body":"and nurses, they will do"},{"speaker":"There are two drugs in particular","startTime":2829.39,"endTime":2832.69,"body":"this, they're very used to it."},{"speaker":"There are two drugs in particular","startTime":2832.69,"endTime":2834.16,"body":"People who are doctors or nurses"},{"speaker":"There are two drugs in particular","startTime":2834.16,"endTime":2835.9,"body":"are used to crash teams the whole time."},{"speaker":"There are two drugs in particular","startTime":2835.9,"endTime":2837.43,"body":"It's a very, very standardized,"},{"speaker":"There are two drugs in particular","startTime":2837.43,"endTime":2840.13,"body":"we're all taught in an"},{"speaker":"There are two drugs in particular","startTime":2837.43,"endTime":2840.13,"body":"incredibly regimented way,"},{"speaker":"There are two drugs in particular","startTime":2840.13,"endTime":2841.9,"body":"whether it's me or the"},{"speaker":"There are two drugs in particular","startTime":2840.13,"endTime":2841.9,"body":"first day house officer,"},{"speaker":"There are two drugs in particular","startTime":2841.9,"endTime":2843.79,"body":"we're all taught exactly the same thing."},{"speaker":"There are two drugs in particular","startTime":2843.79,"endTime":2845.74,"body":"So we can go to any"},{"speaker":"There are two drugs in particular","startTime":2843.79,"endTime":2845.74,"body":"hospital, cardiac arrest,"},{"speaker":"There are two drugs in particular","startTime":2845.74,"endTime":2847.15,"body":"you all do the same thing."},{"speaker":"There are two drugs in particular","startTime":2847.15,"endTime":2848.62,"body":"It's very, very regimented,"},{"speaker":"There are two drugs in particular","startTime":2848.62,"endTime":2850.3,"body":"and usually taught by paramedics,"},{"speaker":"There are two drugs in particular","startTime":2850.3,"endTime":2852.49,"body":"they're much better than"},{"speaker":"There are two drugs in particular","startTime":2850.3,"endTime":2852.49,"body":"doctors at emergencies."},{"speaker":"There are two drugs in particular","startTime":2852.49,"endTime":2853.603,"body":"That's just a reality."},{"speaker":"There are two drugs in particular","startTime":2854.44,"endTime":2856.27,"body":"If there are any doctors,"},{"speaker":"There are two drugs in particular","startTime":2854.44,"endTime":2856.27,"body":"you can hit me afterwards,"},{"speaker":"There are two drugs in particular","startTime":2856.27,"endTime":2857.923,"body":"but it's true, speaking as one."},{"speaker":"There are two drugs in particular","startTime":2859.12,"endTime":2861.43,"body":"They may use drugs, but"},{"speaker":"There are two drugs in particular","startTime":2859.12,"endTime":2861.43,"body":"what you can also have"},{"speaker":"There are two drugs in particular","startTime":2861.43,"endTime":2866.43,"body":"in outdoor settings is you"},{"speaker":"There are two drugs in particular","startTime":2861.43,"endTime":2866.43,"body":"can have defibrillators,"},{"speaker":"There are two drugs in particular","startTime":2866.74,"endTime":2870.7,"body":"which are in many public buildings,"},{"speaker":"There are two drugs in particular","startTime":2870.7,"endTime":2872.92,"body":"and they're usually well-marked,"},{"speaker":"There are two drugs in particular","startTime":2872.92,"endTime":2873.79,"body":"and they're not..."},{"speaker":"There are two drugs in particular","startTime":2873.79,"endTime":2875.65,"body":"What they're designed for"},{"speaker":"There are two drugs in particular","startTime":2873.79,"endTime":2875.65,"body":"is you just need to know"},{"speaker":"There are two drugs in particular","startTime":2875.65,"endTime":2876.61,"body":"where to put the pads,"},{"speaker":"There are two drugs in particular","startTime":2876.61,"endTime":2879.1,"body":"which is one side of"},{"speaker":"There are two drugs in particular","startTime":2876.61,"endTime":2879.1,"body":"the heart and the other,"},{"speaker":"There are two drugs in particular","startTime":2879.1,"endTime":2881.23,"body":"and you turn the thing on,"},{"speaker":"There are two drugs in particular","startTime":2879.1,"endTime":2881.23,"body":"and it will talk to you,"},{"speaker":"There are two drugs in particular","startTime":2881.23,"endTime":2883.713,"body":"and it'll tell you, \"Stand Back.\""},{"speaker":"There are two drugs in particular","startTime":2883.713,"endTime":2884.71,"body":"(audience member laughs)"},{"speaker":"There are two drugs in particular","startTime":2883.713,"endTime":2884.71,"body":"When it says that,"},{"speaker":"There are two drugs in particular","startTime":2884.71,"endTime":2887.02,"body":"please do what it says. (laughs)"},{"speaker":"There are two drugs in particular","startTime":2887.02,"endTime":2887.98,"body":"And then it will give a shock,"},{"speaker":"There are two drugs in particular","startTime":2887.98,"endTime":2889.72,"body":"if it thinks a shock is appropriate."},{"speaker":"There are two drugs in particular","startTime":2889.72,"endTime":2892.24,"body":"So these are really clever"},{"speaker":"There are two drugs in particular","startTime":2889.72,"endTime":2892.24,"body":"bits of kit actually,"},{"speaker":"There are two drugs in particular","startTime":2892.24,"endTime":2893.41,"body":"and they mean that you don't have"},{"speaker":"There are two drugs in particular","startTime":2893.41,"endTime":2894.85,"body":"to have training in using them."},{"speaker":"There are two drugs in particular","startTime":2894.85,"endTime":2897.46,"body":"The main thing you ought to do is CPR,"},{"speaker":"There are two drugs in particular","startTime":2897.46,"endTime":2899.17,"body":"and then stand away when"},{"speaker":"There are two drugs in particular","startTime":2897.46,"endTime":2899.17,"body":"the shock's going to happen"},{"speaker":"There are two drugs in particular","startTime":2899.17,"endTime":2900.7,"body":"because you don't want the"},{"speaker":"There are two drugs in particular","startTime":2899.17,"endTime":2900.7,"body":"shock to go through you."},{"speaker":"There are two drugs in particular","startTime":2900.7,"endTime":2902.383,"body":"That's not a good outcome."},{"speaker":"There are two drugs in particular","startTime":2904.0,"endTime":2907.24,"body":"And this can be, if it's done"},{"speaker":"There are two drugs in particular","startTime":2904.0,"endTime":2907.24,"body":"quickly, highly effective,"},{"speaker":"There are two drugs in particular","startTime":2907.24,"endTime":2910.36,"body":"but most people who have cardiac arrest"},{"speaker":"There are two drugs in particular","startTime":2910.36,"endTime":2912.64,"body":"who've had a long period between collapse"},{"speaker":"There are two drugs in particular","startTime":2912.64,"endTime":2916.27,"body":"and starting CPR will have"},{"speaker":"There are two drugs in particular","startTime":2912.64,"endTime":2916.27,"body":"very, very bad outcomes."},{"speaker":"There are two drugs in particular","startTime":2916.27,"endTime":2919.9,"body":"So it's all about speed, essentially."},{"speaker":"There are two drugs in particular","startTime":2919.9,"endTime":2924.4,"body":"Important to say that"},{"speaker":"There are two drugs in particular","startTime":2919.9,"endTime":2924.4,"body":"many people in hospital"},{"speaker":"There are two drugs in particular","startTime":2924.4,"endTime":2926.29,"body":"worry when someone says to them,"},{"speaker":"There are two drugs in particular","startTime":2926.29,"endTime":2930.46,"body":"do you want your relative"},{"speaker":"There are two drugs in particular","startTime":2926.29,"endTime":2930.46,"body":"to have a resuscitation?"},{"speaker":"There are two drugs in particular","startTime":2930.46,"endTime":2932.08,"body":"And the conversation can"},{"speaker":"There are two drugs in particular","startTime":2930.46,"endTime":2932.08,"body":"be for lots of reasons,"},{"speaker":"There are two drugs in particular","startTime":2932.08,"endTime":2933.31,"body":"but usually it's because you think"},{"speaker":"There are two drugs in particular","startTime":2933.31,"endTime":2935.68,"body":"someone who has not got"},{"speaker":"There are two drugs in particular","startTime":2933.31,"endTime":2935.68,"body":"going to have one of these."},{"speaker":"There are two drugs in particular","startTime":2935.68,"endTime":2937.93,"body":"If they die, they've died."},{"speaker":"There are two drugs in particular","startTime":2937.93,"endTime":2939.1,"body":"And shocking someone who's dead"},{"speaker":"There are two drugs in particular","startTime":2939.1,"endTime":2940.51,"body":"does not do them any good at all."},{"speaker":"There are two drugs in particular","startTime":2940.51,"endTime":2942.4,"body":"It just is undignified"},{"speaker":"There are two drugs in particular","startTime":2942.4,"endTime":2944.77,"body":"as a way for someone to end their days."},{"speaker":"There are two drugs in particular","startTime":2944.77,"endTime":2946.93,"body":"So it's really a conversation about,"},{"speaker":"There are two drugs in particular","startTime":2946.93,"endTime":2948.22,"body":"this isn't just after a heart attack,"},{"speaker":"There are two drugs in particular","startTime":2948.22,"endTime":2950.08,"body":"but we think a cardiac arrest is likely,"},{"speaker":"There are two drugs in particular","startTime":2950.08,"endTime":2952.66,"body":"this is a different pathway"},{"speaker":"There are two drugs in particular","startTime":2952.66,"endTime":2954.76,"body":"because things are not looking too great,"},{"speaker":"There are two drugs in particular","startTime":2954.76,"endTime":2958.06,"body":"so there's a reason for"},{"speaker":"There are two drugs in particular","startTime":2954.76,"endTime":2958.06,"body":"those conversations."},{"speaker":"There are two drugs in particular","startTime":2958.06,"endTime":2961.72,"body":"In the great majority of the films,"},{"speaker":"There are two drugs in particular","startTime":2961.72,"endTime":2964.12,"body":"the shock is 100% successful."},{"speaker":"There are two drugs in particular","startTime":2961.72,"endTime":2964.12,"body":"(audience laughs)"},{"speaker":"There are two drugs in particular","startTime":2964.12,"endTime":2967.48,"body":"In reality, it's only under a"},{"speaker":"There are two drugs in particular","startTime":2964.12,"endTime":2967.48,"body":"narrow range of circumstances"},{"speaker":"There are two drugs in particular","startTime":2967.48,"endTime":2969.19,"body":"that it is likely to work."},{"speaker":"There are two drugs in particular","startTime":2969.19,"endTime":2972.19,"body":"And that conversation is"},{"speaker":"There are two drugs in particular","startTime":2969.19,"endTime":2972.19,"body":"an important one to have,"},{"speaker":"There are two drugs in particular","startTime":2972.19,"endTime":2974.49,"body":"all of us will reach"},{"speaker":"There are two drugs in particular","startTime":2972.19,"endTime":2974.49,"body":"this stage at some stage."},{"speaker":"There are two drugs in particular","startTime":2976.48,"endTime":2978.01,"body":"And then I haven't talked"},{"speaker":"There are two drugs in particular","startTime":2976.48,"endTime":2978.01,"body":"very much about prevention,"},{"speaker":"There are two drugs in particular","startTime":2978.01,"endTime":2979.48,"body":"I'm only going to do"},{"speaker":"There are two drugs in particular","startTime":2978.01,"endTime":2979.48,"body":"one slide on prevention"},{"speaker":"There are two drugs in particular","startTime":2979.48,"endTime":2980.65,"body":"before I summarize."},{"speaker":"There are two drugs in particular","startTime":2980.65,"endTime":2983.68,"body":"And that's because I covered"},{"speaker":"There are two drugs in particular","startTime":2980.65,"endTime":2983.68,"body":"really in the last talk"},{"speaker":"There are two drugs in particular","startTime":2983.68,"endTime":2985.36,"body":"a whole lot about prevention."},{"speaker":"There are two drugs in particular","startTime":2985.36,"endTime":2987.37,"body":"The things that prevent"},{"speaker":"There are two drugs in particular","startTime":2985.36,"endTime":2987.37,"body":"coronary heart disease"},{"speaker":"There are two drugs in particular","startTime":2987.37,"endTime":2988.48,"body":"are also the things"},{"speaker":"There are two drugs in particular","startTime":2988.48,"endTime":2991.96,"body":"that make these rhythms much less likely."},{"speaker":"There are two drugs in particular","startTime":2991.96,"endTime":2996.34,"body":"So avoid the drugs, which are"},{"speaker":"There are two drugs in particular","startTime":2991.96,"endTime":2996.34,"body":"going to make things worse."},{"speaker":"There are two drugs in particular","startTime":2996.34,"endTime":2997.9,"body":"So if you're getting lots of arrhythmias,"},{"speaker":"There are two drugs in particular","startTime":2997.9,"endTime":2999.91,"body":"alcohol is not a good"},{"speaker":"There are two drugs in particular","startTime":2997.9,"endTime":2999.91,"body":"idea to have in excess,"},{"speaker":"There are two drugs in particular","startTime":2999.91,"endTime":3001.743,"body":"it does make rhythms more likely."},{"speaker":"There are two drugs in particular","startTime":3002.64,"endTime":3003.9,"body":"Some recreational drugs,"},{"speaker":"There are two drugs in particular","startTime":3003.9,"endTime":3006.856,"body":"you'll find out soon"},{"speaker":"There are two drugs in particular","startTime":3003.9,"endTime":3006.856,"body":"enough, if you are on them."},{"speaker":"There are two drugs in particular","startTime":3006.856,"endTime":3007.689,"body":"(audience member laughs)"},{"speaker":"There are two drugs in particular","startTime":3007.689,"endTime":3009.51,"body":"But the main thing is to do a whole bunch"},{"speaker":"There are two drugs in particular","startTime":3009.51,"endTime":3012.31,"body":"of different things which"},{"speaker":"There are two drugs in particular","startTime":3009.51,"endTime":3012.31,"body":"can speed up the heart,"},{"speaker":"There are two drugs in particular","startTime":3012.31,"endTime":3014.31,"body":"so it can make them improve the heart."},{"speaker":"There are two drugs in particular","startTime":3014.31,"endTime":3016.41,"body":"Stopping smoking, these"},{"speaker":"There are two drugs in particular","startTime":3014.31,"endTime":3016.41,"body":"are all evidence-based,"},{"speaker":"There are two drugs in particular","startTime":3016.41,"endTime":3018.66,"body":"these are not just dragged out of a hat,"},{"speaker":"There are two drugs in particular","startTime":3018.66,"endTime":3019.68,"body":"these are evidence-based things."},{"speaker":"There are two drugs in particular","startTime":3019.68,"endTime":3022.35,"body":"Stop smoking, exercise is really good"},{"speaker":"There are two drugs in particular","startTime":3022.35,"endTime":3025.35,"body":"for keeping the heart young in a body,"},{"speaker":"There are two drugs in particular","startTime":3025.35,"endTime":3027.75,"body":"which is chronologically getting older."},{"speaker":"There are two drugs in particular","startTime":3027.75,"endTime":3031.05,"body":"Reducing hypertension, if that's an issue;"},{"speaker":"There are two drugs in particular","startTime":3031.05,"endTime":3033.12,"body":"reducing cholesterol, if that's an issue."},{"speaker":"There are two drugs in particular","startTime":3033.12,"endTime":3034.44,"body":"These are the same things as I say"},{"speaker":"There are two drugs in particular","startTime":3034.44,"endTime":3036.57,"body":"that were important for"},{"speaker":"There are two drugs in particular","startTime":3034.44,"endTime":3036.57,"body":"coronary heart disease."},{"speaker":"There are two drugs in particular","startTime":3036.57,"endTime":3037.95,"body":"So things that are good for your body,"},{"speaker":"There are two drugs in particular","startTime":3037.95,"endTime":3039.27,"body":"things are good for your heart,"},{"speaker":"There are two drugs in particular","startTime":3039.27,"endTime":3042.24,"body":"are also good for reducing"},{"speaker":"There are two drugs in particular","startTime":3039.27,"endTime":3042.24,"body":"the risk of arrhythmia,"},{"speaker":"There are two drugs in particular","startTime":3042.24,"endTime":3044.82,"body":"pushing the probability of you"},{"speaker":"There are two drugs in particular","startTime":3042.24,"endTime":3044.82,"body":"getting it off to the right."},{"speaker":"There are two drugs in particular","startTime":3044.82,"endTime":3045.81,"body":"And with all of these things,"},{"speaker":"There are two drugs in particular","startTime":3045.81,"endTime":3048.36,"body":"my view is, you're pushing"},{"speaker":"There are two drugs in particular","startTime":3045.81,"endTime":3048.36,"body":"it off to the right."},{"speaker":"There are two drugs in particular","startTime":3048.36,"endTime":3051.51,"body":"If we live long enough,"},{"speaker":"There are two drugs in particular","startTime":3048.36,"endTime":3051.51,"body":"we'll all get an arrhythmia,"},{"speaker":"There are two drugs in particular","startTime":3051.51,"endTime":3052.71,"body":"but if you're going to get an arrhythmia"},{"speaker":"There are two drugs in particular","startTime":3052.71,"endTime":3056.07,"body":"and you can push it off to,"},{"speaker":"There are two drugs in particular","startTime":3052.71,"endTime":3056.07,"body":"you want 110 and you die at 99,"},{"speaker":"There are two drugs in particular","startTime":3056.07,"endTime":3057.06,"body":"it's not a problem for you."},{"speaker":"There are two drugs in particular","startTime":3057.06,"endTime":3060.18,"body":"So it's all about delaying it"},{"speaker":"There are two drugs in particular","startTime":3057.06,"endTime":3060.18,"body":"(audience member laughs)"},{"speaker":"There are two drugs in particular","startTime":3060.18,"endTime":3061.92,"body":"beyond the point of inevitability."},{"speaker":"There are two drugs in particular","startTime":3061.92,"endTime":3065.19,"body":"And at that point, it doesn't"},{"speaker":"There are two drugs in particular","startTime":3061.92,"endTime":3065.19,"body":"really cause you any trouble."},{"speaker":"There are two drugs in particular","startTime":3065.19,"endTime":3070.19,"body":"So my summary really,"},{"speaker":"There are two drugs in particular","startTime":3065.19,"endTime":3070.19,"body":"bradycardias and tachycardias,"},{"speaker":"There are two drugs in particular","startTime":3070.47,"endTime":3071.303,"body":"to understand it,"},{"speaker":"There are two drugs in particular","startTime":3071.303,"endTime":3073.38,"body":"you need to understand the"},{"speaker":"There are two drugs in particular","startTime":3071.303,"endTime":3073.38,"body":"structure of the heart wiring."},{"speaker":"There are two drugs in particular","startTime":3073.38,"endTime":3076.353,"body":"It's a very impressive bit of biology."},{"speaker":"There are two drugs in particular","startTime":3077.25,"endTime":3080.04,"body":"The system's got a lot of the redundancy."},{"speaker":"There are two drugs in particular","startTime":3080.04,"endTime":3082.8,"body":"In general, if you have"},{"speaker":"There are two drugs in particular","startTime":3080.04,"endTime":3082.8,"body":"symptomatic bradycardia,"},{"speaker":"There are two drugs in particular","startTime":3082.8,"endTime":3084.3,"body":"you are going to end up with a pacemaker"},{"speaker":"There are two drugs in particular","startTime":3084.3,"endTime":3086.25,"body":"in the great majority of cases."},{"speaker":"There are two drugs in particular","startTime":3086.25,"endTime":3087.99,"body":"Drugs are not going to help you."},{"speaker":"There are two drugs in particular","startTime":3087.99,"endTime":3090.06,"body":"If you end up with a tachycardia,"},{"speaker":"There are two drugs in particular","startTime":3090.06,"endTime":3092.49,"body":"you are generally going"},{"speaker":"There are two drugs in particular","startTime":3090.06,"endTime":3092.49,"body":"to be treated with drugs,"},{"speaker":"There are two drugs in particular","startTime":3092.49,"endTime":3095.37,"body":"but increasingly ablation is helpful"},{"speaker":"There are two drugs in particular","startTime":3095.37,"endTime":3098.25,"body":"for some people to stop this,"},{"speaker":"There are two drugs in particular","startTime":3098.25,"endTime":3100.35,"body":"and then basically be off drugs completely"},{"speaker":"There are two drugs in particular","startTime":3100.35,"endTime":3101.94,"body":"or back to normal."},{"speaker":"There are two drugs in particular","startTime":3101.94,"endTime":3105.24,"body":"And you may well need to"},{"speaker":"There are two drugs in particular","startTime":3101.94,"endTime":3105.24,"body":"have some combination of"},{"speaker":"There are two drugs in particular","startTime":3105.24,"endTime":3109.38,"body":"ablation drugs and pacing in"},{"speaker":"There are two drugs in particular","startTime":3105.24,"endTime":3109.38,"body":"more complicated situations,"},{"speaker":"There are two drugs in particular","startTime":3109.38,"endTime":3111.3,"body":"but the outlook for"},{"speaker":"There are two drugs in particular","startTime":3109.38,"endTime":3111.3,"body":"people with arrhythmias,"},{"speaker":"There are two drugs in particular","startTime":3111.3,"endTime":3113.34,"body":"whether too fast or too slow"},{"speaker":"There are two drugs in particular","startTime":3113.34,"endTime":3116.01,"body":"is transformationally"},{"speaker":"There are two drugs in particular","startTime":3113.34,"endTime":3116.01,"body":"different than it was"},{"speaker":"There are two drugs in particular","startTime":3116.01,"endTime":3120.42,"body":"when I was a first-year house"},{"speaker":"There are two drugs in particular","startTime":3116.01,"endTime":3120.42,"body":"officer, first-year doctor,"},{"speaker":"There are two drugs in particular","startTime":3120.42,"endTime":3122.49,"body":"and will undoubtedly improve."},{"speaker":"There are two drugs in particular","startTime":3122.49,"endTime":3125.49,"body":"I consider we're nowhere"},{"speaker":"There are two drugs in particular","startTime":3122.49,"endTime":3125.49,"body":"near the end of the stage"},{"speaker":"There are two drugs in particular","startTime":3125.49,"endTime":3127.98,"body":"in terms of drugs to slow the heart,"},{"speaker":"There are two drugs in particular","startTime":3127.98,"endTime":3131.55,"body":"and pacemakers to speed it up as needed."},{"speaker":"There are two drugs in particular","startTime":3131.55,"endTime":3134.49,"body":"And I think ablation is going"},{"speaker":"There are two drugs in particular","startTime":3131.55,"endTime":3134.49,"body":"to go quite a lot further"},{"speaker":"There are two drugs in particular","startTime":3134.49,"endTime":3135.63,"body":"in terms of this ability,"},{"speaker":"There are two drugs in particular","startTime":3135.63,"endTime":3137.16,"body":"its sophistication than its speed."},{"speaker":"There are two drugs in particular","startTime":3137.16,"endTime":3138.363,"body":"So I think there's a bunch of things"},{"speaker":"There are two drugs in particular","startTime":3138.363,"endTime":3140.07,"body":"that are going to continue to get better,"},{"speaker":"There are two drugs in particular","startTime":3140.07,"endTime":3142.74,"body":"but as I say we are in"},{"speaker":"There are two drugs in particular","startTime":3140.07,"endTime":3142.74,"body":"reasonably good shape now"},{"speaker":"There are two drugs in particular","startTime":3142.74,"endTime":3144.24,"body":"compared to where we were before."},{"speaker":"There are two drugs in particular","startTime":3144.24,"endTime":3145.667,"body":"Thanks very much."},{"speaker":"There are two drugs in particular","startTime":3145.667,"endTime":3148.75,"body":"(audience applauds)"}]}