A PM for the PM by Dr. Kerry Teplinsky – July 23, 2023

“The heart is deceitful above all things, And desperately wicked; Who can know it? Jeremiah 17:9 (NKJV)

Last Saturday PM Netanyahu was hospitalized for lightheadedness or fainting. This was not the first time this has happened. Yesterday, he received a pacemaker (pm) to correct this. The warning signs had been there as far back as 2016, but apparently they were ignored until yesterday.

For many months now the nation of Israel has been unravelling from within as a result of an aggressive attempt to weaken the judicial system and advance an aggressive agenda by the extreme right-wing government of Netanyahu. This week the proverbial dam is scheduled to break as a result of legislation that is likely to be passed by Netanyahu’s coalition to the consternation of the majority of the nation. Are there lessons to be learned about ignoring signs, symptoms, and reality for the sake of pride?

As a cardiologist, I know the human heart is an incredibly complex and well-designed instrument. It is the engine that powers our lives. When it misfires or stops, lives are endangered and forever changed. Among other things, it is a precision electrical organ. Every cell within our hearts can initiate and conduct electricity, and all that is required for our lives to cease are a few rebellious cells functioning in a manner other than that for which they were intended. Considering that over the span of seventy years, the human heart beats over 2.5 billion times, we are indeed fearfully and wonderfully made.

WHAT IS SUPPOSED TO BE HAPPENING? I will praise You, for I am fearfully and wonderfully made; Marvelous are Your works, And that my soul knows very well. Psalm 139:14 (NKJV)

There is a group of cells in the right atrium of our hearts, called the sinoatrial (SA) node, which serves as the pacemaker for the heart. About 70 times a minute, this node fires and initiates a heart beat. The electricity first spreads to the left atrium instantaneously, so that both top chambers can contract at the same time.

Next the electrical impulse travels to the atrioventricular (AV) node, where it is delayed by about 0.2 seconds, to allow the main pumping chambers (ventricles) to fill.

Then, in the next 0.1 second, the electrical impulses travel through the Bundle of His and into the right and left bundle branches, and to every fiber in the ventricles to allow them to squeeze simultaneously and pump blood to our lungs and body. Then over the next .35 seconds the ventricles relax, recover, and await the next electrical instruction to squeeze.

Despite this intricately orchestrated serious of events, it is important to remember that most of the cells in our hearts are electrical components just waiting to be told what to do and when to do it.

WHAT COULD POSSIBLY GO WRONG? In those days there was no king in Israel; everyone did what was right in his own eyes. Judges 21:25 (NKJV)

Sadly, as we see in the streets and halls of Israel today, a good many things can go wrong with human hearts.

One very common ailment of the heart is an arrhythmia called Atrial Fibrillation. Remember that the SA node, located in the right atrium, sets the pace for the heart. When we exercise, it tells our heart to beat more often. When we sleep, it slows our hearts down. The other cells are like sheep listening to the voice of the shepherd.

Sometimes there are rebellious cells in the left atrium that decide they do not like this arrangement, so they begin to fire randomly. This can result in an electrical impulse arriving to the bottom chambers early, called a premature atrial contraction (PAC), and we may feel a flip/flop. A rare flip/flop is not a big deal.

Sometimes however, a bunch of these cells decide to rebel and initiate an electrical storm in the top chambers, causing confusion in the top chambers which just start wiggling like fingers rather than squeezing like a fist. This can have dire consequences. Remember, the bottom chambers only do what they are told, so when they see electricity coming at them 400 times a minute from the rebellious top, which is the typical rate of atrial fibrillation, they try to follow but cannot effectively function. The consequences can be stroke, shortness of breath, passing out, and in rare instances, death.

While all this is going on, the SA node is still doing its job, sending out about 70 impulses a minute from its perch in the right atrium. However, there is so much electrical noise, none of the other heart cells can “hear” it. When this happens, if medication cannot stop the process, a cardiologist needs to shock the heart back into normal rhythm (cardioversion). I liken it to the following scenario.

Seniors in high school have weekly assemblies where the principal stands behind a podium and reads things the students are supposed to know but are typically not interested in. Early in the year, the senoirs kindly pay attention. As the second semester begins, they are on their cell phones, texting one another or searching the web, but remaining respectfully quiet in the process. The principal’s voice can still be heard even though only a few students are listening to it. One week before graduation, nobody cares what the principal is saying or thinking, so the entire student body is talking and laughing, chatting and joking, while the principal dutifully reads the announcements. It is impossible to hear the principal. Imagine the track coach walks in, and is so mortified for the principal that he fires a starting pistol into the air. Nobody sees him, but they hear the shot, and are startled into silence. Throughout the entire time the principal has never stopped reading, but all of a sudden his voice can again be heard.

This is what shocking a heart does. It resets all the rebellious cells so that the noise can no longer interfere with hearing the signal.

I submit that Israel, and the world, have entered a stage where there is so much noise that any important signal cannot possible be heard, even by those earnestly seeking it. We need a shock.

But sometimes a shock isn’t even enough. Sometimes there are cells so rebellious that they keep trying to send out electrical noise in the heart, and the arrhythmia returns. In these instances, those cells need to be electrically isolated from the rest of the heart with an increasingly common procedure called an ablation. They may continue to agitate, but a successful ablation means what they say can no longer be heard by the other cells.

So, to summarize, sometimes we just have too much noise to be able to follow the still, small voice we need to hear. This can be a very uncomfortable and dangerous situation.

I HEAR IT, BUT I AM NOT LISTENING. But they did not obey nor incline their ear, but made their neck stiff, that they might not hear nor receive instruction. Jeremiah 17:23 (NKJV)

We do not only get in trouble when our heart beats too fast. Sometimes it beats too slowly, and that can be a problem. If we think back to the electrical cycle of the heart, once the SA node fires, the electricity must travel through the AV node, the bundle of His, the right and left bundle branches and the fiber network to be able to tell the ventricles to pump. Sometimes the signal is delayed or does not does not make it through at all, and the heart does not pump, resulting in fainting or death. This is called heart block, and the location of the problem tells us what kind of heart block exists. First degree heart block is a slight delay in transmission and does not cause any symptoms. Third degree heart block means no signal gets to the ventricles, and can be fatal. (In truth, there are some failsafe mechanisms built into the heart that can take over providing considerably lower rates compatible with life, but these are not to be relied on any more than that small spare tire in your trunk should be relied on for very long.)

The still small voice of the SA node is still speaking. Unlike in atrial fibrillation, it is not being drowned out by noise. Its message is just being ignored by the ventricles, the powers that be. That which is supposed to lead is being ignored, with resultant bad consequences. This can be caused by many things, but typically it is most often seen in a stiffened, calcified, hardened heart.

Yesterday, Prime Minister Benjamin Netanyahu was discovered, after at least one week of symptoms including passing out, to be ignoring the still small voice in his heart. We do not know for certain the nature of his heart block but he received a permanent pacemaker, which cardiologists call a PM, thereby ensuring that the engine that drives him can never again ignore the still small voice that is supposed to be guiding it.

I encourage you to join me in praying for his physical health, and for an awakening to the ways and voice of God, that he may be able to guide the ship of Israel, which is traversing rougher waters than at any time in its modern existence. Please also join me in praying that not just our leaders, but all of us, will be able to ignore the noise for the sake of being able to hear the true signal.