Autopsy: Life and Death (2006) s01e01 Episode Script
Blood
1
How do you imagine
your own death?
Will it be peaceful?
Will it be quick? Will you be old?
Our death is a mystery to us.
We cast it as an
outsider, a thief,
robbing us of our breath in
an instant without warning.
But death is less
mysterious than he imagined.
Its origins are in our genes,
in the things that happened
to us in what we do all day
in this series, I will show
you how the two causes of your
death can be found in the way you are
designed and the way you live your life.
Lesson one-- Blood.
And investigation,
including a live dissection of a human
body into how diseases of the
circulatory system caused death.
It's often said that
life hangs by a thread
and the sense of this is certainly true
in this series, we're going to be using
real human anatomy to show you some of the
diseases that can intrude into our lives.
But far from being
a catalog of doom
and gloom, understanding
what can go wrong with our
bodies actually gives us a stronger
basis for looking after ourselves.
Now, I said that life
hangs by a thread,
but if we were going to be less
poetic but more accurate about it,
what we should say is that life hangs by
a tube, in fact, by thousands of them.
In this program, we're going to be looking
at the tubes, make up our circulatory
system and what happens
when these tubes go wrong.
And all those tubes all together
run two times to create off
earth and here in this specimen
originated from a body donor.
You see all those
fine little Atari's
running through the debate here
and the lips down and coming out
here and the veins like to
be seen here in the leg.
So what this really
impressive specimen
shows is that embedded in our bodies
is an amazing system of plumbing.
And I can perhaps point out
one or two features of it here.
We have large vessels emanating
from the heart, such as the aorta,
which the pointer is on now, which are for
distributing the blood around the body.
And then we have small,
large vessels such as this vessel here,
the carotid artery in this vessel
here, the vertebral artery,
which are responsible for supplying
the blood to particular organs.
These two arteries on each side supply
all the blood to the brain and head.
So obviously,
if the blood stops flowing
through those arteries,
the brain and head are in trouble.
Or here's another
example down here.
The common iliac artery going down to the
leg, supplies all the blood to the leg.
So, again, if that artery got blocked
up, the leg would have problems.
If I can have a close up of this area
here, I could just point out a couple
of other details to you
on the plasma screen.
You can see some
smaller vessels called
capillaries,
capillaries coming from a Latin word,
meaning hair, because they're
very, very fine.
And the next picture
on the plasma screen
shows you some dilated
capillaries in the skin.
This is what the blood circulation is
all for, to get the blood to these small
vessels, which is where
the exchange takes place.
And the red blood cells are
there inside the small vessels.
These vessels are so
small that you could
fit 100 of them side by
side on the head of a pin.
There's nowhere in our body that's
very far away from the capillary.
So this is what the circulatory
system is all about.
Let's now examine the
circulatory system
in a patient we believe died as a
result of diseases of the circulation.
And this 84 year old lady is now
on this table for some dissection,
for reasons of anonymity.
We have covered her
face with a mask.
She lost her weight
and her mother
had used to fight.
But we wouldn't
expect something else.
In the age of 84,
at least I would be happy to be alive
and in such shape when
I am reaching that age.
And now I like to start
dissection without any delay.
Please us in.
Mice
come in with a dissection table with
our instruments so we can start the
dissection of this fresh,
not fixed body.
So in this dissection,
we'll be examining the inside of her
circulatory tubes to see what can go wrong
with them and what consequences
this may have for the body.
I will open the body
in an oval shape.
And finally, in one
flap, I will open this
thoracic shield together with abdominal
wall and turn it over to my side.
I will start now.
I will take a few minutes.
And I have opened
those abdominal
thoracic cavity.
I have to go a
little bit deeper.
When I do the cut
here across the.
Rips the sternum,
I cannot accidentally cut any organ.
I cut his suit muscles,
pectoral muscle.
So we see some subcutaneous fat
tissue, fat tissue looks yellowish,
and I will start here now.
To
cut through the holes.
The whole sickness of the abdominal wall
and then I am about to feel the intestine
and indeed here I feel
already the intestine.
OK, there is real osteoporosis,
the bones have lost calcium.
It's possible with my
scissors just to cut
through the ribs, which I could certainly
do in a younger body, like in Mice body.
Actually, you're younger.
You dissect me.
So
now I need.
Now it's specialized leap.
What is this? So no.
This is a specialized
Rip's town here,
and in just a moment,
we have opened the flat.
And you can see the
bright yellow color
of fat in the body there in the slightly
more salmon colored mussels exposed to the.
Intimate, can you take it over?
These are the rips
from the inside.
This is some fit, more fit than
expected from the outside inside's
is said there should be a heart.
Left lung, right lung.
I cut here through
the diaphragm,
so I've opened now the.
Abdominal thoracic cavity.
And it's time now to
look for the vessels.
While the dissection is continuing,
let me give you a very simple
demonstration of the
consequences of narrowing
of arterial tubing.
We have here a very simple model
to demonstrate this,
the container at the top represents our
arterial system and we have two tubes here
representing an artery in my right hand
and a diseased narrowed
artery in my left hand.
The trouble with
narrowing of arteries is
that flow through the artery is
very dependent on the diameter.
So narrowing of the artery substantially
reduces the flow to the affected organ.
So let me demonstrate
this to you now.
But I'll show you containers underneath
and I'll fill up our circulatory system.
It's a red fluid
representing blood.
Yeah,
and now I'll just let the
blood flow through to arteries.
You can see the tube on the
right is a narrow diameter.
So if I can stop the
flow just in time.
You can see that there's a lot more fluid
has flown out through the normal artery as
we're having it than
through the narrow artery,
and the importance of understanding
this in the context of disease is one
of the commonest diseases of human
beings has exactly this consequence.
That's the disease
known as hardening
of the arteries, arteriosclerosis,
or pathologists call it Arthur Roemer.
This can cause the lining of the
arteries to become rough and irregular
and narrowed, and this can cause
arteries in the bodies to narrow.
As we can show
you some examples,
a more common expression for other
ailments, arteries, sclerosis.
And when you're putting in
place a collection of
a cut open from
several body donors
at different age,
then what we see here,
this is an open abdominal order
from an 18 years old here.
Both sides
of those arteries going to the
pelvis, iliac arteries.
And here are those shoot offs which
go to the liver, to the bowels,
10 years later, 35 years.
You see already some
irregularities in the ward,
some arteries close,
some incapacitation of calcium.
And it is close now
at the age of 50.
Is here to see atherosclerosis
sclerotic Plax called
here even more severe
and at the age of 60,
when you drink a little bit alcohol,
when you do sports, when you have
good genes, it may be stay like that.
But here it's already
advanced at its closest C.
At this election of all
here, even as rumbas.
And what you also see
could accomplish nothing.
Show me in the outside disease that they
are really distended from the outside.
This one would like about in this
way, but a healthy one is.
About that scene, so I am here in the
middle, so this would be about my size.
And finally,
when this gets more and more severe
at this close to lakes,
may not get enough blood.
You may even get a graft,
an artificial connection between the aorta
of the abdomen and the legs in order
that the legs don't have to be amputated.
Let me share this
process a little bit
more detail in a couple of
photographs taken down the microscope.
This shows an artery which would
originally have had a diameter
indicated by this outer red line here,
but the process of hardening of
the arteries or atherosclerosis has
caused calcification indicated by these
dark areas and thickening of the wall
of the artery so that now the space in
the middle is substantially narrowed.
And this will have the effect of
restricting the flow through this
artery to the organ that's affected if I
could have the next plasma screen image.
This is one of the problems
with this narrowing.
Not only is the flow reduced normally,
but there's a worry that the blood clot
in the artery during life and
this is called a thrombus.
So on this image of two arteries from
the heart, you can see the one over
here is still got an open middle with
blood can flow, but the one on this side
has got blood clot in it,
occupying most of the space in the middle
of the artery, apart from this
little irregular space in the middle.
And obviously,
this would have had disastrous
consequences for the heart
that this artery supplied.
In part two, a demonstration of
those disastrous consequences,
the dissection specimen
is used to show
what happens to the heart when
coronary arteries are obstructed.
Arteriosclerosis
has been described
next, preparations begin for a
demonstration of its consequences.
The dissection
specimen will be used
to simulate an obstruction
to normal blood flow.
The larger order which comes
from the heart and goes to both legs,
septum, auto, we identified exactly here.
And we like edited
in with this tube,
so like it is just a medical term,
meaning that something is tied off
in order to show you the consequences
of lack of blood flow to an organ
in the body, we're first
removing the blood from this
body so that we can then subsequently put
a silicone polymer back in and show you
the effects of lack of flow and
what we are about to do now, we
will flow flush in the water.
And it this very
flush to blood out
through the arteries, through the
capillary bed, coming out of the vein.
In this way,
all the organs will more or
less lose its color because
the reason the lung is already
liver is so dark, it's a blood,
the organ by itself look pale.
Therefore, it start now
with putting some water in
and all the blood will go out.
Careful, careful, you don't want
to explode our bodies or not.
So why are we just waiting
for that process to complete?
Let me show you some
of the commonest
arteries affected by this disease
process of hardening of the arteries.
And we have here
Julietta anatomical
artist is drawn on Denis's our live model
today, an outline of the arterial system.
And some of these arteries supply
the organ, which depends on them.
For example,
these arteries supplying the head.
These arteries here
supply the bowel,
these supply the kidneys,
the supply, the legs.
And all four of those sites are
susceptible to narrowing to an extent that
can damage the organ that they supply.
Now, we tend to think
of the heart as just
a pump that pumps the blood
around the circulation.
But the heart also
needs energy and it
also needs to own vascular
supply, its own supply of blood.
And it gets these from to quite narrow
arteries called the coronary arteries.
And if one of these gets narrowed,
the consequences can be disastrous.
I can show you this over
on the plasma screen.
The coronary arteries or the artery
supplying the heart are quite narrow
to start with,
and if they get damage to the lining,
which causes either narrowing of
the artery or a blood clot to form
in the artery,
the supply to the bit of heart muscle
that that artery was responsible
for stops altogether.
And in the heart,
there are no other arteries that supply
that particular bit of muscle to
that particular bit of heart muscle
will then die,
as I can show you in the next picture.
He we have some normal
heart muscle where
you can see the muscle fibers and
these little blue dots are the nuclei
of the cells, and on this side,
the heart muscle has died as a result
of the blood flow being stopped and indeed
inflammation, which these little blue dots
is beginning to come in and
dissolve the heart muscle.
Heart muscle that's dead like
this won't function anymore.
So the heart can't
pump properly.
And indeed,
it may suffer an arrhythmia,
an electrical impulse which
stops it acting as a pump.
And that will be manifest
as a heart attack.
That's when the heart
stops working as
a pump and the blood supply
went to the whole body fails.
So the heart is really a key
organ in this in this story.
Well, let's have a look now and try
and illustrate this process of lack
of blood supply to the heart
on our dissection specimen.
Now, look how spectacular pale
the organs have become here.
The lung virtually
wiped because the blood
away the liver
here, the intestine.
Everything pale
except for the thin,
especially here covering the
heart, which is yellow.
No, we want to do the opposite.
We don't remove blood.
We were putting in
new artificial blood.
The new artificial blood, Mice you put
something up, stop, please go ahead.
So I will stop now the flow of the water,
because no blood coming out anymore.
Everything here is white.
I call it now the
ultraviolet light,
because within this reason,
we have mixed some unique pigment,
so we should see it much more
pronounced, not only red.
Now, I will do something very
special when the blood comes.
I like to simulate an infection.
I like to clamp
with a tiny clip.
I like to clamp
one coronary artery
in the front I see already one.
Let's go the other way in here.
The camera can see it here.
Should go in here and I take the
heart to the back and I see here
another coronary artery and
here I see important artery.
So we're going to place a clip over
one of the arteries supplying part
of the heart muscle and then put the
polymer into all the other arteries.
And this will mimic
an infarction or
the situation where blood
doesn't reach part of the heart.
So I will do it here.
I clampitt here, OK?
And on the other side,
I always clamp the right coronary artery.
OK, I go here now
to the left coronary
artery and the right coronary artery
is somewhere here in the depths.
I'm not sure that I
see even one moment,
that's the second,
yeah, wonderful Up perfect here.
Yeah, don't playing clamp
in case the heart doesn't
work, it may have to.
I would like to put a big clamp
here into the mesentery to those vessels
that actually nourish the intestine.
So this part of the intestine
should not become red you will see.
Now Mice.
Let's go to give me the artificial
blood that's artificial about coming.
Yeah.
Come in
and I go here into the water.
And
now it's a very decisive moment
of this operation and anxious.
OK, ok, ok, OK.
Now is a big moment is imminent,
so I open here,
I open their Mice, please.
And now let's have a look.
It takes some time.
The blood flows now.
So they all take
to the heart for all the major
arteries and should very soon come up.
The tension can be
not beaten by any
football player or soccer
player, even not by the Olympics.
This is something very
special, great
and wonderful.
Yes, yes.
When you look now on the plasma
screen, you see the wheaty going.
Its path is a coronary artery.
You mentioned at the beginning,
little tubes by which life hangs in here.
You can see some in the
heart full of UV dye.
These are the small tubes of which the
heart muscle depends which nourishment.
And if these are blocked and the flow
doesn't happen, then the muscle will die.
Now, I want to show you
the other part of the heart
here, where I put in the clamp there
is no you will die in this area.
And you can see here
the clamp to stop
the flow of polymer through the artery
in the lower part where you can see some
evidence, it's a bit patchy because
of the fattiness of this heart.
Now, I want to show you that actually all
the organs are infused with a right lung
within the liver to a good
extent, injected again.
And we also see
here the power with
all its arteries filled
up with artificial blood.
This time, again, if we can have a
close up of that part of the intestine.
It's a very striking
comparison here.
You can see between this fold
of intestine, which has been fused
with the red polymer and the white
unary perfused part at the top there
where we clamp the arterial supply.
So the the blood flow,
the blood flow has come back into this
lower segment, not into the upper
segment, which remains white.
And when the blood
supply to part
of an organ is completely stopped,
that's called ischemia a word,
meaning lack of blood flow to
that particular part of the organ.
And when that happens,
that part of the organ then dies.
And now I want to show you the
consequences of Kimock heart disease.
In some person,
it's not what you come in, please.
And what you see on this
table, there are
a number of heart.
So this is a normal heart.
It could be my heart, nice,
small about the size of my fist.
And then, you know, look at this
incredibly big heart when I open this.
You see, it's not healthy here.
This area is not
infused his blood.
This is ischemia.
There is an area of heart infarction,
and I can show you what this looks like
under the microscope on the plasma
screen, where you can see
some remnant heart muscle
in these red areas and in between a
white, pale area of scarring.
Now, about a quarter of us will die
of the effects of this type of damage
to the heart and a heavy heart
with severe scarring here.
When you compare just from the outside,
it's a healthy, small, lovely heart here.
And this diseased heart,
you see a scarring on the outside.
And now when I open this heart,
look on the healthy side here.
Very even signees, about 110
meters, as it should be,
and here it has a Senning also,
you see that the shape of the heart is
distorted because it's arrogated
and here the wall is very thin.
This is a scar
exactly here and now.
Look inside.
Wonderful, red,
healthy, beautiful.
But here, this person,
he didn't die from his heart, in
fact, but he escaped narrowly death.
But all too often, a heart, in fact,
has a much more dramatic result
it results in death, as in this
unhappy body donor, on my left side,
right side, and we did it cut and have now
a transparent plastinated slice from him.
And now look.
His lung surrounding the heart.
The right part of the heart
and here the left part,
which comes to blood into the body,
and here here is a crime story going on.
You see here a Upshaw
you see the bleeding and
all this blood went out
into the pericardial sac, about
this space in this space
which surrounds the heart.
And finally,
as I can show you in a
slice of this unhappy lady.
The blood goes out
of the heart because
this is against the heart and
you see the black blood and the blood.
Is going inside this space again
and the heart pumps and pumps,
it actually is drowning in
the blood which surrounds it.
Finally, within minutes,
this person died.
In part three,
the heart is dissected
to establish whether
arteriosclerosis killed this patient.
Her body is used to illustrate another way
in which arteries can become obstructed.
And a simple demonstration reveals
what happens when arteries burst.
A demonstration has
shown that when blood
flow to an organ is blocked,
the consequences can be devastating.
Now it's time to
find out whether this
woman's arteries were
obstructed by arteriosclerosis.
John, would you join me?
I'd like to cut open the heart.
It is popularity muscle
the inside the heart,
which pumps the
blood into the body.
And from here, I go out.
And I cut the aorta.
Which I just enter here.
Come on here, look,
these are actually the valves
and I open the coronary artery.
With this small scissors.
And now listen to this noise,
this noise is calcium calcifications,
severe atherosclerosis.
A perfect now to see come,
please John come here look.
This now is the
inner side of the left heart
pumping the blood into the body.
This is aortic valve
and he is in terms of the coronary artery
and opening this coronary artery shows.
He distinct are sclerotic
plucks exactly here.
These are the yellow
areas you can see
in the red wall of the artery
there in the artery is healthy.
It looks like that here when
that close looks like that.
Let's look now in the water and go
back to coronary artery and go back.
I go back here to the
border between the heart.
And they all and the
other shows he has,
those little white patches says, is the
artist roses here, here, here, here.
This is artist roses and this is more
marked, which is very normal down.
In the abdominal part here in the
abdominal cavity, again, these
are just clothes and those whitish areas
here with some alterations, some don't.
Look how striking this is.
Roses here shows up here even with
some world effects, some alterations.
So we can see three basic areas here,
the relatively normal wall of the inside
of the aorta here,
these fatty streaks and calcified plaques,
which are the white and yellow areas
here, and an area of ulceration,
which is where the arteriosclerosis burst
through the normal lining of the aorta
and caused some blood
clotting inside the aorta.
And before I showed you this
on the press it, and these are
exactly those ulcerations and Kathak
to see, it couldn't be shown better.
So we've been able
to demonstrate to you
arteriosclerosis in our dissection
specimen and we've shown you how it can
damage the inside wall of the
artery and lead to blood clotting.
But there's an even more dramatic
way in which blood clotting inside
the arterial system in
life can cause a problem.
And this is called embolism.
I can demonstrate to that to you
on our live model here, Dennis,
there are two fundamentally different
ways in which embolism a clot breaking off
inside the body and going around
the circulation can occur.
One of them, which we can start with,
can happen on the basis of a heart attack.
Sometimes following
a heart attack,
a blood clot can form on the interior wall
of the heart and grow and then break off.
And when that happens,
it can be pumped out of the heart round
the aorta until it gets stuck in one
of the smaller arteries, for example,
perhaps going down these arteries here,
which supply the upper bowel causing death
of the upper bowel or into one of these
arteries here, which supply the kidneys,
causing death of a kidney
or part of the kidney,
or even more catastrophically,
it can pass up into the blood vessels
supplying the head and cause
death of part of the brain.
A completely different
type of embolism
happens when you get a
blood clot in your legs.
This can happen for
a variety of reasons.
It's associated with air travel.
Sitting on an airplane with your legs
in a cramped up position for many hours
can cause a blood clot to
form in the veins of the leg.
And it is then
subsequently breaks off.
It can travel up from the leg
into the right side of the heart,
through the right side of
the heart and into the lungs,
blocking off some of the pulmonary
circulation, the circulation to the lungs.
And if this is a
big enough clot,
it's one of the relatively
few causes of instant death.
I think we can see a very simple
demonstration of embolism back
on the dissection specimen.
Well, when the come on
would come in exactly here,
here is the artery which goes through the
pelvis and here and here runs in the leg.
And now I take an
ambulance, some blood and I.
Inserted here into this artery.
A final push now by my syringe with
water simulating the blood flow.
And now.
Stop.
Now, the Emperor's travel
its way and I will open.
The artery and signed
it where it traveled.
Here it is, yeah, you've got it.
Perfect.
Now,
when this would have in life,
the blood flow would be exactly here and
the lake would not have blood supply,
emergency operation,
or this patient would lose his leg.
So we can see on the
plasma screen here
that are not embolism has traveled along
the artery and it's got embedded here.
And it's like
turning the artery.
And in life, there would be
no flow distance to that part.
And so the part of the body in this
case, the leg distant to that part,
would have no blood supply and would
gradually, over an hour or two die.
And this would be a
surgical emergency.
It is possible to remove it
surgically if they're known about, but it
has to be done within a very short time.
Well, we've seen how hardening
of the arteries can cause
narrowing of the arteries and can
cause blockage of the arteries.
But there's another thing
that can happen to tubes.
As any plumber can tell
you, they can burst.
And hardening of the arteries can also
contribute to that because it can weaken
the wall of an artery sufficiently
to cause it to dilate and then burst.
And I can illustrate the process
to you here on the plasma screen.
With a microscopic
picture of a weakened
area of the wall of an artery
and the dark colors here.
Are the original wall of
the artery on this side
and on this side,
but round here where there should be
a continuous arterial wall,
there are only small residual part
of the artery wall and the rest
has been completely replaced.
The wall has been completely
replaced by a blood clot.
And you can easily
imagine how this area
would be quite susceptible to
rupture, to bursting.
Well, I can illustrate this
for you very schematically
with a simple demonstration.
This tube here represents
an artery like they oughta,
and the white bits at either end represent
the normal arterial wall with the red
bit in the middle being the thinned
and weakened part of the arterial
wall due to arteriosclerosis.
Well, let's see what
happens if I blow it up.
As the war dilates,
the pressure in the war increases.
Until eventually.
Sometimes after
considerable time.
It ruptures
now, of course,
a ruptured aneurysm in the body
doesn't make a noise like that, but the
consequences can be equally dramatic.
Sometimes the patient hears this
noise and they die within hours.
I recall such a case
from my clinical time,
and I want to demonstrate now
Nadine could you bring
me some plastinated
exactly this kind of aneurisms.
As you just
demonstrated, in real
place tonight in real specimen's,
so this is a young auto. I would like
to have and this is
already I order 70 about.
And when you cut this open
before I showed
you advance notice,
close with already some ulceration,
some blood clot here when this continues.
It looks like that not only.
One place, this blood clot, several,
and here it is already in a small aneurysm
and here and here, blood clots
here, blood clots here.
And I turn it around.
You see all those buildings.
OK, now the most severe
aneurysm I found.
In this unhappy paternal.
To illustrate to
you, this is a heart.
Opened and this is say
Orta, say Auto which.
And a healthy person
look again like that,
and now look at
that, a bulging
an aneurysm,
thinning of the bone bulging
here and there is no one
there's another one here
and there is another
one, the big one here.
Look at this one from the big
one, big bulging here,
one bulging here and one bulging here.
And all this is filled
up with clotted blood.
And now it's time for questions
on everybody who has a question
will raise his arm, please.
I would like to ask,
why do people get a heart attack
when they have a sudden shock?
If you get a sudden shock,
you get a sudden burst of adrenaline
into the blood and that can increase
the excitability of the heart,
but in hearts that are already disease,
that increased excitability can cause
an arrhythmia to happen so the
heart can stop acting like a pump.
And in fact,
there's a large collection
of examples of the fact that it's entirely
true that you can die of a sudden
shock causing a sudden
stop in the in the heart.
One of the most unfortunate examples
that I know somebody had a heart attack
and died when he got
a hole in one in golf.
Ok next questions,
so let's go right in front, please.
This evening has
all been about blood
flowing and I'm quite pleased my
blood is flowing nicely and my veins.
But athletes are sometimes accused of
taking drugs with always being accused
of taking drugs, was accused of
taking drugs to thicken their blood.
Doesn't seem to make
a lot of sense to me.
Can you help,
John?
Well,
yes, blood has a
normal consistency,
which it's designed to have and which
helps it to flow around the body.
And if you don't have
as many blood cells
in your blood, that's the
condition of anemia or thin blood.
You don't carry as much
oxygen around the body
and the therefore the tissues
don't get as much oxygen supply.
What you're talking about is the opposite
situation where people take drugs
to increase the amount of blood cells
in their blood and therefore to supply
more oxygen to their tissues and
hope to enhance athletic performance.
The downside to this is that it also
makes their blood thicker and less likely
to flow and more likely
to clot in the system.
So although it may
work in the short term,
it's actually really rather
a dangerous thing to do, too,
with thick blood.
I'm better performing, but with
thin blood I sometimes
faint and but I live longer.
That may be the case.
Next question, please.
This gentleman over there,
if you have the
bad luck and get an
ambulance, for instance, in your
leg, how will be the treatment?
How long time do you
have that it can be
treated and what will
be done in that case?
It depends how large the ambulance
is, whether some side flow is allowed.
In the worst case,
you have to rush to the hospital in
minutes, let's say,
in a maximum of one hour,
and then there's an opportunity,
a possibility to dissolve this blood clot.
I ask because on long
distance flights,
you're always you always have to
take care and wear compression
socks and something like that.
The reason why you're
susceptible to them
on long flights is because of pressure
really on the back of your legs.
And anything that changes the flow
of blood in a vessel can predisposed
to clotting and in this case,
pressing on the back of your legs
to predisposed to clotting
in the back of your legs,
which is why it's recommended that,
A, he keep well hydrated on flights.
You drink lots of water,
you don't drink too much alcohol.
And secondly, you get up and walk
around every so often because that helps
the blood flow through your veins,
back to the heart and not to clot in them.
OK, thank you.
And then more
questions over there.
Please go ahead.
What needs to be done
to avoid an early
atherosclerosis or even to prevent
severe atherosclerosis in old age?
Yes, well,
that's a good question.
And in fact, there are things we
can do to look after our arteries.
And I can explain that to you by
using Dennis, our live model again.
Here we've got a
projection of our
arterial system and the main
organs and the reason why diseases
of the arterial system are so important
is because the arteries go everywhere.
They're required to
supply all of our
organs and all of our organs can be
in trouble without an arterial supply.
The commonest organs that are affected
by this lack of supply are the brain,
in which case you get a stroke, the heart
in which case you can get a heart attack.
The kidneys can be
affected with multiple
small scars or bigger ones,
and the bowel can also be affected.
And sometimes, as we've seen, the blood
flow can be blocked off to the legs.
Well,
what are the main risk factors
for this disease if at the moment what
actually predisposes to the most important
one and the one that's
easiest to do something about?
Well, unless you're too addicted
to smoking, smoking is a
major risk factor for a thorough.
It causes it throughout
the body and it
causes it to accelerate and
appear at a younger age.
So not smoking is a good thing
and stopping smoking is a good thing if
you want to look after your arteries.
The second thing that's
important is blood pressure.
The blood pressure
determines how much energy is transferred
to the inside of the arteries.
Every time the heart beats,
so the your blood pressure,
the more of a pounding the inside of your
arteries get and the more likely
they may be to develop an aroma.
And that's why after
you reach your 40s or
50s, it's a good idea to have your blood
pressure checked by the doctor every so
often because there are these days
very effective drugs for lowering blood
pressure into the normal range and
again, protecting our arteries.
And the third thing
that's important is
the type of fats, the type of lipids
that are circulating in your blood.
And there are two ways you
can find out about that.
One is that if you've got a family history
of arterial disease somewhere in the body
of stroke or heart attack happening at
a young age, you should have a blood
test because you can find out whether
or not you're predisposed to that.
Again, if you are,
there are drugs that can know the lipids.
And secondly,
you can have a blood test
randomly to see whether or
not you have high lipids.
This indeed is a
quite unusual program.
And some of you may
have been frightened
in the beginning, but fortunately
enough, nobody frightened to death.
Even you learn something to prevent
this, to live longer.
And therefore, I thanks you everybody
and the see themselves plastinated
as late as possible.
Thank you.
How do you imagine
your own death?
Will it be peaceful?
Will it be quick? Will you be old?
Our death is a mystery to us.
We cast it as an
outsider, a thief,
robbing us of our breath in
an instant without warning.
But death is less
mysterious than he imagined.
Its origins are in our genes,
in the things that happened
to us in what we do all day
in this series, I will show
you how the two causes of your
death can be found in the way you are
designed and the way you live your life.
Lesson one-- Blood.
And investigation,
including a live dissection of a human
body into how diseases of the
circulatory system caused death.
It's often said that
life hangs by a thread
and the sense of this is certainly true
in this series, we're going to be using
real human anatomy to show you some of the
diseases that can intrude into our lives.
But far from being
a catalog of doom
and gloom, understanding
what can go wrong with our
bodies actually gives us a stronger
basis for looking after ourselves.
Now, I said that life
hangs by a thread,
but if we were going to be less
poetic but more accurate about it,
what we should say is that life hangs by
a tube, in fact, by thousands of them.
In this program, we're going to be looking
at the tubes, make up our circulatory
system and what happens
when these tubes go wrong.
And all those tubes all together
run two times to create off
earth and here in this specimen
originated from a body donor.
You see all those
fine little Atari's
running through the debate here
and the lips down and coming out
here and the veins like to
be seen here in the leg.
So what this really
impressive specimen
shows is that embedded in our bodies
is an amazing system of plumbing.
And I can perhaps point out
one or two features of it here.
We have large vessels emanating
from the heart, such as the aorta,
which the pointer is on now, which are for
distributing the blood around the body.
And then we have small,
large vessels such as this vessel here,
the carotid artery in this vessel
here, the vertebral artery,
which are responsible for supplying
the blood to particular organs.
These two arteries on each side supply
all the blood to the brain and head.
So obviously,
if the blood stops flowing
through those arteries,
the brain and head are in trouble.
Or here's another
example down here.
The common iliac artery going down to the
leg, supplies all the blood to the leg.
So, again, if that artery got blocked
up, the leg would have problems.
If I can have a close up of this area
here, I could just point out a couple
of other details to you
on the plasma screen.
You can see some
smaller vessels called
capillaries,
capillaries coming from a Latin word,
meaning hair, because they're
very, very fine.
And the next picture
on the plasma screen
shows you some dilated
capillaries in the skin.
This is what the blood circulation is
all for, to get the blood to these small
vessels, which is where
the exchange takes place.
And the red blood cells are
there inside the small vessels.
These vessels are so
small that you could
fit 100 of them side by
side on the head of a pin.
There's nowhere in our body that's
very far away from the capillary.
So this is what the circulatory
system is all about.
Let's now examine the
circulatory system
in a patient we believe died as a
result of diseases of the circulation.
And this 84 year old lady is now
on this table for some dissection,
for reasons of anonymity.
We have covered her
face with a mask.
She lost her weight
and her mother
had used to fight.
But we wouldn't
expect something else.
In the age of 84,
at least I would be happy to be alive
and in such shape when
I am reaching that age.
And now I like to start
dissection without any delay.
Please us in.
Mice
come in with a dissection table with
our instruments so we can start the
dissection of this fresh,
not fixed body.
So in this dissection,
we'll be examining the inside of her
circulatory tubes to see what can go wrong
with them and what consequences
this may have for the body.
I will open the body
in an oval shape.
And finally, in one
flap, I will open this
thoracic shield together with abdominal
wall and turn it over to my side.
I will start now.
I will take a few minutes.
And I have opened
those abdominal
thoracic cavity.
I have to go a
little bit deeper.
When I do the cut
here across the.
Rips the sternum,
I cannot accidentally cut any organ.
I cut his suit muscles,
pectoral muscle.
So we see some subcutaneous fat
tissue, fat tissue looks yellowish,
and I will start here now.
To
cut through the holes.
The whole sickness of the abdominal wall
and then I am about to feel the intestine
and indeed here I feel
already the intestine.
OK, there is real osteoporosis,
the bones have lost calcium.
It's possible with my
scissors just to cut
through the ribs, which I could certainly
do in a younger body, like in Mice body.
Actually, you're younger.
You dissect me.
So
now I need.
Now it's specialized leap.
What is this? So no.
This is a specialized
Rip's town here,
and in just a moment,
we have opened the flat.
And you can see the
bright yellow color
of fat in the body there in the slightly
more salmon colored mussels exposed to the.
Intimate, can you take it over?
These are the rips
from the inside.
This is some fit, more fit than
expected from the outside inside's
is said there should be a heart.
Left lung, right lung.
I cut here through
the diaphragm,
so I've opened now the.
Abdominal thoracic cavity.
And it's time now to
look for the vessels.
While the dissection is continuing,
let me give you a very simple
demonstration of the
consequences of narrowing
of arterial tubing.
We have here a very simple model
to demonstrate this,
the container at the top represents our
arterial system and we have two tubes here
representing an artery in my right hand
and a diseased narrowed
artery in my left hand.
The trouble with
narrowing of arteries is
that flow through the artery is
very dependent on the diameter.
So narrowing of the artery substantially
reduces the flow to the affected organ.
So let me demonstrate
this to you now.
But I'll show you containers underneath
and I'll fill up our circulatory system.
It's a red fluid
representing blood.
Yeah,
and now I'll just let the
blood flow through to arteries.
You can see the tube on the
right is a narrow diameter.
So if I can stop the
flow just in time.
You can see that there's a lot more fluid
has flown out through the normal artery as
we're having it than
through the narrow artery,
and the importance of understanding
this in the context of disease is one
of the commonest diseases of human
beings has exactly this consequence.
That's the disease
known as hardening
of the arteries, arteriosclerosis,
or pathologists call it Arthur Roemer.
This can cause the lining of the
arteries to become rough and irregular
and narrowed, and this can cause
arteries in the bodies to narrow.
As we can show
you some examples,
a more common expression for other
ailments, arteries, sclerosis.
And when you're putting in
place a collection of
a cut open from
several body donors
at different age,
then what we see here,
this is an open abdominal order
from an 18 years old here.
Both sides
of those arteries going to the
pelvis, iliac arteries.
And here are those shoot offs which
go to the liver, to the bowels,
10 years later, 35 years.
You see already some
irregularities in the ward,
some arteries close,
some incapacitation of calcium.
And it is close now
at the age of 50.
Is here to see atherosclerosis
sclerotic Plax called
here even more severe
and at the age of 60,
when you drink a little bit alcohol,
when you do sports, when you have
good genes, it may be stay like that.
But here it's already
advanced at its closest C.
At this election of all
here, even as rumbas.
And what you also see
could accomplish nothing.
Show me in the outside disease that they
are really distended from the outside.
This one would like about in this
way, but a healthy one is.
About that scene, so I am here in the
middle, so this would be about my size.
And finally,
when this gets more and more severe
at this close to lakes,
may not get enough blood.
You may even get a graft,
an artificial connection between the aorta
of the abdomen and the legs in order
that the legs don't have to be amputated.
Let me share this
process a little bit
more detail in a couple of
photographs taken down the microscope.
This shows an artery which would
originally have had a diameter
indicated by this outer red line here,
but the process of hardening of
the arteries or atherosclerosis has
caused calcification indicated by these
dark areas and thickening of the wall
of the artery so that now the space in
the middle is substantially narrowed.
And this will have the effect of
restricting the flow through this
artery to the organ that's affected if I
could have the next plasma screen image.
This is one of the problems
with this narrowing.
Not only is the flow reduced normally,
but there's a worry that the blood clot
in the artery during life and
this is called a thrombus.
So on this image of two arteries from
the heart, you can see the one over
here is still got an open middle with
blood can flow, but the one on this side
has got blood clot in it,
occupying most of the space in the middle
of the artery, apart from this
little irregular space in the middle.
And obviously,
this would have had disastrous
consequences for the heart
that this artery supplied.
In part two, a demonstration of
those disastrous consequences,
the dissection specimen
is used to show
what happens to the heart when
coronary arteries are obstructed.
Arteriosclerosis
has been described
next, preparations begin for a
demonstration of its consequences.
The dissection
specimen will be used
to simulate an obstruction
to normal blood flow.
The larger order which comes
from the heart and goes to both legs,
septum, auto, we identified exactly here.
And we like edited
in with this tube,
so like it is just a medical term,
meaning that something is tied off
in order to show you the consequences
of lack of blood flow to an organ
in the body, we're first
removing the blood from this
body so that we can then subsequently put
a silicone polymer back in and show you
the effects of lack of flow and
what we are about to do now, we
will flow flush in the water.
And it this very
flush to blood out
through the arteries, through the
capillary bed, coming out of the vein.
In this way,
all the organs will more or
less lose its color because
the reason the lung is already
liver is so dark, it's a blood,
the organ by itself look pale.
Therefore, it start now
with putting some water in
and all the blood will go out.
Careful, careful, you don't want
to explode our bodies or not.
So why are we just waiting
for that process to complete?
Let me show you some
of the commonest
arteries affected by this disease
process of hardening of the arteries.
And we have here
Julietta anatomical
artist is drawn on Denis's our live model
today, an outline of the arterial system.
And some of these arteries supply
the organ, which depends on them.
For example,
these arteries supplying the head.
These arteries here
supply the bowel,
these supply the kidneys,
the supply, the legs.
And all four of those sites are
susceptible to narrowing to an extent that
can damage the organ that they supply.
Now, we tend to think
of the heart as just
a pump that pumps the blood
around the circulation.
But the heart also
needs energy and it
also needs to own vascular
supply, its own supply of blood.
And it gets these from to quite narrow
arteries called the coronary arteries.
And if one of these gets narrowed,
the consequences can be disastrous.
I can show you this over
on the plasma screen.
The coronary arteries or the artery
supplying the heart are quite narrow
to start with,
and if they get damage to the lining,
which causes either narrowing of
the artery or a blood clot to form
in the artery,
the supply to the bit of heart muscle
that that artery was responsible
for stops altogether.
And in the heart,
there are no other arteries that supply
that particular bit of muscle to
that particular bit of heart muscle
will then die,
as I can show you in the next picture.
He we have some normal
heart muscle where
you can see the muscle fibers and
these little blue dots are the nuclei
of the cells, and on this side,
the heart muscle has died as a result
of the blood flow being stopped and indeed
inflammation, which these little blue dots
is beginning to come in and
dissolve the heart muscle.
Heart muscle that's dead like
this won't function anymore.
So the heart can't
pump properly.
And indeed,
it may suffer an arrhythmia,
an electrical impulse which
stops it acting as a pump.
And that will be manifest
as a heart attack.
That's when the heart
stops working as
a pump and the blood supply
went to the whole body fails.
So the heart is really a key
organ in this in this story.
Well, let's have a look now and try
and illustrate this process of lack
of blood supply to the heart
on our dissection specimen.
Now, look how spectacular pale
the organs have become here.
The lung virtually
wiped because the blood
away the liver
here, the intestine.
Everything pale
except for the thin,
especially here covering the
heart, which is yellow.
No, we want to do the opposite.
We don't remove blood.
We were putting in
new artificial blood.
The new artificial blood, Mice you put
something up, stop, please go ahead.
So I will stop now the flow of the water,
because no blood coming out anymore.
Everything here is white.
I call it now the
ultraviolet light,
because within this reason,
we have mixed some unique pigment,
so we should see it much more
pronounced, not only red.
Now, I will do something very
special when the blood comes.
I like to simulate an infection.
I like to clamp
with a tiny clip.
I like to clamp
one coronary artery
in the front I see already one.
Let's go the other way in here.
The camera can see it here.
Should go in here and I take the
heart to the back and I see here
another coronary artery and
here I see important artery.
So we're going to place a clip over
one of the arteries supplying part
of the heart muscle and then put the
polymer into all the other arteries.
And this will mimic
an infarction or
the situation where blood
doesn't reach part of the heart.
So I will do it here.
I clampitt here, OK?
And on the other side,
I always clamp the right coronary artery.
OK, I go here now
to the left coronary
artery and the right coronary artery
is somewhere here in the depths.
I'm not sure that I
see even one moment,
that's the second,
yeah, wonderful Up perfect here.
Yeah, don't playing clamp
in case the heart doesn't
work, it may have to.
I would like to put a big clamp
here into the mesentery to those vessels
that actually nourish the intestine.
So this part of the intestine
should not become red you will see.
Now Mice.
Let's go to give me the artificial
blood that's artificial about coming.
Yeah.
Come in
and I go here into the water.
And
now it's a very decisive moment
of this operation and anxious.
OK, ok, ok, OK.
Now is a big moment is imminent,
so I open here,
I open their Mice, please.
And now let's have a look.
It takes some time.
The blood flows now.
So they all take
to the heart for all the major
arteries and should very soon come up.
The tension can be
not beaten by any
football player or soccer
player, even not by the Olympics.
This is something very
special, great
and wonderful.
Yes, yes.
When you look now on the plasma
screen, you see the wheaty going.
Its path is a coronary artery.
You mentioned at the beginning,
little tubes by which life hangs in here.
You can see some in the
heart full of UV dye.
These are the small tubes of which the
heart muscle depends which nourishment.
And if these are blocked and the flow
doesn't happen, then the muscle will die.
Now, I want to show you
the other part of the heart
here, where I put in the clamp there
is no you will die in this area.
And you can see here
the clamp to stop
the flow of polymer through the artery
in the lower part where you can see some
evidence, it's a bit patchy because
of the fattiness of this heart.
Now, I want to show you that actually all
the organs are infused with a right lung
within the liver to a good
extent, injected again.
And we also see
here the power with
all its arteries filled
up with artificial blood.
This time, again, if we can have a
close up of that part of the intestine.
It's a very striking
comparison here.
You can see between this fold
of intestine, which has been fused
with the red polymer and the white
unary perfused part at the top there
where we clamp the arterial supply.
So the the blood flow,
the blood flow has come back into this
lower segment, not into the upper
segment, which remains white.
And when the blood
supply to part
of an organ is completely stopped,
that's called ischemia a word,
meaning lack of blood flow to
that particular part of the organ.
And when that happens,
that part of the organ then dies.
And now I want to show you the
consequences of Kimock heart disease.
In some person,
it's not what you come in, please.
And what you see on this
table, there are
a number of heart.
So this is a normal heart.
It could be my heart, nice,
small about the size of my fist.
And then, you know, look at this
incredibly big heart when I open this.
You see, it's not healthy here.
This area is not
infused his blood.
This is ischemia.
There is an area of heart infarction,
and I can show you what this looks like
under the microscope on the plasma
screen, where you can see
some remnant heart muscle
in these red areas and in between a
white, pale area of scarring.
Now, about a quarter of us will die
of the effects of this type of damage
to the heart and a heavy heart
with severe scarring here.
When you compare just from the outside,
it's a healthy, small, lovely heart here.
And this diseased heart,
you see a scarring on the outside.
And now when I open this heart,
look on the healthy side here.
Very even signees, about 110
meters, as it should be,
and here it has a Senning also,
you see that the shape of the heart is
distorted because it's arrogated
and here the wall is very thin.
This is a scar
exactly here and now.
Look inside.
Wonderful, red,
healthy, beautiful.
But here, this person,
he didn't die from his heart, in
fact, but he escaped narrowly death.
But all too often, a heart, in fact,
has a much more dramatic result
it results in death, as in this
unhappy body donor, on my left side,
right side, and we did it cut and have now
a transparent plastinated slice from him.
And now look.
His lung surrounding the heart.
The right part of the heart
and here the left part,
which comes to blood into the body,
and here here is a crime story going on.
You see here a Upshaw
you see the bleeding and
all this blood went out
into the pericardial sac, about
this space in this space
which surrounds the heart.
And finally,
as I can show you in a
slice of this unhappy lady.
The blood goes out
of the heart because
this is against the heart and
you see the black blood and the blood.
Is going inside this space again
and the heart pumps and pumps,
it actually is drowning in
the blood which surrounds it.
Finally, within minutes,
this person died.
In part three,
the heart is dissected
to establish whether
arteriosclerosis killed this patient.
Her body is used to illustrate another way
in which arteries can become obstructed.
And a simple demonstration reveals
what happens when arteries burst.
A demonstration has
shown that when blood
flow to an organ is blocked,
the consequences can be devastating.
Now it's time to
find out whether this
woman's arteries were
obstructed by arteriosclerosis.
John, would you join me?
I'd like to cut open the heart.
It is popularity muscle
the inside the heart,
which pumps the
blood into the body.
And from here, I go out.
And I cut the aorta.
Which I just enter here.
Come on here, look,
these are actually the valves
and I open the coronary artery.
With this small scissors.
And now listen to this noise,
this noise is calcium calcifications,
severe atherosclerosis.
A perfect now to see come,
please John come here look.
This now is the
inner side of the left heart
pumping the blood into the body.
This is aortic valve
and he is in terms of the coronary artery
and opening this coronary artery shows.
He distinct are sclerotic
plucks exactly here.
These are the yellow
areas you can see
in the red wall of the artery
there in the artery is healthy.
It looks like that here when
that close looks like that.
Let's look now in the water and go
back to coronary artery and go back.
I go back here to the
border between the heart.
And they all and the
other shows he has,
those little white patches says, is the
artist roses here, here, here, here.
This is artist roses and this is more
marked, which is very normal down.
In the abdominal part here in the
abdominal cavity, again, these
are just clothes and those whitish areas
here with some alterations, some don't.
Look how striking this is.
Roses here shows up here even with
some world effects, some alterations.
So we can see three basic areas here,
the relatively normal wall of the inside
of the aorta here,
these fatty streaks and calcified plaques,
which are the white and yellow areas
here, and an area of ulceration,
which is where the arteriosclerosis burst
through the normal lining of the aorta
and caused some blood
clotting inside the aorta.
And before I showed you this
on the press it, and these are
exactly those ulcerations and Kathak
to see, it couldn't be shown better.
So we've been able
to demonstrate to you
arteriosclerosis in our dissection
specimen and we've shown you how it can
damage the inside wall of the
artery and lead to blood clotting.
But there's an even more dramatic
way in which blood clotting inside
the arterial system in
life can cause a problem.
And this is called embolism.
I can demonstrate to that to you
on our live model here, Dennis,
there are two fundamentally different
ways in which embolism a clot breaking off
inside the body and going around
the circulation can occur.
One of them, which we can start with,
can happen on the basis of a heart attack.
Sometimes following
a heart attack,
a blood clot can form on the interior wall
of the heart and grow and then break off.
And when that happens,
it can be pumped out of the heart round
the aorta until it gets stuck in one
of the smaller arteries, for example,
perhaps going down these arteries here,
which supply the upper bowel causing death
of the upper bowel or into one of these
arteries here, which supply the kidneys,
causing death of a kidney
or part of the kidney,
or even more catastrophically,
it can pass up into the blood vessels
supplying the head and cause
death of part of the brain.
A completely different
type of embolism
happens when you get a
blood clot in your legs.
This can happen for
a variety of reasons.
It's associated with air travel.
Sitting on an airplane with your legs
in a cramped up position for many hours
can cause a blood clot to
form in the veins of the leg.
And it is then
subsequently breaks off.
It can travel up from the leg
into the right side of the heart,
through the right side of
the heart and into the lungs,
blocking off some of the pulmonary
circulation, the circulation to the lungs.
And if this is a
big enough clot,
it's one of the relatively
few causes of instant death.
I think we can see a very simple
demonstration of embolism back
on the dissection specimen.
Well, when the come on
would come in exactly here,
here is the artery which goes through the
pelvis and here and here runs in the leg.
And now I take an
ambulance, some blood and I.
Inserted here into this artery.
A final push now by my syringe with
water simulating the blood flow.
And now.
Stop.
Now, the Emperor's travel
its way and I will open.
The artery and signed
it where it traveled.
Here it is, yeah, you've got it.
Perfect.
Now,
when this would have in life,
the blood flow would be exactly here and
the lake would not have blood supply,
emergency operation,
or this patient would lose his leg.
So we can see on the
plasma screen here
that are not embolism has traveled along
the artery and it's got embedded here.
And it's like
turning the artery.
And in life, there would be
no flow distance to that part.
And so the part of the body in this
case, the leg distant to that part,
would have no blood supply and would
gradually, over an hour or two die.
And this would be a
surgical emergency.
It is possible to remove it
surgically if they're known about, but it
has to be done within a very short time.
Well, we've seen how hardening
of the arteries can cause
narrowing of the arteries and can
cause blockage of the arteries.
But there's another thing
that can happen to tubes.
As any plumber can tell
you, they can burst.
And hardening of the arteries can also
contribute to that because it can weaken
the wall of an artery sufficiently
to cause it to dilate and then burst.
And I can illustrate the process
to you here on the plasma screen.
With a microscopic
picture of a weakened
area of the wall of an artery
and the dark colors here.
Are the original wall of
the artery on this side
and on this side,
but round here where there should be
a continuous arterial wall,
there are only small residual part
of the artery wall and the rest
has been completely replaced.
The wall has been completely
replaced by a blood clot.
And you can easily
imagine how this area
would be quite susceptible to
rupture, to bursting.
Well, I can illustrate this
for you very schematically
with a simple demonstration.
This tube here represents
an artery like they oughta,
and the white bits at either end represent
the normal arterial wall with the red
bit in the middle being the thinned
and weakened part of the arterial
wall due to arteriosclerosis.
Well, let's see what
happens if I blow it up.
As the war dilates,
the pressure in the war increases.
Until eventually.
Sometimes after
considerable time.
It ruptures
now, of course,
a ruptured aneurysm in the body
doesn't make a noise like that, but the
consequences can be equally dramatic.
Sometimes the patient hears this
noise and they die within hours.
I recall such a case
from my clinical time,
and I want to demonstrate now
Nadine could you bring
me some plastinated
exactly this kind of aneurisms.
As you just
demonstrated, in real
place tonight in real specimen's,
so this is a young auto. I would like
to have and this is
already I order 70 about.
And when you cut this open
before I showed
you advance notice,
close with already some ulceration,
some blood clot here when this continues.
It looks like that not only.
One place, this blood clot, several,
and here it is already in a small aneurysm
and here and here, blood clots
here, blood clots here.
And I turn it around.
You see all those buildings.
OK, now the most severe
aneurysm I found.
In this unhappy paternal.
To illustrate to
you, this is a heart.
Opened and this is say
Orta, say Auto which.
And a healthy person
look again like that,
and now look at
that, a bulging
an aneurysm,
thinning of the bone bulging
here and there is no one
there's another one here
and there is another
one, the big one here.
Look at this one from the big
one, big bulging here,
one bulging here and one bulging here.
And all this is filled
up with clotted blood.
And now it's time for questions
on everybody who has a question
will raise his arm, please.
I would like to ask,
why do people get a heart attack
when they have a sudden shock?
If you get a sudden shock,
you get a sudden burst of adrenaline
into the blood and that can increase
the excitability of the heart,
but in hearts that are already disease,
that increased excitability can cause
an arrhythmia to happen so the
heart can stop acting like a pump.
And in fact,
there's a large collection
of examples of the fact that it's entirely
true that you can die of a sudden
shock causing a sudden
stop in the in the heart.
One of the most unfortunate examples
that I know somebody had a heart attack
and died when he got
a hole in one in golf.
Ok next questions,
so let's go right in front, please.
This evening has
all been about blood
flowing and I'm quite pleased my
blood is flowing nicely and my veins.
But athletes are sometimes accused of
taking drugs with always being accused
of taking drugs, was accused of
taking drugs to thicken their blood.
Doesn't seem to make
a lot of sense to me.
Can you help,
John?
Well,
yes, blood has a
normal consistency,
which it's designed to have and which
helps it to flow around the body.
And if you don't have
as many blood cells
in your blood, that's the
condition of anemia or thin blood.
You don't carry as much
oxygen around the body
and the therefore the tissues
don't get as much oxygen supply.
What you're talking about is the opposite
situation where people take drugs
to increase the amount of blood cells
in their blood and therefore to supply
more oxygen to their tissues and
hope to enhance athletic performance.
The downside to this is that it also
makes their blood thicker and less likely
to flow and more likely
to clot in the system.
So although it may
work in the short term,
it's actually really rather
a dangerous thing to do, too,
with thick blood.
I'm better performing, but with
thin blood I sometimes
faint and but I live longer.
That may be the case.
Next question, please.
This gentleman over there,
if you have the
bad luck and get an
ambulance, for instance, in your
leg, how will be the treatment?
How long time do you
have that it can be
treated and what will
be done in that case?
It depends how large the ambulance
is, whether some side flow is allowed.
In the worst case,
you have to rush to the hospital in
minutes, let's say,
in a maximum of one hour,
and then there's an opportunity,
a possibility to dissolve this blood clot.
I ask because on long
distance flights,
you're always you always have to
take care and wear compression
socks and something like that.
The reason why you're
susceptible to them
on long flights is because of pressure
really on the back of your legs.
And anything that changes the flow
of blood in a vessel can predisposed
to clotting and in this case,
pressing on the back of your legs
to predisposed to clotting
in the back of your legs,
which is why it's recommended that,
A, he keep well hydrated on flights.
You drink lots of water,
you don't drink too much alcohol.
And secondly, you get up and walk
around every so often because that helps
the blood flow through your veins,
back to the heart and not to clot in them.
OK, thank you.
And then more
questions over there.
Please go ahead.
What needs to be done
to avoid an early
atherosclerosis or even to prevent
severe atherosclerosis in old age?
Yes, well,
that's a good question.
And in fact, there are things we
can do to look after our arteries.
And I can explain that to you by
using Dennis, our live model again.
Here we've got a
projection of our
arterial system and the main
organs and the reason why diseases
of the arterial system are so important
is because the arteries go everywhere.
They're required to
supply all of our
organs and all of our organs can be
in trouble without an arterial supply.
The commonest organs that are affected
by this lack of supply are the brain,
in which case you get a stroke, the heart
in which case you can get a heart attack.
The kidneys can be
affected with multiple
small scars or bigger ones,
and the bowel can also be affected.
And sometimes, as we've seen, the blood
flow can be blocked off to the legs.
Well,
what are the main risk factors
for this disease if at the moment what
actually predisposes to the most important
one and the one that's
easiest to do something about?
Well, unless you're too addicted
to smoking, smoking is a
major risk factor for a thorough.
It causes it throughout
the body and it
causes it to accelerate and
appear at a younger age.
So not smoking is a good thing
and stopping smoking is a good thing if
you want to look after your arteries.
The second thing that's
important is blood pressure.
The blood pressure
determines how much energy is transferred
to the inside of the arteries.
Every time the heart beats,
so the your blood pressure,
the more of a pounding the inside of your
arteries get and the more likely
they may be to develop an aroma.
And that's why after
you reach your 40s or
50s, it's a good idea to have your blood
pressure checked by the doctor every so
often because there are these days
very effective drugs for lowering blood
pressure into the normal range and
again, protecting our arteries.
And the third thing
that's important is
the type of fats, the type of lipids
that are circulating in your blood.
And there are two ways you
can find out about that.
One is that if you've got a family history
of arterial disease somewhere in the body
of stroke or heart attack happening at
a young age, you should have a blood
test because you can find out whether
or not you're predisposed to that.
Again, if you are,
there are drugs that can know the lipids.
And secondly,
you can have a blood test
randomly to see whether or
not you have high lipids.
This indeed is a
quite unusual program.
And some of you may
have been frightened
in the beginning, but fortunately
enough, nobody frightened to death.
Even you learn something to prevent
this, to live longer.
And therefore, I thanks you everybody
and the see themselves plastinated
as late as possible.
Thank you.