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Hello. I make it half six. So I think we will start me. Just try and hit it, right? If I do this, I see him. People can see me. I don't know if that's gonna work, but I figured I would give this a go. There's actually a human face involved. I'm going to start. We don't go moderate it as of yet, but when what appears? Hopefully they'll let me know. Um, for the time being, honestly, I can't see the Q and A If I've got moderator, so have a bit off. Ah, I have patients with May, um to the Yeah. So any problems with Q and A. I will just check back momentarily if we haven't got moderator. Otherwise, I will see it when I see it. So on Welcome to the first session in our anatomy, Siris. As I put it here, Week one. This is cardiovascular anatomy. It's going to talk by myself today. Uh, for the first time, I believe you can actually see my face. I hope that's not off putting to anyone today. Session of kind of escalate after me. Talk about myself. My name's Freddie. I'm a third year medical student at King's College, London. This photo is actually me in a cath lab. Um, other things. Any patient identifying information in that photo, which is good. Yes. This is me in a cath lab in leads southward. It's highly appropriate for this evening's session given, uh, yeah, um, making the most in session. That's something I've been advised we should put in here. This is just some guidance about what you can do to get the most out of today. Take some notes if you fancy taking notes off so you don't have to. But it does help you learn as you go along. That's good advice. Everything you do in life ask questions. Obviously pleased to ask questions in the queue, and a and I will try announce them as I can. Also, when we have a moderator, they will be able to answer them a bit better. And if you enjoy anything in this and you want to learn mawr, please feel free to email myself on. We cannot, and we can support you to do more. That's my email address. I'm sure you've all probably figure that one out by now. Given I send out emails each session. But please do email me with any problems or questions also follows on instagram or Facebook. If you're so inclined, I'm doing my best to make These is cool. A Z Interesting is that can, um but yeah. Uh, here. Ah, other sessions for a once a month. Siris, please join in them if you want to. And here are the rest of our anatomy. Serious ones again. Please join in. As you wish. They should all be pretty interesting sessions that there's a lot of me talking, so that might put you off. Should be Okay, so that's over, dude, let's get on to this evening. Session. So this is anatomy and physiology of cardiology and circulation, or basically, can't a cardiovascular. Is this on the way to put those both together? It's gonna be mostly the heart, but there is going to be a vascular in the heads weapon of little cartoon blood droplets in the top. So going to start off with, actually, where is your heart on? Basically, your heart isn't on the left side of chest. This pictures will demonstrates quite nicely where it is. Your heart is right in the middle the reason why we should think of it. Being on the left is actually cause the left side of your heart. When you run adult is quite a lot bigger. Is going on big musculature there. So you actually feel your heart being mortal wars the left. But things like your aorta or actually dead middle, slightly to the right, actually, for your aorta on your heart itself is majority in the middle. But with that sort of left overhang, I've just labeled a few bits in this diagram. It's not the best diagram I've realized. It's quite a lot of inaccuracies in it. So I I've done my best to label. I've sort of quite a nice picture in terms of the heart we talk about. I'm going to talk a bit about where the anatomy is, but the mix this will get from this, uh, and the it's that really, if you don't know anything else going forward from the session, learn what Atria are learned. What ventricles are love what the A water is on? Maybe a little bit more about the vasculature, that sort of vessels coming out that and otherwise, the apex and the base These are the two points of reference for the heart that might be useful going forward. Basically, base is where the vessels come out. This sort of the top of the heart and the apex is the tip of the heart. It's this is sort of the point at the bottom, uh, blocks it heart lies in center of the chest. It moves slightly across to the lower left in that, that's where the big, muscular parts of it are. It has to. Circuits is actually two pumps sort of fused together. You could pulmonary circuits that pump blood around the lungs. That's where you are oxygen from. It's where we get rid of carbon is quite important on then. The other thesis Temic circuit, which sends blood all around the body and that's where also we use up the oxygen and we pick up carbon carbon is very important, so I'll waste. Obviously there's other things. Besides, just oxygenation is involved in collecting other waste and taking it to the kidneys to get filtered, collecting other things. Take it to the liver to get filtered on. It's just basically blood. Is is what make sure everything in our body has what it needs to work. I love a little diagram here of lots of labels are talking more about them later. This diagram I actually drew the other day, much to my own sugar in this took me a number of hours to make happen. I'm sorry for how pathetic it is, but I thought it's worth pointing out. This is how your heart forms. So obviously from first is a shin. We are nothing but a ball of cells. We start off. Actually, it's just effectively one cell, which then it divides and divides and divides. Around Day 19, we form what is sometimes called the heart tube. So this is basis, just a widening of the vessel. Well, see, when we're that's small, we don't actually have a blood circulation. It sort of comes from our mother. Mom's heart worries about all our blood. We're not really small enough to warrant having our own heart. By about Day, 23 were starting to develop this heart that that tube is divided and it's starting to twist around on itself. Day 24 it continues to twist by about day 35 was starting to get what starts to look a bit like a heart. It's got a single ventricle. It's got two Atria on gets got sort of one common vessel coming out of it on by about day 60 we have more or less what the adult heart's going to look like. The biggest difference being that in insight, an infant inside of fetus. The right heart does most of the work. The left heart doesn't do a lot, and then when you sort of when you're born, you're left. Heart takes over. There's a better diagram of the heart. More you'd expect in an adult heart. Ah, heart beat. This is a bit talk four. Talk about the heart beat. Let me just quickly label some bits here. I don't if you could see my mouse, but the blue chamber on top here is our right atrium below that is our right ventricle. Then we have our left atrium and are left ventricle. Ventricles are the ones that pump blood out of the heart. Atria, sort of collecting areas and atria in Latin is an entryway off the the Siris we call a trick healthcare. The idea being it's an intruder, A to get into healthcare rolls. And yet, when Atria it collects things, gather there that gets pushed into the ventricles and ventricles. Push it around the body, more or less when I put in this light here, heartbeat is divided into systole and diastole. Sisterly is the contraction of the ventricles. Diastole. Is that the rest of the ventricles? Effectively. So if we name it based on those periods, sisterly is a contraction. Diastole is rest and refill. There's a passive diastole ins and active diastolic, but that's not such a important part. Systole Contraction diastole Relax a shin. Um, it relies on pressure. Grady. It's I'm not going to talk a huge amount about the pressures. I think I've got slide quickly, showing what the pressures inside the heart actually are. This only really matters. If you sort of go into cardiology or anesthesia, I can't think of many other specialties in medicine where it matters and actually to be outside of medicine. I think maybe cardiac physiologists worry about a bit. I think that's it. I can't think of any other specialties where that really matters. Maybe maybe pharmacists. If I have Melanie here, she could correct me on that. But it may be matters pharmacy cause a bit of heart failure works. But really, it's not that important to know. Certainly early on, um, during cyst, this is now fitting in the electrical side of it. So your heart sort of works in two areas. You've got electricity and you got plumbing. The plumbing is pushing blood around. The electricity is what controls the plumbing. I think that may be making a little bit basic, but that you get the idea. Ah, during a heartbeat, electricity starts. It was called the Sinoatrial node. The essay node. This is right up at the top, right of the right atrium. This goes across the right atrium. That's special signaling pathways to take that across the left atrium so that both of these contract at the same time. That signal that enters what it's called the, uh atrioventricular node. Sorry. Done. How? That without my head, The intraventricular note then conducts that that down into the ventricles to allow ventric the ventricles to contract. Um, so the off a tree contract blood gets pushed into the ventricles. This causes the valves that I didn't really mention vows. I mentioned a bit later on more, but the 1st 2000 shut the ventricles, then contract that pushes blood out around the body or to the lungs. Another set of valves, then shut and that starts blood flowing backwards. 1000. Quite important. We'll talk about them in a bit, but they open again once the pressure drops and we, like, passively refilled that I feel like a covered very briskly. So let's quickly check. Ah oh yes, know if someone has commented Yes, Apparently I got the time zone wrong. Sorry about that. I put UK time zone and teams doesn't seem to account for British summer time and not British summertime. It is at this time, Um, yeah, so that's the heart beat. But in a very basic nutshell. Electricity cause things to contract and their special systems in the heart to make sure that electricity makes them correct contract at the same at the right time. And when that goes wrong, things don't go in the right way. This is said, there's a bit quickly about the pressures inside the heart. I wouldn't worry too much about it. Like I said, Yeah, basically, blood moves down a pressure Grady int. So when things contract, it pushes blood. Otherwise, that's about all you really need to know about the pressures. Valves had mentioned themselves. Talk about them here. So you've got four valves inside the heart? Uh, one of them is bicuspid the rest of tricuspid, but we call one of them the tricuspid valve, which to me never makes any sense. So you have your bicuspid mitral valve that Yeah. You have your tricuspid valve, your aortic valve and your pulmonary valve, your tricuspid and mitral valves. What stops Blood flowing backwards from ventricles into the atria. So when the ventricles contract, you don't want all that blood being pushed the wrong way around your system. So they shut to stop that happening. Well, hopefully they stopped. They shut to stop that happening. You can get a lot of diseases where that doesn't happen, and then your aortic and your pulmonary valve shut to stop blood flowing back into the ventricles after they finish contracting and pushing it around the body. That's a big part of how you keep blood going in the right direction, which should be returns into the right atrium, goes into the right ventricle, goes around the lungs to do its thing there, comes back into the left atrium, goes there with the left ventricle and then gets pushed all around the body, the electrics. But I did mention, so I'll just go through it quickly. Here again. This is a very brief overview off the electrics because, I mean, this week alone, I've had about four hours of teaching on E. C. Gs at university. You could go on forever with, um, very, very complicated at times at the most basic, any time that there is a uh yeah, Basically, the heart is controlled by serious electrical impulses that moves across the heart, causing contraction in the symbol A muscles work. Electricity cause them to contract. Um, we can measure this using a series of sticky dots on the chest on we can see rises is points where electricity is moving towards. It rises when it's moving away from something we're looking at on. It comes down when it's moving towards where we're looking from. So if we're looking that direction sort of from the top, right shoulder down to sort of the bottom left of the heart were expecting things to get up. If it's moving in the right direction and it goes down when it's moving the wrong direction. And so as the heart contracts, we see these. These bumps and these bumps control how the heart contracts. I think that was explained terribly by me there. And I'm sorry for that. Uh, but it gives you basically that is how the EKG works. This is an EKG tracing. We have any we divided into the P way. If the Q. R s on the T waves sometimes also think of you waves. I'm going to ignore them because they get complicated and not really important for this on break down how that shaped so that we could sort of diagnosed things that going wrong with the electrics off the heart, we could also sometimes figure out a little bit about what's going on with the shape of the heart, that plumbing of the heart. But again, that gets more complicated. So leave that for a more complicated session. Um, the pool thing to remember is just this shape. This or distinctive shape is what we measure when we're looking at the c G, the electrical pattern across the heart. Um, and from it, we could start figuring things out. Roughly, it works out that the P wave is when the atrial contract or it causes the A treat extract. The Q. R. S complexes, it's called, is normal when the ventricles contracting and the T wave is when everything is set, this ovary setting itself and going back to how it should be in order for the next heartbeat to occur. Here's a diagram of that electricity moving across the heart, your sinoatrial node in the top right of the right atrium. The signal from that travels very, very quickly called What's called Barnes brought Bachmann's bundle into the left atrium. Uh, here it's This allows both atrium, both atria, to contract at the same time we hope on. So then blood is pushed at the same time into the ventricles. The signal also goes across the right atrium into the Navy node and then travels down what's called the bundle of his. The bundle of his is basically a bunch of what's called the Kinji Fibers altogether. Think of it like a rope with all the individual fibers inside that rope. These then sort of branch off as the rope sort of becomes frayed towards the edges. And each back injury fiber goes to a small group of cardiac cells on This allows for the ventricles to contract at the same time. Again, we hope pushing blood out around the body. I think we're quite basic of my partner. You don't check up, Not lost. Everybody. Um, semilunar valves. Okay, I'll talk about semilunar second. When does the session end of session will end About eight o'clock. Semilunar valves I'll mention quickly, are more commonly in the venous system, so we have them in our veins. I'll talk about them a bit later in terms of vascular system. But we have semilunar bowels stop the back flow of blood in the venous system, but only in part of the venous system, which is gonna make it really confusing. But you'll understand later when I explain it bit better. But for now, we'll do heart will do the veins and all that later. Uh, also bit of the aorta. They oughta is the biggest artery in the body. It's the one that carries the blood from the left ventricle down on it carries it well, actually, aorta starts, starts the hearts and ends somewhere around your belly button. It's a very long, sort of curving structure on lots of other arteries. Branch off of it, actually, away over arteries. Branch off of it. Eventually, when we take a BP, we end up with two numbers. Your systolic and diastolic numbers. We talked about them a bit in terms of the the phases of the heart contracting. It's a systolic, basically. Is the pressure when your heart contract so that should be the highest pressure in your arteries on then. Your diastolic number is when your heart is relaxing, so that should actually be the lowest pressure inside your arteries. So we measure both of these are these are important needs. Tell us what's going on a bit with the heart, but also been with the sort of the body as a whole. Um, if you talk about like high BP, this means that one of these numbers, all both of these numbers are quite high and risking damaging those vessels or damaging things that they supply. Never talk about BP being low one or both of those numbers to be quite low, so it's not enough pressure in them to get get fluids about? Well, there's not enough fluid to sort of maintain a pressure. Um, the aorta is quite important in how this happens. Your aorta sort of maintains that lower pressure. So if you have a really bad a water, that diastolic number could drop right off and you end up with it's or dropping really, really low. Or if you have really stiff aorta, it could actually stay really, really high. So nice healthy water gives us a nice, healthy diet stuff like, among other things, that sort of the main role of the aorta in terms of what we measure. Um, yeah, and it results, they said, with the gap between the two numbers is maintained by the aorta. If it becomes a really small gap, that could be because we got a really stiff a water. Or if you have a really overly stretchy gap, that gap can become really, really large because they order is not applying much pressure to the blood again. I think I explained that heart's okay, but if you have questions, please, do you put them in the question, um, this. But again, what you actually need to know from this is we have blood on the blood is useful. Um, but from this So we have about 4.5 to 5.5 liters of blood in an adult off. A slightly bigger person will have slightly more blood. It's like smaller person, probably less blood. Actually, a pregnant person will have quite a lot more blood. You can gain about third, the third extra blood when you're sort of a later stages of pregnancy. It's roughly 7% of your body weight, or 10% in in younger Children on blocks that in pregnant women it could be even higher within your blood. Your four components that we worry about. You have your red blood cells, your reflux sites. If you wanna get scientific your white blood cells, there's a lot of different white blood cells, and that's for a name. You know the lecture. So I'll leave that I won't talk about them too much. Now your platelets, which are sort of closing bodies, they sort of involved in how we clocked how we repair now. We stopped bleeding. Basically, how repair damage to a vascular system on plasma, which is mostly the liquid that all of that floats in, but it was has contains some salt, and it also contains some loose proteins and other bits that we're sort of wanting. Um, the main job. Well, one of the main jobs of the blood is transport oxygen, but it also transports waste. It also transports nutrients, um, transports things we don't necessarily want among waste. You can also have other things in there you don't really like on that carries it around the body partly for filtering it to get it out of the body and partly to carry it to where it needs to be so that we can function. We also have the ability to fight infection because of the white blood cells that floating it on the ability to repair any damage. We get free platelets on those wells for immune cells so we can do clotting and fix things or provide nutrition for cells to divide and repair themselves have been damaged. Um, the blood moves in the vessels. We have arteries. We have veins on. We have capillaries like that. Veins have semilunar. Bowels will talk about that in a second on your capillaries. It is very thin, very porous. vessels. Uh huh. This slide again. I don't expect you to get a huge amount out of this one. Just understand a little bit about the difference. So arteries, particularly big arteries, are very, very thick walled. So actually, the Lumen, which is the the gap in the middle of it, sort of the hole in the donut. That's where the blood sits. The Lumen itself isn't necessarily huge, but the walls around it are. And that maintains pressure because that's very, very elastic. So if blood pushes against it, it will push back, and it will keep that blood high pressure. So it moves very quickly. And so it goes a long way, which is what we like. We haven't really got a second heart halfway down or, you know, I hate or anything like that to try and keep it pumping. Um, so yeah, that that elasticity is important As it goes over away, the elasticity so pretends to remain similar, but the actual Lumen in the middle the gap in the middle could get a bit narrower on this intended so that we can also maintain that pressure. But as you start to get to what's called arterials, which are sort of the beginning of this of the merger between arteries and capillaries. That's what it goes away. And they start to become quite porous. The capillaries very thin. These what basically brings blood toe tiny minute areas of the body. Small groups of cells, for example, Commute supplied by one capillary. Um, she's getting very, very tiny. They contain very, very little blood, but they're very porous. So things were in. The blood can leave and things can enter the blood. That's how oxygen sort of gets I/O. That's got important for the lungs, which is another CT. Another like, I think next week, Um then is the blood begins to come back the way we have venue ALS. This is where they start to get thicker again. Then veins tend to have a very wide Lumen because they carry a lot of blood, but they're not under pressure. So actually, the wall of the vein isn't isn't particularly thick, and that's what helps carry blood back up. And within those veins, we have semilunar valves. That's to stop blood flowing backwards. We don't really want blood to just all end up in our feet. We wanted to will come back up with it. Interesting. If you don't actually have semilunar about in every vein in the body, most of the ones above. Sort of heart level. The ones that are effective, basically affected by gravity. Don't need valves. Gravity pulls blood back down a little. Veins in your head, for example. Don't have valves. The blood just falls back down under gravity, So yeah, semilunar house as it's sort of coming up from your feet Not so much that falls down from your head. What color is blood? I'm gonna put that. I'm gonna ask that in the queue and a for a second while I quickly catch up on what I have not read. So if you think it's, uh yeah, what color do you think blood is If you want to put it there, um, published couple of these. You got a couple of seconds to quickly ask. Uh huh. I'm not getting any answer. So that, uh, much move to the next slide. Ultimately, if you just fought about an answer, that's all I really need. For the time being. Well, I had one answer which says blue. Okay, we'll get a couple more reds rant red maroon over like the idea of a room that's a nice color texture. Um, so actually, it's never blew. Um, the idea of blood being blue is actually just the trick of the light. Blood inside your body is never actually blue. There's not really anything going on with it that would make it become blue. Um, there's always some level of oxygen in it, and actually, when it has no oxygen in it at all, it's It just becomes a dark monkey gray, quite dark color on when it's got lots of lots of oxygen in it, it becomes very bright. Red s actually very dark red and eventually sort of going towards or rusty color. And then eventually, when you sort of, if you're properly dry, it all the way out and have nothing left in it. It sort of goes from monkey brown and eventually can go into a dark monkey gray. Um, yeah, basically, the reason why we see it as blue is it's the short wavelength. Light blue light can come back out on also because if it's very dark race so still, stress is dark red, not much red lights. Well, basically not much red. Like it's back out of the skin. Really? So we we really only see the blue light element. Where's our warm spectrum colors? We got to keep them, uh, color of blood. I go for cherry or strawberry. I shall unlike get the cherry rolls. Breathe depends on sort of your thoughts on it. But actually, if if you get blood oxygenated enough, it goes very, very bright red, as you can see here in this picture of the bottom, Um, that obviously is not quite how you'd expect in the body. Maybe if you're bleeding, you can take up more oxygen from the air. But actually, blood doesn't tend to get quite that bright red. It can if you got problems with it. So you haven't got very much blood. Serve your urine shock, for example. You've lost a lot of blood, and you filled it all up with water. It can go for cherry eight. Very bright red. Um, and also it never quite goes the other way. So in your body, it should never quite get to this almost purple, sort of really funky color. That's what they've managed to do in a lab by giving it by putting into the blood just certain spectrum colors. Certain gas is to make that spectrum of color. Um, yeah, well, read some blues and the chapter. Just want to check that for a second. It's a cherry or strawberry, cherry or raspberry. This all depends on your thoughts on what? What colors are but effectively because dark red when it's not got any oxygen in it on very bright red. But it's gotten lots of extra food and then, obviously an artificial circumstances in vials. You can make it really, really don't write. Getting also brown, purply brown brown um, or you could make it very, very bright red. But that's also an artificial not in, not in the body. Um, this job I may, just because the tutor of mine last year decided it was important that you had to know where your blood actually goes on. But I thought that was quite interesting, really. So it's roughly 80% of the blood from everybody. Eat goes to four places. It goes to your brain. Your heart is in background, supply the heart and goes to your liver or against your kidneys. Um, that's important, remember, because actually, your liver and your kidneys are involved in sort of cleansing blood. They filter things out there clean blood. They make luds what it should be your brain because we want lots of oxygen in your brain. It's how you think were supposedly intelligent creatures. It takes a lot of energy and a lot of oxygen to make that happen and then your heart itself. It's a constantly working muscle. If your heart rate 60 it's contracting 60 times in a minute. That's a really, really hard working muscle. It needs a lot of supply to keep that going. Obviously, 100% your blood on every heartbeat is also going to your lungs. If that makes sense, because off the one side of your heart, 100% that's going to your lungs. The other side of your heart is going off to these various places. And then what's left off? He goes off to your muscles and the like. You can sort of change how it works. In that sense, this is very much rest. If you start running, your body will divert blood to the muscles, get them more supply. If you're eating your divert blood to your guts to help you digest it, absorb, but roughly at rest. If you're sort of in a normal, as I hope most of your right now there's some of you probably just eaten, so probably probably are digesting. It was a normal state. This is sort of where your blood is meant to be going, and that sort of becomes effective. When you start thinking about what happens if we haven't got any blood of your heart stops working, what parts of the body are going to start being affected by it? This'll is a massively over complicated slide, and I'm really sorry for that. But this is basically how a lot of the observations we'd measure routinely in the hospital or in a pre hospital setting sort of tied together. So you, your heart rate and your BP come together. Importantly office. If your BP decreases, your body will increase the heart rate. So it's pushing what's left of that blood. Well, the lower pleasure of blood more often to try and get it around the body, and that was their way around. If you're BP is really high, your heart rate might come down because the blood's getting further, which beat, um, that that affects your respiratory rate. If you're breathing really quickly, your blood skin, your heart's going to start pumping more blood to your lungs to try and get Maura Morris the oxygen out of it and likewise there around. If your heart's beating really quickly, you're gonna have to breathe more quickly to try and supply oxygen to that blood that's moving more quickly. That, in turn, affects your oxygen. SATURATIONS. York Some saturations are basically a very actually quite effective way, but quite old fashioned way of reading. How much oxygen is in your blood. It does that by shire. Normally, the way we measure that were shining a little red light for your finger and see as we showed before certain amount of red light is absorbed in certain amount is reflected. So it's the the darker red to your blood is, the more is gonna be is it that way around? There's there were, and the brighter red your blood is, the more red light is reflected, so if we're getting 100% of that back, we'd measure that as an option saturation of 100% but, well, a tip based on salabrasion. So if you expect yeah, compared to, like samples of think loves, they used to, like, measure against. But that's the morgue. Oxygen in your blood the more red light you get back in the sensor, and that tells you more, they seem how much more oxygen you've got in your blood. Um, there's always a measuring things that as well you can actually measure, like, accurately the oxygen in blood by doing a thing called arterial blood gas. That's sticking a needle, getting arterial blood out and running it for a special machine. But that's a lot more complicated and involves needles and stuff. And it's not very easy to do the measurement compared to sticking a saturations Proventils finger. Your blood sugar plays into all of this. Obviously, if you're using a lot, if you're moving your blood around your body, you're using the muscles a lot. For example, you're gonna use up your blood sugar. Um, low blood sugars can also impede things that your neurological function. So actually, you start going sort of comatose if they get low enough. Talked about this a bit with my diabetes session back in the summer. It really was not seen it go to a link tree or some of that, and you can find the session. Um, ultimately, Yeah. Reduce saturations of oxygen gets really low. We're going to start using less sugar because you can't. Uh, yeah, basically all ties together. You can read it on this, and I'm gonna read off the slide for you. All this can also affect our temperature. Actually, by breathing out is one of the ways we reduce temperature. But I have dogs pant. Believe it, not. We do the same. Just it's norm. A gnrh made our main way off. Uh, our main way of doing temperature regulation. Also, if your breathing more quickly you can actually call yourself down, like was actually start sweating to call yourself down, you lose fluids, and that affects your BP. And then everything else gets affected that way around. Um and then also we do things called. Yeah, I'm not really talked about Berries a constriction yet, but we'll talk about that in a minute. Um, so yeah, basically all of these things tied together and all these things that in turn effect basically, how responsive you are. I'll let you look at that slide off. Seven. Yours to go back over this slight. Feel free to go into the recording later. But this is basically how all of the things we measure tied together, I thought I was quite useful for ah session about the vascular system. Oh, there's a relation. I said I was gonna mention it, and it turns out I'm gonna mention it right now. Let me just quickly check that or not to date on chat. Okay, Yes, There's question about carbon monoxide poisoning that you mentioned that quickly to carbon monoxide is morphine. It basically a red blood cells like it more than oxygen, so they will bind with that more rapid more actively, you then can't use the oxygen in it because carbon likes to hold on to this oxygen in common. Not so it's basically the oxygen is not really available, but it's sort of there so you can end up with very high so oxygen saturations because you've kind of got a lot of oxygen that but it's another. It's usable. That's very, very I'm not going like very primitive way of explaining it this far more complicated in that. But I think that sort of covers. They give you a little idea of what's going on with it. Uh, how does percent of saturation of hemoglobin auction effect the intensity of red color? What causes the blood have darker brown color. That one gets complicated. I and it's the on it I and is the very, very basic. Answer that person. Ask that question. Feel free to email me that if you want, I could go through that bit bit longer in a bit more like detail for you. But it's in a simple, in a word, answer. I am no urine production can indicate cardiac from 2 to 5% out kidneys. Yes, actually, it can indicate cardiac function, and the other side of it it can also Yeah, So, basically, uh, if you've not got very much fluid in your body, so your BP starts getting lower. One of the main things you do is you stop making urine to retain fluid because you're wearing out fluid that you want. That's not great. So actually you're in function urine output, but kidney function and urine output. Quite good measure of how well your heart's doing on, like was their way around. If your heart's not doing well, your kidneys aren't doing well over because they need a lot of that blood just to function. Um, and that they need quite a sort of a wet existence, Really, For one of the better word. So, yes. So the two of them go together quite well. And it's something we measure quite a lot in the hospital, actually. Is how well kidney's doing? Um, color, um, tree color? Um, a tree. I think there's a word there that I do know and I just can't remember it. Well, we got published anyway. I believe that is the measuring of how much of a color is present in order to determine something. It basically is how saturation probes work. It's measuring the presence or lack off color or the intensity of a color. Um, so yeah, I think that is the right word for it. But I I've been in placement all day. I can't remember that word of top ahead. Sorry. Um movement, visit, elation of those a construction. Unless there's more questions, feel free to put him in the chat that are vestal a shin is basically arteries opening up, making themselves making the Lumen that the hole in the doughnut wider by relaxing the wall of thumb to that nice, thick wall, was a muscle muscle in it. So if that that relaxes, you can end up with it's looming opening up. Uh, as this means that basically more blood conflict through the artery a time. Uh, it reduces the BP, but it also, you know, allows more blood flow in one go. Um, and for doing this and the opposite of it vasoconstriction, which we'll talk about in a second, we can sort of determine where our blood is going within our body. Good example of escalation. If you're really warm, you visit a lake near your skin, so you put more blood into capillaries in your skin, and this allows the heat loss so that he can radiate from the skin. That can also cause sweating. So we end up losing fluid that way, and we lose heat that way as well. Or we convey, is it a late mawr blood into the muscles of our leg? If you're trying to run for example, or if you're about to run, Um, but then that same time, it's no always useful. So we want lots of blood in our muscle if we're about to run away or for Vatican for a runoff were in the middle of a run. Um, but it's not great if you just eaten a meal and you want that blood in your gut so you can absorb that meal rather than yeah, so we sort of want blood in certain places. Certain times construction is the other side of it. That's narrowing of lumens that reduces blood flow in the basically more the blood will carry further. We'll go through a system you don't have the chance to sort of slow down and go and being useful. And it can also restrict the amount of blood that goes down and artery. Because obviously, if you've got a big how to explain this very easily arteries old branch off of one another. So if one is very narrow, the amount of blood that goes down it relative to the artery it's coming off will be less so that morbilli will go further along that system and go elsewhere rather than into the area where you're where that particular one is again. I don't think I explained that beautifully, but, you know, do you tell me if any of these explanations don't make sense, so will happen to go through them a bit further. Um, again, the surveys of restriction is very useful. If we want to reduce blood circulation to a certain area, we want to increase BP because maybe we have enough blood. Um, So, for example, you don't really want lots of blood in your stomach and your gut if you're running a race or if you just sort of at rest. Um, so, actually, by constructing all the vessels in the guts, we can move blood further away from them on Have that blood going around. Your muscles are going around your brain. Maybe in an exam. Um, but then, like was the other way around. We want lots of blood in the gut so we can constrict the vessels in the muscles to bring blood back to the gut. Um is also really useful in blood loss. So for bleeding or forgot injury, you can get vasoconstriction. Your body will naturally try to reduce the amount of blood you're losing so vasal constrictor area around it to try and reduce the amount of blood loss. Internet means the blood that's going into the areas on the higher pressure, and it starts flying further away from you. But theoretically, it should be less blood. Then there was to begin with less blood than you would have if it didn't phase a constrict. Um, one of the hormones in our body and we know we're talking about hormones, but I'll mention it here because it's worth remembering. Adrenaline is produced by your adrenal glands. Those view from the more American side of the world or Michael Epinephrine. It's exactly the same thing. Epinephrine and adrenaline. Epinephrine is from the Greek, and adrenaline is from the Latin. Things that way around. Yes, it is that way around best, the same thing. It's a hormone that we released your stress anxiety and this concludes vasoconstriction. So when you get anxious, this is trying to reduce blood flow to part of the body in order to sort of help you with that sort of fight or flight reflex. So you're getting more blood in your muscles, ready to punch something will run away from something on less blood in your stomach, ready to digest something. This is why some people get that sinking feeling and other things wrong. Word vasoconstriction be used to maintain body temperature in competitions. Yes, again, Same sort of thing. You can get vasoconstriction of the skin if you were really cold, because that thing keeps warmth on this part of. So have frostbite can work because actually getting less blood flow to the skin. So in turn, that skin loses supplies. Um, yes, that's that element of how frostbite happens. But again, I'm not going to start talking huge about for us. But if we want to start talking about things that I really do like stuff about frostbite, so we can talk about that over time, pleased to send me an email, if any of these things, the things you'd like us to do this session shock. I'm a volunteer in central ambulance, so I have to mention shock because it's very Synjardy thing to talk about. It's also just very important. Anyway. Shock is basically estate in which you're not getting the supply to tissues that you need. It's very basic way of explaining it. There's a lot of different sorts of shock. We'll talk about them a little bit in a second, but effectively during a state of shock, you're trying to get what, like you've got around the body mortification ble. So this means you end up with your your heart rate going up. You end up with basal constriction in places where you don't want the blood and see how it goes up to push more blood around your your respirators out. Good hyperpoly, um, which is basically just fast breathing to get more extra news, that blood to make it effective. It's possible people get sweaty initially, and then we'll go cold and clammy a bit later on. As you move the blood to the right places, they get anxious because naturally, you're getting blood in sort of the wrong places and your your body, your nose. This is happening and you see you're thirsty. You want to replace fluids, several calls a shock, basically anything that can affect the heart or the circulatory system. All the fluids within those systems has the potential to court shock. Um, there we go types of shock. So we got your car. Realistically, there's only to hear that. I think you're really worth remembering, uh, at a sort of pre pretty university level. If you start doing these things like this is a degree sort of need to know the rest of them. Cardiogenic shock is basically your blood. Your heart isn't pumping the blood enough. There isn't enough. You know you're not getting blood around sufficiently. This could be because the heart's not working. The most common reason is the heart's not working, also can. Because blood's not getting back into the heart. That sort of north comes under obstructive, but yeah, So basically the heart isn't doing its job to meet the needs of the body. You got hypovolemia, which is just there isn't enough blood. This could be because of blood loss or could be because of really severe dehydration that could be due to things that vomiting, diarrhea, lots of sweating. Just not having drunk enough go talking like a lot in order to go into shock from it. We're talking a lot of not having drunk enough talking people who haven't drunk for like, weeks or in heart conditions may be days or a day if you're like doing a marathon in desert. Maybe, but this is the sort of shock where basically just don't have enough fluid going around in order to meet the body's demands in order to get things where they need to go. You think obstructive This is basically two blocks. This could be something like an infarct. Needs to be something tampon are, um, and in fact, like er of myocardial infarction. Some humor heard off. I'll talk about that a bit more in a minute or so you can have infarcts in muscles. You can also have things like if one goes into your brain, that's a stroke, and that is basically just not enough supplied. Getting to the point beyond it on that can cause shock off. See if it's cutting off blood supply. So the whole body or it's cutting off blood supply enough to a large enough area, and you got distributive, which is basically your blood vessels aren't aren't doing what they need to do. They know constricting and dilating in the right places on. This could happen with things like anaphylaxis and septic shock. So you just yeah, your blood vessels aren't doing their job properly to carry what you need around that. It's very basic overview of them again, but I think it gets the point blood supply of your heart. Like I said earlier, your heart's very busy muscle problem on the busiest muscles in your body. It's contracting every sort of. It's contracting roughly once a second. If your heart rate is 60 most people's heart rates will be higher than 60. For example, if you're running and your your heart's 100 20 is contracting twice in a second, that's that's really busy. So it doesn't need a lot of oxygen, a lot of nutrients in order to keep that those muscles doing their job. For that, we have what's called the coronary arteries. This is a big part of anything. Cardiac is the supply of cardiac muscles. Um, they're the first arteries to come off the water, possibly cause they're one of the most important ones, but also just because actually, the blood supply to the heart should be coming. You know, the heart is where the blood comes from. It needs to get back to the heart like logically, that's like the blood supply would come from. I've not made sense of that. But in my head, that makes sense. And basically they are vessels that come straight off the aorta, assumes it leaves the heart and go back around the heart. Because the heart doesn't get its own blood supply from inside, it gets supply from the other from outside. Bit of a weird thoughts for those who have never very forth about how the blood how the heart gets it's blood. But yet the inside of the heart isn't really where it gets anything from. Um, these are big risk for clots because they're very close to the heart. So where the blood gets pumped from below six, they're quite small. Um, this what we call my cardio infarction or a marketing from us basically a something blocking one of these vessels, um and then then cuts off the supply. They get supplied from that point, Think collateralization by one going to collateralization today. If anyone wants to talk about collateralization police to send me an email scheme of heart disease is caused by buildup of fatty plaque within those vessels. In the Lumen, the whole of the doughnut becomes narrowed so blood supply through it becomes weakened. Eventually that can cause a complete construction and cut off blood supply. 30 down. But actually for the time being, if it's just reducing the blood supply, that can cause problems. If you need morbilli supply, that's what's called angina. Um, here's a nice diagram of those coronary arteries. So this is the aorta coming out the top out, the top of the heart coming from the left ventricle. Uh, and then very, very shortly thereafter, like very shortly like millimeters, these two vessels come off one either side. The first branch is they oughta on they wrap around the heart and they divide up. So that's like a diagram here, which I drew part of. I think I copied some of it and then drew some of that just demonstrates where these are the words that the ones that were remembering are your right coronary artery, your left main coronary artery, and then it become that then divides into your left anterior descending and your circumplex. These are sort of the four big name ones before big name ones in terms of blood supply to the heart. Uh, and that's them, or wrapped around the heart up there those ones tend to be quite bad for Ski Mia, so they tend to get quite a lot of narrowing due to ischemia. It's rare. You have a clock big enough to knock out and entire one of these like that. That quite big compared to, um, quite big compared to some of the very narrow ones further along. I like, for example, the left marginal or the sexual perforators I've noted on here. They're much more like to have a clot problem, but you can get big clots, so sometimes you can get a quite a big infarction, which will knock out quite large chunk of the heart muscle. Uh, that brings something acute coronary syndrome. Let me quickly Don't check the check before I move on to keep quiet syndrome. That looks good. Please. Do you put things in there if you have questions again, um, so keep coronary syndrome effectively hostile. We do have a couple of questions in the chair. I can't see anyone. We've got one. We have a new one on a trend in vasoconstriction in, and I'm not sure this is a question, but it's about since John's shock. I'm not saying that again. No, I can't see them. Read them out for me. Okay. We've got one on if adrenaline causes vasoconstriction does nor adrenaline cause days A dilation? No, In short. Um, actually, no adrenaline can also cause vasoconstriction, and that makes it really complicated. Like, really silly. But yeah. Um, you know, it's a simple answer. Adrenaline causes vasoconstriction on. Then thing that relaxes it is called. I think it's a D h. I think 88 pills is phase the dilation, Other things called basic elation. A lack of adrenaline causes phase it Elation is a good example. Um, yeah, and we've also I think someone's I'm not sure if they're joking or not, but they're asking that John Shock is always emotional. And it's old with a cup of sweet tea oil blanket. So I think that expression of short verses, yes, well, if that's your belief about Synjardy shop, you're going to the wrong events. That's all I can say. If your partner Jon, if you know parts and John, I think you've got quite good idea about what's the job is all about. But if you are parts of John, you're going to the wrong events and not saying the right sort of shock. Um told her unit manager about better, better exposure events. I think that covers that, doesn't it? Thank you, Melanie. I didn't know you joined us. Thank you. Hello. Finished dealing with? I didn't explain earlier. Melanie was going agreed to come and be our moderator. But she's also on call for ah, pharmacy and house in. It's not for the whole hospital. Is it used for a part of the hospital? It's the two hospitals. What? Melanie is a busy human being on we. Thank you very much for coming along to help out. Um, not being said, she's not going to tell me. I'm very, very wrong with some of these bits because pharmacist love things to do with the heart because so many medications work that way. Um, so I haven't gotten it from a license in this, so I should be okay. Going. Carry on. So I am distracted. Acute coronary syndrome for heart attacks. These account full sort of. The more physical, the more plumbing. As I said earlier, the plumbing and electrics, These are the sort of plumbing style of heart attacks and angle electric ones as well. But we're going to sort of ignore those for the time being because they're like I said earlier. They they get very, very complicated and long. And I've had about four hours teaching on, um, just this week alone and probably about 15 hours of them in the last couple of weeks. So that gets a bit long for anything like now. So the plumbing ones, though we could go a bit more easily. So you got your three main forms acute coronary syndrome. Some people might include 1/4 which is stable angina. I wouldn't necessarily call that acute coronary syndrome that sort of more chronic coronary syndrome in a way that's not going away. So the three main ones, these ones that are medical emergencies, your ST elevation, um, I, your non ST elevation and my and you're unstable angina. They differentiated by two main factors. You look at the C G and you see ST Elevation. That means ST Elevation and I on. Then you do one called a cone, and this is a a marker of cardiac stress in the blood. Basically, proponents a part of the muscle cells in the heart on when those get damaged and start to, like, break down or die. They're released proponents into the blood, and we can go and measure those proponents to figure out what's going wrong with the heart. Unstable angina gift proponents. It's sort of the tens and hundreds, um, are cardio infarction will be the hundreds in the thousands. So actually a bad, unstable angina and no, not so bad. Instead, me probably won't be until so much difference from that. But we're going to talk a little bit about arterial catheterization in a minute, so I'll show you how you differentiate them in a bit. I mentioned my quality of functions. They branch out into end stemi and stemi. Basically, that depends on how much is blocked off, Basically, is a clot or something else that has gotten stuck in a coronary artery. We mentioned the coronary arteries were earlier on basic. Anything that normally supplied further down the line from that clot is not going to get a supply. Think a bit like maybe like a river and a damn you put a damn in a river where that river was flying previously is now going to get no water in a similar way where that blood was flowing previously is now gonna get no blood. Um, and that's bad. We don't like that. Heart cells use up a lot of energy quite quickly, so they die quite quickly. Uh, that men releases proponents there. A protein, they go into the blood. We measure the troponin, we know how much the heart is stressed or how much of the heart is dying. Um, that cell death then in turn, causes a part of the heart to stop working. We call that being that that is the infarcted area. Um and yeah, that that is what we don't want. We don't want large areas of dead heart because they don't work and they don't heal. Well, don't heal. Very well. Sometimes you get a little bit healing, but no lot. Um, yeah, it basically caught. If this causes problems on the GI, it's a stemi. If it doesn't cause problems on the C G you can have in stem is with changes. But the classic one isn't. There is a nice diagram of plaque buildup, causing that narrowing so you can have basically just a lot of skimming heart disease over time. causing that break or that very narrow part of the Lumen is now more susceptible to a smaller clock. Whereas before it needed quite big one to cause the whole problem. That very narrow part now could be blocked up with a much smaller clot or office in a bubble fat embolus or bitter plastic or all sorts of weird things that can end up floating around in the blood that we don't really want. Um, on the bottom here, they used to table and Gina as a different form of acute coronary syndrome. I wouldn't necessary class it, but it can be. But that shows you basically what is going on in the various formats. Um, as you see here, for example, where you've got that narrowing in the Lumen of the Artery a clot which is represented by this little bundled bit of red blood cells that's going stuck. Obviously, that clock normally would just part straight through that and go somewhere a bit thinner, maybe get stuck later on, or get broken down before it breaks. It clots some it blocks somewhere, but because of that stomach heart disease that this will build up of a fatty plaque is gotten stuck, um, in stable, enjoying her basically what's happening. But if you think of these in terms of symptoms stable and joining us in stable angina, determine in terms of the symptoms. A normal person should be able to get up, go for a run on their heart, gets enough blood to allow it to keep doing what it needs to do while you go for that run in angina. Because of that narrowing, there is a limit on how much blood concave through at one time into that part of the heart. So if you get up and go for a run, you need more blood to that part of the heart. They can't get that, so you end up getting chest pain and problems. Um, while at rest, though, you're still getting enough blood because you don't need quite as much blood in that part of the heart. So it's going. You know you're getting enough supply to sit on the sofa, probably enough to eat your meal. Just know enough to get up and go for a run in unstable angina. This's normally either because that stable angina has just gotten worse or it can be because you've now got a rupture or it could because, you know, got a clot. Some of this making it worse. And this is basically, you know, longer have good enough blood supply to just do your everyday living. So it's not just you can't get up and go for a run without causing yourself chest pain and problems. It's now you can't sit on the sofa without having chest pain and problems. You can't lie in bed without having chest pain and problems. You can't get up and walk to the bathroom without having chest pain and problems. And these could get really bad to the point that actually the amount of the pain, the difficulty you're having Concordes, things like collapse and other problems stable versus unstable angina is determined based on how much you can get on with before you get problems before you get symptoms stable angina at rest, stable angina on exertion. So for those are all the seed well unstable. Angina is normally survivable without interventionally. If you start on the sofa, you're not going to suddenly drop dead. Those saying that you can get unstable angina, it can develop into worse things, and it can also be quite bad at times. Um, your stemi and your instep me are quite bad. These are when you've got no supply at all. It's not just minimal supply. It's know supply to an area of an area of the heart urine. Stemi is normal because it's a small area of the heart, so it's normally a smaller vessels that's been cut off, and instead, me is a larger area of the heart. Normally got a big vessel that's been cut off. Um, and these two you can differentiate based on basically how much heart has been, how much heart is not getting oxygen. How many cells are not doing their job because they haven't got the supply to do it? Um, on the c g. An s stemi ST Elevation M I. The area between the QRS complex and the T wave becomes really high. Um, and that's basically because there's really problems going on in the heart. These are really nasty, really, really, really bad problems, and instead, me is still very, very bad. But it's no, quite a bad. If that makes sense, it's worse than the other two, but not as bad as the stemi. Um And yet, like I said, those two differentiated by how much heart muscle isn't getting oxygen. The other two differentiated by what you have to do to not be getting enough oxygen. But I don't if that quite covers it. But again, any questions? Do you put them in the chat? Um, and these are really interesting things to remember these air. Quite important to know anyone who works in sort of an emergency error of men of health care. So that could be medicine, like the paramedics. And they could be, you know, ambulance technicians that could be nurses in any that could be physios working in anything cardiac also stairs healthcare. These are really worth knowing because you're going to see a lot of it if you see a heart patients on current on a cardiac ward. And I've seen a fair few patients who've had repairs of some of these, and actually, the other day I was in a couple of patients coming into the hospital who are having active instead. He's on one stemi. Yeah, one instead, me one stemi. So, yeah, these are quite and I was like common, but they're quite common emergency to see if you work in an emergency field, you probably will see these at some point. Um, here is just another diagram of thumb happening, So I thought it's quite nice one. So you're unstable angina. You can have these partial ruptures, but actually, more likely, it's a buildup of scheme. Yeah, your stemi is. Then you're you're sort of, uh, fully included. No blood supply beyond that point in quite big vessel. And your instep me can be not enough blood supply to survive. So there is a little bit of blood supply, but not a lot. Or it's a complete occlusion of a smaller vessel. Basically, explain this Stable angina is scarring or buildup of things like a fatty plaque. It's your scheme, me a scheme. It can't disease. Ischemia. Um and that means that they said the blood supply beyond that point isn't enough if you need a lot of blood. So if you get up and go for a run and you're having your heart rate go right up, so from 60 to 100 20 you're gonna need a lot more supply. So you need a lot more blood and in this instance you can't wide in that loom in. You can't get a higher flow of blood through that point. So you're going to not get enough blood, and you're not able to sort of maintain the blood flow you need. Um, classically, an angina is is alleviated of rest. So you bring down your heart rate, you bring down your body's demand for blood. Your heart doesn't have to contract as much. Therefore, actually, it doesn't need a much blood, so actually starts to be okay again. All the other one is with vasodilator is like GT N. That's more Melanie's world. The other versions of those that that basically opens up the Lumen of that that vessel mawr. So then actually get more blood through on alleviate the problem. Um, I don't think this is the but I want to get on to because I've seen a fair bit of this recently. Stenting is you got two elements. This one of them is You can go into a new area of skin like heart disease where that luminous really narrow, and you can blow up a balloon in that area and sort of push everything out. The way and basically make the Lumen nice and wide again. But that's quite likely to collapse again. Uh, stenting is basically putting a Parliament thing in place to keep it open. This is normally a sort of metal coil. It looks like a spring or a bit like a. It's like a fishing net in terms of its structure is sort of a metal mesh, not necessarily metal. It can be made a plastic minimal things, but that keeps that vessel open. So then that the scheme you can't close it off again so it stays, not open on blood supply can could be resumed. Um, we don't tend to do this a stable, um, an angina just because it is quite risky procedure, or so you're putting putting something into the vessels around the heart. There's a lot of risk involved with that. So on a stable angina, you might. You might do it if it's quite bad, but if it's not too bad and it's manageable by other means, you probably would go for the other means first, but unstable angina, so you can't do your normal day to day functions. It becomes a very, very effective treatment to sort of correct for that. And this involves a catheter being a certain over by the radial artery, and the rest normally go for the right wrist, the candy left wrist. Or it can go in through the femoral arteries, which are in the groin on. It's fed up towards the heart, the basic going up for your your venous system, um, or value arterial system. So we get the right way around, goes into the heart into the vessels around the heart. You then injected dye and measure. Look at that dive I X rays today. See? See what's going on on. Then you find the right point and you force it open. Uh, here's a nice diagram of stenting happening, so this is going into the point where you got this nice but a collapsed, not collapsed. It's narrowing. It blows up the balloon to squish it all out the way and then leaves a nice mesh behind to keep it from closing over again. This is actually my dad's heart because he had a heart attack back in April. Maybe that he agreed that I could show his images because, you know, it's nice to use one's quite clear thing going on. So this actually is the coronary arteries around his heart. This is the image you get in a cath lab where you do these sort of things basis is using an X ray to look. A normally X rays passed through lots of soft tissue, but they don't pass through the dye use Norman idea based dye That sort of appears darker. Serve I using that die, we can see all the vasculature that's going around the heart, and you could see normally there's there's nice, wide open lumens. You can see the dye moving through. You can see there's no problem there, but actually I can't. I don't know if you could see my mouth, but roughly where I'm ounces now you can see that it's nice and wide here and then it's nice and wide here in between, it's really thin. So that's basically where that that ah, where the problem is that that's where there's not enough blood supply through it. So all of this bit above it, Although there is a blood supply to it, it's very reduced, and it's not getting through it. The rate you'd like it to so this point here needs to be widened up, and I couldn't implant the videos. I couldn't get it to work. But there's a nice video of them actually inserting the stent and opening it up, and you can then see the blood flow through it again, the diet fluid for it again, much more quickly and much more effectively. It's that is basically how that's have cardiac catheterization works. The house stenting works. This is what you see in a cath lab. That's how we look at these vessels most of the time. Um, and quite nicely. Color is quite a lot of the cardiac, and that's why the cardigan it matters. Because, actually, if your cardiologists, this is all you see, if you're in interventional cardiologist, you have to figure out from this picture just some weird, squiggly lines of dark pink on otherwise pretty white structure what you're looking at. So it's quite important you know what you're doing, because frankly, no, you know, an average person looking at that hasn't got a clue. But that's where your cardiac anatomy knowledge comes into play. I was going to label it, but then I was worried it's going to label it wrong, but I believe that one that's good narrowed is his left anterior descending artery. So actually, this Although that's now on top, this isn't a top down image. This is a sort of a rotated image, but that should be left. Anterior descending artery. I think this here, therefore, is this circumplex artery. And that's his right coronary artery over here. Also, if you can't see my mouth, you have no idea what? What about that? That should be the way around. It is, Um yeah, so are my last couple bits of the question. You want to do some more questions for me? So we've got Can other muscle damage cause troponin release? No such opponents. Quite pretty much specific to the heart If the other muscles are damaged, other things were released on the tissues. The damage. You think of crapping and kinase if muscles of damage. Your think of d dimer says other other proteins that we know exist in those other tissues. And if they get damaged or stressed, cells die. We can measure those and have a bit better idea what's going on. Which is why proponents of beautiful because actually proponent quite specific to the heart. So we know that they are the heart. There's actually three or four different types of proponent of different places. Measure different ones and they some of them. It's like more specific, like Teo Heart cell death rather than heart. Still stress. Um, but yeah, there there's a lot of different. There's a couple of different ones, and they measure them differently to see what's going on. But yet your muscles have different things. Your lungs have different ones, your kidneys. So it's a good way. So differentiate what is being harmed. Next question. We've also how can they control the movement of the catheter to make sure it goes up the right veins? So they it is fitfully as anything. I've been watching it recently, and it's it's a nightmare to watch. They basically got very small hole in you and this sort of basically just wiggling. Really. It's wiggling and rolling. There's a wheel that pushes the cable further on. That's basically they're sort of wiggling it to see it's in the right place and then pushing it to make it go further and then injecting Mawr die as they go along to just see where they are in the body. It's incredibly impressive to watch, and it's part of why a lot of that there's an old joke, which is what's the difference between God and a cardiologists? Gold doesn't claim to be a cardiologists, um, cardiologists, unknown of having quite big ego. But I have full respect for what they do. They they do some incredible things with incredibly fiddly. No, you know, they don't for what they conceived. What they know is going on. They're incredible, Um, lots of training. I think it's the answer as to how you get good at it. Next question. I don't give it. Certainly, general big cardiologists don't always surgeons. There's cardiac surgeons and this intervention cardiologist's medical cardiologists. And, yeah, surgeons do get quite egotistical, being fair. A lot of do something really, really cool. Like you can see on before our ischemic disease is caused by atherosclerosis are skinny to see is caused by after a sclerosis so after a scratch is a form of skin. Year after a Scottish plaque is sort of fatty buildups normally with sort of cells and immune cells, and all that's all mixed in. That's a common form of ischemic plaque. You could also get scar tissues. You could also get sort of, Yeah, just damage. Yes, after a psychotic, black is probably the most common. Every single reassess after a sciatic plaques or what you get in after sclerosis 41 the most common for ski, probably the most common form of ischemia. There's just a couple other weird ones in there as well. And then I've left this one to last. I think it's going to lead on to your next live looking at it. What factors increase the risk of an and stimulus? Tony? Ah, uh, there are quite a few, um, so risk factors causing stemi. And so so certainly in etiquette. I mean, here are some good ones, but basically anything that increases your risk of a blood clot, anything that causes increase your risk of cardiovascular damage. One of the big ones is genetics. Actually, genetics are huge factor in anything heart disease. Unfortunately, certain cultures, not culture, certain racial groups are higher risk strictly South Asians, I think the one we see quite a lot of in London people of South Asian heritage and 40 is just a genetic thing that those groups tend to have genetics that put them up higher risk of heart disease. Um, also then things I think of hyperlipidemia, which is basically high bad cholesterol cholesterol comes in two forms of HDL, which is cardioprotective and LDL, which is cardiac damaging. It's the one that caused the steam. Yeah, um, I'm some people just naturally will release a lot of that in their blood. And some people were naturally, really sort of HDL in their blood, meaning to get protection on. Then some people will just be very sensitive to the LDL. They do release in their blood on a less often ties together. So that's a big factor in your jeans and your background cause of over that's the thing. And then hyperlipidemia lots of lipids in the blood, um, is a big, massive risk factor. That's why people get put on things like statins. Statins help reduce that. Melanie can explain that better than I can. That's my understanding of statins. You think about things like smoking on here. I've got it here that puts you at much higher risk of developing things like clots. Diabetes could put your higher risk because it cause damage to the vessels. Um, obesity. You're You're more like to have higher levels of fat in your blood. And therefore, I see more like to build up the plaques. Uh, certain cancers. They can cause clotting. Um, sedentary lifestyle. People lying people who particularly older people, if they're they're more bedbound. They're more like to develop clots. Um, people who take certain drugs, certain medications. But you're higher risk. Yeah, there's lots of factors in it. Um, but the the big ones, the ones you always ask patients about the things that they their diet and lifestyle. So are they. Very active. Are they're very sedentary. Most was things smoking. That's a really big risk factor. We always ask people about alcohol, because sometimes that can increase risk. That, um, yeah, more like, actually are cold. Causes obesity. A lot of the time. There's a lot of calorific content and alcohol. Um, family background. Have a lot of your family members of heart attacks, how they had heart problems. Have you had a history of heart problems? Um, because I was also, you can help us determine the genetic factors involved, um, and then things like the birth control pill, birth control pill and pregnancy actually, put people are higher risk. Um, which is kind of annoying. It's so damned if you do, damned if you don't. If you're a woman there, you know, use the contraceptive and don't get pregnant. So that puts you at risk. Or don't use the contraceptive and do get pregnant. That can put you on a higher risk. So I'd be careful around these things. The ultimate is a lot of factors that contribute. I'm quite big believer that luck is kind of the worst one. Some people you know can have all the risk factors are often people in there a list day or so or a person come in because he had had a checkup, whether or not he had done from was a water. Salty is basically checks to make sure that he was okay. And he wasn't gonna have a heart attack. We have ah, stemi and Stemi. And he was 81. Had a very sedentary lifestyle. He didn't. He he drove for a living, so they didn't do a lot of walking. He smoked. He had a terrible diet. He had a lease. Actors had had, um His whole life was 81 he was fine, like he was healthy. And I am. But, you know, I drink a lot of alcohol, is smoked a terrible diet full of just take away his junk food whenever he could spend a whole life sat down driving. And yet he's fine. So fortunately, huge part of it is just a look. Um, and there's no what we can do about those. Not enough. Melanie, if you think of anything that I've really missed off there any big glaring problems, So I was out. I'm not doing another question by that message, so I wasn't listening to much. I'm sorry. Sorry about that. That was really good old this one of my favorite questions right now, actually, on here about South Asians and the food, the lots of oil. What's the sugar? Oh, I love this question. So, um, that way to start with it trick carefully because, yeah, basically. So, Coach, there's a couple of different theories in this one. The first one is there. Fact that set certain cultures of obviously for generations eaten their cultural types of food prior to the globalization of the world, you know, So from South Asia probably wouldn't eat a lot beef. They wouldn't eat McDonald's. They wouldn't eat we week flower. They would eat the this sort of more local local equivalents of that. And then actually, over time you get used to eating that your your you know, you eat it as a child, sort of, you know, not so much evolution, but you sort of you've got a push in the direction of becoming better eating that sort of diet and getting used to eating that sort of diet. And then suddenly, if you're eating McDonald's every day or not every day. But you know, you're eating things like lots of beef on different styles of facts different styles of carbohydrate Elise, different things. Actually, your body, you know, isn't necessarily gonna be able to. Well, it was that in a year what you're culturally and effectively genetically at this point, you started on able to process isn't what you're eating. So you're a higher risk that your diet and things of that can cause problems, but also the same time they're genetically. Even if you ate your cultural diets and live the same way you had done for that same your family have done for generations, you still might be a high risk. There's a lot of factors in this and also is quite hard to differentiate them. Um, but it is. Obviously, it is a big factor that a little South Asians living in the UK higher risk of heart disease living back in South Asia. Actually, proportions is slightly off, like, you know, the proportion of people from South Asian heritage in South Asia. Having heart disease is less than the proportion of South Asians living in Europe having heart disease. But they still have a higher proportion having heart disease than what Europeans. And that's why you're peeing is living in Europe or what Europeans living in South Asia? No ever. That's just because what Europeans are less likely to have heart disease forever. It's because South Asian people, South Asian heritage, um, or likely to have heart disease. There's a lot of factors in here that we don't really know. Um, I think in the you know, as medicine progresses and we start doing more genetic testing and things like this, we probably will start to have answers to some of these questions off the time being so that that this point obviously, about their diet, about the diet of South Asia on But, uh, we're not. That puts you at high risk. Maybe this is contrary. Say more than that, Maybe, Um, certainly there are other diseases that that diet that the South Asian diet can put you on high risk for. But then the same thing could be said for like, the Western diet is a lot of red meat in the Western diet. There's a lot of fat in the Western diet. There's a lot of grain in the Western diet that is more likely to cause diabetes. But maybe it's just because people who were in, uh, Europe, you know, European heritage people. And then we've been eating it for longer. And so with more used to dealing with a bad diet, Yeah, you know, there's a lot of factors in this one that aren't necessarily known. Um, there's a lot of really interesting research and papers out there. If you want to read it Questions on nutrition We are gonna have a nutrition session in. I think it's in January, so if you've got questions and interested areas, please doing email them to me and we can still trying to steer it that way. Um, other questions of calcium salts, fibrous tissue on the effort. Yeah, so basically develop plaque, So a plank. Everyone has plaques. Basically, they're They're built to try cover up damage inside all vessels. The problem is that they then fill with what are called, uh, what's the word you know, spun cells for himself. Your phone cells see build up a little bit damaged and normal. There's a nice cap over the top of it, sort of scar tissue or calcium salts. As you said here, fibrous tissue, vibrant based issues. This stuff. There's a nice cap over it, and then that's the end of it. But then some people that cat will allow foam cells, which are basically cells filled with low density lipoprotein fats, toe buildup underneath. Sometimes that cap isn't very thick so they can rupture and little those cells could go everywhere. Sometimes that cap becomes damaged and it clots, and that clot can come away, and that clot can go off elsewhere. Sometimes it lets a lot of fat cells underneath. A lot of these phone cells and it gets really, really big on that. Lumen gets narrower and narrower because one wall, this sort of closing in. Um, So, yeah, there's a lot of ways in which these are in that sort of builds up and can cause problems, but yeah, So I mean, the way I explain it earlier wasn't great. It's not just literally fat, like a big pile of fat. There is things containing it, and it's in different forms. Um, that's sort of how it how it acts, those elements of genetics and sort of affect it. And the elements of just luck affected and your other factors that could make it less, more or less stable. Um, yeah. Okay. We'll go back to this slide now because I wanted to put it here, especially because of the fact. Obviously, we're currently in, um, in a covert invested world. I'm sure most of you noticed that by this point, Um, I'm sure Melanie can comment at length about coated because I know her hospitals had a big problem with it. Most hospitals have. This one was worst thing I want to put in here because I saw it when people were complaining. Vaccine increases the risk of developing a clot. Everything so many things cause a risk of developing increased risk of developing a clot. The birth control pill. Also quality people are on the birth control pill. It's I think it is the most common form of contraception in Europe. But the moment, um and it's yeah, lots of people are on it that increases the risk of developing a clock. We just sort of have to monitor and manage to try and prevent it. Smoking massively increases the risk of developing a clock. You know a lot of people will develop a clot because of smoking. I'm currently, as I said, I'm on cardiac, but I'm also on vascular. The block is sort of combined, and we see a lot of people with peripheral vascular damage due to their smoking. That's a big one. Diabetes is another one that gives you a much higher risk of developing a clot. Um, but Cove, it puts you a huge risk of developing a clot. A lot of people do that since, um, very, very sad patients who covert itself wasn't what cools the damage, but the clots that happened because of the cove. It has caused lasting damage, and they are quite sad that they're no. Yeah, Some quite young, healthy people, because of the covert infection, have now got life lifelong debilitating injuries and illnesses on life limiting ones, ones that mean that it won't live nearly as long as they could have previously. So yeah, um, Cove, it is much less safe in the vaccine. So those of you who aren't into vaccines, anyone who has anti back please do email. May. I would love to have a discussion about why, um, because it's always really interesting to hear people's reasons why they don't want to be vaccinated. I'm quite a strong Provo. Accin. A shin person said. Please do get vaccinated or even on the and explain your ports on. Why not very interested to hear, uh, deep vein thrombosis. I think this is the last thing I want to talk about here. Actually, what we do for time. I got a couple of minutes. So deep vein thrombosis is just another form of where a clock to get stuck. It's just another one. C is is different example away from from heart disease. Obviously, you can also get once in the brain, that's a stroke. You get them in your lung. Pulmonary embolus. A deep vein from both is basically it, blocking one of the deeper veins within your your leg. Normal. It's like, almost always the leg. Um, and basically, this stops blood flow back to the heart rather than away from the heart. And it causes a build up of blood flow within limit issue. And actually, after a period of time, the skin also really impedes the blood flow into the area. Um, here's some pictures of them. They're not particular Gross. That's why I picked deep vein thrombosis, because normally they don't look too bad. Um, in terms of symptoms, what you're expecting a deep vein thrombosis. You're expecting swelling so that the limb gets bigger. You're expecting discoloration. This discoloration happens because effectively blood breaks down and blood the proteins and the elements of blood that caused the coloration end up outside of the vessels, end up in the skin. You end up with modeling, skin comes less shiny, it becomes quite rough, and you end up with this. You can end up with redness. Redness is quite common, like we see in this foot here or in this knee on, then finally, you end up with this thing Over here. It was called Pitting edema. Some pitting edema is basically where there's a lot of fluid buildup in the tissue. You can push that sort of squeeze some of that fluid out of a point on you, hold it for a couple of seconds for it to establish, and then you release and rather than healthy skin springing back if I do it on my own, for example, I hold that for a few seconds and release. And it's straight back to normal. Maybe a bit time for the blood to get back into the capillaries. But the tissues rebound really quickly. Pitting edema is where they really don't. They can take a long time for that to return to its normal state. That's a test that we do a lot of in. Certainly anything cardiac can do quite a lot of pitting edema test because it's a sign of basically critical fluid buildup. So Steve vein from basis management of it if you really want, but I won't I didn't plan to, but yet that's just something I wanted to point out it's a different element of putting problems. Uh, some other resources for anyone interested. I think I put out for you for anyone. This guy at the top sound Webster. I am a huge fan of Sand Webster. He is the head of anatomy for Swansea Medical School on D Does a brilliant, brilliant lot of YouTube videos about anatomy basically doesn't varying between sort of 56 minutes up to sort of some of the longer ones that may be in the 40 minute sections on. I find him a really, really great way to learn on revising Atony. He's really, really good. I used him strength in the beginning of medical school. Really nice guy, really good videos, really well explained. I found him a really good way to learn that to me The next one of the other way, I learned that means Finkel, Ken Hub, Ken Hub is think it's Australian based company that do a lot of anatomy quizzes and videos on their website. You can access some of it for free, but actually, normally you have to buy access to it, so I wouldn't necessarily recommend it financially. I think for about 100 something pounds. You can buy a lifetime access to their resources. I think I did that in my first year of unique, um, and you know that I've used them. I used them quite a lot because that quite easy revision on that quite a good way of testing that you actually know what things are called on where things are. So I quite like 10 Hub know everyone does. On the last one is the geeky medics. Works like anyone wanted to go to Mets and geeky medics. Is it sort of held onto a bit like a Bible for medics. So many videos about how to sort of get through med school lows of the examinations, anatomy. All that kind of stuff is long there, I would say it's no always. It's written by a group of medical of June of doctors and medical students, and people like this, based on how they're medical school, has taught it. Um, so I know people who use this for people use geeky medics for nursing. I know people have used it for Paramount. I know people have used it pharmacy to learn all the various skills I'm sure I can find people have used it. Things like physio. It's really good. But just be cautious because it's not always aimed at your level. And it's not always end of your particular institution. So some things will defer that I was ready. Good set of resources. Um, this one is just a slight, uh, put in the extra food. Interesting. You don't need to learn it, but this is effectively how smoking can affect your cardiovascular system. Increase your BP can cause in the field dysfunction, which is the cells lining the inside of your your vessels, which can also cause things like difference plot stability. Don't lead to stroke. Um, it can calls, uh, in increase in a sign that sympathetic nervous system action, which can turn Kenly insulin resistance and lied down the lines. Diabetes? Um, yeah, it can cause lots. There's basically sort of a really good way of seeing how tobacco smoking can affect all the other things and cause other problems. It's again, if anyone's interested in this slide, pleased to go back on the on the recording and have a look at it a bit more thoroughly. I started really interesting one to put in for interest. And then that is the end. Any more questions I think I've got in slide ago. If anyone knows what that is, what that particular animal is pleased. You put it in the comments, and I will grade you on your zoological knowledge of was any questions? Haven't got any in the chat a moment. It's good if I give them what's acceptable two minutes, maybe to ask questions quick. Yes, I mean, obviously anyone with any questions. Otherwise you'll just feel free to email me them more than happy to see them. Uh, like I said, I'm currently on my I've got another week left on my cardiovascular place in the block. So if anyone does have questions, even if I don't know the answer, I can find someone who very much knows the answer. Um, and here I'm actually really enjoyed cardiac cardiovascular, and I've really enjoyed the cardiac side. I didn't expect to. I really hated cardiology before this placement block, and actually, I've enjoy it more than I want to. Um, I don't think anyone would like me anymore. If I decide to become a cardiologists, though, okay? Like those. But in the comments you got rid off about why it won't anti vaccine go into healthcare, actually know quite a few antibacterial healthcare. It's why it's quite interesting to me to talk to people who are. You know, if people are that way inclined, they don't believe in vaccination. They're not a fan of it. I'm really interested to hear your faults on. Why, um how is it beating up? I said the heart stopped beating. That was quite cool. Like it started up again. But I've watched open heart surgery in which they, in order to operate on the heart, they stop it, they put it on bypass. So the blood is going viral machine, and then they take the actual heart and they stopping, piecing using potassium, and then they restart it again later on when they're done with fiddling around with it. And then I've been there for this sort of 20 minutes of quite nervous like, is it actually going to start up properly? And is it gonna work the way you wanted to? But yeah, that was really cool, actually, um, I've also seen the heart stopped beating when someone did pass away but that was a very different situations. Um, yeah. So it's It's, um, pretty cool. Seeing a heartbeat for the first time is really, really weird When you sort of think about it. You look at it and you know, that's what's going on in my chest has been going on for a long time, but they already cool. Oh, yeah. So, yeah, we'll finish their office. The anyone with any more questions Feel free to email me. You've got my email address. No. One guest will. Animal, This is Someone gets an animal. Melanie, while animal is it? I'm guessing it's not going to see Is you asked. Looks like a good big is is an impala. Oh, you got much close to the melody Points to go to this Saudi. Oh, yes. Melanie only knows what a horse is making a dog. You know what dog is? Oh, Stephanie, Not okay. So who's well, well pointed out. Uh, so, yes, this is a Thompson's gazelle, which is the most common form of cells are quite closer than pilot in parlor is a in the gazelle family. And then goats are ungulates, which means they're in the same. What level is a kingdom violin class, I think with the same fi, not violent one below. That class may be the same class. I think it might be the same class as this. But that side you got down to, like, the right kingdom file in class. Yeah, I think I think they're the same class. And I think so. Side you got them to a whole level of taxonomy. Closer. So point is going to solve you, um, talk to himself, but well, thank you. Everyone who showed up. I will end the meeting here. Like I said, feel free to email me. Thank you, everybody.