Next we're going to look at a few notable cases of people, famous people that suffered problems. The first one was John Ritter. He was an actor. He was in Three's Company as well as, I can't remember the name of the other one, something about dating your daughter.
But he died suddenly at the age of 55 of a little-known disorder called... aortic dissection and his widow created the foundation to promote knowledge of this disorder. What happens is the wall of the aorta tears and blood flows between the tunics or between those layers and as blood fills it creates something called the false lumen and it's diverted away from the true lumen and the tissues that need it. That blood in the false lumen can create more tears and let blood flow back into the true lumen and it can completely tear.
So here this is part of the wall of the blood vessel and blood is flowed out here and flows back in there. So the true lumen is you rarely have a thrombus in it. It's round or oval.
The false lumen is crescent shaped. You don't have good velocity in there so you can develop blood clots in it as well. Type A.
of aortic dissection involves dissection of the ascending aorta, so blood flows out here. Type B is in the descending aorta, and the risk of death if untreated, 25% of people die in 24 hours, 50% in the first 48 hours, 75% in the first week, and 90% in the first month. Most of these are associated with hypertension.
hypertension or connective tissue disorders. There's about 2,000 cases per year, usually men 60 to 80. Three times as many men as women suffer from aortic dissection, and they typically report acute sudden and severe chest pain. That's maximal at onset.
Other notable people who've died from aortic dissection, King George II, Lucille Ball, diplomat Richard Holbrook, and the man who devised surgery to treat aortic dissection, Dr. Michael E. Debicki. Next is the case of Princess Diana. She died at age 36 in 1997 following a motor vehicle accident in Paris. The driver, along with her companion, Dodi Fayyad, who was also in the back seat, were dead on impact. And the bodyguard in the passenger seat, this guy, and Diana were severely injured.
She suffered blunt chest injuries from head trauma. She was found on the floor of the back seat facing the wrong way. Eyes open. She was mumbling incoherently.
Fifteen minutes after the crash, the ambulance crew arrived, and the physician reported she was crying out. He gave her midazolam to calm her down and fentanyl for the pain. Now, the problem there is these drugs have the propensity to cause apnea. which is alteration in breathing, and hypotension, low blood pressure. She arrived at the hospital 101 minutes after the accident.
The way the French do ambulance treatment is different than the way we do. We try to stabilize them, get them there as quickly as possible. They actually treat them in the ambulance.
So it was quickly determined by the time she got there that the internal hemorrhage was causing compression of her heart and lungs. And 10 minutes after... she arrived she went into cardiac arrest again she caught causing the doctors to inject large quantities of epinephrine directly into her heart followed by thoracotomy to find and fix the source of the blood what they found was the source of the blood was a single tear in the left pulmonary vein at the point of contact with the left atrium so right here they repaired it but By that time, she had lost so much blood, it was impossible to reestablish a heartbeat.
And she was pronounced dead at 4 a.m., approximately three and a half hours following the accident. Now, had it been an artery that she had damaged, she would have bled out pretty quickly. But because it was a vein, every time her heart beat, a little blood leaked, a little blood leaked, a little blood leaked.
And she was... given these drugs that caused hypotension or even lowered her blood pressure further. and so she went into shock and she had cardiac arrest.
It's hard to say whether she would have survived if she had gotten to hospital earlier. Chances are she would have been in hypovolemic shock. If she had survived, she may have suffered severe brain damage, perhaps even been in a persistent vegetative state.
The last one is former Vice President Dick Cheney. He suffered his first heart attack at age 37 in 1978. He had a genetic predisposition as well as poor health habits, smoking several packs of cigarettes per day. In 1978, he had his first heart attack at age 37. In 1984, his second heart attack at age 42. In 1985, he had the cardioverter defibrillator implanted.
Now you can see as we go through this that he Certainly had the best medical care there was, and as new things were invented, he got them. So the cardioverter defibrillator implantation, this was something new at the time. In 1980, he had his third heart attack. In 1980, he had quadruple bypass.
In 1994, balloon angioplasty plus two stents were put in. In 2000, he had his fourth heart attack at age 58. He was hospitalized with ventricular fibrillation in 2009. 2010, at age 68, he had his fifth heart attack, and then he had a left ventricular assist device put in. After that, he had a heart transplant.
So the left ventricular assist device, what it does is it is going to propel blood into his aorta. The heart can't pump blood very well. The blood is going to go from the left atrium.
left ventricle, excuse me, into this device and this is going to propel it through the aorta so that it leaves with enough blood pressure to go throughout your entire body. So this is contained in a custom wool vest that holds a small computer near his abdomen with battery packs about the size of videotapes. They're good for about 10 hours.
You put it on in the morning, connects to his chest via insulated cable, powers something. known as this ventricular assist device, and this propels blood into his aorta and circulates throughout his body. The goals for Lecture 9 are to describe hepatic circulation, pulmonary circulation, and fetal circulation, define portal system, ductus arteriosus, foramen ovale, aortic dissection, left ventricular assist device, hypertension, primary hypertension, secondary hypertension. and erectile dysfunction.
How do Viagra and other erectile dysfunction drugs work? What are some treatments for hypertension? Why is hypertension called the silent killer? Describe some age-related changes to the cardiovascular system.