VIDEO SEGMENT 16
"Surgeon Generals' warning: smoking causes heart disease"
This is Mr. Jerome Brown (slide 5). After years of smoking, he developed pressure-like chest pain which radiated down his left arm and occurred each time he walked a few blocks. His doctor suspected that the chest pain originated in his heart and ordered a coronary an-giogram. A coronary angiogram is an x-ray that shows the blood supply to the heart. A normal coronary angiogram is shown on the left. Mr. Brown's coronary angiogram looked like the one on the right and showed a critically blocked coronary artery, seen at the arrow (slide 25).

How did smoking cause this problem and how did it cause Mr. Brown's chest pain?

1) Harmful chemicals in tobacco smoke damage the lining of arteries so that less blood gets to the heart, as shown at the arrow (slide 25). 2) Smoking adds carbon monoxide to the blood which reduces the oxygen supply to the heart. 3) Smoking makes the heart work harder by making it beat faster and against a higher blood pressure

When Mr. Brown's heart was forced to work harder, while receiving less blood and less oxygen because of his smoking, his heart became damaged and produced his chest pain. Despite medication, Mr. Brown's chest pain became more severe, more frequent, occurring even at rest, and required coronary bypass surgery for relief. During the coronary bypass surgery, Mr. Brown's chest was surgically opened, his heart was exposed and the blocked coronary artery was bypassed with a vein taken from his leg (slide 26). This increased the blood and oxygen supply to his heart muscle and fortunately relieved his chest pain. Unfortunately, smoking also decreased the supply of blood and oxygen to Mr. Brown's feet by causing peripheral vascular disease. This resulted in gangrene in several of his toes that had to be amputated (slide 27).

So this poor man had three very serious illnesses, all of which came from smoking. 1) cancer of the larynx which required a laryngectomy and tracheostomy, as seen in the upper panel,