so that would be one of many possible ways that you would diagnose coronary artery disease in someone who is alive and also do a stress test sometimes. a blocked right coronary artery back and contribute to a fatal arrhythmia. any anyone can have a fatal arrhythmia with or without coronary artery disease. and so if a blood vessel is blocked and blood is not getting through got vessel what happens well it depends but i'd like to answer that for you so in the case of mr floyd what has most likely happened based on our understanding of coronary physiology is precisely because he had a narrowing of up to 90 percent and it had calcium in it we know that that

developed gradually and the heart is fascinating and what it does it develops what's called coronary collaterals which means the body makes a dish in a blood vessels so that if there is one an artery that's narrower it recruits and builds many more blood vessels to supply blood to the heart it's actually why you are more likely to die from a heart attack. if you started with a lesser narrowed artery and it the plaque ruptured and blocked the vessel then if you started with a more severe near away because of all these unbelievable coronary collaterals and adaptive responses that the heart does when that happens. what is the safe dose of methamphetamine. prescribed illicit i would never consider any

illicit drug to be off the street that's not prescribed by a physician to be safe and methamphetamine is a vase or constrict act it often can act as a basic construct a means of constricts the blood vessels more direct death that's what that's what basically structure needs narrows them down more. if you understand based on medical records that there's prior evidence of methamphetamine use by mr avoid yes or an methamphetamine can cause some changes to the heart in of itself that corrode in fact that sort of ages the heart or right never use that terminology ok how would you what does it do to the heart or prolonged use every case is different it depends what we mean by prolonged use so one day one week 25 years like most things if you use something for. if

you smoke cigarettes for 50 years you're going to have more problems than if you smoked a cigarette or a pack every once in a while. in terms of what does what does methamphetamine do to the heart itself so methamphetamine if used over a long period of time can sometimes contribute to the development of coronary artery disease as we've been discussing. it can constrict blood vessels as you mentioned. you can have kind of a host of different effects on various parts of the body including the heart and there's lots of things i can make the hard work harder and faster right. i mean methamphetamine being one of them yes. vigorous activity being one of them which are. adrenaline. yeah i mean we all right now have

a lot of adrenaline flowing through our system adrenaline is needed for life for sure increases in adrenaline can cause the heart to work harder and faster. yeah i mean so adrenaline which is the late term for catecholamines that's the purpose of adrenaline is to get it to pop more blood when we go in exercise the purpose of adrenaline is so we can run and we can jump and we asked the heart to allow us to do that correct and have you in your practice work with someone who has a parenting yama. i have had a couple of patients who have had what we call feel feel chromo side tomans which is a type of parroting me on my guess that in the eye in the hip area generally know that generally it's actually near the adrenal of the land which is sort of just near the kidneys but these parodying gliomas can sometimes pop up in different places and how are they typically identified. well so it depends if it was clinically

pertinent that's how i diagnosed the ones that i've had the classic findings are the person who saying i'm always having headaches what is with these headaches i'm always sweating why am i always sweating and you start to say i wonder if something is releasing a hormone that can be contributing to that other times like in my opinion the case here with mr floyd you'll pick them up incidentally see it at an autopsy. they're also often identified because a person contributes to higher blood pressure you can as. you have agreed that you've reviewed the medical records of mr florey correct correct and he has a pretty significant history extremely elevated locker. yes i think the one you referenced the top number was over 200 yeah. more than one

occasion and more than one occasion and the lower number of the blood pressure was likewise our right yes. did you observe evidence that mr in the medical records of mr floyd was taking prescribed medications to control his blood pressure. i saw in the records during an emergency room visit that he was prescribed high blood pressure medication what i could not see is whether he was taking them or not but it did look like at one point there was a prescription given to him i think one of them was for m. a load of peanut which is a calcium channel blocker and one of them was for. i think either hydrochlorothiazide or ct fell down and you drew that the records that you had for mr ford relative limited. you know the words entire life medical records.

i don't know when he started to see medical professionals so i didn't for all i know the 1st instance in the records i saw was the 1st time he started to see medical professionals not sure so how many years of past medical records did you believe we were so i think beginning of 2018 is when i think they started. appearing we know mazower removed from a person. the parenting we almost if they are causing those symptoms that i mentioned the pulsatile headaches the sweating it cetera the surgeon would sometimes remove them. would you prescribe and then try to mean for somebody who has a 90 percent blockage of the right corner and a 75 percent blockage of the left anterior to something i heard so 1st of all i

don't typically prescribe infected means i have many patients who have coronary artery disease that are on stimulants ok for a variety of medical conditions so i just don't prescribe them but i do have many patients with coronary disease who are on stimulants would you recommend to someone that they use methamphetamines with that degree of coronary artery disease i would never recommend that anybody take methamphetamine off the street for any reason. you wear the research showing that deaths where both methamphetamine and fenton all are falling occurs in a much higher incidence. can you repeat the question. are you aware that the

research has demonstrated that deaths of those who are used meth and photo mean in fact not have been notably higher than the math and math or from along the combination of jupiter or. us. as has so many bags that is over whole assuming is that the scope of this holiday season since the state didn't propose quality appeals. which if you want to see something council reference drop world let me answer if you know. i am not familiar with the breath of the literature looking at all of the different combination of drugs and which combination worsens or improve survival. you testified that mr floyd based on your review of the video did start complaining of shortness of breath prior to being placed in the wrong.

prone position yes i heard more than one occasion he say the words i can't breathe and if. mr floyd and simply gotten in the back seat of a squad car do you think he would have survived. you may give it a minute if you have a medical opinion as to that or. so had he not been restrained in the way in which he was i think he would have survived that day i think he would have gone home or wherever he was going to go had he not been subjected to the prone and positional restraint that he was so in other words if you had gotten in the squad car you'd be a lot. i think my answer remains the same anything other

than that scenario he was subjected to i have no reason to think from a medical perspective that he would not have survived that day correct in terms of the proposition you would agree that the proposition is not in and of itself terribly dangerous. in the morning early individual if we were to take away everything else that was going on and we and someone was just simply lying in there in the prone position while there are many patients who that would be inherently dangerous the average individual i would agree with you probably just lying flat in that situation generally would be dangerous even in the i.c.u. there are circumstances where people have serious medical conditions where they're maintaining the proposition. in the i.c.u. when patients are put into the prone position it is when it is a desperate attempt to save someone's life where their lungs have actually

developed what we call acute respiratory distress and or more yes they have a ventilator in to make sure that the amount of air that they get no matter their positioning well always be enough and so it's a funny thing to think about putting someone in the prone positioning in the i.c.u. on a respirator but because of the respiratory physiology sometimes that will actually help open up certain segments of the longs that are needed for oxygenation but it's really important to keep in mind that they are on a respirator every single time to open up those long airways and they're usually on sedation as well to keep them comfortable and my last question doctor is after someone someone's heart stops is it possible that they continue to respond.

it is a pup well. i'm not sure i could answer that with certainty other than to say there are these things that are called agonal breaths so when i'm in the intensive care unit with a patient who has time and they go into cardiac arrest. once in a while you will see them take one or 2 extra profs i'm not sure of the exact mechanism or the physiologic trigger for that. you could potentially see. some extra breaths for a short period of time by a short period of time up to a minute. in in my experience if the heart has completely stopped i would not expect to see the breathing continue for up to a minute but i might expected to see the scene for several seconds and no further questions your honor. and your.

doctorate you were asked several questions. that had to do or at least had as a premise the blockage of most of lloyd's are. is blocking a proper medical term to you as a cardiologist to describe the narrowing in this to 4 doctors. so when we try to use terminology that is not medical terminology try to explain these phenomena. the term blockage i tend to use when the blood vessel is completely blocked it there is a blockage i will usually describe it if i have a patient like mr floyd who has cornered disease like this i would usually use the term narrowing because the blood is still getting through in fact the blood may be

getting through just fine there is no level of narrowing in fact even in the totally blocked artery this is what's fascinating that develops over time the territory of blood that that blood vessel was supposed to supply can still be getting enough blood because of those collateral vessels that develop so i would use the term with mr floyd as narrowings. you were asked questions again about parenting gliomas. and i think you told us that those are usually preceded by headaches of some kind classically correct one of the symptoms is has that is right again did you hear amongst the various complaints mr floyd man had about pain did you hear any of them being. known in fact when i saw that there was a para being glioma described as an incidental finding in the autopsy report i

actually when i went to the medical records i used that control f. button to put headache and make sure that i never found headache in addition to scrolling through all the records i didn't find haddix at any point when you reference a parrot pair gain glioma being an answer. then a finding on the autopsy would you tell the jury what's meant by answer them sure so all of us have things in our bodies that are causing any medical problems but if they're discovered let's say someone gets a cat scan for one reason they might find that there is a cyst on the kidney or the liver sometimes will even pick up benign tumors so we refer to those as incidental findings in fact in the case of up hurting glioma the need we would actually call it is an incidental woma because we don't think it has clinical relevance but it was found in described in the imaging or in this case the autopsy are you familiar with any of the data as to how many people the united

states. ever gotten as a pairing glioma as a principal or primary reason for them. to be honest i don't know the exact numbers i just know that they are very low. now you were asked questions about. what pressure the role impact of methamphetamine parenting glioma marrying are can any of those things in of and by themselves cost someone to die without 1st entering the heart. can you repeat the question is what i'm trying to get out whether we talk about high blood pressure methamphetamine parroting glioma and the impact on the adrenals narrowing of the arteries can any of those things by themselves haws a person to die without 1st impacting. this stoppage of the heart well the

reason i ask you to ask the question again it's because i want to make sure that i'm precise and clear here high blood pressure can cause death in manners outside of the heart for example it can contribute to a stroke which we know mr floyd didn't have and the other thing that can occasionally happen is this thing called an aortic dissection where the aorta the main 2 that leads the heart can tear that can cause death so i want to make absolutely clear that these conditions can cause death on occasion in areas not involving the heart but most of the time if death is going to occur by them it's going to be caused because of their impact on the car and it was deployed have an aortic dissection no yep saluted not based on the review of the autopsy didn't happen he also did not have a stroke so again just to be clear for the jury with all the discussion about the marriage arteries that. was there in damage at

all observed to this of floyd's heart muscle based on my review of all of the evidence the e.k.g.'s the autopsy report i found absolutely no evidence at all of heart damage mr floyd's heart. thank you doctor. and he rose. or if you're just joining us on al-jazeera we've been watching proceedings on day 11 and are there excelled in trial where a cardiologist is on the witness stand don so. jonathan rich who's been testifying. that george floyd died from a cardiopulmonary a rest caused by neural oxygen levels he says floyd did not die from a primary haunt event or drug overdose and dr rich goes on to say that if george

floyd had not been restrained in the way he was that he believes he would have survived that day of course is talking about the needling of the police officer derrick chauvin who's on trial over the death of george floor 8 the doctor has been cross-examined by the defense by eric nelson and the defense has been focusing on george floyd's medical history as well as his drug use so the main focus of this day today day levon in the 3rd week of the derrick show vein trial has been on this doctor's testimony we want to bring in now john hendren who's in minneapolis who's been listening into the trial so john the doctor the cardiologist has been cross-examined by the defense stopped his testimony and again the focus of the defense seems to be on the medical records of

george floyd and on his use of drugs. that's right the defense is searching for another reason that george floyd could have died other than derrick chauvinism the on his neck and they've got a theory that he died of a drug overdose they've also thrown out there that he had narrowed arteries and then they even offered the possibility there in cross-examination that he had a tumor in his pelvis called a para ganglion with and that that might have had something to do with it in him what you saw was that doctor batting back each of those suggestions saying it wasn't this it wasn't that it wasn't that in his original testimony of course is that george floyd died because of his neck was starved of oxygen reaching his heart ultimately causing his heart to stop and according to that doctor that

happened because derrick chauvinism knee was on george floyd's neck so you've got the prosecution coming close to closing its case here we expect what they call a spark of life witness to come up later we're told that will be full loney as floyd a brother of george floyd who can talk about the life that george floyd lived and we're also learning the judge says that he expects closing arguments on monday he denied a request to sequester the jury until then but he said he will doing that do that after closing arguments when that jury is left alone to deliberate and decide if they're each of them is guilty of murder or manslaughter all right john thank you for the moment speak about this some more now with ronald sullivan who's a professor of law and criminal justice at harvard law school joining us from massachusetts thank you so much professor for being with us to to dissect 10 analyze what we're hearing at this child again the doctor the main witness

today taking the stand on day levon out this child what do you make of his testimony and the way he's performed you know while he was questioned by the prosecution and the cross-examination by the defense. well he was an extremely effective witness for the prosecution so in in trial advocacy we have a term we call testimonial capacities that's the way in which we evaluate whether someone will be a good witness a bat witness or a mediocre witness his testimony of capacities were great he was able to take complex ideas and really break them down into discernible understandable nuggets and so he was good with that he looked over to the jury when he spoke to the jury and he affirmed the prosecution's theory of the case now in cross-examination he was also very good for the prosecution because as an expert

and far more knowledgeable than anyone in that courtroom about coronary disease the heart cetera he did not accept the propositions that mr nelson the defense attorney was offering so mr nelson would say something like you know in the emergency room sometimes you put people in prone positions right to suggest that being in the prone position is not necessarily bad and rather than just saying yes that's true the doctor went on to explain it by saying only in extreme circumstances when the lungs it absolutely collapsed and you mean you need to expand the lungs with the machine and so forth and so he didn't let mr nelson put words in his mouth right the defense has been focusing a lot on. choice for his medical record his drug use that seems to be their strategy right now the prosecution's case is about to come to

a kilis and our reporter on the ground there outside the court was telling us earlier that they are panning on conning phenomenas floyd joyce floyd right there to testify how might that help their case. well it will help that case of the prosecution's case because it will show you mine eyes george floyd before the jury so they can envision him not as a body that they've seen dissected and so forth but as a living breathing in the vigil interacting and interfacing with family and the notion is with the spark of life testimony is is that the jury can understand how his life george floyd's life impacted those around him so the prosecution hopes to end with that with with a bang so the last thing i'll say about that is and in trial law we have this concept of primacy and recency jurors remember most what they hear 1st and what they hear last right there in their case with this spark of life information and

that's a strong way that in the case you talked about what jurors hear and how they might base their decision on what they hear and what they see as this trial is resuming today there's been more unrest in the state of minnesota with protests over the night overnight over the killing of a black man after what's to be a police shooting there he is said to have crashed his car after being shot by police how might that you know more more spotlight on police violence against black men in america how might that incident play into the trial and perhaps affects the jury's decision. well for the defense this is the absolute worst thing that can happen another incident right there in minnesota 20 minutes from where the trial is where unarmed black man was killed the fear for the defense is that that

information is going to seep into the jury room in seep into the the deliberation the deliberate the deliberations of individual jurors that they are going to say you know this this these episodes of police shooting black people is too much the fear for the defense is that in some small way you even in some small way the jury may base their opinion on something that happened outside of trial and not the evidence that they heard inside of trial ok thank you so much professor for talking to us about the sanctifier inside ronald sullivan is a professor of law and criminal justice at harvard law dissecting the day's proceedings at the derrick shelvin trial for us said the child getting underway for a 3rd week now the child of the former minneapolis police officer accused of killing george floyd well have plenty more on this and the day's other news stories

here on al-jazeera after this very short break i hope you to stay with us thanks for watching. jumped into the story there was a lot going on in this and julia not global community when i don't have all the misinformation i think we are more afraid than we are and where it be part of the debate don't ever take anybody's one word because there's always a difference when no topic is off the table we have been disconnected from our land we have been disconnected from who we are good enough to heed the new and you to be

part of today's discussion this dream on out is there. when the covert 19 pandemic hit iran. a filmmaker cut adrift from his crew began documenting life under lockdown made on go with international sanctions. an intimate portrayal of isolation in one of the world's least understood countries coronavirus locked down iran people in power on a. xenophobia violent and beating the drum for an ethnic civil war in the heart of europe. generation identity was at one time the fastest growing far right organization on the continent now watch the investigation that led to the french government banning the group. generation hate. cartoon with

a special 2 part investigation on and. capturing a moment in time snapshots of other lives other stories providing a glimpse into someone else's without i am the voice we are the voice witnesses on al-jazeera. 817 g.m.t. and we are taking you now live to ankara where turkey's president bush have type add on has been holding talks with the visiting libyan prime minister abdul hamid did by and by they signed a number of accords and they're now holding a news conference less listening. to historic relations but especially relations. as the brother.