[ ♪ opening music ] for this first programme in our new series of the antiques roadshow, we've come to cornwall and the city of truro. hello and welcome once again as we begin our journey around the country in search of britain's hidden treasures.

we'll be travelling in the coming weeks north to inverness, south to the channel islands, west to wales and to the coast of yorkshire, plus many other places in between. also this year, there are to be more roadshows than ever before, so there's much in store and i'm sure many surprises to come, as we begin our journey here in cornwall. the one feature that totally dominates the skyline at truro, is the cathedral. whichever way you approach the city; by road, rail or up river by boat, it's by far the most dominant local landmark. and rather like the great cathedral at chartres, it can be seen for many miles around. it appears to be a medieval church. in fact, it was only completed in 1910. but in cornwall, it's the sea and the rivers that feed into it which have influenced every aspect of local life. it's never a particularly good idea to be on the losing side, but that's what happened to truro during the civil war

when it paid for its royalist sympathies by losing control of the river which links it to the sea at falmouth. falmouth's ascendancy was later broken by law, but to this day, the mayor truro regularly beats the bounds of the river, and every incoming mayor is presented with this fine set of silver oars, symbolic of truro's open access to the sea, its status as a port, and above all, its independence of the old rival, falmouth. our venue for the day is the cathedral itself, so here we are with our experts who include many familiar faces from previous series. john bly casting his eye over the furniture. hilary kay and eric knowles will be covering a wide variety of things, mainly from the 19th and early 20th centuries. we also welcome for the first time to the antiques roadshow mark poltimore. so let's now join our experts with the people of truro. what i'm pleased to see today is something of a local,

of a local significance. now, i tell you, if i owned a dish like this, it would be salmon every day of the week, because i'd want to use it every day of the week. tell me where it came from. truro city hall flea market. truro city hall flea market. when they first began 20 years ago. right, priced at? £67. it's not cheap for a copper tray, is it, £67? well, i liked it. well, i like it as well, so i would like to think this might be designed by j. d. mackenzie, john d. mackenzie. he was an important painter and designer. mackenzie, for his part, was the gentleman who came down to this part of the world, to newlyn with the newlyn art colony, which was so thriving at the beginning of this century. he was renowned for his copper metal work and he instructed students in newlyn

in the manufacture of handcrafted copper ware. it's a lovely design with these fish. i'm saying fish; i think we've got the odd shark. it's newlyn copper, newlyn school of art. and he does a lot of fish on these things. there should be a tiny mark -- there it is. when you bought this, did you see that mark? did you know that it existed? no. you didn't, so you bought it-- because i liked it. so it's a bonus when you find it's actually stamped "newlyn." i would say a dish such as this should be worth around about £200 or 300. so i do think it's quite a lot of dish for £200 or 300. and as such, i would say that if you see it, buy it. it's not going to be around at these sort of prices for very much longer, that's the tip of the week. you don't see anything like that anymore. there are two sorts of jade, nephrite and jadeite,

the jadeite being this lovely, bright apple-green jade. and because of the... interest in jade in the east, where it's considered lucky and an aid to long life, it has, in the last few years, become very, very valuable. and what affects the value very much is the colour... -- this is a nice colour -- ...and also the translucency of it. if i put my finger behind it with a light shining through, you can see the shadow of it quite clearly. it's very nicely mounted in diamonds, probably platinum and... what's this on the back? ah, well... that adds an awful lot to it because it's signed by boucheron, paris. very famous firm of french jewellers. and that adds very considerably to its value because anything

made by one of these fine firms of french jewellers is very collectable today. any idea of its value? not really, no. well, would it surprise you that the value of this today is probably in the region of £5,000 or 6,000? it should probably be insured for something approaching £8,000 or 10,000. amazing, eh? absolutely, i can't believe it. because there's a lot of money in the far east. we've got a good selection here. thank you. that's a cat. weren't they ingenious? i mean, that would support a stand or a bowl on any uneven floor... a bit like that. in fact, that's the bowl i put on it. is it? what i really wanted to try to get at was this... move out the paper... it's a bit shot, isn't it? yes. but basically it's a toll ware stand for three decanters.

aren't they lovely? look at all that gilding. two odd stoppers. i think these all match; i mean, they're all individually made... 1790. with a tin or toll ware stand like that... these are for the stoppers when you're using them. they were made in bristol. this is what we call bristol blue. even in that condition, those three and the new stoppers, you're still talking about £1,200 to 1,500 for those three today. they're lovely. absolutely beautiful colour. well, that's bristol, so's this probably -- i think this is a beautiful thing. we've got chinese porcelain made for the western market. we've got europeans trying to copy chinese. this is beautifully done. it's so loose. i like it; it's an attempt at an imitation of the chinese. yes, it's got this strange tanglike figure down here

with this person carrying whatever it may be, some gift. they're so loosely done. it's so wacky and english. this is made a little bit earlier than that, which is what, john? 1790. yeah, this one is around 1740. lovely example of that. even in this condition, nice bit of chinoiserie, is probably worth £200 or 300 at least. maybe a bit more. it's the sort of thing i'd like to have. you know these are pot lids. yes. do you know why they were made? well, i understood that they were for gentleman's pomades with their wigs. is that true? kind of, you're on the right direction. the early ones were actually made for bear's grease. they got this poor bear and put it in a pot and rendered it down and took off all the fat. then gentlemen used it to make their hair flat. horrid, isn't it? it must have smelt. oh, disgusting. that's why you get antimacassars on sofas, to stop that bear's grease getting onto the back of the sofa.

these are one of the first ideas of selling a content through good packaging. the value of them lies really in the box itself. of course, they should have a shallow -- my daughter has got those. i didn't bother to bring them because they're plain white. well, he started in the middle of the last century. a man called jesse austin engraved the plates which were used to produce these. the major factory was called pratt in staffordshire, and it's a very clever process. they engraved different plates for each different colour, and there could be up to ten or so on here. look at the colours in that... you prefer this one? i love that one. how fascinating. why? it's the least good. naturally. the problem with them is they've got several different dates when they were made,

using the same plates. the colours are much stronger, they're crisper, whereas, when one gets to this one, you've got a much more sort of orangey overall tone. it's a perfect dome. that's probably why i like that one best. this is a later print than these. this one is around the turn of the century, about 1900. now, the market at the moment is a bit iffy for them. the value varies. this one, because of the fact that it's a later reproduction from an earlier plate, is worth about £30 to 40. this one has got damage. we've got chips on it. that would be worth about £10 or 15. this one which is in good condition, no damage to that at all, is going to be worth about £50 to 70. not that she'll part with them. she was interested to know what they were worth and the history of them.

the only reason to own anything is because you love it. what else have we got here? there's one or two other pieces. this is extremely rare. this piece here is... from plymouth, the factory only ran for a couple of years. it was owned by william cookworthy. he was a quaker chemist. he began experiments way back in, i think, the 1740s. he found suitable material in the area round near st. austell. my family is from that area. towards the end of the 18th century, some of my ancestors actually sold china clay to josiah wedgwood. unfortunately, i've got no wedgwood. i've got the piece of plymouth, which is sort of the link. this is an exceptional piece. the factory only ran in plymouth for two years. it ran from 1768 to 1770 before cookworthy sent it all to bristol where it was taken over by richard champion.

but there is, in fact, the alchemical mark there for the factory, for tin, which, of course, is cornwall. but it's a very, very crisp bit of -- isn't it after a rococo silver shape? absolutely. 1745, 1765. it's a very good little piece. even in damaged condition, this is probably worth maybe £400, 500. lovely little object. the interesting thing is, i saw the globe there, and i know that william cookworthy apparently entertained james cook the night before he began his circumnavigation of the globe. so there it is, down there. isn't that delightful? and as you said -- here, gordon, look at this. you've got "newton's new and improved terrestrial globe, most recent discoveries laid down from accurate observations of captain cook and other modern navigators, london 1816." amazing, wonderful. that is the original papers because usually they brought these up to date.

however early the stand, you usually find that they're papered up in 1836 or 1845. but it's so lovely to see that original paper and, of course, that pretty stand. look at that for a stand. absolutely straight out of sheraton's drawing book... nice swept leg, little turn column foot. then right in the centre where my hand is, that beautiful vase shape. 1795 to 1820, in the height of fashion and such a nice size. you said how much. golly gosh... £8,500 to 10,000. it's a beauty. it was my great-great-aunt's. she gave it to my dad when he was a child. it's marvellous, isn't it? well, this would probably have been made in the 1920s when charlie chaplin was really very, very popular.

and a lot of tin-plate toys were made at that period in germany. do you know, charlie chaplin is so popular, there are a lot of people i could see would be desperate for something like this. i could certainly see certain collectors probably paying as much as... £300 or 400 for something like this. marvellous. you dropped it? no, it was when we were moving house, the crate dropped on it and busted it. it had a little case, brown case that opened up. and it's broken? what a shame. let's wind it up. oh, look at that! obviously there's a broken escape wheel there. that's an example of time flying, isn't it? time is really flying with this today. splendid snuff box that you've brought in. snuff boxes, of course, are very collectable. this one is a family one, is it?

yes, the original owner was a mr. shilston who was one of the venturers, as they called them, in other words, part owner of a tin and copper mine. his son was my godfather. that's splendid. just looking at it as a snuff box, it's a lovely one. particularly desirable having a hunting scene on the lid. the decoration here, wonderful engine turning, which is a mechanical form of engraving. inside, the gilt interior. but the inscription here does make an enormous difference. "this silver was raised from dolcoath mine in the county of cornwall 1828." that is super. and you've actually got a picture, a print, of dolcoath copper mine.

when you find copper, you always find silver as well, in small traces. in fact, a lot of new silver that is extracted today is a by-product of copper mining. yes, some of the records imply that in 1828 quite a lot of silver must have come up, because a number of artifacts were made from silver that year. looking at it, first of all, just as a box, there was a similar, although a gilded one sold quite recently at auction, that went for just over £3,000. this one is a better one. i tell you it's not at the moment insured for that much. so one has to start working up from that sort of figure... as a box i think nearer the £4,000 for this one, and then add to that the local interest. a figure in excess of £5,000

i would not be surprised by. so a lovely box with a fascinating history. yes, indeed. well, this is a beautiful picture. and as i know you know, it's by thomas dichsee who was born in 1819 and died in 1895. i think it's a superb example of a victorian painting. it's signed with a small monogram here... and it's dated 1863, as you can just see. have you had it for long? i've had it for 30 years, and it belonged to an aunt of mine, who was given it as a young girl by an admirer who thought that it looked just like her. i've loved it ever since i can remember. i love the expression in her eyes and i love the lacework here. i think it's beautiful. well, that's what i like as well. the pearl bracelet and the fantastic detail of the lace, but as you say, her face is so charming,

you really would like to get to know her a bit better. i'd like to know what's in the letter. but i suppose dichsee's great claim to fame is that he was the father of frank dichsee, was the president of the royal academy. but thomas francis dichsee taught his son how to paint, so it's a sort of dynasty of painters. it's wonderfully sort of sentimental. typically victorian. typically victorian. it really invokes a whole era, and it's a beautiful piece. have you any idea what it's worth? no, not really. i've never had it valued because i want to keep it. i've no wish to sell it, but i would be interested to know. would you be interested in the insurance value? i think it should be insured for about £12,000, something like that. it's highly desirable. there are some big collectors of this sort of subject. well, that's very interesting. thank you for bringing it. it's always so interesting;

one makes snap judgments; it's a dangerous thing to do. now, before we look at this sideboard, which has every appearance of being late 19th century and northern counties, tell me the history that you know about it. well, it was given to my husband's grandparents on their wedding in 1914. perfect, perfect. it bears out all this mass of lined decoration, cross banding inlays, varying coloured woods, varying types of timber, that would tie in very nicely with the sheraton revival of the late 19th century. yet there's something about it. i'm looking very carefully and closely, and there's a tiny saw cut that goes across your end as well, a little mitre. if you look, that actually cuts through the main body of the timber. now, that is suspicious because an 18th-century, or even a 19th-century craftsman wouldn't have done that at the time.

there was no need to. the only reason you'd put that line across is if you were laying veneer after it was made. so then we start to look at the sideboard... could it be any earlier? it was fashionable to revamp plain 18th-century pieces. and if you look at the front here, you've got new handles and you can see clearly where the old handles went, several series of old handles. so we may be looking at an 18th-century sideboard re-veneered. the best thing to do, then, is to look inside a drawer. now, here you've got a most extraordinary line dug out in the surface. do you see? yes. that's for lead. this was a cooler box. this, again, wouldn't have come into an edwardian one. that's the patch for the bung, for the tap.

i've seen it, i didn't know what it was, though. now we know that we're looking at an 18th-century sideboard, revamped. if we open this drawer, you should see where there was a cupboard door. that was sealed up for propriety, because in the 1780s that was where the potty went, because you had a screen. and when you had to answer the call of nature, you didn't leave the dining room. it's absolutely stunning; a wonderful example. it is slightly to its detriment, this later improvement, but not seriously so. it's a lovely sideboard. i have to ask, do you have it valued? we haven't had it valued, no. well, to replace such a sideboard today would cost you between £8,000 and 9,000. it's a very nice piece of furniture.

we like it very much indeed. thank you very much. thank you very much indeed. why don't they make toys like this today? i'm afraid he's got grubby knees. he's obviously fallen over on the gravel. isn't he splendid? i think i'll just sit on the side of my box now. [ laughter ] on amusement value alone, he must be worth at least between £75 and 100. i think he's just fantastic. basically this would be filled with paraffin or methylated spirits. you are actually missing, like, a comb at the end of there. you would light it and singe the hairs on the horse. the comb would be made of metal? it would just be heated, that's the point. you would be heating the comb, but it was so hot -- you wouldn't get a flame. you'd set the horse on fire, wouldn't you?

my god, there's a derby winner if ever there was. cornwall is very rich territory for us on the antiques roadshow, not least because of the generations of artists who've chosen to come and live and work here. one thinks of the newlyn school of painters, of lamorna birch and friends, and the potters, painters, and sculptors who lived in st. ives. and among the potters, bernard leach, the most pre-eminent, but why? he was a guru. he was the leading potter of the 20th century. he was influenced by the east. he mixed up european ideas, oriental ideas. what he was above everything else was really a teacher. he stimulated interest in studio pottery. thanks to the royal cornwall museum, we've not only got an original piece of leach, students too. this is a fine piece, isn't it? i think this is magic. i'm really fascinated with these enamels, which were done by laura knight in 1914, '15.

i believe that she was taught how to enamel by your aunt. yes, that's right; they were friends. one summer when my aunt was making her jewellery, laura asked if she could be shown the enamelling technique. they're beautifully done. this one's rather interesting because it has these foil pions underneath which reflect the light through. it's quite a free and easy design, whereas, this one is really quite different in feeling, very classical and quite a different range of palettes in painting enamel, which are not translucent at all. and of course, this is one of the typical ballerinas, always one of her favourite subjects throughout her life. this one's not mounted. we can turn it over and see it signed and dated on the back and also to see that it's counterenamelled, because when you do enamelling you have to enamel both sides. otherwise, when you heat it in the furnace, the metal expands and all the enamel flies off one side

if both sides aren't enamelled. that's very interesting. yes, quite a difficult technique. your aunt and laura likely involved in this piece as a partnership. that's a joint effort of my aunt with her jewellery, making the frame, and laura knight doing another ballerina. signed and dated on the back, 1915. this type of jewellery is very rare and interesting to find and very much in demand. i didn't actually know that she did enamelling at all. well, possibly there are only these few pieces that she did in conjunction with my aunt. she needed my aunt's facilities, like the kiln and things. and you've also brought along this, which i think is absolutely beautiful. it's a long time since i've seen such important piece of arts and crafts jewellery, and it's quite unusual to find them made in gold because they were almost always in silver gilt.

arts and crafts designers seemed to think silver was a purer metal than gold. they were very keen not to have anything ostensibly valuable. and these lovely blue moon stones representing a wisteria. i expect you've speculated on the value of these. i have been wondering. when one sees something so unusual, it's difficult to put a price on it, and i don't know of many precedents. i would think that these little plaques are probably worth somewhere in the region of £1,000 each. this one, i think, is not quite so sensational. i should think it's probably worth perhaps £500 or 600. well, this, i should think, could well be worth in the £2,000 to 3,000 range. my goodness. and i would think that this is also in the £2,000 to 3,000 price range. that's very nice to know in that i think it's a beautiful piece of work.

i think it's gorgeous. well, i must say, we could hardly have wished for a better send-off for our new series of the antiques roadshow. our warm thanks to the dean and chapter of truro cathedral for making this possible and also to the organisers of the three spires festival, of which we're a part. now, i must say that today, as with every antiques roadshow, we faced a problem, what you might call an embarrassment of riches... far more items than we can possibly show you within one programme. this year we're going to be able to put that right with two special programmes in which we'll be including the ones that got away... items we weren't able to show you from truro and future programmes. i'll be introducing those from two splendid locations a little later in the series. we're off now to essex. i hope that you'll join us next week at the same time. until then, from all of us here in cornwall, good-bye. captions by: midwest captioning des moines, iowa

>> he was shot and transported by air is to shock trauma and he was in critical condition there. i'm not sure what the most recent status in is on his condition. >> the weapon was a shotgun? >> the weapon was a firearm. we have not yet identified the specific make and model. >> and what can you tell us about the suspect, the degree of this person is cooperating or any other detail. 15 years old? >> correct. the suspect is a 15-year-old boy. he is a perry hall student as

well. he was a junior, shortly after the shooting he was pretended. police have confirmed at least one faculty member helping subdue him before the officers arrive. there was really some heroism there today. he is talking to our investigators as we speak, he has been cooperative, they're getting a lot of good information from him, and we are also working with the baltimore county state's attorney to determine what kind of charges will be appropriated in this case. he is 15 years old. so obviously there's a decision to be made about whether he's charged as a juvenile or charged as an adult. >> a lot of people have seen or heard about a fairly disturbing facebook page that some say is connected to the shooter. is that something police are aware of? is it something that authorities were aware of before today? >> we are aware of reports of

various social media accounts. as is often the case, like today, so social media can be relevant to investigation like this. and this case is no different. so our investigators are looking at social media to see what information they may contain that is relevant to this case. we are not confirming at this point that any of these sites that you've heard of are indeed accurate or relevant, but we are aware and they are part of the investigation. >> before we go, is there anything you would want students or parents at this school or other schools in the county to know about, be aware of, heading into the second day of school tomorrow? >> well, one thing i think that's very important to remember is that this appears to be the work of one individual. we have him in custody. we do not have any indication that he was targeting anyone

here. we certainly understand that all of that notwithstanding, there is going to be tremendous angst. we will have an enhanced police presence at perry hall tomorrow, not because we believe that there's anyone else involved, but simply to help deal with whatever needs the school may have. and we've also made a critical incident stress management team available to the public school schools in case they need it. >> baltimore county, thank you very much for your time on the phone tonight. >> you're welcome. >> now the members of the maryland delegation to the republican national convention have assembled in tampa tonight. the delegates are in place, but the main event has been delayed by tropical storm isaac. that hasn't dampened the

enthusiasm them yet. >> yes, yes, yes. >> full coverage of the proceedings in tampa starts on pbz tomorrow at 7:00. joining us now in the studio are doug harris, associate professor and shares the department of political science at the university, and nina, assistance professor of political science and international relations at goucher for being with us. >> doug first, where's the race stand in your view? >> my view, i would say that at present, the president seems to have a consistent if slim lead over mitt romney. making this convention particularly important for romney, romney's effort to catch up and perhaps redefine himself and change the narrative of the race. >> how do you see it? >> i see it similarly.

the effect of having chosen paul ryan as his vice presidential candidate, definitely has given a boast boos in the sight of wisconsin where polling shows that romney and ryan have pulled ahead of obama. but it's a tight race. all eyes should be on the republican convention. this will be mitt romney's first national speech to an audience. >> as we talked about before, the program, a lot of eyes are going to be somewhere else on this storm unfortunately hitting the gulf coast. >> yeah. so a lot of attention the past couple of days has been whether or not this tropical storm isaac would hit tampa, and we've seen the modification of the convention shortening it by a day. but now its headed west and headed for new orleans. and, you know, with anniversary of hurricane katrina at the same time, a lot of people are focused on what's going to

happen there. at the same time that we're having the convention. it'll be an interesting, it'll be interesting to see how that's handled. >> you wonder if the decision to scrap tonight wasn't premature because the storm hasn't hit anywhere yet. >> yeah, it seems to be premature. i think all of this talk of katrina and hurricane isaac now reinforces what a lot of political sciencetists know is there are two conventions. there's the convention that's happening in the hall in tampa where the party activist convene and meet with one another and talk with one another. but for the last half century or so, the critically important von individual is the one that's viewed on television. >> for the most part as far as i remember, its been settled before you get to the convention. >> right. >> right. >> these are largely phone commercials for parties, and i would say that the republican

party took significant hit in its reputation for governing and confidence during katrina and it seems to be as we saw in 2008 and as apparently we're seeing again now, it seems to be that hurricane season forces the republican party to revisit some of those failures. >> let's focus if on the ryan pick far moment. first, let me remind our viewers, if you have a question about the presidential race, give us a call, we'll have the number up on the screen. so paul ryan, one of the interesting things here is that romney has been perceived as a moderate, at least relative to others who were running, and he selected somebody as his running mate who in his right or apierce to be his right the traditional thing to do is whichever party you're running in, play the debates in the primary then move to the center, is this an unusual pick from that respect? >> yes and no. in part, what you said is true,

ryan is currently to the right of romney. and a lot of folks saw this as a place where the tea party activists and the party, but in fact you have to remember the home state of paul ryan which is wisconsin, and was recent events and the past couple of years with the recall contest of the governor, i think this is strategic move. you know, even was thinking it would be ohio where we would choose the candidate from that state. >> ryan went to college there, there's a little bit of a bank shot. >> there's a little bit. but also, you know, ryan has the reputation for being someone whose really into policy, he has program ideas. and it gives a little bit of meat to what romney's been missing so far. i think it's a good compliment to the team. >> yeah, and i think it's a result of the polarization of

political parties. since ronald reagan, republics have tended to the move to the right with their vice presidential picks. dan quail was a reach to the conservative by george h.w. bush, chaney and palen. >> interesting, let's take a phone call, this is paul in frederick county. thanks for calling, go ahead. >> i'm interested in how you think governor romney's going to address president obama's war on terrorism. i think you could almost argue that the president has, you know, even upped the game from dick chaney's war on terrorism. the way he's using drones, being the first president to order the killing of a united states citizen was a terrorist on a foreign land. president obama -- >> thanks very much for the phone call. not something that's prominent on the radar screen at the

moment. >> no, and the way the romney campaign would like it. their issue is the economy, economy, economy, because on the economy, ronny leads obama. currently he doesn't want to step into issues on the war on there are or policy because of his lack of experience in that arena. that would be the disadvantage of the romney team to go in that direction. >> i would argue is striking for the republican party again go back to reagan, foreign policy and security issues have generally been republican issues. and the republicans are in a diminished position heading into this presidential election because they're going in without foreign policy as a strong card for them. >> let's talk about the tenor of the race a little bit. somebody referred to this as the golden age of mud slinging. i like that quote, but i'm sure there have been previous golden ages of use. address that label the and the roll of the tax, but also the

fact that, those of us sitting in the state of maryland are seeing different race than people who might be watching us over the stateline in virginia or pennsylvania who are being exposed to the commercials. here it's just nonstop bark of the other guy -- bashing of the other guy. >> typically there's one candidate that wants to stay above the fray and there's one that wants to bring them down. >> rose garden strategy, and there's ate tack strategy. >> and usually it's the case that it's the campaign that's behind that wants to go negative. right now, the race is close enough the economy is bad enough from the perspective of the white house, and that i would say that both campaigns have an interest in going negative. in part because the white house doesn't want, can't engage a rose garden strategy because of the state of the economy. and i think there is a

strategic opportunity because the romney campaign has failed to define mitt romney. and the white house has decided to lend them a hand. >> thoughts. >> outside money. we also see traditionally that the candidate campaigns themselves tend to try to be a little bit more even quiet in engaging in that, when you open the door to outside money, there's no constraints especially when you can't really understand where the money is coming from, you can't hold anyone accountable for it. it opens the flood gates. when which, you know, again if you're in pennsylvania and virginia you're flooded with this. the negative campaigning tends to work. >> the good thing is election day will be here soon. mina and doug, thanks to both of you for being with us. >> thank you. >> appreciate the time. coming up new techniques

helping doctors to diagnose chest pain. we'll be right back. >> from may to december each year, the western maryland scenic railroad conducts round trip excursions in maryland. it's a family-fun mix of mountain scenery and local history. but that's not all. this fall on september saturday, you can also enjoy live performances by fans and musicians at the historic old depot doing the layover. live at the depot concert series begins september 7th. so, check out the website for tickets and more information. and by the way, i recommend that you just make a weekend of it. this has been an artworks

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and that's your daily download. and joining us now for our your help segment an assistant professor of medicine at the university of maryland school and medicine and cardiologist at the school of the medical center and dr. charles wife, professor of radiology at the university of school of medicine and radiologist at the university of maryland medical center. doctors, thanks for being with us. let's talk about chest pain. frequently somebody walks into the e.r., complaining of chest pain, how often do you see that? how often is it the heart condition as opposed to the indigestion or whatever they're hoping it is? >> a vast majority of patients who have chest pain, it won't be the heart, but because heart disease is the number one killer of americans and actually worldwide, it's still the one we should be most concerned about. so we don't discourage patients

who have chest pains. we encourage them to find out what's going on. >> because you wouldn't want to find out that it was something serious and you had a worse case of whatever it was because you were too embarrassed to come in. >> correct. >> i think i should put a big plug for prevention. smoking being the leading cause of heart disease. patients can, it won't be a surprise if they're chest pain is from the heart if they're a smoker. other conditions that say it can identify with their primary care doctor, diabetes, high cholesterol, hypertension and identifying their family risk. >> dr. white, let's focus if on technology that comes into play when somebody does show up at the e.r. with one of these conditions, how much is that changed? how is it evolving. >> it's dramaticically changed in the last 20, 25 years. time was that really all you had was your physical exam, the history of course, and ekg, now

you can be stress tested, imaging with cat scans and other things. it has advance dramaticically. >> ekg, is that helpful if someone is having a heart attack? >> certainly if it's, i would refer to my cardiology colleague here, but certainly is arkansas standard typical kind of ekg, it can be helpful, but there's a group that are sort of difficult to interpret and perhaps sean could add to that. >> they're very helpful, but as the doctor said, it's not the only test we can use. and sometimes it's not as helpful as we would like it to be. blood test that can help if someone's having injury to the heart. >> let's talk about some of the technology, what you actually see. we have a couple of images from a ct scan of the heart. it sort of creates a 3d model, how's that possible? >> yeah, well because ct today

is actually volume etic. what does that mean? >> it means we do things in single slices, we're actually getting the entire, the entire extent, a whole heart perhaps or whole chest even. >> see an image like that in short order? i mean that doesn't take days to -- >> no, this could be done in seconds actually. and you could take the individual part of that. that's about half a heart, and you can perhaps see jiggles running down the side. those are the individual coronary arteries. we can look at the whole picture and we can take the individual part. of course the coronary arteries are the areas that we're concerned about. >> the next couple of images involved a very, very serious condition. actually, let's flip to the other one in this series if we can that shows the big tube there, using fancy medical

terminology is the aorta, correct? the blood vessel coming out of the heart. what's going wrong in that image? >> what's happened is if you look at the big tube, there's a line through the center of it. and that line corresponds to what we call an aortic dissension. what's happening is a piece of the wall has come free, and we now have blood in two sides, two parts of it. and this is a serious condition that can lead to all sorts of problems including death. so it's one we really to want diagnosis quickly. >> the other image was a repaired version of that problem aorta. what is the fix? >> so one of the fixes that can be attempted particularly in if it's in a particular part of the aorta, the descending aorta, you can put a stint in there. this can be done through the skin. it doesn't require a huge operation. and so what you're seeing here is the same tube and you may see now these lines across it. and that corresponds to the

stint. so that is one of the treatments that can be used. >> so as cardiologist, how do you feel about imaging? >> well, in that particular example, it's very helpful because someone can present with chest pain and the ekg will not show signs of heart injuries. the chest pain's coming from this aorta that is tearing. and that's a life-threatening emergency that requires surgery urgently. >> that has always been extremely difficult to diagnose. >> yes. >> and when you diagnose it, it's sometimes difficult to address rapidly. >> it requires prompt attention when it does. imaging is very helpful. >> tell me about the study that was i don't know if it's ongoing or recently completed with nih. >> it was published recently in the new england journal of medicine. and we were one of the centers involved in it. it really was an effort to look at what the rule is of the ct scan looking at x-rays by a

heart attack basically. and what we found as part of this was that although ct scanner, the ct scan wasn't necessarily better overall than some of the existing techniques, it was entail somewhat faster. it's an ongoing kind of evolution of the kind of technology that we're trying to do. >> a lot of radiation involved in the ct scan but that's probably not your first concern if your having chest pains. >> that's a mixed blessing. there's also concerns about radiation treatment or radiation effect, but the reality is there's also been a tremendous amount of effort in sort of a cat skin industry to try to reduce that level. a bunch of techniques now that can really lower that level to a point where it is tolerable, and in fact in a life- threatening situation, it is probably the last concern we have. >> dr. robinson, in a couple minutes we have left, let's focus if on the speed part of

this. if somebody is having these symptoms, you want to see them as fast as pung you want to get them worked up as fast as you can. what's the difference if there's a delay? >> well, when they first come in to the emergency room with chest pains, they're going to get an ekg within ten minutes. that'll identify a very significant life threatening condition of a heart attack. very serious heart attack in which case we two to the kat lab. in cases where it is not helpful and the lest will take maybe 15 minutes or so to come back. sometimes they don't always reveal injury either. this imaging process can be very help informal those cases. >> is there an issue at all with insurance and testing like this? >> probably not a problem. >> we try and treat the patients first, certainly at the university of maryland. >> let me squeeze in a quick phone call, this is steven, thank you for the call, go ahead. >> hello.

>> hi, you're on. >> yeah, i'm curious about, i had a stint, i had two heart attacks, and i have a stint put in my main artery. that main artery, is that the artery that twos to your heart? >> steven, thank you for the question. so when somebody does have a stint. it's one of those jiggles we saw on the side of the first image, right? >> sure, although the stint we saw in the image was in the bigger blood vessel. the smaller vessel that supply the heart itself can receive stints. those are the vessels that if they're clogged can cause a heart attack. >> doctors, thanks to both of you for being with us. >> thank you. >> we appreciate it. if you'd like to ask our future guests a question by video, just go to mpt.org/dc, and click the send us your video question. for all of us, i'm jeff, thanks for watching and have a good night.