Shadowing Practice: Hypertrophic Cardiomyopathy - Patient’s Guide for Better Understanding - Learn English Speaking with Video
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Hi, I'm Dr. Kenneth Taylor, Director of the Hypertrophic Cardiomyopathy Center at Piedmont, and I want to talk to you today about hypertrophic cardiomyopathy.
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Hypertrophic cardiomyopathy is a genetic disorder, and it results in a thickening of the heart muscle.
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There are a number of different forms of this disorder, and so we'll talk a little bit about that.
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The classic form of hypertrophic cardiomyopathy involves thickening of what we call the interventricular septum.
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So the heart has four chambers, diagrammed here.
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The left ventricular chamber and the right ventricular chamber are the two pumping chambers of the heart.
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They're separated by this wall that we call the septum.
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Normally that septum is about a centimeter thick.
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In people who have particularly the obstructive form of hypertrophic cardiomyopathy,
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There is a thickening of the septum right here underneath the
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aortic valve where the blood is trying to get out of the heart.
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And so when blood is trying to get out of the heart,
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this thickened muscle gets in the way and obstructs the blood trying to get out.
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It's kind of like if you took a hose
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and put your finger on the end of the hose and blocked it off partially, the water would squirt out of the end of the hose.
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And the reason it squirts out is that there's a pressure gradient
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or a difference in pressure from on one side of where you've put your finger to the other side.
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And that obstruction creates a gradient or a pressure gradient.
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And we can actually measure that gradient with our echo technology.
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So, for example, if you have a blood pressure that's about, let's say, 120 over 70, and you have obstruction here from the septum,
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if you measure the pressure in the chamber of the heart, the top number will be higher than that.
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So, for example, if you have a 50 millimeter gradient, for example, then the pressure inside the heart will be 170,
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whereas the blood pressure is 120.
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And that pressure gradient plays a role in the symptoms of this disease, and it's something we follow with echoes.
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The other thing that happens in people who have this thickening of the septum is
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that right next to the septum is the mitral valve.
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And the mitral valve has these cords, kind of like parachute cords.
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And when blood is accelerated through this outflow tract, it, for lack of a better word,
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sucks these cords into the outflow tract, resulting in more narrowing and more obstruction.
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And it also opens this valve and causes the valve to leak.
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or something we call mitral regurgitation.
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So we also see that in an echo, and depending on how much obstruction there is,
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if there's more obstruction, there may be more leakiness of the mitral valve.
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That also may contribute to symptoms in this disease.
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We typically treat this disease first with medicines to try to reduce how much this heart muscle thickens
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and how much it obstructs blood flow coming out of the heart.
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And we can follow that with echoes
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and with stress echoes to look at the gradient across the
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outflow tract as well as the degree of leakiness of the mitral valve.
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There are several issues that we need to talk about in patients with hypertrophic cardiomyopathy.
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The first one relates to the diagnosis, where in the heart muscle is thickened,
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and whether there's obstruction or not.
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And we typically look at that with an echo and often times we use MRI for better clarification of the pathology.
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So we will typically do an echo if you haven't already had one
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and we will often times do an MRI to look at what the heart muscle actually looks like
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and what the valve structure looks like.
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The next thing we like to assess is what your symptoms are like.
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and typically we will try to assess that with a stress test, either a regular treadmill or more than likely something called a stress echo.
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And with a stress echo what we do is we put you on a treadmill
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or on a bike and we look at that gradient we talked about
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and then we exercise you and see if that gradient changes with exercise.
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We also monitor your blood pressure and see how well you can do to see what kind of symptoms you might have.
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The third issue is that patients with hypertrophic cardiomyopathy are at risk for certain arrhythmias.
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And those arrhythmias can be potentially dangerous.
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And in fact, there is a small population of patients with hypertrophic cardiomyopathy who are at risk for something we call sudden cardiac death,
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where they basically can have an arrhythmia and die suddenly.
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So we look for arrhythmias in a couple of different ways, one of which is with monitoring, something like a Holter monitor.
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And the other is that we have a group of colleagues called electrophysiologists who specialize in the electrical system of the heart.
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And we will typically make sure that our electrophysiologist goes through all of the information
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and has a discussion with you about your particular risks for having an arrhythmia and your risks for having sudden cardiac death.
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And the reason that's important is if your risk is found to be elevated,
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then in some population of patients with this disorder, we recommend defibrillators.
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So as far as therapy,
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we will talk about first medical therapy and then potentially the role for something we call an ICD or defibrillator.
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Lastly, if patients don't do well with medical therapy,
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occasionally we're in a position of talking about more definitive therapy to relieve obstruction.
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And there are kind of two different pathways, one of which is called septal myomectomy where a surgeon goes in
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and opens your chest and cuts out the thickened heart muscle and potentially repairs any abnormalities with the mitral valve.
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And that's been shown to significantly improve symptoms and significantly improve outcomes in patients with this disorder.
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There is an alternative called an alcohol septal ablation where we actually go in with a cath
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and find the blood vessel that feeds this particular area of the heart and inject a little alcohol and cause, for lack of a better word,
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a little heart attack, which can reduce the obstruction.
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We typically think of that as a second choice to the myomectomy
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and used mostly in patients who are felt to be not surgical candidates.
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So we call that whole category what we call septal reduction therapy.
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The vast majority of patients don't need that and can be managed medically.
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Lastly, as I mentioned, this is a genetic disease.
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And so first -degree family members need to be screened.
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And we can talk about the best way to screen them.
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Typically, family members should be screened first -degree relatives, so siblings, children, parents, with an echo and an EKG.
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And we can have a conversation about the role of genetic testing as well.
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Thank you very much for your time.
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I hope this has been helpful for your understanding of hypertrophic cardiomyopathy, and I look forward to addressing any of your questions.
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אוצר מילים והערות הגייה לשיעור הזה
שיעור הדיבור הזה מבוסס על הסרטון “Hypertrophic Cardiomyopathy - Patient’s Guide for Better Understanding”. המילים שחוזרות הכי הרבה: cardiomyopathy, gradient, hypertrophic, valve, pressure. בסרטון הזה יש 83 משפטים ו-1192 מילים לתרגול Shadowing. הדיבור נמשך 7:40. הדובר מדבר בקצב טבעי של כ-155 מילים בדקה, קרוב לשיחה יומיומית. רק 78% מהמילים נמצאות בין 3,000 המילים הנפוצות ביותר באנגלית, כך שאוצר המילים מאתגר.
אוצר מילים מרכזי בסרטון הזה
15 מילים מהסרטון שכדאי ללמוד, עם ההגייה והמשמעות שלהן:
| מילה | הגייה | משמעות |
|---|---|---|
| echo שם עצם | /ˈɛk.oʊ/ | הֵד, בַּת־קוֹל |
| valve שם עצם | /ˈvælv/ | שַׁסְתּוֹם |
| muscle שם עצם | /ˈmʌs.əl/ | שְׁרִיר |
| chamber שם עצם | /ˈt͡ʃeɪ̯mbɚ/ | לִשְׁכָּה |
| symptom שם עצם | /ˈsɪm(p)təm/ | תַּסְמִין, סִימְפּטוֹם |
| disorder שם עצם | /dɪsˈɔɹdɚ/ | אי־סדר |
| distress שם עצם | /dɪˈstɹɛs/ | מוּעָקָה |
| monitor שם עצם | /ˈmɑ.nɪ.tɚ/ | צָג |
| hose שם עצם | /hoʊz/ | צִנּוֹר, קוֹלָח |
| finger שם עצם | /ˈfɪŋɡɚ/ | אצבע \ אֶצְבַּע f) |
| sudden שם תואר | /ˈsʌd.ən/ | פתאומי |
| relative שם עצם | /ˈɹɛl.ə.tɪv/ | קָרוֹב, קְרוֹבָה |
| thick שם תואר | /θɪk/ | עבה |
| suck פועל | /sʌk/ | מצץ |
| whereas | /(h)wɛɹˈæz/ | הוֹאִיל |
דקדוק בסרטון הזה
המבנים שהדובר משתמש בהם הכי הרבה, עם המילים המדויקות מהסרטון:
| מבנה | בסרטון |
|---|---|
| סביל (Passive voice) be + past participle — הדגש הוא על מה שקורה, לא על מי שעושה את הפעולה | is accelerated · is thickened · is found |
| הווה מושלם (Present perfect) have/has + past participle — פעולה שקרתה בעבר ועדיין יש לה חשיבות או השפעה עכשיו | you've put · haven't already had · that's been shown |
| משפטי זיקה (Relative clauses) who / which + clause — מידע נוסף על אדם או דבר | people who have · attack, which can |
הגייה ששווה לשים לב אליה
הדובר משתמש ב-8 קיצורים וצורות מקוצרות, כמו don't, haven't, I'm. אמרו אותם בצורה הקצרה, כפי שאתם שומעים אותם.
- הצלילים של “th”: thick /θɪk/, underneath /ˌʌndɚˈniθ/, pathway /ˈpæθˌweɪ/, pathology /pəˈθɒləd͡ʒi/, thicken /ˈθɪkən/
- הצלילים של “sh” ו-“zh”: obstruction /əbˈstɹʌk.ʃən/, potentially /pəˈtɛnʃ(ə)li/, occasionally /əˈkeɪʒənəli/, reduction /ɹɪˈdʌk.ʃən/, partially /ˈpɑɹʃəli/
- מילים ארוכות — שימו לב להטעמה: potentially /pəˈtɛnʃ(ə)li/, electrical /ɪˈlɛktɹɪkəl/, occasionally /əˈkeɪʒənəli/, definitive /dɪˈfɪn.ɪ.tɪv/, accelerate /ɪkˈsɛl.əˌɹeɪt/
צלילים שדוברי עברית מתקשים בהם:
- /w/ — שפתיים מעוגלות, לא /v/: whereas /(h)wɛɹˈæz/, pathway /ˈpæθˌweɪ/, squirt /skwɝt/
- /æ/ — פתוח יותר מה-“אֶ” העברית, לא כמו “a” ב-“cup”: valve /ˈvælv/, tract /tɹækt/, cardiac /ˈkɑɹdiˌæk/, lastly /ˈlæstli/, vast /væst/
- /r/ — הלשון לא נוגעת בשום מקום, לא ה-“ר” הגרונית: obstruction /əbˈstɹʌk.ʃən/, disorder /dɪsˈɔɹdɚ/, distress /dɪˈstɹɛs/, cord /ˈkoɹd/, tract /tɹækt/
איך לתרגל עם הסרטון הזה
- הקשיבו לכל הסרטון פעם אחת בלי לדבר, ורשמו את המילים שאתם לא מכירים.
- התחילו במהירות 0.75×, תרגלו Shadowing משפט אחר משפט, וחזרו למהירות רגילה כשזה מרגיש קל.
- הקליטו את עצמכם והשוו למקור, תוך תשומת לב למילים כמו echo, valve, muscle.
מהי טכניקת השאדואינג?
שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.