쉐도잉 연습: Hypertrophic Cardiomyopathy Made Easy | (Includes Hypertrophic Obstructive Cardiomyopathy & SAM) - 영상으로 영어 말하기 배우기
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Hypertrophic cardiomyopathy is a genetic disorder of the cardiac muscle tissue,
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characterised by abnormal thickening of the cardiac muscle without any clear cause.
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It is the second most common cardiomyopathy with a prevalence of around 1 in 500,
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and it is the most frequent cause of sudden cardiac death in young patients.
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Overall, males and females are equally affected.
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However, females are more likely to present at an older age with more significant heart failure.
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All ethnicities can be affected.
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However, a form of hypertrophic cardiomyopathy affecting the apex is significantly more prevalent in Asian people.
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It is inherited in an autosomal dominant fashion and the genetic abnormalities occur primarily in genes that code for sarcomere proteins.
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40 % are in the gene coding for beta myosin heavy chains on chromosome 14
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and 40 % in the cardiac myosin binding protein C gene.
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In total over 150 mutations have been identified to be involved with this condition.
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These mutations lead to altered translation efficiency,
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followed by changes in the signaling pathways and ultimately leading to changes in the histology,
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including myocyte hypertrophy and fibrosis.
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This leads to parts of the heart becoming thicker than usual.
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The most commonly affected areas are the interventricular septum and the left ventricle, although any part can be affected.
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The left ventricular outflow tract is particularly susceptible to encroachment from the thickening of the septum,
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leading to obstruction of the left ventricular outflow tract.
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This is known as hypertrophic obstructive cardiomyopathy and is seen in around 25 % of those with hypertrophic cardiomyopathy.
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A unique feature of this obstruction is that it is dynamic, meaning it is not fixed.
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The left ventricular outflow tract is encroached in these patients due to the increased size of the interventricular septum,
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particularly evident during systole.
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Another feature that contributes to the obstruction is systolic anterior motion,
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or SAM, which is the anterior movement of the mitral valve during systole leading to worsening of the outflow tract obstruction.
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This is best seen on a parasternal view on echocardiography.
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Although it is not specific for hypertrophic cardiomyopathy it is more commonly seen.
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Several other factors can also contribute to the dynamic nature of the obstruction such as contractility for example during exercise
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which causes a more forceful contraction and a greater degree of obstruction.
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A reduction in preload can also worsen the left ventricular outflow tract obstruction,
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where preload is the volume in the ventricle at the end of diastole.
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Examples that reduce preload include hypovolemia, vasodilation, such as after administration of nitrates,
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and tachycardia that reduces preload due to shorter diastolic filling time.
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The smaller left ventricular volume facilitates the systolic anterior motion of the mitral valve.
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Over time, as the fibrosis increases, the ventricle becomes stiffer and less compliant, leading to diastolic heart failure,
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also known as heart failure with a preserved ejection fraction.
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A marker of this is increased pressure in the left atrium, which increases the risk of arrhythmias like atrial fibrillation.
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In long -standing cases, the interstitial fibrosis and the left ventricular outflow tract obstruction lead to thinning of the left ventricle,
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eventually producing a systolic failure.
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Often, patients are asymptomatic.
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When symptoms are present, they are usually the result of four main mechanisms.
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First is diastolic dysfunction, leading to increased left atrial pressure and pulmonary vein pressure.
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This is exacerbated in exertion, giving exertional dyspnea.
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It can also manifest as orthopnea, which is breathlessness when lying flat,
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and paroxysmal nocturnal dyspnea, which is sudden onset shorness of breath during sleeping.
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Peripheral edema is another possible or finding.
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Secondly, we have obstruction of the left ventricular outflow tract which can also cause dyspnea but can cause syncope,
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especially during exercise.
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Next we have arrhythmias which can include atrial fibrillation which is seen in around 25 % of patients,
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ventricular tachycardia and ventricular fibrillation.
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These can lead to palpitations, lightheadedness or syncope, shortness of breath and chest pain.
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We also mentioned earlier
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that hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young patients and this is largely due to arrhythmias.
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This brings us to the fourth mechanism, an imbalance between the myocardial oxygen supply and the demand.
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Oxygen supply is reduced because the flow of blood through the hypertrophy tissue is lower,
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while there is an increase in the demand due to the thicker myocardial tissue.
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This can cause chest pain that may have typical features of angina.
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For the diagnosis, a physical exam will often reveal a mid -systolic murmur best heard at the left sternal border.
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An ECG may show left ventricular hypertrophy voltages shown by large amplitude QRS complexes
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and possibly Q waves that are distinguished from previous infarctions by having a width of less than 40 milliseconds.
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The diagnosis of hypertrophic cardiomyopathy is based on abnormal thickening.
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This is defined as a thickness of the interventricular septum of 15 millimeters or greater,
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or 13 millimeters with a family history or genetic background.
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It can be difficult to distinguish between hypertrophic cardiomyopathy and physiological hypertrophy seen in athletes.
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A possible distinguishing feature is that the volume of the cavity in physiological hypertrophy is not reduced,
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whereas the volume is reduced in hypertrophic cardiomyopathy.
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An asymmetrical distribution of the hypertrophy also favours hypertrophic cardiomyopathy.
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The primary therapy is the use of beta blockers as they serve to reduce contractility and to increase diastolic filling time.
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Calcium channel blockers are options in patients not responsive to beta blockers or in patients in whom beta blockers are contraindicated.
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In patients who have developed heart failure, diuretics may be useful, however, must be used with care in order to avoid hypovolemia,
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which as we said, can precipitate the left ventricular outflow tract obstruction.
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Higher risk patients, such as athletes, patients with previous ventricular fibrillation or tachycardia,
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symptomatic patients, patients with significant thickening of the septum or ventricular wall, typically defined above 30 mm,
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or a family history of sudden cardiac death should be considered for an implantable cardioverter defibrillator, known as an ICD.
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Septal myomectomy or ablation can be considered in patients with severe obstruction that despite pharmacotherapy are still symptomatic.
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Thank you.
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이 레슨의 어휘와 말하기 포인트
이 말하기 레슨은 영상 “Hypertrophic Cardiomyopathy Made Easy”을(를) 바탕으로 합니다. 가장 자주 반복되는 단어는 다음과 같습니다: ventricular, patients, cardiomyopathy, obstruction, hypertrophic. 이 영상에는 섀도잉할 문장 76개와 단어 1004개가 있습니다. 말하는 구간의 길이는 8:40입니다. 화자는 분당 약 116단어의 일정한 속도로 말해서 섀도잉하기에 편한 속도입니다. 영어에서 가장 많이 쓰이는 3,000단어에 속하는 단어가 67%뿐이라 어휘가 어려운 편입니다.
이 영상의 핵심 어휘
영상에 나오는 익혀 둘 만한 단어 15개를 발음, 뜻과 함께 정리했습니다.
| 단어 | 발음 | 뜻 |
|---|---|---|
| sudden 형용사 | /ˈsʌd.ən/ | 급격한 |
| beta 명사 | /ˈbeɪtə/ | 베타 |
| gene 명사 | /d͡ʒiːn/ | 유전자 |
| tissue 명사 | /ˈtɪʃ.(j)u/ | 조직 |
| distinguish 동사 | /dɪˈstɪŋ.ɡwɪʃ/ | 구별하다 |
| thick 형용사 | /θɪk/ | 두껍다 |
| muscle 명사 | /ˈmʌs.əl/ | 근육 |
| mechanism 명사 | /ˈmɛk.ə.nɪ.zəm/ | 기구, 메커니즘 |
| oxygen 명사 | /ˈɑksɪd͡ʒən/ | 산소 |
| diagnosis 명사 | /daɪəɡˈnəʊsɪs/ | 진단 |
| valve 명사 | /ˈvælv/ | 밸브 |
| athlete 명사 | /ˈæθ.liːt/ | 육상 경기(陸上競技) 선수, 육상 선수 |
| mutation 명사 | /mjuˈteɪʃən/ | 변형, 변이 |
| occur 동사 | /əˈkɜː/ | 일어나다, 발생하다 |
| thin 형용사 | /ˈθɪn/ | 가늘다, 얇다 |
이 영상의 문법
화자가 가장 많이 쓰는 문형을 영상 속 실제 표현과 함께 정리했습니다.
| 문형 | 영상 속 표현 |
|---|---|
| 수동태 be + 과거분사 — 누가 하는지보다 무슨 일이 일어나는지에 초점 | are equally affected · can be affected · is inherited |
| 관계절 who / which + 절 — 사람이나 사물에 대한 추가 정보 | SAM, which is · orthopnea, which is · dyspnea, which is |
| 현재완료 have/has + 과거분사 — 과거의 일이 지금도 관련이 있을 때 | have been identified · have developed |
주의할 발음
- “th” 소리: thick /θɪk/, athlete /ˈæθ.liːt/, thin /ˈθɪn/, width /ˈwɪtθ/, pathway /ˈpæθˌweɪ/
- “sh”와 “zh” 소리: obstruction /əbˈstɹʌk.ʃən/, tissue /ˈtɪʃ.(j)u/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, mutation /mjuˈteɪʃən/, reduction /ɹɪˈdʌk.ʃən/
- 긴 단어 — 강세 위치에 주의: anterior /ænˈtɪɹ.i.ɚ/, mechanism /ˈmɛk.ə.nɪ.zəm/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, primarily /ˈpɹaɪ.mə.ɹə.li/, efficiency /ɪˈfɪʃ.ən.si/
한국어 화자가 어려워하는 소리:
- /f/ — ㅍ(/p/)으로 바꾸지 말고 윗니를 아랫입술에 대기: define /dɪˈfaɪn/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, efficiency /ɪˈfɪʃ.ən.si/, frequent /ˈfɹiː.kwənt/, facilitate /fəˈsɪlɪteɪt/
- /v/ — ㅂ(/b/)과 구별하기: valve /ˈvælv/, reveal /ɹɪˈviːl/, preserve /pɹəˈzɝv/, voltage /ˈvəʊltɪd͡ʒ/, evident /ˈɛv.ə.dənt/
- /z/ — ㅈ이 아니라 성대를 울리는 /s/: mechanism /ˈmɛk.ə.nɪ.zəm/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, whereas /(h)wɛɹˈæz/, translation /tɹænzˈleɪʃən/, exam /ɪɡˈzæm/
이 영상으로 연습하는 방법
- 먼저 말하지 않고 영상을 끝까지 듣고 모르는 단어를 적어 둡니다.
- 보통 속도로 한 문장씩 섀도잉하고, 화자의 리듬과 맞을 때까지 반복합니다.
- 자신의 목소리를 녹음해 원본과 비교하고, sudden, beta, gene 같은 단어에 특히 주의합니다.
쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법
쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.