쉐도잉 연습: Hypertrophic Cardiomyopathy - Patient’s Guide for Better Understanding - 영상으로 영어 말하기 배우기

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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.

Hypertrophic cardiomyopathy is a genetic disorder, and it results in a thickening of the heart muscle.

There are a number of different forms of this disorder, and so we'll talk a little bit about that.

The classic form of hypertrophic cardiomyopathy involves thickening of what we call the interventricular septum.

So the heart has four chambers, diagrammed here.

The left ventricular chamber and the right ventricular chamber are the two pumping chambers of the heart.

They're separated by this wall that we call the septum.

Normally that septum is about a centimeter thick.

In people who have particularly the obstructive form of hypertrophic cardiomyopathy,

There is a thickening of the septum right here underneath the

aortic valve where the blood is trying to get out of the heart.

And so when blood is trying to get out of the heart,

this thickened muscle gets in the way and obstructs the blood trying to get out.

It's kind of like if you took a hose

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.

And the reason it squirts out is that there's a pressure gradient

or a difference in pressure from on one side of where you've put your finger to the other side.

And that obstruction creates a gradient or a pressure gradient.

And we can actually measure that gradient with our echo technology.

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,

if you measure the pressure in the chamber of the heart, the top number will be higher than that.

So, for example, if you have a 50 millimeter gradient, for example, then the pressure inside the heart will be 170,

whereas the blood pressure is 120.

And that pressure gradient plays a role in the symptoms of this disease, and it's something we follow with echoes.

The other thing that happens in people who have this thickening of the septum is

that right next to the septum is the mitral valve.

And the mitral valve has these cords, kind of like parachute cords.

And when blood is accelerated through this outflow tract, it, for lack of a better word,

sucks these cords into the outflow tract, resulting in more narrowing and more obstruction.

And it also opens this valve and causes the valve to leak.

or something we call mitral regurgitation.

So we also see that in an echo, and depending on how much obstruction there is,

if there's more obstruction, there may be more leakiness of the mitral valve.

That also may contribute to symptoms in this disease.

We typically treat this disease first with medicines to try to reduce how much this heart muscle thickens

and how much it obstructs blood flow coming out of the heart.

And we can follow that with echoes

and with stress echoes to look at the gradient across the

outflow tract as well as the degree of leakiness of the mitral valve.

There are several issues that we need to talk about in patients with hypertrophic cardiomyopathy.

The first one relates to the diagnosis, where in the heart muscle is thickened,

and whether there's obstruction or not.

And we typically look at that with an echo and often times we use MRI for better clarification of the pathology.

So we will typically do an echo if you haven't already had one

and we will often times do an MRI to look at what the heart muscle actually looks like

and what the valve structure looks like.

The next thing we like to assess is what your symptoms are like.

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.

And with a stress echo what we do is we put you on a treadmill

or on a bike and we look at that gradient we talked about

and then we exercise you and see if that gradient changes with exercise.

We also monitor your blood pressure and see how well you can do to see what kind of symptoms you might have.

The third issue is that patients with hypertrophic cardiomyopathy are at risk for certain arrhythmias.

And those arrhythmias can be potentially dangerous.

And in fact, there is a small population of patients with hypertrophic cardiomyopathy who are at risk for something we call sudden cardiac death,

where they basically can have an arrhythmia and die suddenly.

So we look for arrhythmias in a couple of different ways, one of which is with monitoring, something like a Holter monitor.

And the other is that we have a group of colleagues called electrophysiologists who specialize in the electrical system of the heart.

And we will typically make sure that our electrophysiologist goes through all of the information

and has a discussion with you about your particular risks for having an arrhythmia and your risks for having sudden cardiac death.

And the reason that's important is if your risk is found to be elevated,

then in some population of patients with this disorder, we recommend defibrillators.

So as far as therapy,

we will talk about first medical therapy and then potentially the role for something we call an ICD or defibrillator.

Lastly, if patients don't do well with medical therapy,

occasionally we're in a position of talking about more definitive therapy to relieve obstruction.

And there are kind of two different pathways, one of which is called septal myomectomy where a surgeon goes in

and opens your chest and cuts out the thickened heart muscle and potentially repairs any abnormalities with the mitral valve.

And that's been shown to significantly improve symptoms and significantly improve outcomes in patients with this disorder.

There is an alternative called an alcohol septal ablation where we actually go in with a cath

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,

a little heart attack, which can reduce the obstruction.

We typically think of that as a second choice to the myomectomy

and used mostly in patients who are felt to be not surgical candidates.

So we call that whole category what we call septal reduction therapy.

The vast majority of patients don't need that and can be managed medically.

Lastly, as I mentioned, this is a genetic disease.

And so first -degree family members need to be screened.

And we can talk about the best way to screen them.

Typically, family members should be screened first -degree relatives, so siblings, children, parents, with an echo and an EKG.

And we can have a conversation about the role of genetic testing as well.

Thank you very much for your time.

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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이 말하기 레슨은 영상 “Hypertrophic Cardiomyopathy - Patient’s Guide for Better Understanding”을(를) 바탕으로 합니다. 가장 자주 반복되는 단어는 다음과 같습니다: cardiomyopathy, gradient, hypertrophic, valve, pressure. 이 영상에는 섀도잉할 문장 83개와 단어 1192개가 있습니다. 말하는 구간의 길이는 7:40입니다. 화자는 분당 약 155단어로, 일상 대화에 가까운 자연스러운 속도로 말합니다. 영어에서 가장 많이 쓰이는 3,000단어에 속하는 단어가 78%뿐이라 어휘가 어려운 편입니다.

이 영상의 핵심 어휘

영상에 나오는 익혀 둘 만한 단어 15개를 발음, 뜻과 함께 정리했습니다.

단어	발음	뜻
echo 명사	/ˈɛk.oʊ/	메아리, 에코
valve 명사	/ˈvælv/	밸브
muscle 명사	/ˈmʌs.əl/	근육
chamber 명사	/ˈt͡ʃeɪ̯mbɚ/	침실
symptom 명사	/ˈsɪm(p)təm/	증상, 증후
disorder 명사	/dɪsˈɔɹdɚ/	혼란
monitor 명사	/ˈmɑ.nɪ.tɚ/	모니터
cord 명사	/ˈkoɹd/	밧줄
hose 명사	/hoʊz/	호스
finger 명사	/ˈfɪŋɡɚ/	손가락
sudden 형용사	/ˈsʌd.ən/	급격한
vast 형용사	/væst/	광대하다, 거대하다
relative 명사	/ˈɹɛl.ə.tɪv/	친척
thick 형용사	/θɪk/	두껍다
suck 동사	/sʌk/	빨다

영상에 나오는 구동사

단어	뜻
get out 동사	나오다, 나가다

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	is accelerated · is thickened · is found
현재완료 have/has + 과거분사 — 과거의 일이 지금도 관련이 있을 때	you've put · haven't already had · that's been shown
관계절 who / which + 절 — 사람이나 사물에 대한 추가 정보	people who have · attack, which can

주의할 발음

화자는 don't, haven't, I'm 같은 축약형과 약화된 형태를 8번 사용합니다. 들리는 대로 짧게 발음하세요.

“th” 소리: thick /θɪk/, underneath /ˌʌndɚˈniθ/, pathway /ˈpæθˌweɪ/, pathology /pəˈθɒləd͡ʒi/, thicken /ˈθɪkən/
“sh”와 “zh” 소리: obstruction /əbˈstɹʌk.ʃən/, potentially /pəˈtɛnʃ(ə)li/, occasionally /əˈkeɪʒənəli/, reduction /ɹɪˈdʌk.ʃən/, partially /ˈpɑɹʃəli/
긴 단어 — 강세 위치에 주의: potentially /pəˈtɛnʃ(ə)li/, electrical /ɪˈlɛktɹɪkəl/, occasionally /əˈkeɪʒənəli/, definitive /dɪˈfɪn.ɪ.tɪv/, accelerate /ɪkˈsɛl.əˌɹeɪt/

한국어 화자가 어려워하는 소리:

/f/ — ㅍ(/p/)으로 바꾸지 말고 윗니를 아랫입술에 대기: finger /ˈfɪŋɡɚ/, helpful /ˈhɛlp.fl̩/, definitive /dɪˈfɪn.ɪ.tɪv/, clarification /ˌklæɹɪfɪˈkeɪʃən/, hypertrophic /hʌɪpəˈtɹɒfɪk/
/v/ — ㅂ(/b/)과 구별하기: valve /ˈvælv/, vast /væst/, relative /ˈɹɛl.ə.tɪv/, involve /ɪnˈvɑlv/, vessel /ˈvɛsəl/
/z/ — ㅈ이 아니라 성대를 울리는 /s/: hose /hoʊz/, whereas /(h)wɛɹˈæz/, specialize /ˈspɛʃəˌlaɪz/

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자신의 목소리를 녹음해 원본과 비교하고, echo, valve, muscle 같은 단어에 특히 주의합니다.

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쉐도잉 연습: Hypertrophic Cardiomyopathy - Patient’s Guide for Better Understanding - 영상으로 영어 말하기 배우기

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