Shadowing Practice: Hypertrophic Cardiomyopathy Made Easy | (Includes Hypertrophic Obstructive Cardiomyopathy & SAM) - Learn English Speaking with Video
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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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Woordenschat en spreektips bij deze les
Deze spreekles is gebaseerd op de video “Hypertrophic Cardiomyopathy Made Easy”. Deze woorden komen het vaakst terug: ventricular, patients, cardiomyopathy, obstruction, hypertrophic. Deze video bevat 76 zinnen en 1004 woorden om na te spreken. Het gesproken deel duurt 8:40. De spreker praat in een gelijkmatig tempo van ongeveer 116 woorden per minuut, prettig om te shadowen. Slechts 67% van de woorden hoort bij de 3.000 meest gebruikte Engelse woorden, dus de woordenschat is pittig.
Belangrijke woorden in deze video
15 woorden uit de video die het leren waard zijn, met uitspraak en betekenis:
| Woord | Uitspraak | Betekenis |
|---|---|---|
| obstruction zelfstandig naamwoord | /əbˈstɹʌk.ʃən/ | belemmering, obstructie |
| tract zelfstandig naamwoord | /tɹækt/ | gebied |
| sudden bijvoeglijk naamwoord | /ˈsʌd.ən/ | plotseling, plotselinge |
| beta zelfstandig naamwoord | /ˈbeɪtə/ | bèta |
| gene zelfstandig naamwoord | /d͡ʒiːn/ | gen |
| genetic bijvoeglijk naamwoord | /d͡ʒəˈnɛt.ɪk/ | genetisch |
| tissue zelfstandig naamwoord | /ˈtɪʃ.(j)u/ | weefsel |
| distinguish werkwoord | /dɪˈstɪŋ.ɡwɪʃ/ | onderscheiden |
| thick bijvoeglijk naamwoord | /θɪk/ | dik, dikke |
| muscle zelfstandig naamwoord | /ˈmʌs.əl/ | spier |
| contribute werkwoord | /kənˈtɹɪb.jut/ | bijdragen |
| define werkwoord | /dɪˈfaɪn/ | bepalen, determineren |
| dynamic bijvoeglijk naamwoord | /daɪˈnæm.ɪk/ | dynamisch, veranderlijk |
| mechanism zelfstandig naamwoord | /ˈmɛk.ə.nɪ.zəm/ | mechanisme |
| oxygen zelfstandig naamwoord | /ˈɑksɪd͡ʒən/ | zuurstof |
Grammatica in deze video
De structuren die de spreker het meest gebruikt, met de exacte woorden uit de video:
| Structuur | In de video |
|---|---|
| Lijdende vorm be + voltooid deelwoord — het gaat om wat er gebeurt, niet om wie het doet | are equally affected · can be affected · is inherited |
| Betrekkelijke bijzinnen who / which + zin — extra informatie over een persoon of ding | SAM, which is · orthopnea, which is · dyspnea, which is |
| Present perfect have/has + voltooid deelwoord — iets uit het verleden dat nu nog telt | have been identified · have developed |
Uitspraak om op te letten
- De “th”-klanken: thick /θɪk/, athlete /ˈæθ.liːt/, thin /ˈθɪn/, width /ˈwɪtθ/, pathway /ˈpæθˌweɪ/
- De klanken “sh” en “zh”: obstruction /əbˈstɹʌk.ʃən/, tissue /ˈtɪʃ.(j)u/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, mutation /mjuˈteɪʃən/, reduction /ɹɪˈdʌk.ʃən/
- Lange woorden — let op de klemtoon: anterior /ænˈtɪɹ.i.ɚ/, mechanism /ˈmɛk.ə.nɪ.zəm/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, primarily /ˈpɹaɪ.mə.ɹə.li/, efficiency /ɪˈfɪʃ.ən.si/
Klanken die Nederlandstaligen lastig vinden:
- Stemhebbende eindmedeklinker — /b/, /d/, /g/, /z/, /v/ niet verscherpen: valve /ˈvælv/, whereas /(h)wɛɹˈæz/, preserve /pɹəˈzɝv/, voltage /ˈvəʊltɪd͡ʒ/, bind /ˈbaɪ̯nd/
- /æ/ — opener dan de Nederlandse “e”: tract /tɹækt/, cardiac /ˈkɑɹdiˌæk/, anterior /ænˈtɪɹ.i.ɚ/, dynamic /daɪˈnæm.ɪk/, valve /ˈvælv/
- /g/ — een harde plofklank, geen Nederlandse “g”: distinguish /dɪˈstɪŋ.ɡwɪʃ/, diagnosis /daɪəɡˈnəʊsɪs/, exam /ɪɡˈzæm/, exacerbate /ɪɡˈzæsɚˌbeɪt/, exertion /ɪɡˈzɝʃən/
Zo oefen je met deze video
- Luister de hele video één keer zonder te spreken en noteer de woorden die je niet kent.
- Spreek zin voor zin na op normale snelheid en herhaal elke zin tot je ritme gelijk is aan dat van de spreker.
- Neem jezelf op en vergelijk met het origineel; let daarbij op woorden als obstruction, tract, sudden.
Wat is de Shadowing-techniek?
Shadowing is een wetenschappelijk onderbouwde taalleermethode die oorspronkelijk is ontwikkeld voor professionele tolkentraining en gepopulariseerd door polyglot Dr. Alexander Arguelles. De methode is eenvoudig maar krachtig: je luistert naar native Engelse audio en herhaalt het onmiddellijk hardop — als een schaduw die de spreker volgt met slechts 1–2 seconden vertraging. In tegenstelling tot passief luisteren of grammaticadrills, dwingt shadowing je hersenen en mondspieren om echte spraakpatronen tegelijkertijd te verwerken en te reproduceren. Onderzoek toont aan dat het de uitspraaknauwkeurigheid, intonatie, ritme, verbonden spraak, luisterbegrip en spreekvaardigheid aanzienlijk verbetert — waardoor het een van de meest effectieve methoden is voor IELTS Speaking-voorbereiding en echte Engelse communicatie.