Prática de Shadowing: Hypertrophic Cardiomyopathy Made Easy | (Includes Hypertrophic Obstructive Cardiomyopathy & SAM) - Aprenda a falar inglês com vídeo
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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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Vocabulário e dicas de fala para esta lição
Esta aula de conversação usa o vídeo “Hypertrophic Cardiomyopathy Made Easy”. As palavras que mais se repetem: ventricular, patients, cardiomyopathy, obstruction, hypertrophic. Este vídeo tem 76 frases e 1004 palavras para praticar shadowing. A fala dura 8:40. O falante mantém um ritmo estável de cerca de 116 palavras por minuto, confortável para o shadowing. Apenas 67% das palavras estão entre as 3.000 mais comuns do inglês, por isso o vocabulário é exigente.
Vocabulário principal deste vídeo
15 palavras do vídeo que vale a pena aprender, com pronúncia e significado:
| Palavra | Pronúncia | Significado |
|---|---|---|
| obstruction substantivo | /əbˈstɹʌk.ʃən/ | obstrução |
| tract substantivo | /tɹækt/ | extensão |
| cardiac adjetivo | /ˈkɑɹdiˌæk/ | cardíaco |
| sudden adjetivo | /ˈsʌd.ən/ | repentino, súbito |
| beta substantivo | /ˈbeɪtə/ | beta |
| gene substantivo | /d͡ʒiːn/ | gene |
| genetic adjetivo | /d͡ʒəˈnɛt.ɪk/ | genético |
| tissue substantivo | /ˈtɪʃ.(j)u/ | tecido |
| distinguish verbo | /dɪˈstɪŋ.ɡwɪʃ/ | distinguir |
| anterior adjetivo | /ænˈtɪɹ.i.ɚ/ | anterior |
| thick adjetivo | /θɪk/ | espesso, grosso |
| muscle substantivo | /ˈmʌs.əl/ | músculo |
| commonly advérbio | /ˈkɑmənli/ | comumente |
| contribute verbo | /kənˈtɹɪb.jut/ | contribuir |
| define verbo | /dɪˈfaɪn/ | definir |
Gramática neste vídeo
As estruturas que o falante mais usa, com as palavras exatas do vídeo:
| Estrutura | No vídeo |
|---|---|
| Voz passiva be + particípio passado — o foco está no que acontece, não em quem faz | are equally affected · can be affected · is inherited |
| Orações relativas who / which + oração — informação extra sobre uma pessoa ou coisa | SAM, which is · orthopnea, which is · dyspnea, which is |
| Present perfect have/has + particípio passado — uma ação passada que ainda importa agora | have been identified · have developed |
Pronúncia para ficar de olho
- Os sons de “th”: thick /θɪk/, athlete /ˈæθ.liːt/, thin /ˈθɪn/, width /ˈwɪtθ/, pathway /ˈpæθˌweɪ/
- Os sons de “sh” e “zh”: obstruction /əbˈstɹʌk.ʃən/, tissue /ˈtɪʃ.(j)u/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, mutation /mjuˈteɪʃən/, reduction /ɹɪˈdʌk.ʃən/
- Palavras longas — acerte a sílaba tônica: anterior /ænˈtɪɹ.i.ɚ/, mechanism /ˈmɛk.ə.nɪ.zəm/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, primarily /ˈpɹaɪ.mə.ɹə.li/, efficiency /ɪˈfɪʃ.ən.si/
Sons difíceis para falantes de português:
- Consoante final — sem acrescentar um “i” depois: tract /tɹækt/, cardiac /ˈkɑɹdiˌæk/, genetic /d͡ʒəˈnɛt.ɪk/, thick /θɪk/, contribute /kənˈtɹɪb.jut/
- /l/ final — a língua toca o céu da boca, não vira “u”: muscle /ˈmʌs.əl/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, reveal /ɹɪˈviːl/, peripheral /pəˈɹɪf(ə)ɹ(ə)l/, ventricle /ˈvɛn.tɹɪk.əl/
- /h/ — um sopro suave, diferente do “r”: whereas /(h)wɛɹˈæz/, inherit /ɪnˈhɛɹɪt/, hypertrophic /hʌɪpəˈtɹɒfɪk/, hypertrophy /haɪˈpɜɹ.tɹə.fi/, hypovolemia /haɪpoʊvəˈliːmiə/
Como praticar com este vídeo
- Ouça o vídeo inteiro uma vez sem falar e anote as palavras que você não conhece.
- Faça shadowing frase por frase na velocidade normal, repetindo cada uma até o seu ritmo ficar igual ao do falante.
- Grave a sua voz e compare com o original, prestando atenção a palavras como obstruction, tract, cardiac.
O que é a Técnica de Shadowing?
Shadowing é uma técnica de aprendizado de idiomas com base científica, originalmente desenvolvida para o treinamento de intérpretes profissionais. O método é simples, mas poderoso: você ouve áudio em inglês nativo e repete imediatamente em voz alta — como uma sombra seguindo o falante com 1-2 segundos de atraso. Pesquisas mostram melhora significativa na precisão da pronúncia, entonação, ritmo, sons conectados, compreensão auditiva e fluência na fala.