Практика Shadowing: Hypertrophic Cardiomyopathy Made Easy | (Includes Hypertrophic Obstructive Cardiomyopathy & SAM) - Изучайте разговорный английский по видео
Выберите режим практики
Каждый режим открывает полноэкранную комнату практики.
76 предложений
Если предложения слишком короткие или длинные, нажмите Edit, чтобы их изменить.
1
Hypertrophic cardiomyopathy is a genetic disorder of the cardiac muscle tissue,
2
characterised by abnormal thickening of the cardiac muscle without any clear cause.
3
It is the second most common cardiomyopathy with a prevalence of around 1 in 500,
4
and it is the most frequent cause of sudden cardiac death in young patients.
5
Overall, males and females are equally affected.
6
However, females are more likely to present at an older age with more significant heart failure.
7
All ethnicities can be affected.
8
However, a form of hypertrophic cardiomyopathy affecting the apex is significantly more prevalent in Asian people.
9
It is inherited in an autosomal dominant fashion and the genetic abnormalities occur primarily in genes that code for sarcomere proteins.
10
40 % are in the gene coding for beta myosin heavy chains on chromosome 14
11
and 40 % in the cardiac myosin binding protein C gene.
12
In total over 150 mutations have been identified to be involved with this condition.
13
These mutations lead to altered translation efficiency,
14
followed by changes in the signaling pathways and ultimately leading to changes in the histology,
15
including myocyte hypertrophy and fibrosis.
16
This leads to parts of the heart becoming thicker than usual.
17
The most commonly affected areas are the interventricular septum and the left ventricle, although any part can be affected.
18
The left ventricular outflow tract is particularly susceptible to encroachment from the thickening of the septum,
19
leading to obstruction of the left ventricular outflow tract.
20
This is known as hypertrophic obstructive cardiomyopathy and is seen in around 25 % of those with hypertrophic cardiomyopathy.
21
A unique feature of this obstruction is that it is dynamic, meaning it is not fixed.
22
The left ventricular outflow tract is encroached in these patients due to the increased size of the interventricular septum,
23
particularly evident during systole.
24
Another feature that contributes to the obstruction is systolic anterior motion,
25
or SAM, which is the anterior movement of the mitral valve during systole leading to worsening of the outflow tract obstruction.
26
This is best seen on a parasternal view on echocardiography.
27
Although it is not specific for hypertrophic cardiomyopathy it is more commonly seen.
28
Several other factors can also contribute to the dynamic nature of the obstruction such as contractility for example during exercise
29
which causes a more forceful contraction and a greater degree of obstruction.
30
A reduction in preload can also worsen the left ventricular outflow tract obstruction,
31
where preload is the volume in the ventricle at the end of diastole.
32
Examples that reduce preload include hypovolemia, vasodilation, such as after administration of nitrates,
33
and tachycardia that reduces preload due to shorter diastolic filling time.
34
The smaller left ventricular volume facilitates the systolic anterior motion of the mitral valve.
35
Over time, as the fibrosis increases, the ventricle becomes stiffer and less compliant, leading to diastolic heart failure,
36
also known as heart failure with a preserved ejection fraction.
37
A marker of this is increased pressure in the left atrium, which increases the risk of arrhythmias like atrial fibrillation.
38
In long -standing cases, the interstitial fibrosis and the left ventricular outflow tract obstruction lead to thinning of the left ventricle,
39
eventually producing a systolic failure.
40
Often, patients are asymptomatic.
41
When symptoms are present, they are usually the result of four main mechanisms.
42
First is diastolic dysfunction, leading to increased left atrial pressure and pulmonary vein pressure.
43
This is exacerbated in exertion, giving exertional dyspnea.
44
It can also manifest as orthopnea, which is breathlessness when lying flat,
45
and paroxysmal nocturnal dyspnea, which is sudden onset shorness of breath during sleeping.
46
Peripheral edema is another possible or finding.
47
Secondly, we have obstruction of the left ventricular outflow tract which can also cause dyspnea but can cause syncope,
48
especially during exercise.
49
Next we have arrhythmias which can include atrial fibrillation which is seen in around 25 % of patients,
50
ventricular tachycardia and ventricular fibrillation.
51
These can lead to palpitations, lightheadedness or syncope, shortness of breath and chest pain.
52
We also mentioned earlier
53
that hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young patients and this is largely due to arrhythmias.
54
This brings us to the fourth mechanism, an imbalance between the myocardial oxygen supply and the demand.
55
Oxygen supply is reduced because the flow of blood through the hypertrophy tissue is lower,
56
while there is an increase in the demand due to the thicker myocardial tissue.
57
This can cause chest pain that may have typical features of angina.
58
For the diagnosis, a physical exam will often reveal a mid -systolic murmur best heard at the left sternal border.
59
An ECG may show left ventricular hypertrophy voltages shown by large amplitude QRS complexes
60
and possibly Q waves that are distinguished from previous infarctions by having a width of less than 40 milliseconds.
61
The diagnosis of hypertrophic cardiomyopathy is based on abnormal thickening.
62
This is defined as a thickness of the interventricular septum of 15 millimeters or greater,
63
or 13 millimeters with a family history or genetic background.
64
It can be difficult to distinguish between hypertrophic cardiomyopathy and physiological hypertrophy seen in athletes.
65
A possible distinguishing feature is that the volume of the cavity in physiological hypertrophy is not reduced,
66
whereas the volume is reduced in hypertrophic cardiomyopathy.
67
An asymmetrical distribution of the hypertrophy also favours hypertrophic cardiomyopathy.
68
The primary therapy is the use of beta blockers as they serve to reduce contractility and to increase diastolic filling time.
69
Calcium channel blockers are options in patients not responsive to beta blockers or in patients in whom beta blockers are contraindicated.
70
In patients who have developed heart failure, diuretics may be useful, however, must be used with care in order to avoid hypovolemia,
71
which as we said, can precipitate the left ventricular outflow tract obstruction.
72
Higher risk patients, such as athletes, patients with previous ventricular fibrillation or tachycardia,
73
symptomatic patients, patients with significant thickening of the septum or ventricular wall, typically defined above 30 mm,
74
or a family history of sudden cardiac death should be considered for an implantable cardioverter defibrillator, known as an ICD.
75
Septal myomectomy or ablation can be considered in patients with severe obstruction that despite pharmacotherapy are still symptomatic.
76
Thank you.
Скачать приложение
Всё для свободной речи
ИИ-оценка произношенияОценка каждой фразы
Практика IPAОсвойте каждый звук
СловарьСоберите свой словарный запас
Игра со словамиУчитесь играя
Тот же канал
FOR YOU
Рекомендуемое видео
C16
83 предложений
Hypertrophic Cardiomyopathy - Patient’s Guide for Better Understanding
Daily ConversationUniversity Students
C12
39 предложений
Immunology of the rheumatoid joint
Daily ConversationUniversity Students
C11
164 предложений
Genetics of Hypertrophic Cardiomyopathy
Daily ConversationUniversity Students
C11
182 предложений
Thyroid Gland | Anatomy and Embryology | Lobes and Blood supply | Development of the Thyroid Gland
Daily ConversationUniversity Students
C11
124 предложений
Ischemic Stroke - causes, symptoms, diagnosis, treatment, pathology
Daily ConversationUniversity Students
C11
8 предложений
Clinical Cuts - Chronic obstructive pulmonary disease (COPD)
Daily ConversationUniversity Students
C1192 предложений
Other Corneal Disorders - CRASH! Medical Review Series
Daily ConversationUniversity Students
C11
27 предложений
What is AL amyloidosis?
Daily ConversationUniversity Students
C13
14 предложений
Huntington's Disease Overview with Francisco Cardoso
Daily ConversationUniversity Students
C11
230 предложений
Left Sided Heart Failure
Daily ConversationUniversity Students
C1310
17 предложений
How exercise benefits your body
Daily ConversationUniversity StudentsWorking Adults
Лексика и советы по произношению к этому уроку
Этот урок разговорной практики построен на видео «Hypertrophic Cardiomyopathy Made Easy». Чаще всего повторяются слова: ventricular, patients, cardiomyopathy, obstruction, hypertrophic. В этом видео 76 предложений и 1004 слов для шедоуинга. Речь длится 8:40. Говорящий держит ровный темп — около 116 слов в минуту, удобный для шедоуинга. Только 67% слов входят в 3000 самых частых слов английского языка, поэтому лексика сложная.
Ключевая лексика этого видео
15 слов из видео, которые стоит выучить, с произношением и значением:
| Слово | Произношение | Значение |
|---|---|---|
| obstruction существительное | /əbˈstɹʌk.ʃən/ | препя́тствие, обстру́кция |
| tract существительное | /tɹækt/ | уча́сток |
| cardiac прилагательное | /ˈkɑɹdiˌæk/ | серде́чный, кардиа́льный |
| sudden прилагательное | /ˈsʌd.ən/ | неожи́данный, внеза́пный |
| beta существительное | /ˈbeɪtə/ | бе́та |
| gene существительное | /d͡ʒiːn/ | ген |
| genetic прилагательное | /d͡ʒəˈnɛt.ɪk/ | генети́ческий |
| tissue существительное | /ˈtɪʃ.(j)u/ | ткань |
| distinguish глагол | /dɪˈstɪŋ.ɡwɪʃ/ | различа́ть, различи́ть |
| anterior прилагательное | /ænˈtɪɹ.i.ɚ/ | передний |
| thick прилагательное | /θɪk/ | то́лстый |
| muscle существительное | /ˈmʌs.əl/ | мы́шца, му́скул |
| commonly наречие | /ˈkɑmənli/ | обы́чно, обыкнове́нно |
| contribute глагол | /kənˈtɹɪb.jut/ | де́лать поже́ртвования, де́лать взно́сы |
| define глагол | /dɪˈfaɪn/ | определя́ть, определи́ть |
Грамматика в этом видео
Конструкции, которые говорящий использует чаще всего, с точными словами из видео:
| Конструкция | В видео |
|---|---|
| Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает | are equally affected · can be affected · is inherited |
| Придаточные определительные who / which + предложение — уточнение о человеке или предмете | SAM, which is · orthopnea, which is · dyspnea, which is |
| Present Perfect have/has + причастие прошедшего времени — прошлое действие, важное сейчас | have been identified · have developed |
Произношение, на которое стоит обратить внимание
- Звуки «th»: thick /θɪk/, athlete /ˈæθ.liːt/, thin /ˈθɪn/, width /ˈwɪtθ/, pathway /ˈpæθˌweɪ/
- Звуки «sh» и «zh»: obstruction /əbˈstɹʌk.ʃən/, tissue /ˈtɪʃ.(j)u/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, mutation /mjuˈteɪʃən/, reduction /ɹɪˈdʌk.ʃən/
- Длинные слова — следите за ударением: anterior /ænˈtɪɹ.i.ɚ/, mechanism /ˈmɛk.ə.nɪ.zəm/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, primarily /ˈpɹaɪ.mə.ɹə.li/, efficiency /ɪˈfɪʃ.ən.si/
Звуки, трудные для русскоязычных:
- /w/ — губы округлены, это не /v/: distinguish /dɪˈstɪŋ.ɡwɪʃ/, whereas /(h)wɛɹˈæz/, equally /ˈiːkwəli/, frequent /ˈfɹiː.kwənt/, width /ˈwɪtθ/
- /h/ — лёгкий выдох, а не русское «х»: whereas /(h)wɛɹˈæz/, inherit /ɪnˈhɛɹɪt/, hypertrophic /hʌɪpəˈtɹɒfɪk/, hypertrophy /haɪˈpɜɹ.tɹə.fi/, hypovolemia /haɪpoʊvəˈliːmiə/
- Звонкие согласные в конце слова — не оглушайте их: valve /ˈvælv/, whereas /(h)wɛɹˈæz/, preserve /pɹəˈzɝv/, voltage /ˈvəʊltɪd͡ʒ/, bind /ˈbaɪ̯nd/
Как заниматься с этим видео
- Прослушайте всё видео один раз молча и выпишите незнакомые слова.
- Повторяйте предложение за предложением на обычной скорости, пока ваш ритм не совпадёт с ритмом говорящего.
- Запишите себя и сравните с оригиналом, обращая внимание на такие слова, как obstruction, tract, cardiac.
Что такое техника Shadowing?
Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.