Практика Shadowing: Left Sided Heart Failure - Изучайте разговорный английский по видео

Hi everyone, Dr. Mike here.

In this video, we're taking a look at left side heart failure.

Let's jump straight into it.

Alright, to begin, let's orientate ourselves.

I've separated the left and right hand side of the heart up here

so it makes more functional sense because each side has their own circulation.

So because we're focusing on the left hand side, let's look at this.

The left hand side of the heart, which I've got is the left atrium here and the left ventricle here, it receives blood from the lungs.

So here I've got an alveolus, which is a representation of the lungs.

And here's the post capillary aspect of the pulmonary circulation.

So it receives oxygenated blood from the lungs going into the left atrium through the mitral

or bicuspid valve into the left ventricle.

It contracts with all that muscle.

Remember left hand side of the heart is three to four times thicker than the right hand side

because it has to pump blood to the entire body.

So it contracts forcefully, pushes blood out through what's called the aortic semilunar valve into the aorta

and then sends this blood out through the systemic circulation to all the tissues of the body.

So that is the circulation of the left hand side of the heart, receives blood from the lungs, sends blood to the body

so this is really important to understand heart failure behind the

left -hand side of the heart is the pulmonary circulation in

front of the left -hand side of the heart is the systemic circulation

because when we have heart failure

so let's define it an inability of the heart to effectively

work as a pump its job here to effectively work as a pump is to ensure

that there's no congestion behind so it receives the blood it needs and that the blood that enters

leaves appropriately to meet the metabolic demands of the body that's how it needs to work as a pump

if any of those things don't happen so congestion occurs behind or inadequate outflow in front

that's heart failure now let's look at left side heart failure

and some of the causes so that it makes sense anything

that can affect that is going to cause left side heart failure

so let's focus on our first one first one that we want to focus on here is arterial hypertension arterial

hypertension so hypertension is high blood pressure

but it's referring to chronic right you know high blood pressure over time

so effectively you don't just have one vessel here obviously you've got all of these multitude of arteries

and arterioles and if you've got a degree of occlusion

or blockage so let's say there's something that's narrowing this vessel like an atherosclerotic plaque for example

and this atherosclerotic plaque you know it can start forming clots

and then clots can narrow the hollow lumen of the vessel right

but what happens is if that's narrowed or the blood vessels are constricting

when they shouldn't blood tends to back up now this is

arterial hypertension right the left hand side of the heart it's going to receive blood normally,

it's going to fill normally and then the myocardium of the left ventricular wall will contract to eject that blood out.

But look it's facing resistance, now it's facing a pressure resistance so there's pressure to overcome.

Now in order to overcome this pressure, because think if it contracted as normal it would hit this pressure

and some blood would fall back in so not enough blood would leave, that would be heart failure.

We don't want that.

So the left myocardium, the left ventricular myocardium remodels itself in response to this pressure overload.

This is actually called afterload, increased afterload.

So this is really important, particularly when it comes to understanding heart failure,

is that if you have increased pressure or pressure overload that you need to overcome in the heart.

The heart will compensate by changing structurally.

So what the heart does is it undergoes what's called concentric hypertrophy.

So hypertrophy is when the heart gets, or the tissue gets larger.

Here we're talking about cardiac tissue, so the myocardium, it gets larger.

So we need to add some contractile subunits, sarcomeres, to get larger.

So the concentric is telling you in what way it's getting larger

so again if it's in response to having to overcome a pressure

or pressure overload it gets bigger through concentric hypertrophy

which means this the heart will let's say the hollow inside of the heart looks like this,

and there's the myocardium, its response is it will get bigger like this.

Because what it's done is if that is a sarcomere and that's a sarcomere and that's a sarcomere,

it will add sarcomeres in parallel, making it thicker.

So what you get is a thicker heart muscle but what

that means is the hollow inside of the heart reduces and

so you go okay in the early stages of responding to

this pressure overload this concentric hypertrophy works in some degree

because just like going to the gym you're experiencing a resistance the muscle needs to get bigger

and stronger to overcome that resistance right so you get concentric hypertrophy

but over time it's consistently having to overcome this increased pressure

and it starts to encroach on the hollow inside of the ventricle which means that less blood is entering.

So what we get is decreased filling.

Less blood is entering but because I've also got

so much muscle here it's hard for it to relax and it remains stiff.

So you get decreased filling and increased stiffness and these things together result in decreased output and what we get?

Left -sided heart failure.

So that is due to arterial hypertension.

Now there's another cause, there's a couple more for left -sided heart failure.

Another cause here is what we call ischemic heart disease.

Ischemic heart disease.

Sometimes it's referred to as coronary artery disease.

So what we're saying here is, instead of the narrowing happening here in the systemic vessels,

the systemic arteries, the narrowing happens to the blood vessels that are feeding the heart muscle itself, the coronary supply.

So here's a coronary artery here and the blood will enter

and diffuse across to feed this nice thick myocardium but

if it is blocked due to an atherosclerotic plaque

and then maybe a clot forms and travels through and blocks it

so let's say we've blocked a fair chunk of this

that muscle doesn't get fed

and the muscle dies you've probably heard this before it's called a heart attack right a myocardial infarction So an MI,

a myocardial infarct, right?

An MI.

And so that means the heart muscle begins to die off.

And if that heart muscle begins to die off, it can no longer contract, right?

And if it doesn't contract, it can't eject enough blood.

It doesn't work appropriately as a pump.

It's not meeting the metabolic demands of the body, left side heart failure.

But in addition, what can happen is that over time, the heart tries to remodel and compensate.

Now, we spoke about a form of remodeling in response to overcoming pressure, but is there a pressure here to overcome?

No, there's not, right?

100

Because this isn't here.

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We don't have this arterial hypertension.

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All we have is the muscles dying off.

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So what do we do?

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How can we overcome this?

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Think about it.

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If that's dying off and it can't contract properly, right?

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The filling is fine the pressure here is fine, but because it can't contract hard enough, it doesn't eject enough.

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So the filling is normal, but the ejection is low.

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So you get a volume overload issue.

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Remember here, it was a pressure overload issue.

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Now you've got a volume overload issue.

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And the heart remodels in a different way in response to volume overload.

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So in response to volume overload, we get eccentric hypertrophy.

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Eccentric hypertrophy.

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So remember I said here we're adding sarcomeres in series.

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Oh, sorry, in parallel.

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I've given it away.

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We add sarcomeres, however you spell parallel.

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I can tell you all about biology.

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I can't spell.

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We're adding it in series in this instance.

122

So again, the heart starts like this, the left ventricle starts like this as a normal size, but then it goes like this.

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It gets bigger because it's hypertrophy, but you get a dilated hypertrophy,

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what we call a dilated cardiomyopathy.

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Because what we've done is it's gotten bigger, but it's added sarcomeres.

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So there's the sarcomeres that existed.

127

We've added them in series next to them to make it bigger but not thicker

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right so you get this dilated effect

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so this is what can happen over time in response to volume very important

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and so that what ends up happening is it just keeps filling with blood

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and it can't contract adequately to meet the requirements for output all right

132

so that's the second i didn't even finish writing ischemic that's how bad i am at spelling all right

133

so another one we've got arterial hypertension we've got ischemic heart disease

134

and we need to talk about the next one which is valvular disease.

135

All right.

136

So what were the valves I spoke about in the left -hand side of the heart, right?

137

We've got this valve here, which is called the mitral valve, also known as the bicuspid valve.

138

And this valve here, which is called the aortic valve, sometimes called the aortic semilunar valve.

139

All right.

140

here's what can happen in this instance let's start with aortic valve if you have an aortic

141

valve stenosis or a stenotic

142

so stenosis means stiffening hardening uh stiffened aortic valve it's not going to open

143

and close properly right so it stays stiffly shut

144

so it's hard for the blood to get ejected now think about

145

that if it's hard for the blood to get ejected And what was a scenario we spoke about where that happened?

146

Arterial hypertension, remember?

147

In arterial hypertension, it was trying to overcome the systemic blood pressure that was going back,

148

but it's no different really to having to overcome a stiffened valve.

149

So the same thing happens as here, is that because you're trying to overcome that,

150

it's a pressure overload issue and the heart remodels to get thicker.

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So it gets thicker but again this thickness gets so thick

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that it narrows the inside of the ventricle

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and it can't maintain itself over time and so you can then get left side heart failure.

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So that happens as well in the aortic valve stenosis very similar to what's happening here.

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You can have not a mitral valve stenosis but what's called mitral regurgitation

156

so that means it's sort of the opposite of the stiffness it's a bit floppy right

157

so if it's a floppy valve it's not going to close properly it might sort of flat back

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and that means

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when this ventricle contracts not all the blood gets ejected some jumps back up into the left atrium

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which then means think about this which then That means when it relaxes, that blood falls back down and overfills the heart because you got the normal blood entering,

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not the normal blood leaving.

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Some goes up here, so it's adding to the next filling event.

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What's that?

164

It's a volume overload issue.

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So what happens in martial valve regurgitation is you get an eccentric hypertrophy and a dilation of that ventricle.

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See, it's all making sense now, I hope.

167

There's another set of causes here, and this is what we call dilated cardiomyopathies.

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Dilated cardiomyopathies.

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So cardio heart myopathies are muscle pathologies, muscle changes, and it's dilated.

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So it's this that's happening.

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But it's due to non -overload issues or non -overload causes.

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What do I mean by that?

173

Well, these are the overload causes, right?

174

So the fourth set of causes, the dilated cardiomyopathies, that happens,

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but it's not in response to increase pressures that it needs to overcome

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and it's not in response to increased volume effects that it needs to overcome.

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It's due to other strange things that are happening in the body and they all have their own specific mechanisms.

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So what can cause this?

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Well, it can be alcohol abuse.

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It can be cocaine.

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It can be some chemotherapies.

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It can do it.

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Genetics.

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right, so it can be inherited, diabetes, mellitus, obesity, right, so all age,

185

so all these things in their own way can actually result in this dilated cardiomyopathy,

186

but it's not in response to overcoming pressure changes or increased volume, all right.

187

So these are the major causes for left side heart failure.

188

Let's talk a bit about the symptoms, all right, So how does it present should be pretty easy because we know what's happening

189

backwards and forwards and what you can have is backwards the symptoms due to backwards failure

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so due to congestion and symptoms due to forward failure

191

so reduced cardiac output i think that's probably worth writing down what do you think

192

so let's say you can have backward failure backward failure and that's due to congestion

193

and you can have forward failure and that's due to reduced cardiac output so reduced amount of blood leaving the heart.

194

So let's think about this first let's start with backwards failure

195

if you've got blood not ejecting

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and it backs up backs up backs up into the pulmonary circulation here think about

197

that this is coming from the lungs this blood backs up into the pulmonary And you get pulmonary congestion.

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So what you can get for backwards failure is pulmonary congestion,

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which means the blood is just backing up into the pulmonary circulation.

200

But then it gets into the capillary bed and fluid will leak out into the alveoli.

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right and that fluid accumulation is pulmonary edema now if you've got pulmonary edema

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what do you think that means can you exchange gases well no

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because there's a thickened respiratory membrane here so it's harder for oxygen

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and carbon dioxide to get transported mainly the oxygen

205

because carbon dioxide diffuses relatively well in fluid better without it but relatively well.

206

So what are you going to get as your symptoms here?

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It's going to be dyspnea, right?

208

So that's a shortness of breath or an alteration in breathing and orthopnea.

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So this means when you lay down you get this shortness of breath

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and that's because of the way that the fluid sits in the lungs reducing its ability for gas transport to occur.

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So that's the backwards failure effects of left side heart failure.

212

What are the forward failure effects?

213

So let's have a look at the forward failure effects.

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Well, because you've got a reduction in blood flow going forward, right?

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You've got a reduction in cardiac output.

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You end up getting less oxygen and nutrients to the tissues, including muscle.

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So what you end up getting is what?

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Fatigue, right?

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Exhaustion, weakness.

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So fatigue, weakness.

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And it might be exercise or even non -exercise induced depending on the degree, right?

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Exercise or non -exercise induced.

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Again, can't spell induced.

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So that is a set of symptoms that can happen due to the forward failure.

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So left side heart failure, the respiratory issues, pulmonary congestion, pulmonary edema, shortness of breath, orthopnea.

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When it comes to the reduced ability to give oxygen and nutrients to the body, fatigue and weakness because you're not getting the oxygen and nutrients you need, particularly to the muscle.

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So you might exercise and be even more exhausted and weak, fatigued and so forth.

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So look, this is Left Side Heart Failure.

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I'm Dr. Mike and I hope that helps.

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Thank you.

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72 предложений

Лексика и советы по произношению к этому уроку

Этот урок разговорной практики построен на видео «Left Sided Heart Failure». Чаще всего повторяются слова: blood, failure, pressure, valve, overload. В этом видео 230 предложений и 2644 слов для шедоуинга. Речь длится 18:57. Говорящий держит ровный темп — около 140 слов в минуту, удобный для шедоуинга. Только 79% 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
valve существительное	/ˈvælv/	ве́нтиль, кла́пан
overcome глагол	/ˌəʊ.vəˈkʌm/	преодолева́ть, преодоле́ть
muscle существительное	/ˈmʌs.əl/	мы́шца, му́скул
thick прилагательное	/θɪk/	то́лстый
circulation существительное	/ˌsɝkjʊˈleɪʃən/	кругово́е движе́ние, круговоро́т
backward прилагательное	/ˈbækwɚd/	наза́д, обра́тно
congestion существительное	/kənˈd͡ʒɛs.t͡ʃən/	скопле́ние
narrow прилагательное	/ˈnæɹəʊ/	у́зкий, те́сный
vessel существительное	/ˈvɛsəl/	су́дно, кора́бль
lung существительное	/ˈlʌŋ/	лёгкое
output существительное	/ˈaʊtpʊt/	произво́дство, проду́кция
pump существительное	/pʌmp/	насо́с, по́мпа
oxygen существительное	/ˈɑksɪd͡ʒən/	кислоро́д
systemic прилагательное	/sɪˈstɛm.ɪk/	систе́мный
symptom существительное	/ˈsɪm(p)təm/	симпто́м, при́знак

Фразовые глаголы, которые вы услышите

Слово	Значение
back up глагол	дава́ть за́дний ход
end up глагол	зака́нчиваться, зако́нчиться
die off глагол	вымира́ть, вы́мереть
go back глагол	возвраща́ться, возврати́ться
go up глагол	поднима́ться, подня́ться
lie down глагол	ложи́ться, лечь
write down глагол	запи́сывать, записа́ть

Фразы, которые стоит повторять

Короткие законченные фразы из видео, которые пригодятся в повседневном разговоре:

Let's jump straight into it.
Alright, to begin, let's orientate ourselves.
We don't have this arterial hypertension.
How can we overcome this?
What do I mean by that?

Грамматика в этом видео

Конструкции, которые говорящий использует чаще всего, с точными словами из видео:

Конструкция	В видео
Present Perfect have/has + причастие прошедшего времени — прошлое действие, важное сейчас	I've separated · have increased · we've blocked
Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает	is actually called · is decreased · is blocked
Придаточные определительные who / which + предложение — уточнение о человеке или предмете	alveolus, which is · ventricle which means · one which is

Произношение, на которое стоит обратить внимание

Говорящий использует 47 сокращённых и редуцированных форм, например you've, can't, we're. Произносите их коротко, так, как слышите.

Звуки «th»: thick /θɪk/, breathe /bɹiːð/, thickness /ˈθɪknəs/, pathology /pəˈθɒləd͡ʒi/, chemotherapy /ˌkiːməʊˈθɛɹəpi/
Звуки «sh» и «zh»: circulation /ˌsɝkjʊˈleɪʃən/, tissue /ˈtɪʃ.(j)u/, reduction /ɹɪˈdʌk.ʃən/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, martial /ˈmɑɹʃəl/
Длинные слова — следите за ударением: circulation /ˌsɝkjʊˈleɪʃən/, respiratory /ɹɪˈspɪ.ɹət.ə.ɹi/, metabolic /mɛtəˈbɒlɪk/, representation /ˌɹɛp.ɹə.zɛnˈteɪ.ʃən/, mechanism /ˈmɛk.ə.nɪ.zəm/

Звуки, трудные для русскоязычных:

/w/ — губы округлены, это не /v/: backward /ˈbækwɚd/, weakness /ˈwik.nɪs/, inadequate /ɪnˈædəkwɪt/
/h/ — лёгкий выдох, а не русское «х»: hollow /ˈhɑloʊ/, harden /ˈhɑɹdn̩/, inherit /ɪnˈhɛɹɪt/, hypertrophy /haɪˈpɜɹ.tɹə.fi/, hypertension /ˌhaɪ.pɚˈtɛn.ʃən/
Звонкие согласные в конце слова — не оглушайте их: valve /ˈvælv/, backward /ˈbækwɚd/, fluid /ˈflu.ɪd/, fatigue /fəˈtiːɡ/, dioxide /daɪˈɑksaɪd/

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 valve, overcome, muscle.

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.

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Практика Shadowing: Left Sided Heart Failure - Изучайте разговорный английский по видео

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