跟读练习: Hypertrophic Cardiomyopathy Made Easy | (Includes Hypertrophic Obstructive Cardiomyopathy & SAM) - 通过视频学习英语口语
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76 句
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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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本课的词汇与口语要点
这节口语课以视频“Hypertrophic Cardiomyopathy Made Easy”为素材。 视频中反复出现的词有：ventricular, patients, cardiomyopathy, obstruction, hypertrophic。 这段视频共有 76 个句子、1004 个单词可供跟读。 讲话部分时长为 8:40。 说话人语速平稳，每分钟约 116 个词，很适合跟读。 只有 67% 的单词属于英语最常用的 3,000 词，词汇难度较高。
视频中的重点词汇
视频中 15 个值得学习的单词，附发音和释义：
| 单词 | 发音 | 释义 |
|---|---|---|
| sudden 形容词 | /ˈsʌd.ən/ | 突然, 急劇 /急剧 |
| beta 名词 | /ˈbeɪtə/ | 貝塔 /贝塔 |
| gene 名词 | /d͡ʒiːn/ | 基因 |
| tissue 名词 | /ˈtɪʃ.(j)u/ | 纸巾 |
| distinguish 动词 | /dɪˈstɪŋ.ɡwɪʃ/ | 區別 /区别, 辨別 /辨别 |
| anterior 形容词 | /ænˈtɪɹ.i.ɚ/ | 前部 |
| thick 形容词 | /θɪk/ | ху, 厚 |
| muscle 名词 | /ˈmʌs.əl/ | 肌肉, 筋肉 |
| commonly 副词 | /ˈkɑmənli/ | 通常 |
| contribute 动词 | /kənˈtɹɪb.jut/ | 貢獻 /贡献 |
| define 动词 | /dɪˈfaɪn/ | 界定 |
| mechanism 名词 | /ˈmɛk.ə.nɪ.zəm/ | 機械 /机械, 機構 /机构 |
| oxygen 名词 | /ˈɑksɪd͡ʒən/ | 氧 |
| diagnosis 名词 | /daɪəɡˈnəʊsɪs/ | 診斷 /诊断 |
| valve 名词 | /ˈvælv/ | 閥門 /阀门 |
视频中的语法
说话人最常用的结构，并附上视频中的原话：
| 结构 | 视频中的用法 |
|---|---|
| 被动语态 be + 过去分词 — 强调发生了什么，而不是谁做的 | are equally affected · can be affected · is inherited |
| 定语从句 who / which + 从句 — 补充说明人或事物 | SAM, which is · orthopnea, which is · dyspnea, which is |
| 现在完成时 have/has + 过去分词 — 过去发生但与现在仍有关联的事 | have been identified · have developed |
需要注意的发音
- “th” 音: thick /θɪk/, athlete /ˈæθ.liːt/, thin /ˈθɪn/, width /ˈwɪtθ/, pathway /ˈpæθˌweɪ/
- “sh” 和 “zh” 音: obstruction /əbˈstɹʌk.ʃən/, tissue /ˈtɪʃ.(j)u/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, mutation /mjuˈteɪʃən/, reduction /ɹɪˈdʌk.ʃən/
- 长单词——注意重音位置: anterior /ænˈtɪɹ.i.ɚ/, mechanism /ˈmɛk.ə.nɪ.zəm/, physiological /ˌfɪz.i.əˈlɑ.d͡ʒɪ.kəl/, primarily /ˈpɹaɪ.mə.ɹə.li/, efficiency /ɪˈfɪʃ.ən.si/
中文母语者容易读错的音：
- /v/ — 不要读成 /w/，上齿轻触下唇: valve /ˈvælv/, reveal /ɹɪˈviːl/, preserve /pɹəˈzɝv/, voltage /ˈvəʊltɪd͡ʒ/, evident /ˈɛv.ə.dənt/
- 词尾辅音 — 要读清楚，后面不要加元音: tract /tɹækt/, cardiac /ˈkɑɹdiˌæk/, genetic /d͡ʒəˈnɛt.ɪk/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, thick /θɪk/
- /r/ 和 /l/ 的区别: abnormal /ˌæbˈnɔɹ.ml̩/, primarily /ˈpɹaɪ.mə.ɹə.li/, reveal /ɹɪˈviːl/, translation /tɹænzˈleɪʃən/, alter /ˈɔl.təɹ/
如何用这段视频练习
- 先完整听一遍视频，不要开口，记下不认识的单词。
- 用正常速度逐句跟读，每句重复到你的节奏与说话人一致为止。
- 录下自己的声音并与原声对比，特别注意 sudden, beta, gene 这类单词。
什么是跟读法？
跟读法 (Shadowing) 是一种有科学依据的语言学习技巧，最初开发用于专业口译员的培训，并由多语言者Alexander Arguelles博士普及。这个方法简单而强大：您在听英语母语原声的同时立即大声重复——就像是一个延迟1-2秒紧跟说话者的影子。与被动听力或语法练习不同，跟读法强迫您的大脑和口腔肌肉同时处理并模仿真实的讲话模式。研究表明它能显着提高发音准确性，语调，节奏，连读，听力理解和口语流利度——使其成为雅思口语备考和真实英语交流最有效的方法之一。