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Dramatize the dialogue using these expressions.
Case: Chest Pain
Male: Age 67
D: Hello, I am Dr. Khan. How can I help you?
P: I’ve got pain in my chest.
D: How would you describe the pain?
P: It is a heavy, crushing sort of pain.
D: Does the pain go anywhere else?
P: Yes, it seems to go up to my jaw and down my left arm.
D: When did the pain start?
P: About half an hour ago.
D: What were you doing when the pain started?
P: I was watching the boxing on television.
D: Did the pain start suddenly?
P: No, it came on over a minute or two.
D: Does breathing in make the pain worse?
D: Have you ever had a pain like this before?
P: I suffer from angina but this time the pain is much worse and it didn’t go away when I put the little tablet under my tongue.
D: Have you been sick?
P: No, but I feel sick.
D: Have you felt your heart fluttering or thumping in your chest?
D: Do you feel short of breath?
P: Yes, I have felt breathless since the pain started.
D: Do you ever get heartburn when you lie down or bend over?
D: Have you suffered from any flu-like symptoms such as a headache or a sore throat?
D: O.K. just relax. I am going to examine you now.
Ex. 19. Find in the texts the answers to the following questions:
а) What is the cause of ischemic heart disease?
b) What is the most common symptom of a heart attack?
c) What are the types of angina pectoris?
d) What is the difference between these two types?
e) What is myocardial infarction?
f) What are the classic symptoms of it?
What are the most common kinds of heart disease?
We all have good reasons to protect our hearts. Cardiovascular disease today is the leading cause of death and disability in the industrialized world. In America alone heart attacks claim 540,000 victims a year. And another 155,000 die annually because of damage of blockage in arteries supplying blood to the brain, resulting in stroke.
There are many different types of heart disease, many reasons why they strike. The most common kind of heart disease is caused by an insufficient supply of oxygen to the heart – known as ischemic heart disease. Here are some of its more common forms.
A heart attack occurs when the heart receives an inadequate supply of oxygen-carrying blood. During a heart attack, this lack of oxygen causes serious damage to part of the heart. The most common symptom of a heart attack is chest pain.
The term “angina” refers to chest pain usually caused when the heart’s deprivation of oxygen is moderate, rather than catastrophic. There are two types of angina:
“Stable angina” is chest pain that is predictable. That is, it almost always occurs during physical exertion or emotional distress. The heart is saying “I’ve got to have more oxygen, or you have to stop making me do so much work”.
“Unstable angina” is chest pain that is not predictable. It can occur even when one is resting or it can occur during exertion, and keep on hurting even afterward. It may also indicate that previously stable angina has suddenly worsened. Unstable angina often precedes serious heart attack.
Coronary insufficiency may result in myocardial infarction that occurs either with or without occlusion of a branch of a coronary artery. The classic symptoms are: 1) pain, 2) shock, and 3) dyspnea. The pain is similar to that of angina in location. It is not caused by exercise, not is it relieved by rest.
Ex. 20. Read the text. State the main idea of it. Compare the character of pain in angina pectoris and in myocardial infarction. Fill in the table:
Effects of Myocardial Hypoxia
Anginal pain occurs during exertion, following heavy meals, and with anger, excitement and other emotional states; it is not precipitating by coughing or respiratory movements. When anginal pain is induced by walking, it forces the patient to stop or to reduce the speed, it is characteristically relieved by rest and nitroglycerin. The exact mechanism of the pain stimulus is still unknown, but it is probably related to an accumulation of metabolites within the heart muscle. Anginal pain occurs most typically in the substernal region, anteriorly across the mid-thorax; it may radiate to or rarely occur alone in the interscapular region, in the arms, shoulders, and teeth. The more severe the attack, the greater the radiation from the substernal areas to the left arm.
As a rule, myocardial infarction is associated with a pain similar in quality and distribution to that of angina but of greater intensity and longer duration. The pain of myocardial infarction is not relieved by rest or by coronary dilator drugs and may require large doses of narcotics. It may be accompanied by diaphoresis, nausea, and hypotension.
In addition to chest pain, a second effect of myocardial ischemia consists of electrographic changes. Many patients with angina have normal tracings between attacks, and the record may even remain normal during the episodes of pain.
A third effect of myocardial hypoxia is an alternation in myocardial contraction. It has been shown that the left ventricular and-diastolic and pulmonary vascular pressures may arise during anginal attacks, particularly if they are prolonged. This indicates transient depression of left ventricular function, which is induced by the decreased contractility of the ischemic areas. On auscultation a fourth heart sound is also frequently heard during the anginal episode; paradoxic pulsation in the precordium may be evident on palpation and can be regarded by apex cardiography.
Another characteristic effect of myocardial hypoxia is liability to sudden death.
Ex. 21. Read the text. Write down the key sentences of it using the following speech models:
a) This article deals with…
b) It is pointed out that…
c) It is stressed that…
d) It should be remembered that…
e) There is no doubt that…
Hypertension commonly comes to light as a result of some complicating episodes, or because of some functional disorders of when a blood pressure reading is taken during a routine medical examination.
On rare occasions, hypertension is revealed by severe renal failure with raised blood nitrogen or even uremic coma. Equally exceptional are bronchial or gastrointestinal hemorrhages as indicators of hypertension whereas epistaxis ( nose bleeding) is by no means a rare sign in elderly patients. More frequently, hypertension is revealed by a neurological or a cardiac complication.
The varied neurological complications are dominated by hemiplegia, but on occasions there may be signs of meningeal hemorrhage, sudden loss of vision or a facial palsy. Cerebral edema is particularly associated with pregnancy.
The commonest cardiac accident is an episode of acute left ventricular failure with pulmonary edema. Myocardial infarction is a less common indicator of hypertension.
Taken as a whole, some complications are more specific (left ventricular failure, cerebral hemorrhage, renal failure) while others simply indicate acceleration of the arteriosclerotic process under the influence of hypertension.
The symptoms are the main reason why a hypertensive patient comes to the doctor.
Headache is very common. The headache often resembles migraine.
Hypertension may be manifested by a cardiovascular symptom such as angina or dyspnea on exertion, or diagnosed when enlargement of the heart is discovered on a routine X-ray. Attention must also be paid to complaints of physical weakness, this is an early sign of hypertension.
The diagnosis of hypertension depends on a simple clinical measurement of blood pressure. This should be done systematically.
Ex. 22. Scan this medical annotation and give instruction for Renitec usage.
Renitec is indicated in the treatment of all grades of essential hypertension and in renovascular hypertension. It may be used alone as initial therapy or concomitantly with other antihypertensive agents, especially diuretics. Renitecis also indicated in the treatment of heart failure.
Dosage and administration.
Since absorption of Tablets Renitec is not affected by blood, the tablets may be administered before, during or after meals.
The initial dose is 10 to 20mg depending on the degree of hypertension, and is given once daily. The recommended initial dose is 10mg daily. For other degrees of hypertension the initial dose is 20mg daily. The usual maintenance dose is one 20mg tablet taken once daily. The dosage should be adjusted to the needs of the patient to a maximum of 40mg daily.
The initial dose of Renitec in patients with heart failure is 25mg and it should be administered under close medical supervision to determine the initial effects on the blood pressure. In the absence of or after effective management of symptomatic hypertension following initiation of therapy with Renitec in heart failure, the dose should be increased gradually to the initial maintenance dose of 20mg given in a single dose of two divided doses as tolerated by the patient. This dose titration may be performed over a 2 to 4 weeks period, or more rapidly if indicated by the presence of residual signs and symptoms of heart failure. This dosage regimen was effective in reducing mortality.
Renitec is contraindicated in patients who are hypersensitive to any component of this product and in patients with a history of angioneurotic edema relating to previous treatment with an angiotensive – converting enzyme inhibitor.
Symptomatic hypertension, renal function impairment.
Additive effect may occur when Renitec is used together with other antihypertensive therapy.
Renitec has been demonstrated to be generally well tolerated in clinical studies, the overall incidence of side effects was no greater with Renitec than with placebo. For the most part, side effects have been mild and transiet in nature and have not required discontinuation of therapy. The following side effects have been associated with the use of tablets and injections Renitec: Dizziness and headache were the most commonly reported side effects. Fatigue and asthenia were reported in 2-3% of patients. Other side effects occurred in less than 2% of patients and included hypertension, nausea, diarrhea, muscle cramps, rash and cough.
A. 1. Scan the text "Congenital heart disease".
2. Find and translate the sentences in which the following word-combinations are used:certain abnormalities, spectacular advances, prior to birth, the blood is detoured around, sufficient quantity.
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