Skim the text and speak on the location, structure and functions of the organs of the cardiovascular system.

PART I

Skim the text and speak on the location, structure and functions of the organs of the cardiovascular system.

Reviewing anatomy and physiology of the cardiovascular system

The cardiovascular system begins its activity when the fetus is barely a month old and is the last body system to cease activity to the end of life. This system is so vital that its activity defines the presence of life.

The heart, arteries, veins, and lymphocytes form the cardiovascular network that serves as the body's transport system, bringing the supporting oxygen and nutrients to cells moving metabolic waste products, and carrying hormones from one part of the body to another. Often called the circulatory system, it may be divided into two branches: pulmonary circulation, in which blood picks up new oxygen and liberates the waste product carbon dioxide; and systemic circulation (including coronary circulation), in which blood carries oxygen and nutrients to all active cells while transporting waste products to the kidneys, liver, and skin for excretion.

Circulation requires normal functioning of the heart, which propels blood through the system by continuous rhythmic contractions. Located behind the sternum the heart is a muscular organ the size of a man’s fist. It has three layers: the endocardium the smooth inner layer; the myocardium the thick, muscular middle layer that contracts in rhythmic beats; and the epicardium — the thin, serous membrane, or outer surface of the heart. Covering the entire heart is a saclike membrane called pericardium, which has two layers: a visceral layer that is in contact with the heart and a parietal, or outer, layer. To prevent irritation when the heart moves against this layer during contraction, fluid lubricates parietal pericardium.

The heart has four chambers: two thin-walled chambers called atria and two thick-walled chambers called ventricles. The atria serve as reservoirs during ventricular contraction (systole) and as booster pumps during ventricular relaxation (diastole). The left ventricle propels blood through the systemic circulation. The right ventricle, which passes blood through the pulmonary circulation, is much thinner than the left because it meets only one-sixth the resistance.

As a person ages, his heart usually becomes slightly smaller and loses its contractile strength and efficiency.

Mind the pronunciation:

angina pectoris [æn’dʒainə 'pektəris]

endocarditis [,endouka:'daitis]

arteriosclerosis [a:,tiəriəuskIə'rəusis]

atherosclerosis [,æθrəskIiə'rousis]

hypertension [,haipə'ten∫ən]

infarction [in'fa:k∫ən]

ischemia [ is'kimiə]

List of the words to be learned.

1. arrest [ə'rest] – n, остановка, задержка, прекращение;

v, задерживать, останавливать;

2. congenital [kən'dʒenitl] – adj, врожденный;

3. damage ['dæmidʒ] – n, повреждение, поражение;

v, повреждать;

4. disturbance [dis'tə:bens] n, расстройство, нарушение, повреждение;

5. dyspnoea, dyspnea [dis'pniə] – n, одышка;

6. edema [i'dimə] – n, отек;

7. effusion [e'fjuʒən] – n, выпот, излившаяся из сосудов жидкость;

8. failure ['feiljə] – n, остановка, повреждение, нарушение;

9. fibrillation [,faibri'lei∫n] – n, трепетание, фибрилляция;

10. insufficiency [,insə'fi∫ənsi] – n, недостаточность;

11. murmur ['mə:mə] – n, шум (в сердце);

12. occlusion [ɔ'kluʒən]- n, акт закрытия или состояние закрытия, окклюзия;

13. onset ['onset] – n, начало, приступ;

14. pacemaker [peis'meikə] – n, любой ритмический центр, определяющий темп активности, водитель ритма;

15. palpitation [,pælpi'tei∫n] – n, сильное сердцебиение, трепетаниe;

16. radiate ['reidieit] - v, распространяться, излучаться;

17. result in [ri'z٨It] – v, заканчиваться, приводить к чему-либо;

result from - происходить в результате, быть следствием;

18. suffer from['s٨fə] – v, страдать, переносить.

Grammar

Complex Object.

Сложное дополнение.

a) I know that this surgeon operates successfully.

b) I know this surgeon (him) to operate successfully.

Я знаю, что этот хирург (он) успешно оперирует.

Сравните эти предложения:

1. Какое из них является сложноподчиненным, какое простым.

2. Найдите главные и второстепенные члены в каждом предложении.

3. Чем выражено дополнение в предложении b).

4. Как переводится C.O. на русский язык.

Обратите внимание на форму инфинитива в следующих 3 предложениях и его перевод.

I know him to study well.

Я знаю, что он учится хорошо.

I know him to have studied well.

Я знаю, что он учился хорошо.

I want this text to be studied.

Я хочу, чтобы этот текст был изучен.

Обратите внимание на то, как еще может быть выражено сложное дополнение:

He felt the pain increase.

He saw her running.

The doctor made the patient lie down.

Какими глаголами выражено сказуемое в этих предложениях и что нового вы заметили в конструкции сложного дополнения?

Ex. 10. Read and translate the sentences paying attention to Complex Object

Constructions.

1. We know vitamin C to be important in cases of anaemia.

2. The local physician insisted the patient to have been hospitalized as soon as possible.

3. The x-ray examination revealed the heart to be slightly enlarged.

4. He felt his heart beat painfully.

5. The nurse heard somebody coughing at the next ward.

6. The doctor expects this medicine to be very effective.

7. The professor believed the initial diagnosis to be confirmed by laboratory findings.

8. We didn’t expect this patient to suffer from cardiac insufficiency.

9. The researches found smoking to be the risk factor causing the infarction.

10. Cardiologists have observed the children with congenital heart defects have no clinical manifestations of the disease until year after birth.

Ex. 11. Substitute the subordinate clauses for Complex Object:

1. The surgeon believes that an operation is necessary in this case.

2. Scientists consider that cancer will be conquered in this century.

3. The newspapers report that a vaccine against flu was used successfully.

4. My mother wanted that I should become a doctor.

5. Doctors found that interferon was effective against viral diseases.

6. I saw how the students were examining a patient under the instruction of their teacher.

7. The nurse on duty didn’t hear how the patient left the ward.

8. American physicians state that atherosclerosis is among the most common causes of death and disability in this country.

Ex.12. Translate using Complex Object:

1. Мой руководитель хочет, чтобы я сделал доклад о результатах эксперимента.

2. Студенты видели, как сестра делала внутримышечную инъекцию.

3. Врач считает, что химиотерапия будет в этом случае эффективнее.

4. Всем известно, что курение способствует развитию сердечно-сосудистой патологии.

5. Врачебное обследование выявило, что больной страдает врожденным пороком сердца.

6. Больной сообщил, что боль иррадиирует в левую руку.

7. Кардиологи полагают, что длительная сильная сжимающая боль в сердце является признаком инфаркта.

8. Врач определил, что в клапанах сердца имеются органические изменения.

Ex. 13. Look through the text. Find and translate the sentences with the Complex Object. Read the text and answer:

1. What is pericarditis?

2. What are the symptoms of pericarditis?

3. What are the causes of the disease?

Pericarditis

Inflamation of sac that surrounds the heart (peri=around; cardium=heart).

The patients complain of a severe chest pain. Sometimes it becomes worse with inspiration (breathing in) and is improved with position change. The patients admit the pain not to be associated with exercise, nausea, vomiting or sweating.

The doctors consider pericarditis to be caused by viral infection, bacterial infection or inflammation without infection. It can occur after heart attack or after heart surgery and end-stage of kidney disease.

Bacterial infection is very serious and must be carefully treated. Inflammatory pericarditis needs to be treated with medicine against inflammation until symptoms resolve (as long as accumulation of fluid does not occur). If so, it may require drainage.

Pericarditis can be confused with other sources of chest pain. It is therefore imperative the chest pain be evaluated immediately to determine its cause.

Ex. 14. Read the text. State the main ideas of it in a written form. Retell the text according to the plan.

Cardiovascular Diseases

Cardiovascular diseases are now the leading cause of death and disability among the adults over 40 in industrialized societies.

There are some risk factors that may lead to diseases of the heart – there are disorders in fat metabolism, emotional and mental stress, drinking and smoking, and physical inactivity.

There are ways of classifying heart diseases. The 3 layers of the heart wall form the basis for one grouping of heart pathology, as follows:

1. Endocarditis, which means inflammation of the “lining” of the heart cavities, but which most commonly affects the valves of the heart.

2. Myocarditis, or inflammation of the heart muscle.

3. Pericarditis, referring to the disease of the serous membrane of the heart surface.

Another more generally used classification of heart disease is based on causative and age factors. On this basis the more common kinds of heart disease are:

1. Congenital heart diseases, that are present at birth (such as septal defects of tetralogy of Fallot – a combination of four congenital defects).

2. Rheumatic heart disease which begins with an attack of rheumatic fever in childhood or in youth (such as endocarditis, myocarditis, pericarditis or pancarditis).

3. Coronary heart disease which involves the walls of the blood vessels that supply the muscles of the heart (angina pectoris, myocardial infarction, pericarditis or pancarditis).

4. Degenerative heart diseases, which are most common after the age of 45, and are due to deterioration of tissues such as muscles because of the prolonged effects of various disease conditions (such as hypertension or hypotension).

The most important symptoms associated with diseases of the heart are dyspnea, cyanosis, edema, pain, palpitation and early fatigue. Diseases of the heart in their early stage produce shortness of breath on exertion, increased pulse rate, palpitation, discomfort in the precordial region, fatigue, giddiness, loss of appetite. Advanced heart diseases produce breathlessness even at rest, irregularity of heart action, pain in the chest radiating to the neck, left arm or abdomen, cyanosis, edema, and clubbing of fingers.

Ex. 15. Read the text and give the answers to:

1. What are the clinical signs of endocarditis?

2. What are the causes of the diseases?

3. Are there any ways to prevent endocarditis?

Endocarditis

Inflammation and infection of the lining and usually the valves of the heart by bacteria. The inflection maybe very acute, “subacute” (developing steadily over time) or chronic.

Symptoms: For the acute variety, sudden onset of high fever, chills and signs and symptoms of heart failure. For subacute or chronic endocarditis, the symptoms are more subtle: low-grade fevers, generalized fatigue, aches and pains, weight loss, poor appetite, night sweating, often without any indication that the infection is in the heart.

Cause: Infection of the heart lining or valve(s) with bacteria that reach the heart through the bloodstream and attach themselves to the lining or valves. There is almost always an underlying problem with the heart lining or valves (roughened surface, narrowing, congenital heart defect, arteriosclerosis). The bacteria usually originate in another part of the body and are induced to the bloodstream through trauma: dental procedures and cleaning of teeth; introducing a catheter into an infected bladder; surgery on the bowel; procedures that involve inserting instruments into rectum, skin or soft tissue infection. People who have artificial heart valve are at special risk for this problem.

Severity of Problem: Always serious, often life–threatening if the infection is not promptly recognized and treated. Even with vigorous treatment further damage to the heart may occur.

Treatment: Recognizing the problem and identifying the infecting bacteria is one of the most important aspects of treatment, because it enables the correct antibiotic to be used. Antibiotic treatment is required for weeks (six or more and must be given intravenously). General support, treatment of heart failure and good nutrition are important. If there is an artificial heart valve in place, it may need to be removed or required to control for infection.

Prevention: People with known heart defects or valve problems should take antibiotics (usually penicillin) by month before, during and after dental work and other procedures that may lead to showering of bacteria into the blood. They need ongoing medical treatment and supervision.

Ex. 16. Read the text. Name the main symptoms of angina pectoris. How are they detected? What is the key method for making the diagnosis of angina pectoris? What are the possible complications of the disease?

Angina Pectoris

Pain in the chest. Refers to pain that originates in the heart.

Symptoms: Sudden pain in the chest, often with or after exercise, stress or eating. Frequently described as crushing located under the breastbone; may radiate down the arm or into the shoulder, most often – the left. Sometimes felt as “indigestion” or heartburn. There may be faintness, shortness of breath, paleness. Usually lasts less than five minutes.

Cause: Sudden lack of adequate blood supply to the heart muscle. Often brought on by exercise, eating or stress. A common cause is underlying arteriosclerosis or other form of cardiovascular disease, which results in narrowing of the arteries that supply the heart with its nourishment.

Severity of Problem: Potentially life-threatening. Increasing pain or frequent pain can signal worsening of the disease. Can lead to progressive loss of ability to function without pain or shortness of breath.

Treatment: Should be evaluated by a physician if angina is suspected. Avoid unusual or provocative stress if possible. Medication (either long-lasting or short-acting) is often used to help relieve the symptoms.

Prevention: Appropriate diet in early life, as well as ongoing attention to nutrition. Avoid stress where possible.

Ex. 17. Read the texts and speak on the methods of the cardiac patient examination. What data are revealed by each of them?

The examination of the heart should follow the usual routine of inspection, palpation, percussion and auscultation.

Inspection enables the examiner to see the position and extent of the cardiac impulse and rhythm.

Palpation confirms the position of the apex beat and gives more information about the force, duration and character of the cardiac impulse.

Percussion has been described as a method of examining the heart. It may demonstrate the increased dullness due to pericardial effusion.

Auscultation is of great value in the detection of abnormalities of the valves which commonly produce both changes in the heart sounds and added sounds called murmurs.

The electrocardiogram (ECG) yields valuable data about electrical events occurring with cardiac muscle activity.

Echocardiography is a non-invasive method of investigation used particularly for the demonstration of congenital cardiac abnormalities, the diagnosis of pericardial effusion and certain types of valve disease and the assessment of cardiac chamber size and function.

The sample of the examination of the cardiac patient

On examination: The patient is distressed. Centrally cyanosed. Perspiring. Tachypnoeic. Overweight. No ankle oedema. Axillary temperature 36 degrees C.

C.V.S. Pulse 116/min regular. Small volume.

B.P. 150/90 mm Hg

Heart Apex beat – 5^th intercostal space in mid-clavicular line.

Heart sounds. Harsh, saw-like murmur of aortic stenosis loudest at right 2^nd intercostal space.

A.S.: Abdomen unremarkable.

R.S. Trachea central. Chest expansion poor R=L. Percussion note resonant. R=L. Breath sounds – fine inspiratory crepitations at both lung bases not shifted by coughing.

Plan: ECG monitor, chest x-ray, full blood count, urea and electrolytes, serial cardial enzymes, cerial ECGs, refer to physicians.

Ex. 18. Read the dialogue.

Find the English equivalents to: сдавливающая боль, отдает в челюсть, боль усиливается при вдохе, сердце бьется или выскакивает из груди, перехватывает дыхание, изжога, симптомы, напоминающие грипп.

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?

P: No.

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?

P: No.

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?

P: No.

D: Have you suffered from any flu-like symptoms such as a headache or a sore throat?

P: No.

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?

Heart Attack.

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.

Angina.

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.

Myocardial infarction.

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:

Hypertension

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

Indications.

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. Renitec is 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.

Essential Hypertension.

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.

Heart Failure.

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.

Contraindications.

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.

Precautions.

Symptomatic hypertension, renal function impairment.

Drug interactions.

Additive effect may occur when Renitec is used together with other antihypertensive therapy.

Side effects.

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.

Ex. 23.

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.

Congenital heart disease

This category of heart disease includes certain abnormalities which have been present since birth and which usually represent a failure of normal development. In recent years many of these congenital defects have been remedied by heart surgery, one of the most spectacular advances in modern medicine.

The circulation of the fetus differs in several respects from that of the child after birth, one difference being that the lungs are not used until the child is born. Prior to birth the unused lungs are bypassed by a blood vessel which normally closes of its own once the lungs are in use. Sometimes, however, the vessels fail to close with the results that much of the blood is detoured around the lungs instead of through them, and therefore the blood does not receive enough oxygen. This condition can be corrected by surgery.

Another congenital heart defect is an obstruction of narrowing of pulmonary artery, which prevents the blood from passing in sufficient quantity from the right ventricle to the lungs. This condition also can be remedied by surgery.

Coronary artery disease

Disease of the arteries that supply blood to the heart muscle.

Symptoms: There may be chest pain associated with exercise, which resolves when exercise is stopped. Shortness of breath may be associated. Pain may radiate down the left arm and to the jaw. This pain is called angina pectoris. More severe pain associated with nausea, vomiting, sweating and feeling faint are symptoms of “heart attack”. Pain of heart attack may be confused with pain of upset stomach or gas.

Cause: Deprivation of oxygen-carrying blood to the heart muscle because of the narrowing of the coronary arteries by plague formation on the wall. The plague contains cholesterol and cellular debris and may block the entire channel of flow. As a result, the deprived tissue creates the sensation of pain and may die.

Severity of Problem: Depends on the severity of blockage of the arteries, the suddenness of the problem and, in the setting of a heart attack, if ventricular fibrillation occurs. Chronic chest pain should be evaluated by a physician. If chest pain is severe, call the paramedics.

Treatment: In the case of chronic recurrent chest pain, the treatment involves diagnosis, diet, medication and prescribed exercise in a controlled setting. If good control is not possible surgery is considered.

In the setting of a heart attack, the treatment involves immediate hospitalization and administration of medicines for pain and to prevent ventricular fibrillation. If pain occurs after a heart attack, medical treatment and surgery are usually recommended.

Prevention: Diet low in cholesterol and saturated fats; no smoking; maintain weight within 10% of ideal weight; a routine exercise program; control of stress; periodic physical examination for early detection of problems.

Discussion: Coronary artery disease is a major killer in this country. Risk factors that strongly increase the likelihood of the coronary artery disease occurring are cigarette smoking, high blood pressure and diabetes. These should be controlled or avoided where possible. Coronary artery disease does run in families. In recent years dietary changes, exercise, early treatment and the training and use of paramedics have reduced the mortality from coronary artery disease.

Ex. 25.

Pericarditis

The main cause of acute pericarditis is an infection, particularly rheumatic fever. It may be a direct extension of inflammation from the surrounding organs or through the blood stream in general septic processes. Of the acute forms, the suppurative is the most serious type; it develops as a sequel to conditions as pneumonia, empyema, or septicemia. Often the acute fibrinous or serofibrinous types develop and run a comparatively benign course, terminating with complete resolution without the true condition being recognized or diagnosed. Frequently the general infection of the preexisting disease may be so severe that the pericardial lesion is completely overlooked.

It must be kept in mind that acute coronary thrombosis may be an immediate cause of acute pericarditis, but in this case the true nature of the underlying lesion is usually recognized. Tuberculosis too is a very common cause of pericarditis.

The chief symptom of pericarditis is precordial distress. The pain is seldom severe in nature, but usually takes the form of a dull aching sensation over the lower portion of the sternum, which is made worse by pressure on the sternum. Rapid pulse, fever, and an increased respiratory rate are practically always present. After the pain has persisted for a day or two, it often becomes less and less, and finally disappears entirely. Freedom from precordial pain is usually followed by distressful dyspnea.

When the pain gives way to shortness of breath, it is usually a sign that the precordial effusion has become great enough to separate parietal from the visceral layers of the pericardial sac which relieves the pain. The effusion may be mild, moderate, or severe, and the degree of dyspnea is usually dependent upon the amount of effusion. Usually dyspnea lasts for a few days and then disappears. However, this does not mean that the effusion has ceased, since it may persist for a much longer time.

Ordinarily the effusion completely vanishes within a period of a week or ten days, although sometimes suppuration may set in, which precipitates a serious complication. With the disappearance of the effusion, the half-forgotten pain of the earlier stage may return to some degree, together with the classical pericardial friction rub.

On inspection one usually finds some characteristic features of acute pericarditis. The patient with an acute rheumatic infection who has been progressing fairly well, let us say, becomes more restless than usual, the temperature rises to a higher point, the pulse increases in rate, and sometimes a dusky cyanotic tinge appears. Palpation of the precordial area may reveal fremitus friction. On percussion in the early stages no abnormality is found. Auscultation brings out the characteristic to-and-fro friction rub that is not synchronous with either the systolic or diastolic phases of the heart rhythm.

Blue Color (cyanosis)

A blue color of the skin means lack of oxygen in the tissues. Lack of oxygen (called hypoxia) can occur for a variety of reasons, including lung problems, heart problems or circulation problems. When hypoxia is moderately severe, blue color can be limited to the lips, the fingers and toes. Severe hypoxia causes a blue or gray color to appear over the entire body. Cyanosis should always lean to an evaluation by a doctor and often means an emergency situation.

1. What can dizziness mean to people?

2. What is the cause of giddiness?

3. Where does vertigo originate in?

Mind the meaning of new words:

Spinning, vertigo, fuzzy, reeling.

Dizziness

Dizziness can mean several things to people. Some refer to a light-headed or “fuzzy” feeling as dizziness, while others mean a feeling of spinning or reeling (which is more properly called vertigo). Light-headedness or giddiness often results from a decrease of blood flow to the brain. Vertigo, on the other hand, originates in the inner ear, which controls balance.

1. When is it a symptom or a normal reaction of the body?

Fatigue

Excessive tiring and a feeling of weakness or sleepiness can be a symptom of many disorders, or it can be a normal reaction to exercise and exertion. As a symptom of illness, it accompanies nearly all illnesses.

1. What is palpitation?

2. Is it possible for a healthy person to have changes in the heart rate and rhythm?

Heart Rate Changes

The sensation of changing or irregular heartbeat is very bothersome for people, especially if they have or think they have heart disease. Palpitations are the sensations of the heart skipping a beat, beating irregularly or pounding in the chest.

Most people have changes in the heart rate and rhythm as part of a normal day and palpitations may signal no disease at all. Others have this as a sign of heart disease. When palpitations are pronounced, or frequent, or if they are associated with symptoms of light-headedness or difficulty in breathing – seek medical care.

Test yourself

1. What diseases of the cardiovascular system do you know?

2. How are the cardiovascular disorders classified?

3. What are the most common causes of these diseases?

4. What are the general manifestations of the cardiovascular disorders?

5. What is the character of pain in a) angina pectoris b) infarction c) pericarditis?

6. What methods of the cardiac patients' examination are used?

7. What data are revealed by each investigation?

8. What can you say about age, sex, habits of the cardiac patients?

9. Speak on the importance of the prevention of the cardiovascular diseases.

PART I

List of words to be learned

chill [t∫il] – n, озноб;

congestion [kәn'dʒest∫ən] – n, закупорка, застой;

coryza [kɔ`raizә] – n, ринит, острый насморк;

cough [ko:f] – n, кашель;

crackle ['krækl] – n, потрескивание, хруст;

crepitation [, krepi'tei∫әn] – n, хрипы;

dyspnea [dis'pni:ə] – n, одышка;

effusion [i'fju:ʒn] – n, кровоизлияние, потеря крови;

emphysema [, emfi'si:mә] – n, эмфизема;

fever ['fi:və] – n, лихорадка;

hacking ['hækiŋ] – n, покашливание;

haemoptysis [hi:`mә'ptəsis] – n, кровохаркание;

hoarse [hɔ:s] - adj, хриплый, охрипший;

moist [moist] – adj, влажный;

râle [ra:l] – n, хрип;

sneeze [sni:z] – v, чихать;

tachypnea ['tækipniә] – n, тахипноэ, частое дыхание;

wheezing ['wi:ziŋ] – n, одышка;

Mind the pronunciation.

asthma ['æsmə:]

bronchitis [brɔŋ'kaitis]

laryngitis [ֽlærin'dʒaitis]

pharyngitis [ֽfærin'dʒaitis]

pleurisy ['pluərəsi]

pneumonia [nju: 'mouniə]

tonsillitis [ֽtɔnsi'laitis]

tuberculosis [tju:, bә:kju'lousis]

Ex.1. Make up word-combinations and translate them:

costal

shallow (поверхностное)

deep

coarse (harsh) жесткое

respiration slow

(breathing) hard (затрудненное)

artificial

normal (adequate)

irregular

soft

vesicular

moist/ wet/ productive

barking (лающий)

troublesome (мучительный) pus (гной)

constant cough of

dry/ nonproductive mucus

hacking (покашливание)

bronchial

moist

dry râles

coarse (жесткие)

crackling (крепитирующие,трескучие)

colorless

watery

thick

thin analysis

viscous sputum

bloody culture

mucoid

purulent

foul smelling (отвратительный)

Ex.2. Give the synonyms:

moist to evaluate

chill respiration

normal persistent

crackle cold

inspire wet

breath perspiration

sweating shivering

coryza inhale

constant adequate

to assess crepitation

Ex.3. Give the antonyms:

moist exhale

thick irregular

watery shallow

inhale natural

productive dry

inspire thin

deep viscous

artificial expire

regular nonproductive

Ex.4. Match the following English word-combinations with the Russian ones:

depth of breathing сильный озноб

breath-holding ночное потоотделение

apnea испытывать нехватку воздуха

disturbance of respiration частота дыхания

respiratory arrest глубина дыхания

respiratory rate задержка дыхания

to be short of breath угнетенное дыхание

night sweating остановка дыхания

shaking chill расстройство дыхания

Ex.5. Give English equivalents to:

Покашливание, влажные хрипы, охрипший голос, жесткое дыхание, вдыхать пыль, цианоз лица, глотать с трудом, прочистить горло, поверхностное дыхание, лающий кашель, гнойная мокрота

Ex.6. Read and translate the words and their derivatives:

Breath [breθ] – breathe [bri:ð] – breathing – breathless;

inhale – inhaler – inhalation – inhalant;

accumulate – accumulation – accumulative – accumulator;

inspire – inspiration – inspirator – inspiratory;

hoarse – hoarseness – hoarsen – hoarsely;

expire – expiring – expiry – expiration;

Ex.7. Read and translate the terms and their definitions:

dyspnea [dis'pni:ə] - n, difficulty or pain in breathing

coryza [kɔ`raizә] - n, an illness with inflammation of the nasal passages, in which someone sneezes and coughs and has blocked and running nose =cold, common cold;

chill [t∫il] - n, a short illness causing a feeling of being cold and shivering, usually the sign of the beginning of a fever, of flu or a cold;

cough [ko:f] - n, a reflex action, caused by irritation in the throat, when the glottis is opened and air is sent out of the lungs suddenly;

râle [ra:l] - n = сrepitation, an unusual soft crackling sound heard in the lungs through a stethoscope;

sneezing ['sni:ziŋ] - n, a reflex action to blow air suddenly out of the nose and mouth because of irritation in the nasal passages;

cyanosis [,saiә'nousis] - n, condition characterized by a blue color of the peripheral skin and mucous membranes, a symptom of lack of oxygen in the blood;

congestion [kәn'dʒest∫ən] - n, accumulation of blood in the organ: nasal congestion (застой);

emphysema [,emfi'si:mә] - n, a condition in which the walls of alveoli of lungs break down, reducing the surface available for gas exchange;

effusion [i'fju:ʒn] - n, discharge of blood, fluid or pus into or out of an internal cavity;

haemoptysis [,hi:mә'ptəsis] - n, a condition in which someone coughs blood from the lungs, caused by a serious illness such as anaemia, pneumonia, tuberculosis or cancer;

wheezing [`wi:ziŋ] - n, whistling noises in the bronchi when breathing.

Ex.8. Match the diseases with their descriptions:

Bronchitis, lung abscess, pneumonia, laryngitis, bronchial asthma, pleurisy.

1. Change in the voice that makes it more harsh or coarse.

2. Inflammation of the lining surrounding and covering the lungs.

3. Acute inflammation of the trachiobronchial tube (air passage).

4. Lung infection caused by any of a variety of bacteria.

5. A type of asthma mainly caused by an allergen or by exertion.

6. Lung infection accompanied by pus accumulation and tissue destruction.

Grammar

PART II

Ex.1. Read the text “Common respiratory disorders” and find in it the answers to the following questions:

1. What is the most common classification of respiratory disorders?

2. What are the most common diseases of the upper respiratory tract?

3. What are the most typical symptoms and signs of the upper respiratory disorders?

4. What diseases of the lower respiratory tract do you know?

5. Name the main symptoms and signs of these disorders.

Radiography

Special radiological investigations include fluoroscopy (or screening) of the lung and diaphragmatic movements: lateral, oblique and apical views: X-rays focused at different depths in the lung (tomography to detect local lesions; such as a cavity or tumour; and the introduction of a radio- opaque medium into the bronchial tree (broncography) to demonstrate bronchiectasis or bronchial narrowing, or into the pulmonary artery (angiography) to demonstrate arterial occlusions by embolism. Computerized axial tomography (the “CAT scan”) may be used to define the precise size, site and consistency of an intrathoracic lesion.

Ex.3. Read the text and complete the following sentences using the material in the text:

1. The very common symptoms in most respiratory disorders are…

2. There are various types of cough…

3. Sputum is…

4. According to the nature and extent the sputum may be…

5. Dyspnea means…

6. Cyanosis may be caused by…

7. Haemophysis is called…

Acute Pharyngitis

The outstanding symptom of acute pharyngitis, regardless of cause, is a sore throat. About two-thirds of all acute illnesses in families are viral infections of the upper respiratory tract, with varying degree of pharyngeal discomfort present. The acute pharyngitis can be classified into three groups: (1) treatable infections, (2) untreatable infections, and (3) noninfectious disorders.

Physical examination of the pharynx mucosa may reveal changes varying in intensity from mild redness and congestion of blood vessels (many viral infections) to intense red-purple color, patchy yellow exudate, hypertrophy of all the lymphoid tissue, and marked vascular injection. Symptoms may be variable, and may range from a complaint of “scratchy throat” to pain so severe that swallowing of saliva is difficult. The presence of exudate does not establish a specific etiology any may be noted in infections.

Ulceration involving the posterior pharyngeal wall and/or tonsils are characteristically present in fungobacterial infections, tuberculosis, following local trauma to the pharynx.

The tonsils are often involved in the course of viral and bacterial pharyngitis; they may be markedly reddened and swollen.

The etiologic diagnosis of acute pharyngitis is difficult to establish on the basis of visual examinations of the throat.

Laryngitis

Change in the voice that makes it more harsh or coarse.

Symptoms: Change in tone or quality of voice to a coarse, harsher sound, need to clear the throat; sometimes fever, swallowing difficulty and throat pain or discomfort, depending on cause.

Cause: The voice box (larynx) becomes inflamed as a r4esult of inhaling smoke, chemical fames, gases, vapors or dust, overuse or abuse of voice; excessive use of alcohol; diseases such as sinusitis, tonsillitis, bronchitis, flu, the common cold, pneumonia and pharyngitis, polyps in the throat, cancer and others.

Treatment: Depends on basis for problem. However, initial treatment usually includes “not talking” in order to rest the larynx, no smoking or drinking; an increase in fluids and medication if seemed necessary. Further treatment would depend on the cause of the hoarseness.

Ex.7. Read the text and find the answers to:

1. What is bronchitis?

2. What are the clinical manifestations of the disease?

3. What are the causes of bronchitis?

4. How to prevent chronic bronchitis?

Bronchitis Acute

Acute inflammation of the tracheobronchial tube (air passage).

Symptoms: Cough that is initially hacking and dry. Then gradually becomes loose, with production of mucus or yellow sputum. There may be fever (if infection is present), generalized malaise and fatigue, sensation of tickling or tightness in chest and sensation or sound of rafting in the chest. If the bronchitis follows a cold, there may also be congestion of the nose and postnasal dry. Coughing is often worse in the morning than at night.

Cause: Acute Bronchitis may result from infection as a complication of a cold (upper respiratory infection) or as a result of irritation of a lining of the air passages by inhaling substances such as smoke, pollen, dust, fumes or fibers.

The irritant type of bronchitis may progress to involve infection also.

Severity of problem: Usually of mild to moderate severity and resolves with treatment. If cause is not corrected, it may become chronic.

Contagious: Usually not except if caused by a view.

Treatment: Depends on cause but involves removing or avoiding any irritants (stopping smoking, avoiding dust), drinking much fluid and resting. Moisture in the air (involving steam) is sometimes soothing. If the cough is dry and irritating, or interferes with sleep, medication to suppress it might be recommended. Antibiotics may be prescribed by the doctor if bacterial infection is suspected or known.

Prevention: Avoid smoking, exposure to airborne dust or irritants.

Discussion: Mild, acute Bronchitis is almost always present temporarily with upper respiratory infection (common cold) and does not require antibiotic treatment unless high fever occurs, or sputum becomes yellow or greenish rather than white or clear.

Chronic Bronchitis is a real problem in adults, problem thought to be “Chronic Bronchitis” in infants and children are more likely to be asthma or other illness. Bronchitis where there is a lot of wheezing can be suspected of being asthma. People with moderate to severe chronic Bronchitis should probably receive influenza vaccines (‘flu shots’).

BRONCHIAL ASTHMA

Bronchial asthma usually starts in childhood but may not appear until middle age (“late-onset asthma”). It is characterized by attacks of wheezing dyspnoea due to narrowing of bronchial tube by spasm, mucosal edema or mucous secretions. These attacks are brought on by a variety of factors, including allergy to certain inhaled dusts (e.g. house dust, pollens), respiratory infections, emotional upsets or physical exertion (“exercise – induced asthma”). A history of other “allergic” manifestations such as hay fever or a family history of this condition, is common in those with an early onset of the disease. The patient may be quite free of symptoms and abnormal signs between the attacks but the illness can become continuous. Cough usually occurs only during the attacks when it may be associated with the expectoration of vicid mucoid sputum; noctural cough is a characteristic presenting symptom of asthma in childhood.

Physical examination reveals labored breathing associated with a prolonged expiratory wheeze, activity of accessory muscles of respiration, signs of overinflation of the lung due to trapping of air during expiration and, in a severe attack, cyanosis may also be seen. In children, there may be permanent deformity of the chest wall.

Bronchial asthma must be differentiated from the paroxysmal dyspnoea of left heart failure and from localized wheezing due to partial bronchial obstruction by neoplasm.

Ex.9. Read the text, write down the key sentences of it using the following models:

1. This text is concerned with …

2. Particular attention is paid to …

3. It is a well-known fact that …

4. The next point deals with …

5. It has been suggested that …

Pleurisy

Inflammation of the lining surrounding and covering the lungs.

Symptoms: Sudden, intense stabbing pain in the side or shoulder, aggravated by deep breathing, coughing, sneezing or moving. Breathing is usually rapid and not very deep.

Cause: May result from injury or irritation of the underlying lung; entry the irritating substance into the pleural space; entry of infection either from the lung or through the bloodstream; or leakage of tumor cells into the pleural space.

Treatment: depends on treating underlying cause. Heat applied to chest and pain relieves help with symptoms. Antibiotics are used if infection suspected or proved.

Discussion: Inflammation of the pleura, the membranes lining the chest and covering the lungs, causes pain when the lung moves back and forth over the inflamed area. Sometimes infection is irritating enough that fluid gathers in the chest between the ribs and lung (called pleural effusion). This kind of fluid collection, if present can be drained by needle or tube and the fluid studied for infection and abnormal (cancer) cells. Depending on cause, pleurisy can occur one time only or be a recurrent problem.

Ex.10.

Pneumonia

Lung infection caused by any of a variety of bacteria.

Symptoms: With many bacterial forms ofPneumonia, there is a sudden onset of high fever, chill and cough followed by varying degrees of difficulty breathing. There is often chest pain located over the inflamed area of the lung. This may follow mild respiratory symptoms (stuffy nose, mild cough) by several days. Sometimes infection is generalized in the blood, which makes the person appear very ill.

Cause: Infection of the lung with any of the variety of bacteria. Most common in these people who are otherwise healthy is pneumococcus infection. In those who are chronically ill, malnourished, alcoholic, very young or very old, or have underlying lung disease, the Pneumonia may be caused by very unusual bacteria which can be difficult to treat. The bacteria may enter the lung from the respiratory tract (by inhaling them) or, rarely, by spread from another part of the body through the blood.

Severity of problem: Depends on the bacteria involved and the general state of health of the person. Pneumococcal Pneumonia in a healthy person is easily treated with only a few side effects. Pneumonia caused by more unusual bacteria in people with poor resistance is often associated with severe problems, even death.

Contagious: Not as such, for the most part. Bacteria responsible for Pneumonia are elsewhere in the environment and cause disease only in people who are particularly susceptible or as an unexplained event.

Treatment: The mainstay of treatment is antibiotic, with the specific drug used depending on the type of Pneumonia present. Often this??? hospitalization for intravenous therapy but occasionally treatment can be done at home with mild disease. Rest, fever and cough control (when needed), as well as high liquid intake are all important, some people require support of breathing (with a respirator) or other treatment.

Prevention: Only as far as can be done to control any underlying disease that makes a person susceptible to Pneumonia. Asthma and chronic lung disease of other kinds need to be under as good control as possible.

Discussion: Pneumonia caused by bacteria tend to be labor Pneumonia – localized areas of intense infection, sometimes with formation of pleural effusion or pus. These were Pneumonias most often associated with death in the past and are still serious problems.

Lung Cancer

Cancer of the Lungs, the organs that process oxygen for the body and release CO2 from the blood, accounts for 25% of all cancer deaths in the USA.

Symptoms: Chronic cough in early stages. Shortness of breath, pneumonia and bloody sputum are possible signs of moderately advanced lung cancer. In the last stages there is chest pain, weight loss, severe shortness of breath, hoarseness, swallowing difficulty and accumulation of fluid in the chest cavity.

Cause: There appears to be an absolute cause-and effect relationship between cigarette smoking and lung cancer. Estimates indicate that 85% of Lung Cancer deaths are the result of cigarette smoking. At least 111,000 people will die each year as a result of Lung Cancer. Those who smoke more than two packs of cigarettes a day run a risk of dying from Lung Cancer 30 times higher than that of non-smokers. Other causes of Lung Cancer include asbestos, coal tar fumes, petroleum oil mist, arsenic, chromium, nickel, iron, isopropyl oil, radioactive substances and air pollution.

Severity of problem: The survival rate for Lung Cancer is very poor. Less than 10% survive five years after treatment. In 15 years the survival rate has not markedly changed, making it one of the most devastating cancers.

Discussion: Lung Cancer is most often found in adults between the ages of 40 and 70. Each year the number of cases of Lung Cancer increases. One important note: the incidence of Lung Cancer is rising rapidly in women.This reflects the increasing number of women smoking today.

Ex.12. Read the text.

Tuberculosis

This disease is a chronic, destructive inflammation, and is one of the most widespread of all diseases. It isparticularly prevalent among people who live under crowded conditions.

It is seen frequently in all ages, sexes, and all economic groups. The lesions may be small self-limited and the presence of the infection may only be demonstrable by means of laboratory tests.

Tuberculosis used to head the list of killing diseases, but now the disease is steadily becoming less common as well as less dangerous. The reduction in the tuberculosis rate is due to the following factors: (1) improved social living conditions with better nutrition, fresh air, and sunlight; (2) education in hygiene; (3) segregation of the sick in sanatoriums and destruction of tuberculous sputum; (4) earlier seeking of medical advice; (5) improved methods of treatment; (6) vaccination of high risk population.

In the case of tuberculosis, infection may occur in a number of ways.

1. By inhalation. The most likely source of infection from man is the sputum of the patient with active tuberculosis of the lungs. The bacilli may be inhaled from the sputum that has dried.

2. By swallowing, children may readily acquire tuberculosis by drinking infected cow's milk.

3. Through the skin. The infection may spread in 3 ways: (1) Through the tissues, (2) by the lymph, (3) by the blood stream.

Tuberculosis is a chronic inflammation. Any organ of the body may be involved, by tuberculosis. It is exceptional, however, for more than one or two organs to be attacked at the same time, except in military tuberculosis.

The lungs and pleura are most frequently attacked, and pulmonary disease accounts for 85% to 90% of all deaths from tuberculosis. Lymph nodes come next, most often those in the hilum of the lung, less frequently the abdominal nodes. Tuberculosis of the larynx is a serious form, secondary to pulmonary tuberculosis.

Which statements are true?

1. Tuberculosis is a chronic destructive inflammation and is one of the most widespread of all diseases.

2. It occurs rarely among people who live under crowded conditions.

3. Tuberculosis is more common in young men than in women.

4. The disease is characteristic for the developed countries.

5. The infection enters the body through the skin by inhalation, by swallowing.

6. Not all organs are affected by tuberculosis.

7. The lungs and pleura are the most frequently attacked.

TEST YOURSELF

1. What disorders of the respiratory system do you know?

2. How are the respiratory diseases classified?

3. What are the most common causes of these disorders?

4. What are the clinical manifestations of the respiratory diseases?

5. What methods of examination are used for detecting the respiratory pathology?

6. What data are revealed by each investigation?

7. What is the role of smoking in the development of the respiratory diseases?

PART I

List of words to be learned .

1. anorexia [ֽænə'reksiə] – n, анорексия;

2. belching

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