Express the main idea of the text in several sentences.

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.

Infection plays an important part in initiating heart disorders in the young. Bacteria may first involve the tonsils, then the joints, and finally the heart. The “step” throat may be followed by an attack of so-called inflammation of the joints subsided with no permanent damage. The heart is damaged in about 60% of rheumatic patients. The injury may include all three layers of the heart, but most commonly there results in a condition known as rheumatic endocarditis. The infection causes the heart valves particularly the mitral valve to become inflamed. Small deposits of material form the blood produce vegetations, which form along the edges of the valves. The cusps thicken and tend to stick together, that is, to form adhesions. The valvular operating may become permanently narrowed as a consequence, and if, as is usually the case, the mitral valve is affected, the resulting adequate flow of blood from the left atrium to the left ventricle is forced to work much harder than usual in compensation, and eventually may fail. Recently operations to break adhesions have greatly lengthened the life expectancy of rheumatic fever cases.

When the infection subsided, and once inflamed valves begin to heal, the formation of the new tissue on the valve cusps may cause them to retract, so that they are unable to meet when the valve attempts to close itself. This causes a leakage of blood through the valve, and is known as incompetence of the valve.

Since rheumatic fever is most common between the age of 4 and 20 years of age, rheumatic heart disease is really a disease of youth. It is the most important cause of death between the ages of 10 and 14 years of age. In addition to this many are crippled for life, with the need of greatly limiting their physical activities. Prevention of serious respiratory illness and the removal of diseased tonsils will help prevent many cases of rheumatic heart disease.

6) Recently operations to break adhesions have shortened the life expectancy of rheumatic patients.

Ex. 24. Read the text “Coronary artery disease” and ask as many questions as you can. Try to cover the main content of the text.

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.

Study the text “Pericarditis”. Read the passage dealing with the etiology of disease and express its content in 3-4 sentences.

Find and translate in a written form the passage dealing with the inspection of patients suffering 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.

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