Medical English 專欄(三)

THE HEART AND BLOOD CIRCULATION

(I)               Case

Joe, a 48-year-old lawyer, had just gone through an extremely difficult divorce and custody battle. He began to notice some tightness in his chest while he was jogging. At first, he blamed it on indigestion. Finally, when it kept reappearing, he sought a medical diagnosis. A stress test showed an abnormality, and a follow-up angiogram revealed one diseased artery, which was 70 percent blocked. His cardiologist suggested a bypass operation, or an angioplasty.

(II)  Q&A

   Q: Do you have pain or pressure in your chest from time to time?

    A: 1. I feel a sensation of pressure over my chest.

       2. I have pain across the chest from time to time.

       3. My chest hurts when I breathe.

       4. My chest pain gets worse when I bend over.

       5. I can only walk three blocks before becoming short of breath.

       6. I need to sleep on three pillows. Sometimes I have to sit up or else I feel pressure in my chest.

    Q: I am going to take your blood pressure. Do you or your family member have hypertension or heart disease in the past?

      

    A: 1. I have high blood pressure.

       2. My blood pressure is really up.

       3. I feel my heart is beating too rapidly, sometimes I feel irregular heart beats

       4. My father had a heart attack last year. I know hypertension can be hereditary. Therefore, I am very nervous about it.

(III)         What he said

   He, liked most people, had felt heart disease just wouldn’t happen to him. He regularly noshed on lots of meat, hamburgers, cheese-burgers, and French fries. “I guess I was asking for it,” he said. “Although, you know, you always think it could never happen to you. I thought I was in shape – but I found out I really wasn’t.”

(IV)        Atherosclerosis and Coronary Heart Disease

  Atherosclerosis, by blocking blood flow in arteries, is the underlying cause for more death and illness in this country than any other disease. If it is found to cause symptoms in one area, such as with circulation to your legs, it is probably present in your other organ systems as well. Most patients with vascular problems die of their underlying heart disease regardless of which part of the body developed the first symptoms.

  Diagnosis of coronary artery disease can be very quick, easy, and inexpensive based on your history, physical examination, and EKG. However, often other more expensive tests, such as Echocardiogram, Radioisotope Ejection Test or CT Scan of Coronary Arteries, may be necessary to characterize and quantify the problems.

(V)  What he said

  “I was scared,” he said. “That was the closest I’ve ever been to anything major. And as I was wheeled into this room with all those doctors and equipment, I was intimidated. Anything could go wrong. All of a sudden, I felt very much alone, hoping everything would be all right and worrying about my wife and family.”

(VI) Risk Factors

Potentially Correctable	Probably Not Correctable
High Blood Pressure	Family History
High Cholesterol	Male Gender
Cigarette Smoking	Age Over 60
Obesity
Physical Inactivity

(VII) What Is the Role for Lifestyle Changes?

  It is clear from research reports from around the world that lifestyle changes are important for people with heart disease and high blood pressure. The majority of correctable cardiac risk factors can be improved by relatively simple lifestyle improvements.

  Developing a consistent and safe exercise program is a cornerstone for maintaining a healthy lifestyle. Exercise helps to increase vigour and endurance. Coupled with a prudent diet, exercise helps a person achieve and maintain a healthy body weight. Not only can a person’s weight improve, but blood pressure, cholesterol, anxiety, and depression can also improve with a program of regular exercise and a healthy eating plan.

  A healthy eating plan can be especially helpful in lowering cholesterol and blood pressure. The changes can sometimes be substantial enough to make it possible to not have to use lipid-lowering or antihypertensive medications or to at least lower the dosages.

(VIII)  Vocabularies

                           Heart murmur

                           Arrhythmia

                           Cardiac arrest

                           Heart attack

                           Coronary artery disease

                           Myocardial infarction

                           Angina pectoris

                           Pallor

                           Cyanosis

                           Palpitation

                           Shallow breathing / Shortness of breath

                           Chest pain

(IX)        Dialogues

  P: Is it true that heart disease has been the leading cause of death and disability?

  N: Yes. Important heart diseases such as congenital cardiovascular disease, rheumatic heart disease, coronary heart disease, and hypertensive heart disease account for about 30 percent of deaths in the United States.

  P: Really? What are the causes of coronary heart disease?

  N: Long-term, high intake of cholesterol, cigarette smoking, uncontrolled hypertension and lack of exercise all contribute to the development of the disease.

  P: How do you detect heart diseases?

  N: We use and electrocardiogram and cardiac catheterization as the standard cardiac diagnosis.

  P: Have you operated on a human heart?

  N: Of course. We have competent surgeons and the best equipment for any heart operation. Our heart surgery team has successfully repaired the transposition of great arteries of three patients, and performed coronary surgery and heart transplants successfully many times.

  N: Don’t eat so much fat. Fatty deposits will build up on the inside walls of the arteries, making the vessels hard and narrow. This condition interferes with the flow of blood through the arteries, and can lead to heart attacks.

  P: I see. Why hypertension is called “the silent killer”?

  N: Because it seldom produces symptoms until after it has caused widespread damage to the heart and blood vessels.