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.

Dramatize the dialogue using these expressions.