4. Choose the sentences in the text to answer the following questions.

   1. What is the anginal syndrome caused by?

   2. Where is the pain usually located?

   3. What are the typical symptoms of angina pectoris?

5. Write an annotation using the following statements as an outline.

   1. Angina pectoris is a widely spread acute coronary insufficiensy.

   2. Pain in the chest is the prominent clinical manifestation of angi­na pectoris.

   3. Angina pectoris may often be an accompanying disease of some underlying disorders.

CARDIAC ARRHYTHMIAS

Occasionally, the patient is not aware of an arrhythmia and it may be detected only by careful physical examination. Certain arrhythmias can be identified by observing their effect on the pulse rate or rhythm, or by cardiac auscultation.

PAROXYSMAL TACHYCARDIA

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by a few isolated prem»t^Tir^ г^пгЧ"^гяг^^пТ1С +ь_Р аащр frypg The patient is almost always awajre_of the onset, since it is accompaniecTb^JJip anbjaa— tive feeling of_ "somethmg^Eurnllig <Jver"Jji his^c^ejt^J'shock" in the chest, skipped heart beat, or chokingsensation.

Occasionally, no symptoms accompany the paroxysm, but frequently the patient has a fluttering sensation in the chest, feels weak япН іак^ and тяу be nauseated. Arterial blood pressure may fall and cHnical man- ifestations be similar to those of secondary surgicai-shotkTor cardiac foil»ure may develop with or without signs of shock. Danger of such compli­cations increases with the rapidity of the heart rate, and it is greater with ventricular tachycardia than with supra-ventricular tachycardias of the same rate. During an attack, some patients complain of precordial dis­comfort or even anginal pain.

Auscultation reveals a rapid regular heart rate, but is of no help in differentiating the types of tachycardia. The patient's history is impor­tant in distinguishing sinus tachycardia from paroxysmal tachycardias. Maneuvers designed to interrupt the tachycardia are useful for diagnosis and treatment. These induce expiration against a closed glottis, attempt­ed inspiration with the glottis closed, lying down with feet in the air, bending over, emesis, induced mechanically or with warm sodium bicar­bonate, pressure on the eyeballs, or compression of one or both carotid sinuses. It may stop atrial tachycardia or nodal tachycardia.

1. Skim through the text and define its main idea.

2. Read the text and divide it into several independentt parts.

3. Choose the sentences from the text describing:

   1. the symptoms of paroxysmal tachycardia and nodal rhythm.

   2. maneuvers designed to interrupt tachycardia.

4. Write a short summary of the text.

Mitral insufficiency

The mitral valve is the one most often attacked by endocarditis; it's the most common lesion producing mitral insufficiency.

A patient with a mitral insufficiency beginning in childhooc^is^rotta ідд^,- be small in stature, rather рий^^іг^ appearance, and his г are •

clubbed. The precordium mayvlsibly ^bulge'and heave forcibly with each heart beat. His face, lips, ears and extremities are always just a trifle cyanotic; after exertion they actually become blue.

Even while compensation is good, palpitation of the heart, shortness of breath on exertion, and cough due to chronic passive pulmonary con­gestion are common symptoms. The pulse may be regular and of good vol­ume, but not infrequently it becomes irregular either as a result of extrasystoles or of fibrillation, which may persist indefinitely. The blood pressure tends to be low

.The signs of mitral insufficiency include those of transverse intensi­ty at the apex transmitted towards the axilla.