The Anatomy of the Heart

The heart is a muscle, about the size of your fist that is encased in a sac called the pericardium. The pericardium helps to keep the heart in position and protects it from getting hurt. The pericardium and the heart are separated by a layer of lubricating fluid which allows the heart to pump freely inside the walls of the chest. The heart is made up of three layers of muscle, the endocardium, myocardium and epicardium. The myocardium makes up about seventy five percent of the heart tissue. The epicardium is a thin lining that covers the myocardium. There is a layer called the endocardium that is between the myocardium and the inside of the heart. The endocardium acts as the inner covering of the heart and protects the myocardium.

The heart functions as a pump that circulates nourishment and oxygen to, and carbon dioxide and waste away from, tissues and organs of the body. The heart is separated into four different chambers through which blood is pumped. The heart is separated by a thick wall of muscle called the septum, which divides the heart into two halves. Each half is then separated into an upper and lower chamber by valves. The upper chambers are called the atria and are the inputs to the heart. The lower chambers are called the ventricles and are the outputs of the heart.

The valves that separate the upper and lower chambers are called the atrioventriclular valves. The valve that separates the right atrium from the right ventricle is called the tricuspid valve and the valve that separates the left atrium from the left ventricle is called the mitral valve. A different set of valves controls the flow of blood from each ventricle to the main arteries. The valve that separates the right ventricle from the pulmonary artery, the artery that carries blood to the lungs, is called the pulmonary valve. The aortic valve is the valve that separates the left ventricle from the aorta, the main artery that carries blood to the rest of the body's organs and tissues.

Exercise 16. Give Ukrainian equivalents to the following medical terms and word combinations.

main artery, aortic valve, pulmonary valve, right ventricle, mitral valve, pulmonary artery, different set of valves, tricuspid valve, atrioventricular valves, upper chamber, lower chamber, septum, epicardium, myocardium, endocardium, pericardium, thick wall of muscle, inputs to the hear, outputs of the heart, protects the myocardium, thin lining, a layer of lubricating fluid, inner covering of the heart, circulates nourishment.

Exercise 17. Answer the following questions:

1. What is the size of the heart?

2. What does the pericardium help to?

3. What are the pericardium and the heart separated by?

4. What is the heart made up?

5. What is the function of the heart?

6. How many chambers is the heart separated into?

7. What are functions of different valves?

8. What valves is the heart separated by?

9. What is the function of the main artery?

Exercise 18. Form nouns form the following verbs.

To separate, to nourish, to divide, to control, to carry, to depolarize, to move, to pass, to change, to differ, to concentrate, to stimulate, to act, to relax, to contract, to pump, to indicate, to detect, to create, to conduct.

Exercise 19. Change the following sentences into the Passive.

1. The septum divides the heart into two halves.

2. The mitral valve separates the left atrium from the left ventricle.

3. The heart pumps nourishment and oxygen to tissues and organs of the body.

4. The aortic valve separates the left ventricle from the aorta.

5. A different set of valves controls the flow of blood from each ventricle to the main arteries.

6. Three layers of muscle make up the heart.

7. A layer of lubricating fluid separates the pericardium and the heart.

8. The pericardium protects the heart.

9. The pulmonary valve separates the right ventricle from the pulmonary artery.

10. The endocardium protects the myocardium.

11. The epicardium covers the myocardium.

12. The tricuspid valve separates the right atrium from the right ventricle.

Exercise 20. Retell the text “The anatomy of the heart”.

Exercise 21. Read and translate the text in a written form.

Electrical Potential of a Cardiac Cell

The cardiac system is a closed-loop hydraulic system that is constantly contracting and relaxing, pumping blood throughout the body. The cell wall of cardiac cells is a semipermeable membrane that allows the passage of some ions while restricting others. The cell membranes, at rest, tend to be more permeable to some ions than others. The movement of ions across a membrane changes the concentration of ions within and outside the cells which results in an action potential. This action potential of the cell results in a depolarizing and repolarizing of the cell itself. In a cardiac cell the action potential is caused by the movement of sodium and potassium at different rates. A phenomenon in a cardiac cell called the sodium-potassium pump moves sodium outside the cell and potassium inside. This results in a difference of ion concentration which in turn results in an electrical potential.

At rest the concentration of positive sodium ions outside the cell is higher than the concentration of sodium inside the cell which results in the electrical potential. This electrical potential is negative with respect to the outside resulting in a resting potential of a negative seventy to ninety millivolts. When the cell is stimulated, the sodium ions rush into the cell forcing potassium out which results in the action potential. This action potential results in the inside of the cell being twenty to forty millivolts more positive than the outside and the cell is said to have depolarized.

The cell is repolarized when the sodium-potassium pump pumps the sodium back out of the cell and the potassium back into the cell which resets the cell so it can be depolarized again. An ionic electrical conduction is started by the depolarization of one cell which in turn triggers the next cell causing an action potential. This situation causes a triggering of cells in a cascade effect making all the cells depolarized.

Exercise 22. Give Ukrainian equivalents to the following words and word combinations.

To change the concentration of ions, semipermeable membrane, to restrict, outside the cell, to pump blood, passage of some ions, cardiac cell, in turn, difference of ion concentration, electrical potential, within and outside the cells, resting potential, to rush into the cell, with respect to, ionic electrical conduction, cascade effect, concentration of positive sodium ions, sodium-potassium pump, action potential.

Exercise 23. Fill the blanks in the following sentences.

electrical conduction	positive sodium ions
heart	cascade effect
closed-loop	within and outside
allows	electrical potential
depolarizing	potassium

1. The movement of ions across a membrane changes the concentration of ions ………..the cells which results in an action potential.

2. The sodium-potassium pump pumps the sodium back out of the cell and the ……….back into the cell.

3. The …….. pumps blood throughout the body.

4. This results in a difference of ion concentration which in turn results in an electrical potential.

5. At rest the concentration of ………………….outside the cell is higher.

6. The cardiac system is a ……………………hydraulic system.

7. This situation causes a triggering of cells in a ……………………….

8. This action potential of the cell results in a ………………and repolarizing of the cell itself.

9. An ionic …………………..is started by the depolarization of one cell.

10. A semipermeable membrane ………..the passage of some ions

Exercise 24. Speak about a phenomenon in a cardiac cell.

Exercise 25. Read and translate the text.

Electroconduction System of the Heart

The electroconduction system of the heart is a complicated system of the body that begins in the right atrium at the sinoatrial (SA) node. The SA node, a small bundle of cells located on the back wall of the right atrium, serves as a pacemaker for the heart. The SA node fires, by self-excitation, an electrical impulse that is spread across the right atrium and to the left atrium by the Bachman's bundle so that both atria can contract at the same time.

The contraction of the atria forces blood from the atria to the ventricles through their respective valves. The impulse that is started at the SA node then travels to the atrioventricular (AV) node. The AV node acts as a delay line to slow down the action potential along the internal electroconduction system.

This is done so that all of the blood from the atria can be emptied into the ventricles before the ventricles contract. The action potential then travels from the AV node to the Purkinje fibers. The Purkinje fibers are arranged in two bundles, one bundle branching to the muscle in the right ventricle and the other branching to the muscles in the left ventricles.

The action potential moves through these fibers very rapidly and spreads throughout the ventricles at two to four meters per second. This causes the ventricles to pump fast and hard. This forces the blood through their respective valves out to the body at an extremely fast rate.

The contraction of the ventricles is known as systole. The relaxation of the ventricles is known as diastole.

The electroconduction of the heart starting at the SA node and traveling through the AV node to the Purkinje fibers creates a mass electrical signal that can be detected by placing electrodes on a patient's chest or extremities.

This electrical signal can be mechanically plotted and the resultant plot is called an electrocardiogram (ECG). The letters on the ECG represent different functions that occur in the heart. The P-wave indicates atrial contraction. Ventricular contraction is represented by the QRS complex, and the T-wave indicates ventricular repolarization.

Exercise 26. Answer the following questions.

1. Where does the electroconduction system begin?

2. Where is the SA node located?

3. What does the SA node serve as?

4. What does the contraction of the atria force?

5. What is the function of the SA node?

6. Where does the action of the potential travel to?

7. How are the Purkinje fibers arranged in?

8. What is a systole?

9. What is a diastole?

10. What does the electroconduction of the heart create?

11. What is called an electrocardiogram?

12. What does the P-wave indicate?

13. What is ventricular contraction represented by?

Exercise 27. Finish the sentences.

1. The relaxation of the ventricles is known as ___________.

2. A mass electrical signal that can be detected by placing electrodes on a patient's _______________.

3. The action potential moves through these fibers very ________.

4. The T-wave indicates ventricular ________________.

5. The ventricles pump _________ ________.

6. The action potential then travels from the AV node to ________ ________.

7. The electroconduction system of the heart is a complicated system of __________.

8. The contraction of the atria forces blood from the atria to the ventricles through ___ _______ ________.

Exercise 28. Open brackets and use a proper grammar form.

1. The letters on the ECG …..(to represent) different functions that occur in the heart.

2. The P-wave …….(to indicate) atrial contraction.

3. The Purkinje fibers ……(to arrange) in two bundles.

4. The contraction of the ventricles …..(to know) as systole.

5. The impulse …….(to travel) to the atrioventricular (AV) node.

6. The SA node …..(to locate) on the back wall of the right atrium.

7. The SA node serves as a pacemaker for the heart.

8. The blood from the atria …….(to empty) into the ventricles before the ventricles contract.

9. The electroconduction system of the heart ….(to begin) in the right atrium at the sinoatrial (SA) node.

Exercise 29. Read and translate the text.

Electrocardiograph

Electrocardiography is a method of graphic tracing of the electric current generated by the heart muscle during a heartbeat. The tracing is recorded with an electrocardiograph.

Electrocardiograph is a device to be attached to an organism’s chest in order to measure the physical movement of the heart in the chest. This device records the sounds of the heart as the blood moves through the various chambers, valves and vessels. The graph signature reflects the opening and closing of the valves, the contraction and strength of the heart muscle, and efficiency of the movement of blood. In other words, the graph signature is a reflection of heart activity. This graph signature is called an electrocardiogram (EKG or ECG).

ECG is a recording of the heart’s electrical activity as a graph or series of wave lines on a moving strip of paper or video. Three of the waves, the P-wave, the QRS complex and the T-wave, are associated with the heart’s contractions. The P-wave reflects activity in the heart’s upper chambers. The QRS complex and T-wave reflect activity in the lower chambers.

The ECG gives the physician important information about the heart. For example, it can show the heart’s rate and rhythm. It can also imply decreased blood flow (cardiac ischemia), enlargement (hypertrophy) of the heart or the presence of either current or past heart attacks.

ECGs are noninvasive, quick, safe, painless and inexpensive tests that are routinely done if a heart condition is suspected. Depending on what the results show, in combination with the patient’s medical history and a physical exam, the physician may order further tests or a combination of medications and lifestyle changes.

Nowadays the electrocardiograph has been improved by today’s technological advances. It combines high functionality, easy operation and aesthetic design.

Exercise 30. Give English equivalents of the following words and word combinations:

викликати електричний струм, серцебиття, графічне відображення, прилад, грудна клітка, клапани, судини, скорочення м’язу, хвилеподібні лінії, збільшення, наявність серцевих нападів, лікар, передбачати, вдосконалювати, технологічний прогрес, легкість в управлінні…

Exercise 31. Match please the following words and translate phrases that you have composed:

graphic blood

electric chambers

various history

contraction of the operation

movement of test

heart current

upper functionality

blood tracing

noninvasive valves

medical flow

technological muscle

high advance

easy attacks

Exercise 32. Exclude the word which is different in meaning.

method design way

cause generate combine

wave chest heart

examine show test

alter change provide

reflect record call

current past previous

quick fast fluent

reduce enlarge increase

routinely seldom usually

information data date

work rest activity

Exercise 33. Decide whether the sentence is true or false:

1. The ECG doesn’t provide physicians with really important information.

2. Electrocardiograph is attached to a head.

3. The ECG is a reflection of brain activity.

4. Three waves are associated with the heart’s contractions.

5. The P-wave reflects activity in the hearts upper chambers.

6. The T-wave reflects activity in the lower chambers.

7. Nowadays electrocardiographs combine low functionality and aesthetic design.

8. ECG is a recording on a moving paper or video.

9. The heart muscle generates electric current during a heartbeat.

10. The ECG can show the heart’s rate and rhythm.

Exercise 34. Make words of these groups of letters:

Rateh, lemsuc, civeed, raepp, iittvyca, hamciesi, tyrhhm, catkat, gensid, tentiap.

Exercise 35. Continue the following sentences:

1. Electrocardiography is a method of graphic tracing …

2. The ECG gives a physician an important information …

3. Electrocardiograph is a device to be attached to …

4. ECG is a recording of the heart’s electrical activity as a graph or …

5. ECGs are noninvasive, quick, safe, painless and inexpensive tests …

6. The P-wave reflects activity in the …

7. The QRS complex and T-wave reflect …

Exercise 36. Answer the following questions:

1. What is electrocardiography as a method? What is it for?

2. How does electrocardiograph work?

3. What are the three wave lines?

4. What important information does the ECG give to the physician?

5. May a physician order further tests or lifestyle changes?

6. What does the graph signature reflect?

7. By what means has the electrocardiograph been improved nowadays?

8. Does the electrocardiograph record the sounds of the heart?

9. Does the P-wave reflect activity in the heart’s upper chambers or in the lower chambers?

Exercise 37. Read and discuss advantages of the following ECG devices.

Clever, small and lightweight MAC 500 from GE Marquette

The portable electrocardiograph MAC 500 from GE Marquette*, offers you the most in terms of features and technology and it weighs a mere 2 kg.

Whether it's in the hospital ward, during house calls or in an emergency case - no matter where it's needed - this robust, battery-operated instrument is rapidly put into operation.

It combines functionality and aesthetics in a practical solution characterised by its unique design, simple push-button operation, extremely simple configuration, automatic 12 channel ECG documentation and special arrhythmia recording.

Options offer you a wide range of individual application possibilities. For example: automatic ECG measurement using the leading GE Marquette measurement software programme to provide you with a fast and reliable diagnosis.

Using the optional infrared data interface, you can transfer ECGs to cardiology departments for consultation. This data can be stored in the CardioSoft data management system for later analysis. This allows access to existing or future information systems.

MAC 500 stands for today's technology and design, for the demands of tomorrow and for a truly outstanding price performance ratio.

The standard resting ECG MAC 1200

The MAC 1200 is a resting ECG system whose true one-button operation makes it especially suitable for routine use in private practice, emergency medicine, or hospitals.

The MAC 1200 stands out for its high functionality and user friendliness to an unbeatable price and ratio performance. A standard, built-in battery device provides for mobile use - anytime and anywhere.

A unique feature: mains-independent operation, also together with electrode application system with an integrated pump (optional). Brilliant graphic display for 3 leads with easy-to-follow operator guidance.

With its three operational modes and available options the MAC 1200 fulfils standard requirements:

• automatic registration of a 10-second resting ECG with 12 leads simultaneously,

• manual - real-time registration of 6 channels,

• arrhythmia - continuous ECG monitoring for arrhythmia, with event documentation and a report afterwards.

There are individually adjustable output formats for evaluation of the ECG and for archiving:

- one A4 page for the complete 12-channel automatic ECG,

- combined output of all relevant curves, patient data, date, time and instrument settings, measurements, and interpretive text.

It is a pathbreaking technology thanks to networking capability and extendable software functions: - RS232 interface for communicating directly or via modem with CardioSys/ CardioSoft PC or with the MUSE CV data management system. Such software option keys as measurement, interpretation and memory (storage of 40 resting ECGs) are available.

Exercise 38. Read and translate the text.

MAC 5000 resting ECG system

The MAC 5000 is a premier resting EGG system. It delivers the advanced disease management capabilities that only the industry's roost extensive collection of proven algorithms can offer. And it's part of complete suite of networked, noninvasive testing solutions designed to maximize throughput and staff productivity.

The MAC 5000 system provides the sophistication required for advanced EGG applications. While its ease of use extends this degree of performance to the broadest range of users possible.

Advanced algorithm capabilities include true, 12-lead ECG computer analysis and interpretation, P-wave signal averaging, late potential analysis and 15-lead ECG analysis - for effective management of ventricular arrhythmia, atrial arrhythmia and chest pain.

The MAC 5000 system uniquely delivers seamless connectivity to the Catalyst™ MUSE® Information System for data storage and retrieval of ECGs.

Combine this connectivity with the inherent performance of the MAC 5000 system and you've got the ultimate resting ECG system.

Feature Highlights:

• 12SL1" with adult and pediatric interpretive ECG analysis remains your most clinically valuable second opinion.

• QRS signal averaging program.

• The P-wave signal averaging program features a patented templating algorithm which enhances measurement accuracy by maximizing signal fidelity.

• 15-lead acquisition, storage and analysis.

• Digital Compact Acquisition Module helps eliminates non-cardiac electrical noise.

• Order Manager allows auto download of patient demographic data from the Catalyst MUSE Information system.

• Optional Remote Query software facilitates immediate access to the complete ECG patient record.

• Optional ACI-TIPI (Acute Cardiac Ischemia Time-Insensidve Predictive Instrument) generates a numerical score representing the probability that the patient has Acute Cardiac Ischemia.

Exercise 39. Read and translate the text in a written form.

Problems occuring in the Heart

The heart is a system that has to be exact in all of its functions from start to finish for each beat to beat successfully. If an problem occurs, severe or minor, it can cause death for the patient. Physicians can look at a simple ECG reading and can tell if the patient is having any problems that can either be fatal or could lead to something fatal. Some heart problems that plague humans around the world are arrhythmias.

Arrhythmias are abnormal beats that can be detected on the ECG. Two of the arrhythmias that people with heart problems encounter are tachycardia and bradycardia. Tachycardia is a problem in which the heart beats at a rate faster than the normal human heart rate. Treatment for tachycardia consists of cardioversion or the delivery of a broad depolarizing shock to a restricted region of the heart. Rapid bursts of pacemaker impulses timed and placed at the proper time can often stop the tachycardia. Bradycardia is a problem in which the heart beats at a rate slower than the normal human heart rate. An implanted pacemaker can restore the lower heart rate to a more physiological value that will improve cardiovascular function.

Fibrillation is another major problem that affects the heart. Fibrillation is the uncontrolled beating of different parts of the heart. Ventricular fibrillation is a fatal arrhythmia of the heart in which the victim will die in minutes if it is not corrected. Atrial fibrillation is a less serious arrhythmia because the ventricles are still pumping. However it can lead to problems if it is not corrected. Heart block is another problem caused by the interruption of the internal electroconduction system of the heart. These are a few heart problems that people encounter that can be conquered with help from pacemakers, defibrillators, and modern technology.

UNIT 3

Exercise 1. Read and translate the text.

Defibrillators

The defibrillator is a device to be used by physicians for control of all critical care situations. The generation of modern units was developed in close consultation with medical experts to give them more reliability and greater control in any situation.

In critical care situations, physicians need to concentrate on the patient, not on the equipment. It's essential, therefore, that their defibrillator responds intelligently, accurately and on demand. Designed with the patient and user in mind, the new highly portable defibrillator and cardiac care system help emergency care clinicians expedite confident patient care.

Rugged design and water-tight standard conformity make some of the defibrillators ideally suited for both demanding emergency care environments and out-of-hospital use. The vibrant find-it-anywhere yellow housing and lightweight ergonomic design make them easy to use in fast-paced settings.

Sophisticated configuration and service modes allow easy device set-up and servicing. The monitor with its high-resolution display can be rotated by up to 180°, allowing you to keep an eye on your patient wherever you are: on the ward, in the operating theatre, intensive care or emergency admissions. All the important critical event data are recorded automatically and archived in the memory for recall when required, e.g. for a printout.

Just one gesture is all it takes to start the 3-step operating procedure quickly and easily. The clearly identifiable, colour-coded steps exclude virtually all-operating error and win you precious time. In the 'Autosequence' mode, normal adult energy levels (pre-configured) are selected automatically in succession without any need to increase the energy level, leaving you free to concentrate entirely on the patient.

The unit's compact design and low weight (only 8 kg, including mains adaptor, battery and paddles) plus optional SpO (oxygen saturation measurement) and/or external pacemaker means you have all the essential equipment you need at hand in the clinic and in pre-hospital use, now and in the future.

Exercise 2. Make words from the following group of letters and make sentences with them:

Dreotfiablri, leasisten, noexgy, tuin, tenqeuipm, ybraett, tapniet, adat, dyaslp, darw.

Exercise 3. Fill in the gaps:

1. The defibrillator is a ____ to be used by physicians ____ control of all ___ care situations.

2.__ critical care situations, physicians need ___ concentrate on the patient, not __the equipment.

3. The generation ___ modern units ___ developed in close consultation ___ medical

4. Sophisticated configuration ___ service modes allow easy device __ up and _____.

5. All ___ important critical event data ___ recorded automatically and archived in __ memory ___ recall when required.

6. Just one gesture ___ all it takes ___ start the 3-step operating procedure ____ and easily.

7. ___ clearly identifiable, colour-____ steps exclude virtually ___ operating error.

Exercise 4. Decide whether the sentence is true or false:

1.The defibrillator is a device to be used by psychiatrist.

2. In critical care situations, physicians need to concentrate on the equipment.

3. The defibrillators are designed with the patient and user in mind.

4. The monitor with its high-resolution display can be rotated by up to 185°.

5. All the important critical event data are not recorded automatically.

6. It takes a lot of time to start the 3-step operating procedure.

7. Sophisticated configuration and service modes allow easy device set-up and servicing.

Exercise 5. Divide the following words into categories:

Defibrillator, data, service, sophisticated, display, rotate, concentrate, develop, automatically, design, mode, archive, compact, battery, set-up, allow, essential, device.

Exercise 6. Continue the sentences:

1. Just one gesture is all it takes to start the 3-step operating procedure…

2. In critical care situations, physicians need to concentrate on the patient…

3. All the important critical event data are recorded automatically and …

4. The monitor with its high-resolution display allows you to keep an eye on your patient wherever you are: …

5. The generation of modern units was developed in close consultation with medical experts to give them more reliability and …

6. The vibrant find-it-anywhere yellow housing and lightweight ergonomic design makes them easy to …

7. Rugged design and water-tight standard conformity make some of the defibrillators ideally suited for both demanding emergency care environments and…

Exercise 7. Match please the following words and translate phrases that you have composed:

critical care units

modern consultation

close situations

energy adaptor

ideallyconfiguration

sophisticated recorded

automatically suited

mains level

Exercise 8. Answer the following questions:

1. What is the defibrillator used for?

2. Can this device be used only in clinics?

3. How are the important critical event data recorded?

4. What is the weight of this device?

5. Express your opinion: is it necessary to create and develop such devices?

6. What important qualities does the defibrillator have?

7. Does the construction of the defibrillator help the clinician to concentrate on patient or on the equipment?

Exercise 9. Find please in the texts English equivalents for such words and word combination as:

Дефібрилятор, медичні експерти, створені з думкою про пацієнта та споживача, водонепроникний, операційна, палата інтенсивної терапії, виключати фактичні помилки, вимірювання кисневого насичення.

The latest generation of compact defibrillators

The latest generation of compact defibrillators is the ideal defibrillators for rapid, reliable treatment in cardiac emergencies. The colour coded 3-step operating sequence, fail-safe two-hand defibrillation, visual and audible control signals, automatic internal safety discharging if the defibrillation function is interrupted and sophisticated service diagnostics guarantee exceptional reliability. Can be mains or battery operated for complete flexibility, wherever you are.

Modern defibrillators are the technically improved version of the former defibrillators. Essential in cardiology practices and for ergometric measuring, these units is designed to cope perfectly with any emergency situation and ensures safe, reliable defibrillation for babies right through to adults.

Extra functions such as e.g. synchronous defibrillation (Cardio-version) or the option of using different defibrillation electrodes(adhesive electrodes, internal defibrillation electrodes or handheld paddles) allow almost limitless use. Ideal for the stress test labs, in the operating theatre, the electro-physiological laboratory, on intensive care or cardiac wards, or anywhere else where a patient is being monitored.

Exercise 10. Read and translate the text in a written form.

On any ward

Accessories include vehicle mounting system with integrated 12 Volt or 110 to 240 V power supply, stand-alone battery charging and maintenance unit, carry case, and a full range of defibrillation electrodes.

No experiments - this fundamental principle applies to a full range of accessories for all conceivable uses. For it is known very well that the strengths of a product range are often judged by its accessories.

Apart from contact spoons for internal defibrillation and various electrodes for external defibrillation, a separate fast battery charging and servicing unit is also available. For monitoring the SpO level you have a choice of a range of sensors for newborns right through to adults. For pre-hospital use we offer a vehicle mounting unit which securely holds the defibrillator in place should the car overturn, a special 12-Volt connection facility, as well as a rugged, roomy carrying bag.

Exercise 11. Read and translate the text.

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