Lesson 11 grammar: The complex object text: Rheumatic Endocarditis The theoretical part Presentation of a new item

Text: “Rheumatic Endocarditis”

The patient complained of a general malaise, early fatigue on exertion, cardiac discomfort and palpitation.

The physician found him to have been having an increase of body temperature to a subfebrile level for a prolonged period of time. The patient stated that the onset of the disease had been preceded by tonsillitis. The patient’s pulse rate had become irregular and accelerated on physical exertion.

The blood analysis revealed moderate leucocytosis and an elevated ESR. The electrocardiogram showed the changes in the most important readings. On percussion the doctor determined the heart to be slightly enlarged. These findings of the physical examination were confirmed by the X-ray examination.

While listening to the patient’s heart the doctor found a soft systolic murmur to be heard at the heart apex. These symptoms were accompanied by diastole murmur heard at the apex and base of the heart. The doctor estimated the murmurs to be varying in their intensity and duration. It was evidence of an inflammatory process in the valves. The doctor determined the organic changes in the mitral, aortic and tricuspid valves to be clearly marked.

The physician considered the patient to be ill with rheumatic endocarditis and insisted on his following a strict bed regimen at the in-patient department.

Answer the following questions.

1. What most characteristic clinical manifestations has rheumatic endocarditis?

2. What readings does the electrocardiogram show in case of rheumatic endocarditis?

3. How can a therapeutist determine the enlargement of the heart?

4. How can systolic and diastolic heart murmurs be revealed in patients with rheumatic endocarditis?

5. What regimen must a patient with rheumatic endocarditis follow?

The practical part