MED-Text   1

QUESTION            

clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
M1.Q1.	I am a 26 year old female 	I					Force:Time	heart beats	
	experiencing abnormal heart beats. 				Composition:
Abnormality				
M1.Q2.	When an episode occurs,
I feel a heavy and sudden beat and a feeling as if I had been frightened or had missed a step on a stair. 	I	

Irrealis: -  Disinclination: Fear					episode (abnormal heart beat)	
M1.Q3	The occurrences were random, 	I			Composition:
Irregularity			occurrences	
	often in the afternoon					Mood Adjunct: Usuality   Objective	Force: Median		
	but 					Concessive			
	concentrated within a period of two or three hours. 						
Force:Time

M1.Q4	At the worst time,	I	

		- Valuation		Force: Intensifier
	irregular beats	
	I could count					Modalisation:
Ability
Subjective	Force:Low
		
clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
	60 irregular beats				t, - Valuation		Force:Quantity		
	in 7 minutes, 						Force:Quantity		
	often 					Mood Adjunct:
Usuality   Objective	Force: Median		
	2  closely together 
between several regular beats. 						Force:Quantity
Force:Space, Quantity		
M1.Q5	I could also feel
from my pulse
that the interval between the irregular beat and the previous regular beat
				t, Reaction:
- Quality	Modalisation: Ability  Subjective
	Force:Low
	the interval

	
	was shorter than the normal interval between two regular beats
				- Valuation		Force:Manner of degree		
M1.Q6.	This condition first occurred 
when I was 24
	I			- Valuation		

Force:Time 	this condition	
M1.Q7.	I was under lots of 
pressure with a job and planning my wedding
	I	Realis:
Dissatisfaction:
Displeasure				Force:Quantity 	pressure	
M1.Q8.	My doctor told me 	my doctor				Attributed projection
		It	
	it was nothing 						Focus:Sharpen		
clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
	to worry about 

	I	Irrealis:
Disinclination:
Fear				

		
	since I had the EKG
and several blood test including thyroid tests
	I					
Force:Quantity		
	and all results  were normal	I			
t, + Valuation		Focus:Sharpen 		
M1.Q9.	The condition eventually went away	I			
+ Valuation 
		
Force:Manner of degree	the condition	
	after about 3 months and for the past 2 years 
	I					Focus:Soften		
	I only experienced	I				Continuative			
	maybe  	I				Mood Adjunct:
Probability Objective
	Force:Low		
	less than ten very minor occurrences	I			
+ Valuation		Force:Intensifier		
M1.Q10.	But 					Concessive		it	
	it came back
very 
seriously	I			- Reaction:
Impact 
		
Force:Intensifier
Force:Manner of degree		
	this time,	I			t, + Valuation				

clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
	more severe in terms of frequency
	I			
- Valuation		Force:Manner of degree		
	for about three continues day (all in the afternoon)
	I					Focus: Soften		
	and became less severe (but not absent) after the three day period
	I			
- Valuation		Force:Manner of degree		
M1.Q11.	I don't smoke, don't drink coffee and alcohol. 
	I		t, + Propriety, good habit				don’t smoke,  don't drink coffee and alcohol (to avoid unhealthy habits)	
M1.Q12.	I do drink tea and coke. 
	I		t, + Normality				tea and coke	
M1.Q13.	The only causes 	I					Focus:Sharpen	causes	
	I can think of are	I				Modalisation: Ability 
Subjective	Force:Low		
	stress and lack of sleep. 	I	t, Realis: Unhappinnes: Misery						
	I have several questions	I			Not evaluative			

benign	
	1). Is my condition still considered 'benign' ?
	I			t, + Valuation, Technicality	
Continuative			

clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	

	2). What can I expect in the future?
	I			Not evaluative				
	Will 
this occur more and more often and more and more severely?
	I			- Valuation	Modalisation:
Probability
Subjective	Force:Median
Force:Manner of degree	this	
	3). Even if this is
still benign, 	I				Concessive
Continuative		this	
	will this lead to 	I			

	Modalisation:
Probability
Subjective
	Force:Median

	any other kind of more serious conditions? 	I			 - Valuation		
Force: Manner of degree		
	4). Can I just  ignore it, 	I		t, + Tenacity		Modulation:
Ability 
Concesive
Subjective
	Force: Low	I	
	or should					Modulation:
Obligation   Subjective
	Force:Median    		
	I do something to try to prevent  this from happening again? 
	I		t, + Capacity					
	Should I excercise?  	I			t, + Valuation	Modulation: Obligation
Subjective    	Force:Median 	I	
clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
M1.Q15.	This is very frustrating and frightening emotionally if not physically especially 
	I	Irrealis: Disinclination: Fear				Force:Intensifier

 
	this	
	since I am still 
very young 	I				Continuative	
Force:Intensifier		
M1.Q16.	Please give me some guidance
				Not evaluative				

ANSWER

clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
M1.A1.	The description of your condition would   
	Doctor (support giver)			

	Modalisation:
Probability
Subjective	

Force:Median   	PVC	
	be consistent with premature ventricular beats (PVC'S)				t, Appreciation: Balanced, Technicality 	     			
M1.A2.	These beats occur in many healthy individuals  	Doctor			
t, + Valuation    		
Force:Quantity 
	these beats	
	and often 
	Doctor				Mood Adjunct:Usuality
Objective	Force:Median
	symptoms	
	no symptoms are experienced				- Valuation		Focus:Sharpen		
clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
M1.A3.	Some individuals, 
	Doctor		
		
	Force:Quantity  
	some individuals	
	however, are very sensitive    	Doctor		- Capacity      		Concessive	Force:Intensifier 		
	and experience every single ectopic beat  
     	Doctor			t, Reaction: - Quality		
Focus:Sharpen   		
M1.A4.	Most young individuals with PVC'S have no underlying heart disease.
				Not evaluative  				
M1.A5.	To investigate your problem, your doctor will probably want to do several  tests	Doctor	

t, + Valuation: Useful.	

Modalisation:
Probability
Objective

Force:Median
Force:Quantity
	tests	
M1.A6.	A Holter monitor or event monitor will  allow your rhythm
disturbance to be documented on an EKG    
	Doctor			t, + Valuation, Technicality	

Modalisation:
Usuality    
Subjective	
Force:Median	Holter monitor	
M1.A7.	An echocardiogram  will help to discover structural heart disease   
     	Doctor			t, + Valuation, Technicality	
Modalisation:
Usuality 
Subjective   	
Force:Median    	echocardiogram	

clause	instantiation	appraiser	affect	judgement	appreciation	engagement	graduation	appraised	
M1.A8.	You might have a common problem      such as mitral valve prolapse; 
	Doctor			
+ Valuation
Technicality
    	Modalisation:
Probability
Subjective         	Force:Low         	common problem      	
	however  PVC'S        
	Doctor			
	Concessive

	may be a marker for a rare condition  such as cardiomyopathy. 
   				t, - Valuation,
Technicality      	Modalisation: Probability   
Subjective    	Force:Low        

M1.A9.	A stress test will      be useful to investigate the possibility of coronary heart disease
	Doctor			t, + Valuation, Technicality     	Modalisation: Usuality 
Subjective    	Force:Median  

	stress test	
	and many   
	Doctor				
	Force:Quantity 
	arrhythmias	
	arrhythmias will  only show up or 
	Doctor				Modalisation:
Usuality 
Subjective  	Force:Median

	become worse  with exercise.	Doctor			- Valuation     	    	Force: Manner of degree                     		
M1.A10.	Many arrhythmias that are suppressed with exercise                 are benign.
	Doctor			+ Valuation:
Significant, Technicality		Force: Quantity        	benign	

Note:
1)  Normal beats is about 70 times per minute by balanced nerve impulses and muscle squeezes, Mosby Medical Dictionary.

MED- Text  1      TECHNICALITY EXPLANATION

Question

Q1 - Heartbeats: a)  a single complete cycle of contraction and dilation of heart muscle (Hensyl, W.R., 1990:687)  b)  a complete cycle of contraction and relaxation of the heart. (Mosby, 1997)

Q8, A6 - EKG= Electrocardiogram (Hensyl, W.R. , 1990:493) [electro- + G. kardia, heart, + gramma, a drawing]. Graphic record of the heart’s action currents obtained with the electrocardiograph (an instrument for recording the potential of the electrical currents that traverse the heart and initiate its contraction).  ECG = Electrocardiogram (ECG or EKG) is the graphic record of the heart's electrical currents obtained with the electrocardiograph, an instrument designed for recording the electrical currents that traverse the heart and initiate its contraction.  (http://spacebio.net/glossary/e.html)
A7 - Echocardiogram = An echocardiogram is an instrument that uses ultrasound (sound waves at extremely high frequencies) to produce images of the heart and major blood vessels non-invasively (without breaking the skin).  ((http://spacebio.net/glossary/e.html)

Q8 - Blood test= a) Any test designed to discover abnormalities in a sample of a person’s blood, such as the presence of alcohol, drugs, or bacteria, or to determine the blood group (Martin, 1987:72). b) Any test that determine something about the characteristics or properties of the blood (Anderson, 1994:205)

Q8 - Thyroid (function) tests= Any of several laboratory tests performed to evaluate the function of the thyroid gland. Often function tests include protein bound iodine, butanol extracable iodine, T3, T4, free thyroxine index, thyroxin binding globulin, thyroid stimulating hormone, long-acting thyroid simulator, radiactive iodine uptake, and radioactive iodine excretion (Anderson, 1994:1555). 

Q11, A10 - Benign= a) Denoting the mild character of ilness or the nonmalignant   character of a neoplasm (Hensyl,1990:180). b) Noncancerous and therefore not an immediate threat even though treatment eventually may be required for health or cosmetic reasons (Anderson, 1994:179).  Describing a tumour that doesn’t invade an destroy the tissue in which it originates or spread to distant sites in the body, i.e. tumour that is not cancerous. 

Answer
A8 - Premature ventricular beats (PVC’s)=  What are PVCs?
PVCs are extra electrical impulses arising from one of the cardiac ventricles, usually the left ventricle. 
The normal heart rhythm: (Note: Click here for an illustrated explanation of the normal heart rhythm.) Normally, the heart rhythm is controlled by electrical impulses arising in the sinus node portion of the right atrium.  These impulses travel across both atria, then enter the ventricles through the AV node and the His bundle.  This normal pattern of electrical activation causes the atria to contract first, emptying their blood into the ventricles, and then causes the ventricles to contract.  The normal heart rhythm, then, maintains optimal synchrony between atria and ventricles.
A PVC is caused by a spontaneous electrical impulse arising in the ventricle.  This impulse occurs earlier than the normal impulse would (hence it is “premature.”)  Sometimes the presence of PVCs indicates an inherent electrical instability in the heart, and therefore indicates an increased risk of sudden death from its more dangerous cousins, ventricular tachycardia and ventricular fibrillation.  These “dangerous” PVCs are generally limited to patients with significant underlying heart disease. More often, PVCs do not indicate any inherent problem with electrical stability, and are completely benign.  We will describe soon how doctors can determine whether or not PVCs are benign.
A PVC  is illustrated here. Two normal heart beat complexes are followed by a single premature ventricular complex (PVC).  The PVC occurs early, and the heart beat generated by the PVC is therefore relatively "weak."  Because after the PVC there is a delay before the next, normal heart beat, that next beat is typically quite strong.   The patient will often perceive a pause, followed by a very strong beat.  This sensation is often termed a "skipped beat," whereas actually it is an "extra" beat.		

A3 - Ectopic beat= a)  (extrasystole) a heart beat due to an impulse generated somewhere in the heart outside the sinoatrial node.  Ectopic beats are generally premature in timing; they are classified as supraventricular if they originate in the atria and ventricular if they arise from a focus in the ventricles. They may be produced by any heart disease, by nicotine from smoking, or by caffeine from excessive tea or coffee consumption; they are common in normal individuals. The patient may be unaware of their presence or may feel that his heart has ‘missed  a beat’. Ectopic beat may suppressed by drugs such as quinidine, propanolol, and lignocaine; avoidance of smoking and reduction in excessive tea or coffee intake may help.  b) A heartbeat which had its origin at some place other than sino-atrial node (Anderson, 1994:523)

A6 - Holter monitor=  a device for making prolonged electrocardiograph recording on a portable tape recorder while the patients conduct normal daily activities. The patient also may keep an activity diary for the purpose of comparing daily events with ECG tracing (Anderson, 1994:746).  
  
Event monitor=Cardiac Event Monitors    What is a cardiac event monitor?
A cardiac event monitor is a small recorder that records your heart activity only when you want it to. When you experience symptoms, you activate the monitor to make a brief recording of your heart’s electrical activity. There are different models of event monitors. They can be worn like a wristwatch, carried in your purse or pocket, or worn like a beeper. 
A7 -  Structural heart disease=What Is Structural Heart Disease?
Summary 
… the condition must be further described; for example, one must know whether the structural heart disease is due to hypertrophic cardiomyopathy, rheumatic mitral stenosis, recent myocardial infarction, or so forth. If it stands alone, the phrase "structural heart disease" is meaningless. Decisions about which drug(s) should be used in patients with indications for arrhythmia treatment should be based on what is known, and what the physician thinks is the best therapy for the individual patient. Obviously this requires knowledge of the literature, but it also requires clinical judgement.
 (http://www.clinicalcardiology.org/briefs/200006briefs/cc23-397.editorsnote.html)

A8 - Mitral valve prolapse=  by Ronald Hoffman, M.D.  Conscious Choice, May 1996
Mitral valve prolapse is a fairly common medical problem that is the focus of some controversy and even confusion among both physicians and those who suffer from it. There is at the same time less to it and more to it than at first appears. Mitral valve prolapse is named for a heart valve and is usually first diagnosed as a faint heart "click" or murmur, though it isn't a form of "heart disease" in any conventional sense. It's a relatively benign condition, though it is linked to a confusing array of seemingly unrelated symptoms, from shortness of breath to panic attacks. Mitral valve prolapse is generally the most benign of the various types of heart murmurs, and is probably genetic in origin. It is the most common valvular disorder in industrialized nations at the present, since the risk of heart murmurs from rheumatic fever has been reduced. Mitral valve prolapse is thought to affect five percent of the population, or nearly seven million people, though the number of borderline cases may be much higher. (http://www.consciouschoice.com/holisticmd/hmd093.html)

A8 -  Cardiomyopathy=  a) [cardio- + G. mys, muscle, + pathos, disease]. Myocardiopathy; disease of the myocardium. As a disease classification, the term is used in several different senses, but is limited by the World Health Organization to: “Primary disease process of heart muscle in absence of a known underlying etiology”  (Hensyl, 1990:248). b) Any cronic disorder affecting the muscle of the heart. It may be inherited but can be caused by various conditions, including virus infection, alcoholism beriberi (vitamin B deficiency), and amyloidosis. The cause is unknown. It may result in enlargement of the heart, heart failure, arrhythmias, and embolism. There is often no specific treatment but patient improve following the control of heart failure and arrhythmias (Martin, 1987:92).  c) Any disease that affects the structure and function of the heart (Anderson, 1994:266).

A9 -  Stress test
Stress test (usually with ECG; also called treadmill or exercise ECG) - a test that is given while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery. 

A9, 10 - arrhythmias=   a) [G. a-priv. + rhytmos, rhythm]. Lost of rhythm; denoting especially an irregularity of the heartbeat (Hensyl, 1990:120). b) Any deviation from the normal rhythm (sinus rhythm) of the heart. The natural pacemaker of the heart (the sinoatrical node), which lies in the wall of the right atrium, controls the rate and rhythm of the whole heart under the influence of the autonomic nervous system. It generates electrical impulses that spread to the atria and ventricles, via specialised conducting tissue, and cause them to contract normally. Arrhytmias result from a disturbance of the generations or conduction of  these impulses and may be intermittent or continuous. They include ectopic beats (extrasystoles) ectopic tachycardias, fibrillation, and heart block (which is often associated with slow heart rates). Symptoms include palpitations, breathlessness, and chest pain. In more serious arrhytmias the Stoke-Adams syndrome or cardiac arrest may occur. Arrhytmias may result from most heart disease but they also occur without apparent cause (Martin, 1987:42).  c) Any deviation from the normal pattern of the heartbeat. Kind of arrhythmias include atrial fibrillation, atrial flutter, heart block, premature atrial contraction, and sinus arrhythmia (Anderson, 1994:121)