The Heart

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absence makes the heart grow fonder 讲解

absence makes the heart grow fonder 讲解"Absence makes the heart grow fonder" 是一句英文谚语，意思是“距
离产生美”。

这句话的意思是，当人们或者事物不在身边或者不在视线范围内时，人们通常会更加怀念和珍视他们。

这句话的含义是因为当人们不再看到某个人或者事物时，他们开始想念他们，而且想念的感觉会随着时间的推移而增加。

这种思念会让他们更加珍惜对方，觉得对方更美好，因为他们现在能够将对方的美好在记忆中夸大，而不是受到日常接触中可能出现的小摩擦的影响。

此外，这句话也可以理解为当我们不再拥有某个人或者事物时，我们会更加珍视他们。

当我们意识到某个人或者事物已经离开我们时，我们会开始感激他们曾经给我们带来的美好和快乐，并且希望能够重新拥有他们。

总之，"Absence makes the heart grow fonder" 这句话提醒我们珍惜当
下的人和事物，同时也要感激我们曾经拥有过的一切。

z005 How the Heart Works

How the Heart WorksThis is the VOA Special English Health Report.We talked last week about the life of famed heart doctor Michael DeBakey. He died this month at age ninety-nine.Today, we talk about the object of his work. The heart is a complex organ that starts beating a few weeks after conception. At this point the heart is a tube. In the coming days, it grows and bends into the shape of the heart.Later, it divides into four parts. As the heart beats, it pumps blood through these chambers and the blood vessels in the body. The body is estimated to have at least ninety-six thousand kilometers of blood vessels.That is about the same as two and a half times around the Earth. But blood goes the distance in about twenty seconds on its way back to the heart. Each day the heart pumps about eight thousand liters of blood.The blood feeds the brain and other organs with oxygen and nutrients. It also carries away carbon dioxide and other waste.The heart pumps by expanding and contracting of muscle. In a healthy adult, the heart beats an average of seventy-two times a minute -- about one hundred thousand times a day.A healthy adult heart is about the size of two fists and looks like a piece of red meat. But in overweight people, it can look yellow because of fat.Rates of heart disease started growing sharply in the second half of the twentieth century. As machines did more and more work, people did less and less. Not only did physical activity decrease, but people started eating more and more processed foods.Experts say a diet low in fats and high in fruits, vegetables, proteins and whole grains may help reduce the risk of heart disease. At least thirty minutes a day of physical activity, enough to work up a sweat, can also help. Also important to good health is a good night's sleep.Cardiovascular disease is caused by disorders of the heart and blood vessels. It includes heart attacks, strokes and high blood pressure. The World Health Organization says there are three major causes: tobacco use, physical inactivity and an unhealthy diet.The W.H.O. says cardiovascular disease is the world's leading cause of death. And it is predicted to remain that way unless more action is taken. Experts estimate that it could kill twenty million people a year by twenty fifteen. An estimated seventeen and a half million people died in the year two thousand five. Around eighty percent of them died in low- and middle-income countries. And that's the VOA Special English Health Report, written by Caty Weaver. I'm Steve Ember.。

Structure of The Heart 心脏结构

Structure of The Heart心脏结构Cardiac muscle is a unique muscle tissue found only in the heart. Unlike most forms of muscle, which are stimulated to contract by nerves or hormones, certain cardiac muscle cells can contract spontaneously. Without a constant supply of oxygen, cardiac muscle will die, and heart attacks occur from the damage caused by insufficient blood supply to cardiac muscle.The human heart has four chambers. The upper two chambers, the right and left atria, are receiving chambers for blood. The atria are sometimes known as auricles. They collect blood that pours in from veins, blood vessels that return blood to the heart. The heart’s lower two chambers, the right and left ventricles, are the powerful pumping chambers. The ventricles propel blood into arteries, blood vessels that carry blood away from the heart.The right and left sides of the heart are separated from each other by a wall of tissue. Each side pumps blood through a different circuit of blood vessels: The right side of the heart is responsible for pumping oxygen-poor blood to the lungs, while the left side of the heart is responsible for pumping oxygen-rich blood to the body. Blood returning from a trip around the body has given up most of its oxygen and picked up carbon dioxide in the body’s tissues. This oxygen-poor blood feeds into two large veins, the superior vena cava and inferior vena cava, which empty into the right atrium of the heart. The right atrium conducts blood to the right ventricle, and the right ventricle pumps blood into the pulmonary artery. The pulmonary artery carries the blood to the lungs, where it picks up a fresh supply of oxygen and eliminates carbon dioxide. The blood, now oxygen-rich, returns to the heart through the pulmonary veins, which empty into the left atrium. Blood passes from the left atrium into the left ventricle, from where it is pumped out of the heart into the aorta, the body’s largest artery. Smaller arteries that branch off the aorta distribute blood to various parts of the body.Four valves within the heart help prevent blood from flowing backward in the heart. The valves open easily in the direction of blood flow, but when blood pushes against the valves in the opposite direction, the valves close. Two of the valves are located between the atria and ventricles, and are known as atrioventricular valves. The right atrioventricular valve is formed from three flaps of tissue and is called the tricuspid valve, while the left atrioventricular valve has two flaps and is called the bicuspid or mitral valve. The other two valves are located between the ventricles and arteries. They are called semilunar valves because they each consist of three half-moon-shaped flaps of tissue. The right semilunar valve, between the right ventricle and pulmonary artery, is also called the pulmonary valve. The left semilunar valve, between the left ventricle and aorta, is also called the aortic valve.Muscle tissue known as myocardium or cardiac muscle wraps around a scaffolding of tough connective tissue to form the walls of the heart’s chambers. The atria, the receiving chambers of the heart, have relatively thin walls compared to the ventricles, the pumping chambers. The left ventricle has thethickest walls—nearly half an inch thick in an adult—because it must work the hardest to propel blood to the farthest reaches of the body.A tough, double-layered sac known as the pericardium surrounds the heart. The inner layer of the pericardium, known as the epicardium, rests directly on top of the heart muscle. The outer layer of the pericardium is attached to the breastbone and other structures in the chest cavity and helps hold the heart in place. Between the two layers of the pericardium is a thin space filled with a watery fluid that helps prevent these layers from rubbing against each other when the heart beats.The inner surfaces of the heart’s chambers are lined with a thin sheet of shiny, white tissue known as the endocardium. The same type of tissue, more broadly referred to as endothelium, also lines the body’s blo od vessels, forming one continuous lining throughout the circulatory system. This lining helps blood flow smoothly and prevents blood clots from forming inside the circulatory system. The heart is nourished not by the blood passing through its chambers but by a specialized network of blood vessels. Known as the coronary arteries, these blood vessels encircle the heart like a crown. About 5 percent of the blood pumped to the body enters the coronary arteries, which branch from the aorta just above where it emerges from the left ventricle. Three main coronary arteries—the right, the left circumflex, and the left anterior descending—nourish different regions of the heart muscle. From these three arteries arise smaller branches that enter the muscular walls of the heart to provide a constant supply of oxygen and nutrients. Veins running through the heart muscle converge to form a large channel called the coronary sinus, which returns blood to the right atrium.。

Examination of the Heart

Any thrill should be described as to its location, its time in cardiac cycle, and its mode of extension or transmission.
The intensity of the thrill varies according to the velocity of the blood, the degree of narrowing of the orifice and which it is produced and difference in pressure between the two chambers of the heart.
It is usually felt only over a small area at or near the point of maximum impulse. It may not be felt when the patient is lying quietly in bed,
but may be brought out by moving the patient up and down rather rapidly a few times and thus producing more active cardiac contractions, and also by turning the patient on his left side.
Thrill examination by palm
Apical impulse examination by finger
Apical impulse(心尖搏动)
location duration amplitude intensity frequency regularity

The Heart Is a Lonely Hunter

镇上有对形影不离的哑巴. 每天一大早,他们从住处出来,互相挽着去上班. 然而这对朋友无论是外形还是性格,却是一点也不像. 老是选路的那位是个爱乱想的胖希腊人. 一到夏天,他就套着一件黄色或绿色的polo衫,要么邋遢地塞到裤子里,要么松松垮垮地吊在身后. 气温低的时候,他会加上一件不伦不类的灰色毛衣. 他的脸圆且油腻,总是一副睡眼惺忪的样子,嘴角弯出一幅绅士而又傻气的笑容. 另一个哑巴很高. 他的眼中总是闪现着敏捷,睿智的神采. 他很干净,总是穿得一本正经. 每天早上,两个朋友一言不发地走到镇上的主干道. 等走到那个卖水果和糖果的商店,他们会停下来,在人行道旁站上一会. 希腊人斯皮洛思安东那帕罗斯给他的表哥也就是水果店的店主打工. 制作糖果,把水果从包装箱里取出还有负责商店卫生都是他的工作. 瘦点的哑巴约翰辛格,几乎每次离开前都要拉着斯皮洛思的胳膊,看会他的脸. 告别后,辛格穿过街道,独坐一人来到珠宝店,他是那家店里的银器雕刻师. 傍晚的时候.两个朋友会再次见面. 辛格回到水果店等着安东那帕罗斯下班一起回家.希腊人则懒洋洋地打开一箱桃子或者西瓜,或者有时也会瞎瞅商店后面厨房里有趣的墙纸,他就是在那间厨房里烹调的. 离开前, 安东那帕罗斯总会打开一个白天被他藏在厨房搁板上的纸袋子. 里面装了一些各式各样食品——零碎的水果块,糖果样品,只剩一点的肝泥香肠,这些都是他白天小心留下来的. 每次走之前,安东那帕罗斯还要往店门口的玻璃盒里慢慢地填些棉花,盒子里存放着肉和芝士.Sometimes his cousin who owned the place did not see him. But if he noticed he stared at his cousin with a warning in his tight, pale face. Sadly Antonapoulos would shuffle the morsel from one corner of the case to the other. During these times Singer stood very straight with his hands in his pockets and looked in another direction. He did not like to watch this little scene between the two Greeks. For, excepting drinking and a certain solitary secret pleasure, Antonapoulos loved to eat more than anything else in the world. In the dusk the two mutes walked slowly home together. At home Singer was always talking to Antonapoulos. His hands shaped the words in a swift series of designs. His face was eager and his gray-green eyes sparkled brightly. With his thin, strong hands he told Antonapoulos all that had happened during the day. Antonapoulos sat back lazily and looked at Singer. It was seldom that he ever moved his hands to speak at all— and then it was to say that he wanted to eat or to sleep or to drink. These three things he always said with the same vague, fumbling signs. At night, if he were not too drunk, he would kneel down before his bed and pray awhile. Then his plump hands shaped the words 'Holy Jesus,' or 'God,' or 'Darling Mary.' These were the only words Antonapoulos ever said. Singer never knew just how much his friend understood of all the things he told him. But it did not matter. They shared the upstairs of a small house near the business section of the town. There were two rooms. On the oil stove in the kitchen Antonapoulos cooked all of their meals. There were straight, plain kitchen chairs for Singer and an overstuffed sofa for Antonapoulos. The bedroom was furnished mainly with a large double bed covered with aneiderdown comforter for the big Greek and a narrow iron cot for Singer. Dinner always took a long time, because Antonapoulos loved food and he was very slow. After they had eaten, the big Greek would lie back on his sofa and slowly lick over each one of his teeth with his tongue, either from a certain delicacy or because he did not wish to lose the savor of the meal— while Singer washed the dishes. Sometimes in the evening the mutes would play chess. Singer had always greatly enjoyed this game, and years before he had tried to teach it to Antonapoulos. At first his friend could not be interested in the reasons for moving the various pieces about on the board. Then Singer began to keep a bottle of something good under the table to be taken out after each lesson. The Greek never got on to the erratic movements of the knights and the sweeping mobility of the queens, but he learned to make a few set, opening moves. He preferred the white pieces and would not play if the black men were given him. After the first moves Singer worked out the game by himself while his friend looked on drowsily. If Singer made brilliant attacks on his own men so that in the end the black king was killed, Antonapoulos was always very proud and pleased. The two mutes had no other friends, and except when they worked they were alone together. Each day was very much like any other day, because they were alone so much that nothing ever disturbed them. Once a week they would go to the library for Singer to withdraw a mystery book and on Friday night they attended a movie. Then on payday they always went to the ten-cent photograph shop above the Army and Navy Store so that Antonapoulos could have his picture taken. These were the only places where they made customary visits. There were many parts in the town that they had never even seen. The town was in the middle of the deep South. The summers were long and the months of winter cold were very few. Nearly always the sky was a glassy, brilliant azure and the sun burned down riotously bright. Then the light, chill rains of November would come, and perhaps later there would be frost and some short months of cold. The winters were changeable, but the summers always were burning hot. The town was a fairly large one. On the main street there were several blocks of two- and three-story shops and business offices. But the largest buildings in the town were the factories, which employed a large percentage of the population. These cotton mills were big and flourishing and most of the workers in the town were very poor. Often in the faces along the streets there was thedesperate look of hunger and of loneliness. But the two mutes were not lonely at all. At home they were content to eat and drink, and Singer would talk with bis hands eagerly to his friend about all that was in his mind. So the years passed in this quiet way until Singer reached the age of thirty-two and had been in the town with Antonapoulos for ten years. Then one day the Greek became ill. He sat up in bed with his hands on his fat stomach and big, oily tears rolled down his cheeks. Singer went to see his friend's cousin who owned the fruit store, and also he arranged for leave from his own work. The doctor made out a diet for Antonapoulos and said that he could drink no more wine. Singer rigidly enforced the doctor's orders. All day he sat by his friend's bed and did what he could to make the time pass quickly, but Antonapoulos only looked at him angrily from the corners of his eyes and would not be amused. The Greek was very fretful, and kept finding fault with the fruit drinks and food that Singer prepared for him. Constantly he made his friend help him out of bed so that he could pray. His huge buttocks would sag down over his plump little feet when he kneeled. He fumbled with his hands to say 'Darling Mary' and then held to the small brass cross tied to his neck with a dirty string. His big eyes would wall up to the ceiling with a look of fear in them, and afterward he was very sulky and would not let his friend speak to him. Singer was patient and did all that he could. He drew little pictures, and once he made a sketch of his friend to amuse him. This picture hurt the big Greek's feelings, and he refused to be reconciled until Singer had made his face very young and handsome and colored his hair bright yellow and his eyes china blue. And then he tried not to show his pleasure. Singer nursed his friend so carefully that after a week . Antonapoulos was able to return to his work. But from that time on there was a difference in their way of life. Trouble came to the two friends. Antonapoulos was not ill any more, but a change had come in him. He was irritable and no longer content to spend the evenings quietly in their home. When he would wish to go out Singer followed along close behind him. Antonapoulos would go into a restaurant, and while they sat at the table he slyly put lumps of sugar, or a pepper-shaker, or pieces of silverware in bis pocket. Singer always paid for what he took and there was no disturbance. At home he scolded Antonapoulos, but the big Greek only looked at him with a bland smile. The months went on and these habits of Antonapoulos grew worse. One day at noon he walked calmly out of the fruit store of his cousin and urinated in public against the wall of the First National Bank Building across the street. At times he would meet people on the sidewalk whose faces did not please him, and he would bump into these persons and push at them with his elbows and stomach. He walked into a store one day and hauled out a floor lamp without paying for it, and another time he tried to take an electric train he had seen in a showcase. For Singer this was a time of great distress. He was continually marching Antonapoulos down to the courthouse during lunch hour to settle these infringements of the law. Singer became very familiar with the procedure of the courts and he was in a constant state of agitation. The money he had saved in the bank was spent for bail and fines. All of his efforts and money were used to keep his friend out of jail because of such charges as theft, committing public indecencies, and assault and battery. The Greek cousin for whom Antonapoulos worked did not enter into these troubles at all. Charles Parker (for that was the name this cousin had taken) let Antonapoulos stay on at the store, but he watched him always with his pale, tight face and he made no effort to help him. Singer had a strange feeling about Charles Parker. He began to dislike him. Singer lived in continual turmoil and worry. But Antonapoulos was always bland, and no matter what happened the gentle, flaccid smile was still on his face. In all the years before it had seemed to Singer that there was something very subtle and wise in this smile of his friend. He had never known just how much Antonapoulos understood and what he was thinking. Now in the big Greek's expression Singer thought that he could detect something sly and joking. He would shake his friend by the shoulders until he was very tired and explain things over and over with his hands. But nothing did any good. All of Singer's money was gone and he had to borrow from the jeweler for whom he worked. On one occasion he was unable to pay bail for bis friend and Antonapoulos spent the night in jail. When Singer came to get him out the next day he was very sulky. He did not want to leave. He had enjoyed his dinner of sowbelly and cornbread with syrup poured over it. And the new sleeping arrangements and his cellmates pleased him. They had lived so much alone that Singer had no one to help him in his distress. Antonapoulos let nothing disturb him or cure him of his habits. At home he sometimes cooked the new dish he had eaten in the jail, and on the streets there was never any knowing just what he would do. And then the final trouble came to Singer. One afternoon he had come to meet Antonapoulos at the fruit store when Charles Parker handed him a letter. The letter explained that Charles Parker had made arrangements for his cousin to be taken to the state insane asylum two hundred miles away. Charles Parker had used his influence in the town and the details were already settled. Antonapoulos was to leave and to be admitted into the asylum the next, week. Singer read the letter several times, and for a while he could not think. Charles Parker was talking to him across the counter, but he did not even try to read his lips and understand. At last Singer wrote on the little pad he always carried in his pocket: You cannot do this. Antonapoulos must stay with me. Charles Parker shook his head excitedly. He did not know much American. 'None of your business,' he kept saying over and over.Singer knew that everything was finished. The Greek was afraid that some day he might be responsible for his cousin. Charles Parker did not know much about the American language—but he understood the American dollar very well, and he had used his money and influence to admit his cousin to the asylum without delay. Therewas nothing Singer could do. The next week was full of feverish activity. He talked and talked. And although his hands never paused to rest he could not tell all that he had to say. He wanted to talk to Antonapoulos of all the thoughts that had ever been in his mind and heart, but there was not time. His gray eyes glittered and his quick, intelligent face expressed great strain. Antonapoulos watched him drowsily, and his friend did not know just what he really understood. Then came the day when Antonapoulos must leave. Singer brought out Ms own suitcase and very carefully packed the best of their joint possessions. Antonapoulos made himself a lunch to eat during the journey. In the late afternoon they walked arm in arm down the street for the last time together. It was a chilly afternoon in late November, and little huffs of breath showed in the air before them. Charles Parker was to travel with his cousin, but he stood apart from them at the station. Antonapoulos crowded into the bus and settled himself with elaborate preparations on one of the front seats. Singer watched him from the window and his hands began desperately to talk for the last time with his friend. But Antonapoulos was so busy checking over the various items in his lunch box that for a while he paid no attention. Just before the bus pulled away from the curb he turned to Singer and his smile was very bland and remote—as though already they were many miles apart. The weeks that followed didn't seem real at all. All day Singer worked over his bench in the back of the jewelry store, and then at night he returned to the house alone. More than anything he wanted to sleep. As soon as he came home from work he would lie on his cot and try to doze awhile. Dreams came to him when he lay there half-asleep. And in all of them Antonapoulos was there. His hands would jerk nervously, for in his dreams he was talking to his friend and Antonapoulos was watching him. Singer tried to think of the time before he had ever known his friend. He tried to recount to himself certain things that had happened when he was young. But none of these things he tried to remember seemed real. There was one particular fact that he remembered, but it was not at all important to him. Singer recalled that, although he had been deaf since he was an infant, he had not always been a real mute. He was left an orphan very young and placed in an institution for the deaf. He had learned to talk with his hands and to read. Before he was nine years old he could talk with one hand in the American way—and also could employ both of his hands after the method of Europeans. He had learned to follow the movements of people's lips and to understand what they said. Then finally he had been taught to speak.At the school he was thought very intelligent. He learned the lessons before the rest of the pupils. But he could never become used to speaking with his lips. It was not natural to him, and his tongue felt like a whale in his mouth. From the blank expression on people's faces to whom he talked in this way he felt that his voice must be like the sound of some animal or that there was something disgusting in his speech. It was painful for him to try to talk with his mouth, but his hands were always ready to shape the words he wished to say. When he was twenty-two he had come South to this town from Chicago and he met Antonapoulos immediately. Since that time he had never spoken with his mouth again, because with his friend there was no need for this. Nothing seemed real except the ten years with Antonapoulos. In his half-dreams he saw his friend very vividly, and when he awakened a great aching loneliness would be in him. Occasionally he would pack up a box for Antonapoulos, but he never received any reply. And so the months passed hi this empty, dreaming way. In the spring a change came over Singer. He could not sleep and his body was very restless. At evening he would walk monotonously around the room, unable to work off a new feeling of energy. If he rested at all it was only during a few hours before dawn—then he would drop bluntly into a sleep that lasted until the morning light struck suddenly beneath his opening eyelids like a scimitar. He began spending his evenings walking around the town. He could no longer stand the rooms where Antonapoulos had lived, and he rented a place in a shambling boarding-house not far from the center of the town. He ate his meals at a restaurant only two blocks away. This restaurant was at the very end of the long main street and the name of the place was the New York Cafe. The first day he glanced over the menu quickly and wrote a short note and handed it to the proprietor. Each morning for breakfast I want an egg, toast, and coffee $0.15 For lunch I want soup (any kind), a meat sandwich, and milk — $0.25 Please bring me ut dinner three vegetables (any kind but cabbage), fish or meat, and a glass of beer— $0.35 Thank you. The proprietor read the note and gave him an alert, tactful glance. He was a hard man of middle height, with a beard so dark and heavy that the lower part of his face looked as though it were molded of iron. He usually stood in the corner by the cash register, his arms folded over his chest, quietly observing all that went on around him. Singer came to know this man's face very well, for he ate at one of his tables three times a day. Each evening the mute walked alone for hours in the street. Sometimes the nights were cold with the sharp, wet winds of March and it would be raining heavily. But to him this did not matter. His gait was agitated and he always kept his hands stuffed tight into the pockets of his trousers. Then as the weeks passed the days grew warm and languorous. His agitation gave way gradually to exhaustion and there was a look about him of deep calm. In his face there came to be a brooding peace that is seen most often in the faces of the very sorrowful or the very wise. But still he wandered through the streets of the town, always silent and alone.。

习语 home is where the heart is

家若在，心就在；心若在，梦就在；梦若在，啥都在；所以Home is where the heart is.East or west, home is best，可见家对于一个人是多么的必要，多么的重要。

No other places are more comfortable than home where there is a family,金窝银窝不如自己的狗窝，Family is the only place where you can completely relax yourself.家是唯一一处可以使你彻底放松的地方。

Whenever you're troubled, family is always there for you;无论什么时候你遇到困难，家里都会替你出谋划策的；Whenever you're unhappy family is always there for you;无论什么时候你有不开心，家里都会帮你排忧解难的；Whenever you're lonely, family is always there for you;无论什么时候你觉得孤单，家里都会为你随叫随到的；Whenever you're helpless, family is always there for you;无论什么时候你感到无助，家里都会向你提供帮助的；Whenever you're lost, family is always there for you.无论什么时候你迷失自己，家里都会等你早点归来的。

No matter why you leave, there is always a family in your heart；无论你为什么离开家，家一直都是你的终点站；No matter what you do, there is always a family in your heart；无论你从事什么工作，家一直都是你的原动力；No matter where you're, there is always a family in your heart；无论你现在处在哪里，家一直都是你的导航仪；No matter when you return, there is always a family in your heart；无论你什么时候归来，家一直都是你的起点站；No matter who you're ,there is always a family in your heart；无论你是什么样的人，家一直都是你的大舞台；No matter how you live, there is always a family in your heart.无论你现在过的怎样，家一直都是你的大港湾。

Removing the substance from the heart and the bloo

专利名称：Removing the substance from the heart and the blood vessel of the other part of thebody, method and the device which obstacleof the kidney or other organ or loseincompletion, or decrease as much aspossible发明人：モヴァヘッド，エム．レザ申请号：JP2002559107申请日：20020123公开号：JP2005503183A公开日：20050203专利内容由知识产权出版社提供专利附图：摘要：Although in order to achieve the isolation and removal of the substance from blood vessel type, the blood vessel of blood vessel type is blocked the catheter is used. This substance can be isolated with blood vessel system with that, and can remove. This way, this substance is removed before entering into the other part of circulating type. Immediately after filling the contrast medium to the coronary artery, although the contrast medium is removed from the coronary vein cave, it can apply this method. This method must fill the contrast medium, you lose the kidney incompletion which is pulled up by the blood vessel contrast procedure decrease suitably. This kind of blood vessel contrast procedure, often, is executed in intervention procedure. With this method, as for the contrast medium, the kidney (at this place, it can cause kidney incompletion or kidney obstacle) to with it can obstruct the fact that it circulates substantially. Also the device which executes this method is disclosed and.申请人：ザリージェンツオブザユニバーシティオブカリフォルニア地址：アメリカ合衆国カリフォルニア９４６０７－５２００，オークランド，フランクリンストリート１１１１，１２ティーエイチフロア国籍：US代理人：山本秀策,安村高明,森下夏樹更多信息请下载全文后查看。

心脏听诊---Auscultation of the Heart

S1: Character of auscultation 1) Area: apex 2) Pitch 3) Lasting time: 4) Together with apex impulse
S2: Vibration of the closure of AV, PV, during the beginning of ventricular diastole, Indicates the beginning of ventricular diastole
A2: hypertension P2 : pulmonary hypertension in MS, MI A2: AS ,AI P2 : PS, PI
Change in quality of heart sound
When the myocardial muscle is damaged severely, S1 is similar to S2. The heart sound like a pendular— pendular uallyaccompany with tachycardia—embryocardia.
• Protodiastolic gallop rhythm
• S3 gallop, ventricular gallop rhythm. • S1 + S2 + pathologic S3
In early diastole, the blood through into ventricle from atrium in failing myocardium, the ventricular wall tension is poor, produce vibration. Reflex that the ventricular function

the heart is a lonely hunter 英文原版

the heart is a lonely hunter 英文原版The Heart is a Lonely HunterIn the dimly lit room, the ticking of the clock seemed to echo through the silence, a constant reminder of the passage of time. The air was heavy with a sense of melancholy, as if the very walls were imbued with the weight of unspoken emotions. It was here, in this solitary space, that the heart found its solace, a refuge from the bustling world outside.The heart, a complex and enigmatic organ, had long been a subject of fascination and contemplation. Its rhythmic beats, the life-sustaining force that coursed through the veins, were often seen as a symbol of the human experience – a representation of the depths of emotion, the highs and lows that define our existence.Yet, in this moment, the heart felt a profound sense of isolation, a loneliness that transcended the physical boundaries of the body. It was as if the heart had been severed from the very connections it was meant to foster, left to wander in a vast and unforgiving landscape, searching for a kindred spirit to share its burdens.The heart's journey had been a tumultuous one, marked by the ebb and flow of love, loss, and the ever-present search for meaning. It had witnessed the joys and sorrows of human existence, the laughter and the tears, the moments of triumph and the depths of despair. And yet, despite the multitude of experiences it had endured, the heart remained a solitary entity, its innermost desires and yearnings known only to itself.As the clock ticked on, the heart found itself drawn to the window, gazing out at the world beyond. The bustling streets, the faces of strangers, the hum of life – all of it seemed to mock the heart's solitude, a constant reminder of the connections it craved but could not find.In those quiet moments, the heart would reflect on its past, the choices it had made, the paths it had taken. It would revisit the memories of love and loss, the moments of vulnerability and the times when it had felt most alive. And in the midst of this introspection, the heart would be struck by a profound realization: that its very nature, its capacity to feel deeply, was both its greatest strength and its greatest burden.For the heart, to love was to risk, to open oneself up to the possibility of pain and heartbreak. And yet, the heart could not help but long for that connection, that sense of belonging that seemed toelude it at every turn. It was a paradox, a constant struggle between the desire for intimacy and the fear of being truly known.As the days turned into weeks, the heart found itself growing weary, its once-vibrant spirit slowly fading into the shadows of its own isolation. The ticking of the clock seemed to taunt it, a constant reminder of the relentless passage of time and the opportunities that had slipped through its grasp.And yet, even in the midst of this despair, the heart refused to surrender. It clung to the faint glimmer of hope that somewhere, out there, there was a kindred spirit, a soul that could understand the depths of its yearning and offer the solace it so desperately craved.The heart's journey was one of resilience, of a constant struggle to find its place in a world that often seemed indifferent to its needs. It was a testament to the enduring power of the human spirit, a reminder that even in the darkest of times, the heart's capacity to love and to be loved remained a beacon of light, guiding it through the endless sea of loneliness.And so the heart continued its vigil, its steady beats echoing through the silence, a silent prayer for the connection it so deeply desired. For in the end, the heart's loneliness was not a curse, but a testamentto its very essence – a heart that could never be truly tamed, a heart that would forever seek the elusive embrace of another.。

badkidneysarebadfortheheartbutwhatcanwedoaboutit

Editorial CommentBad Kidneys are Bad for the Heart:But What Can We Do About It?Timothy D.Henry,1*MD and Charles A.Herzog,2,3MD 1Minneapolis Heart Institute Foundation,Abbott Northwestern Hospital,Minneapolis,Minnesota2Hennepin County Medical Center,University of Min-nesota,Minneapolis,Minnesota3Cardiovascular Special Studies Center,United States Renal Data System,Minneapolis,MinnesotaChronic kidney disease(CKD)is a major risk factor in patients with cardiovascular disease[1–3].Patients with CKD who present with acute coronary syndromes, or undergo revascularization with either percutaneous coronary intervention(PCI)or coronary artery bypass graft surgery(CABG)have increased mortality.Patients with end-stage renal disease(ESRD)on dialysis are at particularly high risk.In this issue of CCI,Parikh et al.report the in-hos-pital mortality on25,018patients undergoing PCI over a4-year period at four New York state hospitals, stratiﬁed by renal function[4].Nearly30%of patients had moderate CKD(estimated glomerularﬁltration rate(eGFR) 60)(26.4%)or ESRD on dialysis (1.9%).All-cause in-hospital mortality was markedly higher in patients with ESRD(2.1%)and moderate CKD(1.3%)versus patients with preserved renal func-tion(0.3%).The results conﬁrm previously reported data that patients with either CKD or ESRD have high risk characteristics including age,higher rates of prior coronary revascularization,peripheral arterial disease, previous stroke,congestive heart failure,and diabetes. These patients also have more complex coronary anat-omy including calciﬁcation and diffuse disease[5]. Importantly,they are also less likely to receive guide-line recommended therapy including antiplatelet agents,anticoagulants,and revascularization[6].In this registry,they were less likely to receive drug-eluting stents even though they are at higher risk for restenosis.The authors concentrated on in-hospital mortality in their report,but the real clinical issue is what happens after the patient leaves the hospital,a problem not restricted to PCI[7,8].Long-term mortality for ESRD remains extremely high in a wide spectrum of cardio-vascular disease(Figure1).In2009,there were approximately399,000dialysis patients.The overall mortality rate in2009for US dialysis patients was200 deaths/1,000patient years.Theﬁve-year mortality of dialysis patients has improved over time,but it remains depressingly high:66%for a patient starting dialysis in 2004.In contrast,theﬁve-year mortality for renal transplant recipients was27%for the same time period [9].Approximately,45%of the mortality in dialysis patients is attributed to a cardiovascular etiology. About14%of cardiac deaths are ascribed to acute myocardial infarction;66%of cardiac deaths(or26% of all-cause mortality)are attributed to arrhythmic mechanisms[9].Patients with ESRD are particularly vulnerable to sudden cardiac death:the combination of obstructive coronary artery disease,left ventricular hy-pertrophy(at least75%of dialysis patients),myocar-dialﬁbrosis,autonomic dysfunction(including obstruc-tive sleep apnea),and microvascular dysfunction in patients with diabetes places the ESRD patient at heightened risk for sudden death.Coronary revasculari-zation does not nullify the risk:even after surgical re-vascularization with a left internal mammary graft,the two-year mortality of dialysis patients is43%[10]. Other adverse outcomes such as readmission,revas-cularization,myocardial infarction,and bleeding are all markedly higher in these patients as well.The authors discuss the myriad of potential reasons for the increased risk but the solution remains elusive.As the prevalence of diabetes increases and the pop-ulation ages,the number of patients with CKD will continue to increase.Nearly,one-third of the patients in this report had a eGFR<60.CKD presents a major public health challenge in the US and abroad.It is estimated that about12%of the US population(25 million)have CKD,but even more importantly from Conﬂict of interest:Nothing to report.*Correspondence to:Timothy D.Henry,Minneapolis Heart Institute Foundation,920East28th Street,Suite300,Minneapolis,MN 55407.E-mail:****************Received16July2012;Revision accepted16July2012DOI10.1002/ccd.24567Published online8August2012in Wiley Online Library ().'2012Wiley Periodicals,Inc.Catheterization and Cardiovascular Interventions80:358–360(2012)an interventional cardiology perspective,40%or more of people over age 70have CKD [11].The cardiology world has become ‘‘comfortable’’with CKD stages and the concept of eGFR <60as a ‘‘threshold of risk’’but a single dichotomous cutpoint is actually a dull discriminator.A more accurate and comprehensive risk-based CKD staging system which takes into account both eGFR and ranges of proteinuria will take its place in the near future [11].So,bad kidneys are bad for the heart,but what can we do about it?While earlier detection and subsequent prevention of CKD is clearly desirable,we suspect this will continue to be a major challenge.Clinical trials designed speciﬁcally to address patients with CKD and ESRD are sorely needed.Perhaps the best approach for interventional cardiologists is to focus on the use of appropriate guideline-based medications and revas-cularization.This is not so simple as these patients are at increased risk for bleeding and are more likely to present with atypical symptoms.The ideal method of reperfusion in these patients also remains controversial.There are limited randomized clinical trials and it is extremely challenging to have comparable groups in registries such as this [8].Frequently,CKD and partic-ularly ESRD patients are not candidates for surgical revascularization.Reﬂecting this issue,patients in this registry with ESRD and CKD had higher rates ofintervention on bypass grafts,the LAD,and the left main than patients with normal renal function.In summary,CKD is increasingly common and a major risk factor for adverse outcomes in all cardio-vascular disease.An ongoing focus on prevention,clin-ical trials designed speciﬁcally for CKD and ESRD,use of guideline recommended therapies including re-vascularization and careful clinical follow-up remain our best hope to address this growing challenge.REFERENCES1.Collins AJ,Foley R,Herzog C,Chavers B,Gilbertson D,Ishani A,Kasiske B,Liu J,Mau LW,McBean M,Murray A,St Peter W,Xue J,Fan Q,Guo H,Li Q,Li S,Li S,Peng Y,Qiu Y,Roberts T,Skeans M,Snyder J,Solid C,Wang C,Weinhandl E,Zaun D,Zhang R,Arko C,Chen SC,Dalleska F,Daniels F,Dunning S,Ebben J,Frazier E,Hanzlik C,Johnson R,Sheets D,Wang X,Forrest B,Constantini E,Everson S,Eggers P,Agodoa L.Excerpts from the United States Renal Data System 2007an-nual data report.Am J Kidney Dis 2008;51:S1–S320.2.Go AS,Chertow GM,Fan D,McCulloch CE,Hsu CY.Chronic kidney disease and the risks of death,cardiovascular events,and hospitalization.N Engl J Med 2004,351:1296–1305.3.Osten MD,Ivanov J,Eichhofer J,Seidelin PH,Ross JR,BaroletA,Horlick EM,Ing D,Schwartz L,Mackie K,Dzavı´k V.Impact of renal insufﬁciency on angiographic,procedural,and in-hospital outcomes following percutaneous coronary interven-tion.Am J Cardiol2008;101:780–785.Fig.1.January 1,2005point prevalent ESRD patients,age 20and older,with a ﬁrst cardiovascular diagnosis or procedure in 2005–2007.Modiﬁed from USRDS 2009ADR.Catheterization and Cardiovascular Interventions DOI 10.1002/ccd.Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).Bad Kidneys Are Bad for the Heart 3594.Parkih PB,Jeremias A,Naidu SS,Brener SJ,Lima F,SholfmitzRA,Pappas T,Marzo KP,Grubert L.Impact of severity of renal disfunction on determinants of in-hospital morality among patients undergoing percutaneous coronary intervention.Catheter Cardiovasc Interv2012;DOI10.1002/ccd.23394.5.Gruberg L,Rai P,Mintz GS,Canos D,Pinnow E,Satler LF,Pichard AD,Kent KM,Laird JR Jr,Lindsay J Jr,Waksman R, Weissman NJ.Impact of renal function on coronary plaque mor-phology and morphometry in patients with chronic renal insufﬁ-ciency as determined by intravascular ultrasound volumetric anal-ysis.Am J Cardiol2005;96:892–896.6.Tsai TT,Maddox TM,Roe MT,Dai D,Alexander KP,Ho PM,Messenger JC,Nallamothu BK,Peterson ED,Rumsfeld JS.Contra-indicated medication use in dialysis patients undergoing percutaneous coronary intervention.JAMA2009;302:2458–2464.7.Herzog CA,Ma JZ,Collins AJ.Poor long-term survival afteracute myocardial infarction among patients on long-term dialy-sis.N Engl J Med1998,339:799–805.8.Herzog CA,Ma JZ,Collins parative survival of dialysispatients in the United States after coronary angioplasty,coronary artery stenting,and coronary artery bypass surgery and impact of diabetes.Circulation2002;106:2207–2211.9.United States Renal Data System2011Annual Data Report:Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.Bethesda,MD:National Institutes of Health,National Institute of Diabetes and Digestive and Kidney Diseases,2011./.Accessed July13,2012.10.Herzog CA,Strief JW,Collins AJ,Gilbertson DT.Cause-speciﬁcmortality of dialysis patients after coronary revascularization: Why don’t dialysis patients have better survival after coronary intervention?Nephrol Dial Transplant2008;23:2629–2633.11.Levey AS,de Jong PE,Coresh J,El Nahas M,Astor BC,Mat-sushita K,Gansevoort RT,Kasiske BL,Eckardt KU.The deﬁni-tion,classiﬁcation,and prognosis of chronic kidney disease:A KDIGO Controversies Conference report.Kidney Int2011;80:17–28.Catheterization and Cardiovascular Interventions DOI10.1002/ccd.Published on behalf of The Society for Cardiovascular Angiography and Interventions(SCAI). 360Henry and Herzog。

钢琴谱 Dont Break the Heart-Tom Grennan 双手简谱_共3张(全)

同时，还为大家提供了《》曲谱
歌词下方是Don't Break the Heart钢琴谱，大家可以学习。
Don't Break the Heart歌词：
I'm on my knees I'm begging you Don't break the heart That's loving you I'm sitting here in this lonely room No there's nothing left it's only me and you Holding onto heaven But the heavens closed down on me Nothing lasts forever nothing goes to plan Don't you lose your grip you're letting go of my hand 'Cause every single second Is a second that we can't get back Here we go growing cold in the silence Never know 'til you hear all the sirens I should go but if this is The end of the line then Hold me close And we can lay here one last time Don't slip away leave me behind I'm on my knees I'm begging you Don't break the heart That's loving you Try my best at being brave But this is more than I can take I'm on my knees I'm begging you Don't break the heart That's loving you One minute you're here Then you're gone the next Turning into strangers like we never met Counting every blessing Like a lesson that you taught me me me Here we go growing cold in the silence Never know 'til you hear all the sirens I should go but if this is The end of the line then Hold me close And we can lay here one last time Don't slip away leave me behind I'm on my knees I'm begging you Don't break the heart That's loving you Try my best at being brave But this is more than I can take I'm on my knees I'm begging you Don't break the heart

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2012-12-12
Nanjing University of Chinese Medicine
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Atherosclerosis
Varicose Vein
Clinical Terms for Heart Diseases
• Coronary Artery Disease (CAD) Atherosclerosis • Acute Myocardial Infarction (AMI) Angina pectoris • Heart failure (HF) • Arrhythmia • Hypertension • Cerebrovascular accident
Heart Syndromes
• Heart yang deficiency Manifestations: palpitation worsened by exertion, restlessness, oppression in the chest, shortness of breath, pale complexion, cold limbs, pale tongue with white coating, and weak or force less deep and thin pulse
2012-12-12 Nanjing University of Chinese Medicine 5
Blood Pressure
• Blood pressure is the force exerted by blood against the wall of a blood vessel. • Normal resting blood pressure for a young adult is 120/80mmHg.
2012-12-12 Nanjing University of Chinese Medicine 4
Blood Circulation
• pulmonary circuit systemic circuit • artery vein • tricuspid valve bicuspid/mitral valve pulmonary valve aortic valve
systolic pressure/ diastolic pressure
The Vascular System
1. Arteries carry blood away from the heart. 2. Capillaries, the smallest vessels, through which exchanges take place between the blood and the tissues. 3. Veins carry blood back to the heart.
Anatomic Structure
Brief Descriptions
• cardiovascular system (the heart and the blood vessels) • myocardium • endocardium epicardium pericardium • atrium • ventricle
HT7
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Nanjing University of Chinese Medicine
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HT7
• Functions: Calms the Shen, tonifies and regulates the Heart Blood and Qi. • Needling: Perpendicular insertion0 .3 - 0.5 cun.
• Name the main anatomic structure of the heart
• Recognize the roots for the heart and blood vessels • Interpret abbreviations associated with the circulatory system
2012-12-12 Nanjing University of Chinese Medicine 22
What you can do after class…
• Study into roots and affixes of cardiovascular system. • Search online to find videos and flashes to help you understand the cardiovascular system. • Do extensive reading about the heart and its related disease. • ECG……
2012-12-12 Nanjing University of Chinese Medicine 12
Word Parts
Word parts Examples
cardi/o; -cardium
atri/o ventricul/o valv/o ; valvul/o angi/o vas/o; vascul/o
The Heart
2012-12-12
Nanjing University of Chinese Medicine
1
Objectives
Upon completion of this chapter, you will be able to: • List the major organs of the cardiovascular system as well as the basic clinical terminologies
Quick Review
• The heart is honored as ______, because ______________. • The functions of the heart are mainly to ______________. • What are the two meanings of governing blood? • ______, ______, ______ and ______ are key to the normal function of the heart. • What is reddening in TCM?
2012-12-12 Nanjing University of Chinese Medicine 10
Clinical Terms for Syptomes
• Dyspnea • Edema • Ischemia • Shock • Syncope • Palpitation • Chest pain/stiffness
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Nanjing University of Chinese Medicine
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• Heart 7 • Chinese Name: Shenmen (English translation: Spirit Gate) • Location: On the wrist, at the ulnar end of the transverse crease of the writs • Indications: Insomnia, amnesia; Cardiac pain, palpitations due to fright, irritability, chest pain, epilepsy
cardiomyopathy
periatrial ventriculoatrial valvulopathy angiitis cardiovascular
arter/o ; arteri/o
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arteriofibrosis
Nanjing University of Chinese Medicine 13
Fill in the blanks:
• The word cardiogenic means originating in the . • Interatrial means between the . • The word ventriculotomy means surgical incision of a(n) . • The word cerebrovascular means something relating to the vessel of ____.
Quick Review
• What are the symptoms of heart qi deficiency? • If the function of the heart to control the mind is abnormal, it will lead to _______________. • The heart governs the _____, opens into the ______, and its external manifestation is on the ______.
True-False
• The brachial artery supplies blood to the leg. • Tachycardia is a lower than average heart rate. • An artery is a vessel that carries blood back to the heart. • The valve in the septum between left atrium and ventricle is the tricuspid.
2012-12-12 Nanjing University of Chinese Medicine 19
PC6
• Functions: Opens the chest, regulates Heart Qi, calms the Shen, harmonizes the Stomach, relieves nausea and vomiting, regulates Qi. • Needling: Perpendicular insertion .5 1.0 cun.