Method for identifying and severity of coronary insufficiency

 

(57) Abstract:

The invention relates to medicine, particularly cardiology. Spend chamayou transesophageal stimulation (NEP), determine the nature of changes in the segment of W on the ECG. Note the frequency of stimulation from the appearance point of Wenckebach. When programmed stimulation reveal the effective refractory period and the shape of the QRS complex in response to the test pulse. When broadening the last in a complete blockade bundle-determine the area of the vulnerability of the myocardium. About the presence of coronary insufficiency judged by the appearance of broadening of the QRS complex type full blockade bundle-with an area of vulnerability for more than 60 MS, coupled with the point of Wenckebach at a frequency below 130 pulses/min, and lengthening of the refractory period of more than 240 m/s When the value of the zone of vulnerability within 100 MS diagnosed FC diseases in the area of 100-180 MS - FC at 200-260 MS - FC, when the zone of vulnerability more than 260 MS - FC coronary insufficiency. The method allows to detect early coronary insufficiency.

The invention relates to medicine, namely to functional diagnostics of the cardiovascular system.

The purpose of the invention - raising awareness and accurate the functional class of angina, that will allow up to the development of clinical symptoms to conduct medical correction to prevent the progression of coronary and heart failure.

Analogue of the invention is a method for the detection of coronary heart disease by the method of transesophageal stimulation (CPAS) heart [1I. Prototype-the way of programmed CPAS [2], which consists in applying a test pulse in the different phases of the cardiac cycle.

According to the method of the all-Union cardiological scientific center (wcnc) for the diagnosis of latent coronary insufficiency spend chamayou CPAS and in the case of "ischemic" ST-segment depression on ECG, continued after the cessation of stimulation, determine the presence of chronic coronary insufficiency (HCN). The method is limited to cases source modified ECG cicatricial lesions, impaired intraventricular conduction. When programmed CPAS (PCPES) test pulse is served in different phases of the cardiac cycle, determining the time intervals for evaluation of the electrophysiological parameters of the conduction system of the heart, by studying the onset of refractoriness of individual structures of the myocardium or the vulnerability of the latter to RA the impulse.

The essence of the invention. The invention has as its objective the identification and improving the accuracy of diagnosis of early signs of coronary insufficiency in the artificial acceleration of cardiac rhythm method CPAS in patients with ischemic heart disease and those with hypertension, particularly when the source of the modified ECG in the form of cicatricial lesions of the myocardium or violations of intraventricular conduction, as well as determine the extent of ischemic damage to the heart.

The invention is carried out by conducting okadaya and programmed CPAS with progressive shortening the delay test pulse before reaching the lack of response of the ventricles - the disappearance of atrioventricular conduction in the development of refractoriness of the myocardium, and the study of the nature of the ventricular response during application of the test pulse. When deformation and widening of the QRS complex type full blockade bundle for any delay test pulse with a period of Wenckebach exceeding 180 pulse/min, determined by functional blockade bundle. In the case of a combination of deformation of the QRS complex and lengthening the effective refractory period of the atrioventricular connection more than 240 MS and the combination of these characteristics with the presence of a zone of vulnerability (EU) more than 60 MS, the probability of having coronary insufficiency increases. When the values in memory up to 100 MS is diagnosed FC disease ZU 100-180 MS - FC, when ZU 200-260 MS - FC, in cases of lengthening the memory 260 MS - FK chronic coronary insufficiency.

When conducting CPES electrode is inserted into the esophagus and is set at the level of the left atrium on electrogram from the esophagus. The threshold of stimulation is consistent with the increase of the amplitude of pulses until a steady artificial rhythm followed by an increase of 10% from the achieved level. For the proposed method are applied pacemakers designed for CPAS and having modes okadaya and programmed electrical stimulation. When conducting okadaya CPAS estimated the frequency of stimulation from the appearance point of Wenckebach (termination of conduction from the Atria to the ventricles through the atrioventricular connection), as well as recommendations in similar ways - the dynamics of the ST segment at each frequency okadaya CPAS and character of sinus rhythm when you disconnect the stimulator.

At the time of the programmed CPAS is determined by the value of the effective refractory period (minimum delay test pulse, not visa when they are applied with a delay, decreasing to 20 MS, starting from the maximum, which is determined based on 1/2 the length of the source of the cardiac cycle. When the broadening of the QRS complex type full blockade bundle marked maximum and minimum value of the delay test pulse in MS, with preservation of a specified phenomenon and calculated the area vulnerability (MS) as the difference of the maximum and minimum delay test pulse in milliseconds.

When the broadening of the QRS complex during programmed CPAS at least one delay test pulse in combination with the incidence point of Wenckebach more than 180 pulse/min diagnosed functional disturbance of intraventricular conduction. When combined broadening of the QRS complex when programmed CPAS with prolongation of the effective refractory period of more than 240 MS is determined by the reduction of coronary reserve. When this memory up to 100 MS characterizes FC HCN, ZU 100-180 MS - FK, ZU 200-260 MS - FK memory 260 MS - FC HCN. The presence in the latter two cases, shortening the point of Wenckebach less than 130 pulses/min increases the likelihood of diagnosis, indicating 3-FC disease.

The method is preferred in cases where the source of the modified ECG when dinnertime left ventricle with of repolarization abnormalities in the apex anterolateral wall of the left ventricle, as well as in individuals with robovie changes in the myocardium.

Example. B-Neu Century 42 years. (The preamble. map 37547) Diagnosis: ischemic heart disease. Postinfarction cardiosclerosis. Stable angina FC. On the original ECG expressed cicatricial changes of infarction of the anterior wall of the left ventricle. In the survey method CPAS at the time of acceleration of rhythm point of Wenckebach is determined at a frequency of 120 pulses/min Introduction intravenous bolus of 2 ml of 0.1% solution of atropine increases this figure to 140 pulse/min ST Segment at the maximum frequency of stimulation in leads V4-V6 is a horizontal depression of 1.5 mm, not persisting after switching off the stimulator. When carrying out programmed CPAS the effective refractory period is 260 MS. When the value of the delay test pulse 280-500 MS (MS=220 MS) ventricular response is manifested in the form of a full blockade of the left bundle branch. Confirmed FK chronic coronary insufficiency.

References

1. Kozlov, S., Mironov, I. Y., Lyakishev A. A. and others the Value of transesophageal atrial pacing in the diagnosis of coronary heart disease. /Ter. archive.-1991.-1.-108- 111.

2. Characin L. B., Tatar B. A., Shubik Y. C., Senturia E. M EN is Noah orthodrome AV tachycardia according to transesophageal programmed pacing. /Bulletin of Arrhythmology. -1998. -7. -50- 55.

Method for identifying and severity of coronary insufficiency, including chamayou and programmed transesophageal elektrocardiostimulyatsia, characterized in that the study is not complete frequent CPAS, and spend the last in programmed mode, and when values of the zone of vulnerability to 100 MS diagnosed I functional class of chronic coronary insufficiency, at 100 - 180 MS - II functional class, at 200 - 260 MS - III functional class, more than 260 MS - IV functional class of angina, and when the value of the zone of vulnerability more than 60 MS, but in combination with ventricular responses in the form of broad sets of ORS full blockade bundle and lengthening the effective refractory period of more than 240 MS also diagnose the presence of coronary insufficiency, if the point of Wenckebach recorded at frequencies below 130 pulses/min, determine coronary insufficiency high (III-IV) functional class.

 

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