The way to diagnose rhythm disorders in the cardiovascular system

 

The invention relates to medicine, cardiology and functional diagnostics. The patient record the ECG. Find hourly average values of Mean - mean value of RR-intervals in the sample, SDNN - standard deviation of the analyzed RR-intervals, rMSSD - square root of sum of squares of the differences between the values of successive RR-intervals. Compute local indices these indices as the ratio of their average performance of the previous hour to the next. These indexes are built discriminant function whose values are compared with the values of the function for the normal ECG. The method to diagnose the presence or absence of the desired pathology. 1 C.p. f-crystals, 3 ill.

The invention relates to medicine, and is intended for the diagnosis of disorders in the cardiovascular system.

Famous traditional way electrocardiographic diagnosis of disorders in the cardiovascular system, in which register bioelectric phenomena that occur during operation of the heart, in the form of a characteristic curve of the electrocardiogram (ECG), and analyze the time and amplitude ratios of elements of the ECG, such as PQ, RR, QPS, ST, QRST, and so on (see Enza. Leningrad : Nauka, Leningrad branch, 1990).

However, there are cases when abnormalities on ECG despite the obvious clinical picture is not observed, and Vice versa, deviations from the norm are obvious, but their interpretation is extremely difficult or impossible.

To improve the reliability and validity of diagnosis increase the duration of the continuous removal of the ECG, the results of mapping cardiocycle which reveal abnormalities in the cardiovascular system.

For example, patent 2077864, IPC And 61 In 5/04, 5/0402, 1992, ECG is performed a sufficient duration, the results of corresponding process based on the statistical characteristics of the receive operational diagnostics of the cardiovascular system of the patient at a sub clinical conditions.

Another patent of the Russian Federation 2131213, IPC And 61 In 5/02, 5/0250, 5/04, 5/0456, 1998, in narcosis also continuously analyze the duration of cardiocycle sinus rhythm, the results of processing which is judged on the depth and adequacy of anesthesia, prior to the appearance of clinical signs of inadequate anesthesia.

A common disadvantage of the known methods of diagnosis are their limited capacity, obuslovlennye activity of the heart closest to the proposed invention is a method, called Holter monitoring (HM) (see L. M. Makarov. Holter monitoring. M: Malpractice, 2000).

In accordance with the known method within 24 hours continuous ECG is performed (monitoring), processing results which are numeric values of the following eight indicators: MEAP (MS) - average value of RR-intervals in the sample (the inverse of the average heart rate; SDNN (MS) - standard deviation of all measured RR intervals; SDNN-i (MS) - the average value of standard deviations for 5-minute periods; SDNN-i (MS) standard deviation averaged over 5-minute values of RR intervals; rMSSD (MS) - the square root of the sum of squared differences of the values of successive RR intervals; pNN50 (%) - percentage representation of episodes differences of successive RR intervals more than 50 MS; SDSD - the standard deviation of differences between adjacent RR intervals; Counts - the total number of registered 24 hours in advance of the differences between adjacent intervals differing more than 50 MS.

Obviously, in addition to the above (mandatory) parameters characterizing the known method, can be determined and other current indexes and indicators.

The results of the interim analysis variable violations are subject to a physiological and clinical interpretation.

Thus, the disadvantage of this method lies in the fact that despite the objective indicators of abnormalities in the heart, their interpretation depends on the skill of the attending physician, i.e., the subjective with all the ensuing consequences.

Before the invention of the task was to create a way to diagnose rhythm disorders of the cardiovascular system, allowing on the basis of numerical values obtained by analysis of the electrocardiogram of the patient, to identify specific cardiac rhythm corresponding to that particular pathology of the cardiovascular system.

The problem is solved in that a method of diagnosis of heart rhythm disturbances in the cardiovascular system, which mainly within days continuously remove the ECG of the patient and on the received ECG are average values of Mean, SDNN, rMSSD.

New in the proposed method is that finding the local indices of the specified indicators, defined as the ratio of the same name hourly average of the figures of the previous hour to the next, the found index build at least one corresponding desired KG normal functioning of the system and the results of the comparison determine the presence or absence of the desired pathology.

The claimed method is also characterized by the fact that removing the ECG limit of two seven-hour intervals, corresponding to the States with the most active and calm the patient.

The technical result of the claimed method is that it gives 100% detection of pathological phenomena with accuracy of 95% and above. Moreover, the claimed method ECG diagnostics allows you to diagnose a pathology, which was previously diagnosed solely by other types of research, for example, heart ultrasound, transesophageal ECG and other

In Fig. 1 shows the values of the discriminant functions to identify violations of the automaticity of the heart of Fig.2 - the same, for detecting insertion of extrasystoles; Fig.3 - to recognize the localization of the ectopic focus.

The implementation of the inventive method begins with the monitoring of the patient, i.e., continuously during the day with the patient remove the electrocardiogram (ECG). In practice it was found that monitoring can be a maximum of two seven-hour intervals corresponding to the peaks of activity and rest the patient, in accordance with what have been selected daytime from 9 to 15 and nightly from 0 to 6 (inclusive).

Next, on the basis of mathematical clicks the reverse curves - the heart rate);
SDNN (MS) - standard deviation of all the analyzed RR-intervals;
rMSSD (MS) is the square root of the sum of squared differences of the values of successive RR-intervals.

As currently cardiogram (except elementary cases) is removed using well-known computer equipment (for example, "Ramacharitamanas ELON-001", "Digital ECG machine With-804" on a personal computer and others), the need for any mathematical treatment of kardiogramm no, because with appropriate software, the device generates numeric values for all required parameters.

By the numerical values of these metrics are local indices, which determine the hourly average (average) value for each of the given indicator, and then the ratio of the value of the previous hour of this indicator for the next hour.

Similarly, define the index for each of the above all of the indicators.

The method of discriminant analysis is based diagnostic (discriminant) function, variables which are local indexes, so for each set of local indexes you can define St.

Because discriminant analysis and the construction of the discriminant function refers to a known method of mathematical statistics, its description in the materials of the present application is not required. With regard to the claimed method, the construction of discriminant functions is carried out by using the appropriate software, which the applicant provides.

Research and statistical processing of the data set it was found that each of the built discriminant functions, on the one hand, is intended to identify one relevant pathology and, on the other hand, refers to the corresponding age group of the population. Thus, the research found that, for example, for reliable detection of pathology of patients aged 8 to 16 years should be divided into two age groups: 8-11 years 12-16 years.

Within each age group were also determined numerical values of the discriminant functions constructed on the basis of the so-called "typical" ECG, i.e. ECG, reflecting the work of a normally functioning cardiovascular system (no violations), which are the database (in the possession of the applicant available for the fucking program corresponding to the desired pathology and this age group, build a discriminant function of the patient whose values are compared with the values of the corresponding discriminant functions from the database (criteria standards) and comparing the model function with the function of the patient is judged on the presence or absence of the desired pathology.

For example, in Fig. 1 shows the values of the discriminant functions to determine violations of the automatic work of the heart in the middle age group of children (8 to 11 years) of 45 people. Axis "x" are given numerical values of functions, and on the axis "y" is the numerical sequence of patients, which may be different than shown in Fig.1 (Fig.2 and 3 are similarly determined by the solution of other tasks that are not relevant to this application.

It is evident from Fig.1 shows that the value functions for patients with 1 to 30 positive, and for patents from 31 to 35 is negative, which means that there are automation features in the work of the heart in the first (normal) and the lack of a second (pathology).

On another program for another discriminant functions recognized by another pathology, called "insertion extrasystoles" (Fig.2, the older age group - teenagers from 12 to 16 years). Negative values of the function svidetel Fig.3, recognize the localization of ectopic focus (average age group - children from 8 to 11 years old).

In Fig.3 shows that the average numerical values of the discriminant functions for patients with 1 to 13 are in the "corridor" from "0" to "-10", therefore, ectopic lesion localized in the atrium in patients with 4 to 22 in the range from "0" to "+10" in actiontriggered site, patients from 23 to 42 in the range from "-5" to "+5" in the ventricles of the heart.

Abnormalities in the heart, shown in Fig.1-3 in the form of diagrams, can be represented in a tabular form that the claimed method is immaterial.

Implementation of the claimed method is illustrated by the following examples.

Example 1.

Diana H. was admitted to the examination in CCC (cardiac centre) with a diagnosis of dystonia, atrial extrasystole. ECG: main pacemaker is the sinoatrial node, frequent atrial altreitalie.

In the examination of the patient by the claimed method were further identified the following violations of automaticity: the migration of the pacemaker in the Atria, replacement ectopic complexes during sinoatrial blockade, frequent atrial premature beats.

In the earlier post which they are presented under 31.

Example 2.

Maxim D. entered for examination in CCC with rhythm disorders identified in the ECG. Standard ECG characteristics were determined ventricular premature beats, ventricular ECHO rhythm. To confirm the nature of the arrhythmia was performed transesophageal ECG (painful procedure). After the appearance of premature ventricular complex identified prong "R" having the same direction and form, and sinus. At a distance of 0.26 seconds after it was placed unchanged QRS complex. This violation was due to the presence of insertion of ventricular extrasystoles.

After this survey was conducted by the claimed method. Due to the construction of the corresponding discriminant functions previously delivered the diagnosis was confirmed, but simpler for the patient netraverse way. In Fig.2 patient presents under 6.

Example 3.

Alexander C. was admitted to the examination in CCC with a diagnosis of ventricular premature beats". On the standard ECG sinus rhythm, electrical axis is usually, frequent premature beats with a wide QRS complex. However, during transesophageal ECG has doubts about the correctness of the diagnosis, the village is suspected the diagnosis of ventricular premature beats" was changed to "atrial extrasystole", see part of the diagram in Fig.3, labeled as the "atrium": the average value of the discriminant functions of this patent extends beyond the "corridor" between "0" and "-10", which indicates the presence of the desired pathology.

Thus, for example, from Fig.1 shows that the chart is a set of numeric values of the discriminant functions, where its indicators for patients with 1 to 30 are normal (no pathology) and therefore must be logged in the database for comparison. Obviously, for the researcher, the database must only give knowledge about what the norm is different from the pathology (Fig.1 and 2 is only a sign "+" or "-" numeric value function). Therefore, to determine the desired pathology chart in Fig. 1 clearly carries redundant information (intended for other tasks). The same applies to Fig.2 and is similar to Fig.3, however, as already mentioned, the inventive method is immaterial.


Claims

1. The way to diagnose rhythm disorders in the cardiovascular system, which within days continuously remove the ECG of the patient and on the received ECG are average values of Mean - average value is mm squared differences of the values of successive RR-intervals, characterized in that find local indices these indices, defined as the ratio of the same name hourly average of the figures of the previous hour to the next, the found index build at least one related search pathology discriminant function whose values are compared with values similar functions typical ECG normal functioning of the system, and the results of the comparison determine the presence or absence of pathology.

2. The method according to p. 1, wherein removing the ECG limit of two seven-hour intervals, corresponding to the States with the most active and calm the patient.

 

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FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.

EFFECT: high accuracy of diagnosis.

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