The method of estimation of the functional state of the heart

 

The invention relates to medicine, particularly cardiology. Record the ECG. Carry out the calculation of the amplitude and duration of morphological elements and ECG intervals in a temporal sequence. Analysis of temporal sequences ECG made by calculating the areas and segments. Define diagnostic criteria violations functional state of the heart on the average of the ratio of the area of de - and repolarization parts of the ECG. The method allows the detection of early stages of violations of the functional state of the heart. 3 Il.

The invention relates to medicine, particularly cardiology, and can be used for diagnosis and monitoring of treatment effectiveness.

There is a method of assessing the functional state of the myocardium (see author's certificate No. 1697731, MCI And 61 In 5/02), consisting of ECG recording with subsequent determination of the duration of the cardiac cycle, the total duration of electrical systole of the ventricles. The value of the estimated coefficients are judged on the state of cardiac activity.

The disadvantage of this method is that it does not provide analysis of am is not counted as energy characteristics of the myocardium at the stages of depolarization and repolarization of the heart.

There is a method of assessing the functional state of the heart, taken as a prototype (patent RF №2067417, class. And 61 In 5/0452), which along with the registration morphological elements ECG additionally allocate the intervals P-Q+QRS and ST-T+T-R. Then, on the basis of the received data to determine diagnostic criteria and its value is equal to or smaller of 0.4 and equal to or greater 0,6, judge violations of the condition of the myocardium.

The disadvantage of this method is not sufficiently high accuracy of estimation of the functional state of the heart, related to the fact that there is no differentiation of the energy processes in the Atria and the ventricles at the stages of de - and repolarization of the myocardium.

Goal - improving the accuracy of an objective assessment of the functional state of the myocardium.

This goal is achieved by the fact that in the method of estimation of the functional state of the heart, including the registration of the amplitude and duration of the morphological elements of the ECG and the interval P-Q+QRS and ST-T+T-P, analysis of time series of ECG, according to the invention after the registration of the amplitude and duration of morphological elements and intervals produce their separation in time sequence ECG and analysis vremenno intervals and define diagnostic criteria as the average ratio of the squares of de - and repolarization parts of the ECG cycle by the following formulas:

where SP- square wave R; ST- square of the T wave; SR- square R-wave; S(P-Q+QRS)- the area of teeth and segments in the interval P-Q +QRS; S(ST-T+T-R)- the area of teeth and segments in the interval, ST-T+T-P,

when values:

DK1the larger of 0.2 and smaller 0

DK2more than 1, and smaller 0,2

DK3more than 1, and smaller 0,4

judge the violation of the functional state of the heart.

This method allows to differentiate the energetic processes of the Atria and ventricles at the stages of de - and repolarization of the myocardium, which improves the accuracy objective assessment of the functional state of the myocardium. The essence of the proposed method is illustrated in Fig.1, 2, 3.

In Fig.1 shows the results of processing the ECG healthy men.

In Fig.2 - the results of processing the ECG of the patient with the first degree of arterial hypertension.

In Fig.3 - the results of processing the ECG of a patient with Rupniecibas myocardial infarction on the background of arterial hypertension of the third degree.

The inventive method is as follows.

1. Provide registration of the ECG with microscopic elements ECG: P, Q, R, S, T, P-Q, S-T, T-R, and the interval P-Q+QRS and ST-T+T-P.

3. Make the selection of the above morphological elements and intervals in a temporal sequence of the ECG, for example, using an expert evaluation by a doctor of functional diagnostics.

4. Analyze time series of ECG by successive counting squares of teeth and segments at selected intervals. In Fig.1-3 is in the shaded area.

5. Define diagnostic criteria as the average ratio of the squares of de - and repolarization of the parts of the ECG cycle by the following formulas:

where SP- square wave R; ST- square of the T wave; SR- square R-wave; S(P-Q +QRS)- the area of teeth and segments in the interval P-Q+QRS; S(ST-T+T-R)- the area of teeth and segments in the interval, ST-T+T-P;

6. Judge violations of the functional state of the heart at the values:

DK1the larger of 0.2 and smaller 0

DK2more than 1, and smaller 0,2

DK3more than 1, and smaller 0,4

7. Judged of no violations of the functional state of the heart at the values:

DK1not more than 0,2 and ncoi analysis of the ECG registration allows you to compare the energy components of the functioning of the Atria and ventricles at the stages of de - and repolarization of the myocardium alone or in combination.

Example 1

Patient B. N., 19 years. Clinical diagnosis: cervical osteochondrosis in the acute stage.

Notes recurrent pain in the left half of the chest, not associated with physical exercise. Conventional ECG in 12 standard leads intact. By the present method record the amplitude and duration of the morphological elements of the ECG: P, Q, R, S, T, P-Q, S-T, T-R, and the interval P-Q+QRS and ST-T+T-P. Allocate on the above intervals teeth and segments of Fig.1 is the shaded area.

Calculate the area of the selected teeth and segments. The formulas 1,2,3 define diagnostic criteria. DK1=0,14; DK2=0,7; DK3=0,8.

Conclusion: violations of the functional state of the heart is not detected. Diagnosis was confirmed by clinical and instrumental and x-ray graphics research.

Example 2

The patient ie, 32 years. Clinical diagnosis: arterial hypertension of the first degree, the risk 2. ECG pathological changes were found. At the time of the study, the blood pressure within normal limits. By the present method record the amplitude and duration of the morphological elements of the ECG: P, Q, R, S, T, P-Q, S-T, T-R, and the interval P-Q+QRS and ST-T+T-P. Allocate to the above is mentov. The formulas 1,2,3 define diagnostic criteria. DK1=0,26; DK2=1,1; DK3=1,05.

Conclusion: patients received daily monitoring of blood pressure revealed arterial hypertension in the evening.

Example 3

Patient P. C. 73 years. Clinical diagnosis: ischemic heart disease, acute krupnooptovyj myocardial infarction bottom wall of the left ventricle, hypertension 3 degrees, the risk of 4. By the present method record the amplitude and duration of the morphological elements of the ECG: P, Q, R, S, T, P-Q, S-T, T-R, and the interval P-Q+QRS and ST-T+T-P. Allocate on the above intervals teeth and segments of Fig.3 is a darkened area.

Calculate the area of the selected teeth and segments. According to formulas 1, 2, 3 define diagnostic criteria. DK1=-0,49; DK2=-2,89; DK3=-1,83.

Conclusion: patients received echocardiography. Detected area akinesia in the lower wall of the left ventricular, hypertrophy of the interventricular septum.

The proposed method, allowing for the analysis of ECG to differentiate the energetic processes of the Atria and ventricles at the stages of de - and repolarization of the myocardium, can improve the accuracy of the objective evaluation of functional sostoyaniye stage cardiac activity.

Claims

The method of estimation of the functional state of the heart, including the registration of the amplitude and duration of the morphological elements of the ECG and the interval P-Q + QRS and ST-T + T-P, analysis of time series of ECG, characterized in that after the registration of the amplitude and duration of morphological elements and intervals produce their separation in time sequence ECG and analysis of temporal sequences ECG is carried out by successive calculation of the areas of the teeth and segments at selected intervals and define diagnostic criteria as the average ratio of the squares of de - and repolarization parts of the ECG cycle by the following formulas:

where SP- square wave P;

ST- square of the T wave;

SR- square R-wave;

S(P-Q+QRS)- the area of teeth and segments in the interval P-Q + QRS;

S(ST-T+T-P)- the area of teeth and segments in the interval, ST-T + T-P,

and when the values DK1the larger of 0.2 and smaller than 0, DK2more than 1, and smaller 0,2, DK3more than 1, and smaller 0,4 judge

 

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