Method for predicting complex cardiac rhythm disorders in patients suffering from bronchial obstruction lung diseases

FIELD: medicine.

SUBSTANCE: method involves carrying out pulsating Doppler echocardiographic examination. Mean pressure is determined in pulmonary artery. Mean pressure in pulmonary artery being less than 13 mm of mercury column, no cardiac rhythm disorders risk is considered to take place. The value being greater than 13 mm of mercury column, complex cardiac rhythm disorder occurrence risk is considered to be the case.

EFFECT: accelerated noninvasive method.

1 tbl

 

The invention relates to medicine, namely cardiology, pulmonology, internal medicine.

The problem of prediction of arrhythmias, depending on the nature of the disease and the severity of the currents remain virtually unexplored.

A known method for predicting the occurrence of primary arrhythmias and their metastases, including registration correlation ramagrama with the definition of the variation of the amplitude of the R-interval and the wave structure of the heart rhythm (Mirolyubov O.A., patent No. 1584904 from 15.08.1990). To calculate the index of probability of occurrence of arrhythmias requires daily conduct correlation rithmography at rest in the same hours for 7-10 days. Obtaining such important information over a fairly protracted period of time is highly undesirable.

There is another method for predicting recurrence as first developed seizures flicker and flutter by conducting echocardiogram with simultaneous recording of the electrocardiogram (ECG) (V. Shabrov, Olesen A.I., Razumova T.V., patent No. 2192775 from 30.07.1999). It is based on the results of transesophageal pacing. When antegrade conduction of excitation in the Atria is performed at a frequency of greater than 50% frequency baseline sinus rhythm. In the presence of retrograde conduction of excitation in which predserdiam before or after stimulation predict recurrence of paroxysms flicker and flutter within 6 months after the first attack. However, for transesophageal pacing is contraindicated in patients with asthma, in severe clinical obstructive syndrome and condition of patients due to advanced lung diseases (Characin L.V., Shubik Y., Medvedev, M., Tatar B.A. Transesophageal electrocardiography and elektrocardiostimulyatsia. - SPb. - 1999. - P.8).

The leading role in the etiology and pathogenesis of arrhythmias in diseases of the respiratory system is given hypoxia and closely related pulmonary hypertension. We were interested in the possibility of predicting the existence of arrhythmias, depending on the severity of secondary pulmonary hypertension in the pulmonary circulation in patients with obstructive lung diseases.

The technical result of the invention is the prediction of complex cardiac arrhythmias.

The technical result is achieved by determining the level of average pressure in the trunk of the pulmonary artery (LA) time indices of systolic flow in the output Department of the right ventricle during the pulse dopplerechocardiography. These include: the acceleration of blood flow from the beginning of the exile to the top (AST, MS) and the duration of the expulsion of the right ventricle, corresponding to the time from the beginning to the end of the blood flow (RVET, MS). Average Velich what are these indicators are from the first seven dimensions, then calculate the ratio AcT/RVET and the corresponding average pressure in the pulmonary artery in table A. Kitabatake and others (1983). When the level of the average pressure in excess of 13 mm RT. century, it is predicted that the risk of the existence of the group ventricular arrhythmia, paroxysmal supraventricular tachycardia, unstable ventricular tachycardia.

The method is as follows. During echocardiography is the imaging of the pulmonary artery from any of the following access: parasternal, subtotaling, apical. Using a pulsed Doppler registered systolic flow in the output Department of the right ventricle and its temporal indicators: AST and RVET. Their values are determined from the first seven dimensions, and then calculated the ratio of AST to RVET and the average pressure in LA. When the values are within the normal range (9 to 13 mm RT. century), the patient has no complex cardiac arrhythmias. In case of increase of the average pressure in LA more than 13 mm RT. Art. predicted the existence of complex cardiac arrhythmias. That was the conclusion we came, by comparing the results of dopplerechocardiography and data Holter monitoring ECG in 45 patients with chronic bronchopulmonary pathology in the acute stage. Of these 27 patients, the average pressure is LA amounted to more than 13 mm RT. century, with 14 people showed signs of moderate pulmonary hypertension (mean pressure of from 30 to 50 mm RT. article). When holding the rank correlation analysis Spearman revealed a highly reliable positive dependence of the average force between the average pressure in LA and paroxysmal supraventricular tachycardia, group, ventricular arrhythmia, unstable ventricular tachycardia (table 1). Other heart rhythm disorders have a weak, but significant positive correlation with the level of the average pressure in LA.

Example 1.

Patient D., aged 54 history No. 9278. Diagnosis: chronic obstructive lung disease stage II, exacerbation, chronic pulmonary heart, compensation stage; pulmonary heart disease II. When recording a standard 12-lead ECGs rhythm abnormalities were noted. When conducting pulse dopplerechocardiography was calculated temporal indices of systolic flow in the output Department of the right ventricle of the first of seven dimensions: AST(0,099; 0,099; 0,122; 0,084; 0,099; 0,099; 0,107 MS) and RVET(0,206; 0,188; 0,229; 0,206; 0,191; 0,214; 0,199 MS). For each dimension, the ratio of AST to RVET was as follows: 0,48; 0,53; 0,53; 0,41; 0,52; 0,46; 0,54, therefore, the value of the average pressure in LA- 11,4; 9,4; 9,4; 19; 9,4; 12,3; 9,4 mm RT. Art. respectively. The average value of the average pressure in the LA SOS is avilo 11.5 mm RT. Art. By Holter ECG monitoring in the background of sinus rhythm was observed following cardiac arrhythmias in non-pathological quantities, mainly in the daytime: single supraventricular monomorphic beats (9), single monomorphic ventricular beats (total 16).

Example 2.

Patient C., 55 years old, medical history, No. 12860. Diagnosis: bronchial asthma of moderate severity, exacerbation. When recording a standard 12-lead ECGs rhythm abnormalities were noted. When conducting pulse dopplerechocardiography was calculated temporal indices of systolic flow in the output Department of the right ventricle of the first of seven dimensions: AST(0,130; 0,145; 0,091; 0,107; 0,137; 0,137; 0,122 MS) and RVET(0,313; 0,298; 0,214; 0,260; 0,329; 0,298; 0,275 MS). For each dimension, the ratio of AST to RVET was as follows: 0,42; 0,49; 0,43; 0,41; 0,42; 0,46; 0,44, therefore, the value of the average pressure in LA- 16,7; 10,7; 15,7; 17,8; 16,7; 12,9; 14,7 mm RT. Art. respectively. The average value of the average pressure in LA amounted to 15.0 mm RT. Art. By Holter ECG monitoring in the background of sinus rhythm was observed following cardiac rhythm: single supraventricular polymorphic beats (26), steam supraventricular beats (2), group supraventricular beats (just 1), paroxysmal supraventricular tah the cardia (just 1).

Example 3.

Patient, 63 years history No. 9169. Diagnosis: chronic obstructive lung disease stage II, exacerbation; respiratory failure II. When recording a standard 12-lead ECGs rhythm abnormalities were noted. When conducting pulse dopplerechocardiography was calculated temporal indices of systolic flow in the output Department of the right ventricle of the first of seven dimensions: AST(0,084; 0,122; 0,068; 0,130; 0,114; 0,134; 0,099 MS) and RVET(0,283; 0,222; 0,275; 0,298; 0,268; 0,320; 0,275 MS). For each dimension, the ratio of AST to RVET was as follows: 0,30; 0,55; 0,25; 0,44; 0,43; 0,42; 0,36, therefore, the value of the average pressure in LA- 36,3; 9,4; 50,1; 14,7; 15,7; 16,7; 24,6 mm RT. Art. respectively. The average value of the average pressure in LA totaled 23.9 mm RT. Art. By Holter ECG monitoring in the background of sinus rhythm was observed following cardiac rhythm: single supraventricular polymorphic beats (39), steam supraventricular beats (just 1), single polymorphic ventricular beats (49), group ventricular beats (just 1), paroxysm unstable ventricular tachycardia (1).

Example 4.

Patient M., 67 years old, medical history, No. 12296. Diagnosis: chronic obstructive lung disease stage II, exacerbation, chronic pulmonary heart, subcompensation stage; agacino-heart failure II. On the standard 12-lead ECGs were observed single supraventricular extrasystoles. When conducting pulse dopplerechocardiography was calculated temporal indices of systolic flow in the output Department of the right ventricle of the first of seven dimensions: AST(0,091; 0,064; 0,075; 0,076; 0,064; 0,060; 0,080 MS) and RVET(0,268; 0,237; 0,290; 0,229; 0,217; 0,212; 0,217 MS). For each dimension, the ratio of AST to RVET was as follows: 0,34; 0,27; 0,26; 0,33; 0,29; 0,28; 0,37, therefore, the value of the average pressure in LA- 28,5; 44,0; 47,0; 29,9; 38,7; 41,3; 23,1 mm RT. Art. respectively. The average value of the average pressure in LA $ 36.1 mm RT. Art. By Holter ECG monitoring in the background of sinus rhythm was observed following cardiac rhythm: single supraventricular polymorphic beats (just 4819), steam supraventricular beats (26), group supraventricular beats (5), paroxysmal supraventricular tachycardia (1), single monomorphic ventricular beats (8), a pair of supraventricular and ventricular extrasystoles (5).

The positive effect is quite rapid and non-invasive prediction of risk of the existence of complex cardiac arrhythmias during exacerbation of obstructive lung diseases.

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Table 1.
The results of rank correlation analysis between the level of the average pressure in the pulmonary artery and ectopic heart rhythm
Heart rhythmThe Spearman correlation coefficientThe confidence level
 rSp
Single supraventricular beats0,4400,003
Steam supraventricular beats0,4480,002
Group supraventricular beats0,2490,099
Paroxysmal supraventricular tachycardia0,4960,000
Single ventricular beats0,3380,023
Steam ventricular beats0,3900,008
Group ventricular beats and non-sustained ventricular tachycardiato 0.4800,000

A method for predicting complex arrhythmias in patients with obstructive lung diseases, namely, that determine the value of the mean pressure in the pulmonary artery and the level environments, the pressure in the pulmonary artery less than 13 mm RT. senior risk of the existence of complex cardiac arrhythmias is absent, and when it is increased more than 13 mm RT. senior predict the risk of occurrence of complex cardiac arrhythmias.



 

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