Method of determining vasodilating reaction of nitroglycerin in patients with ischemic heart disease

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used in cardiology, cardiac surgery, physiology. In patients with ischemic heart disease thermographic examination of upper extremities is carried out. ECG monitoring is performed. Analysis of heart rhythm variability is realised. Test with sublingual introduction of nitroglycerin is carried out. Presence of vasodilating reaction to nitroglycerin is determined by values of temperature of left hand fingers, index of tension (voltage) and RMSSD index.

EFFECT: claimed invention extends functional possibilities of determining clinical efficiency of nitrates in treatment of patients with IHD.

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The invention relates to medicine and can be used in cardiology, cardiac surgery, physiology.

In the Russian national recommendations BHOK and OCCH for the diagnosis and treatment of chronic cardiac insufficiency (CCI) (second revision, 2007) States: "... must be hard attitude to drugs with unclear mechanism of action and unproven clinical effectiveness..." [7].

The first mention about the effectiveness of organic nitrates for angina refers to 1876, but this group of drugs are still used in the treatment of cardiac patients. They are indispensable in cases when you need to quickly resolve the myocardial ischemia or acute left ventricular heart failure. Nitrates contribute to the expansion of coronary arteries and arterioles of sufficiently large diameter, affecting the vessels of the systemic circulation, causing expansion as peripheral venous vessels, depositing the blood and arterioles. This results in decreased venous return and systolic blood pressure in the aorta. Accordingly decrease the preload, postnagruzku and tension of the walls of the ventricles of the heart, which leads to a reduction in the need of oxygen. Reducing the pressure of filling of the ventricles facilitates blood supply to abandoned the material layers of the myocardium. These mechanisms underlie the anti-ischemic action of nitrates and their ability to reduce the severity of left ventricular heart failure [21]. The main indications for the use of nitrates are well known: the elimination and prevention of myocardial ischemia (stable and unstable angina, acute myocardial infarction), acute heart failure, CCI, arterial hypertension (AH). However, when long-term maintenance of high concentration of active substance in the blood develops a tolerance to nitrates, leading to a decrease in the intensity and duration of their action. The mechanisms of this phenomenon are not completely clear. This leads to the search for more instrumental-pharmacological techniques that will allow us to objectify the inclusion of nitrates in the pharmacotherapy of patients with coronary heart disease (CHD).

It is known that at rest in patients with coronary disease cardiovascular system for a long time to be able to compensate without clinical signs of breaking. Therefore, EKG, registered in 12 standard leads alone may not detect signs of coronary insufficiency of certain departments of the myocardium, but that is no reason to exclude the patient is hemodynamically C is Akimova atherosclerotic lesions of coronary arteries. In this regard, in the cardiology practice have been widely used stress test on a Bicycle Ergometer or treadmill with isotonic load (stress tests) [7]. These samples allow us to assess prognosis in patients after myocardial infarction, to determine a valid physical activity and, in particular, to identify the adequacy of antianginal therapy. Along with the advantages of ECG samples with physical activity (the relative simplicity of implementation, low cost, simultaneous assessment of functional status, the risk of cardiac arrest - a 0.02%, and so on), however, the sensitivity and specificity of these tests does not exceed 70%, and even lower in women [7].

In cases when there is evidence, but for whatever reason, the sample of physical activity cannot be performed (known 23 absolute and relative contraindications to load test), conducted tests with drugs (dipyridamole, adenosine, dobutamine, arbutamine). Drug tests are much inferior in sensitivity of the test with physical activity, so at present in isolated form their little used, and used in combination with other methods of visualization: stress ECHOCARDIOGRAPHY with dobutamine and arbutamine, myocardial scintigraphy with dipyridamole and Aden the zine [7|.

Stress ECHOCARDIOGRAPHY, stress echocardiography (stress ECHOCARDIOGRAPHY) is currently one of the most popular and highly informative methods for non-invasive diagnosis of latent coronary insufficiency. The main premise underlying the method is the fact of occurrence of ischemia of the myocardium with contractile function of the heart. The change in the contractility of the myocardium develops after the reduction in blood flow, metabolic and diastolic function, but before the onset of ECG changes and angina. This phenomenon is called the ischemic cascade and first described by scientists R.Tennant and S.J.Wiggers [28] in 1935. Stress ECHOCARDIOGRAPHY may assist the Clinician in the selection of patients with high and low risk of cardiovascular complications, as well as monitoring the effectiveness of therapeutic and rehabilitative activities. However, stress ECHOCARDIOGRAPHY has its limitations: the inability to perform the study in patients with poor quality of visualization of the structures of the heart; great importance of the subjective factor in the processing of results; limit the application with arterial hypertension, diseases of the lower extremities, musculoskeletal system, and the impossibility of carrying out ultrasonic monitoring during the execution of the load on the treadmill or upright Ergometer that sijaitsevalle samples.

The use of pharmacological tests (dobutamine, Inirida) during stress ECHOCARDIOGRAPHY allows you to get the best quality images of the heart, and to determine the viability asperging attack. However, the introduction of dobutamine (synthetic β1- adrenomimetic) provokes a variety of cardiac arrhythmias that affect blood pressure. Test with digiridoo (arterial vasodilator) has a high specificity, does not cause a rise in blood pressure (BP) and can be recommended for AG, but not indicated in patients with bronchial obstruction, arterial hypotension, and often poorly tolerated. Yes, and the maximum sensitivity of drug samples requires the abolition of antianginal drugs, restricting food intake prior to the study [7].

Scintigraphy of the myocardium with vasodilators (adenosine, dipyridamole) is used to identify areas of relative or absolute reduction of blood flow due to ischemia or scar of myocardial damage. When hemodynamically significant coronary atherosclerosis introduction of these drugs leads to the development of the syndrome coronary "victimize" and heterogeneous capture radiopharmacological drug that will allow, in particular, to evaluate early and long-term effects of drug therapy Bo is lnyh with CHD. The basis of radioisotope techniques laid emission, and not the transmission principle, therefore, visualization is limited by the probability of accidental radionuclide distribution of photons in different directions, so the spatial resolution of the method is considerably lower than with conventional x-ray techniques, which limits their use for the analysis of anatomical areas of the heart [7].

Even such a "gold standard" in the diagnosis of coronary artery disease, coronary angiography, has several limitations: the inability to evaluate lesions of the distal bed of the coronary arteries, the effect extracoronary factors (myocardial hypertrophy, reduced coronary reserve), poor identification of eccentric stenosis and a General description of the collateral channel, the relative threshold criteria stenosis [7].

These methods examine the state of the coronary circulation give objective information about backup options macromanagement necessary conditions forecast pathology, but they are quite time-consuming, have some clinical limitations and do not take into account the degree of involvement of the parasympathetic and sympathetic autonomic nervous system in CHD. Yes, and existing research on the use of pharmacological tests with the methods of invasive and non-invasive diagnostics the latent coronary insufficiency to increase the maximum sensitivity drug test, demand repeal of antianginal drugs in patients with coronary artery disease. In this study, allowing you to give your doctor more information to make correct decisions on whether, for example, the inclusion of nitrates in pharmacotherapy in patients with CHD. Therefore it appears appropriate to use in everyday clinical practice, the known method of diagnosing cardiovascular disease - remote infrared thermography and method of evaluation of the functional status of the various divisions of the autonomic nervous system (vis) by the heart rate variability (HRV) in the dynamics of ad samples to monitor the effectiveness of treatment and rehabilitation interventions in CHD patients.

Many researchers have established a functional relationship metabolic and circulatory processes the periphery of the body from the heart. Thus, the change in the temperature topography limbs disorders of the coronary circulation notice Igitalis et al. in 1974 [22]. Using a special technique, they found that myocardial infarction is the most constant temperature changes in the region of the toes of the left foot. However, temperature and topography of the human body through contact thermometry even with a significant increase in the number of dates is the ISR may not reflect the complexity and diversity of processes, determining the temperature map of a person. The change in heat relief in the heart, the left forearm and the fingers of the left hand in the form of hypothermia, detected by imaging in coronary artery disease, reflect the nature and degree of impairment of coronary blood flow, as evidenced by electrocardiographic data and their dynamics in the course of treatment [8, 12, 13]. The most common imaging a symptom of CHD is the asymmetry of skin temperature of the hand [14], and that thermography distal upper extremities with coronary pathology even more informative than in the region of the heart [15, 16]. In addition, when the coronary artery disease with severe hyperlipidemia changes of temperature elevation of the upper and lower extremities more pronounced, i.e. the deeper disorders of lipid metabolism, the more disturbed the normal thermal pattern of the limbs [6]. Thermal imaging is the most accurate and useful method for the simultaneous study of the temperature of the skin of a person, depending on the intensity of the blood flow, which increase with the combination of the method with pharmacological tests [3, 9]. Therefore, of particular interest is the determination of the capabilities of thermal imaging method in this pathology.

As the prototype is taken there is a method for diagnosing cardiovascular diseases - diest is scianna infrared thermography. Computer modification imager BTV-3 computer (as part of a thermal imaging camera, video device pairing imager with a computer allows you to get the display color gradation picture of the observed object by binding to the temperature scale. The system functions of the imager defined program that allows you to obtain the profiles of the cross sections of the temperature distribution in various directions, by using the device selection isothermally areas can be estimated as the temperature contrast and the absolute value of the temperature. Various markers, cross-isotherm help produce quantitative processing of thermal images directly in the monitoring process. Typical features of thermal pattern at some nosological forms of cardiovascular disease and the absence of others allow the use of imaging as one of the methods of differential diagnosis [8]. Thermal imaging characteristic of patients with disorders of the coronary circulation is characterized by the change of thermal images in the form of reduced infrared radiation in the distal parts of the left hand (lower third of the forearm, hands and fingers), due to the interconnectedness of the sympathetic innervation of the heart and hands, the waste is from the left edge of the trunk nerve [5]. These Dan is s should be considered as a manifestation of irritation vegetative formations cervico-thoracic sympathetic trunk to the left with the formation of specific features of peripheral blood - the differentials between [18]. What determines, on the one hand, highly informative imaging method, and nespecificnomu the received information, which can be interpreted only with the data of the clinic and the sympathetic innervation of the heart and the left hand. Therefore, when examining patients with coronary artery disease arises the need for a detailed study of the state of the coronary circulation, identifying spare capacity and compensatory abilities. In addition, it is necessary to investigate the involvement of vascular spasm in the occurrence of coronary insufficiency and susceptibility to nitrates. Use of nitroglycerin and thermal monitoring vasodilatation effect of the drug, manifested on termogrammy intensification of infrared radiation distal left hand (fingers), will allow us to monitor the dynamics of blood flow in the heart muscle in the treatment of patients with coronary artery disease taking into account the functional status of the various divisions of the ANS on HRV [18].

The aim of the invention is to enhance the functionality of determining the vasodilator effects of nitroglycerin in patients with coronary artery disease.

This objective is achieved in that the patient carry out thermal imaging study of hands and mathematical analysis of HRV dynamics in ad samples, with increasing temperature, PA is icev left hand not less than 1.3 times and to increase the tension index (ti) of the sympathetic division of the ANS is not less than 2.7 times or when the temperature of the fingers of the left hand not less than 1.3 times and the decrease in the activity of the parasympathetic regulation of the ANS (RMSSD) not less than 1.9 times after administration of 0.5 mg nitroglycerin sublingual determine vasodilator response in patients with coronary artery disease.

System assessment of autonomic regulation of the heart and blood vessels can be used data on the variability of hemodynamic parameters, of which the simplest and most affordable is the heart rate [1, 4]. Analysis of heart rate variability (HRV) is a modern methodology and technology research and assessment of regulatory systems of the body, in particular the functional status of the various divisions of the autonomic nervous system. The popularity of this method is due to its high reliability and informative results with sufficient ease of study [2].

Physiological mechanisms of HRV based on the fact that the serial number of the R-interval (cardiotocogram) reflects a regulatory influence on the sinus node of the heart different departments BHC - sympathetic and parasympathetic. At rest, the influence of both divisions of the ANS on the heart is balanced, there is the so-called autonomic balance. Under stress, physical stress increases the activity of the sympathetic BHC and reduced parasympathetic [19]. Sleep, digestion lead to the dominance of the parasympathetic division BHC [1]. Parasympathetic tone predominates in the young healthy people at rest. Circadian rhythm of autonomic tone characterized by an increase in daytime sympathetic effects on the cardiovascular system and the parasympathetic night [23]. During aging reflex influence on the cardiovascular system is weakened, there is a disintegration of the different levels of autonomic regulation of cardiac activity [10, 11]. The seniors on the background of General decline of autonomic tone is generated relative predominance of sympathetic regulation [25]that, given the age - dependent decrease in the functional capacity of the cardiovascular system, creates the preconditions for the deterioration of coronary and peripheral blood flow and the development of arrhythmias [29].

When examining patients with coronary artery disease arises the need for a detailed study of the Central and peripheral blood flow, the extent of participation vascular spasm, identify the compensatory capacity of the macro - and flow. Hemodynamic effects of nitrovasodilators (e.g., nitroglycerin) is well studied and are associated with relaxation of smooth muscle of veins, arteries and arterioles. Although, according to some, the known ability of nitroglycerin to inhibit platelet aggregation, which may have a certain relationship with them (nitrovasodilators) antiischemic action [24]. The presence of these features of vegetative regulation due to the necessity of studying indices of HRV in patients of coronary artery disease especially when the volatility process in relation to evidence for the purpose of antianginal therapy.

On the basis of the variational pulsometry calculates the number of performance indicators, among which the most commonly used index of tension of regulatory systems (INS), which reflects the degree of centralization of control heart rhythm and characterizes mainly the activity of the sympathetic division of the autonomic nervous system [20]. RMSSD is an indicator of the activity of parasympathetic autonomic regulation, based on the dynamic range of the differences between the values of successive pairs of R-interval and does not contain medlennovolnova components of the cardiac rhythm. He is in pure form reflects the activity of the Autonomous loop regulation and higher values of RMSSD, the more link parasympathetic influence ANS [20].

Western scholars generally consider heart rate variability as an indicator of sympathetic and parasympathetic divisions of the autonomic nervous system and investigate changes their balance in various diseases and in the process of pharmacological effects[23, 24, 26, 27, 29]. In our opinion, this approach to the analysis of HRV opens a new in the of moznosti to the selection of the appropriate treatment policy in such a complex patients - with ischemic heart disease.

The study is carried out using complex analysis of heart rate variability "VARICARD-format" models "VK-1,4" (hereinafter - the center), the power which is supplied from the AC voltage of 220±22 W with a frequency of 50±0.5 Hz and the power consumed by the unit, not more than 4 VA. The complex is manufactured in climatic design UHL 4.2. according to GOST R 50444-92 and is intended for use at temperatures between +10°C to +35°C, atmospheric pressure from 630 to 800 mm Hg, relative humidity of 80±15%. The complex is recommended for serial production and use in clinical practice, the MOH of Russia (minutes No. 5 dated 9 June 1998, the Commission on diagnostic instruments and devices), and running an IBM - compatible PC with the help of specialized software and consists of a block of a patient associated with a PC via standard RS-232 interface.

The presence in the complex of means for maintaining the database allows you to store basic information about the captured ECG, cardiointervalogram (CIG), the results of the mathematical analysis of TG for each surveyed, to generate and output to the monitor screen and in print output with the main indicators of the state system of regulation of heart rhythm. The character of the temperature of the reaction, the place and time of their occurrence, severity, and will continue lnost changes in thermal pattern results ad samples - all these data are more reliable and detailed information of the functional state of the coronary circulation.

The method is as follows.

1. Thermographic study begins with the receipt of the initial overviews of the upper extremities in serotonine characteristic.

2. If necessary, thermal image of the upper extremities in computer modification is recorded in the form of tonal multicolor picture.

3. Enable hardware complex "VARICARD-format".

4. Connecting the cable leads and the connection of the ECG electrodes to the patient: the red one to the right hand, yellow - left hand, black - to the right leg, green to left leg.

5. Executing the file.

6. Write, display on the monitor screen and the entry in the database electrocardiograma in one of the three standard leads within 5 minutes.

7. The selection of cardiomegaly TG and display it on the monitor screen.

8. Adjustment CIG includes a visual display saved in computer memory CIG and electrocardiograma for editing erroneous marks R teeth, and the selection of extrasystoles. Editing is done in an interactive graphical mode.

9. The test with 0.5 mg of sublingual nitroglycerin.

10. Identifying the vasodilator response to bat is oglycerin in the form of increased infrared radiation in the fingers of the left hand.

11. Selection 5-minute fragments TG and their mathematical analysis after samples with nitroglycerin.

In the available literature there are no reports about the simultaneous use of thermal imaging and complex for HRV analysis "VARICARD-format" in combination with nitroglycerine breakdown to determine the clinical efficacy of nitrates in patients with CHD. The need for such proposals is primarily due to the fact that the development of objective methods to assess the clinical effectiveness of antianginal drugs for the treatment of ischemic heart disease remains a challenge [7]. This can be explained by the fact that during ischemia myocardial microcirculation due not only to high sympathetic tone, but the original with the paralytic vasodilatation humoral effects of oxidized products of tissue metabolism. Therefore, assessment of autonomic regulation in various parts of the control system of blood circulation along with the formation of a thermal picture vasoconstrictor plan - hypothermia distal left upper extremity indicates a close anatomical relationship of the sympathetic innervation of the heart and the left hand. That allows you to diagnose early signs of changes in the regulatory mechanisms that precede the energetic and metabolic disorders, and thus, may have prognosticheskoe value in terms of appointment of adequate antianginal therapy in patients with coronary artery disease.

Examples of the method

Example 1. Patient K., 57 years old, retired, works part-time watchman, case history No. 9093. Hospitalized in a planned manner. Figures AD - 140/80-180/100 mm Hg Pain angina nature are rare, when you walk about 200 meters. Is nitroglycerin not often. In 2007, suffered acute myocardial infarction in the posterior wall of the left ventricle.

Biochemical blood test: AST - 19 u/l, ALT - 40 u/l, total cholesterol - 6.6 mmol/L.

Triglycerides: PETIT 105,5%, fibrinogen - 4.5 g/l, fibrinolytic activity 3 hours.

ECG: sinus Rhythm with heart rate of 67 in 1 minute. Cicatricial changes in the posterior wall of the left ventricle, moderate changes in the myocardium, excentric types.

Echocardiography: the Aorta and heart cavity is not expanded. The wall is not thickened. Global systolic function of the left ventricular myocardium is not reduced. Pulmonary hypertension no. The pericardium is not modified. Hemodynamically insignificant aortic stenosis.

Rheovasography of hands: the Relative impairment of venous outflow from the left.

Doppler ultrasound: the Nature of laminar flow, some acceleration of the flow over the left subclavian artery.

Thermal imaging: is Determined by the decrease of skin temperature in the distal parts of the left hand (lower third of the forearm, fingers) compared to the symmetric region of the right hand S<, ΔT 0,9°C.

Computer analysis of heart rate variability: a Pronounced predominance of the parasympathetic nervous system, IN (index of tension of regulatory systems) - 39; RMSSD - 67 MS. The pronounced weakening of the activity of the vasomotor center regulates vascular tone. Marked increased activity of the sympathetic cardiovascular center.

Delivered clinical diagnosis: IHD - PEAKS (transferred non-Q AMI in 2007), angina FC II. HSN I FC I. GB stage III, the degree of AG 2 risk 4 (very high). Comorbidities: Atherosclerosis of the aorta, iliac arteries S>D, hemodynamic stenosis.

Patients received a sample of 0.5 mg of sublingual nitroglycerin.

Thermography: an evident "warming" distal left hand - forearm, fingers. Practically fingers in the isotherm S<D, δ t 0,4°C. Convincing vasodilator response - the temperature of the skin in the fingers of his left hand.

Computer analysis of heart rate variability: the Balance of the divisions of the ANS is characterised by a marked predominance of the sympathetic (JN - 963; RMSSD - 2 MS), with a pronounced weakening of the activity of the vasomotor center regulates vascular tone, with a marked increased activity of the sympathetic cardiovascular center.

Thus, the vasodilator effect of nitroglyc the width and increasing the temperature of the fingers of the left hand in 2.2 times confirmed by the increase IN 963/39=24.6 times, the decrease in RMSSD 67/2=33.5 times, that is, changes in the dominant ANS from parasympathetic (initial state) to the sympathetic (after drug tests).

Treatment: kardiket, egilok, capoten, angioprotectors. The patient was discharged in satisfactory condition under outpatient supervision of a cardiologist.

Example 2. Patient D., 55 years old, retired, case history No. 11825. Rare pain in the sternum with emotional stress are accompanied by a sense of "lack" of air. Nitroglycerin practically does not use. Figures AD - 125/80-140/90 mm Hg comorbidities: atherosclerotic hemodynamic lesion of the femoral-popliteal segment on the left of the arteries of the left tibia, KHAN IIB. A year ago made video endoscopic lumbar sympathectomy left with a positive result. Currently complaints about intermittent claudication in the left lower limb does not show.

Biochemical blood test: Total cholesterol - 6,76 mmol/l, TG - 1,19 mmol/l, HDL-C - 1,79 mmol/L.

Triglycerides: PETIT 105,5%, fibrinogen - 3.5 g/l

ECG: sinus Rhythm with heart rate of 73 in 1 minute, moderate muscle changes.

Holter monitoring: ST segment Depression in leads characterizing potentials front, side, walls of the left ventricle, long painless, occurs at rest. Tolerant is here to loads below the average.

Coronary angiography: the Right type of blood supply to the heart. LCA - without a pathology, PMA - without hemodynamic stenosis, PKA - without a pathology.

USDG GCAP: intima-media OCA, HCO, GUS up to 1 mm, intima sealed. 's tortuous GUS without increase in BFV. ISC OSA 53 cm/sec to the left, right - 57 cm/sec. Lbfv by GUS: left 55 cm/sec, right 59 cm/sec. The progress of both vertebral arteries between the transverse processes of the cervical vertebrae is uneven. BFV on vertebrate arteries: right - 34 cm/sec, the left - 25 cm/sec. The diameter of the right vertebral artery 4 mm, left vertebral - 3,5 mm Data for the initial manifestations of atherosclerosis of the extracranial arteries.

Voltmetre registration biopotential distal of both hands:

the lower third of the forearm: left - 1,5 µv, right - 1 µv;

I finger: left - 2 µv, right - 1 µv;

Second finger: left - 1,5 µv, right - 1 µv;

Third finger, left - 2 µv, right - 1 µv;

IY finger: left - 1,5 µv, right - 1 µv;

Y finger: left - 1,5 µv, right - 1 µv;

Thermal imaging: is Determined by the reduction of infrared radiation in the distal left hand (forearm, fingers), the temperature difference ΔT between the symmetric parts S<D 1.5°C.

Computer analysis of HRV: Marked predominance of the parasympathetic nervous system with statistical parameters and the autocorrelation analysis RMSSD - 92 MS; the tension index (ti)- 46. Vegetative homeostasis is a normal activity of subcortical cardiovascular center, a moderate weakening of the activity of the sympathetic cardiovascular center.

Delivered clinical diagnosis: coronary artery disease coronary artery disease, angina painless form, FC III. CCI IIA FC I. GB II stage, degree of AG 2 risk 4 (very high). Atherosclerosis GCA without hemodynamic stenosis. Atherosclerosis of the lower extremities. KHAN IB Art.

The patient performed the test with 0.5 mg nitroglycerin sublingual registration infrared radiation (BTV-3 computer and mathematical analysis of HRV (complex VARICARD-format").

The imaging after 0.5 mg of nitroglycerin: asymmetry Remains (S< (D) distal upper extremities in the form of reduced infrared radiation of the left forearm and fingers ΔT of 1.3°C, i.e. the vasodilator effect on nitroglycerin expressed little.

Mathematical analysis of heart rate variability after 0.5 mg nitroglycerin sublingual: the Balance of the divisions of the ANS is characterized by a moderate predominance of the parasympathetic nervous system with indicators and statistical autocorrelation analysis RMSSD - 82 MS; the tension index (ti) - 74. Vegetative homeostasis - a moderate weakening of the activity of the vasomotor center, normal activity of subcortical cardiovascular price is RA.

Thus, the vasodilator effect of 0.5 mg nitroglycerin according to imaging is not expressed: ∆ T 1.5°C (source) to ΔT of 1.3°C (after drug samples) between the lower third of the forearm and the hand (S<D), which registered an increase IN 74/41=1.8 fold decrease in RMSSD 92/82=1.1 times when the prevailing influence of the parasympathetic division of the ANS before and after drug samples.

Treatment: ACE inhibitors, β-blockers, antiplatelet agents, angioprotectors. Discharged with improvement.

The proposed method is tested in 144 patients with CHD aged from 43 to 83 years (109 person - male, 35 female). Acute myocardial infarction in the second week of the disease is 10 persons, unstable angina 101, angina, postinfarction cardiosclerosis 25 patients, among them 8 people undergoing surgery for myocardial revascularization (CABG). The average age of the examined patients was 60,9 years. Diagnosis is based on typical clinical and instrumental picture. Surveyed patients was characterized by hypercholesterolemia (total cholesterol plasma 6,59±0.29 mmol/l).

The results of our research, based on the simultaneous imaging study of the upper extremities and mathematical processing of the dynamic range of R-R intervals of the ECG recorded at 1-m standard lead within 5 mi the ut on hardware "VARICARD-format" in the dynamics of ad samples from 144 patients with coronary artery disease, summarized, aggregated and presented in the table.

Comparative dynamics of instrumental methods in the dynamics of ad samples from patients with coronary artery disease
Research methodsThe stages of the researchResults studies
nM±Mpr
Heart rate variabilitySympathetic regulation (JN)The source data70184,6±27,20,33
Positive NG sample52498,5±157,6<0,05
Negative NG sample18301,2±75,5<0,2
Parasympathetic regulation (RMSSD, MS)Source Yes is data 7478,1±13,10,33
Positive NG sample3039,7±9,0<0,02
Negative NG sample4452,6±13,1<0,2
The imaging. The temperature difference of the fingers S<D (ΔT°C)Sympathetic regulation (JN)The source data701,0±0,05°C0,33
Positive NG sample520,7±0.03°C<0,001
Negative NG sample180,9±0,05°C<0,2
Parasympathetic regulation (RMSSD, MS)The source data741,1±0,08°C0,33
Positive NG sample300,8±0,09°C<0,01
Negative NG sample441,0±0,08°C<0,4
Determined the correlation coefficient for chetyrehbalnoy table (Kaminski PS, 1959) based on the status of the autonomic nervous system and thermal imaging ad sample

In CHD patients with thermal imaging at the level of the lower third of the left forearm, the fingers of the left hand registered a significant decrease of skin temperature (p<0.05) as compared to symmetric parts of the right hand. Application of 0.5 mg of sublingual nitroglycerin and thermal monitoring vasodilatation effect of the drug, manifested on thermal image intensification and infrared radiation distal hand (fingers), allows you to monitor the dynamics of blood supply to the healing process.

As follows from the table, the vasodilator effect after ad samples significantly (p<0,001) expressed in 52 (74.3 per cent) patients with a predominance of the sympathetic division of the ANS, which correlates with the change in the index of tension of regulatory systems (INS). For example, the index of tension of regulatory systems (INS) have access to the right (p< 0,05) increased after sampling nitroglycerin with 184,6±27.2 to 498,5±157,6. It is known that this indicator reflects the degree of centralization of control heart rhythm and characterizes mainly the activity of the sympathetic nervous system (SNS). This fact is probably due to common ventilatie in combination with a decrease in total peripheral vascular resistance caused by nitroglycerin, which leads to decrease in systemic blood pressure. The reduction of blood pressure, stimulating baroretseptorov conducive to the production of pulses, oppressive vagusnye center and excitatory sympathetic and vasoconstrictor centers, resulting developed tachycardia and vasoconstriction [21], which is confirmed by the autonomic homeostasis according to the results of our study. Indeed, the vasodilator effect after thermal nitroglycerine samples according to the mathematical analysis of heart rate significantly (IN=p<0,05, r=0,33; RMSSD=p<0.02 and r=0,33) due to the weakening of the activity of the vasomotor center regulates vascular tone and increased sympathetic activity cardiovascular center (table). In the group of patients with initial activity of the Autonomous loop regulation was significantly (p<0,01) identified vasodilator response to nitroglycerin in 30 (40.5 percent) of patients with ischemic heart disease in the reduction (p<0,02) show the El parasympathetic activity of the ANS (RMSSD) 78,1±13,1 to 39.7±9,0. From the above it follows that the nitroglycerin is more effective in patients with coronary artery disease who have dominated the activity of the sympathetic division of the ANS. It should be noted that diagnostic and prognostic information content imaging ad samples in CHD patients moderately correlated (r=0,33) with the system state of autonomic regulation of heart rhythm (table). So, when krupnooptovom and re-infarction this vasodilator response significantly weakened in 44 (59.5 per cent) during the initial dominant influence of the parasympathetic division and only 25.7% of cases (18 patients) at the prevalence of cardiac rhythm sympathetic autonomic nervous system.

Dynamic observation of patients with coronary artery disease with a thermal imaging camera, we were convinced that changes in thermal topography of the upper extremities changed relatively little, in some cases, circulatory disorders in the area of the left hand are even more extensive, they capture not only the distal part of the fingers, but also extend to the wrist and forearm. Overview of infrared thermography with nitroglycerine breakdown can be used as a supplementary test in the differential diagnosis of IHD.

The combination of imaging with HRV analysis will provide a more informative view of thaimassageinternational innervation of the heart and hand, and the use of ad samples emphasizes the predominance of sympathetic regulation and the weakening of the parasympathetic in CHD patients, as confirmed by the mechanism of action of nitrates. Analyzing the results of studies of HRV and imaging with the ad break, we can conclude that patients with ulterior vasodilator response to nitroglycerin is not recommended to appoint nitrates as the base of antianginal drugs. Thermal study HRV analysis in the pathology of the cardiovascular system opens up new opportunities for early diagnosis and adequate selection of drug therapy in patients with coronary artery disease.

Literature

1. Baevsky R.M., Berseneva A.P. Assessment of adaptive capacity and the risk of developing diseases. - M.: Medicine, 1997. - 236 S.

2. Baevsky R.M., Ivanov I.I., Ryabikin GV current state of research on heart rate variability in Russia. // The Bulletin of Arrhythmology. - 1999. No. 14. - P.71-75.

3. Brunelli V.B. have been, Shchetkina N.V. Application of functional tests in order to increase the information content of images. // "Applied optics-96": abstracts. Dokl. at the session TEMPO-96". - SPb., 1996. - S-100.

4. Heart rate variability. // Standards of measurement, physiological interpretation and clinical use. The working program of the European is someone society of cardiology and North American society of pacing and electrophysiology. - St. Petersburg: JSC "Incart". - 2000. - 65 C.

5. Golub F.M. Development of cervical edge of the sympathetic trunk in humans. - Leningrad, 1961.

6. Ivanov S. p. Thermography as a method of assessment of the microcirculation with hyperlipidemia and coronary heart disease. // TEMP-88: proc. Dokl. on IY Vsesojuzn. proc. "Th. the honey. equipment and practices - "TEMP-88". - L., 1988. - Part 1. - S-168.

7. Cardiology. // National guidelines. Ed. Corr.-cor. RAP, Acad. The RAMS Upperincome, Acad. RAMP Reganosa. - Moscow: GEOTAR Media, 2007. - 1232 S.

8. Clinical imaging. Ed. Vpolicy, You. - St. Petersburg, 1999. - P.14-43.

9. Kovalev O.V., Selivonenko V.G. Influence of sample corinfar on thermogram and Central hemodynamics in patients with ischemic heart disease. // The Health Of Belarus. - 1992. No. 12. - P.21-23.

10. Korkushko O.V., Pisaruk AV circadian rhythms of autonomic influences on the cardiovascular system with aging. // Problems of aging and longevity. - 1999. No. 1. - P.3-8.

11. Korkushko O.V., ALEXANDER Pisaruk, Lishnevskaya VY Age-related and pathological changes daily heart rate variability. // The Bulletin of Arrhythmology. - 1999. No. 14. - P.30-39.

12. Korolyuk I.P. Application of thermal imaging in the diagnosis of cardiovascular diseases. // Thermal imaging in medicine: Proceedings of Vsesojuzn. proc. "Thermal imaging devices, n is the Board development the practice of medicine "TEMP-79". - L., 1981. - 4.2. - P.69-73.

13. Melnikov V.P., Kozlov Oleg Lundstrem, V.P. Larionov and other Diagnostic possibilities of the method of thermal imaging in cardiology. // International. proc. Applied optics-96": abstracts. Dokl. at the meeting of the "TEMP-96". - SPb., 1996. - P.78-79.

14. Melnikov V.P., Miroshnikov M.M., Brunelli B.B. and other Clinical imaging. - SPb.: GOI them. S.I. Vavilov, 1999. - 124 S.

15. Mirolyubov O.A., Parygin A.A. features of thermographic picture with arterial hypertension and ischemic heart disease. // TEMP-85: proc. Dokl. on Vsesojuzn. proc. "Th. the honey. equipment and practices - "TEMP-85". - L., 1985. - S-215.

16. Eagles G.A., Popov V.A. myocardial Ischemia and the reaction vessels of the upper extremities (analysis of infrared radiation). // Cardiology. - 1981. - T. No. 1. - Pp.96-97.

17. Pisaruk AV Computer analysis of patterns of heart rate. // The journal of practical doctor. - 1996. No. 5. - P.39-40.

18. Popov N.V. Diagnostic capabilities of thermal imaging with somatic pathology: Diss. Kida. the honey. Sciences. - Arkhangelsk, 1997. - 152 C.

19. Ryabikin GV, Sobolev A.V. Analysis of heart rate variability. // Cardiology. - 1996. No. 10. - P.87-98.

20. Y.P. Semenov, Baevsky R.M. Hardware-software complex "VARICARD-format" to assess the functional state of the organism on the basis of mathematical analysis of the heart rhythm. // Variabel the awn heart rhythm. - Izhevsk, 1990. - P.160-162.

21. Sidorenko B.A., Transfiguration A.I Nitrates. - M.: ZAO "Science", 1998. - 130 C.

22. Stoilis I.G., Safferman F.M., Court BS and other Thermometry and thermography in the intensive monitoring of patients with myocardial infarction. // Cardiology. - 1974. - T. No. 1. - P.40-43.

23. Korkushko O.V., Shatilo V.B., Kaukenas J.K. Changes in heart rhythm power spectrum during human aging. // Aging.- 1991. - Vol.3. - P.177-179.

24. Loskaizo J. Antiplatelet and antithrombotic effects of organic nitrates. // Am. J.Cardiol. - 1992. - Vol.327 - P.18-22.

25. Malik, T.Farell, Camm A.J. Circadian rhythm of heart rate variability after acute myocardial infarction and its influence on the prognostic value of heart rate variability. // Am. J.Cardiol. - 1990. - Vol.66 - P.1049-1054.

26. Pagani m, Lombardi P., Guzzetti S, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. // Circ. Res, 1986. - Vol.59. - 178-193.

27. G. Sandrone, Moztara A., Torzilla D. et al. Effects of beta-blockers (atenolol or metoprolol) on heart rate variability after acute myocardial infarction. // Am. J.Cardiol. - 1994. - Vol.74. - P.340-345.

28. Tennant R, Wiggers C.J. The effect of coronary occlusion on myocardial contraction. // Am. J.Physiol. - 1935. - Vol.112. - P.351-361.

29. Zuanetti Z., Latini R., J.M. Neilson, Heart rate variability in patients with ventricular arrhythmias. // J. Am.Coll. Cardiol. - 1991. - Vol.17. - P.604-612.

The method of determining the vasodilator response to nitroglycerin in patients with CHD, characterized in that when the temperature of the fingers of the left hand not less than 1.3 times and to increase the tension index (ti) of the sympathetic division of the autonomic nervous system is not less than 2.7 times or when the temperature of the fingers of the left hand not men who e than 1.3 times and the decrease in the activity of the parasympathetic regulation of the autonomic nervous system (RMSSD) not less than 1.9 times after administration of 0.5 mg nitroglycerin sublingual determine vasodilator response in patients with ischemic heart disease.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention refers in particular to instant diagnosis the CSV of the patient on the basis of the cardiac rhythm variability test. RR intervals (RRI) of the patient are registered and their length is measured. Then the dynamic range of RRI by means of excluding extra systoles which length T3 exceeds double value of the minimum length of RRI 2Tmin and the average length of RRI Tavr in the dynamic range with excluded extra systoles is calculated and changed by the extra systoles on the RRI of length Tavr. Autocorrelation function of the dynamic range RRI is formed and converted to the autocorrelation matrix. The state of the patient's cardiovascular system P is judged by the value of the composite index of the patient's health P, which contains the new index of the regulatory systems tension taking into account maximum and minimum proper values of the autocorrelation matrix and age of the patient in years.

EFFECT: means provides simplification, urgency, advanced objectiveness and accuracy of the diagnosis the cardiovascular system of the patient.

2 cl, 2 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to functional diagnostics. Cardiorhythmographic examination with analysis of heart rhythm is carried out. Vegetative reactivity is determined from the fifth minute of staying in orthoposition, coefficient of adaptation reserve (CAR) is calculated by formula: CAR=TI3/TI2, where TI3 is tension index, calculated by Baevskiy, starting from the fifth minute of staying on orthoposition; TI2 is tension index, calculated by Baevskiy, immediately after transition into orthostasis. By specific values of tension index and CAR and their combination level of vegetative reactivity and state of vegetative adaptation reserve are estimated.

EFFECT: method makes it possible to reduce examination time preserving high result accuracy.

6 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular, to cardiology, therapy, rehabilitating and preventive medicine. In patients after myocardium infarction, at the background of drug treatment, impact is performed on central and autonomous nerve systems by method of biological feedback. Patient in state of relaxed wakefulness is shown formed on the basis of their cardiorhythmogram periodic curve and their registered cardiorhythmogram. 5 seconds after beginning of active test sound signal is automatically switched on. In each further test on superposing cardiorhythmogram with periodic curve, the latter is corrected in such a way that period varies within 4-12 seconds, heart rate - within 60-75 beats per minute.

EFFECT: method makes it possible in a stable way to recover and/or form cardiorespiratory synchronisation, achieving normal values of heart rate and arterial pressure in treatment of patients after myocardium infarction, with recovery of parasympathetic activity.

3 ex, 7 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to therapy. It involves 24-hour electrocardiographic monitoring and calculation of a circulatory heart rate index. Besides, a heart rhythm variability value LF/HF is measured, and an integrated coefficient is calculated by formula: K=CIn/ln (LF/HF), where Cln is a circadian heart rate index, ln(LF/HF) is the LF/HF value is logarithmic form. If the coefficient is less than 0.8, the unfavourable course of cardiopsychoheurosis is predicted.

EFFECT: method provides higher prediction reliability of the clinical course of cardiopsychoheurosis.

2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, cardiology. Electrocardiographic examination is carried out. Late ventricular potentials are recorded by high resolution electrocardiography. The QT interval dispersions are calculated. If an arterial hypertension experience exceeds 1.3 years, while observing the late ventricular potentials combined with the QTapex interval dispersion gain ≥40 ms and the corrected QTapex interval dispersion gain ≥42 ms1/2, disturbed left ventricular geometry is detected and suggested to hypertrophy in children and adolescents suffering arterial hypertension.

EFFECT: method provides higher prediction accuracy with using electrocardiography for the prediction procedure.

1 tbl

FIELD: medicine.

SUBSTANCE: indices of heart rhythm variability are determined: normalised power in low frequency range, mode amplitude, maximal cardiointerval in sample. Values of coefficients F1 and F2 are calculated by formulas: F1=-13.46+35.1 × x1-8.04 × x2+7,48 × x3; F2=-12.17+27.97 × x1+4.41 × x2+7.76 × x3; where x1-LFnorm is normalised power in low frequency range; x2-AMo is mode amplitude (share of cardiointervals, corresponding to mode value); x3-max. is maximal cardiointerval in sample. Of F2 value is higher than F1, presence of intracranial hypertension of more than 20 mm Hg, and with F1 higher than F2, its absence is diagnosed.

EFFECT: method makes it possible to eliminated examination trauma and reduce diagnostics time.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to cardiology. Electrocardiogram is registered, duration of RR-intervals is measured, test with physical exercise is carried out and diagnostic index is calculated. 100 following each other RR-intervals are measured starting from the moment when test with physical exercise is over, diagnostic index being calculated by formula: where Ti is duration of i-th RR-interval. If value of diagnostic index is less than 2.2 units, reduction of functional reserve of cardiovascular system is diagnosed.

EFFECT: method makes it possible to increase reliability ob obtained results in conditions of screening diagnostics.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine. Registration of eye movements is performed, inter-saccadic intervals (ISI) are measured and compared with ISI taxons, specified from condition of temporary scales of mental regulation processes at various levels. Also registered and measured are durations of reactions of activation of skin-galvanic reflex (RA SGR) and compared with said ICI taxons. Additionally determined are P-P intervals of electric cardiogramme (ICR ECG), whose duration is shorter than duration of the previous one by more than value, by which duration of intervals corresponding to impact of parasympathetic nervous system differs from intervals corresponding to impact of sympathetic nervous system. They are compared with ISI taxons and evaluation of activity regulation processes is carried out by data of ISI, whose taxon values are larger than values of RA SGR and ICR ECG taxon values, respectively, and evaluation of processes of functional state regulation is performed by data of ISI, whose taxon values coincide with values of RA SGR and ICR ECG taxon values, respectively.

EFFECT: method extends arsenal of means for evaluation of person's activity and functional state.

1 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine, cardiology. In patients with arterial hypertension, electrocardiogram and its first derivative are recorded. Electrical myocardial activity rate is evaluated in various degrees of arterial hypertension. If ventricular activation speed is 42.18±2.48 s-1 in degree 1 arterial hypertension, and ventricular activation speed is 40.29±1.91 s-1 in degree 2 arterial hypertension, evident decrease in functional myocardial reserves and elasticity is diagnosed.

EFFECT: invention can be used for screening diagnosis of early functional cardiovascular disturbances, early noninvasive diagnosis of myocardial status, elasticity in the patients with arterial hypertension of various severity levels.

1 tbl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to psychology of individual differences. Electric activity of heart is registered and stress index is calculated by means of device "Viport event recorder". Stress index is determined in state of relaxation immediately after carrying out a session of electric tranquilisation and in time interval from 5 to 15 minutes after carrying out two-hour lesson. Obtained values are compared and if excess of stress index after lesson is within 12% high level of professional adaptation is registered, from 12% to 21% - middle, from 21% to 32% - low, more than 32% - dangerously low level of teacher's professional adaptation. Stress index in state of relaxation immediately after carrying out a session of electric tranquilisation is determined as mean arithmetic value of not fewer than 5 measurements, carried out on different days. Session of pulse impact is carried out by means of device for electric tranquilisation "Micro-Lenar".

EFFECT: method extends arsenal of means for diagnosing level of professional adaptation of technical discipline teacher.

FIELD: medicine.

SUBSTANCE: invention refers in particular to instant diagnosis the CSV of the patient on the basis of the cardiac rhythm variability test. RR intervals (RRI) of the patient are registered and their length is measured. Then the dynamic range of RRI by means of excluding extra systoles which length T3 exceeds double value of the minimum length of RRI 2Tmin and the average length of RRI Tavr in the dynamic range with excluded extra systoles is calculated and changed by the extra systoles on the RRI of length Tavr. Autocorrelation function of the dynamic range RRI is formed and converted to the autocorrelation matrix. The state of the patient's cardiovascular system P is judged by the value of the composite index of the patient's health P, which contains the new index of the regulatory systems tension taking into account maximum and minimum proper values of the autocorrelation matrix and age of the patient in years.

EFFECT: means provides simplification, urgency, advanced objectiveness and accuracy of the diagnosis the cardiovascular system of the patient.

2 cl, 2 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers specifically to the diagnosis of the valvular low tension circulation in the lower limbs. Accomplish this micro circulatory blood flow in the upper tissues of the feet is tested by means of supra sonic laser Doppler flow meter. Herewith the measurements and registration of the micro circulatory blood flow parameters are made with further perfusion curve analysis. Examination consists of two stages - one motionless and the other loading test Valsalva's manoeuvre alternately on the right and left legs. Then the average index of perfusion M. The indexes received on the second stage are compared with the base values. While the indexes of the second stage are reduced on 35-40% against the base values the micro circular blood flow is considered as normal, while the indexes are reduced on less than 35% or no reduction the micro circular blood flow is regarded as disturbed so the insufficiency of the valvular low tension circulation in the lower limbs.

EFFECT: method enables quick and accurate diagnosis as well as helps to exclude complications.

1 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: invention is referred to the area of medicine, namely to physiology and cardiology. The registration and analysis of arterial vessels oscillograms is performed in the frequency range from 0-0.1 Hz to 40-60 Hz in process of pressure increase in blood pressure cuff with subsequent electric transformation. The compression of blood pressure cuff is continued until the moment of OSG waves appearance. The diastolic and systolic pressure is determined by the pressure in the blood pressure cuff. The limit value of range and time constant is determined during that. In order to determine the systolic pressure in the systolic part of oscillogram the current range in the first moment of time is registered and the second range is measured in divisible time moment from the initial time value. Two range values and time moments are used to detect the limit value of amplitude and time constant, and then by analogy the diastolic pressure is measured.

EFFECT: increased accuracy of arterial pressure which is reached due to performance of approximation using exponential law.

1 tbl, 4 dwg

FIELD: medicine.

SUBSTANCE: invention is referred to the field of medicine and physical education. The testing is performed in passive, active and recovery diagnostic phases, with strict adherence to the order of functional loading test as described in patent RU 2147208. The test estimates medical and physiological parameters based on the age-related statistical models of health. The recovery phases shall be established within 2-3 minutes after Ruffier probe, after push up test and tucking test. The testing interactions are performed with the motivation established by the demonstration of tests by qualified specialist or by animated subject on screen.

EFFECT: method allows increasing the validity of estimation of health reserves and working capacity of a person.

1 dwg, 21 tbl, 5 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention is referred to the field of medicine and physical education. The testing is performed in passive, active and recovery diagnostic phases, with strict adherence to the order of functional loading test as described in patent RU 2147208. The test estimates medical and physiological parameters based on the age-related statistical models of health. The recovery phases shall be established within 2-3 minutes after Ruffier probe, after push up test and tucking test. The testing interactions are performed with the motivation established by the demonstration of tests by qualified specialist or by animated subject on screen.

EFFECT: method allows increasing the validity of estimation of health reserves and working capacity of a person.

1 dwg, 21 tbl, 5 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention is referred to the field of medicine and physical education. The testing is performed in passive, active and recovery diagnostic phases, with strict adherence to the order of functional loading test as described in patent RU 2147208. The test estimates medical and physiological parameters based on the age-related statistical models of health. The recovery phases shall be established within 2-3 minutes after Ruffier probe, after push up test and tucking test. The testing interactions are performed with the motivation established by the demonstration of tests by qualified specialist or by animated subject on screen.

EFFECT: method allows increasing the validity of estimation of health reserves and working capacity of a person.

1 dwg, 21 tbl, 5 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention is referred to the field of medicine, namely to the area of functional diagnostics. It serves for presence or absence of respiratory failure accompanying ischemic heart disease and arterial hypertension in patients with chronic professional dust bronchitis. The blood type is specified. The determination of mass index of left ventricle myocardium, average pressure in pulmonary artery and sphericity index of left ventricle is performed. Taking into account those parameters the prognostic criteria are defined for determination of prediction of chronic cor pulmonale development in patients with chronic professional dust bronchitis. The total prognostic ratio is determined which is used to predict the probability of chronic cor pulmonale development in this patient.

EFFECT: method provides for quality detection of population with high risk of chronic cor pulmonale development for timely prophylactic measures and does not require significant material expenses.

1 dwg, 2 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment and can be used in treatment and prevention of diseases of cardiovascular system as well as in training endurance during exercise. Device contains source of compressed air, which via receiver with pressure limiter and gas-distributing devices is connected to fixed on patient's body compression cuffs, source of high pressure, ECG analyser and device for plethysmogram registration, connected with unit of control and indication. Additionally introduced is receiver of negative pressure and each gas-distributing device contains four electromechanical distributors and pressure sensor in compression cuff, connected with unit of control and indication, as well as two pneumomechanical quick exhaust valves. Controlling inputs of pneumomechanical quick exhaust valves via electromechanical distributors are connected with source of high pressure, output of one of pneumomechanical quick exhaust valves is connected with respective compression cuff, output of the other being connected with negative pressure receiver.

EFFECT: invention is aimed at increase of therapeutic effect in carrying out procedure of external counterpulsation and reduction of rehabilitation terms in case of cardiovascular system diseases.

8 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: in pregnant women starting from 30-th week of gestation by ultrasonic Doppler examination determined are index of resistance in uterine artery on the side of placentation, index of resistance in umbilical artery, fetus aorta, duration of gestosis in weeks is found out, during morphometric examination of placenta artery determined is coefficient of obliteration of stem and intermediate villi arteries, during pathomorphologic examination of placenta form of fetoplacental insufficiency is determined. Probability of ischemically hypoxic CNS injury development is calculated. If probability value is higher than 0.5, risk of development of CNS disorders in early neonatal period in child is high, and if probability is lower than 0.5, risk of development is low.

EFFECT: method application makes it possible to detect high probability of development of CNS injury in newborn babies, which gives possibility to carry out timely treatment of brain functional disorders and contributes to reduction of risk of child's disability and loss of mental potential by them.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, cardiology. Daily monitoring of ECG with rhythm cardiogram (RCG) analysis is performed. At the same time, patient runs log of daily monitoring. Time and range parameters of daily heartbeat variability (HBV) profile are assessed. Sections of daily HBV profile are compared in daytime and nighttime period of the same duration. Night hypersympathicotonia (ANDS syndrome) is diagnosed. Term of arterial hypertension development is defined by original mathematic formula.

EFFECT: possible reliable determination of long-term arterial hypertension development period for people subjected to radiation, by data obtained by heart rhythm examination.

3 ex, 8 dwg

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to forensic medicine. In order to determine prescription of person's death coming double measurement of corpse temperature in depth of its brain and measurement of environment temperature are carried out. In calculation of death coming prescription used are values; values of thermal constant; temperature of body during life, corpse temperature at the moment of its second measurement, temperature of the environment, values of coefficient K, diameter of corpse head. To calculate thermal constant used are values of: corpse temperature at the moment of its first measurement, corpse temperature at the moment of its second measurement, temperature of the environment, time interval between temperature measurements. Value of coefficient K is calculated by the following values: value of thermal constant, diameter of corpse's head.

EFFECT: method increases accuracy of determination of prescription of person's death coming due to taking into account individual dimensions of corpse's head.

2 ex

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