Diagnostic technique for vegetative disorders in patients with neurogenic syncope

FIELD: medicine.

SUBSTANCE: cardiorhythmography is recorded during an active orthostatic test, and a heart rate variability (HRV) is analysed. During the active orthostatic test, the patient is placed in an initial horizontal position, then transferred into the vertical position, and then into the horizontal position again. If the amplitude of HF waves initially increases more than LF waves in the horizontal position by more than 30%, a prevailing parasympathetic effect is diagnosed. If the amplitude of HF and LF waves decreases after the patient is transferred into the vertical position by more than 30% of the values in the initial horizontal position, vegetative insufficiency is diagnosed. If the amplitude of HF waves decreases after the patient is transferred into the vertical position by more than 80% of the initial value in the horizontal position, a fast adjustment of the parasympathetic department to the changes is diagnosed. If the amplitude of VLF waves increases after the patient is transferred into the vertical position by more than 30% of the initial value in the horizontal position, activation of the supra-segmentary vegetative nervous system is diagnosed.

EFFECT: method provides more reliable diagnosing that is ensured by determining the mechanism of orthostatic test adaptation.

2 tbl, 2 ex

 

The invention relates to medicine, in particular, neurology, and relates to a method of diagnosis of autonomic dysfunctions in patients with neurogenic fainting using spectral indices of HRV.

Many years for research and assessment of the regulatory systems of the body, in particular the functional state of the nervous system in various pathological processes used method of analysis of HRV. For a detailed analysis of vegetative state, as a rule, are temporary settings, less frequency (spectral analysis).

Great value additional functional loads to determine the mechanism of autonomic disorders, underlying neurogenic syncope due to possible failure, excess or inadequate adaptive systems of the body. Required for examination of patients with neurogenic fainting is active orthostatic test, allowing you to accelerate the whole complex of the sympathetic innervation of the heart and the activity baroretseptorov. Analysis of heart rate variability recorded during execution of an active orthostatic samples can provide important information for the physiological interpretation of changes in the spectral indices cardier the TMA. This addition is a promising new approaches in the diagnosis of autonomic dysfunctions in patients with neurogenic fainting.

Known methods of diagnosis of autonomic dysfunctions in patients with neurogenic fainting using different precipitating manipulations, such as massage sinocarotid zone, massage eyeballs, test with hyperventilation, samples Weber and Valsava. However, all of these tests, according to various authors, have low sensitivity and low reproducibility, poorly correlate with the clinical manifestations of autonomic disorders. With suspected vasovagal cause fainting can get important information in the active orthostatic test. The transition in the vertical position should be done after 5 minutes of being in the prone position. The BP measurement carried out on 5-th minute stay in a horizontal position, then after the first and/or third minute after the transition in the vertical position. Lowering systolic blood pressure by 20 mm Hg or more and/or diastolic blood pressure of 10 mm Hg or more, or a decrease of systolic blood pressure to 90 mm Hg or less and/or symptoms of hypoperfusion brain confirm orthostatic hypotension (Syncopal status in clinical practice / edited radcc is her D.B Pasha. - SPb.: "ELBI-SPb", 2009. - 366 C., Fig. P.26-27).

The disadvantages of this method are:

the low information content of the method allows to estimate only the result of an adaptive response of the organism, but not the degree of participation in this reaction at various levels and parts of the regulatory mechanism;

- lack of diagnostic and prognostic efficacy of the method.

Closest to the invention is a method for diagnosing the state of the autonomic nervous system with assessment of heart rate variability (HRV). The method includes the registration of short sections of heart rate, including 256 R-R intervals -, with subsequent transformation by the Fourier method and the allocation of frequency bands, determining the maximum power components of the spectrum at these frequencies the amplitude of the waves, where 1 unit accept mc2/Hz: very low-frequency oscillations VLF (Very Low Frequency) 0.004-0.08 Hz, amplitude of wave $ 30-150, low-frequency oscillations in the LF (Low Frequency) 0.09-0.16 Hz, the amplitude of the wave 15-25 dollar, high-frequency fluctuations of the HF (High Frequency) 0.17-0.5 Hz, the amplitude of the wave 15-35 USD for the five stages of the survey: in the initial state of rest, mental stress, recovery after mental stress, hyperventilation load in the recovery period after hyperventilation load (A.N. F is eisman. Slow hemodynamic oscillations. theory, practical application in clinical medicine and prevention. Novosibirsk: Nauka. Sibprime Russian Academy of Sciences, 1999, p.38-55). Sustainable improvements HF regarded as a sign of activation of the parasympathetic division of the autonomic nervous system that may serve as predisposing to the development of fainting factor.

The disadvantages of this method of diagnosis are:

1. The absence of functional tests, which led to activation baroretseptorov.

2. The inability to assess the mechanisms of vegetative ensure the changing activity of the cardiovascular system.

The objective of the invention is the detection of signs of disorders of autonomic regulation of heart rhythm in patients with neurogenic fainting and improving the quality of diagnosis by identifying the mechanism of adaptation to orthostatic stress.

This object is achieved by a method for the diagnosis of autonomic dysfunctions in patients with neurogenic fainting, which includes a study of heart rate variability (HRV), followed by spectral analysis and by conducting functional tests. Write CARDIORHYTHM with subsequent processing by the method of fast Fourier transform and release waves in the frequency bands: VLF in the range 0.004-0.08 Hz, the amplitude of the waves in the norm $ 0-150, LF in the range of 0.09-0.16 Hz, the amplitude of the wave normal 15-25$, HF in the range of 0.17-0.5 Hz, the amplitude of the wave normal 15-35 $ 5 stages of the survey: in the initial state of rest, mental stress, recovery after mental stress, hyperventilation load in the recovery period after hyperventilation. Conduct research HRV during patients with active orthostatic tests in which the patient is in the original horizontal position, then moves into the vertical position and then again in the horizontal position. During the initial increase of the amplitude of the HF waves over the LF in a horizontal position by more than 30% of the diagnosed prevalence of parasympathetic influence. By reducing the amplitude of the LF and HF after moving in a vertical position by more than 50% of the original horizontal position diagnose autonomic failure. By reducing the amplitude of HF after moving in a vertical position by more than 80% of the original horizontal position diagnose rapid adaptive response in the parasympathetic division to change. By raising the amplitude of VLF after moving in a vertical state by more than 30% from the original horizontal position diagnose activation newsegments divisions of the autonomic nervous system.

ovesna inventions

- Conduct research HRV during patients with active orthostatic tests in which the patient is in the original horizontal position, then moves into the vertical position and then again in the horizontal position. Active orthostatic test - physiological, involves the whole complex of the sympathetic innervation of the heart, including the baroretseptorov, can be performed in any medical facility and does not require additional equipment. The analysis of the spectral indices of HRV allows to evaluate not only the sufficiency or insufficiency of adaptation of cardiovascular system to load, but compensatory mechanisms to maintain adequate blood pressure.

In initial increase in the amplitude of the HF waves over the LF in a horizontal position by more than 30% of the diagnosed prevalence of parasympathetic influence.

- By reducing the amplitude of the LF and HF after moving in a vertical position by more than 50% of the original horizontal position diagnose autonomic failure.

- By reducing the amplitude of HF after moving in a vertical position by more than 80% of the original horizontal position diagnose rapid adaptive response in the parasympathetic division to edit the changes.

- If you increase the amplitude of the VLF after moving in a vertical state by more than 30% from the original horizontal position diagnose activation newsegments divisions of the autonomic nervous system.

The relative dominance of the LF component on HF when moving in an upright position in patients with neurogenic fainting provide a more pronounced decline in HF due to rapid reaction of the parasympathetic regulation circuit to change; adaptation of cardiovascular activity, to maintain a sufficient level of blood pressure, is provided by the increase in the VLF amplitude in comparison with the original in the supine position, indicating that activation of higher levels of regulation, from the centers of the medulla oblongata to the hypothalamic-pituitary level autonomic regulation.

The essential features of the invention allows to obtain a new technical result, namely the claimed invention allows the diagnosis of the vegetative nervous system, leading to neurogenic syncope. The proposed method is easy to use and vasocontriction, the sensitivity of the method is quite high and exceeds the analogous methods.

Spectral analysis of HRV allows you to give an accurate assessment of periodic processes in CE is Dechen rhythm, with his help, we measured the activity of individual level control heart rhythm. We provide early diagnosis of autonomic dysfunction and determine the mechanism of adaptation of cardiovascular regulation to maintain a sufficient level of blood pressure in patients with neurogenic fainting. Determination of the mechanism of the disorder of the cardiovascular system to orthostatic load allows you to allocate risk for the development of neurogenic syncope.

Heart rate variability is considered as the result of activation of various regulatory mechanisms that ensure the maintenance of cardiovascular homeostasis. Recent research in the field of HRV allows for a fresh look at various indicators of spectral analysis. The need for medical interpretation of the results of research, including clinical-physiological correlation, determination of levels of regulation, causing the frequency ranges of heart rate variability, not just justifies and necessitates the study of HRV changes during execution of various functional tests.

The method is as follows.

The study of HRV was performed using a 12-channel electrocardiograph "Neurosoft - polyspectra 8E".

Evaluation variablest the CARDIORHYTHM was carried out according to the method developed in 1994 by Professor Fleishman A.N., on stage:

in the initial state of rest, mental stress, recovery after mental stress, hyperventilation load in the recovery period after hyperventilation load.

Next registration HRV during execution of active orthostatic tests performed by the method:

Step 1. ECG registration in the supine position for 5 minutes

Step 2. Transition to standing

Step 3. The patient re-enters the prone position

Samples correspond to the daily forms of human activity, does not cause additional emotional disorders.

At each stage was carried out short ECG recording from 256 ministriesa intervals. As additional information is made to data on blood pressure and heart rate at the beginning and at the end of each stage. The study was conducted in the morning (from 9 to 12 hours), at rest. The total amount of analyzed information was 2048-R-interval variation at each examination. During visual inspection of the recorded signal were eliminated artifacts physiological or other origin. Analysis of primary data included visual analysis cardiotocogram, frequency indicators, obtained by the Le handle recording method of the fast Fourier transform.

In the spectrum of heart rate variability had three main components:

- VLF (Very Low Frequency) - very low frequency fluctuations are recorded in the range of 0.004-0.08 Hz, determine the activity of newsegments divisions of the autonomic nervous system; the amplitude of the VLF in the rate of from 30 to 150 $ per 1 unit accept mc2/Hz.

- LF (Low Frequency) low - frequency oscillations in the range of 0.09-0.16 Hz, reflect different aspects baroreceptors functions, having in its composition mainly sympathetic influence; the amplitude of the LF normal 15-25 $

- HF (High Frequency) - frequency vibrations in the range of 0.17-0.5 Hz, associated with the activities of the parasympathetic division of the autonomic nervous system; the amplitude of the HF 15-35 $

During the initial increase of the amplitude of the HF waves over the LF in a horizontal position by more than 30% of the diagnosed prevalence of parasympathetic influence.

The active phase of the test by reducing the amplitude of the LF and HF after moving in a vertical position by more than 50% of the original horizontal position diagnose autonomic failure.

By reducing the amplitude of HF after moving in a vertical position by more than 80% of the original horizontal position diagnose rapid adaptive response in the parasympathetic division to change.

Adaptation of the cardio-vessel the stop action to maintain a sufficient level of blood pressure is ensured by increasing the amplitude of the VLF after moving in a vertical state by more than 30% from the original horizontal position, indicating that activation of higher levels of regulation, from the centers of the medulla oblongata to the hypothalamic-pituitary level of vegetative regulation. Thus diagnose activation newsegments divisions of the autonomic nervous system.

This high energy compensation mechanism may be impaired in the presence of additional maladaptive factors: adverse environmental conditions, the intense schedule of work, stress, exacerbation of chronic somatic factors.

We studied 100 patients with neurogenic fainting in history. Depending on the amplitude of the waves in a selected frequency ranges, the reaction on the active orthostatic test mechanism disorders of autonomic regulation of the cardiovascular system. Types of reactivity determined experimentally in statistical processing and analysis of spectral indices in patients.

The method is illustrated by the following specific examples of its implementation.

Example 1

Sick So 25 years. The diagnosis of neurogenic syncope.

The heart rate variability - source-increased levels of HF component (HF 37,51 c.u., VLF 31,23$, LF to 24.02$), testifies to the prevailing vagal influence. Hyperaptive reaction to functional tests of low intensity (increase in VLF to 132,77 W. is. when the original 31,23 c.u. during mental workload and to 111,28 c.u. during hyperventilation) as signs of autonomic instability.

It was active orthostatic test in the supine position is logged predominance of the parasympathetic division of the autonomic nervous system (HF exceeds LF more than 30%), while moving in the standing position the exponents of LF from the source in the supine position $ 33,64 up of 16.05 USD (more than 50% of the original), more pronounced decline HF - source 52,21 c.u. up to 4.81 USD (more than 80% of the original), and there is an increase in VLF source 80,97 to $ 116,93 USD (more than 30% of the original). Transition to standing accompanied by an increase in heart rate of 90 beats per minute at the baseline in the supine position 77 beats per minute, the values of HELL little change (increase systolic blood pressure by 4 mm Hg and diastolic by 3 mm Hg). Subjective complaints of the patient during the examination did not show. (See table 1).

This example illustrates the violation of the reactivity of the autonomic nervous system to orthostatic stress, manifested by depression when performing tests of indexes LF and HF, reflecting the sympathetic and parasympathetic components of the autonomic influence on the cardiovascular system, and the relative dominance of sympathetic activity provides the tsya only more pronounced weakening of the parasympathetic division. The stability of hemodynamic parameters (heart rate, blood pressure) is provided by the activation newsegments vegetative structures, which is reflected in increased VLF.

Thus, in patients with syncope disturbed baroreceptor mechanisms to maintain blood pressure. Transition to standing from a lying position accompanied by a decrease in sympathetic activity. The parasympathetic division implements rapid vegetative reactions, the need for urgent adaptation requires a significant reduction in parasympathetic dominance, which provides the relative predominance of sympathetic activity during orthostatic load. The vascular arterial slightly affected by the parasympathetic influences, but lowering the tone of the sympathetic division of the autonomic nervous system leads to the reduction of the tone of the arteries. The combination with a decrease in contractile and chronotropic ability of the myocardium can lead to decreased blood pressure, ischemia stem structures of the brain and loss of consciousness.

High energy compensation mechanism by activating newsegments divisions of the autonomic nervous system is not stable and may break when additional maladaptive factors (unfavorable environmental conditions, support the drilling of chronic somatic diseases, asthenic conditions).

The patient history was only one faint, but we found changes indicate a high risk of re-syncopal; patient recommendations for vocational guidance (risk of occupational injuries and industrial accidents at work by the operator of the production, transport driver, and so on).

td align="left"> 24,15
Table 1
The HRV indices, the values of blood pressure AND heart rateValues of indicators at different stages of the survey
BackgroundUmst. load (500-7)WestHyperventilationWestLying 1StandingLying 2
VLF ($)31,23132,7754,22111,2851,1280,97116,93135,78
LF ($)to 24.0226,3330,0124,1533,64of 16.0569,70
HF(y.e.)37,5116,2729,4521,6728,2952,214,8138,50
8186778478779071
Heart rate (beats per min)
Blood pressure (mm Hg)107/75110/76105/71105/73107/74104/74108/77104/73

Example 2

Patient B. 21. The diagnosis of somatoform Autonomic dysfunction, neurogenic syncope.

The heart rate variability - throughout the five-step writing dominates the amplitude of the LF wave as a sign baroreceptors disfunct is I.

The predominance of the sympathetic component in the supine position, the active phase of orthostatic samples significantly reduced the performance of all components of the spectrum (VLF source 142,79 to $ 70,43$, LF source 70,43 to 10.44$$, HF source 43,38 to 1.16$$). Autonomic instability is manifested by an increase in blood pressure to 133/74 mm Hg at 121/75 mm Hg in the original supine position, increased heart rate 88 beats per minute during the initial 66 beats per minute (Table 2)

This example illustrates the presence of severe autonomic instability, occurring against the background baroreceptor dysfunction. The patient complained of sudden loss of consciousness while driving in transport and during exercise. Was examined by a cardiologist, heart disease is not detected. Electroencephalogram without features.

Table 2
The HRV indices, the values of blood pressure AND heart rateValues of indicators at different stages of the survey
BackgroundUmst. load (500-7)WestHyperventilationWestThe position of the Le is 1 StandingLying 2
VLF ($)124,83187,06207,7031,0529,76142,7917,64252,62
LF ($)42,0410,1114,5473,4225,8470,4310,4448,43
HF(y.e.)6,184,219,3462,59scored 8.3843,381,1627,27
748299285668865
Heart rate (beats per min)
Blood pressure (mm Hg) 122/87128/74118/80124/84122/85121/75133/74126/85

Autonomic failure is evident in this patient when performing active orthostatic tests, can cause neurogenic syncope. The imbalance of autonomic influences (predominance of sympathetic activity in the supine position, a significant reduction newsegments autonomic influences in the active phase of the test) is an additional criterion that indicates baroreceptor dysfunction, which can cause early development of cardiovascular disease in this patient, in particular hypertension. Patient recommendations for the early prevention of diseases of the cardiovascular system.

Thus, the proposed method is easy to use and vasocontriction, the sensitivity of the method is quite high and exceeds similar ways. The claimed invention allows the diagnosis of the vegetative nervous system, leading to neurogenic syncope.

Method is available, non-invasive, relatively simple and cheap. Allows to develop predictive conclusions based on the assessment of the Ki of the current functional state of the body, the severity of his adaptation responses and status of individual links of the regulatory mechanism. Can be used for selection in employment operators on the production, transport drivers.

Method for the diagnosis of autonomic dysfunctions in patients with neurogenic fainting, which includes a study of heart rate variability (HRV), followed by spectral analysis and by conducting functional tests, recording of heart rate, followed by processing by the method of fast Fourier transform and release waves in the frequency bands: VLF in the range 0.004-0.08 Hz, the amplitude of the waves in the norm $ 30-150, LF in the range of 0.09-0.16 Hz, the amplitude of the wave normal 15-25$, HF in the range of 0.17-0.5 Hz, the amplitude of the wave normal 15-35 USD characterized in that as a functional test conduct the study of HRV in run time active orthostatic tests in which the patient is in the original horizontal position, then moves into the vertical position and then again in the horizontal position, and when the initial increase in the amplitude of the HF waves over the LF in a horizontal position by more than 30% of the diagnosed prevalence of parasympathetic influence; by reducing the amplitude of the LF and HF after moving in a vertical position by more than 50% of the original horizontal position diagnose in gelatinous failure; by reducing the amplitude of HF after moving in a vertical position by more than 80% of the original horizontal position diagnose rapid adaptive response in the parasympathetic division to change; if you increase the amplitude of the VLF after moving in a vertical state by more than 30% from the original horizontal position diagnose activation newsegments divisions of the autonomic nervous system.



 

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15 cl, 18 dwg

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5 tbl, 4 ex

FIELD: medicine.

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3 tbl, 3 ex

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3 tbl, 2 ex

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8 tbl, 2 ex

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7 tbl, 2 ex

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2 ex, 2 tbl

FIELD: medicine; cardiology.

SUBSTANCE: electrocardiogram of patients suffering from arterial hypertension is subject to twenty-four-hours monitoring. Spectral analysis of variability of heart beating is carried out. Very low frequency, low frequency and high frequency wave components are selected. General, day and night strength of wave components of heart beating is determined. Any factor is estimated according to the data taken from the spreadsheet. Generalized factor Z is calculated by original mathematical relation. Value of Z is used for judging on level of influence of hormones of adrenal gland onto pace-maker activity of sinus node.

EFFECT: comfort at usage; higher efficiency at non-invasive application.

2 ex, 2 tbl

FIELD: medicine; functional medicine.

SUBSTANCE: method in based upon remote irradiation of human body with set of super wide-band electromagnet pulses with duration of 0,2-1,0 ns, repetition rate of 0,05-30,0 MHZ and average density of flow of energy at irradiated part of human body being equal or less than 0,2 mcW/cm2. Modulation component of pulse repetition rate is selected from received reflected signal which pulse repetition rate is determined by heart activity, which is used for forming heart beat rate signal. The latter is used additionally for estimating index of stress which value of index of stress is included into transmitted communication message of mobile phone.

EFFECT: prolonged monitoring of functional condition of human.

3 cl, 2 dwg

FIELD: medicine, cardiology.

SUBSTANCE: one should register a rhythmocardiogram, detect spectral values for variability of cardiac rhythm, calculate the value of autonomic index, calculate the value of autonomic tonicity by the following formula: AI/lnTp m sq. sec., where AI - autonomic index, lnTp - total power for the spectrum of variability of cardiac rhythm. At values above 3.1 one should diagnose severe flow of autonomic dystonia syndrome, at values being 3.1-2.2 - moderate flow of the mentioned disease, at values ranged 2.1-1.5 - light flow. The method enables to predict the development of hemodynamic disorders.

EFFECT: higher efficiency and accuracy of diagnostics.

3 ex

FIELD: medicine; cardiology.

SUBSTANCE: device for processing intervals of electrocardiogram has plate with Q-T (J-T) and R-R scales applied onto the plate. Plate is additionally provided with legs, rod and scale pointer at the end, arrows, and catches disposed at ends of Q-T (J-T) scale, Q-Tc (J-Tc) correlated values curves and Q-Tc (J-Tc) scale related to them. Rod is divided by axis to parts to relate as 1:5 in such a way that shorter part of rod has to be movable leg and longer part has to be the pointer of Q-T (J-T) scale. Pointer takes "0" position of Q-T (J-) scale to rest against left catch when legs close up. Motionless arrow is disposed onto longer part of rod under pointer of Q-T and/or J-T scale at level of "0" position of R-R scale. Slider with lock is mounted onto pointer to move along pointer. Slider is provided with two arrows. Formulas for building curves of Q-Tc (J-Tc) corrected values are given.

EFFECT: higher speed and comfort at processing of electrocardiograms.

3 cl, 8 dwg, 1 tbl

FIELD: medicine, electrocardiography.

SUBSTANCE: the present innovation deals with measuring parameters of electrocardiosignal (ECS) ST-segment and their analysis to detect deviations against the norm. At every step of quantization one should form the readings of first-order differences and modules of first-order differences. One should memorize N of readings for the modules of first-order differences coming after ECS readings that correspond to the onset of cardiocycle. Then it is necessary to sum up memorized values of modules and at every step of quantization one should compare the obtained current sum value with previous one. It is necessary to memorize the greater of them and according to maximal value one should form threshold level to compare current value of modules sum. Time moments when sum value is at first greater and then lower against threshold level one should consider to be, correspondingly the onset and the end of ST-segment. Time segment between the onset and the end of ST-segment should be considered as duration of ECS ST-signal. Device to isolate ECS ST-signal on-line contains a block for forming ECS, a block for primary ECS processing, a quantization block, a block for isolating the point of cardiocycle onset and measurement of its duration, a block to form first-order differences, a block to form modules of first-order differences, a block to memorize readings for the modules of first-order differences, a block to detect the number of summarized readings for the modules of first-order differences, a summarizing block, a block to form a threshold level, a block for comparison and a key device. The innovation enables to isolate ST-segment more reliably for wider class of electrocardiograms at different modifications of QRS-complex form.

EFFECT: higher efficiency.

2 cl, 12 dwg

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