Diagnostic technique for risk of developing stress-induced pitted keratolysis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiology and dermatovenerology, to diagnostic technique for a risk of developing pitted keratolysis accompanied by stress as an uncurable element of the professional environment for the purpose of the goal-oriented prevention of the above disease in the individuals having hazardous occupations. A heart rate variability is examined twice - before and 15 minutes after a hot test on a plantar surface. If observing no decrease of the LF/HF value as compared to the reference, a risk of developing stress-induced pitted keratolysis is diagnosed.

EFFECT: technique provides more accurate diagnosis of a risk of developing stress-induced pitted keratolysis by examining the heart rate variability and using the hot test.

1 dwg, 2 tbl, 2 ex

 

The invention relates to medicine, namely to the physiology and dermatology, to methods of diagnosing the risk of developing punctulata keratolysis under stress as a fatal element of the professional environment, to implement targeted preventive treatment of this disease in persons hazardous occupations.

The assessment of severity of exposure to stress and completeness of recovery, including diagnosis and rehabilitation of stress-induced diseases, for professions in which stress is fatal element of the professional environment, is extremely important. The profession of fire and rescue differs fourth, the highest grade the severity of work on physical and psychological stress, and takes the 2nd place in the top ten most dangerous occupations for life. Significant physical and psychological burden, special protective clothing and footwear in the process (weight only breathing apparatus is 14-16 kg), constant voltage in the call waiting - all this leads to a high stress load.

According to the patent information search there are a number of ways of assessing the suitability of personnel for stress resistance in personnel selection are described, for example, in A. C. the USSR №1607777 (operators - assessment dinamichno and nervous system on various motor reactions in response to various positive color stimuli), A. S. No. 1452515 (operators with the assessment of the cost of executing the task by the values of maximum heart rate), A. S. No. 2164776 (testing on the dynamics of indicators collectively significant questions which cause the deviation of the following measured characteristics: galvanic skin response, frequency thoracic and diaphragmatic breathing, heart rate, motor reactions and voice activity in response to the test with three different groups on the importance of the issues). However, these known methods determine any physiological capabilities of the test (A. S. No. 1607777, A. S. No. 1452515), or his motivation for choosing the profession (A. S. No. 2164776), but not physiological condition assessment of risk of development of stress-induced conditions and diseases.

The known method for determining emotional stress and device for its implementation (patent RF №2073484, IPC AV 5/02, AB 5/04, 20.02.1997)based on detection of vegetative indicators person (heart rate, breathing rate and galvanic skin resistance), followed by calculation of cross-correlation coefficients, reflecting the degree of stress development, and the method of determining the level of stress (patent RF №2147831, IPC AV 5/02, 27.04.2000) calculation of stressful the indicator on body weight, heart rate and arterial pulse pressure. This method is not applicable to persons "dangerous" occupations and the disease-specific, because it does not account for the "population" norms and does not involve the initial selection of those most stress-resistant requirements of the profession.

There is a method of assessing the risk of prenosological, premorbid and pathological conditions in long-term space flight (RF patent No. 2448644, IPC AV 5/02, 15.09.2010) to refer the patient to a particular type of vegetative regulation and calculation of a posteriori probabilities. The main disadvantage of this method is its probabilistic nature and inapplicability in the dynamics of extreme loads.

A known method for the diagnosis of hidden suffering of children with atopic dermatitis, with estimates of HRV (on the application for invention No. 2005122100/14, 12.07.2005) to assess the severity of atopic dermatitis and treatment choice on summing the scores, including the assessment of the extent of skin lesions, clinical manifestations of disease and indicators of HRV with the calculation of the threshold values for the proposed formula. The main disadvantage of this method is its narrow focus: applicability for clinically defined disease only in de is her that cannot be applied in healthy adults outside the defined nosological forms of skin diseases.

Identified significant relationships between development punctulata keratolysis and hyperhidrosis stop (90,8%), wearing tight shoes (79,1%), intensive sports (30,1%) and a combination of these risk factors (69,9%) (E. N. Efanova. Punctuate keratosis: clinical manifestations, optimization methods for diagnosis, therapy and prevention: abstract. dis.... K. M. N.: 14.01.10. - Novosibirsk, 2012. - 22 C.), but the criteria applicable to assess the probability of developing the disease depending on the individual characteristics of the organism to respond to stress in the presence of a "well-known" risk factors of the disease has not been established.

There is a method of assessing the physiological status of a person in cardiac rhythm (RF patent No. 2246251, IPC AV 5/00, 20.02.2005), including the measurement of the current total power in the low-frequency and high-frequency regions of the dynamic range of the R-interval and evaluation of the psychophysiological state of a person on the stress index. The stress index gives low accuracy of the measurement, not an individual and is not applicable for those "dangerous" occupations, and the ratio of the frequency spectrum is not relevant to the assessment of risk of development of stress-induced diseases, because undefined "width" their popular the Onna "norm". It is known that to identify the mechanisms of tolerance to professional stress and response to stress as an external stimulus can when conducting an active orthostatic test (AOP) (B. M. Mikhailov. The heart rate variability. Experience in the practical application of the method. Ivanovo, 2000. - 200 C.), and the predominance of the parasympathetic factor individual sustainability of a healthy organism (C. C. Queen et al. Pathogenetic mechanisms of professional adaptation of dangerous professions // proceedings of the XXIV International scientific-practical conference on problems of fire safety, dedicated to the 75th anniversary of the establishment of the Institute. - Moscow: fsbi and VNIIPO of EMERCOM of Russia, 2012. - S. 142-145.). Originally professionally-oriented selection of individuals with a predominance of the parasympathetic requires an individual approach to assessing changes in specific stress-induced conditions, since the "traditional" response to the load change due to a certain imbalance in the autonomic supply of the activity of the heart.

Closest to the proposed method is author of "the Way of evaluation of professional adaptation of cadets of educational institutions of EMERCOM of Russia" (patent for invention №2480151 on application No. 2012103772/14 (005634), priority from 03.02.2012, registered in the State register of inventions of the Russian Federation 27.04.2013), includes the study of heart rate variability before and after simulating extreme loads under fire. Professional adaptation of the cadet shall be considered satisfactory if the indicator TP (background samples) decreases by no more than 50%, the rate 30/15 - not more than 20% from the original values, and the LF/HF (AOP) is increased by no more than 30% of the original.

The pathogenetic basis of the proposed method is the postulate about the relationship vegetative provision of heart activity and nonspecific nature of the response to stress, including in the form of skin reactions: studies J. F. Thayer et al., 2012 (A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health // Neuroscience and Biobehavioral Reviews. - 36 (2012). - P. 747-756), confirm the relationship of heart rate variability and higher activity centers that control the stress response (amygdala and medial prefrontal cortex). Previous studies found that professionally "best" type of stress-response for fire and rescue is the activation of the parasympathetic divisions of the autonomic nervous system that extends the "corridor" adaptive capacity to extreme conditions (K. C. Kopeikin, S. C. Queen. Pathogenetic mechanisms shaped who I psychophysiological frustration at the dangerous professions // International Journal of Applied and Fundamental Research. - 2012. No. 1. - P. 28.). At the same time, morphologically determined that the sweat glands stop innervated by sympathetic nerves. Terminal their nerve fibers secrete acetylcholine, i.e., are cholinergic, like parasympathetic fibers (Trifonov E. C., Pneumopathology person. Russian-English-Russian encyclopedia, 16th ed. 2013 [electronic resource] ). Therefore, we can say that the sweat glands of the skin of the feet have a dual cholinergic innervation, so stress as adrenergic reaction is as a "lever", and supporting disease mechanism due to hyperhidrosis. Therefore, the physiological state of the voltage shown in the increase of segmental sympathetic influences in individuals with high personal stress resistance are prone to adaptation "transition" in the predominance of the parasympathetic. Accordingly, the haste in "fine tuning" of the body and the rigidity in the preservation of segmental (adrenergic) effects during times of stress is a manifestation of the tendency to develop stress-induced conditions and diseases.

The technical result of the proposed method of diagnosing the risk of developing stress-induced punctulata keratolysis is that the study of heart rate variability is twice what about and after a 15-minute thermal tests on the plantar surface of the feet, and in the absence of reduction index LF/HF (background samples) compared to the original is diagnosed, the risk of developing stress-induced punctulata keratolysis.

Research carried out in standard conditions of the research laboratory of FGBOU VPO IWI state fire service of EMERCOM of Russia "disaster Medicine" ethical and legal norms decreed for groups of patients. Used certified standard equipment and hardware and software JSC "Neurosoft" ("ANS-Micro" for the study of heart rate variability, including execution dynamics standard active orthostatic test (AOP), NS-psychometric test" to determine the parameters of the psychophysiological response to professional activity). The experimental group consisted of 35 cadets, randomly recruited from 2 groups of 1 course during a pilot survey to identify stress-induced conditions. All cadets noted the presence of all risk factors punctulata keratolysis: long wearing bercaw, inability frequent change of shoes (cadets were in country training center), intensive training in conditions as close to real fighting (reconstruction of technological disasters on rail and air transport, residential is medineh, industrial debris, etc., teplodekor modes maximum physical load on embedded simulators). All the cadets were in the same living conditions, lifestyle and nutrition. Saturation training, patrolling the outfits was also the same. The health group they were assigned to 1 group. All respondents source was conducted clinical and laboratory examination, does not produce pathological changes. Special methods of investigation included determination of heart rate variability short period (5 minutes lying down) with active orthostatic breakdown of registration of standard indicators in accordance with the "International standard" (Task Force of the European of Cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability. Standards of Measurements, Physiological Interpretation, and Clinical use. Circulation. - 1996. - No. 93. - C. 1043-1065) twice - before and after the proposed thermal samples. Thermal test was carried out for 15 minutes on the plantar surface of the feet: applied electric heating pad at maximum intensity mode (heating temperature when 3 mode is 55-60°C, surface - 40-45°C, used certified for home use electric heating pad PW-210). The data are processed by methods of variation and correlation statistics for comparison of successive measurements used Crete the test Wilcoxon signed, method of marks and paired student test, identification of the most informative indicators produced with the use of factor analysis in the form of a Latin square with a restriction on randomization (the linear effect of the load on the index LF/HF). Method was used blinding: doctor dermatovenerology polyclinic of the Institute did not know the names of the cadets included in the experimental group.

To clarify the epidemiology punctulata keratolysis (MK) conducted a study of the prevalence of this disease among the cadets of the Institute. In 2012, the dermatologist was 408 primary complaints about skin diseases. Of them cadets 1st year of study - 143 (35% of all primary applicants about diseases). Complaints to changes in the skin and its appendages on the feet turned 100 cadets, which accounted for 70% of the initially applied about diseases cadets first year of study. Identified 64 patients MK, which accounted for 44% of all applicants for dermatological use of cadets of the first year of study, or 64% of the number of students who made a complaint to changes in the skin and its appendages on the feet. Thus, the proportion of patients MK in the population of cadets of the first year amounted to 15,68% of all initial claims for sickness to the dermatologist in 2012 (more than 2 times higher than populationa incidence). Among 74 cadets 2 years of study identified two patients with MK, which accounted for 2.7% of the applied to the dermatologist cadets 2 years of training or 0.5% of all initial visits to the dermatologist in 2012. The cadets from the third to the fifth year of training calls about MK was not registered. An additional study (100 cadets of all courses, with up to 20 people each year), it was determined that subjectively maximum stress load (according to the methodology "Scale of life events" ,E. Anderson, designed to measure stress levels of College-age individuals as a basis for the formation of psychosomatic diseases: G. E. Anderson, "Journal of recent experience life in College" (College Schedule of Recent Experience). University of North Dakota (North Dakota State University, 1972)) have the cadets of the 1st year of study (the results are shown in the drawing). Demonstrated that clinically significant in the development of stress-induced diseases stress maximum for 1 year, then it is reduced to a clinically insignificant (Queen ST. et al., The dynamics of the coping strategies of students of universities of state fire service of EMERCOM of Russia in the learning process // the Collection of scientific articles 1 Internet conference with international participation "Actual problems of military and emergency medicine". Gomel, 2013. - S. 97-106)

In terms of heart rate variability (HRV) before and after heat sample all respondents clearly divided into 2 groups:

1. 14 people, index LF/HF after heat samples decreased on average by 39%.

2. 21, the index LF/HF after thermal tests have not changed or increased.

Training in country training center continued for 7 days. Within one month after returning all the cadets were inspected by a specialist. Criteria for the diagnosis MK: typical complaints, anamnesis, specific clinical and dermatoscopic pattern, a negative result of microscopic examination of scales with lesions on the fungus, the lack of a brick-red glow on the soles in the rays of the wood.

It was found that 1 experimental group signs MK marked among 4 people and 10 students considered healthy. In group 2 only 2 people are considered healthy, the rest of the cadets revealed different degrees of severity MK.

Confidence interval (amendment of Yates): 0,49<P1-P2<0,73

Thus, with a probability of 95% it can be argued that the application of the proposed method to identify risk punctulata keratolysis allows to predict the disease from 49% to 73%.

For further research formed 2 groups on the basis of the presence of the disease.

1. Sick of the MK. 23 cadet. Inclusion criteria: typical complaints, anamnesis, specific clinical and dermatoscopic pattern, a negative result of microscopic examination of scales with lesions on the fungus, the lack of a brick-red glow on the soles in the rays of the wood, no prior treatment.

2. Control group of 12 cadets of the same year, under the same conditions of training without clinical signs MK on the results of a clinical examination by a dermatologist.

In the experimental group against non-adaptable parameters (professional adaptation) HRV (prototype) are already in progress AOP indicator LF/HF (from 0.74 to 3.22, p≤0,05). In the control group changes during AOP wore unreliable character. In the control group decreased LF/HF in the dynamics of thermal tests on the criterion of Wilcoxon signed and method characters wore reliable (from 0.92±0.28 to 0,55±0,10, p≤0,0284 and p≤0,0269 respectively).

Conducted correlation analysis allowed us to establish that there is an inverse direction of the average force relationship between the degree of reduction of adrenergic effects (figure LF/HF before and after thermal tests) and the reactivity of the parasympathetic nervous system (figure 30/15 to heat the sample rank correlation coefficient r= - 0.54, Kendall Tau=-0,38, Gamma=-0,38 p≤0,05; p is the 30/15 ratio after thermal tests: rank correlation coefficient r=-0,71, Kendall Tau=-0,54, Gamma=be 0,55 p≤0,05), which not only confirms the methodological hypothesis of the experiment on the target professionally significant parasympathetic response to stress, but also proves its pathogenetic mechanism in the development of the MK.

After treatment (ointment eritromicina for external use 10000 U/g, manufacturer Synthesis JSC, , barrow, twice a day for 7 days) were performed control measurements of HRV proposed complex in the group of patients MK. It is found that after treatment only in 10 out of 23 people index LF/HF demonstrated a decrease in the dynamics of thermal samples, and 13 the changes are preserved, which confirms the clinical data of the frequent recurrence of the disease.

Objective indicators of the diagnostic values of the proposed method for diagnosing the risk of developing stress-induced MK before treatment (Greenhalgh So the Basics of evidence-based medicine: Transl. from English. / So Greenhalgh. - M.: GEOTAR - Media, 2006. - S. 125-140):

- sensitivity 83%;

the specificity of 83%;

- predictive value of a positive result, 90%;

- the negative predictive value of 71%;

- the index of the accuracy of 83%.

After treatment, the proposed method can be considered as an indicator of risk of relapse MK, maintaining its importance:

- chuvstvitelnosti%;

the specificity of 83%;

- predictive value of a positive result 87%;

- the negative predictive value of 50%;

- the index of the accuracy of 66%.

Assessment was conducted of the effect of the intervention (the use of thermal tests) according to the standard scheme before and after treatment in the experimental group (Greenhalgh So the Basics of evidence-based medicine: Transl. from English. / So Greenhalgh. - M.: GEOTAR-Media, 2006. - S. 237.):

the odds ratio for a particular outcome=23,75.

After treatment in the experimental group:

the odds ratio for a particular outcome=6,5.

Thus, even after standard treatment MK applying heat to the sample increases the chance to identify the risk of recurrence of the disease was 6.5 times more effective, and to ensure the application of heat to the sample increases the chance of detection of this condition in more than 23 times.

Testing of the proposed method implemented in the recruitment of cadets 2013/14 academic year, while they are in country training center in July-August 2013 2 groups of cadets for 25 persons each were examined in the proposed method, and selected risk group in the amount of 18 people, whose index LF/HF after the heat of the sample decreased. Some of the cadets (9 people) agreed to undertake preventive treatment (ointment eritromicina for external use 10000 the d/g manufacturer Synthesis JSC, , barrow, twice a day for 7 days), 9 people without subjective complaints for various reasons refused. The control carried out 1 month later (after returning from suburban training center, where they passed the course of a young soldier). Set that to the doctor the dermatologist asked with typical complaints of 11 people, all confirmed the diagnosis of MC. Of the 11 people 9 were from the risk group and only 2 of the pilot, conducted preventive treatment.

Objective indicators of the diagnostic values of the proposed method for diagnosing the risk of developing stress-induced punctulata keratolysis (Greenhalgh, So the Basics of evidence-based medicine: Transl. from English. / So Greenhalgh): GEOTAR - Media, 2006. - S. 125-140):

- sensitivity of 78.6%;

the specificity of 80.6%;

- predictive value of a positive result 61,1%;

- predictive value of a negative result, 90%;

the accuracy index is 80%.

Thus, convincingly demonstrated that with sufficient repeatability, sensitivity and specificity of the application of the proposed method improves the accuracy of diagnosing the risk and recurrence of stress-induced MK in adverse from the point of view of hygiene conditions, which allows to reduce the incidence by prevent the main treatment.

Clinical examples:

1. Cadet Century, 17 years. The results of the baseline survey found an increase in LF/HF before and after the heat test. Diagnosed the risk of developing stress-induced punctulata keratolysis. From preventive treatment refused.

1 month after returning from country training center, where simulated stress the extreme conditions of professional activity, examined, re - confirmed the development/implementation risk stress-induced punctulata keratolysis. The results of HRV in the initial examination and after corrective autonomic disorders treatment are presented in table. 1.

Demonstrated that in the original survey response to heat the sample (+t) in terms of LF/HF with 0,468 increased to 0,715 that allowed us to detect the risk of developing stress-induced punctulata keratolysis. After 1 month of being in conditions simulating extreme (in country training centre inspection completed by a physician - confirmed the development/implementation risk stress-induced punctulata keratolysis. After treatment, including special methods of vegetative correction, index LF/HF in the dynamics of thermal samples decreased with 0,425 to 0,410. The risk of re-development of stress-induced marketcheck the th keratolysis low. During subsequent observations during the school year, the disease had anticipated.

2. Cadet S., age 17. The results of the baseline survey found decreased LF/HF ratio after the heat test. Diagnosed with absence of risk punctulata keratolysis.

1 month after returning from country training center re-examined. Punctuate keratosis not found, no risk of developing the disease is confirmed.

Indices of HRV in the dynamics of the observations is presented in table. 2.

Demonstrated that in the original survey, and after effect of stress simulating load reaction to heat the sample was the "best": the index LF/HF in both surveys decreased. The risk of developing stress-induced punctulata keratolysis in this case was not selected, as was proved later.

Indices of HRV before and after (+t) heat the sample in the initial examination and after treatment cadet Century, 17 years

Indices of HRV in the dynamics of the observation cadet C., 17 years

A method for diagnosing the risk of developing stress-induced punctulata keratolysis (MK), including the implementation of heart rate variability (HRV), characterized in that the HRV perform twice - before and p is after the 15-minute thermal tests on the plantar surface of the feet, and if there is no reduction index LF/HF in comparison with the initial diagnose the risk of developing stress-induced MK.



 

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13 dwg

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

FIELD: medicine; medical engineering.

SUBSTANCE: method involves selecting reference point in every cardiac cycle on TP-segment. Values of neighboring N=2n+1 reference points also belonging to TP-segment are recorded, n=1,2,…, beginning from the first reference point. Other reference points are set to zero. The central reference point value is left without changes in a group of 2n+1 member. Reference point values of each of n pairs of reference points symmetrically arranged relative to the central reference point are scaled relative to condition Uj=U0Kj, where U0 is the central reference point amplitude, Uj is amplitude of j-th reference point pair, j=1,2,…,n is the number of each reference point pair relative to the central reference point, Kj is the scaling coefficients determined from received signal suppression condition of the first n spectral zones in spectrum. The so formed electrocardiogram signal reference point groups sequence is let pass through lower frequency filter with isoline drift signal being obtained being produced on output. The signal is amplified and subtracted from the initial electrocardiogram signal that is preliminarily delayed for lower frequency filter delay time. Device has the first lower frequency filter, discretization unit and unit for selecting anchor reference points connected in series, as well as subtraction unit, unit for saving N reference points, scaling unit, the second lower frequency filter, amplifier and delay unit. Output of the unit for selecting anchor reference points is connected to the first input of memory unit the second input of which is connected to discretization unit output. Each of N memory unit outputs is connected to one of N inputs of scaling units. Scaling unit output is connected to the second lower frequency filter input which output is connected to amplifier input. Amplifier output is connected to the first input of subtraction unit, the second output of subtraction unit is connected to delay unit output. Its input is connected to output of the first lower frequency filter. Subtraction unit output is the device output.

EFFECT: reliable removal of isoline drift.

2 cl, 8 dwg

FIELD: medicine; cardiology.

SUBSTANCE: device has amplifier, analog-to-digital converter provided with multiplexer, arithmetic unit, memory unit, digital modem, increment code analyzer, increment codes number counter, switching unit and control unit as well as second memory unit, digital filtration unit and decimation unit. Electrocardiogram signal is registered within frequency-time area. Increase in volume of diagnostic data is provided due to time localization of spectral components of electrocardiogram signal.

EFFECT: widened operational capabilities; improved precision of diagnosing; higher efficiency of treatment.

6 dwg

FIELD: medicine; radio electronics.

SUBSTANCE: device for taking cardiogram has set of electrodes, cardiologic unit, analog-to-digital converter, cardio signal preliminary treatment unit, computer, lower frequency filter, differentiator, functional converter and controlled filter. Power function calculation units are not included. Preliminary continuous filtering of cardio signal entering the computer is provided.

EFFECT: simplified design; improved precision of measurement.

1 dwg

FIELD: medical engineering.

SUBSTANCE: device has electrodes, input amplifier, unit for protecting against error influence when applying medical electric instruments, low frequency filter, signal analysis unit, unit for eliminating isoline drift and electric power supply units.

EFFECT: high accuracy in plotting rhythmograms; improved instruments manipulation safety.

1 dwg

FIELD: medicine.

SUBSTANCE: method involves modeling real three-dimensional patient heart image based on electrocardiogram and photoroentgenogram data and determining basic functional values of its myohemodynamics.

EFFECT: high accuracy and reliability of the method.

2 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves recording cardiac biopotentials with vector electrocardiograph, processing and visualizing signal with graphical plane integral cardiac electric vector projections (vector electrocardiograms) being built and analyzed. Shape, QRS-loop value and vector orientation-recording process are determined. Analysis is based on planar vector electrocardiograms in horizontal, frontal and sagittal planes and in spatial 3-D-form. Vector loop direction is studied in X-,Y-,Z-axis projections, values, dynamics and localization are evaluated in resulting integral cardiac electric vector delta-vector space. To do it, QRS-loop is divided into four segments, one of which characterizes excitation in middle part of axial partition surface, the second one is related to excitation in lower ventricular septum one-third with cardiac apex being involved and the third and the fourth one is related to excitation in basal parts of the left and right heart ventricles. Delta-vector existence and its magnitude are determined from changes in loop segment localization when compared to reference values.

EFFECT: improved data quality usable in planning surgical treatment.

4 dwg

FIELD: medical radio electronics.

SUBSTANCE: device can be used for testing cardio-vascular system of patient. Differential vector-cardiograph has high frequency oscillator, common electrode, unit for reading electrocardiogram and radio cardiogram provided with amplification channels and filtration channels, multiplexer, microprocessor unit with common bus, analog-to-digital converter, keyboard, mouse and indication unit. Device provides higher precision of measurements due to usage of electric component heart activity and truth of diagnostics due to ability of representation of results of testing in form of variety of vector-cardiograms in real time-scale.

EFFECT: improved precision.

1 dwg

FIELD: medicine, cardiology, arhythmology, functional diagnostics.

SUBSTANCE: one should register electrocardiogram in esophagus, apply an electrode in a site where the maximum signal amplitude is registered, increase the signal 5-fold, not less to be filtered in the range of 0.5-40 Hz to be registered at the rate of 100 mm/sec, not less. The time for intra-atrial process should be measured from the beginning of ascending part of the first positive wave of pre-P-tooth up to the top of the second adhesion of P-tooth; the time for inter-atrial process should be measured from the site of crossing a descending part of the first positive wave and the onset of obliquely ascending pre-P-interval up to crossing this interval with the point of abrupt increase of the first phase of P-tooth. The innovation provides more means for noninvasive evaluation of intra- and inter-atrial stimulation process.

EFFECT: higher accuracy of evaluation.

3 dwg

FIELD: medicine, cardiology.

SUBSTANCE: one should register a standard electrocardiogram (ECG) and measure the duration of a "P"-wave. Moreover, it is necessary to conduct daily ECG monitoring to calculate single, paired and group atrial extrasystoles. Then one should calculate diagnostic coefficient DC by the following formula: DC=DC1+DC2+DC3+DC4, DC1 =-8.8 at duration of "P"-wave below 106 msec, 9.3 at duration of "P"-wave above 116 msec, -3.5 at duration of "P"-wave ranged 106-116 msec. DC2=-1.9 at the absence of group atrial extrasystoles during a day, 8.3 -at daily quantity of group atrial extrasystoles being above 4, 2.5 - at daily quantity of group atrial extrasystoles ranged 1-4. DC3=-2.9 at daily quantity of paired atrial extrasystoles being below 3, 8.1 - at daily quantity of paired extrasystoles being above 35, -1.4 - at daily quantity of paired atrial extrasystoles ranged 3-35. DC4=-5.1 at daily quantity of single atrial extrasystoles being below 15, 4.3 - at daily quantity of single atrial extrasystoles being above 150, -1.0 - at daily quantity of single atrial extrasystoles ranged 15-150, if DC is above or equal to 13 one should diagnose high risk for the development of paroxysmal atrial fibrillation, in case if DC is below or equal -13 it is possible to diagnose no risk for the development of paroxysmal atrial fibrillation, and if DC is above -13 and below 13 - the diagnosis is not established.

EFFECT: higher sensitivity of diagnostics.

5 ex

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