Differential diagnostic technique for cardiogenic myocardial ischemia and enteral cardioinhibitory reflex

FIELD: medicine.

SUBSTANCE: recording ECG is followed by a bilateral translumbar block with an anaesthetic solution in an amount of 120-140 ml from each side. Then 60-90 min later ECG is recorded once again, and this recording is compared to the pre-block recording. If observing a positive dynamics of the ECG results, ischemia caused by the enteral cardioinhibitory reflex with underlying intraluminal intestinal hypertension is diagnosed. No positive dynamics observed enables diagnosing myocardial ischemia caused by a cardiac pathology.

EFFECT: enabling performing the more accurate differential diagnosis of the above pathologies by following a specific procedure in case of pain syndrome in the given category of patients.

1 ex

 

The invention relates to medicine, cardiology and abdominal surgery and directly to the differential diagnosis of myocardial ischemia in the pathology of the heart and enterline-cardiac brake reflex, against flatulence and paresis of the intestine.

In the available literature we did not meet publication of differential diagnosis interline-cardiac brake reflex and the methods of its implementation.

At the same time on the background of paresis of the intestine and development against this background of intraluminal pressure in the lumen of the digestive tract ECG changes can be caused by pathology of the heart, and reflex influences, namely interline-cardiac inhibitory reflex, in which the spasm of blood vessels of the myocardium during transmission of pathological activity stretched from the intestines to the heart. While myocardial ischemia can itself cause inhibition of intestinal motility and development of paresis with increased intraluminal pressure in the digestive tract. In such cases, to determine the tactics of conducting the patient is difficult and error may threaten his life.

The development of intraluminal hypertension may be due to food errors, spastic colitis, adhesive disease of the abdominal organs, diseases of the organs of the retroperitoneal space, Breakfast is STV, injuries of the abdomen and retroperitoneum, subject to supervision in the hospital and so on

The technical objective of the proposed method is to optimize the differential diagnosis of myocardial ischemia in the pathology of the heart and enterline-cardiac brake reflex, against the background of intraluminal pressure in the lumen of the intestine.

The technical result is achieved by first recording the ECG, then bilateral perirenal blockade of the anesthetic solution in the amount of 120-140 ml on each side, then after 60-90 min after blockade carried out for the second ECG recording, which is compared with the ECG recording made before the blockade. Positive dynamics of pathological changes on the ECG diagnosed with myocardial ischemia due to interline-cardiac inhibitory reflex in the background intraluminal hypertension in the intestine, and in the absence of positive changes on ECG diagnosed myocardial ischemia caused by abnormalities of the heart.

The invention consists in that the first ECG recording, then bilateral perirenal blockade of the anesthetic solution in the amount of 120-140 ml on each side, then through 60-90 minutes to produce a re-recording of the ECG, which is compared with the ECG recording made prior to the blockade, and with positive dynamics of pathological change which deposits on the ECG diagnose ischemia, due interline-cardiac inhibitory reflex in the background intraluminal hypertension in the intestine, and in the absence of positive dynamics - myocardial ischemia due to cardiac pathology.

The method is as follows. On the background of intraluminal pressure in the intestines and produces ECG recording, then bilateral perirenal blockade of the anesthetic solution in the amount of 120-140 ml on each side, then after 60-90 min re-record the ECG, which is compared with the ECG recording made before the siege, and in the presence of positive changes on ECG diagnosed with myocardial ischemia due to interline-cardiac inhibitory reflex in the background intraluminal hypertension in the intestine, and in the absence of positive dynamics of ECG myocardial ischemia due to cardiac pathology.

In experiment 10 the cadaver we spent determining the amount of anesthetic that provides for adequate blockade of perirenal region.

Usually when perirenal blockade volume of injectate is from 60 to 100 ml, 25-05% solution of novocaine.

Links to Internet resources:

http://meduniver.com/Medical/Topochka/490.html

http://www.spinanebolit.com.ua/pages/view/paranefralnaya_blokada__vishnevskomu

http://fast-surgery.ru/index.php/2010-08-08-20-03-52/47-2010-08-08-20-03-15.html

When determining the amount of novocaine necessary to blockade the retroperitoneal nerve structures in the perirenal tissue, spending perirenal the blockade was imposed colored solution and evaluated the infiltration solution perinephral fiber. It was found that for adequate blockade perinephral fiber must enter 120-140 ml on each side. At the same time in the production of bilateral perirenal blockade with a smaller volume of solution adequate blockade of perirenal retroperitoneal nerve plexus is not achieved.

Notes on the volume injected novocaine:

When intrapelvic blockade (Shkolnikov-Selivanova) on the background of fracture of the pelvis enter from two sides of 250-300 ml of 0.25% solution of novocaine on each side, which corresponds to 125,0-of 150.0 ml of 0.5% solution of novocaine (http://medarticle.moslek.ru/articles/27717.htm).

That is, even when increasing concentrations of procaine 0.5% of the amount required for blockade of perirenal and retroperitoneal neoplasms, does not exceed used in medicine.

It should be noted that previously under local infiltration anesthesia was performed extensive abdominal surgery (cholecystectomy, gastrectomy, and so on), which indicates the safety of use of significantly large amounts of novocaine.

The method of differential diagnosis of cardiogenic myocardial ischemia and enterline-cardiac brake reflex was used in 23 patients with signs of myocardial ischemia on the fo is e flatulence, due to the development of intraluminal pressure in the intestine. Of these, 18 were found to have myocardial ischemia, caused interline-cardiac inhibitory reflex, and 5 - myocardial ischemia due to cardiac pathology. Diagnostic with no errors.

The example of the patient: the Patient P., 38 years old, delivered by ambulance complaining of intense pain in the chest, palpitations, interruptions in heart work, epigastric pain, bloating in the epigastric and methoctramine areas, and nausea. Palpation of the abdomen is soft, moderately painful in the epigastric and left methoctramine areas, signs of peritoneal irritation negative, percutere determined timpani in the epigastrium and methoctramine areas. History underwent surgery for blunt abdominal trauma with damage to the jejunum and transverse colon, complicated spilled peritonitis. ECG is marked tachycardia, single polytope extrasystoles, ST segment depression. On survey radiographs of the abdominal cavity revealed a single bowl Kloiber, swelling of the transverse colon. Given the more pronounced pain in the sternum, the disruption of the heart, ECG data on the one hand and moderately distinct clinical symptoms from abdominal organs, primarily in the formulation D. the diagnosis leaned in favor of myocardial ischemia. However, given the presence of a single bowls Kloiber and the inability to eliminate the risk of adhesive disease and intestinal obstruction was made bilateral perirenal blockade 0.25% solution of novocaine in the amount of 120,0 ml on each side. Within 15 minutes after the blockade was a decrease in the intensity of pain in the chest and stomach. When repeated electrocardiographic study, after 1 hour and 20 minutes after blockade showed normalization of the ECG. The patient was hospitalized in the surgical Department, where conservative phenomenon of intestinal obstruction have been resolved. In this situation, the use of the method of differential diagnosis of myocardial ischemia in the pathology of the heart and enterline-cardiac brake reflex on the background of intraluminal pressure in the intestine is allowed to specify the diagnosis and to determine the address of hospitalization and treatment of the patient.

Additional symptoms consider new and significant, in order to enhance the differential diagnosis of myocardial ischemia in the pathology of the heart and enterline-cardiac brake reflex on the background of intraluminal hypertension in the gut.

The method of differential diagnosis of cardiogenic myocardial ischemia and enterline-cardiac brake reflex on the background of paresis of cichecki is a, including ECG recording, and then produce bilateral perirenal blockade of the anesthetic solution in the amount of 120-140 ml on each side, and after 60-90 min after blockade re-record the ECG and the obtained record is compared with the ECG recording made prior to the blockade, with positive dynamics of ECG diagnose ischemia caused interline-cardiac inhibitory reflex in the background intraluminal hypertension in the intestine, and in the absence of positive dynamics - myocardial ischemia due to cardiac pathology.



 

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4 tbl, 2 ex

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7 dwg, 1 ex

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1 ex

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1 ex

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1 ex

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3 ex

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1 ex

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23 cl, 12 dwg

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1 dwg, 2 tbl, 2 ex

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8 dwg

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2 ex

FIELD: medicine.

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2 ex, 1 dwg

FIELD: oil and gas industry.

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3 part-s

FIELD: medicine.

SUBSTANCE: invention relates to methods and devices of identifying reasons of cardiac rhythm disturbance. Method consists in perception of signals of heart excitation in multitude of locations with application of multitude of sensors, collection of data from multitude of sensors. Collected data include sensor location for each sensor and time of heart excitation origination in each sensor location, so multitude of times of excitation origination in multitude of locations of sensors are collected, and then their sequence is formed. Obtained data are then analysed and approximate central areas, connected with excitation pathway, pointing to reasons of said cardiac rhythm disturbance, are determined.

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37 cl, 16 dwg

FIELD: medicine.

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EFFECT: method makes it possible to increase the prediction reliability.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, labour safety, vocational selection of rescue workers. The invention can be used for vocational selection in the sectors of industry using personal protective equipment, as well as for the workers labour safety in the sectors of industry with harmful working conditions. The method involves vocational selection and duty control on the basis of electroencephalogram (EEG) values and cardiological findings. The examination is performed prior to and when using the personal protective equipment. The cardiological examination involves assessing the heart rate variability with using the amplitude-frequency spectrum Fourier analysis VLF at a vibration frequency within the range of 0.0033-0.04 Hz, LF - at a frequency of 0.05-0.15 Hz and HF - at a frequency of 0.16-0.80 Hz, and is five-staged: initial resting state, mental work load, recovery of mental work load, hyperventilation load, recovery of hyperventilation load. At the beginning, the heart rate variations and EEG are examined prior to using the personal protective equipment. If any of the five stages of the heart rate variation examination shows the pulse more than 90 beats per minute, as well as changes from the normal values of: approximating entropy - less than 180, LF - less than 6 point, an alpha wave amplitude - to 12 vibrations per second and the presence of the paroxysmal activity by EEG, the prevailing sympathetic nervous system is stated, or if any stage of the heart rate variation examination shows the pulse less than 60 beats per minute, as well as changes from the normal values of: blood pressure - more than 140/90 mmHg, VLF - more than 130 points, HF - more than 16 points, an alpha wave amplitude - less than 25 mcV, the prevailing parasympathetic nervous system is stated; a low level of adaptation to the personal protective equipment is predicted, and a rescue work is not recommended during the vocational selection; the examination is terminated. If the heart rate variation and EEG prior to using the personal protective equipment fall within the normal values, the heart rate variation when using the personal protective equipment is started with the patient examined when using the personal protective equipment and performing a cycle ergometer test, and recording the hyperadaptotic changes of the assessed values: VLF - more than 130 points in relation to the normal value when using the personal protective equipment and LF and HF vibrations; an incomplete or unfinished adaptation to the personal protective equipment, and the rescue worker is suspended from work for several hours; if VLF is more than 130 points recorded 10-15 min after activating the personal protective equipment, a good adaptation level to the personal protective equipment is predicted.

EFFECT: method enables assessing the vegetative nervous function and predicting the rescue workers' adaptation level to the personal protective equipment.

11 tbl, 5 ex

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

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