Method for prediction of risk of cardiovascular complications following ischemic stroke
SUBSTANCE: heart rate variability is assessed. The assessment procedure involves 24-hour Holter monitoring on the 21st day from the moment of the ischemic stroke occurred. And if observing brady-arrhythmias presented by degree 2-3 atrio-ventricular block or degree 2-3 sinoatrial block and sinus pauses of more than 2 sec long, a high risk of cardiovascular fatal complications following the ischemic stroke is predicted.
EFFECT: method provides the high informative and flexible prediction of the risk of cardiovascular fatal complications following the ischemic stroke in the patients with cerebrovascular, cardiac, endocrine comorbidities.
3 tbl, 3 ex
The invention relates to medicine, in particular, neurology and cardiology in the treatment of patients with stroke.
Stroke due to high levels of mortality and disability of patients represents a major problem in modern medicine. Stroke after coronary heart disease (CHD) is the second most common cause of death worldwide (Murray C. J., Lopez A. D. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349:1436-1442). Mortality of stroke patients in the early stages (30-day) reaches 32-42%, and in the first year after onset of the disease increases to 48-63% (Suslin H. A., Varakin Y. Y., Vereshchagin N. In. Vascular brain disease: Epidemiology. The basics of prevention. M, Medpress-inform, 2006. - 256 S.). In several large studies have shown that in patients after ischemic stroke are the leading causes of death from cardiac causes (Broderick J. P., Phillips, S. J., OTallon W. M. et al. Relationship of cardiac disease to stroke occurrence, recurrence, and mortality. Stroke 1992; 23:1250-1256; M. S. Dhamoon et al. Risk of myocardial infarction or vascular death after first ischemic stroke. Stroke 2007; 38:1752-1758). The reason is that most patients with ischemic stroke detected associated cardiac pathology: CHD, revocandi different etiology, the vices and disorders of heart rhythm (D. Bartko et al. The heart and the brain. Aspects of their interrelations. Vnitr Lek. 1996; 42:482-489). It is also expected that in jivamukti after stroke is affected by the dysfunction of the autonomic regulation of the heart (Robinson T. G. et al. Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 2003; 34:705-712).
From a clinical point of view the direct cause of cardiac death in the General clinical practice are cardiac arrhythmias: ventricular tachyarrhythmias and bradyarrhythmia (Kuller L., Lilienfeld A. An epidemiological study of sudden and unexpected deaths in adults. Medicine 1967; 46:341). The cause of cardiac arrest is called the primary atrial ventricular paroxysmal ventricular tachycardia and primary asistoliei (Bayes de Luna A., Guindo Soldevila J. Sudden cardiac death. MCR, Barcelona, 1989).
Reports about the prognostic value of life-threatening ventricular arrhythmias in patients with ischemic stroke not numerous (Lown C., Verrier, R. L. Neural activity and ventricular fibrillation. N. Engl. J. Med. 1976; 294:1165-1170; Limacina I. N. Cerebrocortical syndrome. Bulletin of Arrhythmology, 2009; 58:26-34). It was shown that the presence of ventricular arrhythmias in patients with ischemic stroke is associated with increased mortality (Davis A. M., A. M. Natelson Brain-heart interaction. The neurocardiology of arrhythmia and sudden cardiac death. Those. Heart. Inst. J. 1993; 20:158-169; Colivicchi F. et al. Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke. Stroke 2005; 36:1710-1715). However, these studies included only patients in the acute phase of ischemic stroke, and evaluated the risk of sudden cardiac death. At the same time in the distant post-stroke period, the reasons for the deaths can be also repeat the haunted brain disorders.
As a prototype we have used the work Colivicchi F. et al. Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke. Stroke 2005; 36:1710-1715. Authors within 1 year, conducting surveillance of patients undergoing first stroke, followed by analysis of prognostic significance in relation to risk of death indicators of heart rate variability (HRV) and unstable ventricular tachycardia. In the multivariate analysis identified the adverse prognostic significance of reducing the standard deviation of the R-interval (SDNN) of less than 100 MS and unstable ventricular tachycardia in relation to increased mortality (cardiovascular and due to other reasons) for 1 year after a stroke.
It should be noted that the main aim of this study was to demonstrate an independent effect of destruction of certain brain structures (right island) on post-stroke prognosis. Therefore, these studies have had strict selection criteria. So, included patients only with the first stroke, a cerebral ischemic lesion, absence of diabetes mellitus (DM), cardiac or pulmonary pathology, clinically significant arrhythmias. However, this sample of patients does not reflect the real situation, with the seat in everyday clinical practice. In addition, it is shown that the increased risk of fatal cardiovascular complications after a stroke is stored not only in the first year, and over longer periods of time (Makikallio A. M. et al. Heart rate dynamics predict poststroke mortality. Neurology 2004; 62:1822-1826).
Given these circumstances, there is a need of finding a universal predictor of increased risk of cardiovascular fatal complications such as sudden death after ischemic stroke in a real patient, burdened with previous cerebrovascular, cardiac, endocrine diseases to personify preventive measures and improve remote prognosis of the disease and increase life expectancy of the patient.
The technical result of the invention is highly informative and versatility of the risk prediction of cardiovascular fatal complications after ischemic stroke in patients with concomitant cerebrovascular, cardiac, endocrine diseases at an early stage of the disease (21 days from the time of stroke).
The technical result is achieved by the fact that for predicting the risk of cardiovascular fatal complications after ischemic stroke patient, assess the heart rate variability by daily Holter monitoring (HM) n is 21 days from the date of development of ischemic stroke and bradyarrythmia in the form of atrioventricular block grade 2-3 or sinoatrial blockade 2-3 degrees and sinus pauses longer than 2 seconds forecast high risk of cardiovascular fatal complications after ischemic stroke.
The method is as follows. All patients with ischemic stroke and concomitant cerebrovascular, and/or cardiac and/or endocrine diseases to identify the risk of cardiovascular fatal complications after ischemic stroke spend HMM daily for 21 days from the date of development of ischemic stroke. To conduct HMM used domestic cardioregulatory "Cartotecnica 4000" and "Cartotecnica-04 (INCART, St. Petersburg) with the three-channel ECG recording (lead V4, Y, V6). Upon detection of bradyarrythmia in the form of atrioventricular (AV) blockade 2-3 degree or sinoatrial (SA) blockade of 2-3 degrees and sinus pauses longer than 2 seconds predict a high risk of cardiovascular fatal complications after ischemic stroke. Based on these data, carry out the necessary measures for the timely removal of bradyarrythmia, such as the implantation of the electric car of biostimulator mode "on demand" with a pulse frequency of 60 beats per minute.
Thus, using the presence of bradyarrythmia as a universal prognostic factor of cardiovascular fatal complications is promising to improve the life prognosis of patients who NTA.
Only observation was included 148 patients with ischemic stroke; of these, 94 (64%) males and 54 (36%) women. Patient age at the time of inclusion in the study ranged from 22 to 83 years, on average - 60±14 years. Available in patients with concomitant cardiovascular pathology are presented in table 1.
|Diseases of cardiovascular system in patients with ischemic stroke|
|Disease of cardiovascular system||The number of patients (%)|
|Acute disorders of cerebral circulation in history||26 (18%)|
|Chronic heart failure||87 (59%)|
|Ischemic heart disease||49 (33%)|
|Paroxysmal form of atrial fibrillation||34 (23%)|
|Diabetes mellitus||32 (22%)|
|Mitral valve prolapse, open oval window||18 (12%)|
|Infectious endocarditis||4 (3%)|
All patients underwent daily HMMM performed using a wearable portable monitor with a continuous recording of ECG within 24 hours. To exclude acute cerebrogenic influences on HRV HMM was performed on the 21st day from the moment of the stroke. Used domestic cardioregulatory "Cartotecnica 4000" and "Cartotecnica-04 (INCART, St. Petersburg) with the three-channel ECG recording (lead V4, Y, V6). Implemented continuous recording during the whole observation time providing visual information about the ECG anywhere in the record.
On the basis of 24-hour ECG recording studied all heart rhythm disturbances and the state of HRV. Episodes of transient AV block grade 2-3 or SA blockade 2-3 degree, sinus pauses longer than 2 seconds were classified as bradyarrhythmia.
Computer statistical processing of the obtained results was carried out on the basis of the software package STATISTICA 7.0 (StatSoft, USA). To identify predictors of adverse outcome (fatal complications) was the curves of time of occurrence of cardiovascular death (according to the method of Kaplan-Meier), and we used a regression analysis models the proportional risk of Coke. Multivariate analysis was preceded by a one-factor. In multivariate analysis included variables for which the values of the criterion of statistical significance in univariate analysis was <0,05, as well as characteristics that could be associated with the study outcome according to previous studies. Multivariate regression analysis was carried out step-by-step method. Statistically significant differences were considered when p<0,05.
The duration of the prospective follow-up ranged from 1 year to 10 years, averaged 35±12 months. During the observation time in 15 (10%) patients registered cardiovascular death (table.2).
|Causes of cardiovascular death during the period of prospective follow-up|
|Causes of cardiovascular death||The number of deceased patients (n=15)|
|Re ischemic stroke||7|
|Acute heart failure||3|
|Sudden cardiac death|
|Acute myocardial infarction||2|
When comparative analysis was obtained a number of qualitative differences between survivors and deceased patients. To clarify the prognostic significance using univariate analysis was calculated relative risk of cardiovascular fatal complications and it is shown that with the increase associated with age of 67 years, SDNN <71 MS and the presence of bradyarrythmia.
It is obvious that the influence of prognostic factors may be in some cases combined and overlap, while their presence in one patient. Why was performed multivariate analysis using models is proportional to the risk of Coke to determine independent factors high risk of cardiovascular fatal complications after ischemic stroke based on identified predictors according to univariate analysis (age of 67 years and the presence of bradyarrythmia). Also carried out the adjustment of patients according to the duration of the observation, gender, stroke in history, received medical therapy, presence of hypertension, diabetes, ischemic heart disease, chronic heart failure, atrial fibrillation and atherosclerosis. When assessing the impact on the increased incidence of cardiovascular deaths in many of the factor models, the most significant and the only statistically significant was the impact of bradyarrythmia (p=0,044976).
|Prognostic factors associated with cardiovascular fatal complications in the post-stroke period|
|SDNN <71 MS||0,148426||0,768999||0,19301||1,160006||0,037253||0,846951|
Thus, bradyarrhythmia in the form of atrioventricular block grade 2-3 or sinoatrial blockade 2-3 degrees and sinus pauses lifespan is using more than 2 seconds are an independent risk factor for cardiovascular fatal complications in the distant post-stroke period. Prognostic value of bradyarrythmia persists after adjustment for other prognostic factors, i.e., is an independent factor high risk of cardiovascular fatal complications after ischemic stroke.
Examples of implementation of the method
Example 1: the Patient Z., 72 years old, underwent acute ischemic stroke on the background of arterial hypertension and coronary heart disease: postinfarction cardiosclerosis. On the 21st day from the moment of development of ischemic stroke was conducted daily HMMM. According to his results were detected bradyarrhythmia three episodes SA blockade of 2 degrees with periods of sinus pauses up to 2.2 seconds. These data were factor 8 increased risk of cardiovascular fatal complications after ischemic stroke. The patient was offered surgery to implant a pacemaker, which the patient refused. After discharge from hospital the patient was on the basis of antihypertensive, antithrombotic, and lipid-lowering therapy. However, this therapy has not been sufficient to prevent fatal complications, and after 16 months, the patient died as a result of repeated extensive stroke on the background of bradyarrythmia.
Example 2: the Patient M, 69, suffered acute ischemic stroke on the background paroxysmal form of atrial fibrillation. At 21 days the t stage of ischemic stroke was conducted daily HMMM. According to the results of the episodes bradyarrythmia not found that testified in favor of the absence of risk of cardiovascular fatal complications after ischemic stroke. After discharge from hospital the patient was on the basis of drug therapy, including therapy with oral anticoagulants. Within 4 years prospective follow-up the patient is alive, cardiovascular disorders is not registered.
Example 3: Patient U., 76 years, suffered repeated ischemic stroke on the background of diabetes mellitus and chronic heart failure. On the 21st day from the moment of development of ischemic stroke was conducted daily HMMM. Results revealed bradyarrhythmia in 7 episodes of AV block 2nd degree with periods of sinus pauses up to 2.8 seconds. This was a factor in increased risk of cardiovascular fatal complications after ischemic stroke. The patient was implanted with a pacemaker mode "on demand" with a frequency of 60 pulses per minute. After discharge from hospital the patient carefully follows all the recommendations. Within 3 years prospective follow-up of recurrent fatal cardiovascular complications the patient has not occurred.
Thus, in comparison with the known method of assessing HRV in patients with first stroke without accompanying for the of olivani have the opportunity to predict the risk of cardiovascular fatal complications HMM method with analysis of bradyarrythmia. The use of inexpensive methods for standard specified conditions allows us to predict the risk of cardiovascular fatal complications such as death in the post-stroke period in patients with different comorbidities already 21 days from the date of development of ischemic stroke. The proposed method daily CHILLER with automatic analysis of bradyarrythmia is informative and universal in predicting the risk of cardiovascular fatal complications that can help to optimize the management of the patient post-stroke period to increase the duration of his life.
A method for predicting the risk of cardiovascular fatal complications after ischemic stroke, namely, that the patient assess heart rate variability, characterized in that the evaluation of heart rate variability is carried out by daily Holter monitoring in 21 days from the date of development of ischemic stroke and bradyarrythmia in the form of atrioventricular block grade 2-3 or sinoatrial blockade 2-3 degrees and sinus pauses longer than 2 seconds predict a high risk of cardiovascular fatal complications after ischemic stroke.
SUBSTANCE: electric cardio signal recorder in free motion activity comprises an amplifier (1), an analogue-to-digital converter with a multiplex switch (2) and series decomposition unit (3), second arithmetical-logical unit (4), an arithmetic unit (5), an increment code analyser (6), a switchover unit (7) and a digital modem (8), as well as a control unit (9), first (12) and second (10) memory units, an increment code counter (11). A second output of the second arithmetical-logical unit (4) is connected to a first input of a decomposition unit (3); an output of the second memory unit (10) is connected to a second output of the second arithmetical-logical unit (4); a second output of the increment code analyser (6) is connected to a first input of the first memory unit (12), while a third output - to a first input of the increment code counter (11), an output of which is connected to a second input of the first memory unit (12) an output of which us connected to an second input of the switchover unit (7); first, second, third, fourth, fifth and sixth outputs of the control unit (9) are connected respectively to a first input of the analogue-to-digital converter with the multiplex switch (2), a second input of the decomposition unit (3), an input of the second memory unit (10), a third input of the second arithmetical-logical unit (4), a second input of the increment code counter (11) and a third input of the switchover unit (7). The device also comprises an electrode break detector (13) and a heart critical state detector (14). The amplifier (1), the electrode break detector (13), the analogue-to-digital converter with the multiplex switch (2), the heart critical state detector (14) and the decomposition unit (3) are series connected. A seventh output of the control unit (9) is connected to a fourth input of the switchover unit (7); a second output (17) of the electrode break detector (13) is connected to a first input of the control unit (9), a second input of which is connected to a second output (24) of the heart critical state detector (14), and a second output of the second memory unit (10) is connected to a second input (22) of the heart critical state detector (14).
EFFECT: using the invention enables enhancement by detecting the electrode break and the heart critical state in free motion activity.
3 cl, 12 dwg
SUBSTANCE: invention relates to medicine, namely to paediatric cardiology and paediatric infectious diseases, and can be used for evaluation of indications for cardiometabolic therapy in case of infectious affection of myocardium in children. For this purpose quantitative evaluation of clinical, electrocardiographic, biochemical and echocardiographic indices is determined and realised. As clinical indices auscultative symptomatic: sonority of tones, presence of noises, parameters of arterial pressure are evaluated. As biochemical indices evaluated are: activity of cardiospeciphic enzymes: MB-fraction of creatine phosphokinase, α-hydroxybutyrate dehydrogenase, aspartic transaminase, alanine transaminase and cardiospecific troponin I protein. Echocardiographic examination is realised with application of Dopplerography for evaluation of diastolic ventricular function. Each of indices is evaluated by from 1 to 3 points. Points are summed up and obtained result is used to evaluate indications for cardiometabolic therapy. If the total sum is lower than 3 points, cardiometabolic therapy is not indicated. If the total sum is from 3 points to 7 point including, peroral introduction of cardiometabolic preparations is carried out. If the total sum is from 8 points and higher, parenteral introduction of cardiometabolic preparations is realised.
EFFECT: method provides possibility of determining presence of indications to administering cardiometabolic therapy objectively in minimal terms, including situations, when part of results of additional examination is absent because of some reasons, and of evaluating its efficiency in differential way.
1 tbl, 4 ex
SUBSTANCE: invention refers to medicine, namely to non-invasive techniques for qualitative-quantitative analysis of the cardiovascular functional state. A pulse signal and an electric heart signal are recorded for 2-3 minutes. The slow waves are recovered from two heart signals; slow-wave spectra are detected in two channels. The windowed Fourier transform is used to calculate spectral ratio powers of the slow waves of the heart signal in the second-order slow-term within the range of 0.01 to 0.05 Hz, in the first-order slow-term within the range of 0.05 to 0.15 Hz, in the respiratory component within the range of 0.15 to 0.5 Hz. The derived data are used to form six informative criteria X…X6. As the heart signal recorded in one of the channels, a heart rate is calculated and used as the seventh informative criterion. The generated seven-element vector of the informative criteria is supplied to an input of a trained neuron network, outputs of which correspond to the allocated classes of the cardiovascular diseases.
EFFECT: technique enables early diagnosing aiming at preventing the disease progression, thereby preventing an increase of the primary hypertension incidence by analysing two heart signals.
3 cl, 9 dwg, 2 ex
SUBSTANCE: recording ECG is followed by a perianal block with an anaesthetic solution in an amount of 10.0-15.0 ml. 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 anorectal cardioinhibitory reflex is diagnosed. No positive dynamics observed enables diagnosing cardiogenic myocardial ischemia.
EFFECT: method makes it possible to perform 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.
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.
SUBSTANCE: group of inventions relates to medical equipment. In the method realisation ECG graphs and graphs of tracks of coordinates of the heart electric activity source are built in the system of coordinates, connected to electrodes on the patient's body. After that, the time "zone of beginning" of a P/Q impulse is identified. In the "zone of beginning" a time ECG track is approximated and an intersection of an approximated curve with an isoline is found to determine the time moment of the point of P/Q "beginning". The determined time moments of the "beginning" points are transferred onto an initial track of impulses. The origin of the myocardium coordinate system is transferred into the determined point P of the track. Coordinates of the sinus node of the myocardium SU are tied to the track origin for the complex P, and those of the interventricular septum IVS - to the track origin for the impulse Q. The device for the method realisation contains an electrocardiograph, a unit for the identification of the time area of the "beginning" of the impulse P/Q, a unit of fixation of the "beginning" point on the graph of the tracks and a unit of transfer of the primary system of coordinates into the myocardium coordinate system.
EFFECT: group of inventions makes it possible to increase the efficiency of electrocardiographic examination due to an increased accuracy in the measurement of coordinates of the heart electric activity source.
2 cl, 5 dwg
SUBSTANCE: patient is tested to determine clinical characteristics, each of which is scored to calculate a diagnostic index. The following clinical characteristics are determined: arterial hypertension taking into account its stage and length; diabetes mellitus, its length taking into account the patient's age and complications; ischemic heart disease and its length, cardiac angina, myocardial infarction and its length; the patient's age; compliance; smoking. The absence of any of the above characteristics is scored as 0 points. That is followed by calculating the total score; depending on the derived value, a high, moderate or low probability of the suffered silent stroke is predicted.
EFFECT: method enables establishing the presence of the suffered silent stroke reliably.
3 dwg, 4 tbl, 3 ex
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
SUBSTANCE: invention refers to medical equipment. A device for suppressing a power-frequency noise effect on an electric cardiosignal comprises a TR-segment time domain selection unit (2), a key element (8), a filter (14), an amplifier (15), a delay unit (16) and a subtract unit (17). An input of the device is connected to the first input of the key element and an input of the delay unit; an output of the device is an output of the subtract unit. The device comprises an electric cardiosignal second derivative forming unit (1), a comparator (3), an RS-trigger (4), an AND circuit (5), a binary counter (6), a decoder (7), second (9), third (10), fourth (11) and fifth (12) key elements and a scaling amplifier (13).
EFFECT: using the invention enables the higher noise resistance of the analysed electric cardiosignal without misrepresenting information components.
SUBSTANCE: diagnostic technique for the ischemic heart disease is implemented by stating risk factors, symptoms and ECG findings, diagnostic characters (DC) of which are distributed into groups and assigned with certain numerical scores. Conditional probabilities of the presence or absence of IHD in a specific patient are calculated. The findings are used to establish the diagnosis of IHD or not.
EFFECT: technique enables providing establishing the more accurate diagnosis of IHD by taking into account a complex of various DCs, the records of which are processed by a mathematical model.
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.
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.
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.
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.
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
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.
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.
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.
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.