Method for prediction risk of cardiovascular complications following ischemic stroke
SUBSTANCE: Holter ECG monitoring with recording total vegetative activity and measuring heart rate variability is conducted on the 21st day following ischemic stroke. Daily standard deviation of NN intervals (SDNN) is determined. If SDNN<71 ms, a high risk of cardiovascular complications following ischemic stroke is predicted.
EFFECT: method enables providing the informative and most accurate possible prediction of the risk of cardiovascular complications following ischemic stroke on the ground of daily standard deviation of NN intervals, which represent an independent predictive factor.
3 ex, 1 dwg, 2 tbl
The invention relates to medicine, in particular to neurology and cardiology, in the treatment of stroke patients.
A stroke because of the high prevalence and serious consequences is the most important medico-social problem. The life expectancy of the patient who had the first stroke, is an average of 8.8 years, and in the case of recurrent stroke or myocardial infarction (mi), this figure may be reduced to 3.9 years (Stroke: diagnosis, treatment, prevention. Edited by Z. A. Suslina., M. A. Pirogova. - M.: Medpress-inform, 2009. - 288 p.). In patients after new-onset stroke the risk of recurrent acute disorders of cerebral circulation increased 9-fold, and the risk to THEM, including sudden cardiac death, " 2-3 times, which requires a detailed study of prognostic factors for cardiovascular complications (CVC) for their timely warnings (Pendlebury S. T., P. M. Rothwell Risk of recurrent stroke, other vascular events and dementia after transient ischemic attack and stroke. Cerebrovasc. Dis. 2009; 27 (suppl 3): 1-11).
To date, described a large number of factors associated with increased risk of SSO in the distant post-stroke period. These include genetic predisposition, old age, male gender, Smoking, physical inactivity, overweight, disadvantages of drug therapy, the severity of neurologicas�x disorders, repeated strokes, arterial hypertension, ischemic heart disease (IHD), atrial fibrillation (AF), diabetes mellitus (DM), metabolic syndrome, multifocal atherosclerosis, dyslipidemia, and many others (M. S. Dhamoon et al. Risk of myocardial infarction or vascular death after first ischemic stroke. Stroke 2007; 38: 1752-1758; K. L. Furie et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke 2011; 42: 227-276). The analysis of each risk factor individually greatly complicates the daily work of a doctor, not a fair representation of the forecast and significantly complicates the individualization of post-stroke patient management. In addition, many of the cardiovascular risk factors remain unrecognized, some prognostic factors (possibly critical) we still do not know, respectively, to accurately assess individual cardiovascular risk patients, including stroke victims, it is not always possible. With these circumstances, you need a universal predictor of increased risk MTR to personalize preventive measures and improve the prognosis of the disease and the patient's life.
Among the probable causes of the high risk of post-stroke MTR is called direct cerebral damage, and one of the possible mechanisms of its implementation can become resistant RA�disorder of autonomic regulation of the body. Heart rate is the best indicator of changes in the state of the autonomic nervous system, therefore, the study of heart rate variability (HRV) as an indicator of Autonomous regulation and influencing the prognosis of the MTR after ischemic stroke, are of practical importance (Makikallio A. M. et al. Heart rate dynamics predict poststroke mortality. Neurology 2004; 62: 1822-1826; S. Laowattana et al. Left insular stroke is associated with adverse cardiac outcome. Neurology 2006; 66: 477-483). The main aim of this work was to demonstrate the independent effects of specific lesions of brain structures on the state of HRV and post-stroke prognosis. Therefore, these studies have had stringent criteria, for example, excluded patients with cardiac diseases, diabetes mellitus, recurrent stroke, the presence of diffuse cerebral changes, elderly patients. A similar sample of patients does not reflect comorbidity in the usual (routine) clinical practice. That is why it is necessary to study the prognostic value of HRV changes in the actual patient, burdened with previous cerebrovascular, cardiac, endocrine diseases to optimize remote predict post-stroke. As the primary endpoint in these studies were selected deaths and cardiac disorders, lying� as the highest in the first 2 years after the first stroke is the risk of recurrent stroke.
As a prototype we used the work Makikallio A. M. et al. "Heart rate dynamics predict poststroke mortality". Neurology 2004; 62: 1822-1826. The authors for 7 years spent monitoring of stroke patients, with subsequent analysis of the prognostic value of HRV. As a result of the multivariate analysis and analysis of Kaplan-Meier was identified adverse prognostic significance of reduced indicators of the spectrum of low and very low frequencies in relation to post-stroke mortality.
The technical result of the invention is the versatility of the indicator for predicting the risk of cardiovascular complications in post-stroke patients with concomitant cerebrovascular, cardiac, endocrine diseases.
The technical result is achieved in that the patient on day 21 of ischemic stroke is carried out daily recording of the electrocardiogram using continuous Holter monitoring (HM) with registration total autonomic activity, done by analyzing the daily standard deviation of RR-intervals SDNN, which represents the cumulative effect of vegetative regulation of heart rate and average daily rate SDNN<71 MS predict a high risk of cardiovascular complications after ischemic stroke and implementing intensification honey�comentsno therapy for the timely correction of heart problems.
The method was carried out as follows.
All patients on day 21 of ischemic stroke was performed daily Holter monitoring with evaluation of the standard deviation of RR-intervals SDNN. When the average SDNN≥71 MS post-stroke prognosis was considered to be favorable. When the average SDNN<71 MS was diagnosed with autonomic dysfunction, indicating an increased risk mtrs after ischemic stroke. In this case exercised the intensification of drug therapy for the correction of cardiac disorders. Thus, the use of the parameter SDNN as a universal marker of risk MTR may be promising for the personification of preventive measures and improve the prognosis of the disease and the patient's life.
Only observation was included 148 patients with ischemic stroke; of these, 94 (64%) males and 54 (36%) women. The age of patients at the time of inclusion in the study ranged from 22 to 83 years; mean age was 60±14 years. Available in patients with concomitant cardiovascular disease are presented in table 1.
|Diseases of the cardiovascular system|
|Disease cardiovascular systems|
|Chronic heart failure||87 (59%)|
|Paroxysmal AF||34 (23%)|
|Diabetes mellitus||32 (22%)|
|Heart disease (rheumatic, degenerative)||20 (14%)|
|Mitral valve prolapse, patent foramen ovale||18 (12%)|
|Infectious endocarditis||4 (3%)|
All patients were given a daily Holter performed using a wearable portable monitor with continuous recording of ECG within 24 hours. To exclude acute cerebrogenic influences on HRV HMM performed on 21-22 days from the time of stroke. Used domestic cardioregulatory "Cartotecnica 4000" and "Cartotecnica - 04 (INCART, St. Petersburg) with three-channel ECG recording (leads V4, Y, V6). Implemented continuous recording during the whole time �of aladeniya providing visual information about the ECG anywhere in the record.
Using temporal and spectral analysis of HRV in accordance with the recommendations of the working group of the European society of cardiology and North American society of pacing and electrophysiology (Heart rate variability, 1996) based on 24-hour ECG recording in the present work studied the temporal indicators: SDNN - standard deviation of RR-intervals (MS), which represents the cumulative effect of autonomic regulation of heart rhythm; SDNNi - five-minute average standard deviation of RR-intervals calculated over 24 hours (MS), reproducing the variability of cycle times of less than 5 minutes and reflect the state of the parasympathetic nervous system.
Also analyzed the spectral characteristics of HRV, such as power (MS2), in the range of high frequencies (HF, 0.15 to 0.4 Hz, the average level of parasympathetic activity of the regulation), low-frequency oscillations (LF, 0.04 to 0.15 Hz, the average level of activity of the sympathetic link).
Computer statistical processing of the obtained results was performed using the software package STATISTICA 7.0 (StatSoft, USA). To identify predictors of adverse outcome of the disease curves were constructed time of occurrence of the MTR (Kaplan-Meier) and was also used regression analysis in the Cox proportional hazard models. Mnogie�Torno analysis was preceded by a one-factor. In multivariate analysis included variables for which values of the criterion of statistical significance in the univariate analysis amounted to <0,05 and signs that could be associated with the studied outcome according to the previous studies. Multivariate regression analysis was performed step-by-step method. Statistically significant differences were considered when p values<0,05.
A prospective study duration ranged from 1 year to 10 years, averaged 35±12 months. During follow-up in 37 (25%) patients registered 50 mtrs (PL.2).
|Feature MTR moved during the observation period.|
|All MTR||The number of cases (σ=50)|
|Re ischemic stroke||24|
|Transient ischemic attack||6|
|OS�Paradise heart failure||5|
|Sudden cardiac death||3|
For benchmarking was received by a number of qualitative differences between patients undergoing and not undergoing the MTR. To clarify the prognostic significance using univariate analysis was calculated relative risk MTR and it is shown that with increase associated with indicators such as SDNN<71 (log-rank, p=of 0.0038) (Fig.1. Curves of Kaplan-Meier for the univariate analysis of the influence of SDNN on the survival of patients without cardiovascular complications).
Clearly, the influence of prognostic factors may be in some cases combined and overlap in case of their simultaneous presence in one patient. Why was performed multivariate analysis using Cox proportional hazard models to determine the independent predictors of the MTR after ischemic stroke. After adjustment for patients by duration of observation and known prognostic factors, such as age, gender, size of ischemic cerebral lesion, presence of hypertension, diabetes, ischemic heart disease, chronic heart failure, atrial fibrillation and atherosclerosis, in assessing the influence of HRV in post-stroke prognosis in multivariate models most things�idents and the only statistically significant was the impact of the SDNN index< 71 MS (Chi-Square: 44,38757 df=8; p=0.048).
Thus, the decrease in SDNN less than 71 MS is an independent prognostic risk factor MTR after ischemic stroke with any associated complication. SDNN is an indicator of total autonomic activity, i.e. adaptation to the changing conditions of the external and internal environment of the body. Prognostic value of SDNN persisted after the introduction of amendments to other prognostic factors, i.e. is an independent predictor of the MTR after stroke.
An example implementation of the method:
Example 1: Patient M., aged 59, had an acute ischemic stroke in the basin of the right middle cerebral artery due to atherosclerosis of the internal carotid artery. According to the results of HMM SDNN was 58 MS, which indicated an increased risk of SSO in the post-stroke period. After discharge from hospital the patient was on basic antihypertensive, antithrombotic, and lipid-lowering therapy. After 8 months the patient underwent repeated ischemic stroke. Was held intensification of treatment: increased dosage of antihypertensive and lipid-lowering drugs. In the subsequent 2 years of observation mtrs were not registered.
Example 2: Patient T., aged 62, had an acute ischemic cerebrovascular to�of boomershine in the pool of the left middle cerebral artery, due to arterial hypertension. According to the results of HMM SDNN was 129 MS, which characterized the absence of reducing autonomic activity and low risk of re-MTR. After discharge from hospital the patient was in basic drug therapy. Within 5 years of prospective study repeated the MTR, the patient has not occurred.
Example 3: Patient B., aged 65, had an acute ischemic stroke in the vertebrobasilar system, due to cardiogenic embolism due to post-infarction cardiosclerosis. According to the results of HMM SDNN was 63 MS, which indicated a high risk of recurrence MTR. The patient carried out a full complex of measures aimed at preventing a repeat of the MTR, including categorical Smoking cessation, increasing physical activity, normalization of body weight, personalized combination antihypertensive, antithrombotic, and lipid-lowering therapy. After discharge from the hospital and the patient carefully observed all the recommendations, regularly visited a neurologist and cardiologist at the place of residence. Within 4 years of prospective study re SSO patient has not occurred.
Thus, compared with the prognostic assessment of each of the factors separately have the opportunity to predict the risk of the SDF method�m UM with automatic calculation of total autonomic activity index SDNN. The use of inexpensive standard methods for the given conditions allows to identify patients with different comorbidities in the poststroke period, with an increased risk of SSO. The proposed method with automatic daily Holter analysis SDNN is informative in the prediction of the risk of the MTR that will help to optimize the management of the patient in the post-stroke period with the goal of preventing re mtrs.
A method of predicting the risk of cardiovascular complications after stroke, namely that patients underwent daily Holter monitoring ECG with registration total autonomic activity and assessment of heart rate variability, characterized in that daily Holter monitoring is carried out on day 21 of ischemic stroke in patients with any vascular, cardiac and endocrine disorders, determine the daily standard deviation of RR-intervals SDNN and SDNN<71 MS, predict a high risk of cardiovascular complications after ischemic stroke and implement the intensification of drug therapy for the correction of cardiac disorders.
SUBSTANCE: on the 21st day following an acute ischemic stroke, the patient has continuous Holter monitoring and ventricular extra systole recording. Observing frequent single ventricular extra systoles in number of more than ten an hour and grouped ventricular extra systoles enables predicting the high risk of cerebral complications following the ischemic stroke.
EFFECT: method enables predicting the high-grade risk of cerebral complications on the basis of ventricular extra systoles, which are an independent predictive factor of recurrent cerebral complications.
3 ex, 3 tbl
SUBSTANCE: estimation of the heart rate variability is realised by a method of 24-hour Holter monitoring of the 21st day from the moment of ischemic stroke development. After that, the power of a low-frequency spectrum is determined by means of spectral analysis and, if its value is lower than 117 ms2, a high risk of cardiac complications after the ischemic stroke is predicted.
EFFECT: method makes it possible to increase the accuracy of predicting a risk of development of cardiac complications after the ischemic stroke due to the identification of a certain LF value, an independent prognostic factor.
2 ex, 4 tbl, 2 dwg
SUBSTANCE: ECG is recorded. That is followed by a needle block of an ileocecal plexus with an anaesthetic solution in an amount of 60.0-80.0 ml; that is followed by recording another ECG after 60-90 min. The record is compared to the pre-block ECG record. If observing a positive dynamics in ECG results, ischemia caused by ileocecal-cardial inhibitory reflex is diagnosed, while no positive dynamics shows cardiogenic myocardial ischemia.
EFFECT: providing the more effective differential diagnostics of cardiogenic myocardial ischemia and ileocecal-cardial inhibitory reflex with underlying ileocecal patency.
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
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: 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.