EA036705B1 - Portable telemedical cardio-recorder monitor - Google Patents

Abstract

The invention relates to medical equipment. The objective of the invention is improvement of utilization efficiency of the portable cardio-recorder monitor. The end faces of its housing (2) (Fig. 2) are fitted with additional built-in electrodes (12, 13) connected to an electronic unit containing a leads adder and a programmable microprocessor. Such electrodes are connected to built-in electrodes (8), the adder, the electronic unit inputs and connector (7) outputs for attachment of the electrode cable, with a possibility to record a set of ECG leads by wired and wireless methods. The programmable microprocessor is connected to its control and adjustment components, and is made with a function of a cardio-analyzer, and with an option of calculation and presentation on the display (5) of a group of informative signs of the condition of the tested person, considering the measurement conditions and individual parameters of the tested person; the microprocessor, by means of its adjustment and control components marked with graphical symbols (18), is provided with a capability of setting the above individual parameters of the tested person, measurement conditions, and their displaying. There are also supplementary distinctive features aimed at attaining the objective of the invention.

Description

The invention relates to medical technology, in particular to devices for express control and long-term monitoring of the state of the human cardiovascular system, used both individually and as part of group functional control systems.

According to the invention, the portable telemedicine cardiac recorder-monitor can be used for home self-monitoring, assessment of the functional state of an athlete, observation of cardiac patients and the elderly, children with impaired health, physical education groups, operators of responsible industries, etc.

The main area of application of such a product is telemedicine systems for remote monitoring of public health, where each user of his device can receive a doctor's consultation via mobile communication and the Internet.

Known portable cardiac recorder-monitor [1], containing a housing with placed inside it a power supply, speaker and electronic unit, which are connected to each other, and also connected to the display element placed on the housing, control elements and electrodes. However, such a cardiorecorder cannot be connected to mobile communication devices to transmit the captured electrocardiograms to a remote web server and be used as part of group telemetry control systems. This reduces its functionality and limits the scope of its application.

More functional in this regard, adopted as a prototype of the invention, a portable telemedicine cardiorecorder [2] containing a housing with an electronic unit, a power supply unit, a speaker located inside it, which are connected to each other, and also connected to the display element located on the housing, control elements, a connector for connecting an electrode cable, a pair of built-in electrodes and a connector for data transmission and recharging the power supply. The electronic unit of this cardiorecorder contains a Bluetooth communication module that allows you to transfer an electrocardiogram (ECG) to a mobile Internet connection (smartphone, tablet, etc.), and through it to an advisory web portal. On the basis of such a portable telemedicine cardiac recorder [2], it is possible to organize a system of mass cardiological control.

However, the disadvantage of the prototype [2] is its low efficiency of application due to limited functionality. In particular, the constructive solutions of the cardiorecorder [2] exclude the possibility of ECG recording with built-in electrodes in hard-to-reach places of the human body (for example, removal of chest leads, limb leads, etc.). To do this, the user is forced to connect a multi-wire cable with external electrodes to the device. This is not always convenient, and the duration of the examination increases.

When monitoring the functional state of an athlete during physical training using a prototype [2], measuring the heart rate (HR) in standard lead I, from the hands, will give insufficiently reliable results due to the high level of physiological disturbances caused by the athlete's psychophysical arousal ( deep breathing, galvanic skin reaction, tremor distort the ECG). In addition, there is a low level of the electrocardiogram in this lead.

In this regard, the chest leads are more preferable, since the ECG amplitude is 3-5 times higher, which means that the signal-to-noise ratio is also higher. But in this product, it will take time for the athlete to recover from the chest leads using the external electrodes. This means that the assessment of the heart rate zone in which he completed the exercise will be unreliable.

Another disadvantage of the prototype [2] is that its indication and setting elements are not informative enough for the test subject or his observer (doctor, trainer, family member, etc.) to independently and quickly draw a conclusion about the adequacy of the functional state of the body to the conditions of measurements ... It is important for them to get an answer whether there is a need to urgently send an ECG to a web server and request a consultation from a highly qualified specialist. It is important for a doctor to assess the risks of death in a cardiac patient at rest; the coach - to determine the quality of the athlete's adaptation to the load; to the transport manager or hazardous production - the likelihood of the employee terminating the operator's functions, etc.

According to the description of the prototype [2], the state of the tested person is reflected on the LEDs built into the body, and the pulse rate is displayed on the display. This form of presentation of the data obtained from the ECG does not provide a clear orientation in determining the danger of the functional state of the tested person. For example, an athlete's heart rate may be quite high after completing an exercise, but this does not mean that he is in danger of deteriorating health - after a few minutes, the pulse of a healthy person will recover. In addition, at the same heart rate, the voltage of the systems that regulate the work of the heart can differ significantly. Thus, in a well-known study [3], it was shown that the variability of heart rate intervals decreases significantly at low heart rate in cases of cardiovascular pathology and, on the contrary, it persists and even increases at high heart rate values during training athletes. Finally, it is known that the pulse of a child is initially higher than that of an adult, and the pulse of men is on average less frequent than that of women, etc. Thus, the test person or his observer needs to have additional criteria for assessing the functioning of the heart before deciding whether to urgently send an ECG to the web portal. Prototype [2] does not make corrections for the mentioned research features and does not display on the display

- 1,036705 additional data required for correct conclusions.

The third disadvantage of the prototype is the use of contact pads-electrodes with a large area, which makes the contact area between the hands of the person being tested and the electrodes themselves uncertain and ambiguous. In this case, the known contact and polarization potentials are retained, the difference of which from the hands can be greater than that of conventional galvanic electrodes, with a small area. When taking the chest leads, the difference in the type and area of the electrodes used on the chest and limbs can also cause additional noise and interference that impedes full ECG analysis. From these considerations, it seems doubtful the possibility of a more detailed study of the ECG taken by the electrodes proposed in the prototype [2], as the authors of the application write about. The design of the prototype [2] assumes registration of an ECG only at rest, and in a specific position - sitting. Therefore, it is unsuitable for long-term ECG recording, when the subject's posture is forced to change, as well as for use in stress tests, during operator activity, etc.

The fourth drawback of the prototype [2] is that in the absence of the Internet, such a cardiorecorder cannot be used for group monitoring of the state of people, since the Bluetooth communication module in the device has a short range and allows only one device to be connected to a computer.

These and other shortcomings of the prototype [2] impede its widespread use in the health care system, education, sports and tourism, where group health monitoring is more and more actualized, exercise tests are performed, and the functional state is monitored during health-improving physical culture and sports.

Therefore, the object of the invention is to improve the efficiency of using a portable cardiac recorder-monitor at home and in systems of group telemedicine cardiac monitoring by expanding its functionality.

The problem is solved by the fact that (Fig. 1-8) a portable telemedicine cardiac recorder-monitor (1) containing a housing (2) with a power supply unit (3), a speaker (15) and an electronic unit (4 ), which includes a Bluetooth radio communication module (14) and connected to the display (5) located on the case (2), control elements (6), a pair of built-in electrodes (8), a connector (9) for recharging the power supply (3), and a connector (7) for connecting an electrode cable (23) with external electrodes (26) to it, has distinctive features: on the end sides of the body (2) there are additional built-in electrodes (12, 13) connected to the electronic unit (4), which contains a lead adder (11) and a programmable microprocessor (10), and additional built-in electrodes (12, 13) are connected to the built-in electrodes (8), the adder (11), the inputs of the electronic unit (4) and the outputs of the connector (7) for connection electrode cable to it ( 23) with the ability to remove the complex of ECG leads by a wired and wireless method, and the programmable microprocessor (10) is connected to its controls (6) and settings (16) and is made with the function of a cardioanalyzer and with the ability to calculate and display a group of informative signs of the state of the tested person, taking into account the conditions of measurements and individual parameters of the tested person, while the microprocessor (10), through its adjustment elements (16) and control elements (6), on which graphical symbols (18) are applied, is configured to set the mentioned individual parameters of the tested person , measurement conditions and their display on the display (5).

This technical solution significantly expands the functionality of the portable telemedicine cardiac recorder-monitor and improves its usability.

In particular, it becomes possible to wirelessly record an ECG in hard-to-reach places of the test subject's body (chest, back, lower extremities). And in conjunction with the electrode cable (23) connected to the connector (7), the removal of 12 conventional ECG leads widely used in clinical and sports medicine [4, 5] - standard (I, I, III), enhanced (avR , avL, avF) and thoracic (V1, V2, ... V6), which is explained below in the text and indicated in FIG. 9-14.

A three-wire cable is sufficient to remove the named leads with a portable telemedicine cardiac recorder-monitor (1), and without marking the wires, since in this case it is not important which wire of the three will go to a particular limb. All their conclusions go to the adder (11), and the chest leads (V1, V2, ... V6) are removed with respect to this amount by sequentially applying an additional electrode (12) to the patient's chest in the positions specified by the technique (36). Both the person being tested and his observer (doctor, trainer, family member, etc.) can hold the cardio recorder in his hand.

If it is necessary to free the test person's hands (for example, for working at a computer, exercising on a simulator, driving a vehicle or other operator activities), the chest lead can also be removed by wire. Then a four-wire marked cable is used with established wire markings (R, L, F and V) or according to international designations (RA, LA, LL and C), indicating the addressing of each wire.

Minimization of the number of wires (in relation to the prototype [2] and standard electrocardiograms, where 10 or 6 wires in a cable are used) speeds up the examination process and makes it more comfortable, which is important for sports, physical culture and a number of other areas the use of a portable telemedicine cardiac recorder-monitor (1). Also known to those skilled in the art, wire entanglement associated with multicore electrocardiographic cables is reduced.

Note that in practice, a reliable measurement of heart rate is often required during physical activity and in human movement. Here, a portable telemedicine cardiac recorder-monitor (1) provides greater efficiency than the prototype [2], so in any position of the body (lying, standing, sitting, etc.) you can use the lead type RA-C4 (Fig. 12), RA-C5 and others, where usually the largest ECG amplitude and the best signal-to-noise ratio compared to the leads from the limbs. Moreover, in the case of short-term measurements, it is not required to use an electrode cable (23), it is enough to take the device itself in your hand and attach it to your chest.

The presence of a cable (23) with external electrodes (26), as well as a display (5) as part of a portable telemedicine cardioregistrator (1), gives it the function of a monitor, since it allows for a long and continuous observation on a display or smart device for informative status signs of the tested person, transmit them via the Bluetooth radio module (14) to a remote web server, for example, when the test person is working at the computer (Fig. 13) or when he performs a stress test (Fig. 14). This gives reason to consider the portable cardiorecorder (1) not only as an ECG recording device, but also as a monitor.

A programmable microprocessor (10) provides an express ECG analysis taking into account the measurement conditions (rest / load) and individual parameters of the test person (gender, age, physical fitness, etc.) and displays on the display (5) informative signs of the test person's state (digital heart rate values , stress index (SI), pulse variation range (HR)), which are accompanied by color signals and voice messages indicating to the tested the degree of danger of his functional state, the acceptability of physical activity, the need for a more detailed study of the ECG (including in other leads) ...

This, firstly, clarifies the need to remove the entire complex of 12 ECG leads and send them to the advisory portal. Secondly, the doctor who directly observes the patient can decide for himself which of the leads is of great value for him for a more accurate diagnosis. Thirdly, the efficiency of the use of the cardiorecorder in the systems of group cardiac monitoring, built on its basis, increases. In a physical education group, a sports team, a fitness center, only those persons who receive reports of an unsatisfactory state of the body will seek advice from a teacher or doctor. The absence of such will allow unloading expert operators of the consultative web-portal from a large flow of unreasonable calls, which can be formed with the widespread introduction of telemedicine cardiac recorders, similar to the prototype [2], or do not have information displays at all (an example of the latter is the modern telemedicine cardiac recorders Easy ECG [6] , HeartView [7], Cardiojet [8], Cardio-Rhythm [9], etc.).

Additional distinguishing features for the portable telemedicine cardiac recorder-monitor (1), enhancing its effectiveness and ease of use:

the display (5) is made with the display on it of a number of display symbols (17) and with the possibility of their activation using the setting elements (16) of the programmable microprocessor (10) through the control elements (6) on the surfaces of which graphical symbols (18) are applied;

one of the additional built-in electrodes (12) is made in the form of a plate with rounded edges, adjacent to the side surface of the housing (2) and repeating the contours of its left end, and the other additional built-in electrode (13) is in the form of protruding above the opposite end of the housing (2) the plate and the back surface of the clip-clip enveloping it, while a cutout is made in the protruding part of the plate, and a prismatic recess (22) is made in the adjacent side surface of the body (2);

built-in electrodes (8) and one of the additional built-in electrodes (12) are made capacitive and with parameters that ensure the transmission of an electrocardiographic signal, and another additional built-in electrode (13) is made of a conductive material with the ability to perform the function of a reference electrode;

the surface areas of the built-in electrodes (8), made capacitive, do not exceed the maximum possible contact area of the test person's fingers pressed against them, and the built-in electrodes (8) are located in recesses and are made convex;

the setting elements (16) of the programmable microprocessor (10) and the control elements (6) are made with the possibility of setting the load test mode reflected on the symbolic field of the display (5), while the microprocessor (10) is made with the possibility of feeding through the speaker (15) control sound and voice signals, as well as with the ability to automatically calculate the index of physical readiness of the tested person, which is taken into account in subsequent assessments of his functional state along with other individual data;

- 3 036705 an additional radio modem (30) is included in the electronic unit (4), which is connected to the microprocessor (10) and is configured to operate in a different frequency range.

The essence of the invention is illustrated by illustrations (Fig. 1-14), where Fig. 1 shows a block diagram of a product according to the invention - a portable telemedicine cardiac recorder - monitor; in fig. 2 - its general view; in fig. 3 is a fragment of view A on one of the ends of the cardiorecorder of FIG. 2; in fig. 4 is a rear view B of the article of FIG. 2; in fig. 5 is a side view C of the article of FIG. 2; in fig. 6 and 7 are fragments of views from the other end of the product with the electrode cable removed and inserted, respectively; in fig. 8 shows a variant of the connection diagram of built-in and external electrodes with a signal combiner and an electronic unit with an electrode cable inserted; in fig. 9-14 shows examples of taking different ECG leads using a cardiorecorder.

The device according to the invention shown in FIG. 1-14 has the following numbered items, listed in the table below:

Portable telemedicine cardiac recorder monitor

2 Housing 29 Signal adder resistors 11 thirty Additional radio modem 31 Electrocardiogram amplifier input stage 32 Balancing resistor. 33 Finger 34 Leg 35 Forearm 36 Electrode positions for chest leads ECG

Portable telemedicine cardiac recorder-monitor (1) contains a housing (2) with a power supply (3) located inside it, an electronic unit (4), a Bluetooth radio transmission module (14) and a speaker (15), which are connected to each other, and also contains connected with an electronic unit (4) and placed on the surface of the case (2) from its front side (Fig. 2-5) display (5) and control elements (6), connector (7) for connecting the electrode cable (23) located on one of the ends of the case (2), as well as built-in electrodes (8) located near the control elements (6), two additional built-in electrodes (12, 13) located at the ends of the case, and a connector (9) for recharging the power supply (3) located on one of the side surfaces of the body (2).

The electronic unit (4) provides reception, amplification, analog-to-digital conversion and processing of electrocardiograms (hereinafter abbreviated as ECG). The nodes performing these listed functions in the electronic unit (4) are not shown in the diagram (Figs. 1, 8), since they are well known and reflected in the description of the prototype [2]. The electronic unit (4) also provides data transmission using a Bluetooth radio communication module (14) to an external device for communicating with the Internet (for example, a smartphone or tablet) and contains a programmable microprocessor (10) connected to setting elements (16) and a display (5 ), and a signal adder (11) connected to built-in electrodes (8), (12) and external electrodes (26) so that a portable telemedicine cardiorecorder monitor (1) can record all 12 standard ECG leads generally accepted in clinical practice I, II, III, avR, avL, avF, V1, V2, ... V6, as well as other ECG leads used (DS, R-V4, R-V5, etc.), some of them wirelessly (I , II, III, R-V5, etc.), and some - using an electrode cable (23), but with a minimum number of wires (3 or 4).

The technical features of the product are explained below.

An additional built-in electrode (12) located on the left end of the housing (2) (Fig. 3, view A in Fig. 2) is connected to the built-in electrode (8) located on the same side (Figs. 3 and 8), as well as with one of the inputs of the electronic unit (4) and one of the outputs of the connector (7) for connecting the electrode cable (23) (Fig. 8 and 6), and the output of the signal combiner (11) is connected to another built-in electrode (8) (Fig. 2, 8), which, in turn, is connected to another input of the electronic unit (4). In this case, the built-in electrode (13), located on the right end of the case (Fig. 2 - view B in Fig. 2, 4) and being the reference one, is connected to the third input of the electronic unit (4), and the three inputs of the signal adder (11) are connected with three other outputs of the connector (7) for connecting the electrode cable (23).

In this case, depending on the conditions and tasks of the study, a portable telemedicine cardiac recorder-monitor (1) can quickly remove the required ECG leads by providing contact between the built-in electrodes (8, 12, 13) with the subject's body or external electrodes (26) connected through electrode cable (23). Examples of lead removal are shown in FIG. 9-14 and 4 036705 are explained below in the text.

Built-in electrodes (8) and an additional built-in electrode (12) are made capacitive with parameters that ensure the transmission of an electrocardiographic signal. An additional built-in electrode (13) is made of a conductive material and serves as a reference electrode. Used as the mentioned capacitive electrodes developed by the authors of the design [10], which are more efficient than the electrodes used in the prototype [2], since they do not require treatment of the skin of the body of the investigated and the use of electrode pastes. They have low contact and polarization potentials, which means they are less sensitive to motion artifacts, and provide better noise immunity when taking an ECG in people with increased muscle tremor. This is important for the prompt and effective use of cardiorecorders in the field of physical culture and sports, monitoring the state of the human operator, etc.

The noise immunity of measurements increases in comparison with the prototype [2] also due to the fact that the built-in electrodes (8) and the additional built-in (12), made capacitive, have a small contact area, which practically does not change when the fingers are placed on them. The location of the built-in electrodes (8) in small recesses (19) and the presence of tides (20), which prevent strong finger pressure on these electrodes, also contributes to maintaining a constant contact capacity. As a result, the capacity of the contact between the finger and the built-in electrode (8) depends little on the degree of pressure, therefore, at the input of the electrocardiogram amplifier (31) located in the electronic unit (4), there is no interference that interferes with the measurements and analysis of the useful signal in the absence of complete relaxation of the test person's hands. , for example, when holding the device by an excited (load) athlete.

The location of the built-in electrodes (8) in the recesses (19) and the presence of arcuate tides (20) makes it easier to find the locations of the electrodes on the body (2) at night and for people with impaired vision.

Reducing interference is facilitated by an additional built-in electrode (13) made of a conductive material and connected to the third input of the electronic unit (4), which contains a circuit for compensation of pickups and baseline drift. Such a scheme is not shown, since its solutions are known and reflected in the description of the prototype (2). An additional built-in electrode (13), in addition, performs the function of a lock of a portable telemedicine cardiac recorder-monitor (1), since it is structurally made in the form of a clip-clip (Fig. 4, 14). This solution allows the tested person to contact with an additional built-in electrode (13), which is a reference, both when holding the device in his hands and when placing it on clothing. For example, during a stress test on a treadmill (Fig. 14) or working on a bicycle ergometer, the test person's hands should be free, then the ECG is taken through external electrodes (26) connected to a portable telemedicine cardiac recorder-monitor (1) through an electrode cable (23). The contact of the built-in electrode (13) with the body of the tested person is ensured by fixing the product on the trousers or T-shirt of the tested person, touching the body with the envelope part of the additional built-in electrode (13).

The implementation of an additional built-in electrode (12) in the form of a plate adjacent to the body (2), repeating the contours of its end part and having rounded edges, eliminates trauma to the skin of the tested person when the telemedicine cardiorecorder-monitor (1) is applied to the body and makes it possible to press it against soft tissues , for example, the mammary gland, and the implementation of another additional built-in electrode (13) in the form of a plate protruding above the opposite end of the body (2), where there is a cutout, and in the adjacent surface of the body there is a prismatic recess, provides reliable fixation of the electrode cable (23) in connector (7) using a special connector retainer (25) made in the form of a ring and located on the end part (24) of the electrode cable (23). This increases the reliability and reliability of testing during the motor activity of the tested person, long-term monitoring of the ECG in a seriously ill patient, monitoring the operator's condition, etc., that is, it makes the use of a cardiorecorder more effective.

The reflection of the adjustment elements (16) of the programmable microprocessor (10) on the symbolic field of the display (5) allows the tested person or his observer to check the correctness of the assessments of the functional state of the body and the voice interpretation of informative signs calculated from the ECG and displayed on the display (5), since using setting elements (16) and control elements (6) in the microprocessor (10) before the start of the experiment, the measurement conditions (rest / load), individual parameters of the tested person (gender, age, physical fitness), as well as other settings (duration of ECG recording, thresholds alarm signaling, etc.), if necessary.

Evaluation of informative signs - numerical indicators of the state of the cardiovascular system of the tested (in particular, known medical indicators: heart rate, heart rate, VR), reflected on the display (5), is carried out through its intuitive color illumination, expressed, for example, in a 5-point color scale: green, yellow, orange, red and violet colors, which reflect respectively excellent, good, satisfactory, bad and very bad condition of the tested person.

Voice messages output to the speaker (15) using a programmable microprocessor

- 5 036705 ra (10), give more detailed interpretation and recommendations. Voice messages are generated by a microprocessor (10) based on built-in algorithms and microcircuits available in the electronic unit (4). Voice messages help the elderly, children, non-specialists to quickly master the device and correctly navigate in the numerical indicators shown on the display (5). As a result, voice commentary in most cases eliminates the need for urgent medical consultations and reduces the number of unreasonable calls to the web portal. Thus, the operators and experts of such a portal analyzing the ECG (these are highly qualified cardiologists) will be relieved of the large stream of requests that may result from the widespread introduction of such telemedicine cardiorecorders. They will be able to focus on reaching out to those who really need it.

In order to increase the convenience of holding the telemedicine cardiac recorder-monitor (1) in the hands when registering reinforced and chest leads, when the built-in electrodes (8) should not be touched, the body (2) is made with convex arc sections (21) of its lateral sides, which creates an additional an emphasis on the fingers (33) holding the body (2) when it is pressed against the chest or limb of the tested person.

The main method (Fig. 9) of using a portable telemedicine cardiac recorder monitor (1) is to hold it with both hands of the test subject with his fingers (29) to the built-in electrodes (8) and an additional built-in electrode (13). Such a technique is used for the purpose of operatively taking an electrocardiogram wirelessly, and it provides a recording of the I standard ECG lead. However, not all people have such a high-amplitude lead, therefore, other techniques can be used - to register standard leads from the extremities II or III, holding such a device to the right or left hand, respectively, touching the built-in electrode (8) located on the right in Fig. 2, and an additional built-in electrode (13) and the application of another additional built-in electrode (12) to the left leg (Fig. 10). For reliable self-control of heart rate during group physical exercises, all participants should experimentally, using a smartphone and an appropriate mobile application (not shown), select the most amplitude lead from the quickly available (usually I or II) and use it in the future.

Many athletes and the elderly are more comfortable using other ECG leads, such as the well-known designations R-V4, R-V5, as shown in FIG. 11, with the attachment of an additional built-in electrode (12) to the left side of the chest or abdomen and holding the telemedicine cardiac recorder-monitor (1) with the right hand while touching it with the fingers (33) of the right main electrode (8) and the additional built-in electrode (13). Such a lead does not belong to the classical clinical leads, but its high amplitude makes it possible to successfully record the heart rate and analyze the heart rate during physical exertion or severe hand tremors.

For long-term ECG recording, for example, during night monitoring, holding this device in your hands is inconvenient, therefore it is rational to use an electrode cable (23) and place electrodes (26) on the chest and (or) back, in positions (36) that give the required signal ... This technique is justified when observing the condition of a seriously ill patient or a child, during stress testing of an athlete, monitoring the state of a human operator, self-control when working at a computer (examples in Figs. 13 and 14), etc.

The control elements (6) of the telemedicine cardiac recorder-monitor (1) allow using the settings elements (16) of the programmable microprocessor (10) to set the ECG monitoring mode during the stress test, to set the threshold values of informative signs (HR, HR, VR) for the alarm signal and calculate the index of physical fitness of the tested after completion of the test. A mobile application installed on a smart device used allows you to save and compare ECG parameters (shape, spectrum, rhythm, etc.) in different phases of the test (rest, load, recovery).

This opens up new opportunities in the organization of individual and group cardiac monitoring, since it carries (and can reflect on the server) information about the adaptive abilities of the tested, their dynamics (in the educational process, during postinfarction rehabilitation, sports training, etc.). The control of these data is important for the treatment of patients, judging about the optimal load in athletes. Performing stress tests is very important for educational institutions where health-improving physical culture classes are held. The prototype [2] in this regard is ineffective both constructively and in terms of the functions performed.

In clinical medicine, emphasis is often placed on enhanced limb leads (aVR, avL, avF) and Wilson chest leads (V1, V2 ... V6). To obtain them with this telemedicine cardiac recorder-monitor (1), a 3-wire unmarked electrode cable (23) can be connected to it for leads. In this case, external electrodes (26) are applied to the three limbs of the subject, connected to the contact clips of such a cable. To remove any of the reinforced leads, any two wires from the three electrode cable (23) are connected to the external electrodes (26) on the two limbs of the tested person (their signals go to the adder (11)), and an additional 6 036705 built-in electrode (12), located on the left on the body (2), the test person himself or his observer is applied to the test person's third limb (example in Fig. 11, which shows the removal of the known lead aVF).

The chest leads (V1, V2 ... V6) are removed when connected to three external electrodes (26) on the limbs of all three wires of the electrode cable (23). And it doesn't matter where which one, since all three signals go to the adder (11), and the end additional built-in electrode (12) is applied alternately to the desired positions (36) on the chest.

If the test person's hands should be free, a 4-wire labeled electrode cable (23) is used, where there is a color-coded core (27) or a clip (not shown) with the V symbol (C), which is connected to that external electrode (26), which is placed on the test taker's chest

The electronic unit (4) of the portable telemedicine cardiac recorder-monitor (1) contains, in addition to the Bluetooth communication module (14), an additional radio modem (30) for remote data transmission, operating in a different frequency range. An additional radio modem (30) can work in conjunction with the same modem installed on the observer's remote computer, which allows the telemedicine cardiac recorder monitor (1) to telemetrically transmit data to the observer's computer without the Internet and the use of intermediate smart devices. A programmable microprocessor (10) allows each such cardiorecorder to assign an electronic identification number and transmit it along with the data of the person being tested, which, in turn, makes it possible to correlate these data with the name of the person being tested entered in the database of the remote computer.

These solutions make it possible to organize, using portable telemedicine cardiac recorders-monitors (1), group control that does not depend on the presence of the Internet in the territory limited by the range of an additional radio modem (30), and create on their basis a system of group cardiac monitoring of persons working in closed and local (departmental, industrial military) facilities, for example, nuclear power plant operators, where Internet access is limited and the use of smart devices is prohibited. In addition, such systems of group functional control are conveniently used in educational institutions (kindergartens, schools, universities), health care (hospitals, sanatoriums, etc.), sports and tourism (children's and youth sports schools, etc.), when the use of smart -devices are not always necessary, and sometimes impossible. The test subjects' data collected on the observer's computer can be transferred to a remote web server at the end of the experiment, by writing to a flash memory or by moving the computer to the Internet coverage area.

Concerning the advantages of this recorder relative to the prototype [2], we also note that the control elements (6) and settings (16) of the programmable microprocessor (10) allow you to set the upper and lower thresholds of the numerical values of the informative signs displayed on the display (HR, SI, VR), when going beyond which the speaker (15) gives the tested person or his observer an alarm sound, and through the display backlight (5) - a light alarm.

The sound signal can be a voice message indicating the name of the parameter that has gone beyond the threshold value, the direction and the magnitude of the detected deviations. In this case, the alarm signal can be transmitted to the observer's Bluetooth earpiece (for example, a family member or medical staff on duty, hospital infarction department) via a Bluetooth communication module (14). However, the range of its action is limited, and secondly, this module can be used to transfer data to a smart device and a web server. Therefore, unlike the prototype [2], an alarm sound signal and (or) a voice message in a portable telemedicine cardiac recorder-monitor (1) is transmitted to a computer or an earpiece of a medical staff on duty through an additional radio modem (30), and the speaker (15) can be disabled so as not to disturb the patient and (or) those around him.

Thus, the claimed invention improves the availability, comfort, efficiency and reliability of self-monitoring of the state of the heart, as well as the overall efficiency of mass remote cardiac monitoring systems based on it. Such a product is capable of providing long-term monitoring of the functional state of a group of cardiac patients or athletes both via the Internet and in its absence.

By reducing the burden on the expert operators of the advisory portal with a large number of clients, its capacity for people who really need urgent advice and urgent medical care can be increased.

The invention significantly expands the scope and conditions for the use of portable telemedicine cardiac recorders. For example, it allows you to organize effective night cardiac monitoring, which is not provided for by the prototype, to massively use devices in the education system (medical and pedagogical monitoring of the health status of schoolchildren and preschoolers, students and students in physical education classes), the field of sports and tourism, sports medicine (prevention of frequent cases of sudden death of athletes), at work - to identify threats to health and ensure the safety of closed objects, at home - when driving public and private transport, in scientific research - when conducting experiments related to

- 7 036705 extreme conditions of human stay, etc.

Small overall dimensions and weight (160x35x20 mm, 90 g) of the created samples (Fig. 2) of a portable telemedicine cardiorecorder-monitor (1) make it possible to refer it to portable medical devices for home self-control and telemedicine. It is convenient for a doctor and a patient, a trainer and an athlete, a teacher and a student to carry such a product with them and use it if necessary or as directed by a specialist.

Information sources.

1. Patent US 5365935, IPC А61В 5/0404, priority 12.07.1993, published 22.11.1994.

2. Application ITPI 20130096, IPC А61В 5/0404, А61В 5/0408, А61В 5/0404, priority 03.12.2013, published 04.06.2015 (prototype).

3. Heart rate and type of vegetative regulation in assessing the level of health of the population and functional fitness of athletes: materials of the VI All-Russian. symposium / Resp. ed. N.I. Shlyk, P.M. Baevsky - Izhevsk: Ed. Center Udmurt University, 2016 .-- 306 p.

4. Khan M.G. Quick ECG analysis / Per. from English. under total. ed. prof. Yu.M. Pozdnyakova - M .: BINOM, 2016 .-- 408 p.

5. Sharykin A.S., Badtieva V.A., Pavlov V.I. Sports cardiology. - M .: IKAR, 2017 - 328 p.

6. Electronic resource: www.atesmedica.ru, accessed 07.07.2017.

7. Electronic resource: www.aerotel.com, accessed 07.07.2017.

8. Electronic resource: www.ecomeds.org, accessed 07.07.2017.

9. Electronic resource: www.ckbius.ru/oplot_desk2, accessed 07.07.2017.

10. Grishanovich, A.P., Yarmolinsky, V.I. Experience in the development and application of capacitive electrodes. Medical technology, 1984, No. 1. - S. 35-39.

one Portable telemedicine cardiac recorder monitor 2 Housing 3 _______ _ Power Supply 4 The electronic unit five Display 6 Control element 7 Electrode cable connector 23 8 Built-in electrode nine Connector for recharging the battery of the power supply 3 ten Programmable microprocessor eleven Signal adder 12, 13 Additional built-in electrodes 14 Bluetooth communication module fifteen Speaker 16 Setting item 17 Display symbol 18 Graphic symbol 19 Deepening 20 Arched tide 21 Convex arcuate body section 22 Prismatic recess 23 Electrode cable 24 End of the electrode cable 23

Claims (4)

CLAIM 1. Portable telemedicine cardiac recorder-monitor (1), containing a housing (2) with a power supply unit (3), a speaker (15) and an electronic unit (4), which includes a Bluetooth radio communication module (14), located inside it and connected to each other. and connected to the display (5) located on the case (2), control elements (6), a pair of built-in electrodes (8), a connector (9) for recharging the power supply (3) and a connector (7) for connecting an electrode cable ( 23) with external electrodes (26), while additional built-in electrodes (12, 13) are installed on the end sides of the housing (2), connected to the electronic unit (4), characterized in that the electronic unit (4) also contains a lead adder ( 11) and a programmable microprocessor (10), and the built-in electrodes (8), additional built-in electrodes (12, 13), the lead accumulator (11) and the connector (7) for connecting the electrode cable (23) are connected to each other and to the electronic unit ( 4) with the ability to remove all mplex of 12 standard ECG leads by a wired and wireless method, and a programmable microprocessor (10) is connected to its controls (6) and settings (16) and is made with the function of a cardioanalyzer and a display (5) of a group of informative signs of the patient's state, taking into account the conditions measurements and individual parameters of the tested person. 2. Cardiorecorder monitor according to claim 1, characterized in that the built-in electrodes (8) and one of the additional electrodes (12) are made as capacitive ECG electrodes, and the other additional electrode (13) is made of a conductive material in the form of a staple clamp and connected to the electronic unit (4) as a reference electrode. 3. Cardiorecorder-monitor according to claim 1, characterized in that the electronic unit (4) includes an additional radio modem (30), which is connected to the microprocessor (10), and the microprocessor (10) is configured to monitor and control the state and functions Bluetooth communication module (14) and radio module (30). 4. Cardiorecorder-monitor according to claim 1, characterized in that the microprocessor (10) through the controls (6) and settings (16) is made with the setting of the load test mode displayed on the symbolic field of the display (5), and feeding through the speaker ( 15) voice messages and sound signals for the tested person, with subsequent analysis of the stress ECG and calculation of the test person's physical readiness index.