EA036792B1 - System and method for mass remote cardiac monitoring - Google Patents

Abstract

The invention relates to medical equipment and telemedicine healthcare. The objective is to improve efficiency and to extend the scope of application of the system and the method for mass remote cardiac monitoring. The system (Fig. 1) includes workstations (40) of the medical center expert operators (41) connected via an Internet web server (38), and cardio recorders (1) connected to the server using mobile communication means (42) and fitted on examinees (43); they are provided with two electrodes located on face panels of the cardio recorders and connected to electronic units located inside the cardio recorders and comprising a Bluetooth communication module. The method is implemented using of the above-described system, electrocardiograms of the examinees being also read out by their observers (45) and specialists from other organizations. Embodiments of the system and the method with extended functional capacities are also described. For this purpose, the cardio recorder and workstations of the system are equipped with necessary additional elements, and the method includes additional ordered actions.

Description

The group of inventions relates to medical technology and telemedicine and is associated with the conduct of mass cardiological research, including biomedical, medical and pedagogical, psychophysiological and others, which are carried out in the fields of science, education, sports and tourism, occupational hygiene, home self-control, control the state of the human operator, etc.

The ultimate goal of such research is the prevention of cardiovascular diseases among various groups of the population and the reduction of the risks of deteriorating human health in various activities. Therefore, the task arises of creating information and diagnostic systems that meet the needs of not only medical institutions, but also industrial, educational, scientific, sports and health, military, departmental and other organizations in which measures are taken to form a health-preserving environment, improve the ecology of production, prevent risks occupational diseases.

Known system of remote cardiological monitoring [1], used in a clinical setting for group registration of electrocardiograms in patients with cardiovascular diseases. This system includes mobile cardiorecorders (trade mark - Easy ECG) connected by means of a built-in Bluetooth communication module with mobile means of transmitting electrocardiograms to the Internet. A smartphone, tablet, or laptop with 3G / WiFi modems are used as mobile means of transmission and storage. Further, the electrocardiograms are transmitted to the medical center for receiving and processing group data, which includes a web server and the workstations of expert operators connected to it, in the role of which are highly qualified cardiologists. The latter carry out a comprehensive and detailed analysis of electrocardiograms, using modern methods of their processing, and give recommendations to doctors treating these patients.

The disadvantage of the system [1] is its low efficiency of application in other areas of activity that require remote and mass cardiological control, for example, in education, when solving problems of medical and pedagogical observation of pupils and students involved in physical culture and sports, in sports medicine - in monitoring the functional state of athletes, carrying out stress tests with them, going to training camps in another area, at work - when monitoring the condition of drivers of vehicles, workers in hazardous professions, etc. This is primarily due to the design flaws of Easy ECG cardiorecorders: a bulky packing bag, the dimensions of the device, the type of electrodes used that require the use of gels, the absence of an information display and individual adjustment elements on the device, the dependence of data transmission on the presence of the Internet.

The throughput of the system [1] and the possible scale of its coverage of the population when organizing home self-control and remote counseling are small due to the limited number of workplaces of expert operators working in the medical center. The estimated load of such a center, according to the system developers, is only 300 electrocardiograms per day [1], while tens of millions of people experience the need to monitor the state of the circulatory system.

Due to the obligatory Internet communication of users of cardiorecorders and expert operators of the medical center, the system [1] is not applicable outside the Internet coverage area. Whereas in a number of cases (in areas remote from the camera operator, research on relief terrain, on road cycling races, rallies, in war zones, natural disasters, etc.), there is a need for group remote cardiac monitoring. Even in the presence of the Internet, certain (regime) objects can exclude or restrict the use of household mobile communications. This practice exists at nuclear power plants, closed industries, military organizations, etc.

It is known, taken as a prototype of the invention, a system of mass remote cardiac monitoring [2], which includes workstations of operators of medical center operators connected to the system's web server, as well as cardiorecorders connected to it via mobile communication means (smartphone, tablet), which have a pair of electrodes embedded on their front surface. In this system, the recorded electrocardiograms (hereinafter abbreviated as ECG), heart rate (hereinafter abbreviated as HR) and other indicators of the heart activity of the test subjects are displayed on the screen of a smart device (smartphone, tablet) and are stored in them locally, and are also transmitted to web server via 3G / 4G / WiFi - modems. The programs installed on the web-server of the system, according to the description [2], can provide further analysis of information and the necessary reporting.

This system is also not effective enough for widespread implementation, since it retains almost all of the above-mentioned disadvantages of the system [1]. At the same time, the constructive placement of the built-in electrodes on the flat front surface of the cardiorecorder limits the number of possible ECG leads and does not allow the tested person to remove the signal in hard-to-reach places of the body (from the chest, lower extremities), which is necessary in a number of studies. Moreover, if the patient himself is not able to hold the device in his hands and correctly place his fingers in the existing recesses of the working panel, then it is impossible for him to take an ECG with such a recorder even for an outside observer. And finally, the system

- 1 036792 with such cardiorecorders is not designed to provide long-term monitoring of the ECG signal, for example, during sleep or during operator activity, since it is impossible to keep your hands on the device for such a long time and the web server of the system [2] is not designed for continuous monitoring the client.

A common disadvantage of systems [1] and [2] is the absence of an informative display on the cardiorecorders, which allows the user or his observer to carry out primary diagnostics, that is, to quickly and independently assess the state of the body even before connecting to mobile communications and the Internet, to determine the need for an in-depth analysis of the ECG by specialists. The problem of express assessments increases when working with a group of test-takers, as well as when managing its activities, for example, in a responsible production, before the start of a work shift, or in educational institutions - in classes in health groups, in sports training of a team, etc. In front of a sports doctor , the teacher is faced with the task of quickly determining the functional readiness of the participants in the classes to endure high physical loads, to identify persons who need to be released from them or require more close medical attention. At home, before seeking remote consultation (usually paid), the user of the cardiorecorder is also interested in preliminarily assessing the state of the body, determining the effectiveness of taking prescribed medications, physiotherapy, etc.

Thus, users of cardiac recorders used in systems [1] and [2] are forced to use a smartphone, tablet, or computer with a built-in Bluetooth communication module to visualize and analyze their data, and group control presupposes the obligatory connection of all smartphones tested to a remote web server. This puts the subjects and their observers in a difficult position - their awareness directly depends on the availability of smart devices, the Internet, the stability of the web server, the activities of expert operators, etc.

The absence of other radio communication nodes in the cardiorecorders, which form the basis of systems [1] and [2], except for the Bluetooth communication module, excludes the possibility of collecting data on the state of the tested when they are outside the Internet coverage area or the web server is disconnected.

The problem of operation of the considered remote cardiac monitoring systems [1] and [2] is also in the fact that with the massive introduction of cardiac recorders that underlie them, the number of calls to the web server may exceed the capabilities of expert operators located at the workplaces of the medical center. and because of this, persons who really need urgent consultation and medical assistance may not receive it in a timely manner. One should not lose sight of the fact that expert operators of the medical center work according to its general work schedule and it is problematic to get their advice at night.

Known adopted as a prototype of the second invention, the method of mass remote cardiac monitoring, also described in [2] and including the personal removal of the tested their electrocardiograms using cardiorecorders of the system already considered [2], storage and analysis of data on the remote web server of the system and the formation of the necessary reporting on it ... However, this method has the aforementioned disadvantages of the system [2], which reduces the effectiveness of its application in the previously mentioned areas.

Therefore, the aim of this group of inventions is to increase the efficiency and expand the scope of the system and method of mass remote cardiac monitoring by increasing the functionality of the cardiac recorders included in such a system, as well as by introducing other elements and connections between them. Constructive solutions in terms of cardiorecorders are aimed at increasing the comfort and efficiency of taking electrocardiograms from the test subjects, ensuring the reliability of the assessment of their functional state, creating opportunities for group data collection in the absence of the Internet. The introduction of new elements of the system will expand the scope of ongoing experiments and increase the likelihood of providing urgent medical care to those in need. All this, ultimately, will significantly increase the number of people covered by cardiac monitoring, reduce the workload on expert operators of the medical center and increase the effectiveness of preventive measures for heart diseases carried out in the fields of education, sports, production, transport, etc.

The problem posed for the first invention is solved by the fact that the system of mass remote cardiological monitoring includes workstations of operators-experts of the medical center connected via a web server on the Internet, as well as cardiorecorders connected to it via mobile communication means, which are supplied to the tested and which are performed with two electrodes located on the front panels of the cardiac recorders and connected with the electronic units inside the cardiac recorders, including the Bluetooth communication module, has distinctive features: at least one cardiac recorder is additionally equipped with end electrodes connected to its electronic unit, and contains a signal combiner inside connected to the same electronic unit, and also contains a connector for connecting an electrode cable with external electrodes, and three outputs of this connector are connected to the signal adder, and the fourth output is connected to one of the tor target electrodes and with one of the electrodes,

- 2 036792 located on the front panel of the cardiac recorder, while the other electrode located on the front panel of the cardiorecorder is connected to the output of the signal combiner.

The implementation of cardiorecorders of the system with these distinctive features will allow the tested to take an ECG in hard-to-reach places of the body (from the lower extremities, chest, abdomen, etc.) and select the lead that gives the greatest signal amplitude for their physique and is convenient for further measurements. This is important, for example, for a reliable analysis of the ECG and heart rate in persons with a vertical electrical axis of the heart, in whom the signal amplitude is extremely low between two hands and is at the noise level, and it is also important for measurements under conditions of motor activity of the tested, when the level of interference increases and noise.

In addition, an observer who is next to the tested person can take an ECG from him with such a cardiorecorder in situations where the tested person is not able to do it on his own (for example, in a seriously ill person; a person who has lost consciousness; injured; in a state of intoxication, etc.).

It is equally important that such a cardiorecorder allows the test person to quickly remove the entire complex of 12 (twelve) ECG leads generally accepted in clinical practice and sports cardiology [3,4], which may be required by the operators-experts of the medical center and which cannot be performed using the prototype cardiorecorders [ 2].

Using the mentioned electrode cable with external electrodes, it is possible to free the test subjects' hands from holding the cardiorecorder and provide them with the opportunity to engage in operator activities (work at a computer, operator panel, on a simulator, etc.).

Additional distinctive features of the first invention:

at least one cardiac recorder and at least one of the workstations of the medical center's expert operators are additionally equipped with a radio modem configured to operate in a different frequency range than the Bluetooth communication modules of the cardiac recorder;

the system additionally includes workstations for observers of the tested, as well as workstations of specialists from other organizations, which are also connected to the system's web server and which are equipped with at least one radio modem as the mentioned radio modem of the cardiac recorder;

at least one of each of its groups of said workplaces is made on the basis of mobile computer technology and mobile communications and is provided with its own software for receiving and processing electrocardiograms of the tested;

a local network is formed by at least one group of radio modems connected to said workstations of the system;

radio modems used to form a local network are made with a higher output power than radio modems of cardiac recorders;

at least part of her said workplaces is located on vehicles and is configured to operate in the process of moving vehicles;

radio modems built into cardiorecorders and radio modems, which are equipped with workstations of the system, are made with the ability to adjust their operating frequency;

radio modems, which are equipped with workstations of the system, are made with the ability to work in several frequency ranges at once;

The web server of the system is made with the possibility of long-term and continuous recording of the ECG of the tested, and with the ability to reflect the informative signs of their functional state in the virtual personal accounts of the tested, available for the operators-experts of the medical center, as well as for observers and specialists of other organizations who have received authorized access to the corresponding test-takers' rooms.

The inclusion of a radio modem in the electronic unit of the cardiac recorder, operating in a frequency range other than the Bluetooth communication module, makes it possible to transmit data from the cardiac recorder to a device other than a smartphone, for example, directly to the operator's workstation equipped with the same radio modem. Since the electronic unit of the cardiorecorder allows each device to be assigned its own electronic identification number and to transmit it along with the data of the tested person, this opens up the opportunity for the expert operator to conduct group monitoring of the condition of the test subjects in the absence of the Internet and correlate the data obtained with the names of the test subjects entered in the database. his computer. When providing radio modems to a group of workstations of expert operators, the latter can distribute control functions among themselves or conduct simultaneous observation of the tested. In addition, such a group of workplaces can form a wireless local area network. In the conditions of the aforementioned medical center, this can increase the reliability of monitoring cardiac patients, since malfunctions in the operation of mobile communication devices to which cardiac recorders, web servers, wired networks, etc. are connected are connected.

With the help of cardiorecorders of the proposed design, expert operators will be able to observe the electrocardiograms of those tested during stress tests and rehabilitation measures

- 3 036792 (dosed walking, bicycle ergometry, walks, physiotherapy, etc.), carried out in the process of treating myocardial infarction, heart rhythm disturbances, etc. Moreover, thanks to radio modems, this can be done without connecting to the Internet,

The introduction of workstations into the system of observers for test subjects and specialists from other organizations, who are also connected to the system's web server and equipped with the same radio modems as cardiac recorders, significantly expands the volume of cardiological studies conducted among various organizations and population groups.

The term observers in this invention refers to people who are in direct contact with the test subjects. In a medical center, these can be doctors and nurses, but in general, observers are not required to have special education or undergo medical training, they just need to study the instructions for the cardiorecorder and the user manual for the mobile application. Observers can be relatives of the patient, family members, laboratory assistants of institutions, operators of industrial facilities, security personnel, members of a sports team, etc., in a word, those persons who, due to official duties or other circumstances, can observe the test subjects, provide them assistance in taking an ECG, ensuring the collection of group data on a computer, their broadcast to a web server, etc.

The term specialists of other organizations include, first of all, doctors working in other medical centers and organizations (for example, in scientific and practical centers of cardiology, sports medicine, transplantology, medical units of industrial enterprises, medical centers of educational, sports and tourism institutions, military organizations and etc.). Also, the term specialists of other organizations includes persons of other professions who have specialized education and sufficient competencies to monitor the functional state of the tested and manage their activities. These can be coaches of sports teams, physical education teachers, physiologists, psychologists and other specialists.

Connecting the workplaces of observers for the tested and workplaces of specialists of other organizations to the remote web server of the system and equipping them with the mentioned radio modems is aimed primarily at providing on-line monitoring of the state of the tested and expanding the possible range of sources of advice. For example, in clinics, cardiac recorders equipped with a radio modem can be used directly in wards, primarily in intensive care units and intensive care units, where professional cardiac monitors are often lacking. In educational institutions and sports centers, equipped workplaces of specialists will help solve the problem of functional control of young people during training sessions and sports training.

In the simplest case, the observer's workstation can be his personal smartphone or tablet, provided with a mobile application for contacts with a remote web server of the system and for local processing of electrocardiograms of the tested, received via Bluetooth from cardiac recorders connected in series to this smartphone or tablet. Observers can also use their personal or office computers, which are also equipped with software for receiving (via Bluetooth) and processing electrocardiograms of the tested. These computers can be equipped with radio modems, allowing them to receive data from the radio modems of the cardiac recorders. In the latter case, the observer can carry out group data reception by one radio modem, with a corresponding time division of the polling used in the group of cardiorecorders. If the primary signs of an unsatisfactory state of any of the test subjects are identified (which will be discussed in the description of the utility model below), these observers can request the advice of the expert operators of the remote medical center and send to its web server the data of the test subjects and their electrocardiograms recorded before connecting to the Internet.

Specialists of other organizations, whose workplaces are also connected to the web server, can also use mobile communications (smartphones and tablets) and computers equipped with radio modems of the system, while other, professional software can be installed on these computers, which makes it possible to more accurately analyze the ECG, or conduct research in the interests of their organizations (educational, military, industrial, scientific, etc.).

The implementation of workplaces for observers on the basis of mobile computer technology and mobile communications allows you to establish workplaces outside stationary premises and, if necessary, transport these workplaces and the observers themselves together or after the tested. For example, in a road cycling race, the laptop of the coach following the athletes in the car can be located in the same car, and if he detects signs of an unsatisfactory condition in any of the participants in the race, the coach can send the ECG recorded using the radio modem to the sports doctor of the team or to a remote web server via the Internet and get the necessary advice.

The condition for the use of radio modems in such experiments is the performance of mobile

- 4,036,792 workplaces with the possibility of their efficient operation during the movement of transport, for example

- placing the radio modem antenna on the roof of the car, providing a mobile computer with an energy-intensive battery, etc.

Mobile workstations equipped with a radio modem are convenient to use when managing the activities of the test takers (for example, at the stadium), to use in the absence of the Internet or a malfunction of the web server, as well as in the absence of mobile communications for the test takers, if there is a ban on the use of such communications ... In the future, the collected data can be transferred to a remote web server on a hard drive or when entering the network coverage area, etc.

On-line monitoring of the condition of the tested can be carried out in the form of outpatient remote maintenance of cardiac patients, in order to clarify the domestic circumstances of the deterioration of their electrocardiogram, assess the effectiveness of prescribed pharmaceuticals, etc.

The formation of a local network by radio modems installed at the workstations of the system opens up the opportunity for all research participants to simultaneously see the parameters of the tested and exchange opinions about their state, moreover, regardless of the presence of the Internet and the location of the tested. For example, in the course of biathlon observers' computers can be located at reference points of the track, determined by the range of radio modems, and transmit data over the local network from one workplace to other places in on-line mode. The sports doctor, being in the office, will be able to constantly see the condition of the athletes and comment on it for the coaches along the track.

Strengthening the output power of radio modems installed at the workplaces of specialists can significantly reduce the number of required workplaces and increase the reliability of communication between computers that form a local network.

The connection of computers via a local network and the placement of at least one workplace in the coverage area of the Internet will allow observers, and through them - the test subjects, to receive recommendations from expert operators of the medical center to ensure preventive measures and preserve the health of the tested. In the above example with biathlon, race participants will be able to timely receive a recommendation from a highly qualified cardiologist about the advisability of stopping the race or reducing physical activity when signs that threaten their life appear (exceeding the previously tolerated heart rate threshold, heart rhythm disturbances exceeding the permissible norm, etc.). Another example is the work of a security or industrial facility. Here, in the event of a deterioration in the condition of any of the operators, security personnel will be able to call a medical ambulance in time and replace an employee without stopping the technological process.

The ability to configure the operating frequency of the radio modems of cardiac recorders and the system as a whole, as well as to ensure the operation of the radio modems with which the workplaces are equipped in several frequency ranges at once, will allow the use of the mass remote cardiac monitoring system at those facilities where the use of the Internet is prohibited or restricted, where communication is used dedicated radio frequencies. It is advisable to use radio modems with adjustable communication frequency in mountainous areas, in mines, large cities where there are numerous sources of radio interference, etc.

If it is possible to use radio modems in several frequency ranges at once, data reception can go on one frequency (to which the radio modems of cardiac recorders are tuned), and the exchange of information between observers - on a different frequency. The high output power of the radio modems connected to the observers' computers will provide a large coverage area of the zone of confident cardiac control, which is important in the case of moving test subjects (for example, when training on a rowing channel, river).

The possibility of long-term and continuous recording of the ECG of the tested on a remote web server, as well as the reflection of informative signs of the functional state of the tested in their virtual private offices allows organizing continuous (round-the-clock, night, etc.) monitoring of the tested, both at the medical center and at work places of observers and specialists from other organizations, who are also connected to the system's web server. Examples are observation of the state of patients, athletes, operators of secure facilities, etc. An important point is the display of functional parameters of the tested in their personal web server cabinets in on-line mode or, at least, approaching such a mode in case of high load on the web server. In this case, the relatives of the patient who is in the hospital can access the Internet at any time and see the state of a loved one, including at night. The coach of a sports team will be able to remotely monitor the quality of sleep of an athlete who has undergone intense training or injury and predict his future performance.

The problem posed for the second invention is solved by the fact that the method of mass remote cardiac monitoring (Fig. 2), including the personal removal of their electrocardiograms by the test subjects and their transfer to a remote web-server of the mass remote cardiac monitoring system using mobile communications, with their subsequent storage, analysis by operators -experts and the formation of the necessary reporting, has distinctive features: the considered

- 5 036792 above is the system of mass remote cardiomonitoring according to the first invention, while the electrocardiograms from the test subjects are also taken by their observers and specialists from other organizations, and in cases of the absence of the Internet, disconnection of the web server, or a ban on the use of personal mobile communications, the registration of electrocardiograms carried out with the help of radio modems built into the cardiorecorders and with which the workstations of the system are equipped, with the subsequent transfer of the collected data to a remote web server of such a system, their analysis by expert operators, storing the results of the above registration and generating the necessary reports.

The use of the mass remote cardiac monitoring system according to the first invention will make it possible to use its mentioned advantages and thereby increase the efficiency of the mass remote cardiac monitoring method according to the second invention and expand the scope of its application. The registration by observers and specialists of electrocardiograms from the tested with the subsequent transfer of data to a remote web server, their analysis by expert operators of the medical center, storage and generation of the necessary reporting opens up new opportunities in conducting mass cardiac monitoring and allows it to be implemented in such a way that the time for providing medical care will be significantly reduced. helping those in need.

This is primarily about the prevention of sudden cardiac death (SCD) in cardiac patients and athletes who train with full dedication, transport workers, workers in hazardous and responsible industries, risky professions. Even if we talk about schoolchildren and students, whose health did not cause concern before, then observations of recent years [5] show that control of their functional state is more and more necessary, in particular, when doing physical culture and sports, since cases of SCD have become more frequent and in an educational environment.

The advantages of the second invention are expressed in the fact that in the absence of training of the tested or the incapacity of a person, their observers will be able to take their ECG and transfer the data to the advisory portal. A specialist who manages the work of a group of test-takers will also be able to record their ECG and collect group data, including in the absence of mobile communications or the Internet, using the above-mentioned workplaces with radio modems.

Continuous monitoring of the state of the tested can be carried out using cardiorecorders with electrode cables connected to them with external electrodes. This is necessary, for example, when driving vehicles and performing other operator work, when the test subjects are not able to independently hold the cardiorecorder in their hands, remove and transmit electrocardiograms to the web server. Data collected in the absence of the Internet can be transferred to a web server when this network appears or by transferring it to hard media.

Additional distinctive features of the second invention that increase the efficiency of its application:

during personal recording of electrocardiograms by the cardiorecorders of the above-mentioned system according to the first invention, the subjects themselves and their observers make a primary assessment of the state of the cardiovascular system of those tested at the sites of such personal removal, and without connecting the cardiorecorders to a web server, and at the same time, they make such a primary assessment by numerical values of informative signs reflected on the symbolic-digital display of cardiac recorders, as well as by the color of this display and voice messages coming from the dynamics of cardiac recorders, and the reliability of estimates is associated with the correctness of the settings on the said display of symbols of testing conditions and individual parameters of the tested, performed using an electronic cardiorecorder unit and its controls;

for the above-mentioned initial assessment, observers and specialists from other organizations also use their own mobile communication devices and computers equipped with a Bluetooth communication module, as well as computers equipped with radio modems of the system, and on which they install appropriate mobile applications and software for receiving and processing electrocardiograms of the tested, and in this case, in the case of the formation of a local network according to the first invention, the reception of electrocardiograms is carried out at one frequency corresponding to the operating frequency of the radio modems of the cardiac recorders, and the exchange of information between the observers is carried out at a different frequency;

said primary assessment of the functional state of the test subjects is carried out by means of the system according to the first invention by connecting the system's cardiorecorders to mobile communication devices and computers with a built-in Bluetooth communication module, as well as to computers equipped with radio modems of the said system, followed by visual comparison of the shape of the averaged cardiocycles of the initial and current electrocardiograms reflected on the screen of the used mobile communication device or computer, as well as by identifying changes in the amplitude-time, spectral, fractal and other characteristics of the electrocardiogram, obtained using the software installed on these devices, during long-term monitoring of the state of the tested;

the mentioned primary assessment of the functional state of the test subjects and control of its dynamics

- 6 036792 is carried out using the means of the system according to the first invention by taking and comparing the same, but the most amplitude, quickly accessible and convenient for each test individually, the electrocardiogram leads;

the initial values of informative signs of the functional state of the tested, the shape of their electrocardiogram and its characteristics for subsequent comparison in dynamics are obtained using cardiorecorders of the system according to the first invention, in a comfortable state for the tested, against the background of their good rest, in a posture as close as possible to further studies, and store these data in the memory of cardiac recorders, memory of personal mobile communication devices, memory of computers used, in virtual personal accounts of the tested, placed on the web server, as well as in the cloud storage of the Internet;

registration and transmission of electrocardiograms to the web-server of the system according to the first invention is performed without fail in cases of complaints of the tested about the deterioration of health, when objective signs of their unsatisfactory functional state are identified, as well as during stress tests with maximum physical efforts of the tested, and in other cases, transmission data on the web server is carried out only in a planned manner - for periodic updating of the initial indicators of the tested in their virtual personal accounts;

registration and transmission to the web server of a standard set of twelve leads of an electrocardiogram, adopted in clinical practice, or other electrocardiographic leads specified by an expert operator of a medical center, is carried out by the system according to the first invention when creating a virtual personal account of the person being tested on a remote web server, as well as the decision of a specialist of another organization exercising direct control over the test takers, while saving the registered leads in personal mobile communication devices, the memory of the computer used by the mentioned specialist, in the test taker's virtual personal account, as well as in the Internet cloud storage; in other cases, electrocardiograms are taken and transferred to the web server in only one, quickly accessible and convenient for each test lead, indicating the type of this lead; and only at the request of the operator-expert of the medical center, they begin to pick up and transfer the entire standard set of leads, or individual leads indicated by him;

in persons with an unsatisfactory functional state, night monitoring of their electrocardiograms is carried out using the system according to the first invention, as well as using the workplaces of their observers and involved specialists from other organizations, while the monitoring data is displayed and stored in virtual personal accounts of such tested persons, as well as on used workplaces of the system, and if signs of deterioration in the functional state of such test persons are detected, measures are taken to provide them with urgent medical care;

at night hours of the day, control over the condition of the test takers who are at home and in need of cardiological control is carried out using the system according to the first invention and with the involvement of ambulance station specialists, whose workplaces are also connected to the virtual personal accounts of such test takers and notifying the operator on duty station about the need for such a cardiac monitoring by a specialist.

Many of the listed distinctive features of the method follow from the description of the system, which is the basis for its implementation, however, all of them will be considered in detail and by examples when describing the essence of the system and the method of mass remote cardiac monitoring.

The essence of the inventions is illustrated by illustrations, where in FIG. 1 and 2 show general diagrams explaining, respectively, the structure of the system and the essence of the method of mass remote cardiac monitoring; in fig. 3 shows a general view of the system's cardiorecorder; and in FIG. 4 - its structural diagram; in fig. 5 is a fragment of view A on one of the ends of the cardiorecorder according to FIG. 3; in fig. 6 is a rear view B of the cardiac recorder of FIG. 3; in fig. 7 is a side view C of the article of FIG. 3; in fig. 8 and 9 are fragments of views from the other end of the product, respectively, with the electrode cable removed and inserted; in fig. 9 shows a variant of the connection diagram of the built-in and external electrodes with the signal combiner and the electronic unit of the cardiac recorder of FIG. 3, 4 - with an electrode cable inserted into it; in fig. 10-16 show examples of taking different ECG leads using one of the cardiac recorders of FIG. 3, 4 of the system of FIG. 1 when carrying out the method of FIG. 2.

The system of the first invention, the essence of which is illustrated in FIG. 1-16 has the following numbered items as listed in the table below:

- 7 036792

one Cardiorecorder 2 Heart rate recorder housing 1 3 Cardiac recorder power supply 1 4 Cardiac recorder electronic unit 1 five Display of the heart rate recorder 1 6 Cardiac recorder control 1 7 Cardiac recorder connector 1 for connecting electrode cable 23 8 Built-in electrode for cardiac recorder 1 nine Cardiac recorder connector 1 for recharging the battery of the power supply 3 ten Programmable microprocessor cardiac recorder 1 eleven Cardiorecorder signal combiner 1 12, 13 Additional built-in end electrodes for cardiac recorder 1 14 Cardiac recorder Bluetooth communication module 1 fifteen Heart rate recorder speaker 1 16 Setting item for cardiac recorder 1 17 Display symbol on display 5 of cardiac recorder 1 eighteen Graphic symbol on the body 2 of the cardiorecorder 1 19 Recessing the body 2 of the cardioregistra 1 twenty Arcuate tide of housing 2 of cardiorecorder 1 21 Convex arcuate section of the body of the cardiorecorder 1 22 Prismatic recess of housing 2 of cardiorecorder 1 23 Electrode cable 24 End of the electrode cable 23 25 Connector latch 26 External electrode 27 Core of electrode cable 23 28 Socket for connecting electrode cable 23 (plug) 29 Resistors of the signal adder 11 of the cardiorecorder 1 thirty Additional radio modem for cardiac recorder 1 31 The input stage of the amplifier of the electrocardiogram of the cardiorecorder 1 32 Balancing resistor cardiorecorder 1 33 Finger 34 Leg 35 Forearm 36 Electrode positions for chest leads ECG 37 Mass remote cardiac monitoring system 38 Web server 39 Internet 40 Expert operator workstation 41 Medical Center 42 Mobile communication facility 43 Tested 44 Observer's workplace 45

- 8 036792

45 Observer 46 Internet portal 47 Electrocardiogram 48 Personal data of test subjects 43 49 Diagnostic reports of expert operators and other medical specialists fifty Practical advice from expert operators and other medical professionals 51 Test takers' virtual personal accounts (43) 52 External radio modem 53 The local network 54 Scientific and Practical Center of Cardiology 55 Scientific and Practical Center for Sports Medicine 56 Medical center of an educational institution 57 Sports organization medical center 58 Rescue organizations

The main elements of the system 37 (Fig. 1) according to the first invention are cardiorecorders ⁽¹⁾ .

The design of their preferred implementation is described below.

Such a design of any of the cardiac recorders (1) includes (Fig. 3-9) a housing (2) with a power supply unit (3) located inside it, an electronic unit (4) including a Bluetooth communication module (14), and a speaker (15) that are interconnected. There are also connected to the electronic unit (4) and located on the surface of the housing (2), from the side of its front panel (Fig. 5-7): display (5) and control elements (6), connector (7) for connecting the electrode cable (23) located at one of the ends of the body (2), and located near the control elements (6) built-in electrodes (8), two additional built-in end electrodes (12, 13) located at the ends of the body, and a connector (9) for recharging the power supply (3). The connector (9) is 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 units performing these listed functions in the electronic unit (4) are not shown in the diagram (Fig. 3), since they are well known and reflected, for example, in the description of another similar device [6]. The electronic unit (4) also provides data transmission using a Bluetooth radio communication module (14) to an external communication device via 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 combiner (11) connected to the built-in electrodes (8), (12) and external electrodes (26) so that a portable telemedicine cardiac recorder monitor (1) can record the entire standard complex of 12 (twelve) ECG leads , generally accepted in clinical and sports cardiology [3,4]. These leads are designated as I, II, III, avR, avL, avF, V1, V2, ... V6.

Some of these leads, as well as others that are often used in practice (DS, R-V4, R-V5, etc.), can be removed wirelessly (I, II, III, R-V5, etc.), and some (reinforced, chest) - using an electrode cable (23) with a minimum of three or four wires, depending on the tasks and conditions of the study. (For comparison: in many clinical and portable electrocardiographs, 10, rarely 5-6 wires are used for this).

An additional built-in electrode (12) located on the left end of the housing (2) (Fig. 5, view A in Fig. 4) is connected to the built-in electrode (8) located on the same side (Fig. 5 and Fig. 10), and also 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. 10 and Fig. 8), and the output of the signal combiner (11) is connected to another built-in electrode (8 ) (Fig. 4, Fig. 10), 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. 4 - view B in Fig. 4, Fig. 6), is, in fact, a reference and is connected to the third input of the electronic unit (4), and three inputs signal combiner (11) are connected to three other outputs of the connector (7) for connecting the electrode cable (23).

This technical solution allows you to quickly remove any required ECG lead by providing contact of the built-in electrodes (8, 12, 13) with the subject's body or placing external electrodes (26) on the body, connected via an electrode cable (23). Examples of lead removal are shown in FIG. 13-16 and are explained below in the text.

Built-in electrodes (8) and an additional built-in end electrode (12) are made capacious

- 9 036792 with parameters that ensure the transmission of an electrocardiographic signal. An additional built-in end electrode (13) is made of a conductive material. As electrodes (12), made capacitive, the known structures [7] are used, 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 gels. The electrodes (12) have low contact and polarization potentials, they are less sensitive to motion artifacts, therefore, they provide better noise immunity when taking an ECG in people with increased muscle tremor. This is important for the effective use of cardiac recorders, the entire system as a whole and the method, in all its variants, in the spheres of physical culture and sports, or in the production process, in factories, in dispatch services, for monitoring the state of the human operator, etc.

The noise immunity of ECG monitoring increases, in comparison with the prototype [2], also due to the fact that the built-in electrodes (8) and the additional built-in end electrode (12) have a small contact area, which practically does not change when the fingers are pressed against them. The preservation of a constant contact capacity of the fingers and the built-in electrodes (8) is facilitated by the presence of tides (20), which prevent strong pressure of the fingers on these electrodes.

The location of the built-in electrodes (8) in small 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 end electrode (13), made of a conductive material and connected to the third input of the electronic unit (4), which contains a circuit for compensating for pickups and baseline drift. Such a scheme is not shown, since its solutions are known and reflected in the description of the analogue [6]. An additional built-in end electrode (13), in addition, serves as a fixator for the cardiorecorder (1), since it is structurally made in the form of a clip-clip (Fig. 4). This technical solution allows the tested person to contact with the end electrode (13), both when holding the device in his hands and when placing it on clothing. For example, when testing a patient or an athlete on a bicycle ergometer or a treadmill (Fig. 16), the test person's hands should be free, therefore, the ECG is taken through external electrodes (26) connected to the cardiorecorder (1) through an electrode cable (23), and the contact of an additional of the built-in end electrode (13) with the body is provided by fixing the product on the trousers or T-shirt of the tested person, touching the body with the envelope of the additional built-in end electrode (13).

The implementation of an additional built-in end electrode (12) in the form of a plate adjoining the body (2), repeating the contours of its end part and having rounded edges, eliminates trauma to the skin of the tested person when pressing the cardiorecorder (1) to the body and thus makes it possible to safely apply it to soft tissues , for example - the mammary gland in women.

Implementation of another additional built-in end electrode (13) in the form of a plate protruding above the opposite end of the body (2), in which there is a cutout, and in the adjacent surface of the body there is a prismatic recess, ensures reliable fixation of the electrode cable (23) in the 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 accuracy of measuring informative signs of the test person's state during his physical activity, long-term ECG monitoring in a seriously ill patient, monitoring the operator's condition, etc., that is, makes the use of a cardiorecorder (1) more effective.

Reflection of the setting 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 (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), the individual parameters of the tested person (gender, age, physical fitness), as well as other device settings (hours, recording duration ECG, alarm thresholds, etc.).

Evaluation of informative signs, for example, numerical indicators of the state of the cardiovascular system: heart rate - heart rate, SI - stress index, VR - variation range of the pulse, reflected on the display (5), is performed through its intuitive color illumination, expressed, for example, in 5-point color scale: green, yellow, orange, red and violet colors, which reflect, respectively, excellent, good, satisfactory, bad and very bad condition of the test taker.

Voice messages output to the speaker (15) using a programmable microprocessor (10) provide 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 and non-specialists to quickly master the device and correctly navigate the indicators shown on the display (5). As a result, voice

- 10 036792 comment in most cases allows satisfying the user's request for assessing the state of his circulatory system and eliminating the need for a remote medical consultation (usually paid). With the widespread introduction of cardiorecorders, the number of unjustified calls to the web portal will be reduced and the expert operators of the medical center will be able to pay more attention to the analysis of the ECG of really sick people.

In order to improve the convenience of holding the cardiorecorder (1) in the hands when removing the 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 support for the fingers ( 33), holding the body (2) of the device when it is pressed against the chest or limb.

The main technique (Fig. 11) of using the cardiorecorder (1) is to hold it with two hands by the test person himself, with the fingers (29) applied to the built-in electrodes (8) and an additional built-in end electrode (13).

This technique is used for the purpose of operatively taking an electrocardiogram wirelessly, and it provides a recording of the I (first) standard ECG lead. However, not all people have such a high-amplitude lead, therefore, other methods can be used - to register standard leads from the lower limb (II or III), holding the device with the right or left hand, respectively, with the fingers of this hand touching the built-in electrode (8) located on the body (2) on the right (Fig. 4), and an additional built-in end electrode (13), and applying the device to the left leg (Fig. 12), touching it with an additional built-in end electrode (12).

For reliable self-monitoring of heart rate during exercise, all participants are recommended experimentally, using a smartphone and a mobile application installed on it (not shown in the figures), to choose for themselves the most amplitude, quickly accessible and convenient for ECG recording, and use it in the future ...

Many athletes and the elderly are more comfortable using the R-V4, R-V5 leads as shown in FIG. 13, with the attachment of an additional built-in end electrode (12) to the left side of the chest (or abdomen) and holding the cardiorecorder (1) with the right hand, touching it with the fingers (33) of the right main electrode (8) and an additional built-in electrode (13). This lead is not a standard clinical lead, but its high amplitude allows you to successfully record heart rate and analyze the heart rate during physical exertion or hand tremors.

For long-term ECG recording, for example, during nighttime cardiac monitoring, it is inconvenient to hold this device in the hands, therefore, an electrode cable (23) should be used here and external electrodes (26) should be placed on the chest, in positions (36) that give a high-amplitude signal. Such a 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 are in Figs. 15 and 16).

The control elements (6) of the cardiorecorder (1) allow, using the settings (16) of the programmable microprocessor (10), to set the ECG control mode during the stress test provided in the device, to calculate the physical fitness index (IR) of the tested person after the test is completed. The value of this index and the measured informative signs (heart rate, SI, VR) are stored in the memory of the cardiorecorder. Control elements (6) also allow you to set threshold values of informative signs (heart rate, SI, VR) for an alarm when these thresholds are exceeded.

A mobile application (not shown) installed on the communication means (smart devices) used by testees, observers and specialists allows them to carry out deeper processing of the ECG received via the Bluetooth channel (filtering, averaging, calculating the spectrum, variability indicators, amplitude-time and others parameters), and save all the parameters in the memory of the smart device, as well as transfer them to a remote web server.

The built-in additional radio modem (30) provides the transmission of the same data over another radio communication channel to a remote computer equipped with the same radio modem (52) (Fig. 1, Fig. 2), as was briefly discussed above, when characterizing the system features (37 ), and as explained in more detail below, when considering the essence of system (37) as a whole. Specialists of other organizations, working with their own professional software, receive electrocardiograms through radio modems (30) and (52), and process them at a higher level (for example, with automatic syndromic conclusion, on-line spectrum analysis, late potentials, etc.). etc.). This opens up new opportunities in the organization of individual and group cardiac monitoring, as it increases the reliability of the system and helps to obtain information about the adaptive abilities of the tested during long-term observation of them and when performing stress tests, which is not provided by the prototype [2].

Performing stress tests under the control of an ECG is very important for educational institutions, where physical standards are regularly taken, the evidence base for the effectiveness of health-improving exercises is selected. The analogue of the cardiorecorder described in [6] is also not functional in this regard and is not suitable for use in physical activity.

- 11 036792

A programmable microprocessor (10) allows each such cardiac recorder (1) to assign its own electronic identification number and transmit it via a radio modem (30) 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 ...

Such a technical solution makes it possible to create on the basis of cardiac recorders (1) and workplaces of observers (45) (Fig. 1, Fig. 2) and specialists of other organizations (54-58) a group cardiac monitoring system operating outside the Internet, or connected to this network (that is, the remote web server of the medical center) only when such a need arises.

Such systems of mass group remote cardiac monitoring are in great demand in educational institutions (preschool institutions, schools, universities), healthcare (hospitals, sanatoriums, dispensaries, etc.), sports and tourism (children's and youth sports schools, etc.), in production ( control over the state of operators). In these institutions, the use of smart devices and contact with the web portal are not always necessary, and in some cases (at closed departmental, industrial, military facilities) it is prohibited or impossible. Therefore, the test subjects' data, collected on the observer's or specialist's computer, can be transferred to a remote (departmental) web server at the end of the experiment, on a hard drive or by moving the observer's computer into the Internet coverage area.

Regarding other advantages of the cardiorecorder (1) relative to the prototype [2] and analogs [1, 6], we note that the alarm sound signals of this device can be a voice message indicating the name of the parameter that has gone beyond the threshold value and the magnitude of the detected deviations. Such a message can be transmitted both to the speaker (15) of the heart rate recorder, and to the observer's Bluetooth earpiece (for example, a family member or the clinic's medical staff on duty), via the Bluetooth communication module (14). However, the range of the latter is limited to a few meters, so this message can be transmitted to the earpiece or to the observer's computer (45) through an additional radio modem (30) and (52). In this case, the speaker (15) can be turned off so as not to disturb the patient and those around him.

The small overall dimensions and weight (160x35x20 mm, 90 g) of the created samples (Fig. 1) of such a cardiac recorder (1) make it possible to classify it as a type of portable telemedicine cardiac recorder-monitor used for 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 small-sized product with them and use it if necessary, or as directed by a specialist.

The system of mass remote cardiological monitoring (37) (Fig. 1), based on the use of such cardiac recorders (1), includes the workstations (40) of the expert operators of the medical center ( 41), as well as connected to it, via mobile communication means (42), cardiac recorders (1), which are equipped with the tested (43) and the preferred design of which has already been described.

In addition, as shown in FIG. 1, the system of mass remote cardiac monitoring (37) contains workstations (44) and observers (45) for the tested (43) and workstations of specialists from other organizations (54-58) connected via a web server (38) on the Internet (39) (Fig. 2).

In the example shown in FIG. 1, the test subjects are athletes (43), an observer (45) is their coach or team doctor, with a tablet in hand, connected to the web server (38) of the system (37) or with a mobile computer (40) equipped with a radio modem ( 52). The coach and team doctor can also be seen as specialists working in an educational institution (56) or a sports organization (57), carrying out scientific research on the basis of these institutions and managing the sports training of the group.

There can be many such training groups, as well as single test subjects (43) with their observers (45) at home or working at workplaces (44), in the system there can be many, and each group can solve its own research tasks (according to their direction , the duration of the number of private traders, etc.).

Many well-known studies are carried out mainly in order to control the heart rate in test subjects (43), whose activities are controlled by their observers (45), therefore, only in cases of complaints of the test subjects about their well-being or detection of objective signs of their unsatisfactory functional state, the data of the test subjects and their electrocardiograms are transmitted to the web portal (46) systems for analysis by an expert operator of a medical center (41) or, through the same portal, for specialists from other organizations (54-57). Through a remote web server (38), or directly, using popular instant messengers (viber, e-mail, whatsapp, etc.), ECG fragments of the test taker can be transferred to his attending physician or other consultant, and if the test taker's condition worsens, directly to the service operator rescue (58), which is primarily represented by an ambulance station.

Its workplaces can be permanently connected to a remote web server of the mass remote cardiological monitoring system (37) to provide services for long-term, for example, 12 036792 night monitoring of the condition of test subjects who are at home and in need of such monitoring.

The web-server (38) of the system on the Internet (39) is connected to the web-portal (46), which stores (this is shown in expanded form) virtually all received electrocardiograms (47) and personal data (48) of the tested (43), diagnostic conclusions (49) and practical recommendations (50) of medical center experts (41) and other specialists (54-58). This information is posted in virtual personal accounts (51) of the tested (43).

The web-server (38) is designed with the possibility of long-term and continuous recording of the ECG of the tested (43), and with the possibility of reflecting informative signs of their functional state in their virtual personal accounts (51), available for expert operators of the medical center (41) and other specialists (54-58), as well as observers (45) who got access to virtual personal accounts (51) of those tested with whom they interact.

The system of mass remote cardiological monitoring (37) also includes, with the ability to connect to its workplaces (40, 44, 54-58), external radio modems (52) having the same frequency range of operation as (Fig. 3) radio modems (30) cardiorecorders (1). In this case, these radio modems connected to the workstations of the system can form a local network (53) between themselves (Fig. 2).

Radio modems (52) can be configured with the ability to adjust the operating frequency or work in several frequency ranges at once, which expands the scope of possible application of the system.

The workplaces of specialists associated with the web-portal (46) of the system (37) can be located (Fig. 2) in the centers of scientific and applied research, for example, in the scientific and practical center of cardiology (54), the scientific and practical center of sports medicine (55), in a medical center of an educational institution (56), a medical center of a sports organization (57), as well as at departmental facilities (not shown), academic and industrial institutes (not shown). Specialists of these organizations, being outside their stationary workplaces, can additionally use their own or office mobile communication facilities provided with mobile applications for communication with the Internet portal (46), or mobile computers (40) with professional ECG analysis programs installed on us. thus allowing ongoing and immediate consultation of individual cardiac recorder users (1) or observers (45) interacting with groups.

Mobile computers of observers (45) and specialists (41, 54-48) equipped with radio modems (52) can be placed on vehicles (not shown) and move after the test subjects and provide long-term continuous monitoring of their state in motion. For this, appropriate conditions must be created (backup battery, remote antenna, etc.).

If the movement of the tested is carried out in a circle or along a specific trajectory (metro line, ski track, etc.), then it is more expedient to place the workplaces of observers or specialists along this route and form a local network on their basis. This will allow all participants in the study to simultaneously see the parameters of the test subjects (received on one frequency of radio modems 30 and 52) and exchange opinions about their condition (on a different frequency of radio modems 52, which are equipped with computers). And when contacting the web server of at least one of the computers included in the local network, the data of the tested can, if necessary, be transferred to a medical center (41) or a scientific center (54, 55) or medical centers (56, 57) of organizations, who work with test takers (43). Finally, specialists of the rescue service (58) can remotely participate in such observations, for example, doctors at an ambulance station, who, if necessary, can go to the research site and provide this assistance to a person in need.

The method of mass remote cardiological monitoring (Fig. 1, 2) is carried out due to the personal removal by the tested (43) of their electrocardiograms (47) and their transfer to the system of mass remote cardiological monitoring (37) via mobile communication means (42), with subsequent storage of the results the mentioned pickup on a remote web server (38). These results are analyzed by expert operators of the medical center (41) stationed at their workplaces (40). Workstations (40) are connected to a web server (38), on which the necessary reports are generated. At the same time, observers (45) of the tested (43) and specialists from other organizations (54-58) working with the test (43) can also perform personal ECG recording from the tested (43), with their subsequent transfer to the mass remote cardiac monitoring system ( 37). It provides storage of the results of the above-mentioned pickup on a remote web server (38), their analysis by expert operators of the medical center (41) and the formation of the necessary reporting.

In the absence of the Internet (39), or in the inaccessibility of the coverage area of this network in a particular area, or in the absence of mobile communications (42) or in the presence of a ban on their use, or in case of malfunctioning of the web server (38) or when the Internet is disconnected -portal (46), the method of mass remote cardiac monitoring is carried out using radio modems (30) built into cardiorecorders (1). These radio modems are equipped with workplaces (40,

- 13 036792

54-58) of the system (37), with the subsequent transfer of the collected data to a remote web-server (38) of such a system, their analysis by operators-experts of the medical center (41), storage of the results of the above registration on the web-server (38) and the formation of the necessary reporting.

During personal recording of electrocardiograms (47) by cardiorecorders (1), the test subjects (43) and their observers (45) perform a primary assessment of the state of the cardiovascular system of the test subjects (43) at the sites of such personal removal, and without connecting to the web server (38). They make this initial assessment by the numerical values of informative signs reflected in symbolic-digital form (Fig. 1) of the display (5) of the cardiorecorders (1), as well as by the color of this display (5) and by voice messages coming from the speaker (15 , Fig. and 4) cardiorecorders (1). In this case, the reliability of the estimates is associated with the correctness of the settings on the said display (5) of the display symbols (17, Fig. 1) for the testing conditions and individual parameters of the tested (43) performed using the electronic unit (4, Fig. 2) of the cardiac recorders (1 ).

For the aforementioned primary assessment in the field and transmission of data to the web server (38), mobile communication devices (42) equipped with a Bluetooth communication channel and mobile applications for receiving and processing electrocardiograms, computers with the same Bluetooth communication channel and with built-in 2G / 3G / 4G / 5G / Wi-Fi modems for connecting to the Internet, as well as computers to which external radio modems are connected (52). On these computers, specialists install their own, professional programs for receiving and processing electrocardiograms.

The primary assessment of the functional state of the tested (43) is carried out, for example, based on the analysis of heart rate variability indicators measured by cardiorecorders (1), as well as the perception of the display color (5, Fig. 1) on them and issued through their dynamics (15, Fig. 2 and 4) voice messages depending on the measurement conditions set on the display (5, Fig. 1) and individual parameters of the tested person (43).

The primary assessment of the functional state of the test subjects (43) is also carried out by visual comparison of the shape of the averaged cardiocycles of the initial and current electrocardiograms displayed on the screen of the used mobile communication device or computer, as well as by identifying changes in amplitude-time, spectral, fractal and other characteristics of the electrocardiogram obtained from using the software installed on these devices, during long-term monitoring of the state of the tested.

The primary assessment of the functional state of the tested (43) and the control of its dynamics is carried out, as a rule, by taking and comparing the same, but the most amplitude, quickly accessible and convenient for each individual tested electrocardiogram leads.

When describing the advantages of the cardiorecorder (1) over the prototype [2] and analogues [1, 6], the role of high-amplitude derivation in increasing the reliability of the assessment of the functional state of the tested was explained and possible options for obtaining a high-amplitude signal using the cardiorecorder (1) were shown. It should also be noted that the Wilson chest leads (V1, V2 ... V6) and enhanced limb leads (aVR, avL, avF), illustrated in guidelines for clinical and sports cardiologists, play an important role in the interpretation of the electrocardiogram [3,4] ...

To obtain these leads using a cardiorecorder (1), a three-wire unmarked electrode cable (23) is connected to it and external electrodes are applied to three limbs (arms and left leg) (26) To remove each of the reinforced leads mentioned above, any two wires of this cable connected to external electrodes (26) installed on two limbs (their signals go to the signal combiner (11) (Fig. 10), and the cardiorecorder (1) itself is applied to the third limb, more precisely, its additional built-in electrode (12) (Fig. 3) This technique can be performed both by the tested person (43) and by his observer (45). An example of the removal of the enhanced lead aVF is given in Fig. 13.

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). All three signals go to the signal adder (11) (Fig. 10), and an additional built-in end electrode (12) is applied alternately to the desired positions (36) on the test subject's chest (Fig. 14 - positions V1, V2, ... V6 are marked ).

If the test person's hands are to be free, a four-wire electrode cable (23) is used, where there is a clip marked in white or symbol (V), or (C), or one of the cores (27) of the cable (23), which corresponds to the chest electrode. This clip can be connected to any of the electrodes (26) installed in the indicated (Fig. 14) positions according to Wilson or in another position.

The initial values of informative signs of the functional state, the shape of the electrocardiogram (47) and its characteristics for subsequent comparison in dynamics are obtained using cardiorecorders (1) in a comfortable state for the tested (43), against the background of good rest, in a pose as close as possible to further research. and store them in cardiorecorders (1), in the memory of personal mobile communication devices (42), in the memory of computers used, in virtual personal accounts (51) of the tested (43), located on the web server of the Internet portal (46), and also ( not shown) in the cloud storage of the Internet (39).

Registration and transmission of electrocardiograms (47) to the web server of the Internet portal (46) is performed

- 14 036792 without fail in cases of complaints of the tested about the deterioration of health, when objective signs of their unsatisfactory functional state are identified, as well as during stress tests with maximum physical efforts of the tested, and in other cases, data transfer to the web server is carried out only in a planned manner - to periodically update the initial indicators of the tested in their virtual personal accounts.

Registration of the entire standard complex of 12 (twelve) electrocardiogram leads (47), adopted in clinical practice and sports cardiology [3, 4], or other electrocardiographic leads indicated by an expert operator of the medical center (41), is carried out using the system tools according to the first invention when creating a virtual personal account (51) tested on a remote web server (38), as well as by the decision of a specialist of another organization, (54-58), exercising direct control over the tested, while saving the registered leads in personal mobile communication means (42 ), computer memory (40) used by the mentioned specialist, in the virtual personal account (51) of the person being tested, as well as in the cloud storage of the Internet; in other cases, the electrocardiogram is removed and transmitted to the web server (38) in only one lead, which is quickly accessible and convenient for each tested person (43) separately, indicating the type of this lead; and only at the request of the operator-expert of the medical center (41), they begin to remove and transfer the entire standard set of leads, or individual leads indicated by him.

Individuals with an unsatisfactory functional state carry out night monitoring of their electrocardiograms using the system (37) and connecting the workplaces of their observers and involved specialists from other organizations (54-58) to virtual personal accounts (51) of these tested, while the night monitoring data is displayed in these virtual personal accounts (51) of the tested with the maximum possible approximation to real time and save this data on the connected workstations (40, 44, 54-58) of the system, and if signs of deterioration in the functional state of such test subjects are detected, measures are taken to provide them with urgent medical help.

In addition, at night hours of the day, control over the condition of the test takers who are at home and in need of cardiological control is carried out using the above system (37) and with the involvement of ambulance station specialists, whose workplaces are also connected to the virtual personal accounts of such test takers. , and notifying the station operator on duty about the need for such cardiac monitoring by a specialist.

In the context of the automation of the system's web server, the connection of virtual personal offices of such test subjects to the workplaces of the ambulance station specialists and the workplaces of other rescue services can be carried out automatically, with the issuance of alarms and messages in the mentioned personal offices of the tested.

Below are additional explanations and examples of using the mass remote cardiac monitoring system.

Within the framework of the proposed system (37), expert operators of the medical center (41), specialists from other organizations (54-58), as well as observers (45), to perform their functions, can use their personal personal mobile communication means (42) (smartphones / tablets ) with mobile applications installed on them, as well as personal personal computers with software installed on them. With the help of all the listed electronic means, remote monitoring of the state of the tested (43) is carried out in accordance with the existing conditions and the assigned tasks.

By mutual agreement of the administration of the web portal (46) and the administrations of the mentioned institutions (54-58), many specialists will be able to carry out their research and management tasks, provide advisory services, not being limited by the walls of their institutions, and not adhering to their work schedule. For example, by agreeing on a duty schedule, expert operators of a medical center (41) will be able to advise and give recommendations to test subjects (43) and their observers (45) around the clock, and this is a great need among the population.

Various studies related to the control of the state of the heart will be able to be carried out by physiologists, coaches and sports doctors, teachers and physical education teachers, treating physicians of test subjects, employees of secure facilities, and employees of the armed forces. And although many studies can be performed on the basis of computers equipped with radio modems (30, 52), it is important for each specialist to have the opportunity to receive urgent remote consultation from a highly qualified cardiologist who works as an expert operator at a remote medical center (41).

Connecting radio modems (52) to computers of workstations (40,44, 54-58) allows specialists to carry out group cardiomonitoring in the absence of the Internet or the impossibility of connecting to it. And this increases the likelihood of early identification of persons who may need medical assistance.

In the conducted research, the mobile computers of observers and specialists can be located, depending on the tasks and conditions of the research, on different sides of the tested (43),

- 15 036792 or can be lined up, in a star, in a ring to ensure reliable reception of group data, including when moving (moving) the tested. By forming a local network (53) on the basis of radio modem systems connected to mobile workstations (52), the participants of the experiment can constantly exchange data on the state of the tested, transmitting them from one computer to another at a frequency specified in the modem (52).

In a similar way, it is possible to organize monitoring of the state of metro drivers, city transport drivers, observation of marathon participants, cross-country skiing, biathlon, rowers, rowing canals, cyclists, etc.

At the direction of the doctor, persons who do not have direct access to the Internet, but who have all the signs of stress, can connect their heart rate recorders (1) to this network at the end of a work shift or training, while at home, in order to transmit the ECG to a web server ( 38) and get the opinion and forecast of an experienced operator-expert.

By the decision of the latter, to conduct night monitoring of the heart in order to exclude the risks of possible complications, such a procedure can also be carried out by means of an appropriate mode of operation of the web server (38) and taking an ECG using a connected electrode cable (23) and external electrodes (26). Observers (45), using their mobile communication means (42) to contact the web server (38), as well as specialists from the organization of rescue services (58), for example, station doctors, can be involved in monitoring the state of the test person (41) at night. ambulance, whose workplaces can also be connected to a web server (38).

Under the conditions of a ban on the use of the Internet and the use of a departmental radio network, the built-in radio modems (30, Fig. 2) of the cardiac recorders (1) and external radio modems (52) connected to the observers' computers (45) are tuned to the indicated radio frequencies and used for cardiac monitoring of the tested. In this case, the data exchange between the computers of several observers (44) is carried out, if necessary, at other radio frequencies, with the formation of a local network by modems.

The proposed system of mass remote cardiological monitoring is open for the participation of foreign experts and organizations, which, in agreement with the administration of the web portal (46), can also post their conclusions and forecasts in virtual personal accounts (51) of the tested (43). In difficult cases, thanks to a remote consultation of doctors with different work experience, it is possible to make the optimal decision about treating a patient or admitting an athlete to competitions, etc.

The structure of the system (37) can potentially include workplaces of specialists of various organizations - health and fitness centers, transport, industrial, military and other organizations, where preventive measures are taken to preserve the health of workers.

In addition to the above features of the system and method of mass remote cardiological monitoring, there are other features and capabilities that increase their effectiveness.

So, thanks to the exercise mode provided in the cardiorecorders (1) of the system (37), their users can get a numerical assessment of their physical fitness and save the test electrocardiogram on their mobile communication device (42) and web portal (38), in a virtual personal office (51). For example, after performing the Ruffier test, widely known in sports medicine (30 squats in 45 s), the tested person receives an automatically calculated Ruffier index (RI) on the cardiorecorder, taking into account the heart rate at rest, after squats and after 1 min of recovery. The test result and the electrocardiogram (for example, a student or a pensioner) can be sent via the web port (38) to a specialist of an educational institution (56), a specialist of a sports center (57), a specialist of a scientific and practical center of sports medicine (55) and in case of problems with an ECG, any of them can consult with a colleague, or indicate the need for a deeper ECG examination and forward the ECG to a medical center (41) or a scientific and practical center of cardiology (54) to clarify the diagnosis, and then give recommendations to the test taker. Thus, the means of the system have formed new direct and cross connections between its elements, which increases the reliability of its functioning and information content, scientific potential and practical significance.

The Rufier test with electrocardiogram recording (47) can be easily performed wirelessly, using electrodes (8, 12, 13) built into the cardiorecorder (1). If an ECG recording is required, a mobile application and a smartphone or tablet are used (42). For veloergo-metric testing or a test on a treadmill, an electrode cable (23, Fig. 6, 8) with external electrodes (26, Fig. 8, 11) must be used, which are applied to the body of the tested person (43). The cardiorecorder (1) itself can be attached to the clothes of the person being tested using the end electrode (13) (Fig. 16).

ECG records during a test with maximum physical efforts of the test subjects must be saved on their mobile communication devices and (or) on the specialist's computer (which can be done using a connected radio modem), and are stored in virtual personal accounts (51) of the test subjects (43). This is necessary for recording the progress of a test carrying significant health risks, and the subsequent detailed study of regulatory processes in the body of the test subject (43), analysis of his functional portrait. The preservation of such data can be of great diagnostic value during the further repetition of such a test. , it is necessary for the selection of promising athletes, etc.

For visual and automatic detection of abnormal changes in electrocardiograms (47) and informative signs of the functional state of the test subjects (43) during their treatment, professional activity or physical training, for each test person (43) separately, their so-called individual corridors of permissible values of such informative signs are formed ... This corridor is determined by the minimum and maximum values of these signs, revealed from the records of electrocardiograms in the phases of complete rest (for example, sleep) of the tested person (43) and during his maximum physical load, performed with good health. The exit of this or that indicator from this individual corridor will most likely indicate negative changes in the ECG. These individual corridors of signs are also stored in personal mobile communication devices (42), personal computers of observers (45) and in virtual personal accounts (51) of the tested.

When organizing operative cardiomonitoring of athletes, their electrocardiograms (47) are recorded in the resting phases, before training, then - warm-up, peak load, its completion and in the recovery period, when rhythm disturbances and other electrocardiogram anomalies are very likely. In such studies, all ECG records are made, as noted above, in the same lead that is quickly accessible and convenient for the tested (43) lead. The dynamics of the functional state of the body of athletes (43) is assessed by their observers (45), operators-experts of the medical center (41), specialists from other organizations (54, 55, 57). They do this both by the ratio of informative features in the indicated phases of one training, and by the dynamics of the ratios of the same features obtained in the same phases of different trainings. In this case, in the case of complaints of an athlete (43) about the deterioration of health in the process of physical training, his electrocardiogram (47) is sent to the web server (38) for the purpose of its analysis by specialists (41, 54, 55, 57) and save it in virtual personal account (51), as well as in the cloud storage of the Internet.

Personal readout and transmission of electrocardiograms (47) of the tested (43) to the web server (38) at night is performed, if necessary, continuously, with the display of these electrocardiograms and automatically calculated informative signs in virtual personal offices (51) of the tested, to which connect the workplaces of duty specialists and observers (40, 44, 54-58). On the basis of visual control of informative signs, or with the help of programs for their automatic analysis installed on the computers of the workstations of the system, deviations in the form and parameters of the ECG of the tested (43) are detected in relation to the norm adopted by specialists.

However, for greater reliability of the diagnostic conclusions, the initial forms of ECG leads and the values of informative signs, which, according to the acquisition of cardiac recorders (1) and upon opening of these virtual personal offices, are introduced into the mentioned personal virtual offices (51) of the tested (43). opportunities, they receive in a comfortable state for the tested, against the background of good rest and in a posture as close as possible to the upcoming research. Such information, like biometric data, is also stored in personal mobile communication means (42) of the tested (43) and their observers (45), as well as on the web-portal (38), in virtual personal accounts (51) of these tested (43) and in the cloud storage on the Internet.

Thanks to such data, the observers themselves (45), as well as specialists of organizations (54-57) participating in night cardiological control, will be able to detect unfavorable changes in the ECG faster and more accurately and notify other specialists about this, including rescue service specialists ( 58).

At home, long-term and continuous cardiac monitoring can be performed by the test subjects themselves (43) or their observers (45), for example, family members, relatives, using cardiac recorders (1) and personal mobile communication devices (42), or home computers equipped with a radio modem (52). In this case, the connection to the web server (38) is optional if the corresponding mobile applications and programs are installed on the named devices. An ECG is taken using an electrode cable (23) and external electrodes (26) applied to the body in a convenient lead for the tested (43). If the person being tested (a child, a cardiac patient, an infected patient, etc.) is in an isolated room, the observer can receive alarms and messages via Bluetooth or an installed radio modem (52). If signs of a threatening condition are detected, the observer (45) can establish a connection with the web portal (46) and request advice from an expert operator of the medical center (41), or immediately address his request to a rescue service specialist (58), who, having familiarized himself with the nature of the ECG of the person being tested (43), will decide on the need to visit the test person or the importance of preliminary removal of other ECG leads, etc.

This tactic of home cardiac monitoring is extremely important for people with chronic ischemic heart disease who have had myocardial infarction, as well as who suffer from frequent episodes of atrial fibrillation, respiratory or cardiac apnea, when there is a high risk of stroke, repeated myocardial infarction, ventricular fibrillation and other complications , in which the doctor's visit to the patient is considered urgent.

Healthy people can use a cardiorecorder (1) at home to regularly perform the above-described stress test, as well as to monitor the ECG during various types of operator activities, including during prolonged work at a desk, at a computer (Fig. 15), during work on the simulator (Fig. 16), watching TV, knitting, etc.

The electrode cable (23) with a small number of wires allows you to take an ECG without causing any special discomfort and free the test person's hands (43) for the upcoming activity, and the radio modems (30) and (52) provide wireless transmission of the ECG to a home computer. Thus, the user of the cardiorecorder (1) does not distract the operators of the experts of the remote medical center without sufficient reason (41) and does not spend extra money on Internet communication and interaction with the remote medical center (41).

In addition to home conditions, personal recording and wireless transmission of ECG to the observer's workplace (45) or to a remote web server (38) is also performed, and if necessary, continuously, while driving land vehicles, air vehicles, sea and river vessels. , with the subsequent transfer of data through the aforementioned web server (if we are talking about employees) to a specialized (industry, departmental) medical center for monitoring their condition, and if objective signs of an unsatisfactory condition of the test subjects are identified (43), this data can be immediately transferred to the organization rescue services (58) to decide on the need to provide urgent medical care to those in need.

Personal recording and wireless transmission of ECG to a remote web server (38) is similarly performed during hiking trips, mountain climbing, scientific expeditions, military exercises, peacekeeping missions, etc., and in the absence of the Internet, cardiac monitoring is carried out using radio modems ( 30) and (52), connected to mobile computers of specialists and observers. Upon returning to the coverage area of this network, the data of the test takers is transferred to their virtual personal accounts (51).

When carrying out cardiac monitoring at high-security facilities where a departmental radio network is used, the appropriate frequency setting is performed in radio modems (30) and (52), and the ECG of the tested and other collected data is transmitted from mobile computers to the departmental server on a hard drive.

For the effective operation of the system (37) on the basis of the mentioned radio modems (52), the computers of specialists and observers (45) equipped with them are located within the range of radio modems (30) of the cardiac recorders (1), and when moving (moving) the tested (43) over long distances they organize placing a group of mobile computers along the route of their movement, with the configuration of the local network determined by the nature of this route (in a line, ring, star, etc.), or provide transportation of mobile workplaces of observers (44) in the direction of the test subjects (43), creating the possibility of continuous monitoring of their condition. For this, mobile workstations are provided with backup power supplies, remote antennas for the efficient operation of radio modems (52), means of monitoring the location of the tested, etc.

If objective signs of an unsatisfactory functional state of any of the tested (43) are detected, or his condition deteriorates when performing assigned professional tasks, operator functions or physical training (for example, in military affairs), the initial personal data of the tested (43), located in his virtual personal account (51), either stored in the memory of the mobile communication device (42), or located in the database of the observer's mobile computer (45), as well as the current ECG record is transmitted via a remote web server (38), or via a local network (53) to the workstation of the (mobile) rescue service (58), indicating data on the location of the person being tested (43) or automatically reading his coordinates using the global positioning system GLONASS, GPRS, etc., and the rescue service specialists (58) take measures to provide the necessary assistance to those in need.

Emergency medical services remain the central rescue service in most countries. However, in different areas or at night, the rate at which she provides health services may vary. Therefore, in the absence of a confirmation from the operator of such a station about leaving to the person in need in a given period of time (for example - 20 minutes), a request for assistance in the form of delivery to a medical institution is sent via the Internet or available instant messengers to other rescue services, for example - Ministry of Emergency Situations, Ministry of Internal Affairs, OSVOD, etc., with which they conclude appropriate agreements on cooperation.

In the absence of confirmation of the readiness to provide assistance from the mentioned rescue services, a request for its provision is sent to other public services (for example, taxi dispatch services, express delivery, emergency services of energy, gas, water utility, elevators, etc.), with which they also preliminarily conclude agreement on the provision of similar forms of assistance.

When using the above features and capabilities of the mass remote cardiological monitoring system, a higher efficiency of detecting cardiovascular disorders in various population groups will be ensured and losses from disability of citizens who will receive timely medical care will be significantly reduced.

The considered system (37) makes it possible to increase the accessibility, comfort, efficiency and reliability of monitoring and self-monitoring of the state of the heart, as well as the overall efficiency of using the system of mass remote cardiac monitoring, built on the basis of created and tested in practice cardiac recorders (1). System (37) is capable of providing mass and remote monitoring of the functional state of large groups of people, in various, including non-stationary conditions, both via the Internet and in its absence.

With the development of telemedicine and the range of consulting services being developed, the number of clients of remote cardiac monitoring systems will grow rapidly. The configuration of the system (37), due to the rational use of all its capabilities, will significantly reduce the load on the expert operators of the medical center (41) and its capacity will be increased in relation to people who really need urgent consultation and urgent medical care.

The proposed inventions will significantly expand the scope and conditions for the practical application of the mass remote cardiac monitoring system. For example, it will make it possible to organize effective night monitoring of the state of cardiac patients, which is not provided for by the prototype [2] and known analogs [1,6].

It is also possible to massively use inventions in the education system (to strengthen medical and pedagogical control over the health of schoolchildren, students and students), in the field of sports, tourism and sports medicine (for the prevention of frequent cases of sudden cardiac death of young athletes and sports veterans, group performance stress tests), in production (to identify health threats and ensure the safety of closed objects), in the domestic sphere (for night cardiac monitoring, safe management of personal and public and private transport, etc.), in scientific research (when conducting experiments related to extreme conditions of stay and human activity), etc.

Information sources:

1. Electronic resource: www.atesmedica.ru. Access date 03.08.2017.

2. Patent US 9026202, IPC А61В5 / 00, А61В5 / 04, priority 14.04.2014, published 05.05.2015 (prototype).

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

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

5. Heart rhythm 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 / Otv. ed. N.I. Shlyk., P.M. Baevsky - Izhevsk: Ed. Center Udmurt University, 2016 .-- 306 p.

6. Application ITPI 20130096, IPC А61В 5/0404, А61В 5/0408, А61В 5/0404, priority 03.12.2013, published 04.06.2015.

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

Claims (12)

CLAIM 1. The system of mass remote cardiological monitoring (37), which includes workstations of expert operators (40) of the medical center connected via a web server (38) of the Internet, as well as portable cardiac recorders ( 1), which are supplied to the tested and which are made with two front electrodes (8) located on the front panel, while the cardiorecorder contains a connector (7) for connecting an electrode cable (23) with external electrodes (26) and an autonomous power supply unit (3) connected to an electronic unit (4) with a programmable microcontroller (10) and controls (6) and settings (16), a display (5), a speaker (15), as well as a Bluetooth communication module (14) connected wirelessly with mobile communication device (42), and at least one cardiorecorder is additionally equipped with two end electrodes (12, 13) connected to the electronic unit (4), and contains a connector (9) for recharging an autonomous power supply unit (3), in addition, a web server (38), workplaces of expert operators (40) and mobile communication facilities (42) are provided with software for long-term and continuous data reception and transmission, including at night, characterized in that the front electrodes (8) and one of the end electrodes (12) are made as capacitive electrodes, while the other end electrode is made of a conductive material and is connected to the electronic unit (4) as a reference electrode, while at least one cardio recorder (1) also contains a signal combiner (11) connected to the electronic unit (4), and three inputs of the combiner (11) are connected to the connector (7) for connecting the electrode cable (23) with external electrodes (26), and the output adder (11) is connected to one of the inputs of the electronic unit (4) together with one of the front electrodes (8), while the other - 19 036792 front electrode (8) is connected to another input of the electronic unit (4) together with one of the end electrodes (12) and the fourth input of the connector (7), and the system (37) itself additionally contains the workplaces of observers (44) and specialists other organizations (54-58), which are also provided with mobile communication facilities (42) connected to a web server (38), and on which software tools are installed for connecting to virtual personal accounts (51) of the tested and online viewing of their ECG, while web server software (38) is supplemented with software for online display and analysis of ECG trends in their virtual private offices (51), while a programmable microprocessor (10) is configured to install a continuous ECG transmission mode in the cardiac recorder (1) and load test mode, and to maintain long-term performance to the cardiorecorder (1), including at night, an external source is connected through the connector (9) IR autonomous power supply type PowerBank. 2. The system according to claim 1, characterized in that at least one cardiorecorder (1) and at least one of the workplaces of expert operators (40), and / or observers (44), and / or specialists from other organizations (54- 58), in addition to Bluetooth modules, are additionally equipped with other radio modems (30, 52), tuned to communicate in a different frequency range and made with the ability to tune their operating frequency. 3. The system according to claims 1-2, characterized in that at least one of the mentioned workplaces (40, 44, 54-58) is installed on the vehicle and made with the possibility of its operation during its movement. 4. A method of mass remote cardiological monitoring, including personal reading of their electrocardiograms (ECG) by the tested and their transmission to a remote web server (38) of the mass remote cardiac monitoring system (37) using mobile communication means (42), with subsequent storage of the ECG in virtual personal offices (51) and ECG analysis by experts (40) of the medical center, characterized in that the system according to any one of claims 1 to 3 is used to collect data, while along with the ECG recording of rest during the daytime, the test subjects record the ECG at night during sleep, as well as when performing tests with a dosed physical load, which is set, inter alia, by the applied cardiorecorder (1), putting it into the stress test mode; in addition, the test-takers register the ECG in the conditions of their industrial activity or study, sports training, tourist trips, experiments related to the scientific study of a person, his stay in extreme living conditions, while the test-takers make notes in their virtual personal accounts about the nature of the study, the place its conduct, the type of ECG derivation used, the characteristics of well-being and other factors that are significant in their opinion. 5. The method of cardiomonitoring according to claim 4, characterized in that the recording and analysis of the ECG from the test subjects is also carried out by their observers (45) and specialists from other organizations (54-58), who are also provided with mobile communication means (42) connected to the web -server (38), and on which software tools are installed for remote viewing of data and ECG of the participants in the experiment and dialogue with the expert operator on duty (40) of the medical center, while both observers and their test subjects can move in vehicles equipped in accordance with paragraph .3. formulas. 6. The method of cardiac monitoring according to claims 4-5, characterized in that in the absence of an information network (39), disconnection of the web server (38), or restrictions on the use of personal mobile communications (42), ECG registration is carried out by the system according to claim 2, while the research results are then transferred from the workstation of an expert operator (40) or observer (44) to a web server (38) using a solid-state memory card or after restoring Internet communications. 7. The method of cardiomonitoring according to claims 4-5, characterized in that the primary diagnosis of the heart is carried out by the subjects themselves or their observers, using a cardiorecorder (1) and taking with it the most quickly accessible and convenient (given the circumstances) ECG lead, and this they carry out primary diagnostics according to the numerical values of the informative signs of the ECG, reflected on the symbolic-digital display (5), as well as the color of this display and voice messages coming from the speaker (15), and the reliability of the estimates is associated with the correctness of the settings on the said display (5 ) symbols of testing conditions (rest / load) and individual parameters of the tested person (gender / age). 8. The method of cardiac monitoring according to claim 7, characterized in that in the case of receiving alarms and messages from the cardiorecorder (1), the primary diagnosis of the heart is also carried out using a mobile communication device (42) provided with software for automatic ECG analysis or at least , comparing the shape of averaged cardiocycles (P-QRS-TU waves) of the just recorded ECG and the set of ECG signals previously recorded in the same lead and under the same conditions (rest or load) of ECG signals, and this set of signals is presented on the screen as a loop ECG cycle with the width of the boundaries determined by the extreme amplitude parameters from all previously recorded cycles. 9. The method of cardiomonitoring according to any one of claims 4-8, characterized in that said primary diagnosis of the heart is carried out by preliminary searching for the highest-amplitude response - 20 036792 ECG leads or leads recommended by an expert operator (40) or a specialist from other organizations (54-58). 10. The method of cardiac monitoring according to any one of claims 4-9, characterized in that at the stage of creating a virtual personal account (51) on the server (38), their tested observers (45) sequentially remove the entire complex of 12 standard ECG leads and other necessary leads , which are then stored in the memory of personal mobile communication devices (42), the memory of the computers of expert operators (40) of the medical center, in virtual personal offices (51) of the tested, as well as in an independent cloud storage on the Internet, with subsequent comparison of the captured ECG signal and the corresponding lead stored in the memory of the named devices, not only for diagnostic purposes, but also for the purpose of identifying the identity of the person being tested, located remotely. 11. The method of cardiomonitoring according to any one of claims 4-10, characterized in that when using the system according to claims 1 to 3 and performing a test with a dosed physical load by using a cardiorecorder (1) switched to the stress test mode, the test subjects or their observers it is imperative to register the stress ECG on the web server (38), saving it in a virtual personal account (51) with a corresponding note about the nature of the study, and also save it in their own mobile communication devices (42), otherwise it is considered that physical activity was out of control. 12. The method of cardiomonitoring according to any one of claims 4-11, characterized in that at night the test subjects attributed to the risk group (cardiac patients, elderly persons, operators of responsible or dangerous industries, intensively training athletes, persons with a clearly worsening condition) , as well as interested parties conduct ECG monitoring with the involvement of observers (45) and / or expert operators (40) of the medical center, while the monitoring data is displayed and stored in virtual personal accounts (51) of the web server (38) and upon detection observers or expert operators of signs of the emergence or growth of ECG pathology, work places of workers of other organizations (54-58), in particular, workers of rescue services (58), are connected to observation, and their workplaces are mobile communications connected to a server (38 ), or equipped in accordance with clauses 2-3 of the system.