JPH11151218A - Judgement method and device for supraventricular extrasystole - Google Patents

Abstract

PROBLEM TO BE SOLVED: To surely judge supraventricular extrasystole. SOLUTION: Whether or not a heart rate waveform with prolepsis is present in an inputted electrocardiogram waveform is judged in prolepsis judgement steps A1-A5, and in the case of judging that the heart rate waveform with the prolepsis is present in the prolepsis judgement steps A1-A5, whether or not an ectopic P wave is present in the heart rate waveform is judged in ectopic P wave judgement steps A6 and A7. Then, in the case of judging that the ectopic P wave is present in the ectopic P wave judgement steps A6 and A7, it is judged as the supraventricular extrasystole in a supraventricular extrasystole judgement step A8.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a method and an apparatus for determining supraventricular extrasystole on an electrocardiogram waveform.

[0002]

2. Description of the Related Art Conventionally, as a method for judging supraventricular extrasystole, attention is paid only to the rhythm at which an R-wave is generated, and intercalation and compensatory properties, which are one of the features of supraventricular extrasystole, are considered. The supraventricular extrasystole was detected by detecting a rhythm determined from the extrasystolic heartbeat and the heartbeat before and after it, such as decompensation.

[0003]

However, the prior art has the following problems. The first problem is
In the case of a single supraventricular extrasystole, the characteristic rhythm of the above supraventricular extrasystole may appear remarkably, but if repeated, the characteristic of this rhythm is lost,
This means that supraventricular extrasystole cannot be detected.

[0004] The second problem is that even in the case of a single supraventricular extrasystole, the characteristic rhythm of the supraventricular extrasystole described above may not appear remarkably. The supraventricular extrasystole cannot be detected.

[0005] The third problem is that respiratory arrhythmias and sinus arrhythmias may also be accompanied by the characteristic rhythm of supraventricular extrasystole described above. Erroneous diagnosis of supraventricular extrasystole in a case in which must be detected. This example has been clinically very problematic due to the different methods of treatment.

As described above, a diagnostic method that focuses only on the rhythm in which an R-wave is generated, which is one feature of supraventricular extrasystole, can detect all supraventricular extrasystoles in principle. There was a possibility that a heartbeat that could not be performed and that was not a supraventricular extrasystole was misdiagnosed as a supraventricular extrasystole.

The present invention has been made in view of the above problems, and an object of the present invention is to provide a method for judging supraventricular extrasystole capable of reliably judging supraventricular extrasystole. And a device.

[0008]

SUMMARY OF THE INVENTION The gist of the present invention is to provide an earlyness determining step for determining whether or not an input electrocardiogram waveform has a heartbeat waveform having an earlyness. When it is determined that a certain heartbeat waveform exists, an ectopic P-wave determination step of determining whether or not the heartbeat waveform includes an ectopic P-wave, A supraventricular extrasystole determination step of determining a supraventricular extrasystole when it is determined that a wave is present.

Further, the gist of the present invention is to provide an earlyness judging means for judging whether or not an input electrocardiogram waveform has an earlyness heartbeat waveform, and to provide an earlyness judgment heartbeat waveform in the earlyness judgment means. When it is determined that there is an ectopic P wave in the heartbeat waveform, it is determined that there is an ectopic P wave in the heartbeat waveform. There is provided a supraventricular extrasystole determination device, which comprises supraventricular extrasystole determination means for determining that the supraventricular extrasystole is determined when the determination is made.

[0010]

Embodiments of the present invention will be described below in detail with reference to the drawings. FIG. 1 is a block diagram showing a circuit configuration of one embodiment of an electrocardiograph to which the method for determining supraventricular extrasystole of the present invention is applied. In this figure, signals obtained from a plurality of induction codes 1 are converted into digital signals by an A / D converter 3 after being amplified by an amplifier 2 and input to an MPU 4. 5 is an operation panel for performing various inputs, 6 is an LCD for performing various displays, and 7 is a thermal recorder for recording an electrocardiogram waveform output from the MPU 4.

Next, the operation of this embodiment will be described. FIG. 2 is a flowchart showing a routine for judging supraventricular extrasystole among the operation routines of the electrocardiograph shown in FIG.

In FIG. 2, digital filtering processing such as noise removal of hum or the like by smoothing (summation averaging processing) is performed on an input electrocardiogram (for example, an electrocardiogram waveform of lead II for 20 seconds in this example), The peak of the R wave for each heartbeat is detected and its position is determined (step A1).

Next, based on the position information of the R wave obtained in step A1, each sparse wave (P, Q, R, S,
Recognize the start and end points of the T wave (step A)
2). FIG. 3 is a diagram showing an example of the positional relationship between the heartbeat waveform and each sparse wave. The start and end points of each sparse wave are obtained by secondarily differentiating the electrocardiogram waveform to extract an inflection point, and the position of the inflection point. From FIG.
Is obtained based on the relationship shown in FIG.

Further, each sparse wave (P, Q, R,
Based on the positions of the start and end points of the (S, T waves), the time width and amplitude value of each sparse wave for each heartbeat are calculated (step A3).

Next, based on the position information of the R wave obtained in step A1, it is detected whether or not there is earlyness (step A4). Here, the earlyness means that the time interval (R-R interval) between the target heartbeat and the preceding heartbeat is 10 times shorter than the time interval between the heartbeat one beat before and the preceding heartbeat.
If it is reduced by more than%, it is judged that there is earlyness, and if it is not, it is judged that there is no earlyness. As an example, in the electrocardiogram waveform shown in FIG. 4, the time interval between heartbeats B and C is almost equal to the time interval between heartbeats A and B preceding it, so that heartbeat C has no earlyness. Since the time interval between the heartbeats C and D is considerably shorter than the time interval between the preceding heartbeats B and C, it is determined that the heartbeat D has earlyness. You.

Among the arrhythmias, the extrasystole refers to one that causes an excitement earlier than the cardiac cycle of the basic rhythm. For this reason, the extrasystole has a characteristic that it occurs slightly before the place where it is supposed to occur in normal sinus rhythm (from the left side on the recording paper). In this way, the heartbeat with the characteristic of having earlyness is suspected of the possibility of extrasystole,
This feature of earlyness is one important factor in diagnosing extrasystole.

The heartbeat determined to have earlyness proceeds to step A6 and thereafter, where the shape of the P-wave is examined as described below. Since the condition is not satisfied, the process proceeds to step A9, and it is determined that the supraventricular extrasystole is not present (step A5).

Next, in step A5, the rate of change between the amplitude value of the P wave of the heartbeat determined to have earlyness and the average amplitude value of the P wave of the heartbeat determined to have no earlyness is calculated. Calculation is performed (step A6). At this time, the average amplitude value of the heartbeat group determined to have no earlyness is calculated in advance, and each time it is determined that there is no earlyness in step A5, the amplitude value of the P wave of the heartbeat (this value itself is determined in step A3) The average value has been recalculated each time.

If the rate of change calculated in step A6 exceeds a predetermined threshold value, the P-wave shape of the heartbeat determined to have earlyness is changed to the heartbeat determined to have no earlyness. It is determined that the shape is different from the group P-wave shape (step A7), and it is finally determined that there is an ectopic P-wave characterized by supraventricular extrasystole. The supraventricular extrasystole is accompanied by a P-wave having a different shape compared to the heartbeat of normal sinus rhythm because the stimulus is generated from a site in the atrium different from the sinus node where the original stimulus occurs. This P-wave having a different shape is called an ectopic P-wave, and this feature is one important factor in diagnosing supraventricular extrasystole.
In the example of FIG. 4 described above, an ectopic P wave is generated in the heartbeat D.

Finally, the heartbeat determined to satisfy the necessary and sufficient conditions for the supraventricular premature contraction involving the ectopic P wave in addition to having the earlyness is the supraventricular premature contraction (Step A8), and the heartbeat is diagnosed as supraventricular extrasystole. On the other hand, although ectopic P
Since the heartbeat determined not to have a wave does not satisfy the necessary and sufficient condition for supraventricular extrasystole, it is diagnosed as not supraventricular extrasystole (step A9).

Therefore, the present embodiment has the following effects. The first effect is that supraventricular extrasystole can be reliably detected. The reason is that, in addition to the characteristics of the early nature, by examining the shape of the P wave, there is a determination process regarding the characteristics of the ectopic P wave.

The second effect is that steps A2 and A3 in FIG.
As described above, by using the ECG segmentation point (start / end point) recognition and measurement processing realized in the conventional ECG analysis processing, it is easy to add different processing without adding any new processing. The feature is to be able to verify the characteristics of the ectopic P-wave.

In the above-described embodiment, the case where the supraventricular extrasystole is detected based on the electrocardiogram of lead II for 20 seconds has been described. However, the lead may be other than lead II, and the type of lead and its The length of time is not limited.

FIGS. 5 and 6 are flow charts showing a routine for judging supraventricular extrasystole among the operation routines of the electrocardiograph according to another embodiment of the present invention. In this embodiment, the process of detecting the shape of the P wave is performed by limb guidance (I, II, aV).
R, aVL, aVF) and chest leads (V1, V2, V3, V4, V5, V6)
It is characterized in that each of them has an independent configuration.

That is, the processing for determining the earlyness (steps B1 to B5) is the processing shown in FIG.
1 to A5), but in the process of detecting the shape of the P wave of each lead, the shape of the P wave is detected independently (steps B6 to B7, steps B8 to B9), and the limb lead and the chest If an ectopic P-wave is detected in any of the leads, supraventricular extrasystole is diagnosed (step B10).

In the present embodiment, the present invention is not limited to this, and can be applied to a preferable one in applying the present invention. Further, the number, position, shape, and the like of the constituent members are not limited to the above-described embodiment, but can be set to numbers, positions, shapes, and the like suitable for carrying out the present invention. In the drawings, the same components are denoted by the same reference numerals.

[0027]

Since the present invention is configured as described above, it is possible to provide a method and an apparatus for determining supraventricular extrasystole, which can reliably determine supraventricular extrasystole. This has the effect.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a circuit configuration of an electrocardiograph according to an embodiment of the present invention.

FIG. 2 is a flowchart for explaining the operation of one embodiment.

FIG. 3 is a diagram showing an example of a heartbeat waveform.

FIG. 4 is a diagram showing an example of an electrocardiogram waveform.

FIG. 5 is a flowchart illustrating an operation of an electrocardiograph according to another embodiment of the present invention.

FIG. 6 is a flowchart following FIG. 5;

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Induction code 2 Amplifier part 3 A / D conversion part 4 MPU 5 Operation panel 6 LCD 7 Thermal recorder

Claims (10)

[Claims] 1. An earlyness determining step of determining whether or not an input electrocardiogram waveform has a heartbeat waveform having an earlyness, and it is determined in the earlyness determining step that a heartbeat waveform having an earlyness exists. An ectopic P-wave determining step of determining whether or not the heartbeat waveform has an ectopic P-wave; and when it is determined in the ectopic P-wave determining step that an ectopic P-wave is present. And a supraventricular extrasystole determination step of determining a supraventricular extrasystole. 2. The method according to claim 1, wherein the earlyness determination step includes an R-wave detection step of detecting a position of an R-wave of a waveform for each heartbeat in the electrocardiogram waveform, wherein each heartbeat detected in the R-wave detection step is included. 2. The method for judging supraventricular extrasystole according to claim 1, wherein a time interval between heartbeats is calculated from the position of each R wave, and the earlyness is determined based on the time interval. 3. The ectopic P-wave determining step includes: a P-wave amplitude value calculating step of calculating an amplitude value of a P-wave of a heartbeat waveform determined to have earlyness; and a P-wave of a heartbeat waveform without earlyness. And a change rate calculating step for calculating a change rate between the average amplitude value of the P wave and the amplitude value of the P wave calculated in the P wave amplitude value calculating step, wherein the change rate calculated in the change rate calculating step is predetermined. 3. The method for judging supraventricular extrasystole according to claim 1 or 2, wherein it is judged that there is an ectopic P-wave when the value exceeds the threshold value. 4. The supraventricular property according to claim 3, wherein the average amplitude value of the P-wave is calculated using a P-wave of a heartbeat waveform determined to have no earlyness in the earlyness determination step. How to determine extra systole. 5. In the ectopic P-wave determination step,
The upper chamber according to any one of claims 1 to 4, wherein it is determined that there is an ectopic P wave in any of the heartbeat waveforms obtained from a plurality of leads. A method for determining premature contraction. 6. An earlyness judging means for judging whether or not an inputted electrocardiogram waveform has an early heartbeat waveform, and said earlyness judging means judges that an early heartbeat waveform exists. An ectopic P-wave determining means for determining whether or not the heartbeat waveform includes an ectopic P-wave; and when the ectopic P-wave determining means determines that an ectopic P-wave is present. Supraventricular extrasystole determination means for judging supraventricular extrasystole. 7. The earlyness determination means includes R wave detection means for detecting a position of an R wave of a waveform for each heartbeat in the electrocardiogram waveform, wherein each heartbeat detected by the R wave detection means is provided. 7. The method according to claim 6, wherein a time interval between heart beats is calculated from the position of each R wave, and the earlyness is determined based on the time interval.
The device for determining supraventricular extrasystole according to the above. 8. The ectopic P-wave determining means, comprising: a P-wave amplitude value calculating means for calculating an amplitude value of a P-wave of a heartbeat waveform determined to have earlyness; And a change rate calculation means for calculating a change rate between the average amplitude value of the P wave and the P wave amplitude value calculated by the P wave amplitude value calculation means, wherein the change rate calculated by the change rate calculation means is predetermined. The supraventricular extrasystole determination apparatus according to claim 6 or 7, wherein it is determined that there is an ectopic P-wave when the value exceeds the threshold value. 9. The method according to claim 1, wherein the change rate calculating means calculates an average amplitude value of the P wave using a P wave of a heartbeat waveform determined to be non-early by the earlyness determining means. 8. The method for judging supraventricular extrasystole according to 8. 10. The ectopic P-wave determining means determines that an ectopic P-wave is present when any of the heartbeat waveforms obtained from a plurality of leads has an ectopic P-wave. The method for judging supraventricular extrasystole according to any one of claims 6 to 9.