RU2193343C2 - Method for determining hardly diagnosable atrial extrasystolas - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves recording electrocardiogram and echocardiogram of transmitral blood circulation. Left ventricle early filling peaks E and left atrium systola A are selected and strobed on electrocardiogram. Stable repeating combinations of A and E peaks of regular rhythm are selected. A-peaks durations are determined. Atrial extrasystolas are diagnosed on ventricular QRS-complexes preceded by A-peaks of lesser duration than ones corresponding to regular rhythm. EFFECT: high accuracy of diagnosis. 3 dwg

Description

 The invention relates to medicine, namely to medical diagnosis, and is intended to determine atrial extrasystoles.

 There is a method of determining difficult to diagnose atrial extrasystoles, based on the registration of the atrial or intraesophageal electrocardiogram and conducting its contour analysis (analogue). The method provides high-voltage atrial P waves, clearly defined ventricular complexes QRS and thereby the determination of atrial extrasystoles according to generally accepted rules (V. Orlov. Guide to electrocardiography. - M .: Medicine, 1999. - 526 p.).

 However, the method, being a kind of stress test, is able to change the primary nature of extrasystole and has contraindications for use.

 Closest to the claimed (prototype) is a method consisting in recording an electrocardiogram from the body surface of the subject, conducting its contour analysis, establishing the correct rhythm at stable intervals between the ventricular QRS complexes, which are preceded and associated with them by stable temporal relationships, typical atrial P waves of sinus origin and determination of atrial extrasystoles by prematurely occurring ventricular QRS complexes, which are preceded by atrial P waves of a different shape than in the correct rhythm and with a shortened P interval - QRS.

 However, the method does not ensure the accuracy of determining atrial extrasystoles due to the low voltage level of atrial P waves, which is even common for healthy individuals, on an electrocardiogram recorded from the body surface of the subject, because of the possible aberration of the ventricular QRS complexes in the atrial (and atrioventricular) extrasystoles, the layering of the atrial form P waves to previous T waves or subsequent ventricular QRS complexes.

 The purpose of the invention is to improve the accuracy of the method.

 This goal is achieved by the fact that in the known method for determining atrial extrasystoles by recording an electrocardiogram from the body surface of the subject, conducting its contour analysis, establishing the correct rhythm at stable intervals between the ventricular QRS complexes, which are preceded and associated with them by stable time relationships typical in form, duration and intervals P - QRS atrial P waves of sinus origin and determination of atrial extrasystoles by prematurely occurring QRS complexes, which are preceded by atrial P waves of a different shape than in the correct rhythm and with a shortened P-QRS interval, characterized in that the Doppler echocardiogram of the transmissible blood flow is additionally recorded, peaks of early filling of the left ventricle of the heart E, systole of the left atrium A are isolated on it they are gated on an electrocardiogram, stably repeating combinations of peaks E, A of the correct rhythm are distinguished, durations of peaks A are measured by ventricular complexes of QRS, which are preceded by peaks A shorter duration than in the correct rhythm, atrial extrasystoles are diagnosed.

 The method is as follows. At the subject, electrocardiographic electrodes are placed on the legs and arms and connected with the patient’s cable to the electrocardiographic port of the echocardiograph operating in scanning and Doppler modes, for example, SIM 5000 PLUS type. The electrocardiographic signal is displayed on the display of the echocardiograph, and then the Doppler echocardiogram of the transmissible blood flow is recorded on the display in sync with the electrocardiogram from the apical access according to the generally accepted method. Stop recording. Peaks of early filling E, systole of the left atrium A and the linear cursor of the echocardiograph are gated on the Doppler echocardiogram of the transmissible blood flow, and they are strobed onto the electrocardiogram. Stable repeating combinations of peaks E, A and ventricular QRS complexes of the correct rhythm are distinguished. The durations of A. peaks are measured. Atrial extrasystoles are determined by those ventricular QRS complexes, which are preceded by A peaks of shorter duration than in the correct rhythm. Aberrant conduction of the atrial extrasystole to the ventricles does not complicate the determination of its type, since the presence of a shortened peak A is of primary importance for the diagnosis of QRS. The absence of peak A before the normal duration of QRS rejects the atrial nature of the extrasystole and indicates its origin from the atrioventricular node. Ventricular and aberrant atrioventricular extrasystoles are diagnosed by the absence of peaks A in front of the expanded QRS complexes.

 Example 1

 Patient A., 52 years old. Case history 234. He was admitted on January 15, 2001 to the cardiology department of the Voronezh City Clinical Hospital 20 with a diagnosis of coronary artery disease, angina pectoris FC II. Hypertension stage II; circulatory failure I degree.

 ECG from 01/15/2001. Sinus rhythm, single solitary atrial and ventricular extrasystoles. The horizontal position of the EOS. Amplitude signs of left ventricular myocardial hypertrophy.

 With Holter ECG monitoring (Cardiotechnics-4000 system) on January 16, 2001, a single atrial and ventricular extrasystole was revealed in a sharply pathological amount.

 Echocardiography 637 from 01/23/2001 (SIM 5000 PLUS system). The study was conducted with a 2.5 MHz sensor. Conclusion: The cavity of the heart is not expanded. The interventricular septum is not sharply (I st.) Thickened. The pulsation of the walls is often arrhythmic with sufficient amplitude. Valves are intact.

 In FIG. Figure 1 shows a copy of the Doppler echocardiogram of the transmitral blood flow (curve in the center) from the apical access (sectoral window at the top), recorded simultaneously with the ECG in the II standard lead (curve at the bottom).

 The first, second and fourth (from left to right) cardiocycles are normal: the “narrow” ventricular complexes of QRS are preceded by atrial P waves, and on the Doppler curve - peaks E and A, and the duration of peaks A is 0.137 s. The third cardiocycle is extrasystole with the usual "narrow" QRS complex. The atrial P wave in front of it is practically not determined. Extrasystole on the Doppler curve is preceded by peak A with a duration of 0.114 s. Figure 2 presents a copy of an echocardiographic study of the same patient, made two minutes earlier (12 hours 12 minutes). The third cardiocycle from left to right is extrasystole with a “narrow” QRS and with a previous peak A on the Doppler curve. The duration of this peak A is 0.122 s. Before extrasystolic QRS is clearly visualized, although the atrial P wave changed in phase and amplitude, i.e. this is atrial extrasystole. Thus, in FIG. 1, the atrial tooth P of the atrial extrasystole is layered on the end of the tooth T of the previous cardiocycle and has become practically inaccessible to recognition. Thus, it was not possible to establish whether the extrasystole is atrial or atrioventricular. Synchronous recording of the Doppler echocardiogram of the transmitral blood flow made it possible to establish that the QRS complex of extrasystoles is preceded by atrial contraction (peak A), i.e. extrasystole is atrial. The slightly longer duration of peak A in atrial extrasystole in FIG. 2, than in figure 1 it can be connected with the fact that the atrial extrasystole in figure 2 occurs later than in figure 1. This contributes to greater atrial filling and requires at the same rate of atrial contraction (peak amplitude) longer. However, in both cases, the durations of peak A in atrial extrasystoles were shorter than the duration of peak A in normal cardiocycles.

 Example 2

 Patient V., 60 years old (medical history 4410), was admitted on December 12, 2000 to the cardiology department of the Voronezh City Clinical Hospital 20 with a diagnosis of Stage II hypertension. IHD, atherosclerotic cardiosclerosis, atherosclerosis of the aorta, coronary, cerebral arteries, circulatory failure, grade IIA.

Instrumental research data:
ECG dated 12.12.2000. Conclusion: Sinus rhythm, single and paired ventricular extrasystoles. The horizontal position of the EOS. Nonspecific changes in the atria. Amplitude signs of left ventricular myocardial hypertrophy.

 EchoCG 515 dated 12/14/2000. The study was conducted with a 2.5 MHz sensor. Conclusion: The cavity of the heart is not expanded. The walls of the left ventricle are not sharply (I century) thickened, periodically pulsate arrhythmically with sufficient amplitude. Mitral valve dysfunction.

 In FIG. Figure 3 presents a copy of the image of the Doppler echocardiogram of the transmitral blood flow from the apical access, performed under the control of a sectoral scan together with synchronous ECG recording in the II standard lead. In the presented figure, the first and last ventricular QRS complexes of normal duration (0.09 s) are preceded by peaks A with a duration of 0.140 s. The second and third QRS are expanded to 0.132 s, the P waves in front of them are not determined. Peak A before the second QRS is missing. Before the third QRS, peak A is of shorter duration (0.100 s) (and amplitude) than before the first and fourth QRS. Thus, the third QRS belongs to atrial extrasystole with aberrant ventricular excitation. The second QRS may be of atrioventricular origin with the same aberrant ventricular excitation as in the third QRS. Nevertheless, it is noteworthy that during the second excitation of the ventricles, a powerful regurgitation flow is sent to the cavity of the left atrium, with which, obviously, the atrial extrasystole was launched. According to our observations, this situation is characteristic of ventricular extrasystoles, especially early, which really happened. Thus, in FIG. 3, the first and fourth QRS complexes are elements of the correct rhythm, the second QRS reflects the ventricular extrasystole, and the third reflects the aberrant atrial extrasystole, which was not recognized on the usual ECG.

Claims (1)

 A method for determining difficult-to-diagnose atrial extrasystoles by recording an electrocardiogram from the body surface of the subject, conducting its contour analysis, establishing the correct rhythm at stable intervals between the ventricular QRS complexes, which are preceded and associated with them by stable temporal relationships typical atrial teeth in shape, duration and intervals P - QRS P of sinus origin and determination of atrial extrasystoles by prematurely occurring ventricular complexes of QRS, which are preceded by atrial P waves of a different shape than in the correct rhythm and with a shortened P-QRS interval, characterized in that they additionally record the Doppler echocardiogram of the transmissible blood flow, highlight peaks of early filling of the left ventricle of the heart E, systoles of the left atrium A, and they are gated on an electrocardiogram, stably repeating combinations of peaks E, A of the correct rhythm are distinguished, durations of peaks A are measured by ventricular complexes of QRS, which are preceded by peaks A of shorter duration than in ht rhythm diagnostsiruyut atrial beats.

Images