POLYCARDIOGRAPHY

From Big Medical Encyclopedia

POLYCARDIOGRAPHY (Greek poly is a lot of + a cardiography) — a method of a noninvasive research of phase structure of a cardial cycle on measurement of intervals between elements of synchronously registered sphygmogram of a carotid artery, the phonocardiogram and the electrocardiogram. It is applied in clinic to assessment of sokratitelny function of heart and nek-ry changes noncardiac hemodynamics (see).

Phase structure of a cardial cycle according to V. L. Karpman

Division of a cardial cycle into phases (or the periods) is connected with allocation of stages of functioning of heart as pump which come to light in the analysis of pressure curves in cardial cavities and loudspeakers of volume of these cavities for a cardial cycle. The cardial cycle is subdivided into 11 phases (see the scheme). Two main phases of a systole — the period of tension of ventricles of heart and the period of exile of blood from them — were for the first time established in the middle of 19 in; and attempts to apply to the phase analysis of P. belong to the beginning of 20 century. Modern theoretical development of P. and its implementation in a wedge. practice was carried out in the 40th 20 century by Blumberger (To. Blumberger; 1940, 1942), and improvement of a technique is connected with the subsequent its modifications by Holldak (To. Holl-dack, 1951) and V. L. Karpman (1961).

At P.'s use for the phase analysis is accepted that duration of a wave of the central pulse registered on the sphygmogram of a carotid artery (SCA) is equal to duration of a similar wave on the pressure curve in an aorta, i.e. to the period of exile of blood from a left ventricle of heart. At synchronous registration of the phonocardiogram (FKG) it is possible to define delay of a pulse curve (in relation to the pressure curve in an aorta), a cut corresponds to a time slice between the II tone on FKG and in-tsizury on a wave of SSA, and the beginning of the II tone corresponds to the moment when pressure in an aorta exceeds intra ventricular. The beginning of high-frequency fluctuations of the I tone is accepted synchronous from the beginning of bystry rise in chamber pressure, i.e. from the beginning of a mechanical systole of a ventricle. Simultaneous registration of the electrocardiogram (ECG) allows to add the classical phase analysis with data on electromechanical latency of a left ventricle.

Technique of a research consists in receiving synchronous record ECG, FKG and SSA which in total make the polycardiogram (PKG). For this purpose the multichannel registrars supplied with the corresponding sensors use (see. Polygraph ). Quality of a research depends on the clearness of registration of elements of all curves. The ECG is written down in that assignment, in Krom the tooth of Q, and FKG — in the mid-frequency range accurately comes to light. On SSA shall be well visible the beginning of an anacrotism and intsizur, on FKG — the beginning of high-frequency oscillations of cardiac sounds. Best of all these elements are reproduced by registrars with photorecord or jet ink record with a speed of tape transport not less than 100 mm/sec. Clearness of reproduction of a number of the SSA elements increases at record of differential curves of a central pulse. In nek-ry cases of P. it is reasonable to supplement with record of an apekskardiogramma (see. Cardiography ).

Basic elements of the normal polycardiogram (the electrocardiogram — the ECG, the sphygmogram of a carotid artery — SSA, the phonocardiogram — FKG): Q, R, S, T — designation of the main teeth of the ECG ventricular complex. Points with, e, f on SSA are designated the moments matching changes of pressure in a carotid artery and dynamics of the aortal valve: with — the beginning of rise in pressure, e — corresponds to the beginning of abrupt pressure drop, f — the moment of closing of the aortal valve (an intsizur of SSA). I and II — the beginning respectively I and II cardiac sounds on FKG. Intervals: R — R — a cardial cycle (C); Q — t — an electrical systole; I \II \II \— acoustic systole (Sa); Q — I — a phase of the asynchronous reduction (AR); with — f — the sum of the period of exile of blood from a left ventricle (E corresponds to an interval with — e) and time of a protodiastole (R), to the corresponding interval of e — f.

Duration of a cardial cycle and the phases making it determine by intervals between the PKG elements (fig.), using for their characteristic also a number of settlement indicators (tab. 1).

Establishment phases of izovolyumichesky reduction (IC) and the period of exile (E) allows to define by P. in the presence of data on a stroke output of heart (UO) and the diastolic pressure (DP) important characteristics of action of the heart — the average speed of exile of blood (V e = UO/E) and initial velocity of increase in chamber pressure [V i = (DD — 5 mm of mercury.) IC].

Normal indicators of PKG correspond to fluctuations of their values at the persons which do not have pathology of cordial activity and the general hemodynamics. A number of indicators from presented in tab. 1 divide on so-called static and dynamic. Carry indicators to static, values to-rykh poorly depend on heart rate and make normal: The EXPERT — 0,04 — 0,07 sec.; IC — 0,02 — 0,05 sec.; the sum the EXPERT + IC, i.e. the period of tension (or the period of a predyzgnaniye on the American terminology) — 0,06 — 0,11 sec., duration of a protodiastole — 0,02 — 0,05 sec.

Dynamic designate indicators, values to-rykh strongly depend on heart rate and can be determined as due for this duration of a cardial cycle by Karpman's formulas:

E = + + + + + + + + 0,159 sec.

of Sm = 0,114*C + 0,185 sec.

of S0 = 0,12*C + 0,235 sec.

of D = 0,88*C — 0,235 sec.

Discrepancies between the actual values of these indicators and calculated on the normalized formulas do not go beyond +-0,02 — 0,03 sec.

the Clinical use

define the phase shifts in a cardial cycle connected with disturbances of sokratitelny function of a myocardium or with changes of noncardiac conditions of a hemodynamics by P. Increase in resistance to exile of blood at a stenosis of an aorta concerns to the last, e.g., or increase in a krovenapolneniye of ventricles at aortic incompetence. In the first case loading of heart resistance, in the second — loading volume takes place.

V. L. Karpman (1964) allocated five so-called phase syndromes (tab. 2), i.e. changes of duration of the phases of a cardial cycle characteristic of certain changes of action of the heart or conditions of this activity.

The phase syndrome of loading volume is found at aortal insufficiency, an open arterial channel, at considerable bradycardia, and also in post-extrasystolic reductions which follow compensatory pauses. The phase syndrome of high diastolic pressure (a syndrome of loading elastic resistance) is observed at the raised ABP. The phase syndrome of a stenosis of an output path of a ventricle (a syndrome of loading hydraulic resistance) is noted at a stenosis of an aorta and indicates high degree of hyperfunction of heart.

The phase syndrome of a hypodynamia occurs most often at disturbances of sokratitelny function of a myocardium at patients with a diffusion cardiosclerosis, at a myocardial infarction, aneurism of heart, etc. The functional hypodynamia is observed during an extrasystole, and also at the high-trained athletes (an adjustable hypodynamia).

The phase syndrome of a hypodynamia arises in the conditions of hard muscular work at healthy faces and at tachycardia of various genesis.

Not always phase syndromes come to light in all set of the signs given in tab. 2 that depends on extent of disturbances of sokratitelny function of a myocardium, a combination of different types of pathology of N from a condition of compensatory mechanisms.

Most informatively a research of indicators of P. in dynamics that allows to define in some cases extent of participation of the functional and organic reasons established disturbances and to estimate efficiency of the carried-out treatment.

Table 1. The INDICATORS CHARACTERIZING the CORDIAL RHYTHM AND ACTIVITY of the LEFT VENTRICLE of HEART DEFINED by the POLYCARDIOGRAPHY


Table 2. TYPES of PHASE SYNDROMES ACCORDING TO V. L. KARPMAN





Bibliography: Karpman V. L. Phase analysis of cordial activity, M., 1965; P and l of e e in H. River and To and e in i-Ts e r I. M. The atlas of hemodynamic researches in clinic of internal diseases, M., 1975; Feldman S. B. Assessment of sokratitelny function of a myocardium on duration of phases of a systole, L., 1965; it, Early diagnosis of heart failure, M., 1976; In 1 u m b e of-g e r K. Die Anspannungszeit und Aust-reibungszeit beirn Menschen, Arch. Kreis-laufforsch., Bd 6, S. 203, 1940; L e-w i s R. P. a. R i 11 g e r s S. E. Acritical review of the systolic time intervals, Circulation, v. 56, p. 146, 1977; Progress in cardiology, ed. by P. N. Yu a. G. F. Goodwin, v. 1, p. 155, Philadelphia, 1972; W i g g e r s C. Studies on the consecutive phases of the cardiac cycle, Amer. J. Physiol., v. 56, p. 415, 1921.


H. P. Paleev, V. L. Karpman.

Яндекс.Метрика