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Innovative examination method  in cardiology that radically changes diagnostics of the cardiovascular system performance

Our Heart Analyzer Cardiocode is designed to measure 7 basic volumetric parameters of hemodynamics, providing in such a way the perfect express-diagnostics of the performance of all parts of the heart, supported by qualitative evaluation of their 12 functions!

 

Cardiocode is an analyzer that is used generally in diagnostics of the heart & blood vessel system, making diagnostics at an extremely higher level that has been never the case before. It becomes possible because we succeeded in implementing our innovative concept of heart cycle phase analysis, and this is the first time in the world!

When using our Cardiocode, you will sure enjoy a significant competitive advantage: before our Cardiocode was developed, there was no instrumentation in the world that was capable of measuring blood volumetric parameters in hemodynamics.

What is an idea implemented in our heart analyzer?

We use a special single-channel lead for recording an ECG from the ascending aorta (a simplified version of lead scheme by Frank). This makes possible to produce a more sharply defined ECG curve, especially in the phases of tension and rapid blood ejection. Innovative is that the appropriate criteria to identify all 10 phases on an ECG curve have been described by us theoretically and applied in practice. Innovative is the application of ECG electrodes to produce an ECG and a rheogram simultaneously.

This makes it possible to synchronize the first time an ECG curve and a Rheo by their S waves so that the isoelectric line on the Rheo corresponds to wave S on the respective ECG curve. In doing so, all processes, occurring both before and after opening of the aortic valve, can be evaluated.

In the past, the phase analysis was capable of fixing durations of interval QT only. It was impossible to identify the actual cause-effect relations therein. It should be noted that the said QT interval consists of five phases. Our innovative phase analysis theory is capable of making diagnostics in every phase.

 

 Methodology book

“Theoretical principles of heart cycle phase analysis” 
ISBN 978-3-937909-57-8

This book gives a description of the theory of the heart cycle phase analysis based on a new fundamental scientific discovery explaining the phenomena of blood flow in large blood vessels.

Previously, the concept explained the blood flow as a flow under laminar flow conditions. That was the basis for the former theories of functioning of the heart and the blood vessels. That approach was not capable of explaining many matters of the fact and conflicted with the reality. The use of improper concepts and improper conclusions made it impossible to apply any metrological basis to widely used diagnostics methods. First of all, it referred to the ECG-based diagnostics. As a consequence, all existing methods of non-invasive diagnostics of the heart and blood vessels could be considered to be rather indicating but not measuring systems.
The theory of the superfluidity of blood developed by us makes it possible to create absolutely new diagnostics criteria supported successfully with metrology, based on the relevant ECG and rheogram. The method of the phase analysis described in this book shall be treated as the first step towards the theory of the differential diagnosis of the functioning of the heart and the blood vessels. This alone would show the possibilities of a more precise determination of the cause of pathology as early as possible.
Up to present time, all methods have been based only on integral indices that allowed to diagnosticate deceases postfactum. The theory presented in this book makes it possible to forecast eventual development of pathological processes, if any, that was not the case before.
We would like to express our hope that our researches might contribute to further development of the theory of cardiology, and practicing physicians would be given a new possibility to control diseases of the cardiovascular system in a great variety of their manifestations.
 
Contents
Introduction
Part I. Theory of hemodynamics and metrological support principles when measuring cardiovascular system phase parameters
1. State of electrocardiosignals research methodology
1.1. Conceptual issues of medicobiologic signals research methodology
1.2. Current methods for cardiovascular system investigation
1.3. Paradigm of hemodynamic parameters measurement in cardiology
1.4. Prospects of hemodynamics research based on electrocardiosignals
2. Methodology for electrocardiosignals research based on graphic mathematical differentiation 
2.1. Evaluation of medicobiological signals distortion during recording
2.2. About blood vessel sanguimotion conditions
2.3. Mathematical methods for determination of minute, stroke and phase volumes based on duration of cardiac cycle
2.4. Theorem of identification of cardiac cycle phase transition parameters
2.5. ECG phases representing the myocardium electric biopotential correlation with heart geometric shape variation
2.6. Delimitation of phases using the curve of first-order derivative for ECG when conducting mathematical differentiation
3. Criteria of hemodynamic parameters indirect measurement error evaluation using the elaborated method 
3.1. General state of metrological support of indirect methods for hemodynamic parameters measurement
3.2. Sources of cardiac cycle phase transition parameters measurement errors occurring during ECG recording
3.3. Estimation of hemodynamic parameter measurement errors using the elaborated method
4. ECG recording using Cardiocode-1. Criteria of phases registered on first-order derivative curve in automatic mode
4.1. Making the patient ready for ECG recording
4.2. Setting the electrodes for ECG recording. Distinguishing features of single-channel ECG trace recorded using Cardiocode as compared with standard multi-channel ECG trace
4.3. Near-ideal ECG trace
4.4. Determination of phases based on ECG trace first-order derivative
5. Clinical practice of dynamics investigation on basis of ECG mathematical graphical differentiation
5.1. Volumetric parameters of hemodynamics measured by instruments
5.2. Investigation of boundaries of physiological norm of cardiovascular system hemodynamics. Self-regulation of normal values of hemodynamic parameters
5.3. Research of cardiovascular system parameters with pathology in some cardiac cycle phases
5.4. Orthostatic test
6. ECG and rheogram recording using Cardiocode-2
6.1. Electrodes arrangement procedure
6.2. Rheogram phase characteristic
7. Diagnostics through synchronous recording of ECG trace and rheogram
7.1. ECG and rheogram interrelations used for diagnostics purposes
7.2. Cardiovascular system functions which can be assessed using Cardiocode-2
8. Updating of cardiovascular system pathologic behavior theory based on cardiac cycle phases analysis data
8.1. Common initial conditions for pathology progress. Malfunction of intermembrane transport of biochemical elements
8.2. Thrombosis development
Part II. Atlas for functional diagnostics based on cardiac cycle analysis (ECG trace + rheogram)
9. Practical diagnostics
9.1. Relatively normal functioning of cardiovascular system
9.2. Comparison analysis of diagnostics data: heart cycle phase analysis method data against classical multi-channel ECG registration data
9.3. Comparative analysis of cardiovascular system diagnostics against background of lung diseases
10. Some special cases from practice
10.1. Phase analysis data obtained during pre-stroke & stroke periods and resuscitation & after-therapy periods
10.2. Another case of phase analysis data: stroke successfully avoided
10.3. Data of phase analysis of patient with implanted heart pacemaker
10.4. Data of phase analysis of patients with implanted artificial aortic valve and artificial ascending aorta
11. Phytotherapy of heart diseases
11.1. Case of cardiac abnormalities: weak function of heart muscle, manifestations of cardiac insufficiency
11.2. Herbal medicines recommended against heartbeats attacks
11.3. Herbal medicines used to eliminate edema caused by cardiac insufficiency
11.4. Traditional phytotherapy medicines used for relieving pains in heart area under angina pectoris
11.5. Recommendations: how to prevent angina pectoris attacks
11.6. Herbal teas in therapy of arrhythmia
11.7. Phytotherapy against heartbeats accompanied by edema
11.8. Under heartbeats induced by nervous system
11.9. Under heartbeats accompanied by insomnia
11.10. Under tachycardia
11.11. Under post-infarction conditions
11.12. Under microinfarctation
11.13. Under coronary insufficiency (CHD)
11.14. Under heart arrhythmia
11.15. Under extrasystole accompanied by hypotension
11.16. Persons suffering from coronary heart disease (CHD) with normal arterial pressure
11.17. General recommendations for diet management under any cardiac diseases
Conclusion
Bibliography

Innovation in cardiology.

A new diagnostic standard establishing criteria of quantitative & qualitative evaluation of main parameters of the cardiac & cardiovascular system according to ECG and Rheo based on cardiac cycle phase analysis (for concurrent single-channel recording of cardiac signals from ascending aorta)

M.Rudenko, O.Voronova, V.Zernov, K.Mamberger, D.Makedonsky, 
S.Rudenko, S.Kolmakov, K.Weber

 «Cardiocode– Finland», Kuopio, Finland
www.cardiocode.de;

 Introduction.

Over more than 50 years the theory of functioning of the cardiac & cardiovascular system remained unchanged. As a rule, all conventional diagnostics methods are based on statistics data on changes in shapes of cardiac signals only, so that it is impossible to determine the relevant cause-effect relations with respect to their formation [1,2]. But a theory of elevated fluidity of liquid offered twenty five years ago makes it possible to develop an innovative method of the phase analysis of the cardiac cycle [3]. The successful application of the said method in researches for the last 5 years has enabled a practical implementation of an indirect measuring concept with respect to volumetric hemodynamic parameters [4]. By evaluating hemodynamic parameters upon examination of more than 3000 patients the Authors have identified the actual cause-effect relations in formation of the respective ECG & Rheo so that new capabilities are being offered in cardiology. This article should be treated as a logic result reflecting a long-term experience accumulated in large-scale investigations covering the complete cardiac & cardiovascular system operation.

Research objective.

To provide a considerable increase in the quality and the reliability of diagnostics in cardiology.

Method.

        An application of hemodynamics theory based on the model of the liquid flow maintained in a living body which is characterized by low energy consumption makes it possible to identify the cause-effect relations of the formation of the ECG and the Rheo recorded from the ascending aorta [3]. That is a prerequisite to determine the phase mechanism of the heart operation which comprises ten phases, and further to obtain data on interactions between the quantitative volumes of blood and, as a response to it, the contraction function of the muscles of the heart and the blood vessels in every cardiac cycle phase.

       It has been found that the main characteristics in hemodynamics are as follows:

SV - stroke volume of blood, ml;

MV - minute stroke volume of blood, l;

PV1 – volume of blood entering the ventricle in early diastole phase characterizing the suction function of the ventricle, ml;

PV2 - volume of blood entering the ventricle in atrial systole phase characterizing the contraction function of the atrium, ml;

PV3 - volume of blood ejected by the ventricle in fast emptying phase, ml;

PV4 - volume of blood ejected by the ventricle in slow emptying phase, ml;

PV5 – volume of blood (a share of SV) pumped by ascending aorta as peristaltic pump, ml.

The volumes of blood listed above are pumped by the heart within every cardiac cycle. Every parameter mentioned above can be treated as a final result of the operation of the heart in its cardiac cycle, and a complete set of the above parameters is capable of producing an integrated picture of the actual operation of the heart.

   The formation of the required volumes of blood in every phase of the cardiac cycle depends on the performance of the segments of the heart being involved into the operation. Their functions can be evaluated with use of the phase analysis of the cardiac cycle. The main functional parameters to be evaluated on the qualitative basis are as follows:

- Function of aortic valve;

- Specific anatomic features of aortic valve;

- Elasticityofaorta;

- Availability / non-availability of ascending aorta dilatation;

- Availability / non-availability of narrowing of aorta mouth;

- Contractile function of myocardium;

- Contractile function of interventricular septum;

- Conditions or status of venous flow;

- Availability / non-availability of pre-insult (pre-blood-stroke) conditions;

- Availability / non-availability of stenosis of large blood vessels;

- Conditions or status of lungs function.

   The favorable combination of the qualitative and quantitative phase analysis of the cardiac cycle allows determining the cause-effect relations of the performance of the heart within a wide range of the heart operation conditions from its norm up to extreme pathological cases. For this purpose, boundaries or transient conditions of the norm and pathology have been clearly defined, too. All this makes possible to detect the slightest deviations from the normal performance of the cardiovascular system. So, of great importance is the possibility to evaluate the performance of the heart of sportsmen.

 Results.

        The results of our investigations show that, when considering a separate cardiac cycle, the function of every subsequent phase is corrected by the value of a deviation from the function norm in the previous phase. Such interaction is responsible for establishing a compensation mechanism in the phase operation of the heart and the blood vessels. Therefore, the phases responsible for filling the heart with blood effect those phases that produce the initial minimum and the maximum arteric pressures, respectively, and vice versa. So, if pathology is available, then it is important to identify that phase which is responsible for origination of deviations in next phases. On the face of it, it seems to be an intractable problem. But a solution might be offered in this case by an experienced doctor who is trained in using the cardiac cycle phase analysis procedures in the proper way.

        In general, the dependence of the functions of the systole phases on current results of the operation of the diastolic phases can be described as follows:

?s/d = F(V)

where Ps/d – values of systolic and diastolic pressures in ventricular systole phases;

V – volume of blood entered the ventricles in diastolic phase.

       So, this compensation mechanism is a tool in the qualitative analysis of the cardiac signals recorded as the relevant ECG and Rheo curves. Upon analysis of the measured hemodynamic values, first, a phase shall be identified where deviations from the normal values occur. Then, possible causes of the deviations shall be evaluated. If all values are within their respective norms, the entire complex of the phase structure shall be analyzed for the purpose of the qualitative evaluation of the stability in the operation in every phase in question.

 Table 1. Compensation mechanism in cardiac cycle structure

 

 

Deviationinoperationinaphase

Compensation response to adeviation in operation in the preceding or the succeeding phase

1

QRS phase cannot reduce the volume of the ventricles to trim them in accordance with the actual volume of blood received by them

The amplitude of SL phase is increased to enhance the tension of heart muscles in order to build up the normal systolic pressure

2

A pressure in the ventricle is below its normal level so that it requires a compensation by an increase in the suction function of the aorta to provide the normal blood circulation through the blood vessels.

The high amplitude of ?wave increasing the suction function of aorta.

3

The low amplitude of R wave characterizing a decrease in the contraction of the interventricular septum.

An increased amplitude of ?wave responsible for an increase in the amplitude of the ventricle contraction to trim the ventricles in accordance with the volume of blood actually received by them

4

The low amplitude of R wave in combination with the low amplitude of S wave determining a decrease in the contraction of the muscles of the interventricular septum and the ventricle walls producing a pressure fall up to a pressure below the required level in the ventricles.

An increased amplitude of ?wave responsible for an increase in the suction function of aorta. An increased amplitude of SL wave might be available, too, which is responsible for building-up the required pressure in the ventricles as a compensation mechanism correcting then an improper operation of QRS complex.

5

A deficient stroke volume due to general weakness in the contraction of the ventricles producing an improper difference in pressures between the aorta and the atrium.

U wave generation supporting the blood circulation through the blood vessels.

6

The curve shows a dip of Q wave indicating a loss of function of the atrioventicular valve.

It occurs in a combination with some other compensation mechanisms one of which is represented by U wave.

7

An oxygen deficit in tissues or a deficient flow rate of blood in the blood vessels in phase T?P?detected

?wave is generated closer to ? wave.

8

An increase in the time required for the injection of blood volumes from the atria into the ventricles to produce the required pressure level in the ventricles.

An extension of phase P?Q is available.

9

According to the RHEO curve, an increase in the pressure up to point L in phase SL is found.

The normal mechanism of the regulation of the minimum pressure in the aorta. The pressure can be built up to provide a compensation for an increase in resistance of the blood vessels so that the normal blood flow after T wave is being produced.

10

According to the RHEO curve, the pressure is increasing in phase RS.

Blood leakage through the atrioventicular valve is available.

11

Doubled contraction frequency (vibration) of the muscles of the interventricular septum is available. R wave bifurcation is found.

Interventricular septum muscles contractility is weakened.

12

Doubled contraction frequency (vibration) of the muscles of the ventricles is available. S wave bifurcation is found.

Ventricle wall muscles contractility is weakened.

13

Disturbance in transportation of liquid through cell membranes of the muscles of the interventricular septum or the ventricle walls. Swelling of muscle cells.

A change in the amplitude of R wave in orthostatic testing for the interventricular septum muscle cells occurs, and, correspondingly, a change in the amplitude of S wave for ventricle walls is available.

 

 Table 2. Cardiac & cardiovascular system pathology cases - applicable diagnostics criteria

 

 

Diagnostics factor

Diagnosticscriteria

1

A weak pressure building-up in the aorta in phase Lj – fast emptying.

According to the RHEO curve, a pressure in phase Lj is under 0,5 of the normal pressure value.

2

Hindered venousflow.

According to the RHEO curve, a pressure in the aorta after dicrotic trough remains constant or is being built-up.

3

Stenosis of aorta is available.

According to the RHEO curve, after its maximum, there some disturbances as low-amplitude changes are recorded.

4

A delay in opening of aortic valve in phase Lj.

A delay in building-up or failure to build-up the required aortic pressure in phase Lj.

5

Aorta mouth narrowing

A delay in building-up arteric pressure as a “step” at the leading edge of the RHEO when point j is being registered.

6

Aortic dilatation

A decrease in the pressure on the RHEO curve in phase Lj, when expecting a pressure increase.

7

Passivity in contractility of the ventricle walls.

S wave is not available.

8

A decrease in aorta elasticity.

According to the RHEO curve, the apex is either flat or bifurcated.

9

Pre-insult (pre-blood-stroke) conditions.

Short-time arteric pressure surges which occur spontaneously on the RHEO curve at different time points of closing of the valves. As critical should be treated high amplitudes of pulses. Theyarecalledby us hemopulses.

10

A sign of sudden cardiac death.

An abnormal single QRS complex showing a very high amplitude that is accompanied by a large stroke volume and a high amplitude of the contraction of the interventricular septum followed by its spasm - «locking-up”.

 


Conclusions.

     There are three nerval centres which are responsible for the complete control of the heart. They are as follows: the low-pressure baroreceptors located in the aorta; the SA node – the sinoatrial node in the right atrium and the AV node – the atrioventricular node. An arteric pressure decrease up to its lower level is taken by the low-pressure baroreceptors which are initiating in this case the operation of the SA node. Thereafter the following processes shall be started: generation of wave ?, injection of the required volume of blood from the atrium into the ventricle in order to close the atrioventricular valve. This valve is being closed as soon as pressure levels of 10 and 5 mm hg in the left atrium and right atrium, respectively, have been reached. This point of time corresponds to point Q on the ECG curve. The complete closing of the atrioventricular valve establishes the required conditions for building-up of the proper level of the final arteric pressure. Upon closing of this valve, the AV node is starting its operation: this node is responsible for the generation of QRS complex. The purpose of the operation of this node is to provide the contraction but not the tension of the muscles of the interventricular septum and the ventricle walls sizing in such a way the required geometric volume for receiving blood to be pumped therein. In tension phase SL, an appropriate muscle pressure of the muscles is being built-up that is applied to the volume of blood available in the ventricles. This determines the level of the maximum systolic pressure in the aorta upon receipt of the stroke volume of blood by the aorta. In phase SL, and sometimes in phase RS, too, there is a mechanism of the regulation of the minimum diastolic pressure in the aorta in operation. The volume of blood circulating within the entire cardiovascular system is a constant value. In a pathology case, when some blood vessels show their pathological narrowing, a minor quantity of blood is leaking into the heart valves increasing in such a way the minimum aortic pressure in the aorta which results, in its turn, in an increase in the maximum pressure in general, since the stroke volume of blood is added to the said leakage. In essence, this mechanism works as follows: a certain volume of blood is leaking into the aorta via the closed valve. This is indicated by a slight increase in the arteric pressure on the RHEO in phase SL or up to point S in phase RS. The said leakage seems to be quasi excessive volume in the phase of the early diastole when the ventricles are filled with blood, due to narrowing of the blood vessels and an increase in their flow resistance. This quasi excessive volume of blood cannot stagnate in the blood vessels and is being displaced then due to the above mentioned factors. It is the same minor volume of blood that enters the heart and creates an effect of the excessive volume. Therefore, this leakage is transported by the heart practically unhindered throughout all phases of the cardiac cycle. The circulation of this volume can be stopped upon normalization of the blood vessel resistance only provided that the proper distribution of the said excessive volume within the entire capacity of the blood vessel system is obtained.

      All this considered, it can be concluded that the main control mechanism in the heart operation is the respective pressure level reached in every cardiac cycle phase. The different pressure levels, in their turn, depend on the actual phase-related volumes of blood.

      Now these investigations in the field of the cardiac cycle phase mechanism are being continued by us.

 References

1. New Definition of Myocardial Infarction 
    JACC. – Vol. 36 N3. 2000. September 2000. – ?. 959-969. 
2. K.Caro, .T.Pedley, R.Shroter, W.Sid. The mechanics of the circulation. - M.: Mir, 1981. - 624 pages.
3. Theoretical Principles of Heart Cycle Phase Analysis. – Moscow,
    Helsinki: ICM Publishing House, 2007, 336 pages.
4. http://www.cardiocode.?u/ 

 

 Precise non-invasive measurements of basic values in hemodynamics and qualitative evaluation of heart & blood circulation functions in cardiac cycle phases

M.Rudenko, S.Kolmakov, K.Weber, O.Voronova., V.Zernov, S.Rudenko, 
K.Mamberger, D.Makedonsky 
www.cardiocode.eu
Introduction.  The cardiology specialists have long been interested in measuring hemodynamic parameters. Of prime importance in this case is to determine the volumes of blood delivered by the heart in its every cycle phase. Knowing the volumes of blood pumped by the heart sections in every cardiac cycle phase, one can diagnosticate precisely the finest changes which may occur in the heart and the cardiovascular system both under their normal and abnormal pathological conditions. Until the present time, the volumes of blood have been measured by catheterization of large arteries only. In more recent times, another possibility was offered to measure stroke volumes of blood with ultrasonic scanners. But the possibility of taking measurements of the volumes of blood entering or exiting any individual section of the heart has remained for a long time a dream, and a serious hindrance thereto was an imperfect theory of hemodynamics.
This Article deals with the most significant results obtained by our international research & development team with use of an absolutely new medical instrument developed by us, and these results make it possible to take a fresh look both at the theory and the practice in hemodynamics offering at the same time absolutely new diagnostics capabilities in cardiology.
Since the beginning of the 80-s the Authors have been deeply studying the phase analysis of the cardiac cycle [1]. For this purpose used are results obtained earlier in some other interesting investigations [2] which were very close to the development of an adequate model in hemodynamics. But unfortunately, those theories failed to receive their support in the practice. It becomes clear that it is required to identify precisely those biophysical processes which are responsible for the blood circulation and implement an innovative concept of measuring basic blood circulation parameters. The excellent solutions of the above problems are proposed by us applying the phase analysis of the cardiac cycle when analyzing every cardiac cycle phase identified on an ECG and a RHEO recorded from the ascending aorta [3].
 
Research objective. Development of an absolutely new non-invasive method for measuring basic volumetric values in hemodynamics on the basis of the cardiac cycle phase analysis.
 
Method. Investigations of hemodynamic processes in the blood circulation are conducted on a fundamentally new scientific basis, i.e., on the concept according to which the blood flows through the blood vessels under the so-called “third” flow conditions. The first theoretical and experimental researches in the field of flow dynamics which resulted in the creation of the theory of the “third” conditions of liquid flow have been carried out by G. M. Poyedintsev more than 30 years ago [1]. It was found that within the thinnest boundary lamina in liquid, at the initiation of the flow of liquid from its quiescent state, a packet of concentric friction waves is generated propagating from the pipe wall towards its center. This process is shown schematically in Figure 1.
 
  
 
Fig. 1. Formation of traveling friction waves at the initiation of the liquid flow in a pipe
Upon reaching the axis of the flow, the waves disappear. If this occurs in a long pipe, at subcritical Reynolds numbers, this process lasts for fractions of a second only, till all friction waves disappear, with the exception of the scattered wall wave. As the result, the unsteady flow of liquid is re-formed and becomes the steady-state Hagen-Poiseuille flow (referred to as the laminar flow).
Accordingly, at the initiation of the liquid flow in the pipe, within a very short period of time, there is a changing wave-shaped velocity profile available, and, in accordance with Bernoulli law, a wave-shaped profile of the static pressure occurs, too. Should suspended particles enter this flow, then the transverse gradients of the static pressure push them out into laminae with the lowest pressures which, according to Bernoulli law, are the laminae having the highest velocity. In other words, the structuring of the stream of the flowing liquid occurs in such a way. It should be noted that there is another unique feature of interest – within this period of time the liquid flow is being established with an incomparably less pressure losses due to friction than it may be the case under the steady-state laminar flow conditions.
A method has been found to maintain the flow conditions of the liquid with a standing wave profile of the velocity and the static pressure in the pipe for an indefinite time. [1]. It may exist under pulsating conditions only. Therefore, the most efficient liquid flow conditions can be achieved in an elastic pipe under pulsations with changes of the velocity of the liquid flow and the pipe radius in every pulse according to a strongly defined law, namely:
 
     
where   to > 0,  t > to ;
         rt- current radius of an expansion of the pipe;
         r?- initial radius ( at t = t? );
         t – current time;
         t?– time of acceleration of flow up to maximum of velocity in pulse;
        Wt – current value of liquid flow velocity;
        W?– maximum value of velocity in a pulse (at t = t?).
These flow conditions are called “the third” conditions to distinguish them from other well-known conditions referred to as the turbulent and the laminar (Hagen-Poiseuille) flow conditions, respectively.
It is under “the third” conditions but not under the laminar (Hagen-Poiseuille) ones that blood circulates via the blood vessels throughout our body [1,3]. The distinguishing features of the third flow conditions are that the pressure losses due to friction are significantly less with respect to other cases, and there is a wave-shaped profile of the velocity and static pressure available under the influence of which the flow of blood is laminated forming alternate concentric velocity laminae as follows: alternate high-velocity lamina filled with blood corpuscles and low-velocity lamina filled with plasma (Fig. 2).
Based on the theory of “the third” flow conditions, a mathematical method has been successfully developed by us to determine the values of the basic hemodynamic parameters. They are produced by the phase operation of the heart, or in more exact terms, by the phase structure of the cardiac cycle.
In order to identify the phase structure of every cardiac cycle obtaining all required relevant data, synchronous recording both of ECG and RHEO signals from the ascending aorta is proposed to use. Both curves recorded in such a way are given in Figure 3 below.
The proper location of the areas used for recording ECG and RHEO is of critical importance. The method of arrangement of the electrodes offered by us is similar to that used for the well-known EASI method. According to our method used are 2 (two) electrodes E and S only. Its distinctive property is that at the same time when an ECG is recorded, the relevant RHEO signals are recorded, too. This method is termed by us a “Point Rheography Method”. Actual records produced with this method are given in Figure 4.
 
                                       
                                                     
Figure 2. Liquid velocity distribution profile within the same area of passage in pipe at different times (t1< t2< t3< t4< t5) of starting acceleration. Erythrocytes are concentrated as ring-shaped structures with plasma between them that sharply decreases friction in the blood vessels
 
 Figure 3. Phase correlations between an ECG and a RHEO recorded from ascending aorta
        (point rheography – concurrent recording: ECG + RHEO)
  
                  
     Fig. 4. ECG + RHEO curves recorded from ascending aorta of a healthy young man
    (In this figure given are an ECG curve with its derivatives and a RHEO curve with its derivatives,  
    
espectively)
In order to establish the required criteria to identify the boundaries of the beginning and the end of the phases in a cardiac cycle on the ECG & RHEO curves recorded from the body surface, the respective derivatives of the above curves are used [3]. This approach makes it possible to computerize the process of the identification and evaluation of the structure in every phase of the cardiac cycle.
 
Results. The obtained theoretical results implemented make it possible to calculate the volumetric hemodynamic parameters based on durations measured in every cardiac cycle phase as follows:
SV - stroke volume of blood, ml;
MV - minute stroke volume of blood, l;
PV1 - volume of blood entering the ventricle in early diastole phase characterizing the suction function of the ventricle, ml;
PV2 - volume of blood entering the left ventricle in atrial systole phase characterizing the contraction function of the atrium, ml;
PV3 - volume of blood ejected by the left ventricle in fast emptying phase, ml;
PV4 - volume of blood ejected by the ventricle in slow emptying phase, ml;
PV5 – volume of blood (a share of SV) pumped by ascending aorta as peristaltic pump characterizing the current tonus of aorta, ml.
 
At the same time, a qualitative evaluation of various parameters and functions on the basis of these tools can be produced as follows:
- Function of aortic valve;
- Anatomic peculiarities of aortic valve;
- Elasticity of aorta;
- Availability / non-availability of aorta mouth narrowing;
- Contraction function of interventricular septum;
- Contraction function of myocardium;
- Status / conditions of venous flow;
- Status / conditions of lungs;
- Availability /non-availability of stenosis of large blood vessels;
- Availability /non-availability of pre-stroke (pre-insult) conditions.
The volume-related phase analysis of the functioning of the blood circulation system is an absolutely new research method supplying us with the most informative data on the cardiac and the blood circulation system both under their normal operating and abnormal pathological conditions. As experience has shown, this method is capable of successful competition with all known conventional examination methods due to its significant advantages: it is more informative, simple, budget-priced and easy in use
Let us consider the most extreme cases studied with our medical instrument developed and implemented by us. These cases cover examinations of patients with artificial aortic valve who run a higher risk of sudden cardiac death.
The results of the evaluation of the hemodynamic parameters obtained in these cases are given in Figure 5. The data indicated therein refer to the condition when changing the horizontal position to the vertical one in orthostatic testing. The right bottom part in this Figure shows a deviation of the basic hemodynamic parameters from their normal values in percentage terms. Considering the case in question, they exceed the norms. The greatest deviation of 106, 04% is indicated for PV1 – the volume of blood entering the ventricle in early diastole phase characterizing the suction function of the ventricle. The least deviation demonstrates PV2 – the volume of blood entering the left ventricle in atrial systole phase characterizing the contraction function of the atrium. Upon expiration of several minutes, when transition processes in orthostatic processes gave the way to those of steady-state nature, the hemodynamic parameters tender to reach their normal values.  Sudden cardiac death can be identified by an abnormal QRS complex as shown in Figure 6.
 
  
Figure 5. Phase hemodynamics of a patient with artifical aortic valve.
Examinationresults.
 
  
Figure 6. Abnormal QRS complex and its influence on hemodynamic parameters
 The amplitude of the said complex is approximately three times as high as its normal value. Therefore, the amplitude of the contraction of the interventricular septum exceeds its normal value approximately by the same value. But in this case a stroke volume of blood ejected by the aorta is increased, too. We notice that the stroke volume in cycle two where the abnormal QRS complex is formed is as follows: PV = 128 ml, while an average value is 62 ml only. The case is that the interventricular septum having been strongly contracted hinders contracting of the ventricles that is indicated on the curve by the fact that there is no wave S available. Both the phase of tension and the phase of fast ejection are indicated on the ECG by almost straight line. This practically straight line shows that there are no changes in signals between the differential inputs of the bio-potential amplifier, and hence no myocardium movements in this phase are available.
     Then, in phase of the early diastole, the interventricular septum is recovered and the cyclic process of the normal cardiac cycles occurs again and again. But sometimes, under certain conditions, it might be the case when the interventricular septum is not capable of relaxing and taking its initial position that might lead to the sudden cardiac death.
   One more consideration: a large stroke volume of blood may cause a cardiovascular accident.
    As shown in practice, a certain symptom picture is always available as a prognosticator of an abnormal QRS. Among other symptoms, there might be a periodic loss of consciousness. In such cases we could observe a partial loss of consciousness accompanied by heavy paraequilibrium. Considering sportsmen, it should be noted that “overtrained” people among them could belong to a risky group suffering from myotonia.
    A way could be offered to solve this problem by supplying a high-voltage impulse to the heart area so that the interventricular septum is relaxed.
Beginning with the use of this method in 2004, the total number of patients examined by us with our latest heart analyzer exceeds 3000 persons. The data obtained by us upon their examinations make it possible to re-consider the existing theory of the operation of the heart and the cardiovascular system so that it permits of filling some existing gaps in the cardiology.
Conclusions.
An innovative method and an absolute new instrument of non-invasive determination of volumetric hemodynamic parameters have been developed, the principle of which is measuring durations of every cardiac cycle phase on the ECG and Rheo curves followed by their processing with the relevant mathematical equations describing “the third conditions” of liquid flow and calculating specific hemodynamic values of a patient. This instrument has been certified both in Russia and the EU.
References
1. G.M.Poyedintsev. On Flow Conditions in Blood Circulation. Collection of Scientific Papers: Development of Innovative Non-Invasive Methods of Examination in Cardiology. – Voronezh, 1983, p.17-35.
2. K.Caro, .T.Pedley, R.Shroter, W.Sid.  The mechanics of the circulation. - M.: Mir, 1981. - 624 pages.
3. Theoretical Principles of Heart Cycle Phase Analysis.- Moscow , Helsinki: Publisher: ICM, 2007. – 336 pages.

 

Only a single channel is used to record at the same time two curves, i.e., an ECG and a Rheo, from the ascending aorta.
This method makes it possible not only to measure 7 basic volumes of blood in every heart cycle phase, but also evaluate 12 functions of the cardiovascular system performance, so that, based on ANALYTICAL interpretation of the produced data, the relevant cause-effect relations are identified, and decisive pathological factors and their manifestations as a compensation mechanism, maintaining the proper hemodynamics in some phases are discovered, if any. This innovative method allows identifying actual margins in the operation of the cardiovascular system.

Parts of heart considered by diagnostics; heart anatomy pre-determination.Slide-supported lecture in phase analysis theory.

Of great importance is the scheme of location of the electrodes used for recording the relevant signals. The main factor in our case is a single channel lead to record signals from the aorta. The first electrode is placed within the area of the ascending aorta, at the top edge of the thorax. The second electrode is located on the median front line at the apex of the heart, at the bottom edge of the thorax. Two electrodes to pick up high-frequency signals from the rheograph are located in the neighborhood of the ECG electrodes. The passive electrode is fixed onto the abdomen surface area in the neighborhood of the Rheo electrode.

Why to apply this scheme?
 
This electrode location scheme for recording ECG signals has been developed on the basis of a great number of tests which have demonstrated that only the fix points proposed by us are the most suitable to deliver the relevant data on the phases of the aortic valve tension and opening, captured in our ECG version in full. And in this case, it is very important to locate the high-frequency signal electrodes near to the ECG electrodes, since the ECG electrodes are used to deliver the relevant signals for simultaneous recording an ECG and Rheo. In order to calculate hemodynamic parameters according to the equations by Poyedintsev – Voronova, it is essential and quite sufficient to measure durations of the respective heart cycle phases. By substituting the actual values of the durations into the above equations, we obtain the actual volumes of blood in every heart cycle phase.
The actual functional status of the heart and large blood vessels is analyzed according to an ECG signal amplitude and actual Rheo signal shape in every phase of the heart cycle under analysis.

Parameters considered by diagnostics

Cardiocode is designed to measure volumes of blood entering the heart during the myocardium relaxation and ventricle filling, and volumes of blood leaving the heart during the valve opening and aorta expanding, based on the fact, that the said volumes of blood circulate throughout the blood vessel system and provide transportation of blood corpuscles.

The measured parameters are as follows:
SV – stroke volume, ml;
MV – minute volume, l;
PV1 – volume of blood entering ventricle in premature diastole, characterizing the suction function of the ventricle, ml;
PV2 - volume of blood entering the left ventricle in atrial systole phase, characterizing the contraction function of the atrium, ml;
PV3 – volume of blood ejected by the left ventricle in rapid ejection phase, ml;
 
PV4 - volume of blood ejected by the left ventricle in slow ejection phase, ml;
 
PV5 – volume of blood (a share of SV) pumped by ascending aorta as peristaltic pump, characterizing the actual tonus of aorta, ml.
 
In addition, the following functions are evaluated qualitatively:
-         function of arteric valve
-         elasticity of aorta
-         expanding of ascending aorta
-         narrowing of aorta mouth
-         coronary flow status
-         contraction function of myocardium and septum
-         stenosis of large arteries available/not available
-         peculiarities of aortic valve anatomy
-         actual status of venous flow
-         if pre-stroke conditions available/not available
- synchronization in operation of greater and lesser circulation systems.
-   
 
It is And how to calculate the hemodynamic parameters?

possible to calculate the basic hemodynamic parameters using an ECG version recorded according to the single lead scheme. It can be made with our Cardiocode only. The single-lead ECG recording from the aorta produces the most informative curve. Upon recording of the ECG curve, the signal-related data are processed by our proprietary software used to calculate automatically the actual duration of every one of ten phases in every heart cycle recorded. 
The actual duration of every phase in the heart cycle is an argument in the respective equation for calculations of the hemodynamic parameters. Using these equations, produced are the actual values of all hemodynamic parameters as listed above.
Screen shot for Cardiocode operation Title “Analysis” 
Calculation of hemodynamic parameters is carried out automatically thereunder.

 

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  1. Possibilites of Cardiocode
  2. Measured parameters by Cardiocode
  3. Evaluation
  4. Diagnosis
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