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1. 51 4 17 List of databases 53 4 18 List of doctors 54 4 19 Adjustment of indicators color 55 4 20 Export of examinations from database 55 4 20 1 Export of data 55 4 20 2 Using data export to create archive 58 4 20 3 The month calendar 58 4 21 Import of examinations to database 59 4 21 1 Import of data 59 4 21 2 Running data import operation to view archive 62 4 22 Backup databases during operation 63 5 Annex I 65 5 1 Examples of heart portraitures with different pathologies 65 6 Annex II 68 6 1 Peculiarities of clinical interpreting of heart portrait 68
2. 29 4 3 2 Viewing of the integrated indicators 34 4 3 3 Viewing of the conclusion 36 4 3 4 Viewing of the detailed elaboration 39 4 4 Examination record of the comments 40 4 5 Examination review of additional parameters of the input ECG 41 45 4 6 Classification of deviations 42 4 7 Window of detailing 43 4 8 Scanning ECG 6 leads 44 4 9 Scanning ECG 1 lead 45 4 10 Scanning a portrait 46 4 11 ECG Feature Measurement Indicator 47 4 12 Tendency control portrait gallery viewing 48 4 13 Input ECG viewing 49 4 4 14 Deletion of the examinations from database 49 4 15 Deletion of the patients from database 50 4 16 Printing examination summary report
3. 12 2 3 Structure of text messages 13 2 3 1 Integral indicators 14 2 3 2 Conclusion 16 2 3 3 Detailing 16 2 3 4 Report structure 17 3 Installation of screening analyzer 19 4 Operation 23 4 1 Program overview 23 4 1 1 Start of the program 23 4 1 2 Main menu 24 4 1 3 Button panel 26 4 1 4 Exit 26 4 2 Examination formation of heart portrait 27 4 3 Examination Viewing a heart portrait and text messages 29 4 3 1 Viewing of the portrait
4. G1 right atrium depolarization G2 left atrium depolarization G3 right ventricle depolarization G4 left ventricle depolarization G5 right ventricle repolarization G6 left ventricle repolarization G7 symmetry of ventricular depolarization G8 intraventricular heart blocks G9 symmetry of leads In the G1 G7 groups a wide spectrum of dispersion changes attributable to numerous clinical pathologies is analyzed The names of the groups mainly reflect the electrophysiological characteristics of the changes in the atrial and ventricular myocardium depolarization and repolarization processes In contrast to that the G8 group refers to the highly specified dispersion changes the marked types of which correspond to conduction blocks of myocardial electrical excitation The G9 group is showing deviations of wave front of ventricular depolarization In most cases such deviations correlate to early hypertrophic myocardial changes although in some cases they can be determined by the left ventricle ischemia Despite its rather low specificity the G9 group code is highly sensitive to the change of myocardial depolarization rate The 0 digit in the Detalization means that the image regarding the given group is within the normal range The presence of a non zero digit in any of the G1 G9 groups is to be regarded as the evidence of the similarity of the dispersion characteristics of the given
5. You have an unending flow of patients and it is important for you to increase the reliability and speed of screening tests You monitor the patient s heart during in patient care and want to quickly get information as early as possible in a noninvasive way on small changes in the processes of myocardium electrical activation At the same time it is also important to you to be able to get this information right where the patient lies without moving him her to the functional diagnostics area You monitor the patient for a long time and want to observe tendencies in the changes of heart s state which cannot be seen on the ECG The screening analyzer can be used in clinical medicine instant evaluation of the condition of the heart early detection of progressing changes in the myocardium in preventative medicine screening tests for on time and reliable detection in the groups of patients with pre clinical forms of disorders in departmental medicine preventative medical examination in sanatoriums preventoriums rehabilitation centers objective instant indicator of the condition of the heart and the entire body in emergency medicine for reliable evaluating the current condition of the heart in sports medicine early and accurate detection of negative dynamics of the heart s state In addition to instant visual analysis of the image the system forms an automatic conclusion for t
6. CardioDM 06 software for HeartVUE system 53 When monitoring lists with great number of examinations it becomes necessary to select portraits from any part of this list i e you should select portraits for manual view In order to make such selection you should go back to main menu by clicking button and use left mouse and Ctrl or Shift keyboard combination to generate necessary list Ctrl Left mouse combination allows selecting separate lines and Shift Left mouse combination allows selecting of adjacent lines After generating list click button again If generated list is more than size of portraits view window use scrolling buttons If you wish to enlarge separate portrait in order to view it in details just click left mouse on the same portrait The window of enlarged portrait moves if you drag it by left mouse click on window headline 4 13 Input ECG viewing Buttons and are used to review the ECG Button is used to perform the rhythm check up in a convenient mode since 30 60 sec ECG is presented in this format If it is necessary to review some recording interval set the mouse cursor on the required point of the ECG line and press the right mouse key A window of the ECG meter window measuring screening analyzer will appear The initial point of the measuring screening analyzer will be set on a chosen ECG point The default case is that by pressing the button an indicator lead will be displayed The bu
7. 84 7 Annex III 7 1 Criteria of Comparison of Dispersive Deviations and Generally Accepted ECG Diagnose The present Attachment contains the table of comparison of relevant dispersive characteristics of low amplitude ECG fluctuations used in screening screening analyzer and generally accepted criteria of ECG conclusions in registration of resting ECG from limbs The given comparative table established the relation between the additional text conclusions of screening analyzer and generally accepted methodical recommendations for ECG analysis used by physician in practical work Dispersive deviations in many cases reflect the processes of early stages of changes that have no direct analogues amid the criteria of ECG opinions used in practice For that reason several dispersive conclusions reflecting early stages that haven t yet reached clinical stages may correlate to one generally accepted criteria of ECG analysis describing clinical stages of pathological changes For the same reasons the given list of generally accepted criteria of ECG conclusions is not complete it is given solely for the purpose of simplifying clinical interpretation of additional texts of screening conclusions at the first stages of working with screening analyzer And finally the given comparisons may be neither absolutely precise not categorical as the dispersive conclusions of screening screening analyzer are not diagnostic and the given compari
8. 3 7 Moderate deviations The deviations of the indicator Myocardium in sequential examinations are 8 10 Significant deviations The deviations of the indicator Myocardium in sequential examinations exceed 10 If in the General conclusion or in the section Myocardium of ventricles suspicion on hypoxia or ischemic changes appears it does not yet testify to ischemic illness of heart Due to high sensitivity the screening analyzer responds to both on clinically significant forms of ischemia and short episodes of transient ischemia or CardioDM 06 software for HeartVUE system 79 hypoxia which can not relate to coronary pathogenesis In such cases it is the information that the dispersive characteristics of myocardium at the examination moment have deviated from norm to the characteristics of ischemic states The clinical significance of such message depends on whether it is approved by heart portrait and detailing information and also high recurrence of such messages The more references to hypoxia in detailing groups G3 G7 and the more changes on a portrait the higher probability of clinical form of ischemia table A2 But in any case the screening analyzer indication of ischemic changes when other clinical manifestations of ischemia absence testifies authentically to presence significant subliminal deviations which should been periodically monitored with dynamics of heart portrait and which ca
9. CardioDM 06 software for heart screening User s Manual Rev 3 Address 6805 Mayfield Rd Ste 1203 Cleveland OH 44124 USA Phone 440 829 5590 Fax 440 442 5629 E mail gvgoh adelphia net Internet http www pegasusmedical com Copyright 2006 Heart View LLC Document number 3183 Print errors which may be present in this manual will be corrected in future editions Heart View retains the right to alter the text CardioDM 06 software for HeartVUE system 3 Contents Introduction 3 Abbreviations 6 Terminology is based on 6 1 Purpose and usage 7 1 1 Restrictions 9 1 2 Principle of analysis 10 2 General information 11 2 1 An ideal heart model 11 2 2 Visual structure of the heart portrait
10. top of triangle down Arrangement by date is performed in the same manner in Date field While entering CardioDM 06 program arrangement always performs by date of patient registration Check up size of the established duration of input of an electrocardiogram exposition which is displayed on button For switching click the left mouse button The basic exposition 30 sec An exposition 60 sec is expedient to use in the event that you wish to receive more exact value of indicator Rhythm for example at high stress Quality of a portrait practically does not depend on an exposition Fix the electrodes under the standard scheme of assignments preliminary having greased points of imposing by gel a red electrode R on the right hand a yellow electrode L on the left hand a green electrode F on shin of the left leg a black electrode N on a shin of the right leg If application of gel for any reasons is undesirable it can be limited to wetting the point of contact by water Be convinced that electrodes are fixed without a mistake on the specified color conformity At a weak signal it is desirable to degrease preliminary by skin mix spirit and ether in the 28 ratio 1 1 Pay special attention on quality of contact of electrode N on which quality of an electrocardiogram in other channels R L F depends Diagram of applying electrodes The major factor guaranteeing accuracy of a portrait is the condition of rest o
11. will change its color from green to red according to the degree of the pathology The portrait of the heart gives overall information on dispersion changes in all the cardiac chambers and can be easily interpreted by the doctor within 15 to 20 seconds CardioDM 06 gives the doctor the unique ability to observe the tendencies of changes in the heart s state by analyzing the image sequence The time it takes to display the gallery of the four consequential images while observing the tendencies is 30 to 40 seconds The overall time it takes to obtain the conclusion is 1 5 to 2 5 minutes The doctor can use the standard view and analysis functions of the ECG data from the 6 standard limb leads I aVF The screening test is recorded conclusion report The screening analyzer has functions which allow for managing the patient database and heart portrait database CardioDM 06 software for HeartVUE system 9 1 1 Restrictions CardioDM 06 DOES NOT DIAGNOSE The screening analyzer functions to detect early dispersive deviations in the in between heart group and warn of acute pathology CardioDM 06 screening analyzer is not a distinguishing condition of Acute Myocardial Infarction AMI among recognizable conditions of myocardial ischemia In such cases the screening analyzer shows the probable myocardial ischemia and the need or urgent need for a clinical examination for diagnosing and rejecting a confirmed diagnosis of acute myocardial
12. 6 2 Features of heart portrait 75 6 3 The clinical significance of ischemic manifestations in the border line group 76 7 Annex III 80 7 1 Criteria of Comparison of Dispersive Deviations and Generally Accepted ECG Diagnose 80 CardioDM 06 software for HeartVUE system 5 Introduction We are happy to welcome you as a user of the CardioDM 06 software for heart screening hereinafter the screening analyzer This screening analyzer significantly differs from the traditional ECG analyzers because it is based on a new approach to ECG signal analysis the ECG Dispersion Mapping method The ECG DM method uses traditional ECG signals only as the way of capturing low amplitude oscillations of body surface potentials Therefore the result of ECG signal digital processing is not the traditional ECG data but a map of dispersive changes of the myocardium which is formed on a computer screen as a so called heart portrait The main structural component of the ECG DM method is the dispersion analysis of low amplitude ECG signal oscillations during particular PQRST cardio cycle intervals Low amplitude oscillation disper
13. Export to directory function and export whole database to selected archive directory indicating Export of the entire list option in patients list and All in date list 4 After successful export delete all outdated records from current database and empty local recycle bins using function Recycle Clean all local bins When deleting examinations it recommends keeping only separate examinations just to monitor dynamics of disease during long period Upon completion of above mentioned procedures a current copy of local database will be created as a subdirectory in selected archive directory Date_Time which can be viewed anytime by function Import from directory If archieve directories are copied on CD and later copied back on hard drive for review in this case it is necessary before import operation to unmark lt Read only gt option for all files and folders on Attributes field using standard Explorer function right click mouse lt Properties gt If this option is marked import of such database will not be possible 4 20 3 The month calendar CardioDM 06 software for HeartVUE system 63 The month calendar control provides the user with a simple calendar interface from which the user can select a date The user can change the display by Scrolling backward and forward from month to month Clicking the Today text to display the current day Picking a month or a year from a pop up menu 4 21 Impo
14. are possible otherwise the found deviations will be episodes of a short term transient ischemia or have non coronary etiology Such situation is frequently observed in malicious smokers 1 2 messages of possible ischemia classified as most likely or very likely Most likely considerable deviations confirmed by the text of detailed explanations in groups G3 G7 Ischemic changes are possible a complete examination is necessary Myocardium of ventricles Messages about hypoxia or ischemic changes Message of potential initial ischemic changes or of obvious ischemia Message of potential initial ischemic changes or of obvious ischemia General conclusion Messages about hypoxia or ischemic changes Message of potential initial ischemic changes or of obvious ischemia Message of potential initial ischemic changes or of obvious ischemia Value of the Myocardium indicator total of the dispersive deviations From 15 to 22 From 22 to 27 Heart portrait changes Vast or local but significant changes to the red color Vast or local but significant changes to the red color Deviations Recommende d actions Synthesis Situation 3 Deviations Situation 3 Synthesis for situation 3 Recommended actions Situation 4 Deviations Situation 4 Synthesis for situation 4 Recommended actions
15. image in the group to one of the pathologies here the digit denotes the conventional index of the pathology The higher the digit value is the more evident the deviation is The quantity of reference pathologies is specific for each group and determined by the following values G1 17 references G2 10 references G3 16 references G4 22 references G5 3 references G6 14 references G7 21 references G8 2 references G9 21 references The quantity of the references has been chosen so as to ensure the possibility to distinguish among approximately 130 enlarged deviation types and to form recommendation messages concerning the presumptive pathology The main function of the detailing code is to provide a user with quick perceptible high quality information about the presence of presumptive pathologies with similar dispersion characteristics The presence of a few indices equal to 1 or 2 in the code e g 0 0 1 0 1 0 0 0 1 is evidence of minor dispersive deviations In contrast to that the presence of high indices equal or similar to the quantity of references in the given group e g 0 8 10 19 1 4 20 2 12 testifies considerable deviations The name of a presumptive pathology corresponding to the index of the conclusion code is displayed in the Detailing message group see further The L code refers to a border line state where the changes have come closely to a
16. infarction In some cases metabolic changes in valvular diseases and cardiomyopathy are indistinguishable from myocardial ischemia by the structure of the dispersion map i e the screening analyzer states that myocardial ischemia as a possible reason for changes in dispersion However such cases can only be found during acute pathological changes which in any case need a full examination with a diagnosis Therefore such specificity mistake doesn t affect high screening sensitivity of this screening analyzer in pathological changes of myocardium While analyzing the rhythm CardioDM 06 DOES NOT DIAGNOSE THE TYPE OF ARRHYTHMIA Only the facts of the existence and acuteness of arrhythmia are analyzed and the most probable type of disorders which are connected to the changes in the atriums is determined The emphasis of the analysis is on separating the acute forms of arrhythmia and stress For this reason some forms of short arrhythmia paroxysms may be undetectable However even in such cases the portrait of the heart gives the doctor early information about the subliminal functional or organic myocardial changes that can cause disorders in the heart rhythm The drug taking can influence on the accuracy of the heart portraits visualization and forming the conclusion and comments If the system is used during the drug treatment it is necessary to compare the current data with the data collected before the drug taking Th
17. minimal or maximal boundaries of norm are present they are displayed in corresponding columns of the table Indicator Lead Data To get a more detailed view of the ECG in large scale and to view additional measurement of intervals or amplitudes in any lead I aVF press the Amplitude button located at the bottom of the table In the window that came up namely Average Wave Amplitudes in all Leads choose the lead as required and press ECG button The ECG feature measurement window will come up on the screen 4 6 Classification of deviations The window consists of nine deviation group The code of each group corresponds to the number of the listed typical deviations CardioDM 06 software for HeartVUE system 47 4 7 Window of detailing The text of conclusion contains screening estimation as well as additional information about the expressiveness and the type of probable pathology to take subsequent decisions Screening estimation differs from additional information by color the text of screening estimation is colored while additional text is black and white Additional information given in black and white is NOT DIAGNOSIS It is recommendable information about probable pathological states dispersive characteristics of which resemble dispersive characteristics of the ECG under analysis Only complete examination can confirm or verify additional text messages In the right part of the window there is a section of tex
18. of indicator lead The data of the rhythm characteristics are shown in the left lower table of the indicator lead window The more exceeding above acceptable limits of values RRmax RRaverage RRmin RRaverage and the more indexes of relative lengthened and shortened RR the more significant abnormalities of cardiac rhythm These abnormalities have the changed color on the data table The special attention is necessary on increased rigidity of rhythm which is additionally indexed on an index HRV Abnormalities At enlarged rigidity the index RRmax RRaverage is much less than a low border 1 04 and simultaneously the index RRmin RRaverage is more than a high border 0 95 The considerable abnormalities of rhythm especially at presence intraventricles blockades can be accompanied with extrasystoles The arrhythmias are always accompanied with dispersive abnormalities either in atriums or in ventricles or in all chambers of heart The monitoring of dispersive abnormalities in the given screening analyzer is a main source of information about state of myocardium and estimation of rhythm variability is auxiliary Therefore the observation of dynamics of dispersive heart portraits in such cases allows qualitatively to judge about probability of electrical instability of heart Due to auxiliary character of the analysis of rhythm the automatic classifier of extrasystoles working only on indicator lead has a hyposensitivity 90 Th
19. pathological gradation The S code shows that certain changes have started within the normal range In 16 other words the S and L codes are indicators of border line values of the dispersion characteristics 2 3 2 Conclusion Conclusion contains a general screening estimate determined by the similarity of the present portrait with pathology portraits Besides it contains an additional information on the manifestation and type of the possible pathology which serves as a recommendation for future decision making The screening estimate differs from the additional information by colour coding the screening estimate text is coloured while additional recommendation text is black and white Positioning of text in the detailed information window 2 3 3 Detailing Detailing contains the names of probable pathologies whose portraits for each group are the most similar to the given portrait Moreover the doctor can see some typical quantitative characteristics of waves and intervals of initial ECG in the left part of the detailed information window ATTENTION If you are examining a patient with an electrical cardio stimulator the rhythm deviations information provided by the CardioDM 06 may be false CardioDM 06 software for HeartVUE system 17 2 3 4 Report structure There are two templates for documenting results in the appliance complete and shortened The Complete ECG protocol contains
20. reading can vary within a low range up to 8 during successive examinations Indicator variations of more than 8 between consecutive examinations which simultaneously change the colour of the heart portrait are evidence of myocardial instability and the need to check status with increased frequency of examinations unless these variations are caused by features of the ECG e g the electrodes being poorly connected to the skin or a muscle tremor while the ECG is being carried out If the myocardium reading is consistently above 19 and other inferable information causes you to suspect potential ischemic change then a full clinical diagnosis becomes necessary to differentiate ischemic from non ischemic change Changes of the Rhythm indicator are due to arrhythmia or stress or the combined action of both The background color for this indicator is determined as follows Rhythm indicator range Indicator colour Status lt 15 Green No significant deviations 15 50 Yellow Minor deviations 51 80 Yellow Border line status or moderate deviations gt 80 Red Significant abnormal rhythmic deviations The Rhythm indicator is a fairly dynamic value especially during a short 30 second exposure time Furthermore this indicator is highly sensitive even to minor disturbances in the resting state while the ECG is being carried out Its readings are guaranteed to be stable only at ei
21. standard ECG fragments with the leads I II III aVR aVL aVF heart portrait general conclusion text detailed information text doctor s comments text input from a keyboard Detailed information text and doctor s comments maybe removed by user from the report in the Settings Type of form section of the main menu 18 The Short ECG protocol contains only ECG fragments and short general conclusion CardioDM 06 software for HeartVUE system 19 3 Installation of screening analyzer Check that the hardware installation has been finished see chapter 5 of the HeartVUE system for non invasive screening of heart User s Guide and then install CardioDM 06 screening analyzer from the Installation CD 1 Insert the Installation CD in the CD ROM and wait till the installation runs automatically or run the Autorun file from the Installation CD In either case the following window appear 2 Press the Setup button 3 When the InstallShield Wizard s window appear press the Next button 4 Select English language and press the Next button 20 5 Select the folder for the CardioDM 06 screening analyzer installation for example C Programm Files or press the Change button and appropriate folder Then press the Next button 6 If the folder is right press the Next button once more time 7 Press the Finish button when the installation is completed Making of the illegal copy of the d
22. values more 11 V are in orange color The TW alternations line is basic for calculation of the average amplitude of micro alternations in The indicator of electrical instability window This window gives the extra information about type of changing of repolarization micro fluctuations though for the indicator of electrical instability the average value of the TW alternations line is only used The TW alternations window The window of The indicator of electrical instability is the main two dimensional indicator for estimation of probability of electrical instability of a myocardium The vertical axis corresponds to the average amplitude of micro alternations calculated by line integration in the TW alternations window The horizontal axis corresponds to the variation coefficient of RR intervals measured during input of an CardioDM 06 software for HeartVUE system 33 ECG signal at an examination Variation coefficient KR is calculated by the formula KR SDNN 100 M where SDNN standard deviation of NN intervals NN an interval between neighbor R waves on an ECG the average value of NN duration The current examination value in the viewed window is pointed by the four squares pointer 6 All window area is divided on five areas with different colors 1 Minor probability of electrical instability of a myocardium green color 2 Uncertainty increased probability of electrical instability of ven
23. And on the contrary similar changes on portraits in some cases can correspond to various pathologies These features do not influence reliability screening estimation i e on reliability of differentiation of conditions norm pathology CardioDM 06 software for HeartVUE system 31 There is auxiliary graphical indicator located on the left side from portraits where direction of electrical axis of the heart on frontal plane QRS angle is displayed Some typical quantitative characteristics of waves and intervals of initial ECG as shown in Detailing duplicate above this indicator To the procedure of viewing of a heart portrait a new function was added which provides monitoring of probability of electrical instability of a myocardium This function is turned on by setting of an option Standard in drop down menu Settings of the top menu bar Besides this function can be launched by the push button panel in the right part of the screen Match the mouse cursor with the button Viewing of one portrait in large scale and press the right button of the mouse In an appeared window choose the option Standard by the left button of the mouse If only the viewing of portraits is necessary choose the option Screening An active mode of visualization is displayed by the button Viewing of one portrait in large scale If the Standard mode is switched on this button has the following icon At the Screening mode of visualizatio
24. CG leads are located on the right side of this window 50 4 10 Scanning a portrait The indicator Detailing informs the doctor of possible pathological deviations Their names can be scanned with the button Detailing of the button panel Besides these names can be seen without exit from the portrait window For this purpose place the cursor on indicator Detailing the cursor in this case does not change the pictogram and press the left key of the mouse The tag window Deviations classification will appear The code of each group corresponds to the number of the listed typical deviations There is located auxiliary graphical indicator on the left side from portraits where direction of electrical axis of the heart on frontal plane QRS angle some typical quantitative characteristics of waves and intervals of initial ECG are displayed CardioDM 06 software for HeartVUE system 51 4 11 ECG Feature Measurement Indicator ECG Feature Measurement Indicator This window has three functional modes measurement is switched off initial mode amplitude measurement and temporal measurement assigned in Mode field by means of indicator setting in appropriate position None Amplitude or Time First in the initial mode measurement is switched off the user selects the required fragment of the ECG and convenient amplitude scale by scrolling on vertical and horizontal bars and utilizing Amplitude tu
25. It allows a doctor precisely monitor the changes dynamics for screening tasks 5 Myocardium of ventricles 5 1 Manifestations of hypoxia or ischemia of myocardium The ECG dispersions indirectly reflect current changes of the electrical characteristics of ionic canals of cardiac myocytes These changes can have steady or temporary transient character For this reason it is impossible to distinguish transient hypoxia from ischemia of myocardium at small dispersive abnormalities In case of significant hypoxia manifestations in the dispersive characteristics ischemia has high probability and the specificity concerning ischemia of myocardium is 75 The remaining 25 cases of major abnormalities are stipulated for heart defects cardiomyopathies and some other pathological changes of myocardium Such decreased specificity to ischemia is reasonable for screening analyzer as its intention is well timed to reveal the fact of developing pathology but not its type Thus at detection of significant changes which are referred to probably ischemic by the screening screening analyzer CardioDM 06 software for HeartVUE system 77 N The screening conclusion The comments and references approximately 25 of them will be not ischemic origin However in all such cases the fact of presence of significant abnormalities which require verification is absolutely authentic The clinical diagnosis can be only made with complete examination
26. a dispersion map is projected onto the quasi epicardium of a 3 D digital heart model demonstrating the anterior and posterior heart surface Expression and supposed localization of changes are identified according to colour changes of the quasi epicardium which if consistently green is considered normal 6 Abbreviations Abbreviation Meaning MCS Medical Computer Systems Ltd ACG Aorta coronary grafting AH Arterial hypertension ECG Electrocardiogramm ECG DM Electrocardiogramm Dispersion Mapping method HCMP Hypertrophic cardiomyopathy HF Heart failure HK Hypokinesia IHD Ischemic heart disease LBBB Left bundle branch block LVH Left ventricular hypertrophy MI Myocardial infarction OMICS Old myocardial infarction cardiac sclerosis Terminology is based on 1 Stedman s Medical Dictionary 2nd edition published by Houghton Mifflin Company Boston New York 2004 2 Russian English Medical Dictionary 3rd edition published by Russo Moscow 1997 CardioDM 06 software for HeartVUE system 7 1 Purpose and usage The computer screening analyzer CardioDM 06 generator of the portrait of the heart allows an instant evaluation of the condition of the heart using ECG signals from the limbs 4 electrodes Why do you need the benefits of the CardioDM 06 screening analyzer You need a simple and reliable screening unit which even your junior medical staff can operate
27. and the intervals are far beyond the norm limits Deviations from the norm rhythm variability are possible Parameters of rhythm variability and the intervals are not far beyond the norm limits Abnormality due to sinoatrial or AB junction blocks are possible There are signs of abnormality of excitation and conduction processes A type of arrhythmia Parameters of rhythm variability and the intervals are far beyond the norm limits Significant ARRHYTHMIA Parameters of rhythm variability and the intervals are far beyond the norm limits Significant missing of ventricular complexes A type of tachyarrythmia or bradyarrhythmia 3 Electric Axis Electric axis deviation to the LEFT Electric axis position is to the left of 15 Electric axis position is HORIZONTAL Electric axis position is between 30 and 15 Electric axis position is NORMAL Electric axis position is between 75 and 30 Electric axis position is VERTICAL Electric axis position is between 90 and 75 Deviation of heart electrical axis to the RIGHT Electric axis position is to the right of 90 DEXTROCARDIA is possible Electric axis position is to the right of 130 or to the left of 120 4 Atrium myocardium plus P Q changes Atrial FIBRILLATION is possible Irregular low amplitude waves instead of P waves Atrial FLUTTER is possible Higher frequency saw tooth P waves Atrial FIBRILLATION FLUTTER
28. are not yet visible with echocardiogram EchoCG The instability of this feature at dynamics monitoring can testify to periodic oscillations of myocardium metabolism 7 Other changes 7 1 Manifestations of increased stress reaction of an organism The given manifestation reflects common changes of indicators of rhythm variability and P Q Q T intervals This message is auxiliary and testifies to high tension of all links of heart rhythm control Constancy of this message can be manifestation of approaching failure of adaptation Such situation is typical either for the significant stress or for compensatory reactions in case of myocardium damage The screening screening analyzer does not make a diagnosis but points out the likeness of dispersive characteristics of patient ECG at the examination moment and the dispersive characteristics of standard ECG of some clinically significant pathologies For this reason the interpreting clinical significance of certain examination results should be based on synthesis of all three output components of the screening analyzer a portrait Conclusion and Detailing item 4 4 The advisable order of such synthesis for probable ischemic manifestations is represented on the table A2 of the given appendix At dynamics monitoring dispersive deviations is divided in three groups of stability Stable The deviations of the indicator Myocardium in sequential examinations do not exceed
29. between the perfect myocardium and an abnormal myocardium Thus a physician has an opportunity to identify border line conditions between a norm and an abnormality that is there is a possibility to observe myocardium changes at early stages preceding disease development 2 2 Visual structure of the heart portrait A heart portrait is a snapshot displayed on a computer screen as a result of computing median dispersion characteristics of low amplitude fluctuations during the ECG input A heart portrait of the ventricular areas reflects the integral picture of dispersion changes involving both ventricular depolarization and repolarization Dispersion changes on a heart portrait of the atrium areas correspond to the depolarization phase only The heart portrait colour changes are observed under deviations of amplitude dispersion characteristics as well as under changes of delay or acceleration of dispersion characteristics in time phases of dispersion characteristics which correlate with values of P Q Q T QRS intervals of ECG input signal The location of amplitude and phase colour indicators on a heart portrait is shown in figures left projection and right projection Amplitude indicators correspond to the anatomical structure of a heart and the location of phase indicators is an approximate projection of relevant depolarization fronts onto the quasi epicardium of a heart portrait Examples of heart portraits with differen
30. correlating with clinically significant changes The degree of a saturation of red color in different areas of quasi pericardium is not always unequivocally connected with the adverse forecast For example at some slowly varying conditions of post infarction cardio sclerosis red color is more significant than at some kinds of a sharp heart attack though the probability of relapse of deterioration of a condition in case of cardio sclerosis as a rule is less than at a heart attack of a myocardium This particular feature of the portrait relates with the fact that appearance of dispersive deviations is proportional to total changes of myocardium at depolarization and repolarization At the same time changes of repolarization components of electrical fluctuations at post infarction may significantly prevail over repolarization changes at the earlier stage of myocardial infarction Therefore having seen a portrait it is necessary to familiarize with the conclusion and size of indicators Please pay attention The present guide despite of high individual repeatability color changes on a portrait of heart not always are highly specific for pathology of one kind Changes of dispersive characteristics give integrated reaction to changes morphological electrophysiological etc structural parameters of a myocardium Thereof at the same clinical diagnosis portraits at different patients can essentially differ on the area and expressiveness of changes
31. cteristics of leads symmetric of QRS angle are identical Any asymmetry of these characteristics testifies to electrophysiological changes of normal excitation of myocardium Screening sensitivity of these changes is very high 90 At the same time clinical specificity is insignificant i e it is impossible to reliably classify a genesis of the detected changes in the given screening analyzer The common dependence is those if the deviations are significant and simultaneously present in detailing group G9 there is high probability it is connected with diagnosed hypertrophy of one of ventricles or preclinical stages of hypertrophy or compensatory dilatation of one of ventricles If dispersive deviations are small or moderate it is a testimony of constant compensatory reaction as a rule of left ventricle A reason of such reaction can be inherent peculiarities of 78 N The screening conclusion The comments and references myocardium or heart valves Besides such reaction can be observed at acute ischemia when regulatory mechanisms try to save a reasonable level of cardiac ejection in conditions of partial injury of myocardium If in the rest parts of General conclusion and the Detailing significant changes are not present but they are present in group Symmetry of leads the dynamics monitoring is necessary The steady character of such changes can be an indicator of initial dilatation changes which
32. d review the table Indicator Lead Data indicator lead in this program refers to the lead with the maximal amplitude of the R wave i e the lead closest in direction to the electric axis of the heart This table can be retrieved using button The table which appears displays the results of automatic measurement of a number of amplitude and time quantitative features These represent the average values determined on all PQRST complexes of an ECG and which do not contain artifacts The symbol implies low reliability of the measurement assessment is lacking Abbreviation HRV means heart rhythm variability 46 While calculating the average values on all analyzed PQRST complexes the representative complex is not singled out therefore the interface does not contain representative complex with wave marking traditional for the ECG ANALYSIS To increase the accuracy of interval duration monitoring the automatic measurement is conducted on the enlarged scale of the ECG Such measurement sometimes results in the 10 15 increase of the duration of an R wave with respect to the measurements conducted with a standard ECG of usual amplitude This increase is conditioned by a more exact fixing of the beginning and termination points of the R wave on an enlarged scale When required the accuracy of the automatic measurements of amplitudes and intervals can be verified in a manual mode by utilizing ECG feature measurement window If
33. d the indication of corresponding probable nosologic units appear in the right part of the window In the top part of that section color code of the detailing is indexed Color indication of detailing code Indicator color of a code shows a degree of similarity of dispersive characteristics of the heart of a patient with dispersive characteristics of the certain group of pathologies in accordance with the following table 44 Code color of detailing Text of detailing Degree of similarity with a probable pathology Light green Probably The portraits of a patient s heart and a specified pathology are virtually congruous Average gray green Possible Significant similarity of portraits Dark Uncertainty specific peculiarities The significant form of this deviation will be as follows The portrait of the patient s heart has many peculiarities Exact congruence is not present however it is very likely that the significant stages of the changes will become congruous with a specified pathology portrait Detailed elaboration is carried out on nine groups of automatic classifier G1 G9 This information allows for specification on additional reports of the general conclusion For example if in the additional information of the conclusion in the section entitled VENTRICLS appears a message on a probable ischemia of the myocardium and at the same time in the detailed elaboration in groups G3 G7 m
34. dar To call out calendar click left mouse on calendar opening icon located at right side of entry field Calendar window will appear on monitor screen 4 After selecting time interval i e after going back to Data export window you have to make sure once again that correct export directory be selected and click CardioDM 06 software for HeartVUE system 61 Execute button If no examination is available within indicated time interval a warning message In such case another time interval or All option in time settings to be selected During export operation a sand glass busy indicator will appear on monitor screen Upon completion of export process Data export does not close For next export operation it could be used again If all export operation are performed click Cancel button to exit Data export function 5 Upon completion of export operation to directory a subdirectory creates as Date_Time where digital Date name will have YYYYMMDD format and Time name HHMMSS format e g If data export was performed on August 18 2005 at 09 10 57 then there will be created subdirectory as 20050818_091057 If necessary this name can be changed by Explorer Such change will not lead to loss of information as export date and other working parameters duplicates in database However standard name Date_Time is more comfortable for visual view of directory when using next export operations Selection of this o
35. differentiation between variant of norm from an initial phase of significant deviations 1 2 There are small CHANGES in the process of ventricle excitation it is expedient to monitor the DYNAMICS as these changes can signal either the onset of significant deviations or a sign of temporary functional irregularities 1 2 Subtle irregularities of the left ventricle function are probable 2 Myocardium 16 19 Moderate CHANGES of the ventricles myocardium Monitoring the DYNAMICS is advisable 2 Deteriorations of the left ventricle function are probable 3 Myocardium 20 27 DEVIATIONS see probable detailed elaboration on deviation groups 4 Myocardium gt 27 SIGNIFICANT DEVIATIONS pathological changes are probable See probable detailed elaboration on deviation groups 2 RHYTHM 1 NORMAL sinus rhythm 1 2 Moderate TACHYCARDIA 3 4 SIGNIFICANT TACHYCARDIA 1 2 Moderate BRADYCARDIA 3 4 SIGNIFICANT BRADYCARDIA 3 ELECTRIC AXIS 1 NORMAL position of the electric axis of the heart 1 HORIZONTAL position of the electric axis of the heart 1 VERTICAL position of the electric axis of the heart 2 4 Electric axis deviation to the LEFT 2 4 Electric axis deviation to the RIGHT CardioDM 06 software for HeartVUE system 43 The additional information in sections of the conclusion is traced out in black and white The additional reports hav
36. e no indications on possible hypoxia or other changes it is feature of physiological norm Thus the heart portrait has solid green color and the text contains the following conclusion No significant DISPERSIVE abnormalities from norm This conclusion CAN be used only by comparison to history and physical data If the patient takes medicines this conclusion requires obligatory pr cising based on complete examination and dynamics control with the help of the given screening analyzer However the dispersive characteristics approximately in 5 7 of cases can be normal at presence of a pathology in history A main reason of such cases is the current effective medicinal therapy If a dosage and composition of medication are optimally selected the electrical stability of myocardium in rest can become enough high that leads to essential decrease of dispersive abnormalities For this reason in case of medicamental treatment the given screening analyzer can be used only for monitoring heart state dynamics and efficiency of medicinal therapy If the indicator Myocardium changes in sequential tests and exceeds 14 or there is other clinical basis for an improvement of the conclusion it is necessary to take additional recommendations of table A2 of the given manual on carrying out of examination at a minimum load The simplest way of such additional examination is orthostatic test For the healthy patient at this test the 74 N The sc
37. e screening analyzer CardioDM 06 is intended for screening analysis of ECG signal only for adults CardioDM 06 is not suitable for children under 12 This screening analyzer can be used for children and teenagers 12 18 years of age only for monitoring the tendencies in dispersive parameters changes This resource is determined in each specific case by the doctor 10 1 2 Principle of analysis Amplitudes directly measured on ECG and indirect parameters calculated on the basis of new mathematical model of bio generator of the heart vary within minor ranges in successive PQRST complexes Amplitude and phase characteristics of these variations have a heightened sensitivity to the changes in the processes of myocardial depolarization and repolarization It is the dispersion of these variations that is analyzed in CardioDM 06 The term dispersion corresponds to the generally accepted in cardiology determination of the difference between the maximum and the minimum of the varying value Dispersive changes give an integrative estimate of changes in an ample quantity of structural characteristics of the myocardium that depend on blood parameters electrolyte balance blood pressure and similar factors These dispersive changes are observed both in cases of presence of standard electrocardiographic changes in the ECG and in cases of their absence for example at the early stages of myocardial changes CardioDM 06 allows direct screen obser
38. eart portrait and text messages Procedure of viewing of output data of program CardioDM 06 is expedient for carrying out in the following order viewing of the portrait viewing of the integrated indicators viewing of the conclusion viewing of the detailed elaboration 4 3 1 Viewing of the portrait On a portrait the slightest changes of dispersive characteristics of electric excitation are visible The picture of changes in color at presence of deviations has characteristic individual attributes therefore a portrait of heart during long time keeps these individual attributes similarly individual attributes of a face of the separate person These individual variations happen significant enough but all of them submit to a uniform principle 30 The more intensive red color and the more the area on which there was a change of green color aside red there are more deviations Usually the most significant pathological changes cover left ventricle or at once both ventricle and also area 15 of final phase of depolarization of ventricle on the left projection of a portrait of heart The special attention should be turned on a bright red strip in the field of 15 even if all other departments of quasi epicardium have color of norm In case of stable repeatability this attribute correlates with clinically significant changes of a myocardium Red band in section 15 final phase of depolarization of the right ventricle
39. ed changes on ventricles border cover the whole right ventricle though the functional or morphological changes occupy only small part of myocardium near projections of intraventricular septum This topological inaccuracy of the given screening analyzer is 80 Area of visual changes The comments and references irremovable However it does not influence on screening sensitivity and possibility of precise dynamics monitoring 3 Duration of processes of electrical excitation P Q interval The redder colour this area has the more elongation of P Q interval When duration of P Q interval decreases colour varies to blue Q T interval This area colour characterizes average deviations from the empirical standards based on the Bazett s formula The red colour corresponds to elongation of Q T interval QRS duration This area colour correlates with QRS duration Green colour corresponds to norm 6 3 The clinical significance of ischemic manifestations in the border line group The given table contains the description of the four typical situations which occur during the analysis of messages received from the auto classifier of the screening screening analyzer in so called border line group conclusions This group includes the patient s myocardium states which either are connected with the stable pathology or with transient changes in myocardium caused by some functional metabolic and other reasons of the transient nat
40. een norm and pathology is possible DEVIATIONS refer to probable detailing in deviation groups SIGNIFICANT DEVIATIONS Pathologic deviations are possible Refer to probable detailing in deviation groups ECG is pathologic Q T interval prolongation SIGNIFICANT PROLONGATION of Q T Q T interval prolongation from the norm at specified heart rate Q T is longer than 0 44 s 2 Rhythm Sinus rhythm is NORMAL Rhythm at heart rate of 60 to 80 per minute in cardiac pacer P waves are positive in leads I II aVF and negative in aVR lead Pulse is NORMAL but rhythm is deviated from the NORMAL one Rhythm at heart rate of 60 to 80 per minute with some P waves missing or little deviations of rhythm variability 86 Moderate TACHYCARDIA Rhythm at heart rate of between 80 and 110 per minute Significant TACHYCARDIA Rhythm at heart rate of higher than 110 per minute Moderate BRADYCARDIA Rhythm at heart rate of lower than 60 per minute Significant BRADYCARDIA Rhythm at heart rate of lower than 50 per minute High rhythm is caused by high STRESS Significant arrhythmia is NOT detected Observed ECG section has sinus rhythm but parameters of rhythm variability and the intervals are slightly beyond the norm limits Integral rhythm is high Little signs of arrhythmia HIGH STRESS is the most probable cause Significant deviations of sinus rhythm are not appeared but parameters of rhythm variability
41. elect the all patients Selection of all result to select the all examinations Recycle Clean selected bins to remove examinations from the bin of selected patients Clean all local bins to remove examinations from all bins Import Export from the directory to copy the set of examinations from the directory into current or new database from a database to copy the set of examinations from the other database into current or new database into the directory to copy the set of examinations from the current database to the directory into a database to copy the set of examinations from the current database to the other database into a clipboard from the clipboard If it is necessary to copy single examination from a folder of one patient in a folder another one for example if the doctor mistakenly has written examination in folder of other patient it is possible to copy this examination in clipboard Import Export into a clipboard then to select an exact folder of the patient and to realize in his her copying from clipboard Import Export from the clipboard By the default given possibility is disabled To unblock it set up menu option Settings Enable clipboard 26 4 1 3 Button panel 4 1 4 Exit To finish operation click menu File Exit CardioDM 06 software for HeartVUE system 27 4 2 Examination formation of heart portrait Initially it is necessary to activate patient s name in databa
42. erefore for the target analysis of extrasystoles 76 N The screening conclusion The comments and references 3 Electrical axis 3 1 In the given screening analyzer the direction of heart electrical axis is defined by QRS angle which is calculated on a gradient of electric potential The exceeding of value of QRS angle above limits 15 90 degrees is always connected to presence of dispersive changes This feature has no independent value for dispersive analysis In the screening analyzer interface it is only intended for informing about the value of feature generally accepted in the ECG analysis 3 2 If measured QRS angle is more to the right 130 degrees on standard 6 axial coordinate system or more to the left 120 degrees in most cases it is connected to dextrocardia In such situation the doctor has to clarify the heart position in a chest by the generally accepted ways and if dextrocardia is confirmed to repeat examination with the changed position of electrodes R L 4 Myocardium of atriums 4 1 Changes of atriums depolarization In the given screening analyzer classification sensitivity i e the sensitivity of the text reports concerning changes of atriums myocardium is diminished It is connected to that the dispersive clusters of atriums at monitoring only limb leads have less stability than dispersive clusters of ventricles However on heart portrait the visual sensitivity is saved on initial state
43. es emergency archive can be deleted from drive space CardioDM 06 software for HeartVUE system 69 5 Annex I 5 1 Examples of heart portraitures with different pathologies The first indicator in captions under the portraitures is a Myocardium indicator The text corresponds to the verified clinical diagnosis not to ECG decision Normal Normal Normal Normal Ischemia OMICS Valvular heart disease LVH IHD OMICS Atrial fibrillation AH Recurent MI AH Mild of LVH 70 The combined heart disease Atrial fibrillation Metabolic disorders Acute MI HK of back wall Asymmetrical HCMP LBBB AH Hypokaliemia IHD OMICS IHD OMICS IHD OMICS IHD OMICS IHD OMICS Stenocardia 1 year after ACG IHD OMICS 7 years after MI CardioDM 06 software for HeartVUE system 71 IHD OMICS Diabetes mellitus IHD OMICS LVH 72 6 Annex II 6 1 Peculiarities of clinical interpreting of heart portrait This screening screening analyzer monitors repetitions of the characteristics of low amplitude oscillations of ECG SIGNAL unavoidably generated at each heart beat The amplitudes of these oscillations dispersion of oscillations do not exceed 0 01 0 03 mV i e in tens of times less amplitudes than ECG waves The term dispersion which is assigned to a used method of the analysis corresponds to the definition generally accepted in cardiology as a difference between the
44. essages appear of ischemic onsets this clearly indicates a high probability that a full diagnostic examination will detect the ischemia The automatic classifier of screening analyzer CardioDM 06 essentially differs from renowned computer interpreters in that it does not require lengthy and effortful reliability control of the ECG conclusion The portrait is formed on objective dispersive signals irrespective of the conclusion therefore a glance at the heart s portrait is sufficient for purposes of reliability estimate Deviations always give rise to changes on a green palette indicating a normal myocardium 4 4 Examination record of the comments In the bottom part of a detailing window is the window of comments where a doctor can input through the keyboard any required information regarding the examination or his her final conclusion To input the text press the button and proceed inputting the text in the new window that came up For saving the text press the lt gt button In the printed version doctor s comments will appear on page 3 of the form The free space of this page can further be used by the doctor for hand writing notes CardioDM 06 software for HeartVUE system 45 The window is used to write doctor s notes 4 5 Examination review of additional parameters of the input ECG If the doctor needs to assess some general features of RR intervals or amplitudes and the durations of the some ECG waves she he shoul
45. exchange is possible Saw tooth P waves intermittent with irregular or missed P waves CardioDM 06 software for HeartVUE system 87 Pacemaker MIGRATION is possible Variation of form and amplitude of P waves If P waves are inverted in leads I and II then pacemaker migrates to AB junction Abnormal atrial depolarization is possible Unstable form and low amplitude of P waves Typical changes of atrial repolarization with possible ischemic changes of the left ventricular PQ line and ST line depression like concave parabola near R wave Slantwise ST upline with possible little depression at J point Signs of the left atrium enlargement The left atrium hypertrophy is possible P wave is longer than 120 ms P wave direction on the front plane is to the left of 60 So maximum amplitude of P wave is shifted to I and aVL leads Signs of the right atrium enlargement P wave amplitude is higher than 2 5 mm 0 25 mV P wave direction on the front plane is to the right of 60 So maximum amplitude of P wave is shifted to aVF III leads P Q ENLARGEMENT Take note to dynamics P Q interval is SHORTER PQ is longer than the norm Norm 200 ms at heart rate of 40 50 per minute 120 ms at heart rate of 130 160 PQ is shorter than 120 ms 5 Ventricular myocardium Ventricular myocardium changes like ischemic ones It s wise to take note of DYNAMICS and examine completely Moderate depression or elevati
46. f myocardium Thus electrophysiological temperature of myocardium is not nosological parameter but measure of a level of adaptive capabilities Exactly this property gives this index a special status independently on nosology it is possible to accurately observe and predict a dynamics of compensatory reactions which determines effectiveness of current treatment as well as long term forecast 4 3 2 Viewing of the integrated indicators The indicators are located at the top of the portrait window The main indicator is the myocardium indicator which gives a cumulative evaluation of the dispersive deviations from the norm on a scale of 0 100 The background colour on the indicator informs the doctor about the intensity of any deviations diagnosed in accordance with the following chart Myocardium indicator range Indicator colour Status lt 15 Green No significant deviations If there are small changes of the portrait these are individual peculiarities and a version of the norm CardioDM 06 software for HeartVUE system 39 Myocardium indicator range Indicator colour Status 15 19 Yellow Border line status transient episode of short term increase in dispersive characteristics or early stages of possible pathology 20 23 Yellow Possible covert pathology 24 47 Brown Probable pathology gt 47 Red Probable significant pathology The Myocardium indicator
47. f archive has required format in this case name of archive directory Data_Time will be marked by icon in Select directory window Perform data import from CDM_Arc Date Time directory to current database created specially for viewing archive If archive directory is not marked by icon it means that archive corrupted Further use of this archive is not possible Upon completion of archive operation current database created for archive view can be deleted from list of databases CardioDM 06 software for HeartVUE system 67 ATTENTION If local databases have large capacity then import export operations of appropriate lists may take several minutes even on fast response computers 4 22 Backup databases during operation Manufacturer guarantees uninterrupted and non conflicting operation of CardioDM 06 program if serviceable computer and standard operating system are used However there can be some cases of malfunction of CardioDM 06 program caused by failure of operating system e g at emergency electricity shut down or mistaken action in a root directory of program by unskillful user If you face emergency related with malfunction of program while entering ECG or portrait creation it recommends using Db2crasharc exe utility To run Db2crasharc exe utility you should do the following steps Exit CardioDM 06 program if it is still running Enter root directory of CardioDM 06 program using Explorer Roo
48. f the patient at input of an electrocardiogram If the patient is in position sitting he she should accept the convenient weakened position as much as possible excluding a muscular tremor Breath during input of an electrocardiogram should be usual it is desirable without deep breaths or exhalations If the patient is in a condition of nervous excitation it is possible to recommend to patient to close eyes During input of an electrocardiogram conversation or turns of a head are inadmissible Press the left key of the mouse button If the screening analyzer of input of an electrocardiogram is connected to a computer on the screen of the display there will be a window of input of an electrocardiogram signal and two buttons of management of input Start and Stop If input unit disconnects from the computer the button is blocked In this case the computer should be connected to the input screening analyzer of an electrocardiogram and the program should be restarted to leave it and again to make active Inform the patient about the beginning of test and necessity to keep a condition of rest during 30 60 seconds press button Start The first 5 seconds are carried out auxiliary procedures of optimum adaptation of the screening analyzer to an input signal Thus on the indicator of time of an exposition there is a return readout 5 4 0 These 5 seconds simultaneously are a pause for a relaxation of the patient Indication of an elect
49. greatest and least values of the varying value To observe and to measure the characteristics of such random oscillations it is necessary to superimpose signals of one type ECG waves i e synchronize a beginning of electrical excitation of several sequential waves The examples of such low amplitude oscillations of QRST complex in one lead are represented on fig 1 and fig 2 In fig 1 the low amplitude of oscillation of a healthy person ECG is represented in fig 2 same in case of a subacute stage of MI Some amplitude and frequency peculiarities of oscillations changes are visible in these cases Fig 1 Low amplitude oscillation of ECG in sequential QRST complexes of healthy heart a separate complex b 7 sequential synchronized complexes Fig 2 Low amplitude oscillation of ECG in sequential QRST complexes for MI The especially important information contained in oscillations of fronts of sequential analyzed waves is not visible on a usual ECG Experimentally shown these hidden dispersive features despite the low values of analyzed differences of amplitudes of ECG SIGNAL with particular mathematical processing will form steady groups dispersive clusters in new space of small fluctuations of ECG The dispersive clusters have appeared to be effective markers of micro changes of electrical activity in the myocardium The physical basis of creation of dispersive clusters is made by a continuous control of potential differences measured i
50. gure out adaptive resources of heart Window Repolarization s Microfluctuations and window Electrical Instability are formed on TW ALTERNANS VECTOR REPORT 36 CardioDM 06 software for HeartVUE system 37 To see it click button and after Portrait Viewing window forming click Subject to setting lt Type of form gt option TW ALTERNANS VECTOR REPORT will put in file emf or print This report is formed only in window Clicking from other interface windows calls only screening form In lower part of it as well as in left part of Portrait Viewing window there is an indicator of Electrophysiological Temperature of Myocardium Its range is selected in correspondence with standard thermo dynamical temperature of body This parameter indirectly defines a level of functional reserves of myocardium Electrophysiological Temperature of Myocardium Equivalent Value of Myocardium Levels of functional reserves of myocardium 36 6 36 9 97 9 98 4 F 5 14 Physiological norm for current heart rate during reading 37 0 38 0 15 25 Deficiency of 38 98 6 100 4 F functional reserves of myocardium 38 1 41 0 100 6 105 8 F 26 80 Severe exhaustion of functional reserves of myocardium Than higher electrophysiological temperature the less free energy of myocardium and less compensatory capabilities o
51. he pathological changes of another genesis which cannot be detected in the conclusions presented by this medical screening analyzer These are mainly cardiomyopathies myocarditis and some heart defects 82 Table A2 Detailing Messages about hypoxia or ischemic changes in groups No or no more than one message with gradation Individual peculiarities Most probable it is the norm the patient s state is normal If there are clinical reasons for a more accurate conclusion decision it is recommended to increase the patient s pulse by 15 25 with the help of any load test and take successively 2 3 portraits more The best option to raise the load and the best load magnitude is determined by the doctor for each particular case If after the load realization in General conclusion decision based on successive images a notification message Deviation from the norm appeared Or the Myocardium indicator reading exceeds 18 and the recurrence time of the image to its initial condition exceeds 4 minutes it is recommended to conduct a full patient s examination Otherwise an intermittent dynamics monitoring on the basis of the images obtained is necessary for a precise conclusion decision 1 2 notification messages about a probable ischemia with gradation most probable and very probable Most probable the changes are significant If this condition is d
52. he doctor which includes 1 An integral deviation index of the dispersive characteristics of the low amplitude ECG variations index of metabolic changes from the norm on a scale of 0 to 100 8 2 An integral index of rhythm disturbance on a scale of 0 to 100 a total deviation of statistical characteristics of rhythm variability 3 A text screening evaluation CardioDM 06 quickly and accurately ascribes the heart to one of four groups 1 Normal 2 Border line state 3 Moderate pathology 4 Acute pathology At the same time the doctor gets visual information on the intensity and the most probable localization of the center of the changes In addition this information allows controlling the pre clinical near threshold changes of the state of the heart Exposure time duration of the ECG data entering is 30 or 60 sec The portrait of the heart can be obtained without undressing the patient while he or she is sitting up The time it takes the image to form after the entering of ECG data is 5 to 20 seconds and the time it takes to inspect the portrait of the heart from two views from the right and from the left does not exceed 60 seconds The portrait of the heart is simultaneously formed from two views from the right side and from the left side In the normal state the epicardium is green in the image If there is a center of pathological changes in the myocardium the correspondent area of the heart portrait
53. iagnosed for the first time it is recommended to take 2 3 additional portraits successively If the deviations are repeating this means that these are significant deviation If the Myocardium indicator magnitude decreases and the portrait in successive examinations becomes better it is recommended to increase the patient s pulse with any load test and take successively one after another 2 3 portraits more The best option to raise the load and the best load magnitude is determined by the doctor for each particular case If in General conclusion on successive images after the load a message Deviation from the norm or Severe deviations appeares Or the Myocardium indicator fluctuation exceeds 7 pathologic changes are probable Otherwise the diagnosed deviation can be episode of short term passing ischemia An accurate conclusion in the latter case requires a brief review of image dynamics Myocardium of ventricles Messages about hypoxia or ischemic No messages Notification message about the probable initial ischemic changes General conclusion Messages about hypoxia or ischemic changes Message about hypothetical probable initial ischemic changes Notification message about the probable ischemic changes or frank ischemia Value of the Myocardium indicator total of the dispersive Less then 15 From 15 till 22 Heart portrait changes Slight
54. ield by left mouse click 4 After selection of time interval i e after going back to Data import window you have to make sure once again that correct export directory selected and click OK button If no examination is available within indicated time interval a warning message window will appear and import of empty patients list stops In such case select another time interval or All option in time setting During import operation a sand glass busy indicator will appear on monitor screen Imported list of patients opens in a current database only after exiting lt Data import gt function A list of imported patients marked by a special symbol in lt Surname gt field in window of 66 patients database symbol attaches to last character of surname It allows easily distinguishing main list from imported one There can be a situation where after import operation you cannot see in a current database window a patient selected in Data import window for importing It is not an import operation mistake but automatic reaction of program on lack of examination form of that patient If program found no data in examination form of that patient during data import operation analysis in this case saving of empty patient s data list to current database will be blocked Selection of this option is necessary to transfer data from one local database to another one Import of data to another local database perform
55. information on the type and intensity of possible pathology to aid further decision making The screening evaluation can be distinguished from the additional information by a color code the screening evaluation text appears in color whereas the additional information is in black and white There are four distinct levels within the screening evaluation norm minor deviations from the norm moderate deviations and significant deviations The colour of the text will indicate the level of deviation from the norm in accordance with the following chart Colour of screening evaluation text Index and designation for level of deviation from norm Green 1 Norm no significant deviation or on the norm s outer limits Light orange 2 Minor deviations from the norm Red 3 Moderate deviations Red 4 Significant deviations 42 Texts of the screening assessment on sections of the conclusion include the following basic text messages Deviations Gradation Index The screening estimation text 1 GENERAL CONCLUSION 1 Myocardium lt 15 NO significant deviations found Such conclusion may be used only for comparison with anamnesis and physical parameters If the patient is taking MEDICINE such conclusions necessarily has to be defined more precisely based on complete examination and monitoring of dynamics by this screening analyzer 1 2 Little changes WITHIN the NORMAL RANGE it is advisable to check the DYNAMICS for
56. ing other operations of CardioDM 06 at the same time At lower processing speed of printer it is reasonable to print report forms at the end of working day as in this case you can set printing queue which the computer does automatically For this purpose choose first examination for printing and click print button In 3 sec sent to print process of report form will end sand glass busy indicator disappears Then without waiting for printing process CardioDM 06 software for HeartVUE system 57 termination you can choose next examination for printing and repeat above procedures etc Length of queue is limited by the computer performances For correct operation of report form creating function at least installation of one printer in Windows operating system is compulsory Installation of printer is performed via normal system function Start Settings Printers Setup printer 4 17 List of databases CardioDM 06 program has a list of databases where user can select current database necessary for operation Mechanism of creation many databases makes it easy to operate this screening analyzer at a great flow of patients It is also possible to create separate database for certain clinical departments and group of patients etc There can be 500 databases stored in one screening analyzer at the same time Taking into consideration the feature of exporting data to archive this screening analyzer is the best solution fo
57. ing the high clinical importance for example messages of probable ischemia are traced out in contrast black color If the following message is being formed probable signs of the left ventricle abnormality it means that there are significant changes of dispersive characteristics of the left ventricle However these changes have a diffuse type and it is not possible to make a more elaborate statement on a probable deviation thereby full clinical diagnosis is necessary for this purpose The additional information represented by the black and white text is not the DIAGNOSIS It is the recommendatory information on the most probable pathological conditions which dispersive characteristics are similar to the dispersive characteristics of an analyzed electrocardiogram Only full examination can confirm or specify additional text messages 4 3 4 Viewing of the detailed elaboration If the indicator Code of detailed elaboration contains indexes of deviations nonzero figures or if you wish to view quantitative values of typical parameters of an input electrocardiogram press button Detailing window The window of detailed elaboration will appear on the screen The text of the conclusion is repeated in the top part of this window for convenience some standard parameters of the input ECG appear in the left part A section with text messages on the probable pathological portraits which are the most similar to patient s portrait an
58. ion and list of main numerical ECG characteristics displayed on window of Data of indicator lead Text of main message of screening examination conclusion is displayed by underlined font Additional recommendations are displayed by italic font on page 1 Date and time of examination of summary report are displayed on headline of summary report form in square brackets Additional text messages of General conclusion and Detailing are displayed on page 2 Doctor s recommendations typed on keyboard are displayed on page 3 In addition there is empty space left on third page for doctor s hand written prescription and advice All three pages of summary report contain full copy of text messages of screening analyzer classifier 56 Shortened report contain single page Unlike complete report form shortened report form have no heart portraits and they replace by standard fragment of ECG for rhythm monitoring Options of summary report view have two meanings Print and File If you choose File option a report directory will be called as disk file with emf format This vector format provides best display of summary report at any resolution of monitor screen or printer User can edit name of created file Default name of file is name of a current patient File with such name will be saved as default in directory CDM_EMF and lt gt symbol refers to a disk space where CardioDM 06 program is installed It is reasonable to create summar
59. ions performs by function of main menu Export Import Export Submenu of this function contains two options to directory and to database Selection of this option is necessary for normal case of export 1 For efficient classification of export procedures CardioDM 06 program creates default directory CDM_Export on root disk disk where program installs If necessary user can create another directory for export by system explorer Explorer or use any directory available on disk After selection of to directory option Data export window opens Export to the directory Data export performs as follows 1 Choose directory for export through standard Windows function using Review button It is recommended to use default directory CDM_EXPORT which is displayed in Export directory field at the first call out of export function Program saves last path to directory for export 2 Set amount of exported data by either selecting Export of the entire list or Export of the selected list option In the latter case do not forget to select appropriate list in patients database in advance 3 Set time interval you would like to use for export If you need export all examination available on examination database select All option To set time interval by date select Interval field by left mouse click and move mouse pointer to right to initial date indicator field and set required date Date enters via keyboard or using calen
60. istributive is prohibited The disk is copyrighted The CardioDM 06 screening analyzer runs only if the USB protection key HASP HL key is plugged in the free USB socket The HASP HL key is included into the packaging CardioDM 06 software for HeartVUE system 21 ATTENTION The key should be plugged in the computer s free USB socket ONLY if the installation of the CardioDM 06 screening analyzer is finished After the key is plugged and the system defines it the LED will light up and also the Aladdin HASP Key and Aladdin USB Key will appear in the Screening analyzer Manager under the Universal Serial Bus controllers If you forget to plug the key in therefore the CardioDM 06 screening analyzer won t run and the error massage will appear If you are going to uninstall the CardioDM 06 screening analyze from your computer pay attention to the databases saving The Windows will ask you to uninstall the CardioDM 06 screening analyzer by showing the message CardioDisp Do you want to completely remove the selected application and all of its features Select OK if you want to completely remove this screening analyze During the screening analyze s uninstallation the message Attention Do you want to save the databases before uninstalling the CardioDM will appear Press Cancel if you want to uninstall the CardioDM 06 screening analyze from your computer without saving the databases Press Next if you want to uninstal
61. l size in millisecond as related to the zero reference point in the indicator 52 Time in the ECG field If it is necessary to set a new reference point move the marker till the required value and press the left mouse key once again In that way it is possible to measure the time between the time selected points of ECG Both horizontal and vertical ECG scroll work in the measuring state 4 12 Tendency control portrait gallery viewing CardioDM 06 offers unique possibilities of precise and fast control over the tendencies on the basis of viewing of the successively obtained portraits which are stored in the examination database This allows to detect more precisely pre clinical forms of pathological changes and to monitor more effectively mild changes in the process of electric excitation of myocardium that are not displayed on the ECG For that a mode of portrait viewing on small scale is intended Choose from list the desired patient from examination database and press the button A scroll box of the portraits will appear on the screen Selection of examinations for default view is set so that activation of view window will automatically cause portraits of last examination of the patient You can find view control panel at the bottom of view window You can choose view zoom 4 or 16 portraits and scroll list of portraits i e list of examinations The gallery of selected portraits can be printed out through the button
62. l the CardioDM 06 screening analyze from your computer with the databases are being saved Then the databases are 22 copied to the TmpCardioDisp folder which is located on the disk where the CardioDisp screening analyzer s files were located For example if the screening analyzer s files location was F Program Files the databases will be saved in the following folder F TmpCardioDisp At the same time each local database is copied to its own folder YYYYMMDD_hhmmss_n where YYYY means year MM month DD day hh hour mm minute ss second of the database s creating n the identifier of the database CardioDM 06 software for HeartVUE system 23 4 Operation 4 1 Program overview 4 1 1 Start of the program You can run CardioDM 06 program by double left mouse click on the program icon located on Windows desktop There is also another option to activate program click Start system panel button on the left bottom of screen enter All Programs and CDM 06 section and run CardioDM 06 program After running program the main window of the program will appear on screen and window showing List of doctors Main window on the left shows current database of the patient on the right database of the heart portraits examination database The database of the patient has two columns with dates Date and Original The value from a column Date specifies date of registration of the patient i
63. lity of the differentiation of norm abnormality states CardioDM 06 software for HeartVUE system 11 2 General information The CardioDM 06 is intended for quick identification of heart performance abnormalities which are manifested in the above mentioned dispersive characteristics and may be associated with developing heart pathology The CardioDM 06 DOES NOT DIAGNOSE The function of this screening analyzer is to define earlier dispersive deviations which may forego pathology and monitor its dynamics In many cases this allows observation of changes at an early stage as well as control of the dynamics of dispersive deviations with a high level of accuracy The CardioDM 06 IS NOT A SUBSTITUTE for other clinical methods of heart diagnostics and MAY be used only under consideration of other clinical data General methods of operating the CardioDM 06 are as follows 1 Electrodes are applied in accordance with the standard arrangement of ECG limb leads 2 The New Test button please see the interface description below is pressed ECG data acquisition is performed depending on the chosen time exposure of 30 or 60 seconds 3 In about 40 to 70 seconds an portrait of a heart in two projections is formed on a screen together with a general conclusion and integral data indices related to a patient s condition The quasi epicardium area of the image is coloured green if normal When various abnormalities are obser
64. local changes towards red color Slight or medium local changes towards the red color Deviations Recommended actions Synthesis Situation 1 Deviations Situation 1 Synthesis for situation 1 Recommended actions Situation 2 Deviations Situation 2 Synthesis for situation 2 Recommended actions CardioDM 06 software for HeartVUE system 83 Table A2 continuation Detailing Messages about hypoxia or ischemic changes in groups G3 G7 None or no more than one message graded individual peculiarities or most probable Most likely considerable changes but there exists a possibility of a short term ischemic episode as in the groups G3 G7 unlike in situation 2 the reaction to ischemia is hardly noticeable If this condition is detected for the first time it s advisable to register 2 3 pictures one after another If the deviations repeat persistently these are significant deviations It the indicator Myocardium is reducing and the picture is improving it s advisable to increase the pulse by15 25 with any stress test and again take 2 3 pictures one after another In case in the General Conclusion on consecutive pictures after stress there appears a message Deviation from Norm or Significant Deviations from Norm or the fluctuations of the indicator Myocardium have exceeded 7 pathological changes
65. m are possible Complete examination is NEEDED IT S WISE to observe DYNAMICS as NORM BORDER CHANGES may be the beginning of ischemic changes of myocardium CHANGES of ventricular depolarization it s wise to examine completely as correlation of these changes with coronary ones is possible There are little changes of ventricular repolarization It s needed to observe DYNAMICS these deviations are either BEGINNING OF THE SIGNIFICANT CHANGES or sign of temporary functional instability Nonspecific moderate local ST depression at some leads Lower amplitude and T wave deformation In some cases significant deviations in the standard ECG are absent MODERATE QRS prolongation SIGNIFICANT QRS prolongation is a sign of interventricular heart block QRS is from 105 to 115 ms QRS is longer than 115 ms Wide S waves in I aVL leads block of the right bundle branch qR complex in I aVL leads rS complex in II aVF deformed R waves block of the left bundle branch
66. m in the given region are attributable to one s individual peculiarities This conclusion is to be compared with the other clinical data 15 19 border line state dynamics monitoring is advisable 20 22 pathology is likely If the deviation has been detected for the first time dynamics monitoring is necessary and examination is advisable 23 27 pathology is likely If the deviation has been detected for the first time dynamics monitoring is necessary and examination is required More then 27 pathology or evident pathology If the deviation has been detected for the first time and has been invariably confirmed by successive examinations Similarly the Rhythm 100 corresponds to the most evident changes in the R R intervals variability characteristics which are inherent to significant arrhythmias or intense stresses immediate examination is required The Detailing indicator offers information on the similarity of the given image to the images of certain typical widespread pathologies The Detailing indicator includes 9 symbols which can be represented by digits as well as L and S letters The number of the symbols in the code is equal to the number of the pathological groups used by the automatic classifier of the screening analyzer while analyzing the fluctuations CardioDM 06 software for HeartVUE system 15 The pathological groups include the following
67. m the list Remove function used to complete deletion of local database from the list The indicator of database arrangement is located over patient s database window 4 18 List of doctors After running program the main window of the program will appear on screen and window showing List of doctors In order to start running program you should necessarily select name of the doctor To select doctor s name from list who will start current session of program you should locate mouse pointer on necessary line and double click left mouse or click OK at the bottom of window The current name of the doctor is displayed on headline of main window and headline of examination summary report If the doctor s name is not included in the list you should enter new name by clicking Add button It is not recommended to enter doctor s name longer than 20 25 characters This can cause incorrect display of doctor s name on window headline on the screen and examination summary report Window List of doctors CardioDM 06 software for HeartVUE system 59 Change and Remove buttons are provided for editing and deleting doctor s name from the list These operations are performed in a free running mode regardless your exit from List of doctors by clicking either OK or Cancel button Current doctor s name can be changed via function of main menu Settings and List of doctors without exiting program The default list of doctors provided toge
68. n it looks like The additional function Standard forms of two additional windows Micro alternations of repolarization and The indicator of electrical instability Micro alternations of repolarization window contains an average line of amplitude deviation of low amplitude dispersions on a wave interval of an initial ECG This line called a TW alteration diagram determines a functional dependency of micro 32 alternations amplitude on repolarization time which corresponds to an average time interval from the beginning to ending of a wave Horizontal scale is synchronized with 6 points highlighted with white circles on a line The first three points correspond to time interval of a wave increasing from an isoline up to the maximum amplitude The next three points correspond to time interval of decreasing of wave amplitude from the maximum to an isoline Thus the horizontal axis corresponds to an average duration of a wave and the vertical axis corresponds to micro alternations amplitude For a TW alternations line the norm border is 11 V At considerable deviations the TW alternations value can exceed 60 V The norm border as 11 V is defined by measurement method of micro alternations amplitude and it is a technological constant for the given device The other methods give values from 3 to 15 V To improve visual perception of the TW alternations line values less 11 V are in green color and
69. n reveal in clinical forms at unfavorable circumstances 6 2 Features of heart portrait The heart portrait in the given screening analyzer is only intended for screening tasks therefore on quasiepicard surface of 3D model of heart the most important information about dispersive changes both for the depolarization and repolarization of myocardium is simultaneously displayed Such artificial association of depolarization and repolarization processes in one portrait enlarges efficiency of visual review and simplifies dynamics monitoring of dispersive changes At review of portraits it is necessary to remember some methodical limitations described in the following comments Area of visual changes The comments and references 1 Atriums Depolarization When P wave amplitude decreases or changes colour of atriums varies from green to brown When electrical activity increases colour of appropriate atrium becomes blue and at the significant hypertrophy violet 2 Ventricles Depolarization These areas on a portrait reflect dispersive changes in a final stage of depolarization which are most informative when myocardium hypoxia is monitored The greatest correlation with hypoxia has a reddening of this area in the left departments of heart Repolarization The topological resolution ability of repolarization dispersions is a little reduced at monitoring of areas close to intraventricular septum For this reason in some cases r
70. n the given database and the value of a column Original specifies date of the very first registration for the imported databases For example the patient the first time was registered 03 10 2006 in the database DB_01 further on 08 20 2006 his her data were copied in the database DB_02 by means of operations of import export In this 24 database the column Date will contain value 08 20 06 and column Original 03 10 2006 If a column Original is empty it means that the patient was registered only in the current database CardioDM 06 program has a list of databases where user can select current database necessary for operation Database can be switched to current session through main menu via Settings List of databases The name of current database highlights on headline of main window after the name of doctor You can see main menu line under the headline While starting database of patients left window they always arrange by date of registration of patients The examination database portraits database of selected patient in a current database activates on the right window Examination database is filtered by date where the first record complies the last one by time of registration Setting of filter is performed by function of main menu Filters and includes five filter options Last day Last week Last month All Interval The indicator of current setting of a filter is located over examination database window Interval setting
71. n two close points in certain areas on the body surface at depolarization repolarization of myocardium For augmentation of classification CardioDM 06 software for HeartVUE system 73 stability of dispersive clusters such control is made for many pairs of closed points Potentials of some points which are necessary for the analysis but which are not measured directly are defined on the basis of special calculation The dispersive characteristics Due to the significant nonlinearity of depolarization repolarization processes of myocardium at origin of abnormalities from norm start to vary earlier than it appears on a usual ECG For this reason the given screening analyzer can react on hidden or preclinical forms of myocardium changes Thus the dispersive characteristics in most cases do not duplicate the common ECG analysis but give new specific information about myocardium These methodical peculiarities generate appropriate features of clinical interpreting of heart portraits and text conclusions These features are formulated in the following references which it is necessary to be guided in practical operation with this screening analyzer N The screening conclusion The comments and references 1 General conclusion 1 1 The indicator Myocardium 0 14 This conclusion is arrived at when the dispersive characteristics are within normal parameters If in other text reports including groups G1 G9 there ar
72. neously the digital indicator Myocardium gives more rough current estimation of a clinical significance of these abnormalities Therefore presence of changes on a portrait at the Myocardium value less than 10 12 means that the probability of pathological manifestations of these changes is insignificant 1 2 The indicator Myocardium 15 22 The given category of abnormalities corresponds to a case of border line states If necessary to improve of the conclusion take the references of tab A2 item 6 2 on additional test with a small load 1 3 Indicator Myocardium 23 100 Authentic dispersive abnormalities For given category of abnormalities the complete examination for diagnosis and observation of portrait dynamics are necessary CardioDM 06 software for HeartVUE system 75 N The screening conclusion The comments and references 2 Rhythm 2 1 The most probable reason of the enlarged indicator Rhythm is increased level of stress The given abnormalities testify to enlarged rhythm variability If this report is steadily observed during some hours or periodically repeated within several days at value of the Rhythm indicator more than 60 the examination for clearing up of stress reason is necessary 2 2 There are manifestations of abnormalities of generation or conduction of excitation These deviations are always accompanied with the recommendation to analyze data
73. ning analyzer do not separate sinoatrial rate and clear arrhythmia A rhythm deviation from the sinoatrial rate is indicated by separate additional messages in the Rhythm conclusion section see below The indicator Detailing informs the doctor of pathological deviations similar to standard These can be identified by pressing the button Moreover this can be done without having to exit the portrait window In order to do this you must align the cursor with the Detailing indicator the cursor will change the pictogram and left click on the mouse A bookmark window entitled Classification of deviations will appear The code for each group corresponds to a number in the list of generic deviations 4 3 3 Viewing of the conclusion The conclusion is located under the window with the large portrait and contains the following subsections 1 GENERAL CONCLUSION general screening evaluation 2 RHYTHM 3 ELECTRIC AXIS 4 ATRIAL MYOCARIDUM 5 VENTRICULAR MYOCARDIUM 6 SYMMETRY of LEADS To gain access to all conclusion subsections scroll down the text as normal on the right hand side of the window In the case of consistently heightened stress CardioDM 06 software for HeartVUE system 41 level readings consistent deviation from the norm in some rhythm variability indices with no arrhythmia a section entitled OTHER CHANGES will appear The concluding text contains the screening evaluation as well as further
74. ning option If the signal has a lot of noise interference it is advisable to turn on the Filter option by left clicking the mouse It is important to note that amplitudes measured with the additional filtration option will appear to be 7 15 less than their true value To measure the amplitudes set the indicator to Amplitude by the left mouse click Move the mouse cursor in the ECG field a horizontal line of marker of the amplitude meter will appear Set the marker in the position that you choose as a zero reference point and press the left mouse key to fix a line of the point of origin Then move the marker of the measuring screening analyzer till the required point on the ECG Read the amplitude value in mille volt as related to the point of origin on the indicator Amplitude in the ECG field If it is necessary to set a new zero reference point move the marker to the desired value and press the left mouse key once again In that way it is possible to measure the amplitude between the two selected points of ECG To measure the interval size set the indicator to Time by the left mouse click Move the mouse cursor in the field of ECG a vertical line of the timing meter marker will appear Set the marker in a position that you choose as a zero reference point for time and press the left mouse key a fixed line of the point of origin will appear Next move the marker till the required point on the time scale Read data of the interva
75. of a patient for which the screening analyzer has revealed significant abnormalities from norm The sensitivity to ischemia of myocardium with recommendations of the table A2 on additional testing of border group is 80 Approximately in 20 cases at some forms of ischemia the screening analyzer does not reveal abnormalities or reveal them not significant indicator Myocardium less than 16 This effect is characteristic for two practically important cases at first for back localization of ischemic changes with shift to basal departments secondly for intensive medicamental treatment If in these cases there are clinical basis for more detailed analysis it is necessary to take the recommendations of the table A2 pulse augmentation on 15 25 or orthostatic test Such additional testing with load which is much lower submaximal considerably raises screening analyzer sensitivity in such situations Due to relative rarity of such events and fast examination procedure the additional testing practically has no effect for average time of examination which is not exceeding 4 min 6 Symmetry of leads 6 1 Asymmetry of ventricles depolarization in comparison with norm This specific for dispersive analysis feature gives the important additional information about abnormalities of amplitude and temporal relations in electrical excitation of the right and left ventricles In norm the dispersive chara
76. on located on Patients block of button panel On default this function is locked For the purpose to delete patient from database you can turn off this locking function by pressing Removal of the patient from Setting in main menu Deletion of patient done will completely delete appropriate data without recycling it In order to avoid mistaken delete alert window for delete confirmation will pop up If you need to delete several patients at the same time click left mouse and press Shift or Ctrl on keyboard simultaneously Pay attention When you delete a patient all his her examination data deletes without restoration There is no recycle bin for temporary storage of deleted patient s data Above mentioned procedures are not convenient to repeat if you need complete deletion separate database To delete full list of patient enter into main menu section Filters and choose Select full list of patients option by left mouse click Filters close selecting list of Patients completely Further more click button to delete selected list After such operation current database will be empty but it remains in list of databases and it can be used as a current database further more If you need to delete database from list of databases follow below steps Select List of databases option in Settings section of main menu A List of databases window will appear where current database is selected by highlighted line Select database for deleti
77. on by left mouse click and click Delete button Warning message concerning lost of all data if deleted will appear Upon confirmation of this message selected local database will be deleted from database of screening analyzer Current database can t be deleted If you need to delete current database you should first switch to another database For this purpose locate mouse pointer on appropriate line and double click left mouse or click button at the bottom of window Such operation will switch from current database to another CardioDM 06 software for HeartVUE system 55 one Afterwards you should repeatedly activate List of databases window and delete the same database which has no status currently It is reasonable to delete stale databases after making preliminary achieve copy 4 16 Printing examination summary report The view of examination summary report can be changed Function of summary report setting activates through main menu Settings Type of form Opened window displays options of page numbers of summary report preview options to printer file and summary report view options complete shortened Complete report may contain 1 2 or 3 pages First page is obligatory 2nd and 3rd pages can be deleted from report by user To insert appropriate page in summary report you should switch on selection indicator in opened window of Type of form Page 1 contains ECG portraits texts of screening examination conclus
78. on of ST lower amplitude and T wave deformation ABNORMAL QRS prolongation Signs of MYOCARDIUM injury are possible Examination shall be complete SIGNIFICANT ISCHEMIC changes of ventricular myocardium are possible Examination SHALL be complete If these signs for this patient were not observed before but are repeated in stable manner now then emergency complete examination is needed SIGNIFICANT ISCHEMIC changes of ventricular myocardium are possible Complete examination is NEEDED Correlation of these signs with cicatrical changes is possible If these signs for this patient were not observed before but are repeated in stable manner now then immediate complete examination is needed ISCHEMIC changes of ventricular myocardium are possible Complete Significant elevation of ST at J point at one or several leads Simultaneous ST depression at other leads Abnormal Q waves of 40 ms long and 25 of R wave amplitude at the same lead Deep negative T waves with ST depression Simultaneous depressions of parabolic PR and ST or Significant slantwise downward ST depression 88 examination is NEEDED Correlation of these signs with myocardium FOCAL CHANGES is possible ISCHEMIC changes of ventricular myocardium are possible Take note of this sign repetition Myocardium FOCAL CHANGES or temporary myocardial ischemia is possible ISCHEMIC changes of ventricular myocardiu
79. options accessed via calendar The list of examinations may be empty if the dates of examinations are out of current setting of filter Therefore you should necessarily select All filtration option if you should monitor portraits of a longer period time In order to avoid unsuccessful setting of a filter for current database filtration option is not saved The program automatically initializes All option at every start operation A vertical button panel performing main functions of screening analyzer is located on the right side of main window The buttons arranged in four panels Active buttons are shown by light background highlight and inactive by dark background 4 1 2 Main menu CardioDM 06 software for HeartVUE system 25 Menu s folder name Purpose File Exit to exit program Settings List of databases to display the list of database List of doctors to display the list of doctors Type of form to set the form of report Color setup to set the indicator s colours Removal of the patient removal of the patient permission Enable clipboard clipboard operations permission Filters Last day to display the examination list for the last day Last week to display the examination list for the last week Last moth to display the examination list for the last year Interval to display the examination list for the period time All to display all examinations Select entire list of patients to s
80. ption is necessary if necessary to transfer data from one local database to another one Export of data to another local database is performed in the same way as above described export procedure to directory The only difference is that Review button selects one of the local databases available on this screening analyzer Possible mistaken export of data to current database i e incidental copy of data to the same directory is blocked by pop up message This is current DB Upon completion of export operation new patients will appear in appropriate database They can be visible after opening indicated database as current Export to the database 62 4 20 2 Using data export to create archive It is reasonable to delete old examinations from working lists of local database It relates with the fact that more examinations stored the lower performance of screening analyzer we have Therefore it is recommended to regularly export current databases to archive and clean working databases from old data after making back up archive copy It is recommended to keep the databases of CardioDM 06 program in the following way 1 Create directory for saving archive on any available disk partition using Explorer e g C CDM_Arc It is possible to create several archive directories by certain calendar intervals separate local database etc 2 Make the required database current using function Settings List of databases 3 Call out Export import
81. r resolving any practical task Database can be switched to current session through main menu via Settings List of databases Structure of List of database window is similar to that of List of doctors window Default database list of patients supplied together with program contains one database Database of Heart View This database contains only demonstration section Samples The default database can be renamed if necessary For selection of current database from the list you should activate List of databases window via Settings List of databases Window List of databases 58 The third table column contains the information about total amount of the patients in the database first number and amount of examinations second number You should locate mouse pointer on required line and double click left mouse or press OK button on the bottom of window The name of a current database displays on main window headline and headline of examination summary report after name of doctor If you want to create a new database click Add button Enter name of new database in the opened input window by keyboard It does not recommend entering the name longer than 30 40 characters This can also lead to incorrect text headlines Name of database automatically displays as a short name of clinical department firm on the headline of examination summary report Change and Remove buttons provided for editing database name and deleting database name fro
82. reening conclusion The comments and references dispersive characteristics do not vary or are worsened very insignificantly Myocardium no more than 15 Thus the homing of heart portrait to the initial state on the average does not exceed 4 min Opposite to this for diseased patients the considerable augmentation of dispersive abnormalities and slow homing to the initial state exceeding 4 min are observed In the given category of abnormalities opposite situation also is possible when the value of the indicator Myocardium does not exceed 14 but the changes are visible on a heart portrait If the additional test according to tab A2 confirms norm this situation corresponds to individual peculiarities of myocardium More often reason of such peculiarities is the small abnormalities of an electrical symmetry of leads which is the testimony of compensatory changes in one of ventricles more often in left and can be inherent or acquired In such situation the observation of dynamics is expedient since such changes can be a precursory manifestation of starting development of pathology At comparison of the text conclusion and portrait always it is necessary to remember that in the given screening analyzer automatic screening conclusion and heart portrait are shaped independently to increase conclusion reliability The heart portrait gives more precise information on presence of even inappreciable dispersive abnormalities Simulta
83. reening estimation 4 gradations of deviations which is the body of the conclusion The screening estimation also furnishes additional reference information on the presumptive pathology The reference information not being the diagnosis is probabilistic It helps to make the efficient and task oriented plan for further clinical instrumental examination or other prompt activities on the basis of the screening estimation The text messages include three main data groups 1 integral indicators 2 conclusion 3 detailing 14 2 3 1 Integral indicators The integral indicators embrace the following four indices Myocardium Rhythm Pulse and Detailing CardioDM 06 screening analyzer integral indicators The Myocardium and Rhythm indicators are relative characteristics which describe the total value of dispersive deviations and range from 0 to 100 The higher the value of the indicator is the greater the deviation is Physically the Myocardium 100 corresponds to the pathological complex implying evident deviations virtually in all the chambers of the heart The Myocardium 0 corresponds to the total absence of any significant deviations from the ideal heart model The Myocardium indicator is the main parameter in the clinical interpretation of a screening conclusion less than 15 no significant deviations have been detected The changes in the myocardial metabolis
84. rked with blue heart icon If heart icon does not appear in selected 64 directory it means that there is no any import data for import in this directory Select appropriate directory for import which has icon On the right side of window Select directory and operating information will be displayed in Comments field showing number of patients and date of creation of this directory After confirming selection by clicking OK Select directory window will be closed and main import window appeared Program automatically remember last selected path of import directory If the option Current database is chosen the selected patients and examinations will be copied in the current database If the option New database is selected the new database is formed which will be automatically included in the list of databases 2 After going back to Data import window click OK button Window of import function settings will open Set amount of data imports by either selecting Import of the entire list or Import of the selected list option In the latter case do not forget to select appropriate list on top of this window in advance using left mouse click and Shift or Ctrl on keyboard CardioDM 06 software for HeartVUE system 65 3 Set time interval that you would like to use for import If you need to import all examinations available in examination database select All option To set time interval by date select Interval f
85. rocardiogram begins with readout 0 Input of an electrocardiogram given comes to the end in 35 65 seconds from the moment of pressing of button Start an exposition plus 5 sec CardioDM 06 software for HeartVUE system 29 If during input of an electrocardiogram there will be a necessity to interrupt process press the button Stop If after interruption of process by the button Stop you wish to return to the main window of system press button After end of input of an electrocardiogram there will be an indicator of process of generation of a portrait sand glass on the screen Through 10 40 seconds depending on speed of a computer process will come to the end with a display on the screen of a portrait of heart in large scale portrait Simultaneously with a portrait in the same window integrated indicators and the text conclusion are presented Thus through 1 min from the moment of pressing of button Start at an exposition of 30 seconds the user receives a portrait of heart of the patient If during input of an electrocardiogram there were any noises which have caused sharp changes baseline of electrocardiogram it is expedient to repeat test remove wrong examination in this case from base of examinations At detection of deviations from norm on the first portraits to except casual influence of artifacts at examination expediently not removing electrodes to receive one more portrait 4 3 Examination Viewing a h
86. rt of examinations to database CardioDM 06 program allows you to import examinations from databases created by export system Examination import operation as well as export operation performs in three standard situations 1 To save current database of examination from other screening analyzer and further send it through storage screening analyzers CD internet 2 To review archive copies of local databases located on specified directory 3 To copy current database of examination from another local database of the same screening analyzer This procedure is a mirror action as regards to export procedure of examinations from one local database to another one Import operation performs by function of main menu Export Import Import Submenu of this function contains two options from the directory and from the database 4 21 1 Import of data After selecting lt from directory gt option Data import window will appear Import from directory Data import performs in the following manner 1 Click Review button and after appearance of Choose directory window specify directory using standard Windows function wherefrom you would like to perform import To enter any directory of Windows list double click left mouse on appropriate directory CardioDM 06 program automatically analyses content of selected directory If selected directory contains subdirectories in required format of databases in this case they are ma
87. s in the same way as above described import procedure from directory The only difference is that Review button selects one of the local databases available on this screening analyzer Possible mistaken data import from current database i e incidental copy of data to the same database is blocked by the pop up message lt This is current DB gt Upon completion of import operation new patients will appear in appropriate database There will be symbol at the end of surnames of imported patients Import from the database 4 21 2 Running data import operation to view archive To view archive copy of local database it is reasonable to create new empty database in list of databases e g name it as Archive Creation of new database is performed via main menu function Setting List of databases by clicking Add button After creation new database it should be selected as current and exit List of databases by clicking OK Archive copy created by export function of this program has appearance of directory Date_Time located in archive directory e g in directory C CDM_Arc To view this directory it is necessary to follow below steps 1 If archive directory Date_Time was stored on CD and later copied back to archive directory C CDM_Arc in this case it is necessary to unmark lt Read only gt option for all files and folders on Attributes field using Explorer 2 Choose function via Import Export Import from directory I
88. se If patient is already registered in database select appropriate line in patients window by left mouse click If patients list is big use Search of patient function in the following way Locate mouse pointer on Search of patient window located on bottom of patients list and activate this part of menu by left mouse click Enter any part of a name Indicator on a patients list automatically shows you appropriate line If such combination of symbols doesn t correspond to those in the list of patients search operation is not performed In such case you should register new patient For this purpose push button in Patients block of button panel It is not necessary to fill all details of a patient But it is necessary to enter only surname and push OK button in input window All data of a patient including age weight and height are used only for reference of a doctor This data has no effect on calculation of dispersion mapping After performing above mentioned actions a line with new name appears in database of patients Two characteristics displays in database of patients QRS angle direction of electrical axis of last examination and date of patient s registration in database If you locate mouse pointer on Last name field on headline of window and click left mouse a triangle for alphabet arrangement by numbers letters arrangement of a list will appear If you click left mouse again the arrangement will be top down
89. sive analysis is performed during 30 60 seconds of continuous ECG signal monitoring The incoming signal is provided by limb leads only electrodes RA LA RL LL Amplitude dispersion medians are in range 5 30 microvolt which is significantly lower than average amplitude of ECG waves Special analysis of such low amplitude signals ECG fluctuation ensures the reliable identification of small deviations of myocardium polarization and repolarization processes This analysis is related to ECG electrocardiogram fluctuations with myocardial metabolism changes Monitoring of ECG fluctuations provides indirect conditional assessment of antioxidant systems electrolyte shifts adenosine triphosphate ATP concentration and other parameters of metabolism as an integral coefficient of metabolic changes The change of this coefficient allows determining even a minor disorder of myocardial depolarization and repolarization processes which are not available in other methods of ECG analysis In ECG DM method of ECG analysis even minor disorders are effective indicators of pathological changes of myocardium which are not sufficiently significant in conventional ECG characteristics As a result of such analysis you will get a map showing deviations of low amplitude characteristics with amplitude of such deviations and their presumable location by parts of the heart To allow a physician to have a comprehensive and easily assessed view of the myocardium changes
90. son always has certain borders of probability Such tolerance of comparisons is inevitable as analogues of many dispersive deviations due to high sensitivity of the latter may be seen only on standard ECG from 12 leads and some deviations only on ECG with physical activity CardioDM 06 software for HeartVUE system 85 Table A3 Correlation of Dispersive Deviation with Standard Electrocardiographic Diagnoses Screening conclusions on dispersive deviations of low amplitude fluctuations ECG conclusions appropriate to the dispersive deviations 1 General conclusion Significant deviations are NOT DETECTED This conclusion is ALLOWED ONLY in comparison with additional clinical evidence If patient takes MEDICINE this conclusion shall be exacted on base of the complete clinical examination ECG is OK Little DEVIATIONS WITHIN THE NORM LIMITS It s wise to observe DYNAMICS to correct the normal due to initial phase of the significant deviations Little DEVIATIONS of ventricular excitation it s wise to observe DYNAMICS as these deviations are either beginning of the significant ones or sign of temporary functional instability Mild signs of left ventricular abnormalities are possible ECG is OK deviations are not appeared at the rest ECG Little changes of ventricular myocardium It s wise to observe DYNAMICS Signs of left ventricular abnormalities are possible Intermediate ECG betw
91. t directory always has an appearance as CDM i e same path as given for installation e g if program is installed on default directory C Program Files in this case root directory will be C Program Files CDM Select Db2crasharc exe in root directory and run it by double left mouse click Db2crasharc exe program requires directory for emergency save of current database Select directory and click OK button As a result emergency archive including subdirectory as Name of local database creates in selected directory Abbreviation of Name of local database is exact copy of name from list of local databases If command windows appeared corrupted at emergency backup this utility replace them by indexed command names Number of subdirectories created by Db2crasharc exe will be equal to number of local databases Furthermore deinstallation of CardioDM 06 program performs Uninstallation can be done via Start Setting Control panel Installation and removal of program or Start Programs CDM 06 Uninstall Reinstall CardioDM 06 After reinstallation it is necessary to recover current database For this purpose do the following 68 Create new local database and make it current and import first local database from emergency backup directory indicated in list of import directory Repeat described steps for number of recoverable local databases Upon completion of importing all local databas
92. t messages about probable pathological portraits bearing most resemblance to each other with indication of corresponding nosologic units The upper part of this section shows colors of detailing code 48 4 8 Scanning ECG 6 leads This window is used for a simultaneous view of the initial interval of all the leads If cursor is matched with the line of any of the leads and the right mouse key will be pressed a window of ECG measuring screening analyzer with corresponding ECG line will also appear The initial point of the measuring screening analyzer will be set on a chosen ECG point If the button I II III aVR aVL aVF will be pressed a window of ECG measuring screening analyzer with corresponding ECG line will also appear The initial point of the measuring screening analyzer will be set on the beginning of ECG line ECG fragments can be scrolled simultaneously with using scrolling in the button of the window CardioDM 06 software for HeartVUE system 49 4 9 Scanning ECG 1 lead This window is used to perform the rhythm check up in a convenient mode since 30 60 sec ECG is presented in this format If it is necessary to review some recording interval set the mouse cursor on the required point of the ECG line and press the right mouse key A window of the ECG measuring screening analyzer will appear The initial point of the measuring screening analyzer will be set on a chosen ECG point The buttons switching of the E
93. t states are given in the gallery of portraits CardioDM 06 software for HeartVUE system 13 Left projection Right projection 1 precava 2 aorta 3 integral indicator of rhythm 4 indicator of the right atrium myocardial state depolarization dispersion 5 P Q interval anomalies indicator 6 conduction stability indicator 7 integral indicator of both atria state common properties determined by the common excitation source 8 indicator of the completion phase of the right ventricle depolarization projection in the area of the interventricular septum 9 indicator of ventricular repolarization duration correlates with Q T 10 indicator of the right ventricle myocardial state repolarization dispersion 11 indicator of ventricular depolarization duration QRS duration 12 indicator of the left atrium myocardial state depolarization dispersion 13 indicator of the completion phase of the left ventricle depolarization 14 indicator of the left ventricle myocardial state repolarization dispersion 15 indicator of the completion phase of the right ventricle depolarization projection onto the posterior wall 2 3 Structure of text messages The main function of the screening analyzer is to form the heart portrait ensuring the efficient accomplishment of the screening control tasks The text messages that accompany each image are not to be regarded as the diagnosis Those messages give a doctor a sc
94. ther extreme of the range If the patient is healthy and the sympathetic and parasympathetic effects on rhythm are perfectly 40 balanced the rhythm indicator will remain consistently in the 0 20 range In cases of increased stress or significant arrhythmia the indicator will be in the gt 70 range For a healthy city dweller the range should vary from 20 60 as a rule and increase towards the evening If the rhythm indicator consistently exceeds 50 at any time of day and the patient does not have significant arrhythmia this is evidence of a constant source of heightened tension of the regulatory systems within the body nervous tension internal organ abnormalities inflammatory process etc If heightened rhythm indicator readings are simultaneously combined with a significant decrease in heart rhythm variability and this combination consistently repeats itself it is a sign of a poor prognosis If this is the case the appropriate warning appears in the Rhythm conclusion section If you wish to deliberately follow the patient s stress level while there are no significant pathological myocardial changes we recommend you use the 60 second exposure This makes the rhythm indicator more stable Change in color of the indicator Pulse corresponds to generally accepted borders of normocardia bradycardia and tachycardia for an adult person The bradycardia and tachycardia limits in this scree
95. ther with program contains only one name Doctor Allowable number of doctors names on the list is enough for practical operation of the screening analyzer it is limited up to 500 doctor s name 4 19 Adjustment of indicators color User can change color of integral indicators of Myocardium Pulse Rhythm in the list of examinations Standard resources of Windows system can do it by clicking button 4 20 Export of examinations from database Examination export operation is necessary for three standard situations 1 To save selected examinations on a certain directory to send it further to another doctor by any storage screening analyzers such as floppy disks CDs or internet 2 To restore selected examination in another local database of the same screening analyzer 3 To create archive copies of local database on a specified directory 4 20 1 Export of data First operation which has to be done before calling out lt Export gt function is selection of exported patients This operation done through main window in the same manner as deletion of patient s list i e simultaneous left mouse click and Shift or Ctrl buttons on keyboard Such selection operation is necessary only when exporting small lists If you wish to export all patients data of current database there 60 is no need to make preliminary selection of all list this option clearly indicates in Data export window Export of examinat
96. tricle myocardium yellow color 3 High probability of electrical instability of ventricle myocardium red color 4 Uncertainty increased probability of electrical instability of conductive system or atrium myocardium light yellow color 5 High probability of electrical instability of conductive system or atrium myocardium pink color The farther pointer 6 is posed from area 1 of green color the more probability of electrical instability of a myocardium The shift of the cursor to the area 3 is connected with increasing of probability of ventricular tachycardia or ventricle fibrillation The shift of the cursor in the area 5 is connected with electrical instability of atrium myocardium or myocardium conductive system The indicator of electrical instability window By observing shifts of the pointer by the button 10 Monitoring of the tendencies it is possible to reveal on time negative tendencies of increasing of electrical instability of heart 34 The conclusion about probability of electrical instability of heart is displayed in the upper part of the window of portrait viewing CardioDM 06 software for HeartVUE system 35 To increase accuracy of this conclusion it is recommended dynamics monitoring after small exercise loading to increase pulse on 5 15 a simple case is an orthostatic test By comparing the pointer shifts in the tendencies monitoring mode before loading and after it is possible to fi
97. tton is used for simultaneously view of the initial interval of all the leads If cursor is matched with the line of any of the leads and the right mouse key will be pressed a window of ECG measuring screening analyzer with corresponding ECG line will also appear 4 14 Deletion of the examinations from database To delete the examinations data it is necessary to select the required line in the examination database and press button which can be found in the key block Examinations If you wish to delete several examinations then select lines for deletion by simultaneous left mouse click and Shift or Ctrl on keyboard A local bin is provided as a means of erase interlock All the deleted examinations stored in the bin If you wish to restore some images enter the bin select them and press the restore button 54 Be careful by the deletion of the files from the bin the full list of files is deleted that is why it is necessary to perform the restoration of the required files The bin lists all deleted examinations only of the patient selected by you It is recommended to clean the bins from time to time to prevent extra memory keeping It is recommended to perform the cleaning of the local bin using the main menu function Clean selected bins and Clean all local bins 4 15 Deletion of the patients from database To delete patient from current database you should select required line in patient s database and click butt
98. ure To this group the value of the integral indicator is in the range 10 23 as a rule Each situation in the table is described by three lines The first line Deviations includes the description of the deviations and changes related to the obtained image and conclusion for myocardium of heart ventricles The second line Recommended actions gives the recommendations how to get additional heart portraits that are helpful for making more accurate conclusion The third line Synthesis includes the recommendation for the final interpretation of the clinical significance of the obtained screening conclusion The recommendations stated in the table are advisable to be used in those cases when the anamnestic data and the physical examination data do not correspond to the obtained screening conclusion of this medical screening analyzer or when there are other clinical reasons to specify to make the screening conclusion more accurate CardioDM 06 software for HeartVUE system 81 If during the application of the recommendations given in the table the doctor obtains the conclusion about probable ischemia it is recommended to pay attention to the textual message for the groups G3 G4 and the color of the region 15 on the heart portrait If there are no significant pathological changes in the groups G3 G4 or the region 15 is green stained IHD ischemic heart disease is an unlikely conclusion Such cases as a rule correspond to t
99. vation of the picture of the quasi epicardium changes in the computer heart model that reflects with a certain precision both the size and the localization of myocardial changes The information on abnormality of myocardial depolarization repolarization processes is presented in the form of quasi epicardium color changes on 3D image of the heart heart portrait Take note of the fundamental methodical peculiarity of the heart portrait in the screening analyzer CardioDM 06 Visualization of dispersive characteristics on the heart portrait reflects integral changes in morphological electrophysiological and other such structural parameters of the myocardium As a result the map of color changes in the quasi epicardium of the heart portrait of a specific patient has its own stable individual peculiarity resulting from personal features of current metabolic changes of patient s myocardium As a result the heart portrait is highly specific with respect to individual structural characteristics of the myocardium However the same reason causes the fact that portraits of different patients with the same clinical diagnosis may differ substantially in individual characteristics of localization size and degree of the changes And vice versa similar changes in the portraits may in some cases correspond to different pathologies The indicated peculiarities in no way affect the sensitivity and specificity of the screening assessment i e the reliabi
100. ved the colours in relevant areas change to yellow or red The larger the red area of a quasi epicardium the more an abnormality is significant When dispersive changes are combined with large positive ventricular repolarization amplitudes a peaked ECG T wave a purple shade is added to the red of the corresponding quasi epicardium areas At the same time the more evident deviation from the standard occurs the more changes in quasi epicardium texture is observed 2 1 An ideal heart model The CardioDM 06 compares a patient s dispersion characteristics and the dispersion model of an ideal heart Such a model corresponds to a heart of a healthy young man over the age of 20 If quasi epicardium performance fully coincides with the ideal heart model it will be displayed in green on the patient s heart portrait A dispersion map is an indirect indicator of myocardium cell metabolism therefore an ideal heart model corresponds to the perfect functional state of the myocardium which is characterized by perfect metabolism and corresponds to the norm It is obvious that the functional status of a normal that is not pathological myocardium may differ from this standard under some specific longitudinal 12 conditions during pregnancy or during an athlete s intensive physical training for example As a result a certain border line area thoroughly controlled by the CardioDM 06 screening analyzer is observed
101. y report in emf format while preparing illustration materials or sending summary report via internet The emf format files can be viewed and printed by any vector graphical editor such as CorelDRAW Mostly available way of reading emf files is a widely spread word processor of Microsoft Word To read emf files by Microsoft Word you should run Word and perform below steps Call out this function from main menu File Page Setup Select lt Orientation gt bookmark in opened window and select lt Landscape gt option If you need to print file you should also set up required margins settings To get maximum viewable margin size of summary report you should fix 0 on all margins fields Go back to main menu and call out function from Insert Picture From file Add file in opened window using standard dialog box and indicate path to emf file and click OK To view opened file without distortion set up suitable zoom of view To print a summary report from Microsoft Word processor select function via File Print Several seconds after clicking print button formatted report form will be sent to printer or emf file and CardioDM 06 program ready to continue work sand glass busy indicator disappears Printing time is determined only by processing speed of printer If printer has low processing speed for printing image formats Windows system set a printing queue and slowly print out report forms perform

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