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Software for screening heart investigations CardioVisor-06c

1. 1 The portrait in a series of a few successive examinations should be stable and indicator Myocardium should not exceed 14 2 The portrait obtained after a slight load with increasing frequency of pulse by 15 25 should not show distinct deviations For a heart without clinically significant deviations after a slight load only massages of border changes and small local changes in the portrait to pink or yellow are permissible These changes with a heart without clinically significant deviations return to the initial pre loaded state in 3 4 minutes More distinct or long changes after loading can testify to expedience or necessity of complete examination If indicator Myocardium is more than 27 and the portrait shows distinct changes this is manifest PATHOLOGY In other cases indicator Myocardium more than 15 and less than 27 comprising the border group clinical significance of the revealed probable ischemic changes is determined by combination of value and stability of deviations as per Table A 2 Clinic significance of ischemic manifestations in the border group of this Annex Table A 2 gives recommendations for the four typical situations 4 If in the General conclusion in the section Ventricular myocardium there is suspicion of ischemic changes this is not evidence of cardiac ischemia The device due to high sensitivity reacts both to clinically significant forms of ischemia and to short episodes of transient ischemia whi
2. These signs can correlate with FOCAL CHANGES in the myocardium Probable ISCHEMIC changes in ventricular myocardium control of regularity of this sign is necessary Possible focal changes in the myocardium or temporary transient myocardial ischemia Possible ISCHEMIC changes in Ventricular myocardium complete examination is necessary DYNAMICS control is EXPEDIENT as there are CHANGES on the BORDER of norm which can be the beginning of ischemic changes in the myocardium CHANGES in depolarization of ventricles complete examination is expedient as such changes can correlate with coronary changes Moderate changes in repolarization of ventricles Dynamics control is OBLIGATORY The deviations can be sign of temporary functional instability or sign of the BEGINNING DISTINCT CHANGES 51 Non specific moderate local depression ST in individual leads Decreasing amplitude And distortion of the form of peak T MODERATE lengthening of QRS DISTINCT lengthening of QRS sign of intraventricular QRS length more than 105 msec and than 115 msec QRS length mor than 115 msec Wide peaks S in leads aVL blockade of right leg of His bundle Complex qA in leads I aVL complex rS in leads Il leg blockade aVF deformed peaks R left Medical computer systems
3. normal Colors not lower than High Color 16 bit Screen area 1280x1024 Font large Colors not lower than High Color 16 bit Screen area 1600x1200 Font large Colors not lower than High Color 16 bit 2 To ensure high quality of screen design in Windows XP it is necessary to perform the following Enter Screen lt Start Settings gt lt Control Panel gt lt Display gt Select tag lt Appearance gt and on the line Windows and Buttons set Windows standard Move the cursor to icon CardioVisor O6c on topdesk and click the right key of the mouse In the opened window select line lt Properties gt Then in window lt Properties gt set up compatibility mode in position Windows98 Windows Me 3 2 Limitations of the program e One examination takes 220 KB 30sec or 400 KB of disk memory e Number of patients not limited e Number of examinations not limited e input ECG signal at rest only e CCF operation range 30 160 beats per min outside this range the program does not work The number of examinations and patients is limited only by free disk of the computer Page 16 of 51 MKC CardioVisor O6c User s manual 3 3 Connecting ECG module to the computer ECG module is connected to the computer according to document 3 Nine channel computer cardioanalyzer KARD Operation instructions are supplied at delivery 3 4 l Installation of CardioVisor 06c
4. 12 Printing FRE POM TORI are el sel ee ed ed eke tel kcal oe 31 413 Selling indicators color sau nein ound ended ell ed ond eel nd ed nd ede 31 4 14 Exit from the program 2 2 cccceccncceneeeeeeeneneneeeneeeneeeneneeeeeneneneeeneneneeenenenene 32 4 15 Servicing the patients database ccccccccececeecteceeeeetereeeeetenereeetenereeeeer 32 4 16 Testing the program in OperatiONn cccccccceceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 33 Medical Computer Systems Page 3 of 51 CardioVisor O6c User s manual AIT Lc 6 Pee Peer eee rere Pera ete Per ete Peay te Petr ee PY Ae PoP OY ee POY Ae PPO ee POY A CPO ee PEO 33 9 2 Aa A gt leita tout cade nee ae AI 34 5 1 Examples of heart portraits with different pathologies 34 De Annex een ae nenne 38 6 1 Peculiarities of clinical interpretation of heart portrait 38 6 2 Clinical significance of ischemic manifestations in the border group 43 ty SONOS IN Sondaar len tog tieniu Seta E aml ley bolton long loud oe Play te 46 7 4 Criteria of comparison of dispersion deviations with generally accepted elecirocardiographie diagnoses f csececccestcenccevecenceeuccenccedes ceareverenecenccentcesteeneeeseceneeel 46 Page 4 of 51 MKC CardioVisor O6c User s manual Introduction We are pleased to greet you as user of computer screening analyzer CardioVisor 06c This device significantly differs f
5. Software Switch the computer on After starting the operation system insert the installation CD in CD ROM drive The installation CD has autostart therefore in some time InstallShield for setting CardioVisor 06c Software will appear on the screen This window has two buttons lt KARDi2 gt and lt Exit gt Press lt KARDI2 to start installation If before this operation you have already left the installer with lt Exit gt for instance when connecting ECG module according to p 3 3 or for other reasons the installer autostart will not operate In this case it is necessary to withdraw and again insert the installation CD Besides if there is no autostart it is possible to enter CD ROM drive with system conductor Explorer to move to catalog Setup KARDi2 and with double clicking of the mouse to start Setup exe At last it is possible with CD ROM to start AUTORUN exe which is at the rood directory If CardioVisor 06c Software is already installed in the computer the installer will inquire about the preliminary deinstallation of the previous version To complete deinstallation press the button lt OK gt After deinstallation is completed press the button lt Ready gt and repeat the procedure of installation After that the standard dialog with InstallShield begins At the beginning of dialog the installer requires about location of CardioVisor 06c Software If you are satisfied with the location of the program in C Program F
6. Visor 06c The term dispersion corresponds to the generally accepted in cardiology definition of difference between maximum and minimum of the varying value Dispersion changes give integral estimation of changes in a great number of structural characteristics of the myocardium which are dependent on parameters of blood electrolytic balance blood pressure and other factors Dispersion changes are observed in both cases when there are standard electrocardiographic changes in an electrocardiogram and when they are absent e g in the early stages of structural changes in the myocardium CardioVisor 06c makes it possible to see on the screen a picture of quasi epicardial changes on the computer model of the heart which with a certain accuracy reflects the value and localization of myocardial changes Information about deviations from the norm of myocardial depolarization and repolarization process is presented by color changes of quasi epicardium in a three dimensional picture of the heart in the heart portrait The heart portrait in the ventricular area reflects an integral picture of dispersion changes rated both for myocardial depolarization and repolarization Dispersion changes in the heart portrait in the area of auricles correspond to depolarization phase only Pay attention to principle methodological peculiarity of the heart portrait in CardioVisor 06c Visualization of dispersion characteristics in the heart portra
7. a patient from the data base single out the required line in the patients data base and press K4 which is in the block of Patients Patients can be deleted only one by Page 30 of 51 MKC CardioVisor O6c User s manual one as it is connected with complete erasing the correspondent data without the basket To exclude accidental delete there is an intermediate window of confirmation Caution when deleting a patient data concerning this patient is deleted without return No basket for intermediate storage of deleted patients is provided 4 11 Correcting the patient s name If it is necessary to change the name or other data of a patient press K3 Enter the alteration and exit by lt OK gt 4 12 Printing Report form Short form of Report containing only input ECG is printed with K15 Complete form is printed with K13 Printing of one form is made from the window of scanning the portrait i e first you should press K9 and only after that press K13 After you pressed the printing buttons K13 K15 the filled in form in a few seconds is conveyed to the printer to be printed while CardioVisor 06c Software gets ready for continuing operation the sand clock indicator of process disappears The time of receiving a printed form depends on the speed of the printer If the printer has a slow printing speed when printing graphic formats the Windows system will form a printing queue and will slowly prin
8. continuation 4 Auricular myocardium changing P Q Probable FIBRILLATION of auricles No peaks P Instead of them irregular low amplitude waves Probable FLUTTER of auricles Saw like high frequency waves P Probable change in FIBRILLATION FLUTTER of auricles Saw like peaks P alternating with irregular or absent waves P Probable change in MIGRATION of rhythm driver Variations of form and amplitude of peaks P If peaks P invert in leads I Il rhythm driver migrates to AB junction Probable disturbance in auricular depolarization Unstable form and mall amplitude of peaks P e Characteristic changes in auricular repolarization which can accompany probable ischemic changes in the left ventricle Depression of P Q and ST lines of concave parabola type close to peak P Line ST of slantwise type with probable slight depression in point J e Signs of the left auricle enlargement Probable left auricle hypertrophy Peak P length exceeds 20msec Vector P direction in frontal plane 60 degree left i e Peak P maximal amplitude is shifted to leads I aVL e Signs of the right auricle enlargement Peak P amplitude exceeds 2 5 mm 0 25mB Vector P direction in frontal plane 60 degrees right i e peak P maximal amplitude is shifted to leads aVF Ill e P Q lengthening Watch dynamics Short P Q interval P Q lengthening exceeds the norm Norm 200 msec with CCF 40 50 per min 120 m
9. form and demonstrate about 15 successive QRST complexes Permissible number of analyzed QRST complexes in this technology is 10 20 The singled out complexes in each of the leads under analysis are synchronized with the starting moment of registration Fig A 1 Fig A 1 a as an example shows one moment of registration in different QRST complexes which is 11 msec from the beginning of QRS complex Fig Al b shows 6 curves of low amplitude fluctuations for this moment which correspond to 6 limb leads 1 aVF Signal values from 1 aVF limb leads are calculated in the standard way by signals from two leads I III electrodes L R L F The whole block of fluctuations includes similar data for 250 300 moments which embrace the whole QRST complex This block resembles digital data analyzed in the method of high resolution ECG when data are time averaged 8 The principle peculiarity of the block of low amplitude fluctuations is a small volume of selection for each moment which is 10 20 points according to the number of QRST complexes under analysis This peculiarity calls for special methods of analysis as the traditional statistic estimations with such short selections are not well founded or impossible Therefore the digital block of low amplitude fluctuations is passed through a special weak signal coherent amplification module information amplifier This module amplifies slight fluctuations which are repeated in all QRST complexes i e s
10. from the norm practically always increase local heterogeneity of the myocardium and respectively deteriorate the regularity of the corresponding dispersion characteristics Naturally the regularity of dispersion characteristics of low amplitude fluctuations even in a healthy heart is not ideal as in every cardiac cycle the conditions of excitation periodically vary breath changing position of diaphragm local fluctuations of metabolic processes etc However in any case the higher regularity of dispersion characteristics of low amplitude ECG signal fluctuations the more stable the electric state of the myocardium This is the first characteristic of signals under control which is the basis of high sensitivity of dispersion characteristics to myocardial changed To reveal slight Medical Computer Systems Page 39 of 51 CardioVisor O6c User s manual deviations from regularity in early stages of pathologic changes regularity in early stages directly by ECG is impossible The most significant changes in dispersion characteristics are observed in myocardial ischemia As known ischemia is a relative state 4 Only a certain length of ischemic state of the myocardium without restoration of perfusion can result in irreversible necrosis changes in the myocardium 9 States of transient ischemia can appear even in a healthy heart with disturbance of optimal ratio of indicators of coronary blood flow and the level of blood oxygenation indicators
11. number of indexes in the code equal to 1 or 2 is evidence of insignificant dispersion deviations for instance 0 0 1 0 000 1 Contrary to that the appearance of high indexes equal or close to the number of standards in a group is evidence of significant deviations for instance 0 8 10 19 1 4 20 2 12 The name of probable pathology corresponding to the code index of the conclusion is given in the group of Detailing messages see further The code L means the border state when the changes are very close to any of the pathological gradations The code S is evidence of the beginning of changes within the norm i e the codes L and S are indicators of border values of dispersion characteristics 2 3 2 Conclusion The conclusion contains general screening estimation which is determined by resemblance of the present portrait with pathology portraits Fig 4 The text of the Medical Computer Systems Page 13 of 51 CardioVisor 06c User s manual conclusion contains screening estimation as well as additional information about the degree of expressiveness and the type of probable pathology which is recommendable for taking further steps Screening estimation differs from additional information by color the screening estimation is colored while the additional text is white and black EKG Conclusion GENERAL CONCLUSION 18 There are small CHANG cess of depolarization of ventricles DYNAMICS
12. of contact in electrode N as it has effect on ECG quality in channels R L F The most important factor ensuring the accuracy of the portrait at ECG input is the state of the patient at rest If the patient is sitting he must take comfortable relaxed position maximally excluding muscular tremor Breathing at the time of ECG input should be usual preferably without deep breathing in and out If the patient is in a state of excitement it can be recommended to him to shut the eyes At ECG input talking and turning the head are impermissible Page 20 of 51 MKC CardioVisor O6c User s manual Press the left key ofthe mouse on K5 If the ECG input device is connected with the computer window of ECG signal input and two input control buttons K17 Start and K18 Stop Fig 8 will appear on display K17 Start gt gt K18 St O e Time indicator Fig 8 P t control If the input device is disconnected the indicator in the lower left part of the main button panel heart symbol is dark red At the same time the button K5 is blocked In this case you must connect ECG input device with the computer at the first connection make operations as per p 3 of the present manual and reset the program exit and activate again Tell the patient about the beginning of examination and that he must remain at rest for 30 60 sec press the button K17 Start The first 5 seconds are taken by auxiliary procedure of o
13. of myocardial load and other known factors 4 The specificity of dispersion changes in dispersion characteristics revealed by screening analyzer which accompany even moderate ischemia manifestations considerably depends on the number of leads The more leads the more accurately one can differentiate dispersion changes caused by ischemia from similar dispersion changes caused by other pathologic changes For instance with the use of 12 generally accepted leads the specificity of dispersion changes in relation to ischemia with this technology is 85 90 If the number of leads is increased up to 35 60 it is possible to reach specificity indicators 95 In this screening device only two ECG signals from extremities are used when average specificity of dispersion deviations in relation to ischemia is 70 76 Therefore significant dispersion changes which the autoclassifier of screening analyzer cannot precisely refer to nosologic units of the internal base of dispersion standards are classified as ischemic This is a second peculiarity of control of dispersion characteristics of low amplitude fluctuations This peculiarity means that the screening analyzer accurately reveals ischemic changes in 75 while in 25 it detects changes that are undifferentiated from ischemic changes but are of another etiology Therefore some types of heart disease cardiomyopathy and some other pathologic changes in the myocardium are classified by the device as isch
14. of probable ischemic changes it is necessary to have complete clinical diagnosis to differentiate ischemia from ischemic changes Variations of Rhythm are conditioned by arrhythmia or stress or by joint effect of the above factors The color background of this indicator is determined by the following conditions Myocardium Indicator State lt 15 green No significant deviations 15 50 yellow Slight deviations 51 80 yellow Border state or mean value deviations gt 80 red Distinct rhythm deviation from norm The Rhythm indicator is a sufficiently dynamic value especially with short exposition of 30 seconds Besides this indicator is fairly critical even to slight disturbances of rest during ECG input Its values are assuredly stable only at the initial and final points of the Medical Computer Systems Page 23 of 51 CardioVisor O6c User s manual range If the patient is healthy and sympathetic and parasympathetic effects on the rhythm are optimally balanced the indicator Rhythm is permanently within 0 20 With high stress and distinct arrhythmia the indicator is in the range gt 70 With a healthy town dweller this indicator varies in the range 20 60 and as a rule increases by the evening If Rhythm constantly exceeds 50 at any time within 24 hours and the patient does not have significant arrhythmia it means that in the organism there is a permanent sour
15. of the device is to detect early dispersion deviations which can precede pathology In many cases this makes it possible to see pre clinic stages and to control the dynamics of dispersion deviations with high sensitivity CardioVisor 06c DOES NOT SUBSTITUTE other clinic methods of examining the heart and CAN be used only in comparison with other clinic data General procedure of operating CardioVisor 06c includes the following 1 Applying electrodes in accordance with the standard diagram of ECG limb leads p 4 3 2 Pressing the button New examination see further interface description in 40 60 sec a two aspect portrait of the heart is formed on the screen At the same time an automatic conclusion and integral heart indexes are formed The quasi epicardium of the portrait in the norm is greenish blue With different deviations from the norm the color in the area turns yellow or red The bigger the red area of the quasi epicardium the bigger degree of expressiveness of deviation If dispersion changes go with great positive amplitudes of myocardial repolarization of ventricles keen peak T in ECG red of the corresponding sections of the myocardium acquires purple hue 2 1 Model of ideal heart CardioVisor 06c compares dispersion characteristics of ECG low amplitude fluctuations of the patient under examination with the model of similar dispersions of the ideal heart This model corresponds to the heart of
16. of the ideal heart The indicator Myocardium is the main marker of the clinic interpretation of screening conclusion under 15 no significant deviations are detected This conclusion requires obligatory comparison with other clinic data 15 19 border state It is expedient that dynamics control be made 20 22 probable pathology If this deviation is detected for the first time it is necessary to control dynamics and it is expedient that examination be made 23 27 probable pathology If this deviation is detected for the first time it is necessary to control dynamics Examination is obligatory Above 27 pathology or manifest pathology If this deviation is detected for the first time and is permanently repeated in subsequent examinations it is necessary that immediate examination be made Page 12 of 51 MKC CardioVisor O6c User s manual Similarly Rhythm 100 corresponds to the most expressed changes in characteristics of R R intervals variability which are characteristic of manifest arrhythmias or high stress Detailing code gives information about the resemblance of the present portrait with portraits of some typical frequent pathologies The indicator Detailing code contains 9 characters A character can be a figure or one of the letters L or S The number of symbols in the code depends on the number of pathology groups which are used by th
17. some slowly varying states of post myocardial cardiosclerosis red is more intensive than in some types of acute infarction probability of relapse of worsening in case of cardiosclerosis as a rule is less than with myocardial infraction Therefore after scanning the portrait it is necessary to familiarize oneself with the conclusion and the values of indicators Please MIND As stated in p 1 of this manual despite high individuality of repeated color changes in the heart portrait they are not always highly specific for pathologies of a particular type Varying dispersion characteristics have integral reaction to morphological electrophysiological etc structural parameters of the myocardium Due to this with the same clinical diagnosis with different patients areas and expressiveness of changes can considerably differ On the contrary similar changes in portraits in some cases can correspond to different pathologies These peculiarities have no effect on the authenticity of screening estimation i e differentiation of norm pathology states On the left of the portraits there are two auxiliary rectangular graphic indicators The lower one indicates the direction of the electric axis of the heart in front plane QRS angle Page 22 of 51 MKC CardioVisor 06c User s manual The sector of the norm is shown green The upper indicator duplicates the color setting of the indicator Myocardium Saturation of red increases with gr
18. the signal has great noise interference it is expedient with the left key of the mouse to switch option Filter In this case you should remember that amplitudes under measurement with additional filtration will be less authentic by 7 15 Page 28 of 51 MKC CardioVisor O6c User s manual The procedure of scaling with the help of setting Amplitude can be performed in the state measuring put off In the process of measuring this setting does not change gesnssnnennsnnensenuesen To measure amplitudes with the left key of the mouse switch indicator Move the cursor to the ECG field the horizontal line of the marker of amplitude meter will appear Place the marker in the position which you choose as beginning of count and press the left key of the mouse the fixed line of the beginning of count will appear Now move the meter marker to the required ECG point In the indicator Amplitude read the value of amplitude in mB relating to the beginning of count If it is necessary to set a new beginning of count move the cursor to the required value and again click the left key of the mouse In this way you can measure amplitudes between any two ECG points To measure the length of intervals switch indicator with the left key of the mouse Move cursor to the ECG field the vertical line of the marker of the time meter will appear Set the marker in the position which you choose as beginning of count and
19. time and you want within 1 2 minutes to see the trends and changes in the heart which do not manifest in electrocardiogram The instrument can be used in clinic medicine operative express estimation of the state of a heart early detection of progressing changes in the myocardium in prophylactic medicine screening examination for timely and reliable singling out a group of patients with pre clinic forms of deviation in prophylactic medical examination in sanatoria preventoria reabilitation centers objective express indicator of the state of the heart and the whole organism in emergency medical service to reliably estimate the current state of a heart In addition to visual express analysis of the portrait the system forms automatic conclusion for the doctor including l 2 3 Integral index of deviation from the norm of dispersion characteristics of ECG low amplitude variations in the range 0 100 Integral index of arrhythmia in the range 0 100 summary deviation of statistic indexes of rhythm variability from the norm Text screening estimation Medical Computer Systems Page 7 of 51 CardioVisor O6c User s manual CardioVisor O6c ensures a quick and accurate referring of a heart to one of the following groups 1 Norm 2 Border state 3 Indistinct pathology 4 Manifest pathology At the same time the doctor receives visual information about the degree of expressiveness and the
20. to form a heart portrait ensuring an effective solution of screening control tasks Text messages accompanying each portrait are not diagnosis These messages give the doctor screening estimation four gradations of deviation from the norm which is the main part of the conclusion and ensures additional recommended information about the possible type of pathology The recommended information being not a diagnosis has a probability character and makes it possible in a more precise and effective way to plan further clinic instrumental examination or other operative steps according to the results of screen estimation Text messages include three main groups of data e integral indicators e conclusion e detailing 2 3 1 Integral indicators These include four indicators Myocardium Rhythm Pulse and Detailing code Fig 3 Myocard Rhythm Pulse Detailing code 18 61 L 0 5 7 5 5 2 5 4 Fig 3 Integral indicators of CardioVisor 06c Myocardium and Rhythm are relative indicators which characterize summary value of dispersion deviations from the norm and vary in the range 0 100 The higher the value of the indicator the greater deviation from the norm Physically Myocardium 100 corresponds to a pathologic complex related to manifest deviations from the norm practically in all heart chambers Myocardium 0 corresponds to absolute absence of any significant deviations from the model
21. while the location of phase indicators reflect the projection of the corresponding fronts of excitement on the epicardium Examples of heart portraits with different states are given in Annex I Fig 1 Visual structure of a heart portrait Fig 2 Visual structure of a heart portrait right sections left sections 1 vena cava superior 2 aorta 3 integral indicator of rhythm 4 indicator of state of the myocardium of the right auricle 5 indicator of anomalies in interval P Q 6 integral indicator of AB conduction 7 integral indicator of the state of two auricles general characteristics caused by common source of excitation 8 indicator of the final phase of the right ventricle depolarization projection in the area of the interventricular septum 9 indicator of the length of repolarization of ventricles Q T 10 indicator of the state of the right ventricle myocardium 11 indicator of the length of depolarization of ventricles QRS length 12 indicator of the state of the left ventricle myocardium 13 indicator of the final phase of the left ventricle depolarization 14 indicator of the state of the left ventricle myocardium 15 ndicator of the final phase of the right ventricle depolarization projection on the back wall Medical Computer Systems Page 11 of 51 CardioVisor O6c User s manual 2 3 Structure of text messages The main function of the device is
22. Software for screening heart investigations CardioVisor 06c User s manual MKC Medical Computer Systems Pages 51 CardioVisor 06c User s manual Data Version Author Note The controller 5 03 2004 1 1 creation Statistic File CardioVisor UserGuide doc Size 866 K6aiit Date of creation 09 03 2004 Date of editing 04 06 2004 Date of printing 19 11 2004 MKC Page 2 of 51 CardioVisor O6c User s manual Contents Introduction ee a a a a a a 5 Abbreviation Sa eeen e e e e i E E E ee a AU 6 Reference LEE nn aR tads aa antec daa ER LH HE atante cdaaadtadsaaan lan naecetcet teats 6 1 Purpose andapplicali n z ss han 7 AS Tan Bil 14 Ir Lilo a1 POSRUNESSFERLSRRESRTRERNLERILBERLERILERRLERIRBENLERELERULERESBENLERILBENLERIRBENLERIRBENLERTRRGHERE 8 1 2 Prineipleof analysis 9 2 General INIOLrmalOns sweet ee ine net ine nenne 10 24 Mod l of id al heart tes cenicesecestceiecestcenscestceneceeteenecestcenecenteenecesecentces 10 2 2 Visual structure of the heart portrait 4444444400044400Rn nennen 10 2 3 Structure of text Messages munrsennsennnnnnnnnnnnnn nennen Hure nenn nennen nennen nennen 12 2 3 1 Imegralindicalofs sr 12 2 32 BOHelision aerru24 EEE 13 233 Detailllng efigie ieee enideoiee ideore ideoi e ideoin ideoi e ideoin ideoi poig 14 2 4 Structure of report ee een hen 14 3 Installation of screening analyzer nenne eee 16 3 141 Gomp terlealifesssn 22 2 ne heme n
23. a young healthy man at the age of above 20 In case of complete coincidence with the model of the ideal heart the quasi epicardium in the portrait of the patient under examination is green along the entire surface of the heart Annex I CardioVisor 06c is intended for screening analysis of ECG signal only with adult people CardioVisor 06c is not suitable for children at the age under 12 For children and teenagers from 12 to 18 this device can be used only to control trends in dispersion characteristics which is determined by doctor in each particular case 2 2 Visual structure of the heart portrait The heart portrait is a snap shot on display as a result of calculating mean dispersion characteristics of low amplitude fluctuations during ECG input The heart portrait in the area of ventricles reflects an integral picture of dispersion changes calculated both for Page 10 of 51 MKC CardioVisor 06c User s manual depolarization and repolarization of the myocardium Dispersion changes in the portrait in the area of auricles correspond only to the phase of depolarization The colors in the portrait change with deviations of amplitude dispersion characteristics and with changes in phase dispersion characteristics correlative with integral values P Q Q T The location of amplitude and phase color indications in the portrait are shown in Fig 1 and Fig 12 The amplitude indicators correspond to the anatomic structure of the heart
24. alfunction of the program occurs it is recommended to use utility Test which is automatically set simultaneously with the installation of the main program l To activate the program Test press the system button lt Start gt in the lower left part of the screen enter the section lt Program gt gt lt K ARDi2 CV06s gt and activate the program Test the main program KARDi2 CV06s during the operation of utility Test should be switched off After the analysis is completed the program Test in automatic mode will perform analysis of the integrity ofthe program and will form recommendations for the use If the previous step failed deintsall by Windows means the program CardioVisor 06c lt Start gt gt lt Start gt gt lt Setting gt gt lt Control panel gt gt lt Setup and Delete gt and install the program again as in p 4 Before deinstallation it is necessary to save the copy of catalog Db_Vis which contains the current data base After installation the copy should be rewritten in the root directory of the program instead of the initial database When performing deinstallation only files registered in the system during installation should be deleted 4 17 Help The present manual is given in the section lt Help gt gt lt Subjects gt in the main menu of the system The required window is standard window Help Windows He required sectionis brought to display by double clicking of the left key of the mouse Hyperlink in th
25. ant deviations or sign of temporary functional instability Indistinct symptoms of dysfunction of the left ventricle are probable Normal ECG in ECG at rest no changes Moderate CHANGES in ventricular myocardium Dynamics control is expedient Symptoms of dysfunction of left ventricle are probable ECG is probable border between norm and pathology DEVIATIONS see probable detailing in deviation groups DISTINCT DEVIATIONS pathologic changes are probable See probable detailing in deviation groups Pathological ECG Lengthening of Q T interval DISTINCT LENGTHENING of Q T interval Interval Q T is lengthened regarding norm for this FCC value Q T exceeds 0 44 sec 48 CardioVisor 06c User s manual Table A3 continuation 49 signs of arrhythmia are found 2 Rhythm e NORM sinus rhythm Rhythm with FCC from 60 to 80 per min arising in sinus knot Peaks P positive in leads Il aVF negative in aVR e Pulse norm but there are Rhythm deviations from norm Rhythm with FCC from 60 to 80 per min accompanied with falling out of individual peaks P e Moderate TACHYCARDIA Rhythm with FCC more than 80 but less 110 per min e Distinct TACHYCARDIA Rhythm with FCC more than 110 per min e Moderate BRADICARDIA Rhythm with FCC less than 60 per min e Distinct BRADICARDIA Rhythm with FCC less than 50 per min e High rhythm indicator is caused by high STRESS but NO ECG sec
26. ardium is under or equal to 14 and with no quasi epicardium color changes to red in the heart portrait e Border state indicator Myocardium is about 15 22 with some changes in the portrait e Pathology indicator Myocardium is about 23 27 with some changes in the portrait e Manifest pathology indicator Myocardium is above 27 with some distinct quasi epicardium color changes in the heart portrait Additional massages of the conclusion are shown in screen interface in gray Medical Computer Systems Page 41 of 51 CardioVisor 06c User s manual By stability deviations belong with one of the following three groups e Stable groups Fluctuation values of indicator Myocardium in successive examinations do not exceed 3 7 e Moderate fluctuations indicator Myocardium fluctuations in successive examinations are 8 10 e Distinct fluctuations indicator Myocardium fluctuations in successive examinations exceed 10 If indicator Myocardium less than 15 there are no quasi epicardium color changes to red in the portrait and there are no indications of probable deviations in the text messages of Conclusion and Detailing this is NORM This screening conclusion CAN BE USED only in comparison with other clinic data If the patient is under DRUGS this conclusion requires verification on the basis of complete clinic examination Two additional factors can be the main criteria verifying screening conclusion NORM
27. as these changes ca r beginning of significant deviation instability If these deviations are for the first time and at the given n portraits of heart dynamics mor necessary In case of the negative i complete testing is expedient CHANGES of process of ventric rization Dynamics monitoring is ol episode of a probable short term or start of clinically significant char There are changes in process of c tion of atriums RYTHM Pulse norm Tas a as Je nnd nn a 1 7 hr un ISTO C ce vr es I xl Detailing 12 5 WH s 0 Deviation 18 G1 RA d Rhythm deviation 43 lost probably Pulse 67 G2 LA di P Q duration msec 144 ery probable QT QTc 374 400 Moderate inversion of depolariza P duration msec 84 tates a flicker flutter It can corre ORS Duration msec 110 eniricle QRS Corner degrees 1 G3 RVd T Corner degrees 1 Incertainty individual features T ill P Corner degrees 0 e following Tuna nf a rhythm Narmara wove nhaca adkt mnece nf dannlar Fig 4 Location of text information in detailing window 2 3 3 Detailing Detailing contains the names of probable pathologies the portraits of which for each group most resemble the present portrait Fig 4 Besides in the left part of the detailing window the doctor can see certain typical quantitative characteristics of peaks and integrals of input ECG If you examine a patient with an electrocardiostimulator be cautious in this case informat
28. beei nd cee ee bhai ohne ob meio 16 3 2 Limitations Of the program nee 16 3 3 Connecting ECG module to the computer cceceeceeeeeeeeeeeeeeeeeeeeeeeeeees 17 3 4 Installation of CardioVisor O6C Software cccccceceeeeeeeeeeeeeeeeeeeeeeeeeeeees 17 As ADOT AGI green EEE A AAA A ER HR 18 4 1 Starting the programs ee 18 AZ FUNGI OTS aaea eae eE aer Ea ar a aa Ea eee eee eee es 18 4 3 Examination forming a heart portrait 44444444HHHRnnnnnnnnnnnnnnnnnnnn 19 4 4 Examination scanning portraits and text messages mnnn een 21 4 4 1 Scanning the Portrait z 2 22 2 lt a er re res 22 4 4 2 Scanning integral indicators 2 2 22 23 4 4 3 Scanning the Conclusion 0 24 AAA Scanning CStalliNG vosccesicesi cen cest cost cost ces cent Cestcesicesicentceyiceutcesicentcentcestces 26 4 5 Examination recording comments ccccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 27 4 6 Examination Scanning additional parameters of ECG input 27 4 7 Control of trends scanning the gallery of portraits eee 29 4 8 Scanning ECG inputsignals zsnsssescs eee 30 4 9 Deleting portraits from the examination data base nenene 30 4 10 Deleting patients from the data DaSEC cc ceccecceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 30 4 11 Correcting the patients name nennen nennen nennen 31 4
29. ce of high strain in the regulatory system nervous tension dysfunction of internal organs inflammation etc If high value of Rhythm is combined with decreasing variability of cardiac rhythm VCR and this combination is permanently repeated it is a sign of inauspicious prognosis In this case the section RHYTHM in the conclusion will show the following warning If in the absence of significant pathological changes in the myocardium you wish to single mindedly observe the patient s stress it is recommended to use 60 second exposition In this case the indicator Rhythm will be stable Change in color of the indicator Pulse corresponds to generally accepted borders of normocardia bradycardia and tachycardia for an adult person Annex III The borders of bradycardia in this device do not differentiate sinus rhythm and manifest arrhythmias Deviation of rhythm from sinus rhythm is indicated by additional messages in the section Rhythm of the conclusion see further The indicator Detailing code informs the doctor of similar pathological deviations see p 2 3 Their names can be scanned with the button K14 Detailing Besides these names can be seen without exit from the portrait window For this purpose place the cursor on indicator Detailing code the cursor in this case does not change the pictogram and press the left key of the mouse The tag window Deviations classification will a
30. ch may not relate to coronarogenic pathogenesis In these cases it is information that dispersion characteristics of the myocardium at the time of examinations deviated from the norm to characteristics of ischemic states Clinic significance of such a message depends on whether it is confirmed by the portrait and detailing information as well as by high regularity of such messages The more references to probable ischemia in detailing groups G3 G7 and the more changes in the portrait the higher probability of clinic form of ischemia Table A 2 In any case device indication of ischemic changes with absence of other clinic symptoms of ischemia is clear evidence of significant subliminal deviations which are expedient to be periodically controlled by dynamics of the heart portrait and which in unfavorable conditions can manifest in clinic forms Page 42 of 51 MKC CardioVisor O6c User s manual 6 2 Clinical significance of ischemic manifestations in the border group The present Table contains description of four typical situations which arise in analysis of the screening analyzer autoclassifier in the so called border group of conclusions This group embraces myocardial states which can be related either to stable pathology or transient changes in the myocardium caused by functional metabolic or other transient factors As a rule values of integral indicator Myocardium in this group are in the rage 10 23 Each situation in the Table is desc
31. clusion therefore to estimate the authenticity of the conclusion it is just sufficient to have a look at the heart portrait 4 5 Examination recording comments In the lower part of the detailing window is the window of comments into which the doctor with the help of the keyboard can enter any necessary information about the examination or his final conclusion To enter a text press the button and with the keyboard enter the requires text To save the text do not fail to press the button lt OK gt 4 6 Examination Scanning additional parameters of ECG input If the doctor finds it necessary to estimate some generalized characteristics of RR intervals or amplitudes and length of some ECG peaks he needs to scan the table Data of the indicatory lead indicatory lead in this program stands for the lead with maximal amplitude of peak R i e for the lead which is the closest by direction to the electrical axis This table can be drawn out only in the window of scanning the large scale portrait the button K9 Medical Computer Systems Page 27 of 51 CardioVisor O6c User s manual When in this window press the button amp on the left in the upper part of the window The table presents the results of measuring a series of amplitude and time quantitative characteristics These are mean values determined by all PQRST complexes of ECG which do not contain artifacts Character means low trustfulness of measurem
32. details according to deviation groups RHYTHM 1 Norm sinus rhythm 1 2 Moderate tachycardia depending on the peculiarities of each particular case this screening estimation can correspond to a few adjacent deviation gradations shown in the first column of the table Medical Computer Systems Page 25 of 51 CardioVisor 06c User s manual 3 4 Distinct tachycardia 1 2 Moderate bradycardia 3 4 Distinct bradycardia ELECTRICAL AXIS 1 NORMAL position of the electrical axis of the heart 1 HORISONTAL position of the electrical axis of the heart 1 VERTICAL position of the electrical axis of the heart 2 4 Deviation of the electrical axis TO THE LEFT 2 4 Deviation of the electrical axis TO THE RIGHT Additional information in the conclusion sections is given in black and white Additional messages with high clinical significance like massages about probable ischemia are given in black If the message Symptoms of probable dysfunction of the left ventricle appears it means there are significant changes in dispersion characteristics of he left ventricle However these changes are of diffusion character and detailing the probable deviation is hardly possible complete clinical diagnosis is necessary I Additional information given in black and white is NOT DIAGNOSIS It is recommendable information about probable pathological states dispersion characteristics of which res
33. dient to increase pulse beating by Recommended any loading test by 15 25 and make a series of 2 3 portraits Type and value of loading is determined by doctor in each steps particular case ed oe If in General conclusions successive portraits after loading bear message Deviation from norm or indicator Myocardium exceeds 18 and time of return of the portrait to initial form is more than 4 minutes complete examination is expediently or periodic control of dynamics by portraits to verify the conclusion Situation 2 na 2 eak ar MOTETA From 15 to 22 Messages about Messages about 1 2 messages about deviations local changes to eee ere f ie red probable initial probable initial probable ischemia with ischemic changes or ischemic changes gradation most probable manifest ischemia or very probable Situation 2 gt Most probable significant deviations If this state is revealed for the first time it is expedient to make additionally a series of 2 3 Recommended portraits If deviations are steadily repeated these are significant deviations If indicator Myocardium decreases and the steps portrait steps in subsequent examinations becomes better it is expedient to increase pulse beating by any loading test by 15 25 and make a series of 2 3 portraits Type and value of loading is determined by doctor in each particular case Synthesis for Situation 2 Page 44 of 51 e If in the General conclusion on consecutive por
34. dium decreases and the portrait becomes better it is expedient to increase by any loading test pulse beating by 15 25 and again to make 2 3 successive portraits Synthesis for If in General conclusions successive portraits after loading bear message Deviation from the norm Situation 3 or Distinct deviations from the norm or Myocardium fluctuations exceed 7 pathologic changes are probable Otherwise revealed deviation may be an episode of short time transient ischemia or have non coronarogenic etymology Such situation is often observed with smoker Situation 4 2 Large or local but From 22 to 27 Messages about Messages about 1 2 messages about deviations ae j Re distinct changes to probable primary probable primary probable ischemia with red ischemic changes or ischemic changes or gradation most probable or manifest ischemia manifest ischemia very probable Situation4 gt Most probable the significant deviations confirmed by detailing text in groups G3 G7 Recommended steps Synthesis for Probable ischemic changes complete examination is necessary Situation 4 Medical Computer Systems Page 45 of 51 CardioVisor O6c User s manual 7 Annex lll 7 1 Criteria of comparison of dispersion deviations with generally accepted electrocardiographic diagnoses This annex contains a table of comparative correspondence of ECG fluctuations used in screen
35. e automatic classifier when analyzing fluctuations These groups are as follows e G1 depolarization of the right auricle e G2 depolarization of the left auricle e G3 depolarization of the right ventricle e G4 depolarization of the left ventricle e G5 repolarization of the right ventricle e G6 repolarization of the left ventricle e G7 symmetry of ventricles depolarization e G8 intraventricular blocks e G9 ventricular hypertrophy 0 in the code means that in the present group the portrait is in the norm Appearance of any figure except 0 in any of the groups G1 G9 is evidence that dispersion characteristics of the present portrait in this group resembles a certain pathology in this case the figure is equal to the conventional index of pathology The higher the figure the clearer the expression of the deviation The number of standard pathologies in each group is determined by the following values G1 17 standards G2 10 standards G3 16 standards G4 22 standards G5 3 standards G6 14 standards G7 21 standards G8 2 standards G9 21 standards The number of standards is selected so as to ensure difference of 130 enlarged variants of deviation and on this basis to form recommendation messages about the possible type of pathology The main purpose of detailing code is to give the user explicit qualitative information about probable pathologies with similar dispersion characteristics A small
36. e A3 is made by screening conclusion sections p 4 4 3 including 1 General conclusion 2 Rhythm 3 Electrical axis 4 Auricular myocardium 5 Ventricular myocardium 6 Ventricular hypertrophy 7 Other changes In section 2 Rhythm the following abbreviations are used CCF cardiac contraction frequency SDDN standard RR interval length deviation TI tension index unmeasured value 10 In the autoclassifier of the screening analyzer the following limits of norm are used 25 msec lt SDDN lt 100 msec TI lt 200 Page 46 of 51 MKC CardioVisor 06c User s manual Table A3 1 Gene Criteria of comparison of dispersion deviations from generally accepted electrocardiographs diagnoses Screening conclusions of dispersion deviations low amplitude fluctuations ral conclusion ECG conclusions corresponding to these dispersion deviations No significant deviations from the norm This conclusion CAN be used only in comparison with other clinical data If the patient DRUGS this conclusion requires verification on the basis of complete clinical examination Normal ECG Minor CHANGES within the LIMITS of the NORM It is expedient to control Dynamics to differentiate variant of norm from primary phase of significant deviations Minor CHANGES in process of ventricular excitation It expedient to control DYNAMICS as these changes can be either the beginning of signific
37. e stored in the current archive copy The database of the Program is a standard index list of data therefore no joint operations with catalogs Db_Vis are permissible If you wish to scan any of the saved archive catalog Db_ Vis do the following 1 For some time move the cuarrent working catalog Db_ Vis from root directory of the program to another buffer catalog Page 32 of 51 MKC CardioVisor O6c User s manual 2 Copy archive catalog Db_Vis into root directory radical catalog of the program instead of the shifted working catalog activate the program and scan the examinations you are interested in print the forms After that it is necessary to exit the program and to return current working base Db_Vis from the buffer catalog to the previous place These irregular manipulations can be performed by only an experienced user and in cases of extreme necessity only It is NOT PERMISSIBLE to do these operations when the program is activated in this case the data base will be irreversibly lost 4 16 Testing the program in operation If the computer is in good state and the operative system is adequate the manufacturer guarantees the work of CardioVisor 06c without faults and conflicts However unlikely situations when the integrity of the program due to some malfunctions of the operation system or the errors of unskilled user in the root directory of the program are possible If irregular situation related to m
38. e text are given in green italics To move over to a new link set the cursor on green italics and press the left key The program contains context prompt with F1 of the keyboard pressed the screen shows the help section corresponding to the current state of interface Medical Computer Systems Page 33 of 51 CardioVisor O6c User s manual 5 Annex 5 1 Examples of heart portraits with different pathologies Page 34 of 51 MKC CardioVisor O6c User s manual Medical Computer Systems Page 35 of 51 CardioVisor O6c User s manual Page 36 of 51 MKC CardioVisor O6c User s manual Medical Computer Systems Page 37 of 51 CardioVisor O6c User s manual 6 Annex Il 6 1 Peculiarities of clinical interpretation of heart portrait Screening analyzer controls regularity of characteristics of ECG low amplitude ECG signal fluctuations which always appear with every contraction of the heart Low amplitude fluctuations demonstrate deviations from normal course of depolarization repolarization of the myocardium in a way which is considerably different from the way of control of the traditional ECG deviations To describe in short the peculiarities of clinical interpretation of low amplitude ECG fluctuations let us refer to general principles of the technology under survey Let us consider the principles of this technology 6 7 on the example of analysis of QRST complex 30 second ECG input signals at rest take digital
39. emble dispersion characteristics of the ECG under analysis Only complete examination can confirm or verify additional text messages For convenience the background of conclusion is also in the same color as the indicator Myocardium Only in absolute absence of significant deviations the background of the conclusion is bright green If screening conclusion is NOTM there are grounds to verify this conclusion anamnesis or physical signs of a lesion of the cardiovascular system Use recommendations of Table 2 Annex Il 4 4 4 Scanning detailing If the indicator Detailing code contains deviation indexes other figures accept 0 or if you wish to scan the quantitative values of typical indicators of input ECG press K14 of Detailing The screen will show the window of detailing Fig 4 For convenience the text message of conclusion is repeated in the upper part of this window while in the left part some standard ECG indicators will appear In the right part of the window there is a section of text 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 Fig 10 Indication color of the code shows the rate of resemblance of Page 26 of 51 MKC CardioVisor 06c User s manual dispersion characteristics of the patient s heart to dispersion characteristics of a certain pa
40. emic changes Such low specificity in relation to ischemia is acceptable for a screening device as it is designed to timely reveal the fact of developing pathology and not a type of pathology Thus 25 of revealed significant changes which the screening analyzer refers to probable ischemic changes will not be of ischemic origin However in all these cases it is an absolute fact that significant deviations are evident and require examination Clinic diagnosis can only be made with a complete examination of the patient in whom the screening analyzer revealed significant deviations from the norm The above two methodological peculiarities of the screening analyzer give rise to corresponding peculiarities of clinic interpretation of heart portraits and text conclusions These peculiarities consist in the following recommendations which should be taken as guiding lines in practical work with the device The screening analyzer does not form diagnosis but indicates the resemblanceof ECG dispersion characteristics of a patient at the time of examination to dispersion characteristics of standard electrocardiograms to some clinically significant pathologies Due to this interpretation of clinically significant results of a concrete examination should be based on synthesis of all three output components of the device the portrait Conclusion and Detailing p 4 4 The recommended order of such synthesis for probable ischemic manifestations is given
41. ent no estimation The abbreviation CRV means cardiac rhythm variability When calculating mean values by all PQRST complexes the representative complex is not singled out therefore interface does not contain the traditional representative complex with marked peaks Accurate measurement of amplitude and time characteristics of a particular PQRST complex if necessary can be performed by the user in the window of measuring ECG characteristics Fig 10 CE EEE BEE Time msec 506 Amplitude my 0 43 Amplitude 0 34mi do OFF UF Amplitude Marker of time meter Fig 11 ECG characteristics meter If there are minimal or maximal limits of the norm they are given in the corresponding columns of the table If you wish a more detailed scanning of ECG in large scale and additional measurement of intervals or amplitudes in any lead I aVF press Amplitudes in the lower part of the table In the opened window Mean peak amplitudes of all leads choose the required lead and press the button ECG The window of measuring ECG characteristics will appear Fig 11 This window has three functional states measuring put off initial state amplitude measuring and time measuring First in the initial state measuring put off the user with the help of vertical and horizontal scroll and setting Amplitude should choose the required ECG fragment and a convenient scale for amplitude If
42. gy designers called the heart portrait Fig A 1 d Page 38 of 51 MKC CardioVisor 06c User s manual QRST 1 QRST 2 QRST3 i Ga 15 50 aY F microvolt a oO D i A c d Fig A 1 Diagram of forming information topology model of low amplitude ECG fluctuations a Input ECG signals with synchronization marks b block of low amplitude ECG fluctuations for one moment c surface map of dispersion characteristics d information topology model of dispersion characteristics heart portrait Dispersion characteristics of ECG low amplitude fluctuations controlled in this way reflect the characteristics of regularity of the movement of depolarization and repolarization fronts in the myocardium with every contraction of the heart calculated during 10 20 sec Verification tests showed the better the state of the myocardium by generally accepted criteria of the norm the better regularity i e stability of dispersion characteristics in the successive cycles of depolarization repolarization It should be noted that this position considerably differentiates regularity of dispersion characteristics of electric excitation of the myocardium from regularity of cardiac rhythm characteristics As known high stability of RR intervals length low variability of cardiac rhythm is always evidence of deterioration of functional state of the heart 5 Contrary to this functional and organic deviations of the myocardium
43. hysiologischer Funktionsparameter 2001 High resolution electrocardiography edited by G G Ivanov C B Grachev A L Syrkin M Triada 2003 In Russian Cardiology in tables and charts edited by M Frida C Grain translated from Eng M Pub House Practica 1996 In Russian R M Baevsky O P Kirillov S Z Kletskin Mathematic analysis of cardic rhythm in stress M Nauka 1984 In Russian Page 6 of 51 MKC CardioVisor O6c User s manual 1 Purpose and application Computer screening analyzer CardioVisor 06c generator of heart portrait is designed for express estimation of the state of a heart by ECG signals coming from extremities 4 electrodes The circumstances in which screening analyzer CardioVisor 06c can be useful You need a simple and reliable screening instrument which cab be used even by junior medical personnel You have a large flow of patients and it is important for you that the screening conclusion should be more reliable and operative You observe the heart of a patient during hospital treatment and you want quickly and in undisturbed working conditions obtain possibly earliest information about slight changes in the course of electrical excitation of the myocardium At the same time along with express procedure it is very important for you to have this information right where the patient is without transferring him to the room of functional diagnosis You observe a patient for a long
44. igned to detect early dispersion deviations in a group of border state of heart and to warn about manifest pathology CardioVisor 06c version 1 1 does not single out acute myocardial infarction among discernible states of myocardial ischemia In these cases the device indicates the necessity or emergent necessity of clinic examination to diagnose Drugs can make effect on the view of a heart portrait and the text of screening estimation In case the analyzer is used in medicamentous treatment of a patient it is obligatory to compare current heart portraits and the portraits obtained before or at the beginning of medicamentous therapy CardioVisor 06c is designed for screening analysis of ECG signals in an adult person CardioVisor 06c is not to be applied with children under the age of 12 For children at the age of 12 18 this can be used only for control of trends of changes of dispersion characteristics Page 8 of 51 MKC CardioVisor O6c User s manual 1 2 Principle of analysis Amplitudes of direct i e directly measured in electrocardiogram and those of indirect parameters determined on the basis of the present mathematical model of heart biogenerator in successive PQRST complexes vary in not great limits The amplitude and phase characteristics of these variations have high sensitivity to changes in depolarization and repolarisation of the myocardium It is the dispersions of the above variations that are analyzed by Cardio
45. iles KARDi2 CV06s just press lt Next gt in dialog windows If you wish another location of the software indicate it when enquired by InstallShield with the keyboard or the button lt Review gt When InstallShield formed the message about the completion of installation press the button lt Ready gt In case the computer is supplied with a few hard disks C D it is recommended to choose a disk with maximum capacity After the completion of the above operations the icon of program start will appear on the topdesk while in the section lt Start gt lt Programs gt new extension KARDi CV06c will appear This extension contains program KARDi2 and autotest program Test p 4 16 Installation of only one program copy in the computer is allowed Medical Computer Systems Page 17 of 51 CardioVisor O6c User s manual 4 Operation 4 1 Starting the program CardioVisor 06c Software is started by double clicking of the left key of the mouse on the program icon on Windows topdesk Another way of activating the program Press the system button lt Start gt in the left part of the screen enter lt Programs gt KARDi2 CV06s and start program KARDi2 After the start the main window of the program will appear on the screen of display The main window on the left includes the patients base while that on the right the base of heart portraits examinations base At the start the patients base is al
46. in Table A 2 of this Annex 2 The sensitivity of the screening analyzer to ischemia is 80 specificity 76 Practically this sensitivity level is commeasurable with mean sensitivity to ambulatory ischemia and exceeds the monitoring and exceeds mean sensitivity of ECG stress tests by 10 15 In this case the above level of sensitivity of the device is reached with ECG Page 40 of 51 MKC CardioVisor O6c User s manual analysis at rest which can be made in ambulatory conditions In approximately 20 of certain cases of ischemia the device does not find deviations from the norm or finds them insignificant indicator Myocardium is less than 16 This effect is characteristic of two practically important cases firstly with back localization of ischemic changes shifted to basal sections secondly with intensive medicamentous treatment If in these cases there are clinic grounds for a more detailed analysis it is expedient to make a few portraits at a run after a short mediacamentous or physical load a 15 25 pulse increase The type and volume of such load is chosen by the doctor in each particular case This load which is considerably lower than submaximal can be in some cases easily reached by 10 15 squattings Dispersion characteristics are very sensitive to even small loads which in such situations makes it possible to considerably raise the sensitivity of the device Conclusion messages about significant deviations after such moderate l
47. ing analyzer and generally accepted criteria of ECG conclusions when registering limb ECG at rest This comparative table establishes connection between additional text conclusions of screening analysis and generally accepted methodological recommendations according to ECG analysis which are used by doctor in practical work Dispersion deviations in many cases reflect processes in early stages of changes which have no direct analogs in practical criteria of ECG conclusions For the same reason a certain generally accepted criterion of ECG analysis characterizing clinical stages of pathological changes can correspond to several dispersion conclusions reflecting changes in early stages which are still not clinical stages For the same reasons the list of cited generally accepted criteria of ECG conclusions is not complete it is to be used only for simplified clinical interpretation of additional screening conclusion texts at the beginning of work with the screening analyzer Finally the cited comparisons cannot be absolutely strict or categorical as screening analyzer dispersion conclusions are not diagnosis and the comparison is always confined to some probability limits Such tolerance of comparison is inevitable as analogs of many dispersion deviations due to their high sensitivity can only be seen in standard ECG from 12 leads while deviations only in ECG with physical loading Comparison of dispersion conclusions and ECG conclusions in Tabl
48. ion about rhythm deviation given by CardioVisor 06c can be unauthentic 2 4 Structure of report The device provides two documentation forms of the results complete form and a short form Page 14 of 51 MKC CardioVisor O6c User s manual Complete form contains e Standard fragments of an ECG for leads I II III aVR aVL aVF e heart portrait e text of the general conclusion Short form contains only fragments of input ECG Medical Computer Systems Page 15 of 51 CardioVisor O6c User s manual 3 Installation of screening analyzer 3 1 Computer features e Recommended video memory not less than 32 MB e Recommended RAM not less than 128 MB e Recommended free disk capacity not less 400MB program core 18 MB e Recommended processor frequency not less than 1000 MHz With lower computer characteristics CardioVisor 06c can operate However in this case the time of forming a portrait can increase to 2 minutes Disk capacity limits only the number of Patients and examinations which are permanently stored in data base See p 3 2 1 CardioVisor 06c Software interface with different screen area and different types of system fonts can vary in design of buttons and some auxiliary graphic elements To achieve the highest quality of screen interface it is recommended after the installation of CardioVisor O6c program to set one of the following display properties Screen area 1024x768 Font
49. it reflects integral summary changes in morphologic electrophysiologic and other structural parameters of the myocardium Due to this the chart of color changes in the quasi epicardium in the portrait of the heart of a particular patient has its own stable characteristic individual peculiarities i e the heart portrait is highly specific in respect of individual structural peculiarities of the myocardium However due to the same factor in case of one and the same clinic diagnosis portraits with different patients can be significantly different in individual characteristics of localization area and degree of expressiveness of changes And vice versa similar changes in portraits in some cases can correspond to different pathologies The above peculiarities can in no way have any effect on sensitivity and specificity of screening estimation i e reliability of differentiation of norm and deviation This tells only on specificity in relation to certain concrete pathologies i e in solving problems in differential diagnosis which are beyond the possibilities of screening device CardioVisor 06c Medical Computer Systems Page 9 of 51 CardioVisor O6c User s manual 2 General information CardioVisor 06c is designed for operative detection of deviations in the work of a heart which manifest in the above dispersion characteristics and can be related to developing pathology CardioVisor 06 DOES NOT DIAGNOSE The purpose
50. leting work through the menu 4 15 Servicing the patients database The only operation which is expedient to perform periodically when working with the program is to empty the basket of examinations of each patient or delete patients who are not served with this device Versions of Software 1 do not stipulate built in export import of data However with a great number of examinations the user can create a current copy of the data base by use of Explorer The operation should be made in the following order 1 Exit from CardioVisor 06c program if it is activated 2 Using Explorer enter radical catalog of Cardio Visor 06c software The root directory is always presented as KARDi2 CV06s KARDi2 i e it corresponds to the way which was assigned at installation for instance if during installation the program is set in the catalog by defaults C Program Files KARDi2 CV06s the root directory is C Program Files KARDi2 CV06s KARDi2 To ensure reliable localization the installer always adds the last subcatalog KARDi2 the selected way 3 Single out sub catalog Db_Vis in the root directory and copy it in the reserve catalog in which you store archive files Caution If you accidentally lose subcatalog Db_Vis the data base will be irreversibly destroyed Db_Vis can be only copied but not shifted After the data base is copied it is necessary to activate the program and delete useless records as now they ar
51. mall deviations of high correlation but weakens deviations which hardly correlate in the complexes under analysis Dispersion characteristics give integral estimation of changes in many structural myocardial characteristics depending on blood parameters electrolyte balance blood pressure and other factors The final procedure of calculation of dispersion characteristics consists in determining probable localization of sections of the myocardium with changes that became the cause of dispersion changes as well as in determining the integral indicator of deviations of dispersion characteristics from the norm in localized sections The accuracy of probable localization of dispersion changes is determined by the number of leads under analysis Screening analyzer registering limb leads provides singling out only the following enlarged types of localization of changes back or side side front septum or side front septum or lower lower lower with a shift to the right Finally at the output of the information amplifier a surface map of dispersion characteristics is formed which reflects only significant deviations of these characteristics from the norm Fig A 1 c This map by determined algorithm is projected on the epicardial surface of the computer three dimensional anatomic model of the heart The screen shows a digital model of dispersion characteristics on the surface of quasi epicardium i e on the computer model of the epicardium which the technolo
52. most likely localization of the center of changes The length of exposition length of ECG input is 30 or 60 sec A heart portrait can be obtained without unclothing the patient in the sitting position The period of forming the portrait after the ECG input is about 20 sec the period of scanning the portrait in two aspects right and left does not exceed 60 sec The portrait is formed in two aspects at a time right view and left view In the normal state the epicardium in the portrait is green With a focus of pathologic changes in the myocardium the corresponding area of the portrait changes from green to red depending on degree of pathology expression The heart portrait gives full information about dispersion changes in all heart chambers simultaneously and it is easy to perceive by the doctor in 15 20 sec CardioVisor 06c gives the doctor a unique facility to control trends of changes in the heart by scanning successive portraits The length of scanning a gallery of four successive portraits to control the trends is 30 40 sec The total time of obtaining a conclusion is 1 5 2 5 minutes The doctor can use the functions of the standard scanning and ECG analysis of six standard extremity leads I aVF The system provides screening examination documentation conclusion form and functions of control of the base of patients and the base of heart portraits 1 1 Limitations CardioVisor 06c DOES NOT DIAGNOSE The instrument is des
53. ndicators e scanning the conclusion e scanning the detailing Medical Computer Systems Page 21 of 51 CardioVisor O6c User s manual 4 4 1 Scanning the portrait The portrait shows the slightest changes in dispersion characteristics of electric excitation With deviations the color picture of color changing has characteristic individual features therefore the heart portrait retains these individual features for a long time similar to individual features of a particular face These individual features are rather significant but they all have a common peculiarity The more expressive red and the larger the area in which green turns to red the bigger deviation Most significant pathological changes cover the left ventricle or both ventricles at a time as well as section 15 of the final phase of ventricular depolarization on the left view of the heart portrait Fig Special attention should be paid to the bright red band in section 15 even though all the other sections of the quasi epicardium have the normal color Repeated appearance of the bright red band is correlated with clinically significant changes in the myocardium ae rs Fig 9 Red band in section 15 final phase of depolarization of the right ventricle correlating with clinically significant changes The rate of saturation with red in different sections of the quasi epicardium is not necessarily connected with inauspicious diagnosis For instance in
54. oad and distinct color changes in the portrait testify to expediency or necessity of complete examination With deviations from the norm dispersion characteristics begin to change earlier than it is seen on the usual ECG i e the device can react to latent or pre clinic forms of myocardial changes Most often it refers to ischemia There are cases when ECG is in the norm while dispersion characteristics testify to significant probable ischemic deviations in the myocardium Such situations are not errors of the device They reflect objective changes in depolarization repolarization in the myocardium during the examination Moreover there may be cases when probable ischemic manifestations revealed by the device can considerably vary in successive portraits within a few minutes This is evidence of the fact that the myocardium is in the border state and episodes of transient ischemia interchange by time with the norm Clinical significance of such manifestations of ischemia can also be verified after a slight load increasing pulse beating by 15 25 Table A 2 Estimation of clinical significance of additional messages of the conclusion about probable ischemic changes is determined by two factors by the value of revealed deviations from the norm and by their stability in 2 3 successive portraits By value of deviations any conclusion of the device belongs with one of the following four groups of screening conclusions e Norm indicator Myoc
55. onal component of screening estimation this analyzer uses a simplified dynamic integral estimation of the variability of cardiac rhythm calculated by general activity of regulatory systems of cardiac rhythm by the method of R M Baevsky The screening analyzer can also be used for the standard ECG analysis from six limb leads I wave In order to ensure the most effective application of our product we ask you to familiarize yourself with this manual in a very careful manner Medical Computer Systems Page 5 of 51 CardioVisor 06c User s manual Abbreviations Abbreviation Meaning ECG Electrocardiogram CRV Cardiac rhythm variability CCF Cardiac contraction frequency Reference 1 Medical Computer Systems www mks ru 2 Electrocardiography site www ecg ru 3 Computerized nine channel Cardioanalyzer KARD Operation instruction 4 Galen C Wagner Practical electrocardiography by Marriott translated 10 from Eng CIIG Nevsky Dialect M Publishing House BINOM 2002 in Russian G V Ryabykina A V Sobolev Variability of cardic rhythm Manuscript M Star co 1998 Cardiology in Russian Patent DE 198 01 240 Soula A Gillessen W Kitashine Y Verfahren und Vorrichtung zur Darstellung und Uberwachung von Funktionsparametern eines physiologischen Systems 1999 Patent DE 199 52 645 Soula A Kitashine Y Gillessen W Verfahren unf Vorrichtung zur visuellen Darstellung und Uberwachung p
56. ons and parameters of their supposed localization So that the doctor may have an integral and explicit picture of changes in the myocardium the dispersion card is projected against the quasi epicardium of a three dimensional computer model of the heart reflecting the front and back surfaces of the heart The manifestation and supposed localization of changes are determined by color changes of the quasi epicardium which in the norm is evenly green As a result the doctor is enabled to directly see the quasi epicardium on the surface of the three dimensional computer model of the heart which is reconstructed by ECG low amplitude fluctuations This model of quasi epicardium was named heart portrait With screening examination of a patient direct observation of the topology of low amplitude fluctuations on the surface of the quasi epicardium ensures significantly higher accuracy and effectiveness of ECG signal interpretation while the most important is that it enables the doctor quickly and reliably observe the earliest changes in the heart which do not manifest in the standard ECG characteristics Differentiation of norms and pathologies is made with the use of standard methodology of clinicostatistic analysis by trained classifier of the program in a control group of healthy people and in a group of patients with seriously verified clinic pathologies including hypertensive disease various forms of myocardial ischemia heart disease etc As an additi
57. owing deviations 4 4 2 Scanning integral indicators The indicators are in the upper part of the portraits window Fig 3 The main indicator is Myocardium which gives summary estimation of dispersion deviations from the norm in the range 0 100 p 2 3 The color background of this indicator informs the doctor of expressivity of revealed deviations according to the following table ES Al indicator color State lt 16 green No significant deviations Slight changes in portrait stand for individual peculiarities Variant of norm 16 19 yellow Border state transient episode of short time increase in dispersion characteristics or initial stage of probable pathology 20 23 yellow Probable indistinct pathology 24 47 brown Probable pathology gt 47 red Probable distinct pathology The value of the indicator Myocardium with successive examinations can vary within slight limits up to 8 Fluctuations of this indicator with difference between successive examinations exceeding 8 and simultaneously changing color in the heart portraits is evidence of instability of the myocardium This necessitates control of dynamics with a higher frequency of examinations if these fluctuations are not due to ECG inadequacy bad electrode contact with skin or muscular tremor during ECG input If the value Myocardium is permanently above 19 and in auxiliary messages of conclusion there is suspicion
58. ppear The code of each group corresponds to the number of the listed typical deviations 4 4 3 Scanning the conclusion The conclusion is in the upper part of the window with the big portrait and includes the following sections 1 General conclusion generalized scanning estimation 2 Rhythm 3 Electrical axis 4 Auricular myocardium 5 Ventricular myocardium 6 Ventricular hypertrophy To access to all sections of the conclusion use the typical text scanning mechanism which is in the right part of the window In case of constantly high stress values stable deviations of some indicators of rhythm variability from the norm in the absence of arrhythmia section OTHER CHANGES appears 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 Page 24 of 51 MKC CardioVisor 06c User s manual information by color the text of screening estimation is colored while additional text is black and white There are 4 gradations of screening estimation norm manifest deviations distinct deviations The color of the text indicates the value of deviations from the norm in accordance with the following table Color of creening estimation text Index and name of gradation of deviation from norm green 1 Norm no significant deviations or within limits of norm b
59. press the left key the fixed line of the beginning of count will appear Now move the marker to the required point the time scale In the indicator Time read the interval length value in msec relating to the beginning of count If it is necessary to set a new beginning of count move the marker to the required value and again click the left key In this way you can measure time between any two ECG points When measuring the ECG horizontal and vertical scrolls are in operation 4 7 Control of trends scanning the gallery of portraits CardioVisor 06c is a unique facility to accurately and quickly control trends by scanning successive portraits stored in the examinations base This makes it possible to reveal pre clinic forms of pathological changes much more accurately and in a more reliable way to control minor changes in the process of electrical excitation of the myocardium which do not manifest in ECG For this the device provides scanning of portraits in a small scale If you are not in the main window of the system return to it with the help of button K1 f Select the required patient and press K11 portraits will appear on the screen The window of scanning four The choice of examinations for scanning is set in such a way that by activating the window portraits of four latest examinations of the chosen patient appear automatically However with control of large lists of examinations it becomes neces
60. ptimal adaptation of the device to the input signal the time exposition indicator counts backward 5 4 0 These five seconds are a relaxation pause for the patient ECG indication begins from 0 Input of ECG data is completed 35 65 sec after pressing the button K17 exposition 5 sec If during the ECG input it is necessary to interrupt the process click on Stop Fig 8 If after the interruption with the button Stop you wish to return to the main window of the system press K1 Patients base When ECG input is completed the screen displays the indicator of generating a portrait sand clock In 10 40 sec depending on the computer speed the process is completed with the appearance of a large scale portrait on the screen of display At the same time together with the portrait in this window appear integral indicators and text conclusion In this way in minute after pressing the button K17 with 30 sec exposition the user receives the portrait of the patient s heart If in the process of ECG input there is some interference which caused abrupt changes in ECG insulation it is expedient to repeat the examination in this case the incorrect examination should be deleted from the examinations base see p 4 10 4 4 Examination scanning portraits and text messages It is expedient to scan the output data of CardioVisor 06c Software in the following order e scanning the portrait e scanning integral i
61. ribed in three lines The first line Deviations includes description of deviations and changes relating to the portrait obtained and the conclusion concerning ventricular myocardium The second line recommended steps recommends to get additional heart portraits to verify the conclusion The third line Synthesis includes recommendations concerning the final interpretation of clinical significance of the screening conclusion It is expedient to use the recommendations cited in Table A 2 in cases when data of anamnesis and physical examination do not correspond to the screening conclusion of the device or when there are other clinic grounds for verification of screening conclusion Medical Computer Systems Page 43 of 51 CardioVisor 06c User s manual Table A2 Deviations jaye ee i General conclusion Ventricular Detailing Steps Changes in Myocardium value myocardium f portrait Total dispersion messages about messages about messages about ischemic e Synthesis deviations ischemic changes ischemic changes changes in groups G3 G7 Situation 1 2 Weak local changes Less than 15 Messages about No messages initial No or more than one deviations j f 7 to red probable primary ischemic changes message with graduate ischemic changes individual peculiarities or most probable Situation1 gt Most probable norm If there are clinical grounds for verification of the conclusion it is expe
62. right orange 2 slight deviations from norm red 3 manifest deviations 4 distinct deviations Screening estimation texts according to sections of conclusion include the following text messages Index of deviation gradation Screening estimation text General conclusion 1 Myocardium lt 15 No significant deviations from norm are found This conclusion CAN be used only in comparison of anamnesis and physical data If the patient takes DRUGS this conclusion necessitates verification based on complete clinical examination 1 2 Slight CHANGES WITHIN LIMITS of the NORM It is expedient to control DYNAMICS for differentiation of a norm variant from the initial phase of significant deviations 1 2 Slight CHANGES in stimulation process of ventricles it is expedient to control DYNAMICS as these changes can be either the beginning of significant deviations or a symptom of temporary functional disorders 1 2 Probable indistinct symptoms of functional disorders of the left ventricle 2 Myocardium 16 19 Moderate myocardial changes of ventricles Dynamics control is expedient 2 Probable symptoms of functional disorders of the left ventricle 3 Myocardium 20 27 DEVIATIONS See probable details according to deviation groups 4 DISTINCT DEVIATIONS probable pathological changes See Myocardium gt 27
63. rom the traditional ECG analyzers as it is based on a new method of analysis of ECG signals which does not control the generally accepted temporary and amplitude electrocardiographic characteristics with subsequent syndrome analysis The main structural component of the method is the analysis of dispersion of low amplitude fluctuations of an ECG signal within certain temporary intervals of the PQRST cardio cycle Dispersion analysis of low amplitude fluctuations is made during a 30 60 sec uninterrupted monitoring of an ECG signal The in line ECG signal comes only from the leads from extremities electrodes R L F N in the usual transmission band of 0 150 Hz The mean values of amplitude dispersions correspond to 5 30 mV i e they are significantly smaller than the mean amplitudes of ECG peaks A special analysis of such low amplitude signals ensures a reliable manifestation of small disturbances in myocardium depolarization and repolarization The main purpose of the analysis of such low amplitude signals consists in reliable detection of slight disturbances in myocardium depolarization and repolarization With this method it is small disturbances that are effective markers of pathologic changes in the myocardium The traditional ECG characteristics exclude reliable manifestations The result of the analysis is presented as a card of deviations of dispersion low amplitude characteristics from the norm including the amplitudes of these deviati
64. s names in the alphabetical order figures Latin letters Russian letters If you press the left key again the list of patients will be in the reversed order the triangle top downward Medical Computer Systems Page 19 of 51 CardioVisor O6c User s manual Patients Surname A1 patient 1 7 26 6 2002 A2 patient 2 58 14 6 2002 Fig 6 Table of the patients base Check the value of the length of ECG input exposition which shown the button K6 To switch it over click it with the mouse The main exposition is 30 sec It is expedient to use 60 sec exposition only in case you wish to have a more precise value of the indicator Rhythm For instance with high stress The quality of portraits practically does not influence the quality of the portrait 1 Apply electrodes according to the standard diagram of limb leads preliminarily lubricated with gel in application points red electrode R is placed on the right hand the yellow L on the left hand the green F on the left shin the black N on the right shin Fig 7 If for some reason application of gel is not desirable moistening with water is sufficient Make sure that the electrodes are put correctly according to color respectively If the signal is weak it is desirable before application to remove grease with Nikiforov mixture spirit and ether pro rata 1 1 Fig 7 Diagram of applying electrodes Give special attention to the quality
65. sary to choose any four portraits from the list When in the window of scanning a gallery of portraits appears press Choice Fig 12 14 U 12 0 f 1 12 0 EP Choice va Z k Fig 12 Control of a gallery of portraits Medical Computer Systems Page 29 of 51 CardioVisor O6c User s manual With the use of the left key of the mouse mark in the first column of the table examinations which you wish to scan at a time you can scan up to four examinations The chosen results will be marked in the first column To change the choice press once again the choice character for desired examination the choice character will disappear If you completed forming the choice press the activated button 5 to transfer the result of choice to the window of portraits If you wish to delete from the gallery the portraits you chose press OmmG6xa O beKT He MoxeT bITb C031AH H3 KOAOB NOJIEH PEHAKTHPOBAHHN If you wish to enlarge the portrait to see it in more detail just press the left key of the mouse on the required portrait The window with the enlarged portrait can be shifted if you drag the heading of the window with the left key 4 8 Scanning ECG input signals For ECG scanning use the buttons K10 and K12 K10 is convenient to use to control rhythm as this format is for 30 sec ECG If it is necessary to scan a certain fragment of recording in more detail set the cursor at the required point of ECG line and press the righ
66. sec with CCF 130 160 P Q length lt 120 msec 5 Ventricular myocardium e Ventricular myocardial changes resembling ISCHEMIC changes Dynamics control and complete examinations expedient Moderate depression or elevation distortion ST decreasing amplitude and peak T e QRS length ANOMALLY increased Probable symptoms of MYOCARDIUM lesion Complete examination necessary e Probable DISTINCT ISCHEMIC changes in ventricular myocardium complete examination necessary If these signs in the given patient were not observed earlier while now are repeatedly stable urgent complete examination is necessary e Probable DISTINCT ISCHEMIC changes in ventricular myocardium complete examination NECESSARY These signs can correlate with cicatricial changes If these signs in the given patient were not observed earlier but now repeatedly stable urgent complete examination is necessary Distinct elevation of segment ST in point Jin one or several leads At the same time depression ST in other leads Anomalous peaks Q 40msec with amplitude 25 of amplitude peak P in the same lead Deep negative peaks T in combination with depression of segment ST Variants of simultaneous depression of parabola type lines PR and ST or distinct slantwise declining depression ST 50 CardioVisor 06c User s manual Table A3 continuation Probable ISCHEMIC changes in ventricular myocardium complete examination is NECESSARY
67. t key ECG meter window will appear Fig 11 The beginning of the meter will be set in the chosen ECG point By default K10 always displays the indicatory lead the lead with the peak R maximal amplitude To change the lead press the corresponding button in the left part of the scanning window The button K12 is used for simultaneously scanning the initial interval of all leads If the cursor is on the line of any of the leads and the right key of the mouse is pressed The ECG meter window will appear bearing the corresponding ECG line 4 9 Deleting portraits from the examination data base To delete it is necessary to single out a required line in the examination data base and press K7 which is in the block of buttons Examinations If you whish to delete simultaneously a few examinations singled press the left key of the mouse and Shift on the keyboard To block accidental deletes the system is provided with a local basket All deleted portraits are in the basket yi If you wish to return some portraits enter the basket single these portraits and press the return button D Caution The files are deleted from the basket by a full list therefore first it is necessary to perform restoration The basket gives a list of deleted portraits only for an activated singled out patient It is expedient from time to time to empty these local baskets to save memory 4 10 Deleting patients from the data base To delete
68. t forms and at the same time perform other functions of CardioVisor 06c software The text of the main message of screening conclusion are given underlined Additional recommendations are given in italics The date and time of examination on the form is given in the heading of the form in square brackets If the printer is of low capacity it is expedient to print forms at the end of the working day as in this case you can form a printing queue which will be served by the computer in automatic mode With this purpose select the first examination for printing and press the printing button K13 or K15 In 3 sec the form will be completed the sand clock will disappear You can without waiting for the end of printing the first form select the next examination to be printed repeat the above operations etc The length of the queue is limited only by the digital resources of the computer 4 13 Setting indicators color If the user wishes he can change the color of integral indicators Myocardium Pulse and Rhythm in the list of examinations This is done by standard means of Widows system with the button K16 Medical Computer Systems Page 31 of 51 CardioVisor O6c User s manual 4 14 Exit from the program To complete the work press the standard button Ld in the upper right hand corner of the main window and press lt File gt gt lt Exit gt in the menu Fig 13 Files Help Exit nts A Fig 13 Comp
69. tabase main window name K2 Registration new entry m Examinations K5 New examination a K3 Correcting a patient s K4 Deleting a patient from datebase K7 Deleting examination from database K6 Switch 30 60 a K8 Deleting examination m Portraits ECG K9 Scanning a portrait P K11 Scanning portraits large scale control of trends K10 Scanning ECG E K12 Scanning ECG 1 lead 6 leads Print K13 Printing a form K15 Printing form full format 8 short format K14 Detailing A S K16 Setting indicator color Fig 5 Panel of the main functions of the device 4 3 Examination forming a heart portrait 1 Press the button K2 in the block Patients to register the name of a new patient in the data base It is necessary to print only the last name of the patient and press OK on the entry panel You need not give any other details about the patient After that a line with the new name will appear in the patients data base If the patient is already registered in the data base choose the required line with the left key of the mouse There are two other characteristics in the patients data base QRS angle direction of electrical axis of the last examination and date of the patient s registration in the data base Fig 6 If you move the pointer to the field Name in the patients window and press the left key of the mouse you will see the triangle of the list of patient
70. thology group according to the table below Detailing code Rate of resemblance to probable Detailing text color pathology Bright green Probable Portraits of patient s heart and indicated pathology practically coincide Middle Probable The portraits greatly resemble each other grey green Dark Uncertainty individual features The heart portrait has many peculiarities No Distinct form of this deviation will complete resemblance but with most probability be as follows distinct stages of these changes will coincide with the portrait of the indicated pathology LL 0 S segs Fig 10 Color indication of detailing code Detailing is performed by nine groups of automatic classifier G1 G9 see p 2 3 This information makes it possible to verify additional messages of the general conclusion For instance if in additional information in the section VENTRICULAR MYOCARDIUM there is a message about probable myocardial ischemia and at the same in detailing groups G3 G7 there is a message about similar ischemic manifestations it is a clear indication that with most probability a complete diagnostic examination will reveal ischemia Automatic classifier of CardioVisor 06c Software differs from known computer interpreters in principle as it does not require long and time consuming verification of authenticity of ECG conclusion The portrait is formed by objective dispersion signals irrespective of the con
71. tion shows sinus rhythm but rhythm variability parameter SDDN and TI moderately outside norm limits High value of integral rhythm indicator Insignificant signs of arrhythmia Most probable cause high level of STRESS No manifest disturbances of sinus character of rhythm but SDDN and TI considerably exceeded norm limits Deviations of variability of a rhythm from norm are probable SDDN and IT insignificantly exceeded norm limits Probable disturbances c connected with blockades of sino atrial node or blockades of AB junction Signs of disturbances in arising or conducting excitation One of arrhythmia types SDDN and TI significantly exceeds norm limits Distinct ARRHYTHMIA SDDN and TI considerably exceed norm limits Manifest falling out of ventricular complexes One of tachyarrhythmia and bradiarythmia types 3 Electrical axis Deviation of heart electrical axis to the LEFT Electrical a axis 15 degrees left HORIZONTAL electrical axis Electrical axis between 30and 15 degrees NORMAL electrical axis Electrical axis between 75 and 30 degrees VERTICAL electrical axis Electrical axis between 90 and 75 degrees Deviation of heart electrical axis to the RIGHT Electrical axis 90 degrees right Probable DEXTROCARDIA Electrical axis 130 degrees right and 120 degrees left Medical computer systems CardioVisor 06c User s manual Table A3
72. traits after loading the message Deviations from the norm has appeared or Distinct deviations from the norm or fluctuations of indicator Myocardium exceed 7 pathological changes are probable Otherwise the revealed deviations may be episode of short time transient ischemia In the latter case for detailing the situation a short time control is expedient MKE CardioVisor 06c User s manual Table A2 continuation Deviations 7 Indicator General conclusion Ventricular Detailing St i Myocardium value myocardium eps Changes in portrait Total dispersion messages about messages about messages about ischemic Synthesis deviations ischemic changes ischemic changes changes in groups G3 G7 Stuatons Large or local but Messages about Messages about No or not more than one the expressed From 15 probable primary probable primary message with gradation changes aside red o ischemic changes or ischemic changes or individual characteristics or to 25 a color manifest ischemia manifest ischemia most probable Situation 3 gt Most probable significant deviations There is probability of a short time ischemic episode as in groups G3 G7 unlike in Recommended situation 2 there is very indistinct to ischemia If this state is revealed for the first time it is expedient to make a series of 2 3 steps portraits If deviations are repeatedly stable they are significant deviations If indicator Myocar
73. ways formed by the date of registration of patients In the right window is displayed a base of portraits referred to a particular patient In the left part of the main window there is a vertical button panel of the main functions of the device Fig 5 The buttons are placed in four blocks The activated button is indicated by lighting while an idle button is dark Full activation of all accessible functions is performed only in the main window of the program If you are in a mode in which the required button does not get activated press K1 Patients base to return to the main window of activation of all buttons Function K13 Printing a form full format is activated only with Scanning portrait only K9 4 2 Functions The user has access to the following functions Fig 5 K1 Patients data base K2 Registration new entry K3 Correction of the name of a patient K4 Deleting a patient from the data base K5 Forming a new portrait K6 Varying exposition time 30 60 sec for ECG input K7 K8 Deleting an examination from the base basket K9 Scanning a portrait in large scale K10 K12 Scanning and measuring ECG characteristics in two formats K11 Scanning portraits in small scale control of trends K13 K15 Printing Report form in two formats K14 Scanning text messages about most probable pathologies Page 18 of 51 MKC CardioVisor 06c User s manual K1 Patients da

Software for screening heart investigations CardioVisor-06c

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