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The Heart
From physiology to ECG measurement and beyond
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Lesson overview
I. Introduction to the physiology of the heart
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Activation potential
Basic anatomy
II. ECG
III.Devices for ECG measurement
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Electrophysiology of the cardiac muscle cell
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The anatomy of the heart and associated vessels
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The conduction system of the heart
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Propagation of activation front between a pair of
extracellular electrodes
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Electrophysiology of the heart.The different
waveforms for each of the specialized cells found in
the heart are shown. The latency shown
approximates that normally found in the healthy
heart.
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The generation of the ECG signal in the
Einthoven limb leads
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The generation of the ECG signal in the
Einthoven limb leads
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Einthoven, Wilson and Goldberg’s precordial
leads
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Holter
 Dlouhé záznamy, 24-hodinové, zjednodušený svodový systém
 Rozdíly proti standardnímu 12-ti svodovému EKG:
 Nevýhody
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Méně kanálů
Více šumu
Obtížná detekce P-vlny
Pohybové artefakty
Velká dynamika RR-intervalů
 Výhody
» Větší časový záběr
» Lepší detekce arytmií
» Pokrytí běžných lidských činností
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Holter
 Demonstrace variability signálu při
holterovském měření
 Je třeba velké robustnosti jak u
analýzy signálu tak při diagnostice
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Holter příklad
 Roztřídění (clustering)
beatů z holterovského EKG
záznamu
 Na základě změřených
parametrů vypočítán medián
 Cíl: Koherentní skupina pro
další diagnostiku
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Mapy - příklady uspořádání elektrod
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Mapy uspořádání elektrod
 80 elektrod rovnoměrně rozložených
na hrudníku a zádech pacienta (systém Cardiag)
 pro předzpracování signálů bylo využito několikero metod,
včetně metody vlnkové transformace
 Na generovaných mapách se dají, stejně jako na signálu,
hledat příznaky
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Okamžikové potenciálové mapy
 základní typ map definovaný Pi = U i (t), t = konst., i = 1,2,...,n
 příklad potenciálové mapy z oblasti QRS komplexu
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Integrálové mapy
t2
 typ map vytvářený podle vztahu Pi =  U i (t)dt
t1
 příklad integrálové mapy z oblasti QRS komplexu
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Isochronní mapy
 typ map vytvářený podle vztahu Ti =f  U i (t) 
 příklad isochronní mapy časů trvání intervalů QT
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Rozdílové mapy
 typ map vytvářený podle vztahu Di = U i1 - U i2 , resp Pi1 - Pi2
 příklad rozdílové integrální mapy z oblasti QRS komplexu
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Mapování 3D – inverzní úloha
 Vyhledávání a zobrazení potenciálů srdce na samotném epikardu
 Měření prováděno buď přímo v srdci
 Nebo hledání rozložení potenciálů na srdci z povrchového rozložení
 Vede na řešení inverzní úlohy
 Hledání ložisek v objemu srdce
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Nové trendy v elektrokardiografii
 Větší důraz na
prevenci
 Větší možnosti
pacienta podílet se na
kontrole svého
zdravotního stavu
 Nové způsoby
měření EKG – senzory
přímo v oblečení
 Nové zpracování na
mobilních telefonech
 Telemedicínské
aplikace
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Nové trendy v elektrokardiografii
▣ Sensorické tílko
▣ Základna
GPRS
Healthcare Center
Bluetooth
▣ PBM
▣ Mobilní telefon
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
An average heart pumps 2.4 ounces (70 milliliters) per heartbeat. An average heartbeat is 72 beats per minute. Therefore an average heart pumps 1.3 gallons (5 Liters) per minute. In other
words it pumps 1,900 gallons (7,200 Liters) per day, almost 700,000 gallons (2,628,000 Liters) per year, or 48 million gallons (184,086,000 liters) by the time someone is 70 years old. That's not
bad for a 10 ounce pump!

For more information on the human heart and related topics, check out the links on the next page.

What causes the sound your heart makes?

When someone listens to your heart with a stethoscope the sound is often described as - lub-dub lub-dub. The 1st heart sound (lub) is caused by the acceleration and deceleration of blood
and vibration of the heart at the time of the closure of the Tricuspid and Mitral Valves. The 2nd heart sound (dub) is caused by the same acceleration and deceleration of blood and vibrations at the
time of closure of the Pulmonic and Aortic Valves.

How many times does you heart beat?

The average heartbeat is 72 times per minute. In the course of one day it beats over 100,000 times. In one year the heart beats almost 38 million times, and by the time you are 70 years
old, on average, it beats 2.5 billion times!

Does your heart rate change as we age?

Everyone's pulse (average heart rate per minute) changes as we age. Here is a chart of average pulse at different ages:

Age
Pulse

Newborn
130

3 months
140

6 months
130
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1 year
120

2 years
115

3 years
100

4 years
100

6 years
100

8 years
90

12 years
85

adult
60 - 100

How much blood does your heart pump?

An average heart pumps 2.4 ounces (70 milliliters) per heartbeat. An average heartbeat is 72 beats per minute. Therefore an average heart pumps 1.3 gallons (5 Liters) per minute. In other
words it pumps 1,900 gallons (7,200 Liters) per day, almost 700,000 gallons (2,628,000 Liters) per year, or 48 million gallons (184,086,000 liters) by the time someone is 70 years old. That's not
bad for a 10 ounce pump!

For more information on the human heart and related topics, check out the links on the next page.
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
The AbioCor, developed by Abiomed, is a very sophisticated medical device, but the core mechanism of the device is the hydraulic pump that shuttles hydraulic fluid
from side to side. To understand how it works, let's look at the various components of the system:

Hydraulic pump - The basic idea with this device is similar to the hydraulic pumps used in heavy equipment. Force that is applied at one point is transmitted to
another point using an incompressible fluid. A gear inside the pump spins at 10,000 revolutions per minute (rpm) to create pressure.

Porting valve - This valve opens and closes to let the hydraulic fluid flow from one side of the artificial heart to the other. When the fluid moves to the right, blood
gets pumped to the lungs through an artificial ventricle. When the fluid moves to the left, blood gets pumped to the rest of the body.

Wireless energy-transfer system - Also called the Transcutaneous Energy Transfer (TET), this system consists of two coils, one internal and one external, that
transmit power via magnetic force from an external battery across the skin without piercing the surface. The internal coil receives the power and sends it to the internal
battery and controller device.
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Internal battery - A rechargeable battery is implanted inside the patient's abdomen. This gives a patient 30 to 40 minutes to perform certain activities, such as
showering, while disconnected from the main battery pack.

External battery - This battery is worn on a Velcro-belt pack around the patient's waist. Each rechargeable battery offers about four to five hours of power.

Controller - This small electronic device is implanted in the patient's abdominal wall. It monitors and controls the pumping speed of the heart.

The AbioCor heart, which is composed of titanium and plastic, connects to four locations:

Right atrium

Left atrium

Aorta

Pulmonary artery

The entire system weighs about 2 pounds (0.9 kg). In the next section, you will learn how surgeons implanted the AbioCor heart during a seven-hour operation.
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 Until recently, the only option for many severe heart failure patients has been heart transplants. However,
there are only slightly more than 2,000 heart transplants performed in the United States annually, meaning that
tens of thousands of people die waiting for a donor heart. On July 2, 2001, heart failure patients were given new
hope as surgeons at Jewish Hospital in Louisville, Kentucky, performed the first artificial heart transplant in nearly
two decades. The AbioCor Implantable Replacement Heart is the first completely self-contained artificial heart and
is expected to at least double the life expectancy of heart patients.
 In this article, you will get an in-depth look at how this new artificial heart works, how it's implanted into a
patient's chest and who might be a candidate for receiving one of these mechanical hearts. We will also compare
the AbioCor heart to the artificial hearts that have failed in the past.
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 Heartbeat
 Smaller animals have faster heartbeats. This is evident within a species as well, as the young
beat their hearts faster than the adults. See "Early development" above for information about the
early human heart rates. The Gray Whale's heart beats 9 times per minute, Harbour Seal 10 when
diving, 140 when on land, elephant 25, human 70, sparrow 500, shrew 600, and hummingbird
1,200 when hovering. An ectothermic animal will usually have a slower, and more variable
heartbeat than an endothermic animal of similar size.
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
he study of diseases of the heart is known as cardiology. Important diseases of the heart include:

Coronary heart disease is the lack of oxygen supply to the heart muscle; it can cause severe pain and discomfort known as Angina.

A heart attack occurs when heart muscle cells die because blood circulation to a part of the heart is interrupted.
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Congestive heart failure is the gradual loss of pumping power of the heart.

Endocarditis and myocarditis are inflammations of the heart.

Cardiac arrhythmia is an irregularity in the heartbeat. It is sometimes treated by implanting an artificial pacemaker

Congenital heart defects.
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If a coronary artery is blocked or narrowed, the problem spot can be bypassed with coronary artery bypass surgery or it can be widened with angioplasty.

Beta blockers are drugs that lower the heart rate and blood pressure and reduce the heart's oxygen requirements. Nitroglycerin and other compounds that give off
nitric oxide are used to treat heart disease as they cause the dilation of coronary vessels.

At Groote Schuur Hospital in Cape Town, South Africa, 53-year-old Louis Washkansky on December 3, 1967 became the first human to receive a heart transplant
(however he died 18 days later from double pneumonia). The transplant team was headed by Christiaan Barnard.
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 The heart (Latin cor) is a hollow, muscular organ in vertebrates that
pumps blood through the blood vessels by repeated, rhythmic contractions,
or a similar structure in annelids, mollusks, and arthropods. The term
cardiac means "related to the heart", from the Greek kardia (καρδια) for
"heart". The human heart is the most studied organ in biology.
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 So the heart is the beginning of life, the Sun of the Microcosm, even as the Sun
deserves to be call'd the heart of the world; for it is the heart by whose virtue and
pulsation the blood is moved, perfected, made apt to nourish, and is preserved from
corruption and coagulation; it is the household divinity which, discharging its function,
nourishes, cherishes, quickens the whole body, and is indeed the foundation of life,
the source of all action."
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 http://www.invisionguide.com/heart/flash/index_pro.php
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Přehled prezentace
OBECNÁ ČÁST
 Úvod do Biomedicínských signálů
 Vzorkování
 Vzorkování – Shanon.
 časová a frekvenční reprezentace signálu
 Filtrace
 Princip –
 Příklady
 Analýza EKG
 Rozměřování signálu
 Výběr příznaků
 Diagnostika
 Co umožňuje automatická diagnostika
 Příklady
PRAKTICKÁ ČÁST
 12-ti svodové EKG
 Holter
 Holter v mobilu?
 BSPM
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