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Informace v tomto článku nepíšu ani jako lékař ani jako odborník na medicínu, mohou být chybné a slouží výhradně pro základní orientaci. V žádném případě byste na jejich základě neměli provádět sebevyšetření! Autor článku se od takového jednání distancuje a nenese za něj zodpovědnost. Máte-li zdravotní potíže, jděte k lékaři!

Vždycky mě fascinovaly všechny ty nemocniční přístroje, které nějakým způsobem sledují a měří zdravotní stav pacienta. I napadlo mě, že bych si mohl jeden takový doma vyrobit. Už nějaký čas jsem nic nenavrhnul a nepostavil a v rámci udržování se ve formě by bylo záhodno s tím něco udělat . Volba padla na EKG, protože jeho stavba by IMHO neměla být moc složitá. V následujících odstavcích osvětlím, o co jde, jak to funguje a k čemu je to dobré.

EKG je zkratka pro ElektroKardioGram, tedy zařízení sloužící pro záznam srdeční činnosti na základě elektrických signálů. Patří mezi nejdůležitější přístroje, které monitorují životní funkce. V nemocnici ho nalezneme snad u všech lůžek na JIP a pacient je na něj připojen v průběhu i sebebanálnější operace, kde slouží zejména jako asistent pro anesteziologa. S jeho pomocí lze poměrně přesně sledovat celkovou funkci srdce, srdeční rytmus a jeho poruchy, a dále některá poškození srdce. To se netýká poškození, která se nepodepsala na tkáních nesoucích elektrický signál. Proto se pro podrobnější vyšetření srdce používá echokardiografie (ultrazvuk) nebo nukleární medicína (např. MR). Já přístroj v budoucnu užiji v bio-feedback systému v součnnosti s EEG, jehož stavbu také chystám. Ale o tom až někdy příště.

Jak to funguje? Předpokládám, že základy anatomie každý zná alespoň ze ZŠ a tak přejdu rovnou k jádru pudla. V srdci nalezneme tzv. sinoatriální uzel. Jedná se o skupinu buněk umístěnou na stěně pravé síně, poblíž dutiny horní duté žíly. Tento uzel generuje elektrický signál, který doktoři nazývají sinusový rytmus (matematici a elektrikáři by ho tak ale rozhodně nenazvali , jak uvidíte později) a je zodpovědný za většinu srdeční elektro-aktivity. Onen elektrický signál se distribuuje do různých části srdce a spouští srdeční systoly a kontrakce. Snad pomůže taková jednodušší mapa elektrických tras v srdci:

Elektrické trasy

Při diagnostice nás kromě podoby a tvaru signálu zajímá i to, do jakých části (a zda vůbec a do jaké míry) se šíří. Využíváme přitom několika poznatků. Signál proniká až na povrch kůže, kde je možné za pomocí neinvzaivních metod změřit jeho amplitudu. Pokud navíc budeme měřit rozdíly potenciálu mezi několika různými správně umístěnými body, dostaneme přibližný přehled i o tom, kudy a jak signál prochází. V drtivé většině profesionálních EKGček se používá tzv. 12ti-svodový sytém, kdy se na tělo umístí 10 elektrod a měří se napětí (v lékařské terminologii svody) mezi různými z nich. Svod reprezentuje dvojici elektrod, která tvoří imaginární průřez tělem. Namístě je otázka, proč se nepoužívá 24 elektrod, když mluvíme o 12ti svodovém sytému. Existují hned 2 vysvětlení. Za prvé může být jedna elektroda společná pro více svodů a za druhé se v systému používá i takzvaného unipolárního měření vůči referenčnímu bodu. Naprosto první způsob rozložení elektrod, jež je dosud používán jako základ, se nazývá po německém vynálezci EKG a sice jde o Einthovenův trojúhelník. Svod č.I v něm představuje napětí mezi levou a pravou paží (+ elektroda na levé a - na pravé). Svod č. II je mezi levou nohou a pravou paží a konečně svod č.III je mezi levou nohou a levou paží. Myslím, že teď už je jasné, proč se hovoří o trojúhelníku. Sice popisuji připojení podle nohou a rukou, ale ve skutečnosti se elektrody umísťují co nejblíže srdci a zachováno je pouze umístění na stejné přímce. Je to z historický důvodů - pan Einthoven používal jako elektrody vědra se slanou vodou a ponořoval do nich končetiny.

Kvůli jednoduchosti bude má amatérská konstrukce vybavena jen jedním dipólem (dvěma elektrodami) a proto budu v jeden okamžik schopen měřit pouze jeden svod. Za to si však budu moci vybrat, který to bude Jako nejuniverzálnější (je tam celý sinusový rytmus dobře vidět) se mi jeví použití svodu II. Krásně ho vystihuje tato animace:

Svod II

Na následujícím obrázku je vidět, jak takový sinusový rytmus vypadá. Pokusím se popsat, co jednotlivé části znamenají a jaká terminologie se v souvislosti s ním používá.

"Zdravý" sinusový rytmus

Než se dostanu k hodnocení signálu z pohledu lékaře, slušelo by se něco říct i o jeho elektrické povaze. Signál se stále opakuje, je tedy periodický a mění polaritu, je tedy střídavý. Jeho amplituda nikdy nepřesáhné 4 mV. Udává se, že jeho harmonické spektrum je 0,05 Hz - 150 Hz. Jednotlivé části (lékaři tomu říkají vlny) označil již pan Einthoven velkými písmeny. Mezi nejdůležitější patří P, Q, R, S, T (dle pořadí v periodě). Je jich sice více, ale nejsou příliš výrazné, nemusí se vždy objevit (to nemusí ani ty uvedené) a ne každé EKG je dovede zobrazit. Na obrázku výše jistě zaujme “trčící” R vlna. Budete se divit, ale ta je z lékařského hlediska nejméně podstatná. Perioda začíná vlnou P, která představuje depolarizaci síní a pokračuje vlnami Q, R a S, jímž se souhrně říká QRS komplex (i v případech, kdy jedna z těchto tří vln chybí). Perioda je zakončena T vlnou, jenž je následkem repolarizace komor. Z EKG jistě každý z vás dovede poznat srdeční zástavu (oblíbené hlavně ve filmech, kde se za nepřerušovaného tónu přístroje stane z křivky plochá čára). Při běžné pokročilejší diagnóze se ale posuzuje zejména:

• frekvence periody, která odpovídá pulzu a měla by se pohybovat kolem 70
• přitomnost jednotlivý vln. Např. nepřítomnost P vlny značí obvykle fibrilaci
• amplituda
• časové intervaly jednotlivých vln (např. QRS komplex by měl trvat 80 ms)
• vzdálenost mezi vlnami (segmenty)
• počítají se různé poměry a koeficienty (nejznámější je třeba QTc)

EKG se může od normálního lišit kromě akutních případů i v případech chronické srdeční vady, nebo když má pacient kardiostimulátor - ten lze poznat velice dobře podle velkého umělého impulzu před P vlnou. Podrobnější analýzy EKG průběhů mám v plánu popsat, až budu mít funkční zařízení a bude tedy co analyzovat - a to bude Máme v rodině kardiaka po čtyřech infarktech.

Na závěr jak vypadá celý EKG průběh zdravého člověka ze všech svodů (z wikipedie) (ty nepřirozené obdelníky na začátku jsou pouze kalibrační 1 mV; 200 ms):

EKG

Příště se pokusím sepsat něco praktického pro konstrukci EKG. Jaké použít zesilovače, ochrany, jak signál zpracovávat, atd.

publikoval: Dandýs | kategorie: Elektronika |
Září 25, 2008 v 2:39

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     Duben 9, 2009 ve 16:05

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     Duben 9, 2009 ve 16:08

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     Duben 9, 2009 ve 16:20

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     Duben 9, 2009 ve 16:23

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     Duben 9, 2009 ve 16:26

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     Duben 9, 2009 ve 16:29

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     Duben 9, 2009 ve 16:35

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     Duben 9, 2009 ve 16:39

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     Duben 9, 2009 ve 16:49

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     Duben 9, 2009 ve 16:53

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     Duben 9, 2009 ve 16:57

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     Duben 9, 2009 ve 17:03

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     Duben 9, 2009 ve 17:08

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     Duben 9, 2009 ve 17:27

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     Duben 9, 2009 ve 17:30

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     Duben 9, 2009 ve 17:34

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     Duben 9, 2009 ve 17:37

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     Duben 9, 2009 ve 17:40

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     Duben 9, 2009 ve 17:45

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     Duben 9, 2009 ve 17:59

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     Duben 9, 2009 ve 18:03

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     Duben 9, 2009 ve 18:06

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     Duben 9, 2009 ve 18:17

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     Duben 9, 2009 ve 18:22

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     Duben 9, 2009 ve 18:27

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     Duben 9, 2009 ve 18:31

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     Duben 9, 2009 ve 18:33

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     Duben 9, 2009 ve 18:36

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     Duben 9, 2009 ve 18:39

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     Duben 9, 2009 ve 18:42

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     Duben 9, 2009 ve 18:45

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     Duben 9, 2009 ve 18:48

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     Duben 9, 2009 ve 18:51

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     Duben 9, 2009 ve 18:54

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     Duben 9, 2009 ve 18:56

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     Duben 9, 2009 ve 18:59

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     Duben 9, 2009 ve 19:02

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     Duben 9, 2009 ve 19:04

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     Duben 9, 2009 ve 19:08

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     Duben 9, 2009 ve 19:11

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     Duben 9, 2009 ve 19:16

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     Duben 9, 2009 ve 19:19

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     Duben 9, 2009 ve 19:24

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     Duben 9, 2009 ve 19:28

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     Duben 9, 2009 ve 19:33

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     Duben 9, 2009 ve 19:36

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