Open Access e-Journal Cardiometry No.16 May 2020

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Results and discussionThe cohort of 36 patients has been covered by theabove hemodynamic examinations, and 28 of the examinedpatients have died. The obtained informationwas compared with the medical history records issuedto the patients before admission to hospital. Findingsprepared by pathologists have been also obtained andconsidered herein. Some summarized data on the patientsare presented in a table given further herein.Figures 1 and 2 herein show cardiometric data inone of the critical patients treated in an intensive careunit. After careful examination of the screenshots youcan see that the PV1 and PV2 phase blood volumeshave changed. As to parameter PV1-atrial systole, ithas been reduced: its deviation from the norm reaches36.17%, while the ventricles are overloaded by 23.50%.The PV5 parameter representing the aorta pumpfunction is also overloaded by 5.36%. The oxygenconcentration is 0.29 arb.u., and it is significantly belowthe norm. It is evident that the heart accumulateslactate. While the normal value of lactate is 7 arb.u.,in our treated case we record the actual lactate levelof 26.39 arb.u.. The phosphocreatine concentration isalso below the norm and reaches 0.17 arb.u.. But it isimportant that the RV1parameter of ejection fractionis 15,31% that is very low as compared with its norm of62%. The respective Rheo shows blood pressure spikesthat confirms weakness of the heart performance.Figure 2 herein shows the monitoring results in thesame critical patient: next six measurements have beenmade. The resulting diagrams show that in paralleloxygen, lactate and phosphocreatine concentrationshave decreased below the norm in the patients beforehis lethal outcome. The ejection fraction parametersin this case have been also decreased dramatically. Atthe same time, the stress index SI values demonstratesits sharp increase. Next day the patient died.Other phenomena, which have occurred before thedeath, have been also recorded. The most pronounceregularity has been detected in our analysis of the recordedheart rate variability values. So, before the deathstress index SI has increased sharply and exceeded thelevel of 1000 (see Figure 2 herein) that indicates thepresence of one and the same heart rate level. Immediatelyprior to the lethal outcome, the variability hasbeen restored.The phenomenon of the restoration before thelethal outcome has been observed in all segments ofthe ECG complex. It has seemed that the critical patientsuddenly have become fully healthy. AP has beenmaintained at the same level.One more factor of interest is the S-L phase elevation.This is a compensatory mechanism for maintainingthe proper hemodynamic parameters, and theelevation appears under critical conditions. In ourcase it has been reported before each fatal outcome.An ECG with the S-L phase smoothing has been alsorecorded. It refers to the case of "the adrenaline heart",when Ca ++ accumulates in large quantities in cells anddisrupts mitochondrial membranes that leads to a declinein the myocardial contraction. It also has led tothe patients’ death.Before the death, the rheogram curve rises witheach inhaling and falls with each exhaling; if the respirationrate is low, the critical patient can live up to 12hours. The performance of the lungs makes a directeffect on the rheogram shape, since the lungs are capableof supplying blood before the critical patient’s unfavorableoutcome. In case when the Cheyne–Stokesrespiration is found, then after 12 hours, such a criticalpatient dies.ConclusionsThe obtained evidence data have been properly analyzed,so that identified are those critical values of thehemodynamic and metabolic parameters, the exceedingof which leads to lethal outcome in critical patientsunder the intensive care unit conditions.1. Diagnostic efficacy of the identified criteria applicableto critical hemodynamic and metabolic parametersin intensive care unit patients, exceeding of whichleads to lethal outcome, is high and sufficient to provideeffectively decision-making.2. Prior to the lethal outcome, there is a rise in thestress index value observed: it demonstrates a sharpincrease over 1000.3. In the period immediately before the lethal outcome,themodynamics is provided due to the lungsperformance.4. Simplicity and accessibility of the diagnostic methodis based on using an electrocardiogram processing only5. The data of high value are obtained very easy andfast due to automatic data processing technology.Statement on ethical issuesResearch involving people and/or animals is in fullcompliance with current national and internationalethical standards.76 | Cardiometry | Issue 16. May 2020
Conflict of interestNone declared.Author contributionsThe authors read the ICMJE criteria for authorship andapproved the final manuscript.References1. Froelicher V., Yong C.M., Wagner G. The electrocardiogramat a crossroads. Circulation. 2013 Jul 2;128(1):79-82. doi: 10.1161/CIRCULATIONAHA.113.003557.2. M. Rudenko. Voronova, O. & Zernov. V. TheoreticalPrinciples of Heart Cycle Phase Analysis. ISBN 978-3-937909-57-8, Fouqué Literaturverlag. Frankfurt a/M.München - London - New York. 336 р.Issue 16. May 2020 | Cardiometry | 77
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Prof. Mohammad AleemCairo Universit
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Open Access e-Journal Cardiometry No.16 May 2020

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