2. Practical Diagnoses Using the Cardiolert System Cardiolert Systems copyright 2007 C ardiolert S ystems

3. Practical Diagnoses Using the Cardiolert System Diagnosing hemodynamic disease with the Cardiolert System an impedance cardiographic system (ICG) Jim Buell, MD, FACC The same symptoms, three different diagnoses The Making of a Master Diagnostician Cardiolert Systems copyright 2007

4. Hemodynamic Information Assume the System accurately reflects: Stroke Volume (SV) Heart Rate (HR) Cardiac Output (CO) Total Systemic Resistance (TSR) BP as measured at testing Two Posture Testing™ – supine and standing Venous return decreases upon standing Normal values by age, sex, and posture Cardiolert Systems copyright 2007

5. Patient Elderly Woman – 75 years of age ◦ Overweight ◦ Lower extremity edema ◦ Systolic hypertension ◦ Gained weight ◦ Mild dyspnea on exertion Cardiolert Systems copyright 2007

6. Physical Examination BP 140/70 Pulse 80 2+ edema Clear lungs Cardiolert Systems copyright 2007

7. Case 1 Supine ◦ Stroke volume index normal ◦ Total systemic resistance normal Standing ◦ Stroke volume index drops 60% versus normal -15% ◦ Total Systemic Resistance rises above normal values ◦ Heart rate increases ◦ Mean BP unchanged Profound drop in stroke volume suggests functional hypovolemia caused by venous insufficiency – varicose veins Treatment = support hose Cardiolert Systems copyright 2007

8. Case 2 Supine ◦ Stroke volume index above normal ◦ Total systemic resistance below normal Standing ◦ Stroke Volume Index rises above normal ◦ Total systemic resistance drops further ◦ Mean BP decreases Suggests autonomic dysfunction or drug effect from arterial dilator Change drug therapy Cardiolert Systems copyright 2007

9. Case 3 Supine ◦ Stroke volume index below normal ◦ Total System resistance above Normal Standing ◦ Stroke volume index above normal ◦ Total systemic resistance drops to normal ◦ Cardiac Output increases Descending limb of the Starling Curve Consistent with functional hypervolemia and heart failure. Cardiolert Systems copyright 2007

10. Starling Curve Indicates Heart Failure Indicates Normal or hypovolemia Visual indicator of heart failure produced through two posture testing (TPT™) Cardiolert Systems copyright 2007

11. Diagnostic Matrix Sup-SVISup-TSRStd-SVIStd-TSRDiagnosis Case 3DecreasedIncreased DecreasedHeart failure Case 2NormalDecreasedIncreased Greatly Decreased Arteriolar Dilating Medication Case 1Normal Greatly Decreased Increased Venous Insufficiency Cardiolert Systems copyright 2007

12. Thank you for your time Cardiolert Systems Cardiolert Systems copyright 2007