Cardiolert Systems
Practical Diagnoses Using
the Cardiolert System
Cardiolert Systems copyright 2007
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
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
Patient

Elderly Woman – 75 years of age
◦
◦
◦
◦
◦
Overweight
Lower extremity edema
Systolic hypertension
Gained weight
Mild dyspnea on exertion
Cardiolert Systems copyright 2007
Physical Examination
BP 140/70
 Pulse 80
 2+ edema
 Clear lungs

Cardiolert Systems copyright 2007
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
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
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
Starling Curve
Visual indicator of heart failure produced through
two posture testing (TPT™)
Indicates
Normal or
hypovolemia
Indicates Heart Failure
Cardiolert Systems copyright 2007
Diagnostic Matrix
Case 3
Sup-SVI
Sup-TSR
Std-SVI
Std-TSR
Diagnosis
Decreased
Increased
Increased
Decreased
Heart failure
Arteriolar
Dilating
Medication
Venous
Insufficiency
Case 2
Normal
Decreased
Increased
Greatly
Decreased
Case 1
Normal
Normal
Greatly
Decreased
Increased
Cardiolert Systems copyright 2007
Thank you for your time
Cardiolert Systems
Cardiolert Systems copyright 2007