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Ballistocardiography
ballistocardiography.
Since force can be calculated from acceleration it seems that the ideal instrument for
general use in ballistocardiography would be
an accelerometer which is rugged, portable,
282
ACCELERATION BALLISTOCARDIOGRAPHY
additional equipment which is often cumbersome and subject to its own critical standards.
With such an instrument anyone possessing an
electrocardiograph could take ballistocardiograms directly from a patient, and by presetting the sensitivity to a previously determined 1-millivolt deflection, could read the
ballistocardiogram in terms of force. This
would mean an accurate quantitative evaluation of the ballistocardiogram in a comparable
manner to that now used in electrocardiography.
We have been able to construct an instrument that is capable of a flat response from 0 to
3000 cycles per second (without capacitance
in the circuit) and shows a linear response from
0 to 0.015 g forces and above. It reproduces the
typical ballistocardiogram in its gross contour
and is capable of recording consistent small
deflections in the systolic pattern not seen in
the smooth record of the velocity or displacement type apparatus. These changes will be
described in more detail below.
This accelerometer is an electrokinetic device
whose operation is determined by electrical
changes at the surfaces of contact of a mercurysulfuric acid interface, the so-called "U
effect." The general theory of the "U effect" is
given in several papers by Ueda and others'2' 13
and is summarized briefly in an interesting
manner by Yeager and Hovorka.14 Although
the theory is beyond the scope of this paper, the
construction of this apparatus is amazingly
simple. The actual pickup consists merely of a
capillary tube with alternate layers of metallic
mercury and 1 normal sulfuric acid, thereby
creating multiple interfaces of mercury and
electrolyte solution. At each end of the capillary
a mercury seal is employed into which a small
283
g,
Colper Electrode
CDir1ty Element
Diejre~ A
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0.003 m~d
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Circuit
Electricel Circuit
Electrical
DieLgem'n, 8
284
ACCELERATION BALLISTOCARDIOGRAPHY
ballistocardiography.) When this has been accomplished, the "loaded" tube may be cut at its
desired length near the proximal end, and a small
copper wire electrode inserted into the large mercury
cellule and again sealed with sealing wax or suitable
substance. The distal limit of the element is then
measured, cut, and the above process of inserting a
copper electrode is repeated, and the element is
finished. (See fig. 1, diagram A.)
Construction of the Acceleration Ballistocardiograph
The cross piece can be designed of metal, plastic,
or wood. Additive capacitors in parallel are embedded in the cross piece, and connected to a rotor
switch, which allows selection of the dlesired
capacitance ranging from 0 to 0.009 microfarad
with 0.0015 or 0.003 microfarad gradations. A three
pole plug is mounted for connection of the two
electrode leads from the electrocardiograph and a
grounding wire. The electrical circuit is diagrammed
in figure 1, diagram B.
The capillary tube is next enclosed in a cylindric
aluminum or copper shield, which is connected to a
ground wire. This shield is advisable to prevent the
possibility of picking up alternating current interference from surrounding electrical fixtures and also
affords protection against breakage of the glass tube.
Grounding has been found necessary because the
capillary element I)roduces an electrical potential
and is capable of acting as an antenna for electrical
swing. *
= ma =
mg tan 4
ELLIOTT, PACKARD
AND KYRAZIS
285
FIG. 3. Response of the acceleration ballistocardiograph to known forces (as delivered by the
pendulum). Note the linear response as the force increases. The output is increased with a capacitance
of 0.009 microfarad in the circuit, but this in no way affects the linear response. A stylus deflection,
from 1 millivolt, of 16 mm. was used in all tracings. The sensitivity setting should be made with the
instrument in the circuit. Measurements are made from valley to peak of the seventh cycle; dividing
this measurement by two gives the correct deflection from any given force, since the 0 point of the
pendulum is midway between the valley and peak deflections.
The instrument illustrated in figure 2 has maintained a constant output to a given force for a period
of eight months, and shows no signs of deterioration
286
ACCELERATION BALLISTOCARDIOGRAPHY
paper,
equation:
DISCUSSION
stable.
matter. In an attempt to avoid further confusion, we have used the nomenclature used by
Arbeit and Lindner1 of labeling the prominent
headward deflection of acceleration as Ja. The
subscript, a, would likewise be appropriately
used on H, I, and K waves that correspond in
gross contour to waves so labeled in displacement and velocity tracings. In such a system
of labeling, it is to be noted that Ja, occurs
simultaneously with I (of displacement).
Consequently, it must be kept in mind that the
genesis of Ja and J are not the same as would
be assumed by such a lettering system.
Since all systolic complexes are not identical,
even in the same person, we feel it inadvisable
to compare anything other than simultaneous
displacement and acceleration ballistocardiograms. We accomplish this by mounting acceleration and electromagnetic ballistographs
on a patient's legs at the same time and recording their output simultaneously on a doublechannel, direct writing electrocardiograph. We
obtained displacement tracings by using a 20
microfarad capacitance in the circuit of a
reference.
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FIG. 4. J. B., 24-year-old white male, weighing 74 Kg. Displacement and acceleration ballistocardiograms are considered normal. Note the notching of the Ha wave, in both the normal and high
speed tracings, and that La and Ma are greater in amplitude in acceleration tracings. The amplitude
of the Ja waves represents 98.6 X 104 dynes during inspiration. Acceleration is seen to be 180 degrees
out of phase with velocity.
ballistocardiograms.
By quantitative analysis of the cases illustrated, the force in any phase of cardiac
systole can be appreciated. If we consider the
normal tracings to be representative of expected limits, we find a range of Ja amplitude
in
288
ACCELERATION BALLISTOCARDIOGRAPHY
25
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FIG. 5. A. P., 23-year-old white male, weighing 77 Kg. Displacement and acceleration ballistocardiograms are considered normal. The entire systolic complex is of smaller amplitude than in the
preceding case, far smaller in terms of actual force than would be expected by comparing displacement tracings on both individuals. The Ja amplitude in inspiration, represents a force of 70.6 X 104
dynes, far less than in the preceding case. Note the slight irregularity of the Ia-Ja limb in the acceleration tracing not seen in the displacement tracings. High-speed tracings reveal this irregularity to
be actually a slight notching, still not evident in the displacement tracings.
289
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FIG. 6. Simultaneous displacement and acceleration tracings of A. H. Note that the 1 millivolt
standardization is 16 mm. (as in all acceleration tracings illustrated) yet most of the Ja waves fail to
represent more than 34.4 X 104 dynes and many are far less than that. Of interest is the definite
biphasic component of the Ja wave following a compensatory pause after a premature ventricular
contraction (labeled as Jai and J, in the acceleration tracing). A notch is noted in the displacement
J wave of the same origin, but the acceleration Ja wave clearly demonstrates the forces, as well as
their direction, far more vividly. The high-speed tracing demonstrates notches of the Ia and Ja waves,
not even suspected in the displacement I and J waves.
290
ACCELERATION BALLISTOCARDIOGRAPHY
digitalis and remains in borderline decompensation in spite of restricted activity and full
digitalization. The high speed tracing (50 mm.
per second) vividly demonstrates the notching
listocardiography.
manuscript.
SUMARIO EsPAmOL
La construcci6n de un aceler6metro linear
para el uso en balistocardiografia se presenta
incluyendo la relaci6n entre aceleracion, des-
streaming potential by
Mem. Coll. Agr., Kyoto
YEAGER, E., AND HOVORKA, F.: Ultrasonic waves
and electrochemistry. I. A survey of the
electrochemical application of ultrasonic waves.
J. Acoust. Soc. Am. 25: 443, 1953.
'5BRAUNSTEIN, J. R.: A proposed nomenclature
16
291
7: 929, 1953.
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