Wireless transmission-ST-segment preserved of the standard 12 leads EKG apparatus for the remote administration of thrrombolytic therapy under severe cellular channel impairment
First Claim
1. ) A home appliance portable and autonomous cardiac supervisor comprising:
- Means of acquisition from n electrodes through a single amplifier of the standard 12 leads and XYZ frank leads
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Abstract
In accordance with the present invention a combination of electrode patch is provided for the acquisition, detection, and compaction of the 12 leads EKG data and XYZ over a severely band limited channels such as the US cellular channels. The integrity (reduced error rates of data and maintenance of connectivity for physician and heath care professional continuously monitoring remote patient experiencing heart attack (MI)) of this data is vital to immediate decisions regarding therapy indication or contraindication as to the administration of thrombolytic therapy. Furthermore, novel High frequency relying on spatio-frequency decomposition of the averaged signal and thereby detection algorithms are also presented for early detection of ischemia and provides measures of predictive accuracies. Thrombolytic therapy is the clinical therapy used to manage acute heart attacks. Precisely, we provide an end-to-end unit comprising a patch to acquire the electro physiological signals from the individual, an acquisition device providing an event detection and compaction routines over the cellular and other band limited wireless channels and a receiver to display the data.
87 Citations
73 Claims
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1. ) A home appliance portable and autonomous cardiac supervisor comprising:
Means of acquisition from n electrodes through a single amplifier of the standard 12 leads and XYZ frank leads
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2. ) An internet based algorithm with the said device for daily and routinely self-assessment at any time and or with assistance of physician protocol and internet based analysis software.
- 3. ) A vigilant supervisor preempting 90% of Sudden Cardiac Death by convenience of simple patch ubiquitously surveying and detecting new cardiac precursors such as frequent and multimorphic Premature ventricle Contractions PVC predisposing to more complex or sustained Ventricular Tachardia leading to SCD.
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4. ) A convenient method for continuously monitoring people via 2 metallic dry electrodes in the position 2 and 10 o'"'"'clock simulating the right arm and the left arm embedded in the steering wheel of a driver with patient'"'"'s thumbs gripping as he or she drives.
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6. ) Similar to the claim in 3, with gel or dry electrodes may be placed on standard chest leads with blue tooth enabled and compression to allow transmission over the cellular.
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7. ) A reduced noise electrode Array for stress testing and mobile modalities.
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8. ) An electrode Array comprising disjoints concentric non adhesive electrodes
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9. ) A cable interface mediating and reducing the pulling action on electrode due to muscle motion.
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10. ) A configurable cutoff passes band analog front-end filter for 75 Hz, 100 Hz, 150 Hz, 250 Hz.
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11. ) Analysis software provides for the individual heart portfolio as base lines and can intercept precursors that previously were not detectable in routine clinical test.
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12. ) The device monitors all standard leads to include Frank leads for high frequency analysis as an individual goes about daily routines
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13. ) An algorithm to stabilize baseline undulation while and due to motion.
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14. ) An algorithm that locates the J point and J+10, . . . , J+80.
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15. ) The device quantifies the total Ischemic burden and injury currents due to imbalances resulting form systolic and diastolic acute MI and that a score is assigned reducing all the 12 dimensionality if the EKG into a single number
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16. ) The device increases the sensitivity and specificity of a test by normalizing the injury currents at any of the J+n points to the rate and slope at these points.
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17. ) Immediate and simultaneous, in real time transmission over U.S narrow band cellular channels (14.4 Kbps) of the standard 12 ECG leads.
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18. ) The invention also allows the transmission of 12 leads over the conventional cellular telephone lines utilizing the 911 Emergency services over severely narrowed and available bandwidths.
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19. ) Method by which the portable monitor detects the fiduciary EKG points whereby the waveform is decomposed by transforms using highly regular Kernels. The synthesized coefficients in the various scales refer to the onset of these points in terms of onset and offset that determine the time duration and peak amplitude. The durations and amplitude excursions of the P, Q, R, S, J, ST, TP, QT are used to for diagnosis and interpretation of the rhythm.
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20. ) The device detects early onset of arrhythmia and the reassuring post Throlmbolytic therapy arrhythmia. Four independent methods by which an entopic cite, such as Para systolic or premature ventricular contraction is detected. The first method utilizes the regularity of specialized functions. The specialty here refers to possession of high degrees of continuity and differentiability. Discriminatory Features are derived from the intrinsic correlations amongst the sequential series of in a barrage of normally conducted complexes. A Fourier based method in conjunction with R wave detection from the last claim and the phase excursion is the disciminant for detection. An FM third method utilizes a pulse width as a discriminant. An R wave synchronized decision directed matched filter. Another method exploits the Hotling transform in the detection of PVC from and amongst normally conducted R synchronized wave decision directed.
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21. ) Ischemia and infarction indicators from scales depicting high energy levels when compared to isoelectric ST segments. Sensitive bands to ST deviation may be offset for populations with Normal variant (ST segment) and Juvenal type of elevated ST segment may be adjusted. The detection is equally applicable to transient Ischemia. The test shows more sensitivity if the R or the J point are localized and exact ST deviation are now quantified.
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22. ) A tool utilizing the matrix inversion properties of the principle component transform to assess discriminates sensitive to ST segment elevation and depression.
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23. ) Counter measures to reduce the effect of displacement currents going in to the body and becomes interfering conduction currents. The invention allows for adaptively selecting an optimum ground electrode to allow flow to ground of induced currents. Optimality here is in terms of minimizing the 60 Hz components by selecting the ground electrode that constitute the easiest (least resistive) for the displacement currents flow.
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24. ) Quantitative tool relying on sound statistical inference techniques in assessing and interpreting results.
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25. ) The polymorphic PVC diagnostic detector comprises of Eigen value decomposition of each PVC detected. Various forms indicate multiple sites and etiologies.
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26. ) An adaptive cancellor for coherent AC interference and is much needed for High resolution XYX frank lead interpretations.
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27. ) Novel wavelet based non-invasive algorithm for testing reperfusion after AMI treated patients with thrombolytic therapy and PTCA.
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28. ) Novel noninvasive tool to test impact of anesthesia on cardiac and non-cardiac patients undergoing operations.
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29. ) Novel analytical tool that helps assessing (to enhance the negative and positive predictive accuracies of High frequency ECG) incoherent noise owing to
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30. ) A processor that enhances the positive predictive accuracy for cardiac micro potential tests.
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31. ) Non invasive algorithm comprising a hybrid index exploiting jointly the reduced Heart Rate variability and broad band small features ECG in classifying Coronary Artery disease with single and multiple vessel.
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32. ) Total ischemic burden is completely characterized over the narrow cellular band by allocating more of the significant bits to the ST segment. Localizing the R peak and the J point first does this. An on demand window is allocates the necessary bits from the corresponding detail at the appropriate scale.
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33. ) A novel and combined index assessing the degree of coronary artery disease CAD utilizing both Heart rate variability and broadband ECG with enhanced sensitivity and specificity in one Spatio-spectral index.
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34. ) A novel spectrally directed discriminants based on moving average of the combined synchronized QRS and HRV variations
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35. ) A Sepeterally directed discrminants based on autoregressive model fit of a combined HRV and the averaged QRS.
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36. ) A combined ADPCM with the implicit null trellis. Further economies are obtained from the se interactions. The quantizer is applied to a lower variance difference and hence the savings in coding.
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37. ) Real time Algorithm that allows immediate ability for patients to receive analysis (index) over IP to patient own heart portfolio.
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38. ) An episode detector that captures in addition to symptomatic events, a symptomatic and silent one via a single score capturing qrs width and deviation along with ST deviations from the bioelectric base.
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39. ) Longer maninenace of sessions connectivity over cellular imperative for physician remote intervention and therapy decision for Acute Myocardial Infarction, exploiting features perception sensitive bands, exploiting unequal error protection and the volatile robust channel state information
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40. ) Inherently encrypted for patient privacy.
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41. ) Robust matrix inversion for principle and Eigen value Hoteling decomposition.
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42. ) Channel identification and hence equalization using coarse scales inverse impulse equivalence.
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43. ) Optimized length FIR unit and impulse responses interims of its invariance.
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44. ) Indicators based on wavelet packets for ascertaining varying stationarities.
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45. ) Reduced and multiplication free full search block matching for motion estimation.
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46. ) An Optimized arithmetic encoder (multiplication free)
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47. ) Source controlled encoder
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48. ) Reduced CPU image compression.
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49. ) Improved decoder memory manager.
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50. ) Wavelet based SNR estimator for the channel dependent error correcting codes.
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51. ) Combined vector quantizer and multiscale source encoder.
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52. ) Rate controlled elasticity viz., SNR estimator.
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53. ) SNR enhancement via a monolithic silicon and adaptive multiple antenna polarization diversity.
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54. ) Detection of minute and settle levels of total ischemic burden of patient with cad and those that Relief of a symptomatic silent angina;
- Resolution reversible silent ischemic defects found upon radio nuclide assessment;
Improved exercise treadmill times;
Elimination or reduction of nitrate use;
Ability to enjoy a more active lifestyle.
- Resolution reversible silent ischemic defects found upon radio nuclide assessment;
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55. ) A threshold based on spatial stionarity rather than a deterministically decreasing one across scales and resolutions. Moments supervised thresholds provide higher economies by jointly observing the decision space.
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56. ) Convenient N-dimensional joint density (multivariate probability density) characterization.
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57. ) A tool preventing misdiagnosis due to the invariably and inadvertently misplaced electrodes.
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58. ) FH and DS combination with intelligent wavelet based intruder detection and avoidance.
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59. ) A stationarity predictor that combines wavelet packet with a moving corolometer to assess stationarity of the Random process and to attain further coding gain. Transient detector for local wide sense stationary (short term stationary).
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60. ) Multiple electrodes for RL reference, Optimized current sink through grounding all displacement currents induced and due to 60 or 50 HZ.
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61. ) The event recorder begins with prepping the patient. Depending on the size of that patient and physician recommendation, physician, nurse, or patient him/herself may administer the appropriate patch of three sizes with 10 electrodes per patch. The patch is easily centered on the patient body by referring to a bone marker or the “
- reference point”
typically two inches below the Manubrial notch of the sternum. The patch contains the conductive/adhesive gel with Silver-Silver chloride electrodes and leads embedded within the lining of the patch. Patch may last for 2 weeks.
- reference point”
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62. ) Two simple snaps, patient connects the RJ/10 to unit 3×
- 2×
0.5″
which snaps to small cellular unit via serial rs232 connection and a long life rechargeable spare cellular battery. The cellular battery has continuous operational session of 5 hours before it is replaced and recharged.
- 2×
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63. ) A session is established by the initiation of transmission upon a push of a button by the patient due an event occurrence experienced by the patient. A dial up precedes a transmission of configurable 15 seconds prior to action taken by the patient and 15 seconds post action upon the occurrence of the episode. The event will more likely to fall with that window with its symptomatic onset occurring prior to the action by patient time marker but well within the configurable window of typically 30 seconds duration.
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64. ) The monitor server returns an acknowledgment of patient initiated transmission with a receipt in terms of intermittent paroxysmal beeps similar to a pager sounding beep or a short and silent vibrating shake acknowledgment to patient upon monitoring personnel approval of complete and successful session.
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65. ) The server is also capable of a feature that exploits the duplex capability and availability of the cellular network. The monitor server can interrogates, if necessary, in cases like a lost session whereby the monitor may retrieve a valid patient record that has been initiated by the patient and that has been corrupted or never been completed without calling and disturbing the patient. The initiating event along with the post configurable duration is stored until the occurrence of newer event.
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66. ) Feature whereupon the occurrence of certain events such as silent arrhythmia and other sustained arrhythmia that are beyond physician'"'"'s prescribed thresholds, the operator, in addition to perhaps the already existing protocol of calling the patient, ER, or physician, may now signal the mobile patient over the Event cellular module. If the current protocol stipulates reaching the patient upon occurrence of certain events, such beeps may now alert the patient who otherwise might not be reachable in a prompt manner, can now benefit from such optional feature.
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67. ) A patient using default mode of event recorder of the POTS from home or elsewhere. The cellular module is blue tooth enabled technology with a receiver base station that is commonly blue tooth enabled too. So long the patient is within several yards a way form the base station, the patient may initiate a transmission just like he or she would normally with telephone lines. The wireless capability isolates the patient from the relatively high voltages associated with these base modems connected to the wall jacks. Base stations that are Blue tooth enabled will automatically discover a blue tooth mobile user in the immediate local vicinity as part of a local Pico wireless network.
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68. ) N roaming patients each will have his/her own cellular number suggest that the probability of two “
- customers”
arriving independently to one server and overlapping within a time window equivalent to a total transmission session interval of one minute, over 24-hour interval is very small. The probability, however, gets even smaller as you increase the number of servers so we always have one less server than the number of the arriving customers. We feel that and with the assumption of independent events (We patients calling) and a total session from beginning to end of 1 min (service time) with twenty patients, that the expected number for line roll over (operators servicing the customers) should be no less than 5 lines (available at any time) with a probability of 99.9% of the time.
- customers”
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69. ) An N wireless 12 leads over cellular carrier neutral service handler, resolving even if the likelihood of two events occurring (two patients calling at exactly the same time) is high, a minimum of at least two lines (roll over assuming patients call same number) will preclude the occurrence of this impossible event. Also the 20 patient models assumes maximum number of patients calling every day, actual data, however, suggests it is seldom that all patents with event recorders will initiate a transmission every day, but also there is the possibility of one patient initiating more than one transmission in one day.
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70. ) An event model assuming independent events, is intuitively logical since there is no reason why should the occurrence of a transient episode in one patient, correlate with the already “
- random by definition”
event of another. However, the possibility of one patient having multiple events after having a single event in one particular day may not be considered all too unlikely. That is why data from previous traffic trends can help refine the estimate on the true number of lines with lower variance (higher confidence)
- random by definition”
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71. ) An cardiac event conservative servicing model assuming that if calls were to be made in one hour interval in that day, for some reason, as opposed to being spread logically over the 24 hrs, the required number of lines remains to be no more than N lines with a scalable confidence.
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72. ) A model for the pharmaceutical trials may differ and hence warrant adjusting the above model slightly since the likelihood of episodes may no longer be independent and tend to correlate due to patients regiment taking medications on synchronized circadian basis.
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73. ) A server is Windows based OS with a seamless switch over capability and data base manager over Windows NT comprising a plurality of inventions enabling
Immediate and discrete one push button transmission convenience Provides the concise standards 12 leads needed for life saving immediate assessment Scalable for Multimedia architecture Designed and Optimized specifically for mobility and freedom of cellular sessions and by default to POTS High signal fidelity with stable base line, no acoustics involved, digital coupling Resilient to channel volatility and designed to benefit from available and proprietary algorithms Ubiquity, neutral to all cellular carriers and precludes tolls by carrier operators for assisting non-English speaking patients. Patient convenience, easily attachable array and the convenience of a single push button. Inherently secured and benefits from existing encryption algorithm Multi layered authentication protocols Designed for real time and simultaneous transmission of the 12 leads Immediate analysis update of recording to patient heart portfolio over IP (optional). Courtesy and patient acknowledgment to transmission receipt. Ability to remotely interrogate patient events and ability to alert upon device inadvertent malfunction such as an electrode becoming lose or detecting a silent ST segment by random patient polling without disturbing the patient.
Specification