ISCHEMIA DETECTION USING HEART SOUND TIMING

• US 20080177191A1
• Filed: 01/19/2007
• Published: 07/24/2008
• Est. Priority Date: 01/19/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Zhang, Yi
• Granted Patent: US 7,736,319 B2
• Time in Patent Office: Days
• US Class Current: 600/509
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

A system comprising a heart sound sensor to produce a heart sound signal representative of at least one heart sound. A signal analyzer circuit measures a baseline time interval between a first detected physiologic cardiovascular event and at least one second detected physiologic cardiovascular event. At least one of the first and second detected physiologic cardiovascular events includes a heart sound event obtained from the heart sound signal. The sensor analyzer circuit determines that an ischemic event occurred at least in part by detecting a specified measured subsequent change from the established baseline time interval. Other systems and methods are disclosed.

Claims

1. A device comprising:

a heart sound sensor configured to produce a heart sound signal representative of a heart sound, the heart sound associated with mechanical cardiovascular activity of a heart of a subject; and

a signal analyzer circuit in electrical communication with the heart sound sensor, wherein the signal analyzer circuit is configured to;

establish a baseline time interval between a first detected physiologic cardiovascular event and at least one second detected physiologic cardiovascular event, wherein at least one of the first and second detected physiologic cardiovascular events includes a heart sound event detected using the heart sound signal; and

determine that an ischemic event occurred when a measured subsequent change from the established baseline time interval occurs with a time constant that is within a specified range of time constants.

2. The device of claim 1, further including at least one cardiac signal sensing circuit coupled to the signal analyzer circuit, the cardiac signal sensing circuit configured to produce an electrical cardiac signal representative of cardiac activity of the subject, wherein the first detected physiologic cardiovascular event includes a sensed Q-wave of a QRS complex.

3. The device of claim 2, wherein the second detected physiologic cardiovascular event includes a heart sound selected from the group consisting of:

an S1 heart sound; and

an S2 heart sound.

4. The device of claim 1, further including at least one cardiac signal sensing circuit coupled to the signal analyzer circuit, the cardiac signal sensing circuit configured to produce an electrical cardiac signal representative of cardiac activity of the subject, wherein the first detected physiologic cardiovascular event includes a sensed R-wave of a QRS complex.

5. The device of claim 1, wherein the first detected physiologic cardiovascular event includes a first heart sound and the second detected physiologic cardiovascular event includes a second heart sound.

6. The device of claim 1, wherein the time interval between the first detected physiologic cardiovascular event and the second detected physiologic cardiovascular event includes a time interval selected from the group consisting of:

a time interval from an S1 heart sound to an S2 heart sound;

a time interval from an S2 heart sound to an S3 heart sound;

a time interval from an S4 heart sound to an S1 heart sound;

a time interval from an S2 heart sound to an S1 heart sound;

a time interval from an aortic component of an S1 heart sound to an aortic component of an S2 heart sound;

a time interval from a mitral component of an S1 heart sound to an aortic component of the S1 heart sound; and

a time interval from an aortic component of an S2 heart sound to a pulmonary component of the S2 heart sound.

7. The device of claim 1, wherein the signal analyzer circuit is further configured to measure:

a first baseline time interval between the first and second detected physiologic cardiovascular events, wherein at least one of the first and second detected physiologic cardiovascular events includes a first detected heart sound event;

at least a second baseline time interval between third and fourth detected physiologic cardiovascular events; and

wherein the signal analyzer circuit is configured to apply at least one function to the first and second baseline time intervals to determine a relative baseline calculation and to determine that an ischemic event occurred using a measured subsequent change from the established relative baseline calculation.

8. The device of claim 7, including at least one cardiac signal sensing circuit coupled to the signal analyzer circuit, the cardiac signal sensing circuit configured to produce an electrical cardiac signal representative of cardiac activity of the subject, and wherein the first detected physiologic cardiovascular event includes a sensed Q-wave (Q) of a QRS complex.

9. The device of claim 8, wherein the first detected heart sound event is an S1 heart sound, wherein the third and fourth detected physiologic cardiovascular events are the S1 heart sound and an S2 heart sound respectively, and wherein the function includes a ratio including the first interval and the second interval.

10. The device of claim 8, wherein the first detected heart sound event is an S1 heart sound, wherein third and fourth detected physiologic cardiovascular events are S2 and S3 heart sounds respectively, and wherein the function includes a ratio including the first interval and the second interval.

11. The device of claim 7, wherein the first detected physiologic cardiovascular event includes the S2 heart sound, wherein the second detected physiologic cardiovascular event includes an S3 heart sound, wherein the third and fourth detected physiologic cardiovascular events are S2 and S4 heart sounds respectively, and wherein the function includes a ratio including the first interval and the second interval.

12. The device of claim 7, including at least one cardiac signal sensing circuit coupled to the signal analyzer circuit, the cardiac signal sensing circuit configured to produce an electrical cardiac signal representative of cardiac activity of the subject, wherein the first detected physiologic cardiovascular event includes a sensed R-wave (R) of a QRS complex, wherein the first detected heart sound event is an S1 heart sound, wherein the third and fourth detected physiologic cardiovascular events are the S1 heart sound and an S2 heart sound respectively, and wherein the function includes a ratio including the first interval and the second interval.

13. The device of claim 1, wherein the signal analyzer circuit is further configured to measure a baseline amplitude of a first heart sound of the heart sound signal normalized with respect to a measured characteristic of the heart sound signal;

and

wherein the signal analyzer circuit is configured to determine that an ischemic event occurred using a measured change in a time interval from the established baseline time interval and a measured change in a normalized amplitude from an established baseline normalized amplitude.

14. The device of claim 13, wherein the measured characteristic of the heart sound signal is selected from the group consisting of:

a measured amplitude of a second heart sound of the heart sound signal;

a measured power of the heart sound signal measured during systole;

a measured energy of the heart sound signal; and

a measured area under a curve of the heart sound signal.

15. The device of claim 13, wherein the first heart sound of the heart sound signal normalized with respect to a measured characteristic of the heart sound signal includes at least one of:

an S3 heart sound amplitude normalized with respect to an S1 heart sound amplitude;

an S4 heart sound amplitude normalized with respect to an S3 heart sound amplitude;

an S1 heart sound amplitude normalized with respect to an S2 heart sound amplitude;

an S3 heart sound amplitude normalized with respect to an S2 heart sound amplitude; and

an S4 heart sound amplitude normalized with respect to an S2 heart sound amplitude.

16. The device of claim 1, wherein the IMD includes at least one second sensor in electrical communication with the signal analyzer circuit, the second sensor operable to produce a second sensor signal representative of a physiologic condition of a subject;

and wherein the signal analyzer circuit is operable to measure a heart sound in association with the second sensor signal.

17. The device of claim 16, wherein the second sensor includes at least one sensor selected from the group consisting of:

a posture sensor, and the signal analyzer circuit is operable to measure a heart sound in association with posture of the subject;

an activity sensor, and the signal analyzer circuit is operable to measure a heart sound in association with activity of the subject; and

a respiration sensor, and the signal analyzer circuit is operable to measure a heart sound in association with respiration of the subject.

18. The device of claim 1, wherein the signal analyzer circuit is further operable to re-establish a baseline heart sound signal if the signal analyzer circuit determines an ischemic event has occurred.

19. The device of claim 1, wherein the signal analyzer circuit is operable to distinguish between an ischemic event that occurred and a heart failure condition that has worsened by using a time constant of the measured subsequent change from the baseline signal, and wherein the signal analyzer circuit is further operable to re-establish a baseline heart sound signal if the signal analyzer circuit determines a heart failure condition has worsened.

20. A method comprising:

sensing a heart sound event, the sensing including producing at least one heart sound signal representative of the heart sound event, the heart sound event associated with mechanical cardiovascular activity of a heart of a subject;

establishing a baseline time interval between a first detected physiologic cardiovascular event and at least one second detected physiologic cardiovascular event, wherein at least one of the first and second detected physiologic cardiovascular events includes a heart sound event detected from the heart sound signal; and

determining that an ischemic event occurred when a measured subsequent change from the established baseline time interval occurs with a time constant that is within a specified range of time constants.

21. The method of claim 20, wherein determining the baseline time interval includes determining a baseline time interval from a sensed Q-wave of a QRS complex to a heart sound event.

22. The method of claim 21, wherein determining the baseline time interval includes determining a baseline time interval from a sensed Q-wave of a QRS complex to at least one of:

an S1 heart sound; and

an S2 heart sound.

23. The method of claim 20, wherein determining the baseline time interval includes determining a baseline time interval from a sensed R-wave of a QRS complex to a heart sound event.

24. The method of claim 20, wherein determining the baseline time interval determining at least one interval from the group of time intervals consisting of:

a time interval from an S1 heart sound to an S2 heart sound;

a time interval from an S2 heart sound to an S3 heart sound;

a time interval from an S4 heart sound to an S1 heart sound;

a time interval from an S2 heart sound to an S4 heart sound;

a time interval from an aortic component of an S1 heart sound to an aortic component of an S2 heart sound;

a time interval from a mitral component of an S1 heart sound to an aortic component of the S1 heart sound; and

a time interval from an aortic component of an S2 heart sound to a pulmonary component of the S2 heart sound.

25. The method of claim 20, wherein the baseline time interval is a first baseline time interval, and wherein the method further includes:

determining at least a second baseline time interval between third and fourth detected physiologic cardiovascular events;

applying at least one function to the first and second baseline time intervals to determine a relative baseline calculation; and

determining that an ischemic event occurred using a measured subsequent change from the established relative baseline calculation.

26. The method of claim 25, wherein the first baseline time interval includes a time interval from a sensed Q-wave of a QRS complex to an S1 heart sound, wherein the second baseline time interval includes a time interval from the S1 heart sound to and an S2 heart sound, and wherein the function includes a ratio including the first interval and the second interval.

27. The method of claim 25, wherein the first baseline time interval includes a time interval from a sensed Q-wave of a QRS complex to an S1 heart sound, wherein the second baseline time interval includes a time interval from an S2 heart sound to an S3 heart sound, and wherein the function includes a ratio including the first interval and the second interval.

28. The method of claim 25, wherein the first baseline time interval includes a time interval from an S2 heart sound to an S3 heart sound, wherein the second baseline time interval includes a time interval from an S2 heart sound to an S4 heart sound, and wherein the function includes a ratio including the first interval and the second interval.

29. The method of claim 25, wherein the first baseline time interval includes a time interval from a sensed R-wave of a QRS complex to an S1 heart sound, wherein the second baseline time interval includes a time interval from the S1 heart sound to and an S2 heart sound, and wherein the function includes a ratio including the first interval and the second interval.

30. The method of claim 20, further including:

measuring a baseline amplitude of at least one heart sound of a heart sound signal normalized with respect to a measured characteristic of the heart sound signal; and

determining that an ischemic event occurred using a measured change in an interval from the established baseline time interval and a measured change in the normalized amplitude from an established baseline normalized amplitude.

31. The method of claim 30, wherein measuring a baseline amplitude includes measuring a characteristic of the heart sound signal selected from the group consisting of:

a measured amplitude of a second heart sound of the heart sound signal;

a measured power of the heart sound signal measured during systole;

a measured energy of the heart sound signal; and

a measured area under a curve of the heart sound signal.

32. The method of claim 30, wherein measuring a baseline amplitude of at least one heart sound of a heart sound signal normalized with respect to a measured characteristic of the heart sound signal includes measuring at least one of:

an S3 heart sound amplitude normalized with respect to an S1 heart sound amplitude;

an S4 heart sound amplitude normalized with respect to an S3 heart sound amplitude;

an S1 heart sound amplitude normalized with respect to an S2 heart sound amplitude;

an S3 heart sound amplitude normalized with respect to an S2 heart sound amplitude; and

an S4 heart sound amplitude normalized with respect to an S2 heart sound amplitude.

33. The method of claim 20, further including producing at least one second sensor signal representative of a physiologic condition of the subject, and wherein sensing a heart sound event includes sensing the heart sound event in association with the second sensor signal.

34. The method of claim 33, sensing the heart sound event in association with the second sensor signal includes sensing at least one of:

sensing the heart sound event in association with a posture signal indicative of a posture of the subject;

sensing the heart sound event in association with an activity signal indicative of activity of the subject; and

sensing the heart sound event in association with a respiration signal representative of a respiration of the subject.

35. The method of claim 20, further including re-establishing a baseline heart sound signal if the signal analyzer circuit determines an ischemic event has occurred.

36. The method of claim 20, further including:

distinguishing between an ischemic event that occurred and a heart failure condition that has worsened by using a time constant of the measured subsequent change from the baseline signal; and

re-establishing a baseline heart sound signal if the signal analyzer circuit determines a heart failure condition has worsened.