Virtual Physician Acute Myocardial Infarction Detection System and Method

• US 20100022902A1
• Filed: 07/25/2008
• Published: 01/28/2010
• Est. Priority Date: 07/25/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Wengreen, Eric John, Song, Zhendong, Lee, Brian Bruce
• Granted Patent: US 8,712,509 B2
• Time in Patent Office: Days
• US Class Current: 600/509
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/076 Permanent implantations telemetry using implanted circuitry A61B5/0031; implanted stimulators for therapy A61N1/3605, A61N1/362, A61N1/372
• CPC Class Codes: A61B 5/332 Portable devices specially adapted therefor
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/358 Detecting ST segments
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system and method for virtually detecting a medical condition, such as acute myocardial infarction (AMI), in a patient using holistic diagnostic procedures implemented in medical devices. Physiological parameters in a patient are monitored in an implantable medical device (IMD) to detect deviations from desired characteristics. When severe physiological parameter deviations exist indicating with a desired certainty that the patient is experiencing a medical condition (e.g., AMI), an alert is generated. If only minor deviations from the desired characteristics exist, additional holistic diagnostic procedures are performed virtually for diagnosing whether the patient is likely to be experiencing the medical condition, such as querying the patient through an external device regarding symptoms the patient is experiencing and analyzing the patient'"'"'s responses to the questions to determine whether the patient is experiencing the medical condition. When diagnosis is still unclear, additional holistic diagnostic procedures can be performed virtually until diagnosis is certain.

Claims

1. A method for virtually diagnosing a medical condition in a patient comprising:

monitoring at least one physiological parameter of a patient using an implantable medical device;

virtually detecting when the physiological parameter indicates a possibility that the patient is experiencing the medical condition;

virtually collecting additional symptom-related information from the patient related to symptoms being experienced by the patient;

virtually determining whether the collected symptom-related information in view of the monitored physiological parameter information indicates with a desired probability that the patient is experiencing the medical condition.

2. The method of claim 1, wherein the diagnosed medical condition is acute myocardial infarction.

3. The method of claim 2, wherein the monitored physiological parameter comprises monitoring ST segment deviations in electrogram (EGM) or electrocardiogram (ECG) information received by the implantable medical device.

4. The method of claim 1, wherein after the monitored physiological parameter indicates a possibility that the patient is experiencing the medical condition, the method further comprises transmitting a command from the implantable medical device to an external device to query the patient with symptom-related questions.

5. The method of claim 4, further comprising:

determining whether the response to the symptom-related questions are received within a predetermined period of time; and

using the timeliness of the received response to the symptom-related questions as a additional factor in determining whether the patient is experiencing the medical condition.

6. The method of claim 1, further comprising automatically generating an alert to at least one of the patient, a physician, a caregiver, and an emergency response team when the collected symptom-related information indicates with a desired probability that the patient is experiencing the medical condition.

7. The method of claim 1, wherein when the symptom-related information collected from the patient fails to indicate with the desired probability that the patient is experiencing the medical condition while the monitored physiological parameter indicates a possibility that the patient is experiencing the medical condition, the method further comprises performing at least one additional diagnostic test to determine whether the patient is experiencing the medical condition.

8. The method of claim 7, further comprising providing instructions for the patient to follow to assist in the performance and reliability of the at least one additional diagnostic test.

9. The method of claim 7, wherein the additional diagnostic test includes at least one of a heart sounds diagnostic test and a biomarker test.

10. The method of claim 7, wherein the additional diagnostic test includes tests performed by the patient, the results of which are provided by the patient for use in detecting with the desired probability whether the patient is experiencing the medical condition.

11. The method of claim 1, further comprising monitoring the at least one physiological parameter using a plurality of distributed devices arranged with respect to the patient.

12. The method of claim 1, further comprising initiating the method for virtually diagnosing the medical condition in the patient in response to a request received from the patient.

13. The method of claim 1, further comprising automatically generating an alert to at least one of the implantable medical device and another medical device for causing certain therapies to be delivered to the patient in response to a diagnosis that the patient is experiencing a certain medical condition.

14. The method of claim 1, further comprising providing a notification of a negative diagnosis when it is virtually determined that the patient is not experiencing the medical condition.

15. A method for virtually diagnosing a medical condition in a patient using a holistic diagnostic procedure comprising:

monitoring at least one physiological parameter using signals received in an implantable medical device for deviations from desired characteristics;

virtually determining using automated procedures operating on at least one medical device whether sufficient deviations are present in the monitored physiological parameter(s) that indicate with a desired level of certainty that the patient is experiencing a certain medical condition and generating an alert when the desired level of certainty that the patient is experiencing the medical condition exists; and

virtually determining using automated procedures operating on the at least one medical device whether minor deviations are present in the monitored physiological parameter that potentially indicate that the patient is experiencing the medical condition without reaching with the desired level of certainty that the patient is experiencing the medical condition and performing additional holistic diagnostic procedures for diagnosing whether the patient is experiencing the medical condition when minor deviations are determined.

16. The method of claim 15, wherein the additional holistic diagnostic procedures include:

transmitting a command from the implantable medical device to an external device to query the patient regarding symptom-related questions;

collecting responses to the symptom-related questions; and

analyzing the responses to the symptom-related questions in view of the detected minor physiological parameter deviations to diagnose whether the patient is experiencing the medical condition.

17. The method of claim 15, further comprising:

monitoring electrogram (EGM) or electrocardiogram (ECG) information received in an implantable medical device for ST segment deviations from desired ST segment characteristics;

determining whether sufficient ST segment deviations are present in the monitored electrogram (EGM) or electrocardiogram (ECG) information that indicate with a desired level of certainty that the patient is experiencing acute myocardial infarction and generating an alert when the desired level of certainty that the patient is experiencing acute myocardial infarction exists; and

determining whether minor ST segment deviations are present in the monitored electrogram (EGM) or electrocardiogram (ECG) information that potentially indicate that the patient is experiencing acute myocardial infarction without reaching with the desired level of certainty that the patient is experiencing acute myocardial infarction and performing additional holistic diagnostic procedures for diagnosing whether the patient is experiencing acute myocardial infarction when minor ST segment deviations are determined.

18. The method of claim 16, wherein the monitored physiological parameter monitors electrogram (EGM) or electrocardiogram (ECG) information received in an implantable medical device for ST segment deviations and wherein the medical condition to be diagnosed is acute myocardial infarction, the method further comprising:

determining when the symptom-related information collected from the patient fails to indicate with the desired probability that the patient is experiencing acute myocardial infarction while the monitored ST segment deviations indicate a possibility that the patient is experiencing acute myocardial infarction, and

performing at least one additional diagnostic test to determine whether the patient is experiencing acute myocardial infarction that includes at least one of a heart sounds diagnostic test and a biomarker test.

19. The method of claim 15, further comprising automatically generating an alert to at least one of the patient, a physician, a caregiver, and an emergency response team when the additional holistic diagnostic procedures indicate with a desired probability that the patient is experiencing the medical condition.

20. The method of claim 15, further comprising providing instructions for the patient to follow to assist in the performance and reliability of the additional holistic diagnostic procedures that are performed.

21. The method of claim 15, further comprising initiating the method for virtually diagnosing a medical condition in a patient using a holistic diagnostic procedure in response to a request received from the patient.

22. The method of claim 15, further comprising automatically generating an alert to at least one of the implantable medical device and another medical device for causing certain therapies to be delivered to the patient in response to a diagnosis that the patient is experiencing a certain medical condition.

23. The method of claim 15, further comprising providing a notification of a negative diagnosis when it is virtually determined that the patient is not experiencing the medical condition.

24. A virtual physician system comprising:

an medical device implantable in a patient and configured to monitor at least one physiological parameter from sensed physiological signals for deviations from desired characteristics;

the implantable medical device configured for determining whether sufficient deviations are present in the monitored physiological parameter(s) that indicate with a desired level of certainty that the patient is experiencing a certain medical condition, the implantable medical device configured for generating an alert when the desired level of certainty that the patient is experiencing the medical condition is determined to exist,

the implantable medical device further configured for determining whether minor deviations are present in the monitored physiological parameter that potentially indicate that the patient is experiencing the medical condition without reaching with the desired level of certainty that the patient is experiencing the medical condition, the implantable medical device configured for causing additional holistic diagnostic procedures to be performed for diagnosing whether the patient is experiencing the medical condition when minor deviations are determined.

25. The virtual physician system of claim 24, further comprising an external device capable of communicating with the implantable medical device, the external device including an interface for allowing information to be communicated to and from the patient,

the implantable medical device further configured for transmitting a command to the external device to query the patient regarding symptom-related questions.

26. The virtual physician system of claim 25, wherein the external device is further configured for collecting responses to the symptom-related questions and analyzing the responses to the symptom-related questions in view of the detected minor physiological parameter deviations to diagnose whether the patient is experiencing the medical condition.

27. The virtual physician system of claim 26, wherein when the symptom-related information collected from the patient fails to indicate with the desired probability that the patient is experiencing the medical condition, the external device is further configured for causing at least one additional physiological parameter diagnostic test to be performed to determine whether the patient is experiencing the medical condition.

28. The virtual physician system of claim 27, wherein the implantable medical device is configured to monitor electrogram (EGM) or electrocardiogram (ECG) information received in the implantable medical device for ST segment deviations and wherein the medical condition to be diagnosed is acute myocardial infarction, further wherein the at least one additional physiological parameter diagnostic test includes at least one of a heart sounds diagnostic test and a biomarker test.

29. The virtual physician system of claim 24, further comprising a plurality of distributed devices arranged with respect to the patient for monitoring the physiological parameter in conjunction with the implantable medical device for deviations from desired characteristics.

30. The virtual physician system of claim 25, wherein the external device is further configured for receiving a request for the activation of the implantable medical device to initiate the monitoring of the physiological parameter from sensed physiological signals and for delivering instructions to the implantable medical device to initiate said monitoring.

31. The virtual physician system of claim 25, wherein the external device is further configured for providing instructions for the patient to follow to assist in the performance and reliability of the at least one additional diagnostic test.

32. The virtual physician system of claim 25, wherein the external device is further configured for providing instructions for the patient to perform at least one additional diagnostic test and configured to receive the results of such tests performed from the patient, the results of which are provided by the patient for use in detecting with the desired probability whether the patient is experiencing the medical condition.

33. The virtual physician system of claim 25, wherein the external device is further configured for receiving a request from the patient for initiating the procedures for determining whether the patient is experiencing a certain medical condition.

34. The virtual physician system of claim 25, wherein the external device is further configured for providing a notification of a negative diagnosis when it is virtually determined that the patient is not experiencing the medical condition.