System And Method For Automated Diagnosis Of Myocardial Ischemia Through Remote Monitoring

• US 20140135859A1
• Filed: 01/23/2014
• Published: 05/15/2014
• Est. Priority Date: 11/16/1999
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Bardy, Gust
• Application Number:
  US14/162,229
• Publication Number:
  US 20140135859A1
• Time in Patent Office: Days
• US Class Current: 607/3
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02438 with portable devices, e.g. worn by the patient
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/358 Detecting ST segments
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/486 Bio-feedback A61B5/375 takes precedence
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system and method for automated diagnosis of myocardial ischemia through remote monitoring is described. Physiological measures comprising data either recorded on a regular basis by a medical device or derived therefrom is stored. Qualitative measures associated with the physiological measures are matched. Indications of myocardial ischemia are remotely identified. The qualitative measures for both of a reduction in exercise capacity and respiratory distress occurring contemporaneously are examined. The qualitative measures for angina that accompanies the reduction in exercise capacity and the respiratory distress are evaluated. A time course for each of the indications is determined. A patient status is formed comprising an onset of myocardial ischemia conditioned on the time course comprising a short duration.

Claims

1-18. -18. (canceled)

19. A system for automated treatment of myocardial ischemia through ST segment monitoring, comprising:

a database module configured to store physiological measures comprising data either recorded on a regular basis by an implantable medical device or derived therefrom;

an analysis module configured to determine indications of myocardial ischemia by identifying the physiological measures that comprise electrocardial signals and detecting a period of increased activity indicated thereby, determine an elevation in electrical potential during an ST segment of the electrocardial signal within the period of increased activity, and deliver an intracardiac electrical therapy to treat the indications of myocardial ischemia in response to the elevation in electrical potential.

20. A system according to claim 19, wherein the analysis module is further configured to confirm an absence of QRS duration of the electrocardial signal greater than 120 ms, and declare the elevation in electrical potential as an a priori indicator of the myocardial ischemia when exceeding 2.0 mm.

21. A system according to claim 19, wherein the analysis module is further configured to deliver a further therapy selected from the group comprising anticoagulation, antiplatelet drugs, beta-blockade, coronary vasodilators, afterload reduction, lipid lowering drugs, and mechanical therapies.

25. The system of claim 19, wherein the physiological measures comprise baseline data from an initial observation period.

26. The system of claim 19, further comprising:

a comparison module configured to compare one or more physiological measures to an indicator threshold to determine a patient status change over a time period; and

a feedback module configured to indicate whether changes to the therapy are appropriate based on the patient status change over the time period.

27. The system of claim 26, wherein the feedback module is further configured to compare the patient status change over the time period to a stickiness threshold and the system is configured to undertake a treatment program based on the comparison of the patient status change over the time period to the stickiness threshold.

28. The system of claim 19, further comprising a feedback module configured to indicate whether changes to the therapy are appropriate based on a threshold stickiness.

29. The system of claim 19, further comprising:

a comparison module configured to compare one or more updated physiological measures to an indicator threshold to determine a patient status change over a time period, wherein the database is further configured to periodically receive the updated physiological measures; and

a feedback module configured to indicate whether changes to the therapy are appropriate based on the patient status change over the time period.

30. The system of claim 29, wherein the received updated physiological measures comprise data associated with patient therapy outcomes.

31. The system of claim 19, wherein the physiological measures comprise data associated with patient therapy outcomes.

22. A method for automated treatment of myocardial ischemia through ST segment monitoring, comprising:

assembling physiological measures comprising data either recorded on a regular basis by an implantable medical device or derived therefrom;

determining indications of myocardial ischemia, comprising;

identifying the physiological measures that comprise electrocardial signals and detecting a period of increased activity indicated thereby; and

determining an elevation in electrical potential during an ST segment of the electrocardial signal within the period of increased activity; and

delivering an intracardiac electrical therapy to treat the indications of myocardial ischemia in response to the elevation in electrical potential.

23. A method according to claim 22, further comprising:

confirming an absence of QRS duration of the electrocardial signal greater than 120 ms; and

declaring the elevation in electrical potential as an a priori indicator of the myocardial ischemia when exceeding 2.0 mm.

24. A method according to claim 22, further comprising:

delivering a further therapy selected from the group comprising anticoagulation, antiplatelet drugs, beta-blockade, coronary vasodilators, afterload reduction, lipid lowering drugs, and mechanical therapies.

32. The method of claim 22, wherein the physiological measures comprise baseline data from an initial observation period.

33. The method of claim 32, further comprising:

comparing, by a comparison module, one or more physiological measures to an indicator threshold to determine a patient status change over a time period; and

indicating, by a feedback module, whether changes to the therapy are appropriate based on the patient status change over the time period.

34. The method of claim 33, further comprising comparing, with the feedback module, the patient status change over the time period to a stickiness threshold and undertaking a treatment program by the system based on the comparison of the patient status change over the time period to the stickiness threshold.

35. The method of claim 22, further comprising indicating, by a feedback module, whether changes to the therapy are appropriate based on a threshold stickiness.

36. The method of claim 22, further comprising:

comparing, by a comparison module, one or more updated physiological measures to an indicator threshold to determine a patient status change over a time period, assembling physiological measures comprises periodically receiving the updated physiological measures; and

indicating, by a feedback module, whether changes to the therapy are appropriate based on the patient status change over the time period.

37. The method of claim 36, wherein the updated physiological measures comprise data associated with patient therapy outcomes.

38. The method of claim 22, wherein the physiological measures comprise data associated with patient therapy outcomes.