Diagnostic methods and apparatus employing monitoring of myocardial ischemia

• US 4,798,211 A
• Filed: 04/25/1986
• Issued: 01/17/1989
• Est. Priority Date: 04/25/1986
• Status: Expired due to Fees

• Current Assignee: Itamar Medical Ltd. (Asahi Kasei Corporation)
• Original Assignee: Daniel Goor, Ihsan A. Haddad, Raphael Mohr, William R. Oliver
• Inventors: Haddad, Ihsan A., Mohr, Raphael, Oliver, William R., Goor, Daniel
• Primary Examiner(s): Jaworski, Francis J.
• Application Number:
  US06/856,502
• Time in Patent Office: 998 Days
• Field of Search: 604/344, 128/713, 128/668, 128/671-675, 128/691-694, 128/700
• US Class Current: 600/481
• CPC Class Codes: A61B 5/02108 from analysis of pulse wave characteristics
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives

Abstract

A method and apparatus monitor myocardial ischemic events in various medical applications for providing continuous and contemporaneous information regarding, for example, modifying the amount of medication for a patient, determining response during (PTCA) balloon angioplasty, monitoring the onset of myocardial ischemic events during induction of anesthesia, determining painless myocardial ischemia in a resting patient, and monitoring the onset of myocardial ischemic during stress conditions in a patient. The method and apparatus also provide a calibration method for determining from a Resistive Index and using the resulting transformation for calculating, on a continuing basis, both systemic vascular resistance and cardiac output.

Claims

1. A method for monitoring the onset of a myocardial ischemic event during the induction of anesthesia in a subject comprising the steps of

monitoring values of a parameter corresponding to systemic vascular resistance of the subject, and

detecting the onset of myocardial ischemic events during the induction of anesthesia when said monitored parameter value changes in accordance with a selected numerical amount.

2. The method according to claim 1 wherein said parameter monitoring step comprises the steps of:

A. detecting the arterial pressure, P, of the subject and generating in response thereto a blood pressure signal having a waveform in accordance with the detected arterial pressure;

B. differentiating said blood pressure signal to produce a dP/dt signal having a waveform varying in accordance with the rate at which the blood pressure signal varies;

C. detecting the peak of said dP/dt signal to determine the peak dP/dt;

D. determining a value which is substantially equal to the arterial pressure at the time of said peak DP/dt; and

dividing said latter value by said peak dP/dt signal, which thereby produces a measurement of the parameter corresponding to the systemic vascular resistance of said subject'"'"'s cardiovascular system.

3. A method for quantifying the extent of myocardial ischemic response during (PTCA) balloon angioplasty of a subject comprising the steps of

monitoring values of a parameter corresponding to systemic vascular resistance of the subject, and

detecting when said parameter value changes by a selected numerical value for indicating the degree of myocardial ischemia developed during said (PTCA) balloon angioplasty.

4. The method of claim 3 wherein the parameter monitoring step comprises the steps of:

A. detecting the arterial pressure, P, of the subject and generating in response thereto a blood pressure signal having a waveform in accordance with the detected arterial pressure;

B. differentiating said blood pressure signal to produce a dP/dt signal having a waveform varying in accordance with the rate at which the blood pressure signal varies;

C. detecting the peak of said dP/dt signal to determine the peak dP/dt;

D. determining a value which is substantially equal to the arterial pressure at the time of said peak dP/dt; and

E. dividing said latter value by said peak dP/dt signal, which thereby produces a measurement of the parameter corresponding to the systemic vascular resistance of said subject'"'"'s cardiovascular system.

5. A method for monitoring the onset of painless myocardial ischemia in a resting patient comprising the steps of

monitoring a parameter corresponding to systemic vascular resistance of the patient, and

detecting when the parameter being monitored changes above or below a predetermined base line value as an indication that a myocardial ischemic change in the patient has occurred.

6. The method of claim 5 wherein the parameter monitoring step comprises the steps of:

A. detecting the arterial pressure, P, of the patient and generating in response thereto a blood pressure signal having a waveform in accordance with the detected arterial pressure;

B. differentiating said blood pressure signal to produce a dP/dt signal having a waveform varying in accordance with the rate at which the blood pressure signal varies;

C. detecting the peak of said dP/dt signal to determine the peak dP/dt;

D. determining a value which is substantially equal to the arterial pressure at the time of said peak dP/dt; and

E. dividing said latter value by said peak dP/dt signal, which thereby produces a measurement of the parameter corresponding to the systemic vascular resistance of said patient'"'"'s cardiovascular system.

7. A method for monitoring the onset of myocardial ischemia during a stress condition in a patient comprising the steps of

monitoring a parameter value corresponding to the systemic vascular resistance of the subject, and

detecting when said parameter value increases a selected amount of determining the onset of the myocardial ischemic event during said stress condition.

8. The method of claim 7 wherein said monitoring step comprises the steps of:

A. detecting the arterial pressure, P, of the subject and generating in response thereto a blood pressure signal having a waveform in accordance with the detected arterial pressure;

B. differentiating said blood pressure signal to produce a dP/dt signal having a waveform varying in accordance with the rate at which the blood pressure signal varies;

C. detecting the peak of said dP/dt signal to determine the peak dP/dt;

D. determining a value which is substantially equal to the arterial pressure at the time of said peak dP/dt; and

E. dividing said latter value by said peak dP/dt signal, which thereby produces a measurement of the parameter value corresponding to the systemic vascular resistance of said subject'"'"'s cardiovascular system.

9. A method for determining the drug dose level for inhibiting myocardial ischemic events in a subject comprising the steps of:

monitoring a parameter value corresponding to the systemic vascular resistance of the subject,

recognizing the time of myocardial ischemic event by a selected increase in value of said monitored parameter, and

increasing the subject drug level in response to said selected increase in the monitored parameter value.

10. The method of claim 9 wherein the monitoring step comprises the steps of:

A. detecting the arterial pressure, P, of the subject and generating in response thereto a blood pressure signal having a waveform in accordance with the detected arterial pressure;

B. differentiating said blood pressure signal to produce a dP/dt signal having a waveform varying in accordance with the rate at which the blood pressure signal varies;

C. detecting the peak of said dP/dt signal to determine the peak dP/dt;

D. determining a value which is substantially equal to the arterial pressure at the time of said peak dP/dt; and

E. dividing said latter value by said peak dP/dt signal, which thereby produces a measurement of the parameter value corresponding to the systemic vascular resistance of said subject'"'"'s cardiovascular system.

11. A method for continuously determining systemic vascular resistance and cardiac output of a patient comprising the steps of

A. generating values of a parameter corresponding to systemic vascular resistance of the patient by a first method;

B. determining the systemic vascular resistance of the patient at two operating conditions using a method other than that of step A above; and

C. calibrating said determining method of step A for providing a one-to-one reading of the thus calibrated parameter and said systemic vascular resistance.

12. The method of claim 11 wherein the generating step comprises the steps of:

A. detecting the arterial pressure, P, of the patient and generating in response thereto a blood pressure signal having a waveform in accordance with the detected arterial pressure;

B. differentiating said blood pressure signal to produce a dP/dt signal having a waveform varying in accordance with the rate at which the blood pressure signal varies;

C. detecting the peak of said dP/dt signal to determine the peak dP/dt;

D. determining a value which is substantially equal to the arterial pressure at the time of said peak dP/dt; and

E. dividing said latter value by said peak dP/dt signal, which thereby produces a measurement of the parameter value corresponding to the systemic vascular resistance of said patient'"'"'s cardiovascular system.

13. The method of claim 12 further comprising the step of

determining cardiac output from said measurement corresponding to systemic vascular resistance.