Myocardial ischemia detection system

• US 5,159,932 A
• Filed: 02/07/1992
• Issued: 11/03/1992
• Est. Priority Date: 03/16/1990
• Status: Expired due to Fees

• Current Assignee: John M. Zanetti
• Original Assignee: Seismed Instruments Incorporated
• Inventors: Salerno, David M., Zanetti, John M.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): MANUEL, GEORGE C
• Application Number:
  US07/833,630
• Time in Patent Office: 270 Days
• Field of Search: 128/696, 128/701, 128/702, 128/706, 128/710, 128/661.04
• US Class Current: 600/508
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R

Abstract

A method and apparatus for non invasively monitoring the motion of the patient'"'"'s heart, to detect and display ischemia induced variations in the heart'"'"'s motion which indicate coronary artery disease.

Claims

1. Apparatus for the diagnostic display of a motion signal;

characterizing ventricular wall motion of a patient'"'"'s heart;

from cardiac induced compression waves detected at the surface of said patient'"'"'s body;

to a diagnostician comprising;

compression wave monitoring means, responsive to compression waves at the surface of said patient'"'"'s body, for generating a plurality of compression wave signals corresponding to said ventricular wall motion;

selecting means for detecting the systolic time interval of normal sinus beats of said patient'"'"'s heart, and for generating a data collection window interval during such systolic time interval;

means for averaging said compression wave signals collected during said data collection window intervals; and

for generating a composite wave form from said collected compression wave signals.

display means for presenting a representation of said composite waveform to said diagnostician.

2. Apparatus for the diagnostic display of a motion signal, characterizing the ventricular wall motion, of a patient'"'"'s heart, derived from heartbeat induced compression waves detected at the surface of said patient'"'"'s body, each heartbeat corresponding to the motion of the heart during one complete cardiac cycle, to a diagnostician comprising:

means for collecting compression wave information during cardiac heartbeats creating compression wave data;

means for selecting the cardiac contraction portion of said compression wave data for each heartbeat, creating a cardiac contraction compression wave record for each heartbeat;

means for averaging said cardiac contraction compression wave records, creating a composite compression wave record reflecting the ventricular wall motion of several heartbeats;

means for displaying said composite compression wave record to said diagnostician.

3. The apparatus of claim 2 wherein said means for collecting compression wave information comprises an inertial transducer responsive to motion at the surface of said patient.

4. The apparatus of claim 2 wherein said means for selecting the cardiac contraction portion of said compression wave data comprises:

independent cardiac event marker means for indexing said compression wave data to underlying cardiac events;

ventricular contraction detection means coupled to said independent event marker means for identifying said ventricular contraction portions of said compression wave data generating a cardiac compression wave record substantially corresponding to the ventricular contraction portion of said heartbeats.

6. The apparatus of claim 2 wherein said means for generating a diagnostic display from said composite for display to said diagnostician, comprises:

scaling means for plotting selected compression wave records on an arbitrarily selected time scale;

normalizing means for plotting selected compression wave records on a arbitrarily selected amplitude scale.

5. The apparatus 2 wherein said means for averaging said ventricular contraction compression wave records, creating a composite compression wave record comprises:

fiducial marking means for designating segments of said ventricular contraction compression wave records;

arithmetic means for adding a series of said compression wave records indexed by said fiducial marking means, whereby said arithmetic means generates a composite compression wave record.

7. Apparatus for the diagnostic display of a motion signal characterizing the ventricular wall motion, of a patient'"'"'s heart, derived from cardiac heartbeat induced compression waves detected at the surface of a patient'"'"'s body, each heartbeat corresponding to the motion of the heart during one complete cardiac cycle, to a diagnostician comprising:

inertial transducer means responsive to motion at the surface of said patient, for collecting compression wave information during selected cardiac heartbeats creating compression wave data;

means for selecting the cardiac contraction portion of each of said heartbeats, creating a cardiac contraction compression wave record for each of said selected heartbeats;

means for averaging said cardiac contraction compression wave records, creating a composite compression wave record reflecting the ventricular wall motion of several heartbeats;

means for displaying said composite compression wave record to said diagnostician.

8. Apparatus for acquiring cardiovascular diagnostic data from a patient'"'"'s heart, and for displaying said diagnostic data to a diagnostician comprising:

inertial transducer means, adapted to be coupled to the surface of said patient, for collecting compression wave data, arising from the motion of said patient'"'"'s heart during a cardiac cycle of said patient'"'"'s heart;

cardiac event marker means for generating index data corresponding to selected portions of cardiac cycles of said patient'"'"'s heart;

processing means coupled to said inertial transducer means and coupled to said cardiac event marker means;

for averaging a plurality of said selected portions of compression wave data generating display data;

display means coupled to said processing means for presenting said display data to said diagnostician.

9. The apparatus of claim 8 wherein said processing means for averaging comprises:

identifying means for identifying heartbeats arising from normal sinus depolarization of said cardiac tissue and for generating a set of candidate records, corresponding to compression wave data collected during said heartbeats arising from normal sinus depolarizations of said cardiac tissue;

window means for selecting portions of said candidate records which include the ventricular contraction portion of heartbeats, arising from normal sinus depolarizations of said cardiac tissue, and for generating a set of windowed data records corresponding to compression wave data collected during the ventricular contraction portion of said heartbeats arising from normal sinus depolarizations of said cardiac tissue;

computing means for generating display data corresponding to averaged data derived from said set of windowed data records.

10. Apparatus for detecting and characterizing the cardiac wall motion of a patient'"'"'s heart comprising:

independent marker means for generating a representation f said patient'"'"'s cardic rhythm;

seismocardiographic means for detecting compression waves resulting from cardiac wall motion;

detector means, coupled to said independent marker means, for detecting individual beats of said patient'"'"'s heart, and for defining a plurality of measurement windows, each window corresponding to one of said individual beats of said patient'"'"'s heart;

selector means for collecting seismocardiographic data during each of said measurement windows, generating collected seismocardiographic data;

averaging means, coupled to said selector means for generating a composite representation of cardiac wall motion from said collected seismocardiographic data;

diagnostic display means coupled to said averaging means for presenting said composite representation to said diagnostician.

11. The apparatus of claim 10 wherein said independent marker means comprises:

electrocardiographic means for detecting the surface electrogram resulting from electrical activity of said patient'"'"'s heart.

12. The apparatus of claim 10 further comprising:

rejection means coupled to said independent marker means for excluding abnormal beats of said patient'"'"'s heart;

whereby said composite representation of cardiac wall motion excludes compression wave data generated by said abnormal beats.

13. The apparatus of claim 12 wherein said diagnostic display means displays said composite representation and displays said representation of said patient'"'"'s cardiac rhythm.

14. The apparatus of claim 12 wherein said rejection means excludes non sinus heartbeats.

15. The apparatus of claim 12 wherein said rejection means excludes premature ventricular contract heartbeats.

16. Apparatus for the collection and display of data characterizing the motion of as patient'"'"'s heart during heartbeat cycles, each heartbeat cycle corresponding to the motion of the heart during one complete cardiac cycle comprising:

compression wave monitoring means proximate said patient'"'"'s heart, for generating compression waveform data corresponding to the motion of said patient'"'"'s heart during said heartbeat cycles;

segmenting means for generating compression wavedata sets, each data set corresponding to heart motion during a portion of a heartbeat cycle;

indexing means for defining fiducial points in each of said compression wave data sets;

averaging means for collecting compression wave data sets and for averaging said compression wave data about said fiducial points, generating representative compression wave data;

display means for generating a diagnostic representation of said representative compression wave data.

17. The apparatus of claim 16 wherein said compression wave monitoring means further comprises:

classifying means for excluding compression wave data arising from non-sinus heartbeat cycles, from said averaging means.

18. The apparatus of claim 16 wherein said indexing means further comprises:

means for establishing one of said fiducial points in each one of said compression wave data sets corresponding to a selected heart motion during one heartbeat cycle.

19. The apparatus of claim 17 wherein said indexing means further comprises:

means for establishing one of said fiducial points in each one of said compression wave data sets corresponding to a selected heart motion during one heartbeat cycle.

20. The apparatus claim 16 wherein said averaging means further comprises:

heartbeat rate detecting means for reducing rate dependent averaging error by assigning the set of fiducial points applied to a compression wave form data record as a function of the measured repetition rate of said heartbeat cycles.

21. A method for the collection and display of data characterizing the motion of a patient'"'"'s heart comprising the steps of:

(a) collecting compression wave data from the surface of said patient at a location near said patient'"'"'s heart;

(b) defining a set of compression wave records, each of said records corresponding to the motion of said patient'"'"'s heart during one heartbeat cycle;

(c) collecting a set of said heartbeat records corresponding to natural sinus rhythm of said patient'"'"'s heart;

(d) averaging said records collected in step (c) to form a representative record;

(e) displaying data corresponding to said representative record.