Non-invasive method and device to monitor cardiac parameters

• US 8,808,191 B2
• Filed: 07/27/2009
• Issued: 08/19/2014
• Est. Priority Date: 10/31/2001
• Status: Expired due to Fees

• Current Assignee: Robert Hirsh
• Original Assignee: Robert Hirsh
• Inventors: Hirsh, Robert
• Primary Examiner(s): Schaetzle, Kennedy
• Application Number:
  US12/509,631
• Publication Number:
  US 20090287105A1
• Time in Patent Office: 1,849 Days
• Field of Search: None
• US Class Current: 600/526
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• 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 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 8/06 Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00

Abstract

A method of and a device for non-invasively measuring the hemodynamic state of a subject or a human patient involve steps and units of non-invasively measuring cardiac cycle period, electrical-mechanical interval, mean arterial pressure, and ejection interval and converting the measured electrical-mechanical interval, mean arterial pressure and ejection interval into the cardiac parameters such as Preload, Afterload and Contractility, which are the common cardiac parameters used by an anesthesiologist.

The converted hemodynamic state of a patient is displayed on a screen as a three-dimensional vector with each of its three coordinates respectively representing Preload, Afterload and Contractility. Therefore, a medical practitioner looks at the screen and quickly obtains the important and necessary information.

Claims

1. A method of monitoring cardiac parameters, comprising the steps of:

non-invasively measuring predetermined non-invasive cardiac parameters of Ejection Interval (EI) and electrical-Mechanical Interval (E-M) from a subject, the E-M being measured in part using a peripheral artery; and

determining a value of stroke volume (SV) based upon the EI and the E-M.

2. The method of monitoring cardiac parameters according to claim 1 wherein the subject is a human.

3. The method of monitoring cardiac parameters according to claim 1 further comprising an additional step of displaying the stroke volume value.

4. The method of monitoring cardiac parameters according to claim 1 wherein the SV value is proportional to EI*[exp(1/E-M)].

5. The method of monitoring cardiac parameters according to claim 4 wherein ln(SV/EI)=k4/(E-M)+C4, and the SV value is determined according to EI*exp(c4)*[exp(k-4/E-M)], where k4 and c4 are empirical proportionality constants.

6. The method of monitoring cardiac parameters according to claim 1 wherein the M in the E-M is defined as a time when a second derivative with respect to time, M″

(t), reaches a maximum value.

7. The method of monitoring cardiac parameters according to claim 1 wherein the E in the E-M is defined as a time according to any one wave selected from the group consisting of a Q-wave, a R-wave, an S-wave, and an artificial ventricular pacemaker spike.

8. The method of monitoring cardiac parameters according to claim 1 wherein the E in determining the E-M interval is determined by double differentiating an EKG voltage curve which corresponds to ventricular depolarization, V(t), with respect to time and defining the electrical event as a time when V″

(t) reaches a maximum positive value.

9. The method of monitoring cardiac parameters according to claim 1 wherein the M in determining the E-M is selected from the group consisting of arterial blood pressure and flow velocity upstroke.

10. The method of monitoring cardiac parameters according to claim 1 wherein the E-M is determined by electrocardiograph as denoted by EKG and by placing a Doppler ultrasound device over a major artery.

11. The method of monitoring cardiac parameters according to claim 1 wherein the E-M is determined by electrocardiograph as denoted by EKG and by placing a fiberoptic device over a major artery.

12. The method of monitoring cardiac parameters according to claim 1 further comprising the step of determining management of an anesthetic-related procedure of the subject based upon the SV value.

13. The method of monitoring cardiac parameters according to claim 1 further comprising the step of determining an abnormal cardiac condition of the subject based upon the SV value.

14. The method of monitoring cardiac parameters according to claim 1 where an average rate of outflow of blood from the left ventricle during the EI is k4*exp(1/E-M)+c4], where k4 and c4 are empirical proportionality constants.

15. A system for monitoring cardiac parameters, comprising the steps of:

a non-invasively measuring unit for non-invasively measuring predetermined non-invasive cardiac parameters of Ejection Interval (EI) and electrical-Mechanical Interval (E-M) from a subject, the E-M being measured in part using a peripheral artery; and

a processing unit connected to said non-invasively measuring unit for determining a value of stroke volume (SV) based upon the EI and the E-M.

16. The system for monitoring cardiac parameters according to claim 15 wherein the subject is a human.

17. The system for monitoring cardiac parameters according to claim 15 further comprising a display unit connected to said processing unit for displaying the stroke volume value.

18. The system for monitoring cardiac parameters according to claim 15 wherein said processing unit determines the SV value to be proportional to EI*[exp(1/E-M)].

19. The system for monitoring cardiac parameters according to claim 15 wherein ln(SV/EI)=k4/(E-M)+C4, and said processing unit determines the SV value according to EI*exp(c4)*[exp(k-4/E-M)], where k4 and c4 are empirical proportionality constants.

20. The system for monitoring cardiac parameters according to claim 15 wherein the M in the E-M is defined as a time when a second derivative with respect to time, M″

(t), reaches a maximum value.

21. The system for monitoring cardiac parameters according to claim 15 wherein said non-invasively measuring unit includes an EKG instrument and the E in the E-M is defined as a time according to any one wave selected from the group consisting of a Q-wave, a R-wave, an S-wave, and an artificial ventricular pacemaker spike.

22. The system for monitoring cardiac parameters according to claim 15 wherein said non-invasively measuring unit includes an EKG instrument and the E in determining the E-M interval is determined by double differentiating an EKG voltage curve which corresponds to ventricular depolarization, V(t), with respect to time and defining the electrical event as a time when V″

(t) reaches a maximum positive value.

23. The system for monitoring cardiac parameters according to claim 15 wherein the M in determining the E-M is selected from the group consisting of arterial blood pressure and flow velocity upstroke.

24. The system for monitoring cardiac parameters according to claim 15 wherein said non-invasively measuring unit includes an EKG instrument and Doppler ultrasound device, the E-M being determined by electrocardiograph of said EKG instrument and said Doppler ultrasound device placed over a major artery.

25. The system for monitoring cardiac parameters according to claim 15 wherein the E-M is determined by electrocardiograph as denoted by EKG and by placing a fiber optic device over a major artery.

26. The system for monitoring cardiac parameters according to claim 15 wherein said processing unit further determines management of an anesthetic-related procedure of the subject based upon the SV value.

27. The system for monitoring cardiac parameters according to claim 15 wherein said processing unit further determines an abnormal cardiac condition of the subject based upon the SV value.

28. The system for monitoring cardiac parameters according to claim 15 where ln(SV/EI)=k4/(E-M)+C4, and said processing unit determines an average rate of outflow of blood from the left ventricle during the EI according to exp(c4)*[exp(k-4/E-M)], where k4 and c4 are empirical proportionality constants.

29. A method of monitoring cardiac parameters, comprising the steps of:

non-invasively measuring predetermined non-invasive cardiac parameters of Diastolic Filling Interval (DI) or Ejection Interval (EI) from a subject; and

determining a value of Left Ventricular End-Diastole Pressure (LVEDP) based upon (T−

the EI) or the DI being substantially equal to {(A1−

A2)/[1+exp{LVEDP−

x0}/dx]}}+A2, where T is a time period of a cardiac cycle, A1 and A2 are asymptotes, A2>

A1, (T−

EI) at x0 is an average value of the A1 and the A2.

30. The method of monitoring cardiac parameters according to claim 29 wherein the subject is a human.

31. The method of monitoring cardiac parameters according to claim 29 further comprising an additional step of displaying the LVEDP value.

32. The method of monitoring cardiac parameters according to claim 29 wherein the LVEDP value is determined when the (T−

EI) or the DI is not near the A1 and the A2.

33. The method of monitoring cardiac parameters according to claim 29 wherein the (T−

EI) or the DI is substantially linear or at least monotonically increasing with respect to the LVEDP by multiplying the (T−

EI) or the DI by MAP*(Q-A″

max), wherein MAP is Mean Arterial Pressure and (Q-A″

max) is a time interval between a Q-wave on EKG and a time point of a maximum value of the second derivative of arterial pressure with respect to time.

34. The method of monitoring cardiac parameters according to claim 29 further comprising the step of managing an anesthetic-related procedure of the subject based upon the LVEDP value.

35. The method of monitoring cardiac parameters according to claim 29 further comprising the step of determining an abnormal cardiac condition of the subject based upon the LVEDP value.

36. A system for monitoring cardiac parameters, comprising:

a non-invasively measuring unit for non-invasively measuring predetermined non-invasive cardiac parameters of Diastolic Filling Interval (DI) or Ejection Interval (EI) from a subject; and

a processing unit connected to said non-invasively measuring unit for determining a value of Left Ventricular End-Diastole Pressure (LVEDP) based upon (T−

the EI) or the DI being substantially equal to {(A1−

A2)/[1+exp{LVEDP−

x0}/dx]}}+A2, where T is a time period of a cardiac cycle, A1 and A2 are asymptotes, A2>

A1, (T−

EI) at x0 is an average value of the A1 and the A2.

37. The system for monitoring cardiac parameters according to claim 36 wherein the subject is a human.

38. The system for monitoring cardiac parameters according to claim 36 further comprising a display unit connected to said processing unit for displaying the LVEDP value.

39. The system for monitoring cardiac parameters according to claim 36 wherein said processing unit determines the LVEDP value when the (T−

EI) or the DI is not near the A1 and the A2.

40. The system for monitoring cardiac parameters according to claim 36 wherein said processing unit processes the (T−

EI) or the DI to be substantially linear or at least monotonically increasing with respect to the LVEDP by multiplying the (T−

EI) or the DI by MAP*(Q-A″

max), wherein MAP is Mean Arterial Pressure and (Q-A″

max) is a time interval between a Q-wave on EKG and a time point of a maximum value of the second derivative of arterial pressure with respect to time.

41. The system for monitoring cardiac parameters according to claim 36 wherein said processing unit further manages an anesthetic-related procedure of the subject based upon the LVEDP value.

42. The system for monitoring cardiac parameters according to claim 36 wherein said processing unit further determines an abnormal cardiac condition of the subject based upon the LVEDP value.