Multimode system for monitoring and treating a malfunctioning heart

• US 5,269,301 A
• Filed: 10/19/1992
• Issued: 12/14/1993
• Est. Priority Date: 10/06/1987
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Leonard Bloom
• Inventors: Cohen, Todd J.
• Primary Examiner(s): Howell, Kyle L.
• Assistant Examiner(s): MANUEL, GEORGE C
• Application Number:
  US07/963,113
• Time in Patent Office: 421 Days
• Field of Search: 128/419 PG, 128/419 D, 128/697, 128/709, 128/419 P
• US Class Current: 607/6
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/3918 characterised by shock pathway, e.g. by electrode configuration
• CPC Class Codes: A61N 1/3962 in combination with another heart therapy
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A system for monitoring a patient and treating the malfunctioning heart of the patient, either in an automatic mode or in a semiautomatic mode, includes means which derive at least one electrical signal resulting from action of the patient'"'"'s heart and means which derive at least one physiologic signal from or related to the patient'"'"'s circulatory system. A central processing unit, which may be a programmable microprocessor, with a RAM and a ROM, receives and responds to the at least one electrical signal and to the at least one physiologic signal. Output means, which may include a heart assist pump, pacers, drug delivery devices and cardioverting/-defibrillating apparatuses, controlled by the central processing unit provides corrective measure(s) to the patient. Adjustable or variable baselines, against which a representation of the current, short-term magnitude of the selected physiologic parameter or parameters are provided. The variable baseline(s) is (are) a representation of the selected physiologic parameter(s) determined over a long term of greater duration than the short term over which the current magnitude(s) of the parameter(s) is (are) measured. In its monitoring only mode,the system monitors vital signs and/or the like, including the above-mentioned electrical signal and the physiologic signal and displays them on a monitor.

Claims

1. A Multimode system for monitoring a patient and treating a malfunctioning heart of the patient selectively in automatic and semiautomatic modes, the system comprising means for deriving at least one electrical signal representative of electrical action of the heart and at least one physiological signal representative of a physiologic parameter of the patient, monitoring means for displaying the at least one electrical signal and the at least one physiologic signal, means for controlling delivery of at least one heart-malfunction-corrective input to the patient, means for inputting the at least one electrical signal and the at least one physiologic signal to said means for controlling delivery, output means responsive to output signals from said means for controlling delivery for providing the at least one heart-malfunction-corrective input to the patient, and means operable by a clinician or physician for enabling said means for providing the at least one heartmalfunction-corrective input to operate selectively in an automatic mode without action of the means operable by a clinician or physician and in a semiautomatic mode requiring confirmation by the clinician or physician, whereby at least one malfunction of the heart may be treated selectively in automatic and semiautomatic modes.

2. The multimode system of claim 1, wherein said means for controlling delivery comprises a central processing unit for controlling delivery of selected heart-malfunction-corrective inputs to the patient, wherein said means for inputting the at least one electrical signal and the at least one physiologic signal input same to said central processing unit, and wherein said output means respond to output signals from the central processing unit and provide under control of the central processing unit selectively in automatic and semiautomatic modes at least one heart-malfunction-corrective input to the patient from among a plurality of the heart-malfunction-corrective inputs, whereby malfunctions of the heart may be corrected.

3. The multimode system of claim 2, wherein the output means includes antitachycardia pacing means controlled by the central processing unit.

4. The multimode system of claim 2, wherein the output means includes antibradycardia pacing means controlled by the central processing unit.

5. The multimode system of claim 2, wherein the central processing unit is programmable.

6. The multimode system of claim 2, wherein the output means includes drug delivery means controlled by the central processing unit.

7. The multimode system of claim 2, wherein the output means includes a heart-assist device controlled by the central processing unit.

8. The multimode system of claim 2, wherein the output means includes drug delivery means, antitachycardia pacing means and antibradycardia pacing means and cardioverting/defibrillating means controlled by the central processing unit.

9. The multimode system of claim 2, wherein the output means includes antitachycardia pacing means and antibradycardia pacing means controlled by the central processing unit.

10. The multimode system of claim 2, wherein the output means further includes antibradycardia pacing means controlled by the central processing unit.

11. The multimode system of claim 2, wherein said output means includes cardioverting/defibrillating means.

12. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying stable supraventricular tachycardia.

13. The multimode system of claim 12, which includes means for supplying therapy to the patient whereby stable supraventricular tachycardia may be overcome.

14. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying unstable supraventricular tachycardia.

15. The multimode system of claim 14, which includes means for supplying therapy to the patient whereby unstable supraventricular tachycardia may be overcome.

16. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying stable ventricular tachycardia.

17. The multimode system of claim 16, which includes means for supplying therapy to the patient whereby stable ventricular tachycardia may be overcome.

18. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying unstable ventricular tachycardia.

19. The multimode system of claim 18, which includes means for supplying therapy to the patient whereby unstable ventricular tachycardia may be overcome.

20. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsible to the at least one electrical signal for identifying rapid ventricular tachycardia and ventricular fibrillation.

21. The multimode system of claim 20, which includes means for supplying therapy to the patient whereby rapid ventricular tachycardia and ventricular fibrillation may be overcome.

22. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to at least one electrical signal and to the at least one physiologic signal for identifying rapid ventricular fibrillation.

23. The multimode system of claim 22, which includes means for supplying therapy to the patient whereby rapid ventricular fibrillation may be overcome.

24. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying asystole.

25. The multimode system of claim 24, which includes means for supplying therapy to the patient whereby asystole may be overcome.

26. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying stable bradycardia.

27. The multimode system of claim 26, which includes means for supplying therapy to the patient whereby stable bradycardia may be overcome.

28. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying unstable bradycardia.

29. The multimode system of claim 28, which includes means for supplying therapy to the patient whereby unstable bradycardia may be overcome.

30. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one electrical signal and to the at least one physiologic signal for identifying ischemia.

31. The multimode system of claim 30, which includes means for supplying therapy to the patient whereby ischemia may be overcome.

32. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at lest one electrical signal and to the at least one physiologic signal for identifying early infarction.

33. The multimode system of claim 32, which includes means for supplying therapy to the patient whereby early infarction may be overcome.

34. The multimode system of claim 1, including means for monitoring heart rhythm to develop the at least one electrical signal, and means responsive to the at least one electrical signal and to the at least one physiologic signal for identifying heart failure alone.

35. The multimode system of claim 34, which includes means for supplying therapy to the patient whereby heart failure alone may be overcome.

36. The multimode system of claim 1, including means coupled to said means for deriving at least one physiologic signal and responsive thereto for determining a change in a given physiologic parameter of at least a predetermined magnitude from a baseline for the parameter as represented by the physiologic signal.

37. The multimode system according to claim 1, including means coupled to said means for deriving at least one physiologic signal and responsive thereto over a period of given duration for establishing a varying baseline for a given physiologic parameter as represented by the physiologic signal, and means coupled to said means for deriving at least one physiologic signal and responsive thereto for determining current level of the parameter as represented by the physiologic signal over a period of predetermined duration which is shorter than the period of given duration.

38. The multimode system according to claim 1, including means for adjustably setting a baseline for a given physiologic parameter as represented by the physiologic signal.

39. A multimode system for monitoring a patient and for treating a malfunctioning heart of the patient selectively in automatic and semiautomatic modes by supplying cardioverting/defibrillating energy to the patient to overcome or avoid hemodynamic compromise, the system comprising means operable by a clinician or physician for providing a confirmation signal indicating a decision by the clinician or physician to apply cardioverting/defibrillating energy to the patient, computerized means having at least a first input and a second input, and at least one output, means for obtaining an electrical signal representative of electrical action of the patient'"'"'s heart and for feeding that electrical signal to the first input of the computerized means, means for sensing at least one selected parameter of the patient'"'"'s circulatory system to develop a physiologic signal representation thereof, means for feeding the physiologic signal to the second input, cardioverting/defibrillating means for delivering cardioverting/defibrillating energy to the patient, monitoring means for displaying the at least one electrical signal and the at least one physiologic signal, and means coupled to and responsive in its automatic mode to the output from the computerized means for triggering the cardioverting/defibrillating means to thereby provide automatically cardioverting/defibrillating energy to the patient'"'"'s heart and responsive in its semiautomatic mode contemporaneously to the output from the computerized means and output from the confirmation signal source to thereby provide semiautomatically cardioverting/defibrillating energy to the patient'"'"'s heart to avoid or overcome hemodynamic compromise of the patient.

40. The multimode system according to claim 39, including means within the computer means for establishing a baseline for the selected parameter of the patient to develop a baseline signal representation thereof, comparison means within said computerized -means for comparing the baseline signal on a short term basis with the physiological signal.

41. A multimode system treating a malfunctioning heart of a patient selectively in automatic and semiautomatic modes, the system comprising means for deriving at least one electrical signal representative of electrical action of the heart and at least one physiological signal representative of a physiologic parameter of the patient, means for controlling delivery of at least one heart-malfunction-corrective input to the patient, means for inputting the at least one electrical signal and the at least one physiologic signal to said means for controlling delivery, output means responsive to output signals from said means for controlling delivery for providing the at least one heart-malfunction-corrective input to the patient, and means operable by a clinician or physician for enabling said means for providing the at least one heart-malfunction-corrective input to operate selectively in an automatic mode without action of the means operable by a clinician or physician and in a semiautomatic mode requiring confirmation by the clinician or physician, whereby at least one malfunction of the heart may be treated selectively in automatic and semiautomatic modes.

42. A multimode system for treating a malfunctioning heart of the patient selectively in automatic and semiautomatic modes by supplying cardioverting/defibrillating energy to the patient to overcome or avoid hemodynamic compromise, the system comprising means operable by a clinician or physician for providing a confirmation signal indicating a decision by the clinician or physician to apply cardioverting/defibrillating energy to the patient, computerized means having at least a first input and a second input, and at least one output, means for obtaining an electrical signal representative of electrical action of the patient'"'"'s heart and for feeding that electrical signal to the first input of the computerized means, means for sensing at least one selected parameter of the patient'"'"'s circulatory system to develop a physiologic signal representation thereof, means for feeding the physiologic signal to the second input, cardioverting/defibrillating means for delivering cardioverting/defibrillating energy to the patient, and means coupled to and responsive in its automatic mode to the output from the computerized means for triggering the cardioverting/defibrillating means to thereby provide automatically cardioverting/defibrillating energy to the patient'"'"'s heart and responsive in its semiautomatic mode contemporaneously to the output from the computerized means and output from the confirmation signal source to thereby provide semiautomatically cardioverting/defibrillating energy to the patient'"'"'s heart to avoid or overcome hemodynamic compromise of the patient.

43. A multimode system for treating a malfunctioning heart of the patient selectively in automatic and semiautomatic modes by supplying at least one heart-malfunction-corrective input to the patient, the system comprising means operable by a clinician or physician for providing a confirmation signal indicating a decision by the clinician or physician to apply the at least one heart-malfunction-corrective input to the patient, computerized means having at least a first input and a second input, and at least one output, means for obtaining an electrical signal representative of electrical action of the patient'"'"'s heart and for feeding that electrical signal to the first input of the computerized means, means for sensing at least one selected parameter of the patient'"'"'s circulatory system to develop a physiologic signal representation thereof, means for feeding the physiologic signal to the second input, means for delivering at least one heart-malfunction-corrective input to the patient, and means coupled to and responsive in its automatic mode to the output from the computerized means for triggering the means for delivering at least one heart-malfunction-corrective input to thereby provide automatically corrective input to the patient and responsive in its semiautomatic mode contemporaneously to the output from the computerized means and output from the confirmation signal source to thereby provide semiautomatically corrective input to the patient to avoid or overcome at least one heart malfunction.