Ambulatory electrocardiographic patient monitoring system and method therefor

• US 5,309,920 A
• Filed: 05/21/1993
• Issued: 05/10/1994
• Est. Priority Date: 11/12/1991
• Status: Expired due to Fees

• Current Assignee: Protocol Systems Inc
• Original Assignee: Stuart Medical, Inc.
• Inventors: Gallant, Stuart L., Caron, Paul R., Palmer, Walter E.
• Primary Examiner(s): Kamm, William E.
• Application Number:
  US08/064,454
• Time in Patent Office: 354 Days
• Field of Search: 128/702-705, 128/708, 128/710, 128/908
• US Class Current: 600/523
• 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 5/02208 using the Korotkoff method
• CPC Class Codes: A61B 5/02225 using the oscillometric method
• CPC Class Codes: A61B 5/0225 the pressure being controlled by electric signals, e.g. derived from Korotkoff sounds
• CPC Class Codes: A61B 5/335 using integrated circuit memory devices
• CPC Class Codes: A61B 5/7232 involving compression of the physiological signal, e.g. to extend the signal recording period
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 7/045 Detection of Korotkoff sounds A61B5/0225 takes precedence; measuring blood pressure A61B5/021
• CPC Class Codes: Y10S 128/90 Blood pressure recorder
• CPC Class Codes: Y10S 128/908 Patient protection from electric shock

Abstract

An ambulatory patient monitoring system (100) is provided for measuring and storing predetermined diagnostic parameters of a patient. The monitoring system includes a personal type computer (120) which may be selectively coupled to the portable portion (102) of system (100). Portable portion (102) may include one or more monitoring modules, such as ECG monitoring unit (110) and blood pressure monitoring unit (210). When ECG monitoring unit (110) and blood pressure monitoring unit (210) are disposed in side-by-side relationship and with respective optical interfaces (50, 254) in optical alignment, the two units operate in concert. ECG monitoring unit (110) supplies an R-wave gating signal to blood pressure monitoring unit (210) for establishing a window in which the receipt of a Korotkoff sound is expected. Additionally, the ECG unit (110) may trigger the blood pressure unit (210) to take a reading responsive to unit (110) identifying a predetermined abnormality in the ECG signal. Alternately, ECG monitoring unit (110) and blood pressure monitoring unit (210) may be used independently of one another as separate monitoring devices.

Claims

1. An ambulatory patient monitoring system for measuring and storing a plurality of electrocardiographic signals, comprising:

a housing;

a portable power supply disposed within said housing;

microprocessor means disposed within said housing and being coupled to said portable power supply, said microprocessor having a plurality of operational speeds for (1) identifying a heart beat from said electrocardiographic signals at one of said plurality of operational speeds, and (2) identifying and categorizing abnormalities in said electrocardiographic signals at another of said plurality of operational speeds for generating abnormality data;

memory means disposed within said housing and coupled to said microprocessor means for storing said electrocardiographic signals and said abnormality data;

variable clocking means disposed within said housing and coupled to said microprocessor means for varying said plurality operational speeds thereof responsive to a signal from said microprocessor representing a respective one of (1) said identification of said heart beat, or (2) said storage of said electrocardiographic signals and said abnormality data to thereby conserve power from said portable power source;

signal conditioning means disposed within said housing and coupled to said microprocessor means for providing said electrocardiographic signals thereto; and

,

lead means coupled to said signal conditioning means on end thereof for coupling said electrocardiographic signals from a patient to said signal conditioning means.

2. The ambulatory patient monitoring system as recited in claim 1 further comprising means for measuring a predetermined physiological parameter of a patient disposed external said housing and coupled to said microprocessor means, said microprocessor means further including means for generating a control signal responsive to said microprocessor means identifying a predetermined electrocardiographic abnormality for transmission of said control signal to said measurement means for triggering a measurement of said physiological parameter responsive to said control signal.

3. The ambulatory patient monitoring system as recited in claim 1 further comprising:

a. means for measuring a predetermined physiological parameter of a patient disposed external said housing, said measuring means including (1) an optical input for receiving an optical signal, (2) measurement control means coupled to said optical input for triggering a measurement of said physiological parameter responsive to a received optical signal, and (3) an optical output coupled to said measurement control means for serially transmitting data therefrom; and

,

b. an optical interface disposed within said housing and coupled to said microprocessor means, said microprocessor means including means for generating a control signal responsive to said microprocessor means identifying a predetermined electrocardiographic abnormality, said control signal being optically transmitted from said optical interface to said optical input of said measuring means for triggering said measurement of said physiological parameter responsive to said control signal.

4. The ambulatory patient monitoring system as recited in claim 3 where said optical interface includes:

a. a plurality of light emitting diodes; and

;

b. a plurality of tri-state drivers, each of said plurality of tri-state drivers having (1) a power consuming on state, (2) a power consuming off state, and (3) a power saving high impedance state, each of said tri-state drivers having an input coupled to said microprocessor and an output coupled to a respective one of said plurality of light emitting diodes, each of said tri-state drivers having a control input coupled to said microprocessor for switching said tri-state drivers into said high impedance mode for disabling said respective light emitting diodes.

5. The ambulatory patient monitoring system as recited in claim 4 where said optical interface further includes phototransistor means having a pair of output terminals coupled to a respective pair of input terminals of said microprocessor means for coupling respective signals thereto responsive to receipt of said serial data transmitted from said optical output, said microprocessor means generating an interrupt signal responsive to a first of said signals from said phototransistor means responsive to a first portion of said serial data from said optical output for generating a ready-to-receive signal output from a particular one of said plurality of light emitting diodes, said microprocessor means, receiving a second of said signals from said photoresistor means subsequent to said first signal, said second signal being defined by a second portion of said serial data transmitted from said optical output.

6. An ambulatory patient monitoring system for measuring and storing a plurality of electrocardiographic signals, comprising:

a housing;

a portable power supply disposed within said housing;

microprocessor means disposed within said housing and coupled to said portable power supply for identifying and categorizing abnormalities in said electrocardiographic signals for generating abnormality data;

memory means disposed within said housing and coupled to said microprocessor means for storing said electrocardiographic signals and said abnormality data;

signal conditioning means disposed with in said housing and coupled to said microprocessor means for providing said electrocardiographic signals thereto, said signal conditioning means including an adjustable gain amplifier coupled to said microprocessor means for adjusting a gain value thereof responsive to a digital control signal generated by said microprocessor means by comparing an amplitude of a detected R-wave of said electrocardiographic signals with a predetermined threshold value; and

,

lead means coupled to said signal conditioning means on one end thereof for coupling said electrocardiographic signals from a patient to said signal conditioning means.

7. A method of monitoring the electrocardiographic signals of an ambulatory patient, comprising the steps of:

a. coupling at least a pair of electrodes to the ambulatory patient to conduct electrical signals therefrom;

b. amplifying said signals conducted from said electrodes by a gain value;

c. filtering said amplified signals;

d. providing a semiconductor memory and storing said filtered signals therein;

e. selecting a threshold amplitude value;

f. identifying an R-wave portion of said filtered signals and comparing an amplitude of said R-wave portion with said threshold amplitude value for increasing said gain value if said amplitude of said R-wave portion is less than said threshold amplitude value;

g. measuring a timing value between each successive R-wave portions of said filtered signals;

h. setting predetermined limits for said timing value to identify predetermined abnormal clinical conditions;

i. classifying said timing value responsive to said timing value being outside said predetermined limits for identifying said predetermined abnormal clinical conditions;

j. storing said identified clinical conditions in said semiconductor memory;

k. preselecting a particular clinical condition;

l. comparing said identified clinical conditions with said preselected clinical condition;

m. providing means for output of a signal indicating at least one of said identified clinical conditions being identical to said preselected clinical condition;

n. measuring and classifying successive timing values to identify heart rhythms;

o. storing said identified heart rhythms in said semiconductor memory;

p. providing means for reading and displaying data stored in said semiconductor memory, said data being defined by (1) said filtered signals, (2) said identified clinical conditions, and (3) said heart rhythms, said means for reading and displaying data including an optical interface coupled to said semiconductor memory;

q. reading said data from said semiconductor memory through said optical interface; and

,

r. displaying said data read from said semiconductor memory.