System and method for deriving relative physiologic signals

• US 5,904,708 A
• Filed: 03/19/1998
• Issued: 05/18/1999
• Est. Priority Date: 03/19/1998
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Goedeke, Steven D.
• Primary Examiner(s): Getzow, Scott M.
• Application Number:
  US09/044,613
• Time in Patent Office: 425 Days
• Field of Search: 607/2, 607/9, 607/18, 600/509
• US Class Current: 607/18
• CPC Class Codes: A61B 2560/0209 adapted for power saving
• CPC Class Codes: A61B 5/002 Monitoring the patient using a local or closed circuit, e.g. in a room or building A61B5/0017 takes precedence
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02055 Simultaneously evaluating both cardiovascular condition and temperature
• CPC Class Codes: A61B 5/02156 Calibration means
• CPC Class Codes: A61B 5/1455 using optical sensors, e.g. spectral photometrical oximeters
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61N 1/36042 of grafted tissue, e.g. skeletal muscle
• CPC Class Codes: A61N 1/3621 for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3655 controlled by body or blood temperature
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/37252 Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
• CPC Class Codes: A61N 1/39622 Pacing therapy

Abstract

A patient monitoring and/or therapy delivery system and method employing an implantable medical device for sensing absolute physiologic signal values within the body of a patient, e.g., absolute blood pressure, temperature, etc., and an external monitoring device for monitoring and conveying ambient signal values to the implantable medical device, wherein the absolute physiologic signal values and the ambient signal values are combined to derive relative physiologic signal values for storage and/or control of a therapy provided by the implantable medical device. In the context of an implantable physiologic monitor, the relative and optionally, the absolute and/or ambient physiologic signal values are stored in memory for telemetry out to an external programmer in an uplink RF telemetry transmission initiated by medical personnel operating the external programmer. In the context of an implantable therapy delivery device, the relative physiologic signal values are also employed in therapy delivery algorithms.

Claims

1. An implantable medical device method for deriving relative physiologic signal value data for use by and/or storage within an implantable medical device implanted within a patient'"'"'s body comprising the steps of:

providing an external monitoring device associated with the patient, and in the external monitoring device,

sensing an ambient state or condition outside the body affecting a sensed physiologic state or condition within the body;

deriving an ambient signal value from the sensed ambient state or condition; and

conveying the ambient signal value from the external monitoring device to the implantable medical device; and

in the implantable medical device implanted in the patient'"'"'s body,

sensing a physiologic state or condition within the body of the patient;

deriving an absolute physiologic signal value from the sensed physiologic state or condition;

receiving the ambient signal value conveyed from the external monitoring device; and

combining the derived absolute physiologic signal value and the conveyed ambient signal value to derive a relative physiologic signal value therefrom.

2. The method of claim 1, wherein the implantable medical device comprises implantable device memory and further comprising the step of:

storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

3. The method of claim 1, wherein the implantable medical device comprises an implantable monitor having implantable device memory and further comprising the step of:

storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

4. The method of claim 1, wherein the implantable medical device comprises an implantable monitor having implantable device memory and data conveying means for conveying data stored in the implantable memory to an external memory device further comprising the steps of:

storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory; and

activating said data conveying means to convey the relative physiological signal value data stored in the implantable memory to an external medical device.

5. The method of claim 1, wherein the implantable medical device comprises implantable device memory and a therapy delivery system for delivering a therapy to the patient and further comprising the steps of:

storing a predetermined number of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory; and

employing the relative physiologic signal values to control the delivery of the therapy by the implantable medical device.

6. The method of claim 1, wherein the implantable medical device comprises a therapy delivery system for delivering a therapy to the patient and further comprising the step of:

controlling the delivery of the therapy by the implantable medical device as a function of the relative physiologic signal value.

7. The method of claim 6, wherein the implantable medical device comprises a bradycardia pacing therapy delivery system for delivering a pacing therapy to the patient to provide sufficient cardiac output for the patient'"'"'s body, the physiologic state or condition reflects the cardiac output requirement of the patient'"'"'s body, and the delivery controlling step further comprises the steps of:

employing the relative physiologic signal values to control the bradycardia pacing rate of the implantable medical device to satisfy the cardiac output requirement; and

delivering pacing pulses to the heart at the controlled pacing rate.

8. The method of claim 6, wherein the implantable medical device comprises an anti-tachyarrythmia therapy delivery system for delivering an anti-tachyarrythmia therapy to the patient to convert a tachyarrythmia to a normal heart rhythm, the physiologic state or condition reflects normal heart rhythm or a tachyarrythmia of the heart, and the delivery controlling step further comprises the steps of:

employing the relative physiologic signal values to differentiate between normal heart rhythm and a tachyarrythmia of the heart; and

delivering an anti-tachyarrythmia therapy to the heart to convert the tachyarrythmia to a normal heart rhythm.

9. The method of claim 6, wherein the implantable medical device comprises a drug delivery system for delivering a drug to the patient to treat an abnormal medical state or condition, and the delivery controlling step further comprises the steps of:

employing the relative physiologic signal values to determine dosage of the drug to the patient; and

delivering the drug to the patient.

10. The method of claim 6, wherein the implantable medical device comprises a heart pump for providing sufficient cardiac output for the patient'"'"'s body, the physiologic state or condition reflects the cardiac output requirement of the patient'"'"'s body, and the delivery controlling step fuirther comprises the step of:

employing the relative physiologic signal values to control the operation of the heart pump to satisfy the cardiac output requirement.

11. The method of claim 6, wherein the implantable medical device comprises a cardiomyostimulation pacing therapy delivery system for pacing a skeletal muscle wrapped about the patient'"'"'s heart to augment contraction of the heart muscle to provide sufficient cardiac output for the patient'"'"'s body, the physiologic state or condition reflects the cardiac output requirement of the patient'"'"'s body, and the delivery controlling step fuirther comprises the steps of:

employing the relative physiologic signal values to control the pacing of the skeletal muscle to satisfy the cardiac output requirement; and

delivering pacing pulses to the skeletal muscle.

12. The method of any of the preceding claims 1-11, wherein the physiologic state or condition comprises the blood pressure of the patient, the sensed absolute physiologic signal value is absolute blood pressure value, the ambient state or condition comprises barometric pressure affecting the patient and the absolute pressure value, the relative physiologic signal value is relative blood pressure;

and the step of combining the derived absolute physiologic signal value and the conveyed ambient signal value comprises subtracting the barometric pressure from the absolute blood pressure.

13. The method of any of the preceding claims 1-11, wherein the physiologic state or condition comprises the blood temperature of the patient, the sensed absolute physiologic signal value is absolute blood temperature, the ambient state or condition comprises systemic patient temperature affected by fever or ambient conditions, the relative physiologic signal value is relative blood temperature;

and the step of combining the derived absolute physiologic signal value and the conveyed ambient signal value comprises subtracting the ambient temperature from the absolute blood temperature.

14. The method of any of the claims 1-11, wherein the steps performed by the external monitoring device are performed periodically to periodically derive and convey the ambient signal value to the implantable medical device, and the conveyed ambient signal value is used in the derivation of a plurality of relative physiologic signal values in the period between successive conveyances of the ambient signal value to the implantable medical device.

15. A system for deriving relative physiologic signal values from absolute physiologic signal values for use by and/or storage within an implantable medical device comprising:

an external monitoring device associated with the patient comprising,

external sensing means for sensing an ambient state or condition outside the body affecting a sensed physiologic state or condition within the body;

signal processing means coupled with said external sensing means for deriving an ambient signal value from the sensed ambient state or condition; and

signal conveying means for conveying the ambient signal value from the external monitoring device to the implantable medical device; and

the implantable medical device implanted within a patient'"'"'s body comprising,

implantable sensing means for sensing a physiologic state or condition within the body of the patient;

signal processing means coupled with said implantable sensing means for deriving an absolute physiologic signal value from the sensed physiologic state or condition;

receiving means for receiving ambient signal values conveyed from said signal conveying means; and

means for combining each derived absolute physiologic signal value and the sensed ambient signal value to derive a relative physiologic signal value therefrom.

16. The system of claim 15, wherein the implantable medical device further comprises:

implantable device memory; and

means for storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

17. The system of claim 15, wherein the implantable medical device comprises an implantable monitor further comprising:

implantable device memory; and

means for storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

18. The system of claim 15, wherein the implantable medical device comprises an implantable monitor further comprising:

implantable device memory;

means for storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory;

data conveying means for conveying data stored in the implantable memory to an external memory device; and

means for activating said data conveying means to convey the relative physiological signal value data stored in the implantable memory to said external medical device.

19. The system of claim 15, wherein the implantable medical device further comprises a therapy delivery system for delivering a therapy to the patient further comprising:

implantable device memory;

means for storing a predetermined number of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory; and

means for employing the relative physiologic signal values to control the delivery of the therapy by the implantable medical device.

20. The system of claim 15, wherein the implantable medical device comprises a therapy delivery system for delivering a therapy to the patient further comprising:

means for controlling the delivery of the therapy by the implantable medical device as a function of the relative physiologic signal value.

21. The system of claim 20, wherein the implantable medical device comprises a bradycardia pacing therapy delivery system for delivering a pacing therapy to the patient to provide sufficient cardiac output for the patient'"'"'s body, the physiologic state or condition reflects the cardiac output requirement of the patient'"'"'s body, and the delivery controlling means further comprises:

means for employing the relative physiologic signal values to control the bradycardia pacing rate of the implantable medical device to satisfy the cardiac output requirement; and

means for delivering pacing pulses to the heart at the controlled pacing rate.

22. The system of claim 20, wherein the implantable medical device comprises an anti-tachyarrythmia therapy delivery system for delivering an anti-tachyarytimia therapy to the patient to convert a tachyarrythmia to a normal heart rhythm, the physiologic state or condition reflects normal heart rhythm or a tachyarrythmia of the heart, and the delivery controlling means further comprises:

means for employing the relative physiologic signal values to differentiate between normal heart rhythm and a tachyarrythmia of the heart; and

means for delivering an anti-tachyarrythmia therapy to the heart to convert the tachyarrytlmia to a normal heart rhythm.

23. The system of claim 20, wherein the implantable medical device comprises a drug delivery system for delivering a drug to the patient to treat an abnormal medical state or condition, and the delivery controlling means further comprises:

means for employing the relative physiologic signal values to determine dosage of the drug to the patient; and

means for delivering the drug to the patient.

24. The system of claim 20, wherein the implantable medical device comprises a heart pump for providing sufficient cardiac output for the patient'"'"'s body, the physiologic state or condition reflects the cardiac output requirement of the patient'"'"'s body, and the delivery controlling means comprises:

means for employing the relative physiologic signal values to control the operation of the heart pump to satisfy the cardiac output requirement.

25. The system of claim 20, wherein the implantable medical device comprises a cardiomyostimulation pacing therapy delivery system for pacing a skeletal muscle wrapped about the patient'"'"'s heart to augment contraction of the heart muscle to provide sufficient cardiac output for the patient'"'"'s body, the physiologic state or condition reflects the cardiac output requirement of the patient'"'"'s body, and the delivery controlling means fiuther comprises:

means for employing the relative physiologic signal values to control the pacing of the skeletal muscle to satisfy the cardiac output requirement; and

means for delivering pacing pulses to the skeletal muscle.

26. The system of any of the preceding claims 15-25, wherein the physiologic state or condition comprises the blood pressure of the patient, the sensed absolute physiologic signal value is absolute blood pressure value, the ambient state or condition comprises barometric pressure affecting the patient and the absolute pressure value, the relative physiologic signal value is relative blood pressure;

and the means for combining the derived absolute physiologic signal value and the conveyed ambient signal value comprises means for subtracting the barometric pressure from the absolute blood pressure to derive the relative blood pressure.

27. The system of any of the preceding claims 15-25, wherein the physiologic state or condition comprises the blood temperature of the patient, the sensed absolute physiologic signal value is absolute blood temperature, the ambient state or condition comprises systemic patient temperature affected by fever or ambient conditions, the relative physiologic signal value is relative blood temperature;

and the means for combining the derived absolute physiologic signal value and the conveyed ambient signal value comprises means for subtracting the ambient temperature from the absolute blood temperature to derive the relative blood temperature.

28. The system of any of the preceding claims 15-25, wherein the external monitoring device further comprises:

means for periodically deriving and conveying the ambient signal value to the implantable medical device, and the conveyed ambient signal value is used in the derivation of a plurality of relative physiologic signal values in the period between successive conveyances of the ambient signal value to the implantable medical device.

29. An implantable medical device method for deriving relative physiologic signal value data for use by and/or storage within an implantable medical device implanted within a patient'"'"'s body comprising the steps of:

providing an external monitoring device associated with the patient, and in the external monitoring device,

periodically sensing an ambient state or condition outside the body affecting a sensed physiologic state or condition within the body and deriving an ambient signal value from each sensed ambient state or condition;

storing a plurality of the ambient signal values; and

conveying the plurality of ambient signal values from the external monitoring device to the implantable medical device; and

in the implantable medical device implanted in the patient'"'"'s body,

periodically sensing a physiologic state or condition within the body of the patient and deriving an absolute physiologic signal value from each sensed physiologic state or condition;

storing a plurality of the absolute physiologic signal values;

receiving the plurality of ambient signal values conveyed from the external monitoring device; and

combining the plurality of derived absolute physiologic signal values and the plurality of conveyed ambient signal values to derive a plurality of relative physiologic signal values therefrom.

30. The method of claim 29, wherein the implantable medical device comprises implantable device memory and further comprising the step of:

storing said plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

31. The method of claim 29, wherein the implantable medical device comprises an implantable monitor having implantable device memory and further comprising the step of:

storing said plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

32. The method of claim 29, wherein the implantable medical device comprises an implantable monitor having implantable device memory and data conveying means for conveying data stored in the implantable memory to an external memory device further comprising the steps of:

storing said plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory; and

activating said data conveying means to convey the relative physiological signal value data stored in the implantable memory to an external medical device.

33. The method of claim 29, wherein the implantable medical device comprises implantable device memory and a therapy delivery system for delivering a therapy to the patient and further comprising the steps of:

storing said predetermined number of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory; and

employing the relative physiologic signal values to control the delivery of the therapy by the implantable medical device.

34. The method of claim 29, wherein the implantable medical device comprises a therapy delivery system for delivering a therapy to the patient and further comprising the step of:

controlling the delivery of the therapy by the implantable medical device as a function of the relative physiologic signal value data.

35. The method of any of the preceding claims 29-34, wherein the physiologic state or condition comprises the blood pressure of the patient, the sensed absolute physiologic signal value is absolute blood pressure value, the ambient state or condition comprises barometric pressure affecting the patient and the absolute pressure value, the relative physiologic signal value is relative blood pressure;

and the step of combining the derived absolute physiologic signal value and the conveyed ambient signal value comprises subtracting the barometric pressure from the absolute blood pressure.

36. The method of any of the preceding claims 29-34, wherein the physiologic state or condition comprises the blood temperature of the patient, the sensed absolute physiologic signal value is absolute blood temperature, the ambient state or condition comprises systemic patient temperature affected by fever or ambient conditions, the relative physiologic signal value is relative blood temperature;

and the step of combining the derived absolute physiologic signal value and the conveyed ambient signal value comprises subtracting the ambient temperature from the absolute blood temperature.

37. A system for deriving relative physiologic signal values from absolute physiologic signal values for use by and/or storage within an implantable medical device comprising:

an external monitoring device associated with the patient comprising,

external sensing means for periodically sensing an ambient state or condition outside the body affecting a sensed physiologic state or condition within the body;

signal processing means coupled with said external sensing means for deriving an ambient signal value from the sensed ambient state or condition;

memory means for storing a plurality of the ambient signal values; and

signal conveying means for conveying the plurality of ambient signal values from the external monitoring device to the implantable medical device; and

the implantable medical device implanted within a patient'"'"'s body comprising,

implantable sensing means for periodically sensing a physiologic state or condition within the body of the patient;

signal processing means coupled with said implantable sensing means for deriving an absolute physiologic signal value from the sensed physiologic state or condition;

receiving means for receiving the plurality of ambient signal values conveyed from said signal conveying means; and

means for combining the plurality of derived absolute physiologic signal values with the plurality of sensed ambient signal values to derive a plurality of relative physiologic signal values therefrom.

38. The system of claim 37, wherein the implantable medical device further comprises:

implantable device memory; and

means for storing said plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

39. The system of claim 37, wherein the implantable medical device comprises an implantable monitor further comprising:

implantable device memory; and

means for storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory.

40. The system of claim 37, wherein the implantable medical device comprises an implantable monitor fuirther comprising:

implantable device memory;

means for storing a plurality of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory;

data conveying means for conveying data stored in the implantable memory to an external memory device; and

means for activating said data conveying means to convey the relative physiological signal value data stored in the implantable memory to said external medical device.

41. The system of claim 37, wherein the implantable medical device further comprises a therapy delivery system for delivering a therapy to the patient further comprising:

implantable device memory;

means for storing a predetermined number of relative physiologic signal values as relative physiologic signal value data in the implantable medical device memory; and

means for employing the relative physiologic signal values to control the delivery of the therapy by the implantable medical device.

42. The system of claim 37, wherein the implantable medical device comprises a therapy delivery system for delivering a therapy to the patient further comprising:

means for controlling the delivery of the therapy by the implantable medical device as a function of the plurality of relative physiologic signal values.

43. The system of any of the preceding claims 37-42, wherein the physiologic state or condition comprises the blood pressure of the patient, the sensed absolute physiologic signal value is absolute blood pressure value, the ambient state or condition comprises barometric pressure affecting the patient and the absolute pressure value, the relative physiologic signal value is relative blood pressure;

and the means for combining the plurality of derived absolute physiologic signal values with the plurality of sensed ambient signal values to derive a plurality of relative physiologic signal values therefrom comprises means for subtracting the barometric pressure value from the absolute blood pressure value to derive a relative blood pressure value.

44. The system of any of the preceding claims 37-42, wherein the physiologic state or condition comprises the blood temperature of the patient, the sensed absolute physiologic signal value is absolute blood temperature, the ambient state or condition comprises systemic patient temperature affected by fever or ambient conditions, the relative physiologic signal value is relative blood temperature;

and the means for combining the plurality of derived absolute physiologic signal values with the plurality of sensed ambient signal values to derive a plurality of relative physiologic signal values therefrom comprises means for subtracting the ambient temperature from the absolute blood temperature to derive a relative blood temperature.