Method for correction of posture dependence on heart sounds

• US 7,951,087 B2
• Filed: 12/23/2009
• Issued: 05/31/2011
• Est. Priority Date: 01/18/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Siejko, Krzysztof Z., Maile, Keith R.
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Behringer; Luther G
• Application Number:
  US12/645,906
• Publication Number:
  US 20100099997A1
• Time in Patent Office: 524 Days
• Field of Search: 600/528, 607 17- 19
• US Class Current: 600/528
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61B 8/0883 for diagnosis of the heart
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters

Abstract

A system to monitor heart sounds. The system comprises an implantable heart sound sensor configured to produce an electrical signal representative of at least one heart sound, an implantable posture sensor operable to produce an electrical signal representative of a patient'"'"'s posture, and a controller circuit. The controller circuit is configured to determine a patient posture, measure at least one heart sound in correspondence with at least one corresponding patient posture, adjust the heart sound measurement by using the corresponding determined patient posture to reduce or remove variation in the heart sound measurement due to patient posture, detect a change in the adjusted heart sound measurement, and provide an indication of congestive heart failure to a user or an automated process in response to the detected change.

Claims

1. An apparatus comprising:

an implantable heart sound sensor configured to produce an electrical signal representative of at least one heart sound, the heart sound associated with mechanical activity of a patient'"'"'s heart;

an implantable posture sensor operable to produce an electrical signal representative of a patient'"'"'s posture; and

a controller circuit, communicatively coupled to the heart sound sensor interface circuit and the posture circuit, wherein the controller circuit is configured to;

determine a patient posture using the posture sensor signal;

measure the at least one heart sound in correspondence with at least one corresponding determined patient posture;

adjust the heart sound measurement by using the corresponding determined patient posture to reduce or remove variation in the heart sound measurement due to patient posture;

detect a change in the adjusted heart sound measurement; and

provide an indication of congestive heart failure (CHF) to a user or an automated process in response to the detected change.

2. The apparatus of claim 1,

wherein the implantable heart sound sensor is configured to produce an electrical signal representative of an S3 heart sound, and

wherein the controller circuit is configured to:

measure the S3 heart sound in correspondence with the determined patient posture;

detect a change in an adjusted S3 heart sound measurement; and

generate an alarm indicative of progression of CHF in response to the detected change in the adjusted S3 heart sound measurement.

3. The apparatus of claim 1, including:

a therapy circuit communicatively coupled to the controller circuit and configured to provide electrical pacing therapy to the patient, and

wherein the controller circuit is configured to initiate delivery of pacing resynchronization therapy according to the detected change in the adjusted heart sound measurement.

4. The apparatus of claim 1, including:

a trans-thoracic impedance sensor communicatively coupled to the controller circuit and configured to provide an electrical signal representative of trans-thoracic impedance of the patient, and

wherein the controller circuit is configured to;

measure trans-thoracic impedance of the patient in correspondence with the determined patient posture; and

provide the indication of CHF according to the adjusted heart sound measurement and the measured trans-thoracic impedance.

5. The apparatus of claim 4,

wherein the trans-thoracic impedance sensor is configured to provide an electrical signal representative of near-DC trans-thoracic impedance, and

wherein the controller circuit is configured to provide the indication of CHF according to the adjusted heart sound measurement and the measured near-DC trans-thoracic impedance.

6. The apparatus of claim 1, including:

an intra-cardiac impedance sensor communicatively coupled to the controller circuit and configured to provide an electrical signal representative of trans-thoracic impedance of the patient, and

wherein the controller circuit is configured to;

measure intra-cardiac impedance of the patient in correspondence with the determined patient posture, and

provide the indication of CHF according to the adjusted heart sound measurement and the measured intra-cardiac impedance.

7. The apparatus of claim 1, including:

a hematocrit sensor communicatively coupled to the controller circuit and configured to provide an electrical signal representative of hematocrit of the patient, and

wherein the controller circuit is configured to;

measure hematocrit of the patient in correspondence with the determined patient posture; and

provide an indication of patient health to a user or process according to the adjusted heart sound measurement and the measured hematocrit.

8. The apparatus of claim 1, including:

a trans-thoracic impedance sensor configured to provide an electrical signal representative of trans-thoracic impedance of the patient, and

wherein the controller circuit is configured to;

monitor trans-thoracic impedance of the patient;

determine breathing rate using the monitored trans-thoracic impedance; and

measure the heart sound in correspondence with the determined patient posture when the measured breathing rate indicates that the patient is inactive.

9. The apparatus of claim 1, wherein the controller circuit is configured to:

determine heart rate of the subject using sensed heart sounds; and

measure a specified heart sound in correspondence with the determined patient posture and when the determined heart rate indicates that the patient is inactive.

10. The apparatus of claim 1, including:

an activity sensor communicatively coupled to the controller circuit and configured to provide an electrical signal representative of patient activity, and

wherein the controller circuit is configured to;

determine patient activity using the activity signal; and

measure the heart sound in correspondence with the determined patient posture and when the controller circuit detects that the patient is inactive.

11. A method comprising:

determining posture of a patient using an implantable medical device;

measuring a heart sound in correspondence with at least one corresponding determined patient posture;

adjusting the heart sound measurement by using the corresponding determined patient posture for reducing or removing variation in the heart sound measurement due to patient posture;

detecting a change in the adjusted heart sound measurement; and

providing, in response to the detected change, an indication of CHF to a user or an automated process.

12. The method of claim 11,

wherein measuring a heart sound includes measuring an S3 heart sound in correspondence with the determined posture,

wherein detecting a change includes detecting a change in an adjusted S3 heart sound measurement, and

wherein providing an indication includes generating an alarm indicative of progression of CHF in response to the detected change in the adjusted S3 heart sound measurement.

13. The method of claim 11, including initiating delivery of pacing resynchronization therapy according to the detected change in the adjusted heart sound measurement.

14. The method of claim 11, including:

measuring trans-thoracic impedance of the patient in correspondence with the determined patient posture, and

wherein providing the indication of CHF includes providing the indication of CHF according to the adjusted heart sound measurement and the measured trans-thoracic impedance.

15. The method of claim 14,

wherein measuring trans-thoracic impedance includes measuring near-DC trans-thoracic impedance, and

wherein providing the indication of CHF includes providing the indication of CHF according to the adjusted heart sound measurement and the measured near-DC trans-thoracic impedance.

16. The method of claim 11, including:

measuring intra-cardiac impedance of the patient in correspondence with the determined patient posture, and

wherein providing the indication of CHF includes providing the indication of CHF according to the adjusted heart sound measurement and the measured intra-cardiac impedance.

17. The method of claim 11, including:

measuring hematocrit of the patient in correspondence with the determined patient posture; and

providing an indication of patient health to a user or process according to the adjusted heart sound measurement and the measured hematocrit.

18. The method of claim 11, including:

measuring trans-thoracic impedance of the patient;

determining breathing rate using the trans-thoracic impedance, and

wherein measuring a heart sound includes measuring the heart sound in correspondence with the determined patient posture when the measured breathing rate indicates that the patient is inactive.

19. The method of claim 11 including:

determining heart rate of the subject using measured heart sounds, and

wherein measuring the heart sound includes measuring the heart sound in correspondence with the determined patient posture and when the determined heart rate indicates that the patient is inactive.

20. The method of claim 11, including:

sensing patient activity using an activity sensor; and

wherein measuring the heart sound includes measuring the heart sound in correspondence with the determined patient posture and when the activity sensor indicates the patient is inactive.