Virtual physician acute myocardial infarction detection system and method

• US 8,712,509 B2
• Filed: 07/25/2008
• Issued: 04/29/2014
• Est. Priority Date: 07/25/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Lee, Brian Bruce, Wengreen, Eric John, Song, Zhendong
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): Patel, Natasha
• Application Number:
  US12/180,268
• Publication Number:
  US 20100022902A1
• Time in Patent Office: 2,104 Days
• Field of Search: 600/509, 600/513, 600/516, 600/301, 607/30, 607/32, 607/59, 607/60, 607/62
• US Class Current: 600/513
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/076 Permanent implantations telemetry using implanted circuitry A61B5/0031; implanted stimulators for therapy A61N1/3605, A61N1/362, A61N1/372
• CPC Class Codes: A61B 5/332 Portable devices specially adapted therefor
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/358 Detecting ST segments
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A system and method for virtually detecting a medical condition, such as acute myocardial infarction (AMI), in a patient using holistic diagnostic procedures implemented in medical devices. Physiological parameters in a patient are monitored in an implantable medical device (IMD) to detect deviations from desired characteristics. When severe physiological parameter deviations exist indicating with a desired certainty that the patient is experiencing a medical condition (e.g., AMI), an alert is generated. If only minor deviations from the desired characteristics exist, additional holistic diagnostic procedures are performed virtually for diagnosing whether the patient is likely to be experiencing the medical condition, such as querying the patient through an external device regarding symptoms the patient is experiencing and analyzing the patient'"'"'s responses to the questions to determine whether the patient is experiencing the medical condition. When diagnosis is still unclear, additional holistic diagnostic procedures can be performed virtually until diagnosis is certain.

Claims

1. A virtual physician system comprising:

a medical device implantable in a patient and configured to monitor at least one physiological parameter from sensed physiological signals for deviations from desired characteristics;

the implantable medical device configured to;

determine whether sufficient deviations are present in the monitored physiological parameter(s) that indicate with a desired level of certainty that the patient is experiencing a certain medical condition;

generate an alert when the desired level of certainty that the patient is experiencing the medical condition is determined to exist;

determine whether minor deviations are present in the monitored physiological parameter that potentially indicate that the patient is experiencing the medical condition without reaching with the desired level of certainty that the patient is experiencing the medical condition, wherein the minor deviations are not sufficient to indicate with the desired level of certainty that the patient is experiencing the certain medical condition;

cause additional holistic diagnostic procedures to be performed for diagnosing whether the patient is experiencing the medical condition when minor deviations are determined;

cause, as at least part of the additional holistic diagnostic procedures, an external device to query the patient regarding symptom-related questions and collect responses to the symptom-related questions from the patient; and

cause, when the minor deviations are determined to be present, a determination of whether the patient is experiencing the medical condition based on the presence of the minor deviations and the collected responses to the symptom-related questions from the patient.

2. The virtual physician system of claim 1, further comprising the external device, wherein the external device is configured to communicate with the implantable medical device, the external device including an interface for allowing information to be communicated to and from the patient,

the implantable medical device further configured for transmitting a command to the external device to query the patient regarding symptom-related questions.

3. The virtual physician system of claim 2, wherein the external device is further configured to collect responses to the symptom-related questions and analyze the responses to the symptom-related questions in view of the detected minor physiological parameter deviations to diagnose whether the patient is experiencing the medical condition.

4. The virtual physician system of claim 3, wherein, when the symptom-related information collected from the patient fails to indicate with the desired probability that the patient is experiencing the medical condition, the external device is further configured to cause at least one additional physiological parameter diagnostic test to be performed to determine whether the patient is experiencing the medical condition.

5. The virtual physician system of claim 4, wherein the implantable medical device is configured to monitor electrogram (EGM) or electrocardiogram (ECG) information received in the implantable medical device for ST segment deviations and wherein the medical condition to be diagnosed is acute myocardial infarction, further wherein the at least one additional physiological parameter diagnostic test includes at least one of a heart sounds diagnostic test and a biomarker test.

6. The virtual physician system of claim 1, further comprising a plurality of distributed devices arranged with respect to the patient for monitoring the physiological parameter in conjunction with the implantable medical device for deviations from desired characteristics.

7. The virtual physician system of claim 2, wherein the external device is further configured to receive a request for the activation of the implantable medical device to initiate the monitoring of the physiological parameter from sensed physiological signals and to deliver instructions to the implantable medical device to initiate said monitoring.

8. The virtual physician system of claim 2, wherein the external device is further configured to provide instructions for the patient to follow to assist in the performance and reliability of the at least one additional diagnostic test.

9. The virtual physician system of claim 2, wherein the external device is further configured to provide instructions for the patient to perform at least one additional diagnostic test and configured to receive the results of such tests performed from the patient, the results of which are provided by the patient for use in detecting with the desired probability whether the patient is experiencing the medical condition.

10. The virtual physician system of claim 2, wherein the external device is further configured to receive a request from the patient for initiating the procedures for determining whether the patient is experiencing a certain medical condition.

11. The virtual physician system of claim 2, wherein the external device is further configured to provide a notification of a negative diagnosis when it is virtually determined that the patient is not experiencing the medical condition.

12. The virtual physician system of claim 2, further comprising a remote server, wherein the external device is configured to collect responses to the symptom-related questions and transmit the collected responses to the remote server, and wherein the remote server is configured to analyze the responses to the symptom-related questions in view of the detected minor physiological parameter deviations to diagnose whether the patient is experiencing the medical condition.

13. The virtual physician system of claim 1, wherein the implantable medical device is configured to, upon determining that minor deviations are present, cause the additional holistic diagnostic procedures to be performed for diagnosing whether the patient is experiencing the medical condition when minor deviations are determined.

14. The virtual physician system of claim 1, wherein the implantable medical device is configured to determine whether the patient is experiencing the medical condition based on the minor deviations and the collected responses to the system-related questions from the patient.

15. The virtual physician system of claim 1, wherein the external device is configured to determine whether the patient is experiencing the medical condition based on the minor deviations and the collected responses to the system-related questions from the patient.

16. The virtual physician system of claim 3, wherein the external device is configured to:

prompt the patient to respond to the symptom-related questions;

determine when at least one of the responses to the symptom-related questions is not collected within a certain period of time; and

diagnose whether the patient is experiencing the medical condition based, at least in part, on not collecting the at least one response within the certain period of time.