Systems and methods for use by implantable medical devices for detecting and discriminating stroke and cardiac ischemia using electrocardiac signals

• US 8,989,852 B2
• Filed: 08/10/2011
• Issued: 03/24/2015
• Est. Priority Date: 08/10/2011
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Gill, Jong, Bharmi, Rupinder, Karst, Edward, Rooke, Ryan, Shah, Riddhi, Qu, Fujian, Bornzin, Gene A., Park, Euljoon, Farazi, Taraneh G.
• Primary Examiner(s): BEHRINGER, LUTHER G
• Application Number:
  US13/207,307
• Publication Number:
  US 20130041274A1
• Time in Patent Office: 1,322 Days
• Field of Search: 600/513
• US Class Current: 600/513
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• 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 5/02158 provided with two or more sensor elements
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4839 combined with drug delivery
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

Techniques are provided for detecting and distinguishing stroke and cardiac ischemia based on electrocardiac signals. In one example, the device senses atrial and ventricular signals within the patient along a set of unipolar sensing vectors and identifies certain morphological features within the signals such as PR intervals, ST intervals, QT intervals, T-waves, etc. The device detects changes, if any, within the morphological features such as significant shifts in ST interval elevation or an inversion in T-wave shape, which are indicative of stroke or cardiac ischemia. By selectively comparing changes detected along different unipolar sensing vectors, the device distinguishes or discriminates stroke from cardiac ischemia within the patient. The discrimination may be corroborated using various physiological and hemodynamic parameters. In some examples, the device further identifies the location of the ischemia within the heart. In still other examples, the device detects cardiac ischemia occurring during stroke.

Claims

1. A method for use with an implantable medical device for implant within a patient, the method comprising:

sensing atrial and ventricular electrocardiac signals within the patient along a plurality of sensing vectors and detecting morphological features within the signals;

detecting changes in the morphological features associated with both cerebral stroke and cardiac ischemia;

determining whether the changes in the morphological features are relatively global or relatively local; and

distinguishing cerebral stroke from cardiac ischemia within the patient, in response to the determining, based on whether the changes in the morphological features are relatively global or relatively local.

2. The method of claim 1 wherein detecting morphological features within the atrial and ventricular signals includes detecting one or more of:

PR intervals;

ST intervals;

QT intervals; and

T-waves.

3. The method of claim 2 wherein detecting changes in the morphological features associated with both cerebral stroke and cardiac ischemia includes detecting one or more of:

PR elevation shift;

ST depression;

QT elongation;

QT dispersion; and

T-wave inversion.

4. The method of claim 1 wherein sensing atrial and ventricular electrocardiac signals within the patient along a plurality of sensing vectors comprises:

sensing at least one atrial unipolar electrocardiac signal along at least one atrial unipolar sensing vector; and

sensing at least one ventricular unipolar electrocardiac signal along at least one ventricular unipolar sensing vector.

5. The method of claim 4 wherein determining whether the changes are relatively global or relatively local comprises determining whether significant changes in the morphological features are present in both the atrial and ventricular electrocardiac signals.

6. The method of claim 1 further including identifying a location within the heart of a cardiac ischemia, if occurring.

7. The method of claim 1 wherein detecting changes in the morphological features of the electrocardiac signals includes detecting relative magnitudes of the changes along different sensing vectors.

8. The method of claim 7 further including detecting an indication of cardiac ischemia occurring during cerebral stroke based on comparison of the relative magnitudes of the changes in the morphological features along different sensing vectors.

9. The method of claim 8 wherein detecting an indication of cardiac ischemia occurring during stroke is based on the relative magnitude of changes in one or more of ST intervals and QT intervals along different sensing vectors.

10. The method of claim 8 wherein detecting an indication of cardiac ischemia occurring during cerebral stroke based on the magnitude of the changes in the morphological parameters is based on a comparison of changes detected within parameters detected within a subset of a plurality of electrocardiac signals as compared to all of said plurality of electrocardiac signals.

11. The method of claim 1 wherein distinguishing cerebral stroke from cardiac ischemia includes setting separate detection thresholds for each of a plurality of morphological parameters derived from different atrial and ventricular sensing vectors.

12. The method of claim 1 wherein distinguishing cerebral stroke from cardiac ischemia includes assessing a rate of change in the morphological features and associating a faster rate of change with cerebral stroke as opposed to cardiac ischemia.

13. The method of claim 1 wherein sensing atrial and ventricular electrocardiac signals within the patient along a plurality of sensing vectors comprises:

sensing at least one bipolar electrocardiac signal along at least one bipolar sensing vector and detecting morphological features within the bipolar signal; and

wherein determining whether the changes in the morphological features are relatively global or relatively local is based at least in part on the features derived from the bipolar signal.

14. The method of claim 1 further including controlling at least one device function in response to distinguishing cerebral stroke from cardiac ischemia within the patient.

15. The method of claim 14 wherein controlling at least one device function includes controlling one or more of:

delivery of therapy, generation of warning signals and recordation of diagnostic information.