System and method for improved ischemia and acute myocardial infarction detection

• US 9,538,919 B2
• Filed: 07/09/2008
• Issued: 01/10/2017
• Est. Priority Date: 07/09/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Boute, Willem, Hampton, David Robert, Wesselink, Wilbert, Pietersma, Anna
• Primary Examiner(s): Patton, Amanda
• Assistant Examiner(s): EDWARDS, PHILIP CHARLES
• Application Number:
  US12/170,037
• Publication Number:
  US 20100010361A1
• Time in Patent Office: 3,107 Days
• Field of Search: 600/515
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/358 Detecting ST segments
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: G16H 40/63 for local operation

Abstract

A system and method are provided for the detection of a heart-related condition by obtaining information in real-time when a condition is initially identified as potentially occurring. A physical exercise and recovery episode is initially detected from physiological signals sensed in a patient. Once detected, a HR-ST segment deviation hysteresis analysis is performed in an implantable medical device (IMD) from certain physiological signals over portions of the exercise and recovery episode to identify the probability that a certain condition is occurring. Once a desired level of probability that the heart-related condition has been detected exists, data utilized in the analysis can be transmitted remotely for clinical review and confirmation of the device'"'"'s detection of the condition. The patient may be prompted to answer questions related to symptoms that patient is experiencing through an input device in order further confirm the probability that the condition is occurring in the patient.

Claims

1. A method comprising:

detecting an exercise and recovery episode in a patient using an implantable medical device (IMD);

performing an analysis of heart rate (HR)-ST segment hysteresis over the exercise and recovery episode using the IMD; and

determining whether the patient is experiencing a particular heart-related condition based on the results of the HR-ST segment hysteresis analysis.

2. The method of claim 1, wherein the heart-related condition includes at least one of an ischemia, unstable angina and an acute myocardial infarction, the method further comprising determining whether the patient is experiencing a particular heart-related condition by computing a probability that the particular heart-related condition is occurring and determining whether the computed probability exceeds a predefined detection threshold.

3. The method of claim 1, wherein the HR-ST segment hysteresis analysis includes at least one of (i) a detailed analysis of an initial recovery period after exercise ceases, (ii) a determination of a prevailing direction of HR-ST hysteresis during the exercise and recovery episode, and (iii) a determination of an average magnitude of HR-ST hysteresis during the exercise and recovery episode.

4. The method of claim 1, further comprising collecting additional information from a patient relating to symptoms being experienced by the patient for use in confirming the detection of the particular heart-related condition.

5. The method of claim 4, wherein the additional information is collected by querying the patient with symptom-related questions after a certain level of probability that the patient is experiencing a particular heart-related condition is reached from the HR-ST segment hysteresis analysis.

6. The method of claim 1, wherein upon a determination that the patient is experiencing a particular heart-related condition based on the results of the HR-ST segment hysteresis analysis, the method further comprising comparing data used in making such determination against at least one of historical data for the patient and baseline data for confirming the detection of the particular heart-related condition.

7. The method of claim 1, further comprising detecting the exercise and recovery episode by sensing at least one physiological signal and deriving a corresponding physiological parameter from each sensed signal.

8. The method of claim 7, wherein the physiological signals comprise at least one of a cardiac electrical signal and a respiratory signal.

9. The method of claim 7, wherein the at least one physiological signal comprises a patient activity signal generated by a sensor.

10. The method of claim 9, wherein the sensor comprises an accelerometer.

11. The method of claim 1, further comprising sensing an electrocardiogram (ECG) signal for deriving Q-wave and T-wave information from the ECG signal for use in confirming the detection of the particular heart-related condition.

12. The method of claim 1, further comprising generating an alert signal using the IMD upon the determination that the patient is experiencing a particular heart-related condition, the alert signal providing at least one of a notification of the detection of the heart-related condition and an instruction for treating the heart-related condition.

13. A system comprising:

at least one physiological sensor configured to sense a corresponding physiological signal in a patient;

a controller configured to derive a corresponding physiological parameter from each sensed signal and to detect an exercise and recovery episode in the patient; and

a housing configured for implantation in the patient, wherein the at least one physiological sensor and the controller are included in the housing, and

wherein the controller is further configured to;

collect ST-segment information from a corresponding physiological sensor;

perform an analysis of heart rate (HR)-ST segment hysteresis over the exercise and recovery episode; and

determine whether the patient is experiencing a particular heart-related condition based on the results of the HR-ST segment hysteresis analysis.

14. The system of claim 13, wherein the controller is further configured to generate a command to an external device to query the patient with symptom-related questions after a certain level of probability that the patient is experiencing a particular heart-related condition is reached from the HR-ST segment hysteresis analysis.

15. The system of claim 13, wherein the at least one physiological sensor is configured to sense at least one of a cardiac electrical signal and a respiratory signal.

16. The system of claim 13, wherein the controller is further configured to communicate sensed physiological sensor data to a remote device for use in comparing the sensed data against at least one of historical data for the patient and baseline data for confirming the detection of the particular heart-related condition.

17. The system of claim 13, wherein the at least one physiological sensor is configured to sense a patient activity signal.

18. The system of claim 17, wherein the at least one physiological sensor includes an accelerometer.

19. A system comprising:

means for detecting an exercise and recovery episode in a patient using an implantable medical device (IMD);

means for performing an analysis of heart rate (HR)-ST segment hysteresis over the exercise and recovery episode using the IMD; and

means for determining whether the patient is experiencing a particular heart-related condition based on the results of the HR-ST segment hysteresis analysis.

20. The system of claim 19, further comprising means for performing the HR-ST segment hysteresis analysis by performing at least one of (i) a detailed analysis of an initial recovery period after exercise ceases, (ii) a determination of a prevailing direction of HR-ST hysteresis during the exercise and recovery episode, and (iii) a determination of an average magnitude of HR-ST hysteresis during the exercise and recovery episode.

21. The system of claim 19, further comprising means for initiating a query containing questions relating to symptoms being experienced by the patient for use in confirming the detection of the particular heart-related condition.

22. The system of claim 19, further comprising:

means for deriving data related to at least one physiological parameter corresponding to a sensed physiological signal; and

means for communicating the physiological parameter data to a remote location for use in comparing the sensed data against at least one of historical data for the patient and baseline data for confirming the detection of the particular heart-related condition.

23. The system of claim 19, further comprising means for generating an alert signal using the IMD upon the determination that the patient is experiencing a particular heart-related condition, the alert signal providing at least one of a notification of the detection of the heart-related condition and an instruction for treating the heart-related condition.

24. The system of claim 19, further comprising means for detecting the exercise and recovery episode by sensing at least one physiological signal and deriving a corresponding physiological parameter from each sensed signal, wherein the at least one physiological signal comprises a patient activity signal generated by a sensor of the IMD.

25. The system of claim 24, wherein the sensor of the IMD comprises an accelerometer.