U.S. patent number 3,773,033 [Application Number 05/198,863] was granted by the patent office on 1973-11-20 for method and apparatus for obtaining and displaying cardiovascular data.
This patent grant is currently assigned to City of Hope. Invention is credited to Bruce E. Mount, Simon Rodbard.
United States Patent |
3,773,033 |
Rodbard , et al. |
November 20, 1973 |
METHOD AND APPARATUS FOR OBTAINING AND DISPLAYING CARDIOVASCULAR
DATA
Abstract
Method and apparatus for obtaining and displaying cardiovascular
data by simultaneously sensing the performance of both the heart
and an artery during a succession of cardiac cycles. A microphone
adjacent the heart and a sensor adjacent an artery are coupled to
the input of a cathode ray tube for intensity and/or amplitude
modulation of its output. The horizontal sweep of the cathode ray
tube is initated at the beginning of each cardiac cycle as by ECG
electrodes. Variable pressure applied externally to the artery is
also used to establish the quiescent vertical output of the cathode
ray tube. In one embodiment, a memory tube temporarily stores the
output of the cathode ray tube for visual examination, after which
facsimiles can be made if desired.
Inventors: |
Rodbard; Simon (Arcadia,
CA), Mount; Bruce E. (Diamond Bar, CA) |
Assignee: |
City of Hope (Los Angeles,
CA)
|
Family
ID: |
22735172 |
Appl.
No.: |
05/198,863 |
Filed: |
November 15, 1971 |
Current U.S.
Class: |
600/500; 600/513;
600/528 |
Current CPC
Class: |
A61B
5/02208 (20130101); A61B 5/318 (20210101); A61B
7/00 (20130101) |
Current International
Class: |
A61B
5/02 (20060101); A61b 005/04 () |
Field of
Search: |
;128/2.6R,2.6A,2.6B,2.6F,2.6G,2.6V,2.1A,2.1R,2.5R,2.5A,2.5H |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
704,883 |
|
Mar 1941 |
|
DD |
|
429,748 |
|
Jun 1935 |
|
GB |
|
Other References
The Review of Scientific Instruments, Vol. 32, No. 9, pp.
1022-1023, Sept. 1961..
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Cohen; Lee S.
Claims
We claim as our invention:
1. Apparatus for obtaining cardiovascular data, including in
combination:
Ecg electrodes;
microphone means for detecting heart sounds;
sensing means for monitoring the pulse waveform of a specified
artery;
a cathode ray tube having x-axis, y-axis and z-axis inputs, said
ECG electrodes connected to said x-axis inputs for initiating a
horizontal sweep at the beginning of each cardiac cycle, and said
microphone means and said sensing means each connected to at least
one of said y-axis and z-axis inputs;
pressure means for applying variable external pressure to said
artery, said pressure means connected with said y-axis input to
control the quiescent vertical position of said output of said
cathode ray tube and to display the waveforms generated by said
microphone means and said sensing means during each of a succession
of cardiac cycles with the waveforms of each of said succession of
cardiac cycles vertically aligned; and
readout means coupled to said ECG electrodes and said sensing means
for continuously monitoring, measuring, and displaying the
magnitude of the time interval between the beginning of each
cardiac cycle and the onset of the pulse waveform in the
artery.
2. The apparatus of claim 1 including means for connecting said ECG
electrodes with at least one of said y-axis and z-axis inputs of
said cathode ray tube.
3. Apparatus for obtaining and displaying cardiovascular data
including in combination:
1. a cathode ray tube having x-axis, y-axis and z-axis inputs;
2. ECG electrodes connected to said x-axis input for initiating the
horizontal sweep at the beginning of each cardiac cycle;
3. first microphone means for detecting heart sounds;
4.
4. second microphone means for detecting arterial sounds;
5. said first and second microphone means connected with said
y-axis input to provide amplitude modulation of the output of said
cathode ray tube and also connected with said z-axis input to
provide intensity modulation of the output of said cathode ray
tube;
6. pressure means for applying variable external pressure to an
artery, said pressure means connected with said y-axis input to
change the quiescent vertical position of the output of said
cathode ray tube at a rate proportional to the variable external
pressure applied to the artery to generate a series of vertically
aligned waveforms of both heart sounds and arterial sounds; and
7. means coupled to said cathode ray tube for temporarily
preserving the output of said cathode ray tube during a succession
of cardiac cycles and
for producing a facsimile of said output of said cathode ray tube.
4. A method of obtaining cardiovascular data during a succession of
cardiac cycles, including:
detecting an onset reference for each cardiac cycle;
applying a varying external pressure to an artery;
sensing the existence and magnitude of heart sounds and arterial
vibrations relative to said onset reference;
initiating a horizontal sweep of a cathode ray tube at the same
predetermined time during each cardiac cycle;
modulating the output of the cathode ray tube to generate a
waveform reflecting the existence and magnitude of the heart sounds
and the arterial vibrations obtained by said sensing; and
changing the quiescent vertical output of the cathode ray tube at a
rate proportional to said varying to display the modulated output
for one cardiac cycle in vertical alignment with the modulated
output for the other cardiac cycles.
5. The method of claim 4 including measuring and displaying the
magnitude of the time interval between the onset reference for each
cardiac cycle and the leading edge of the waveform reflecting the
magnitude of the arterial vibrations.
Description
This invention relates generally to the field of cardiovascular
medicine, and more particularly to a system of obtaining and
displaying cardiovascular data derived from a succession of cardiac
cycles.
In the course of detecting, diagnosing and treating cardiovascular
problems, it is desirable and often necessary to be able to
evaluate the performance and condition of the heart and arteries
without having to resort to intra-arterial puncture, exploratory
surgery, or the like. One such prior art technique provides for
recording a succession of arterial sounds (Korotkoff sounds) during
blood pressure measurement, simultaneously with a reference tracing
by an electrocardiograph, as more fully described in the following:
"Device for Indirect Registration of the Calibrated Arterial
Upstroke in Man," by Simon Rodbard and Roderick Mohrherr, published
in The Review of Scientific Instruments, Vol. 32, No. 9, pp.
1022-1023, September 1961; and "A Device for Objective Indirect
Recording of the Arterial Pressure and Related Data," by Simon
Rodbard and Thomas C. MacArthur, published in Medical Research
Engineering, Vol. 8, No. 4, 1969. Another prior art technique
provides for the recording and analysis of heart sounds and murmurs
by displaying such acoustics in an aligned consecutive series of
discrete impulses, as more fully set forth in the following: "A New
Technique for the Recording and Analysis of Heart Sounds and
Murmurs," by S. Rodbard and M. Keller, published in Cardiologia,
52: 145-153, 1969.
Another prior art technique provides for the generation of a
contourgraph of successive electrocardiogram waves such that each
wave is displayed in adjacent aligned relationship.
However, nothing has been developed to obtain and display in simple
composite form cardiovascular data for up to one hundred or more
successive cardiac cycles, including electrocardiogram (ECG)
waveforms, heart sounds, arterial (or Korotkoff) sounds, arterial
pressure waves, the systolic propagation time QKs, the diastolic
propagation time QKd, the systolic and diastolic arterial
pressures, the time consistency and patterns of the sequential
succession of such parameters, and therefore such obtaining and
displaying of cardiovascular data in the aforementioned manner are
a primary object of the invention.
Another object of the invention is to provide for automatic
recording of the aforementioned cardiovascular data, including
visual monitoring of the actual display of such data before making
a facsimile thereof for evaluation and storage.
A further object of the invention is to provide for intensity
and/or amplitude modulation of the ECG waves, heart sounds and
arterial sounds in order to accurately reflect the existence,
position and magnitude of such data.
A more specific object of the invention is to provide monitoring of
the performance of the heart and arteries by providing a microphone
for detecting the Korotkoff sounds resulting from applying a
variable external pressure to a specific artery, and a cathode ray
tube coupled to the microphones to produce a modulated output. A
related object is to couple the variable external pressure to the
cathode ray tube to establish the vertical quiescent position of
the output.
Another specific object is to provide a method and apparatus having
the aforementioned characteristics wherein ECG electrodes are
coupled to the cathode ray tube to initiate the horizontal sweep at
the onset of each successive cardiac cycle.
Another object is to provide an invention having the aforementioned
characteristics which allows time-sharing of the inputs of the
cathode ray tube in order for identification and calibration
indicia to be generated as part of the output.
Further purposes, objects, features, and advantages of the
invention will be evident to those skilled in the art from the
following description of the preferred and alternate embodiments of
the invention.
In the drawings:
FIG. 1 is a block diagram showing a system for obtaining and
displaying cardiovascular data which incorporates a presently
preferred embodiment of the invention;
FIG. 2 shows an alternative embodiment of the portion of FIG. 1
enclosed by broken lines;
FIG. 3 shows an exemplary form of data display for the embodiments
of FIGS. 1 and 2; and
FIG. 4 is a timing diagram showing how the system shown in the
embodiments of FIGS. 1 and 2 produces the exemplary form of data
display of FIG. 3.
Referring to the block diagram of the preferred embodiment of FIG.
1, a scan converter 10 includes a cathode ray tube having x-axis,
y-axis, and z-axis inputs at 11, 12, and 13, respectively. The
usual fluorescent screen is replaced by a memory tube for
temporarily storing the output of the cathode ray tube for such
time as is necessary for viewing on a connected television monitor
14 and also for "hard copy" reproduction by a connected facsimile
generator 15. A typical high resolution scan converter usable here
is made by Princeton Electron Products and incorporates a Lithocon
Storage tube, although high resolution storage scopes and the like
could also be used. Exemplary facsimile generators are made by
Tektronix and also by Alden.
A conventional sweep generator circuit 16 connects to the x-axis
input 11 and is activated by a Q-wave trigger device 17 which
initiates the horizontal sweep at a predetermined time in each
cardiac cycle, such as at time 18 when the Q deflection of a QRS
wave complex 19 occurs (see FIG. 4). ECG electrodes 20 connect
through an amplifier to the Q-wave trigger 17. A heart microphone
21 and an arterial vibration sensor 22 are provided to monitor the
performance of the heart and arteries during a succession of
cardiac cycles. A pressure cuff 23 applies variable pressure to a
specified artery being monitored by the arterial vibration sensor
22. The invention is not limited to any specific arterial vibration
sensor, so long as the sensor detects the existence and magnitude
of the vibrating "flitter" action of the artery walls resulting
from the combination of external cuff pressure and the internal
pressure wave generated from the heart. In this regard, ultrasonic
sensors are available which monitor the motion of the arterial
wall. However, in the preferred embodiment, a microphone is
employed to sense the arterial Korotkoff sounds generated by the
arterial vibrations.
These three voltage waveforms produced by ECG electrodes 20, heart
microphone 21, and arterial vibration sensor 22 are amplified, and
then transmitted through an analog adder and intensity modulator 24
to the z-axis input 13 and also through an analog adder and
vertical amplifier 25 to the y-axis input 12 of the cathode ray
tube. Both modulators 24, 25 include conventional analog adding
circuits to assure proper mixing of the incoming waveforms. The
pressure existing in the pressure cuff 23 is converted by a
conventional transducer to electrical form for passage through the
analog adder and vertical amplifier 25 to the y-axis input 12 to
vary the quiescent vertical position of the cathode ray tube output
in accordance with the variation of the cuff pressure. Typical
waveforms coming from the ECG electrodes 20, the heart microphone
21, the arterial vibration sensor 22, and the pressure cuff 23 are
displayed in the timing diagram of FIG. 4, along with the
concurrent voltage wave of the sweep generator 16 and a typical
arterial pressure wave passing through the artery being
monitored.
Referring now to FIGS. 3 and 4, the actual accumulation of
cardiovascular data occurs as follows. The patient to be examined
is placed in the desired position, such as reclining, and ECG
electrodes 20, heart microphone 21, arterial sensor 22, and
pressure cuff 23 are appropriately placed on the patient's body.
Typically, the arterial vibration sensor 22 is placed over the
antecubital fossa (opposite the elbow) and the pressure cuff 23 is
positioned around the upper arm. The cuff pressure is increased to
a pressure of 200 mm of Hg and then slowly decreased, as at the
rate of about 2 mm of Hg per second. At the same time a horizontal
sweep is initiated in the cathode ray tube at the Q-wave or onset
of each cardiac cycle, thus producing a succession of horizontal
plots in vertically aligned adjacent relationship (see FIG. 3).
In order to facilitate comparison and analysis of the
cardiovascular data waveforms of each successive csrdiac cycle, the
illustrated embodiment provides for suppression of the base line
output of the cathode ray tube by adjusting z-axis bias (intensity)
such that the base line is just suppressed, with zero amplitude
present at the y-axis input. Voltage input from any one of the
elements 20, 21, 22 produces a signal which varies both in
amplitude and intensity at the cathode ray tube output. Of course,
the invention contemplates either amplitude modulation or intensity
modulation alone where the need requires.
When the cuff pressure decreases to a point slightly less than the
systolic arterial pressure, the blood begins passing through the
artery and produces the first arterial sounds as at 26. During each
successive cycle, as the external cuff pressure is continually
decreasing, the arterial sounds are heard sooner, thereby making
the QK2 time less than the QK1 time for the preceeding arterial
pressure wave (see FIG. 4). Thus, the left side of the envelope of
arterial sound waveforms constitutes a reproduction of the leading
edge of the arterial pressure wave. The diastolic arterial pressure
is indicated by the cessation of the arterial sound waveforms, as
at 26a. The arterial sounds usually occur at both the onset of the
arterial pressure wave, as at time 27, and also at time 28 on the
decreasing portion of the pressure wave. The actual waveforms shown
in FIG. 3 are exemplary only both as to shape, specific
positioning, and number of cardiac cycles shown, but the general
representation of a sequence of heart sound waveforms and arterial
sound waveforms positioned in exact adjacent relationship relative
to a predetermined reference time in successive cardiac cycles as a
result of decreasing external arterial pressure has been found
useful in examining and studying more than 500 cardiovascular
patients. The inclusion in the display of an aligned sequence in
electrocardiogram waves has also been found useful, although in
some instances such display is not necessary, so long as ECG
electrodes or the like are used to generate the necessary
synchronizing pulse.
In order to provide initial information on the cathode ray tube
output for display adjacent the succession of waveforms, a
calculator 38 is connected through a character generator 29 to the
inputs of the scan converter 10. A grid line generator 30 is also
connected to the inputs. The calculator 38 is connected to the
arterial sensor 22 and the measures the systolic propagation time
QKs and the diastolic propagation time QKd, and can also be used to
sense the actual systolic and diastolic pressure magnitudes, as
well as make any other calculations deemed pertinent. This data can
be processed by a data logger and/or digital readout 31 to make it
independently accessible to the doctor, as well as being
transmitted to the character generator 29 for display purposes. The
character generator is a conventional type, and can also be used in
connection with a thumb-wheel switch or magnetically encoded card
to generate the patient's identification number for display
purposes. The grid line generator can be used for varying the
calibration of the output of the cathode ray tube. The output of
the character generator 29 and the grid line generator 30 as well
as the outputs of the intensity modulator 24 and the amplitude
modulator 25 all pass through control circuitry (not shown) to
allow the inputs of the cathode ray tube to be time-shared without
interfering with the display of data.
The combination of the scan converter 10 and the television monitor
14 enables the physician or operator to visually examine the output
display of the cathode ray tube to assure that the data is
reasonable, and that no malfunction has occurred in the system. If
desired, the facsimile generator 15 can then be actuated to produce
a hard copy for further examination and storage. In this regard, it
is possible to replace elements 10, 14, and 15 of FIG. 1 with an
oscilloscope 32 and camera 33 as shown in FIG. 2. However, the
alternative embodiment in FIG. 2 requires that the camera shutter
be kept open during the entire examination in order to store on the
camera negative each output of the cathode ray tube, thereby
requiring development of the film before being able to view the
display of cardiovascular data obtained. Of course, a camera would
be unnecessary if a storage scope were used. However, most storage
scopes currently on the market do not have sufficiently high
resolution for use here.
It will be appreciated from the foregoing that the invention
provides a unique method and apparatus for obtaining and displaying
cardiovascular data which greatly facilitates the analysis and
retention of such data in a way not heretofore possble.
Although exemplary embodiments of the invention have been disclosed
herein for purposes of illustration, it will be understood that
various changes, modifications, and substitutions may be
incorporated in such embodiments without departing from the spirit
of the invention as defined by the claims which follow.
* * * * *