U.S. patent number 3,757,778 [Application Number 05/106,008] was granted by the patent office on 1973-09-11 for electrocardiograph lead distribution and contact testing apparatus.
This patent grant is currently assigned to Comprehensive Health Testing Laboratories, Inc.. Invention is credited to Martin H. Graham.
United States Patent |
3,757,778 |
Graham |
September 11, 1973 |
ELECTROCARDIOGRAPH LEAD DISTRIBUTION AND CONTACT TESTING
APPARATUS
Abstract
An electrocardiograph apparatus including a recorder
electrically connected by a patient cable to a number of electrical
terminals in a distribution head so that each terminal forms a
contact point for a series of lead wires each adapted to receive
electrical impulses from a selected location of the patient's body.
To assist verification of correct interconnection, the distribution
head incorporates the configuration of a schematic representation
of the body with the position of each distributor terminal
corresponding to actual examination locations on the patient. As
another verification check, the lead wires may be of varying length
corresponding to the distance between the terminals and the
patient's contact points. An indicator light in the
electrocardiograph circuit is de-energized upon establishing
connection with the patient to indicate satisfactory contact.
Electronic circuitry is provided for comparing and controlling
various voltages and reference ground with the patient to derive
standard output signals commonly used in EKG analysis.
Inventors: |
Graham; Martin H. (Berkeley,
CA) |
Assignee: |
Comprehensive Health Testing
Laboratories, Inc. (San Francisco, CA)
|
Family
ID: |
22308991 |
Appl.
No.: |
05/106,008 |
Filed: |
January 13, 1971 |
Current U.S.
Class: |
600/508;
128/902 |
Current CPC
Class: |
A61B
5/276 (20210101); A61B 5/303 (20210101); Y10S
128/902 (20130101) |
Current International
Class: |
A61B
5/0408 (20060101); A61B 5/0402 (20060101); A61B
5/0428 (20060101); A61B 5/0424 (20060101); A61b
005/04 () |
Field of
Search: |
;128/2.6A,2.6B,2.6E,2.6F,2.6G,2.6R,2.6V,2.1B,2.1R,DIG.4 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Claims
I claim:
1. In electrocardiograph apparatus, a distributor having a
plurality of input terminals for receiving electrical signals
generated at selected positions on a patient under examination, a
plurality of input leads terminating in electrodes adapted to be
placed into contact with the patient and connected to said
terminals, buffer amplifier means associated with said leads for
accepting a high imput impedance signal from the patient and for
converting it to a low output impedance signal, extended cable
means for connecting the low output impedance signals from said
distrubutor to remote amplifying and recording means, a driven
ground circuit including means for sensing induced voltages in the
patient and means responsive to said last named means for
introducing a compensating voltage to one patient electrode whereby
the voltage of the patient is kept zero relative to ground, and
further in which said means for sensing induced voltages in the
patient consists of a filter circuit selectively sensitive to low
frequency signals and insensitive to high frequency signals, a
differential output for receiving signals from said filter circuit,
a ground sensing means for providing a second input to said
differential amplifier.
2. An electrocardiograph apparatus comprising a distributor having
a plurality of input terminals for transmitting electrical signal
generated at selected positions on a patient under examination, a
plurality of input leads terminating in electrodes adapted to be
placed into contact with the patient, buffer amplifier means
associated with said leads for accepting high input impedance
signals from the patient and for converting them to low impedance
output signals, extended cable means for connecting the low
impedance output signals from said distributor to a remote
amplifying and recording means, a summing circuit for adding
certain ones of said output signals to derive a common signal,
differential amplifier means connected to at least two different
ones of said buffer amplifier means and summing circuit to amplify
the output thereof, means forming a DC sensing circuit with respect
to the DC level of the patient and including a feed-back loop for
supplying a DC bias signal to the input of said differential
amplifier, said feed-back loop having means to define a first
sensitive condition for controlling base line drift including means
for applying DC bias to the input of said differential amplifier,
said drift control means being operable within approximately .+-.
one-half volt position, and means for establishing circuit
centering in which the total voltage wave form of an incoming
signal is sensed and said signal centered within .+-. one and
one-half volt to define a second sensitive condition and means for
selectively controlling the operation of said first and second
conditions of said feed-back loop.
3. In an electrocardiograph system of the type employing an
electrocardiograph having input terminals, apparatus for
interconnecting said electrocardiograph to a patient including
distributor means, a plurality of first leads coupled between said
electrocardiograph input terminals and said distributor means for
transmitting thereto electrical signals from said distributor
means, said first leads adapted to permit remote location of said
distributor means in the immediate proximity of the patient,
diagram means formed on said distributor means for forming an
outline representation of a human form showing body, arms and legs
thereon, a plurality of terminal locations formed on said
representation, and including right and left arm, right and left
terminal locations and chest terminal locations, at least said arm
and leg terminal locations being positioned on the corresponding
leg or arm of said representation, a plurality of second leads
terminating in electrodes adapted to be placed in contact with the
respective examination point on the patient, and including at least
right and left arm, right and left leg, and chest leads and
connected to the respective ones of said terminal locations, said
second leads adapted to extend from the respective terminal
locations on said distributor means to the proper examination point
of said patient, circuit means within said distributor for
connecting said second plurality leads to said first plurality of
leads, said circuit means including a plurality of identical buffer
amplifiers respectively connected to each electrode lead for
accepting a high input impedance signal from the patient and for
converting the signal to a low output impedance, indicator means
responsive to proper contact of any of said electrodes with the
patient to give a visual signal thereof, said indicator means being
disposed adjacent to each related terminal location on said
distributor means, said indicator means including a light source
and a means responsive to a shift in impedance caused by contact of
an electrode to the patient to de-energize said light source upon
proper connection being established to the patient.
4. A device as in claim 3 wherein said distributor means has a
shape including essentially flat surface on which said
representation is formed.
5. A device as in claim 3 wherein said distributor means itself is
formed in a doll-like representation of the human form.
Description
BACKGROUND OF THE INVENTION AND OBJECTS
Electrocardiographs are widely used in cardiology to examine
patients for their function irregularities. These devices produce
electrocardiogram strip charts in response to electrical signals
produced by sensing various points of the body by electrodes from
which lead wires connect to terminals on the electrocardiograph. In
connecting such leads to the body, there is a standard system for
the placement of each specific lead so that the resulting recording
is presented as a standard format to facilitate reading and
analysis. Such systems include the standard 12-lead system and the
Frank system, and may use identifiers to indicate proper connection
points such as the abbreviations RA, LA for the right and left
arms. This type of labeling has usually been placed on the patient
cable junction or at the end of each lead wire to specify the
proper connection.
The above type of electrocardiograph system is subject to two
principal sources of error. First, there are enough leads that
frequently the lead for a specific portion of the body is
mislocated by the technician. A second source of error is that of
the technician making insufficient electrical contact of the
electrode to the patient thereby resulting in an inaccurate
electrocardiogram.
Also, the electrical signals being sensed are small and subject to
electrical interference, particularly where remote station
operation is desired, and there is, therefore a need for a new and
improved electrocardiograph apparatus.
SUMMARY OF THE INVENTION AND OBJECTS
In general, it is an object of the present invention to provide an
electrocardiograph apparatus which overcomes the above
disadvantages and limitations.
It is a more particular object of the invention to provide a
distributor in the above system which decreases the probability of
human error in mislocating the lead wires on the patient.
It is another object of the invention to provide in the above
system an indicator responsive to faulty contact of the electrodes
with the patient.
Another object of the invention is to provide a distributor and
electrocardiograph apparatus of the above character which is
adapted for multistation use with a single electrocardiograph
recorder.
The invention is directed to electrocardiograph apparatus in which
an electrocardiograph base station provides a plurality of
electrical input terminals for receiving electrical signals and for
amplifying and recording such signals. A patient cable is also
provided and terminates in a remotely located distribution head
having a distribution means including a plurality of lead wires
each adapted to receive electrical impulses from an electrode
positioned at selected examination regions of the patient. The head
is provided with a representation of the human body and the lead
wires emerge from the distribution head at regions of said
representation corresponding to actual examination regions on the
patient. In one preferred embodiment indicator lights are
associated on the representation adjacent to each of the associated
examination regio-s and serve to provide visual indication of the
effectiveness of connection of the electrode. One suitable
indicator is a small electric light which remains energized until
proper connection of the electrode is made to the patient.
The distribution head is provided with electronic circuitry for
facilitating remote electronic operation and includes preamplifier
buffer stages, driven ground control circuit and summing amplifier
for generating a common signal. In one form of the invention
commercial electrocardiograph may be employed, but preferably an
electrocardiograph of the present invention is used and provides
special trace control and centering functions.
Additional objects and features of the invention will be apparent
from the following description in which the preferred embodiments
are set forth in detail in conjunction with the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a drawing illustrating the electrocardiograph apparatus
of the present invention.
FIG. 2 is an electrical schematic of a representative portion of
the circuitry used in the apparatus of FIG. 1.
FIG. 3 shows a block diagram of the circuit of the
electrocardiograph apparatus of the present invention.
FIG. 4 shows a schematic diagram of a buffer preamplifier circuit
of the apparatus of FIG. 3.
FIG. 5 shows a summing amplifier circuit as used in the apparatus
of FIG. 3.
FIG. 6 shows a schematic diagram of a driven ground circuit
constructed for use in the apparatus of FIG. 3.
FIG. 7 shows a schematic diagram of trace control circuitry as used
in the circuit of FIG. 3.
FIG. 8 shows another embodiment of the distribution head for use
with the apparatus of FIG. 1.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to FIG. 1, there is shown an electrocardiograph system
constructed in accordance with the present invention and includes
an electrocardiograph signal processor and recorder 11 such as is
shown in detail in FIG. 3. Commercial electrocardiographs such as
Model 5000 manufactured by Hewlett Packard Corporation of Palo
Alto, California or Brush Model 260 manufactured by Brush
Instruments of Cleveland, Ohio, may also be employed with reduced
features.
The electrocardiograph 11 input is electrically connected by a
multiconductor patient cable 12 to a remote distribution head
13.
Distribution head 13 consists of a case 13a which contains the
associated electronics and incorporates a representation 10 of a
human form from which associated terminals connect to respective
ones of a plurality of lead wires 15a-j. Each lead wire is disposed
upon representation 10 in positions corresponding to the desired
point of connections to the patient such that terminal 14a, wire
15a emerges from the right arm of the representation; terminal 14b,
wire 15b the left arm; and 14c, 15c and 14d, 15d emerge from the
left and right foot respectively. Terminals 14e-j and wires 15e-j
are located in any convenient position, such as on the side of the
distribution head, and correspond to chest connections commonly
designated V.sub.1 - V.sub.6. If space permits, these are
preferably placed in corresponding positions on the chest of the
representation as shown in FIG. 1 and indicated as terminals 14e' -
14j'.
The other ends of lead wires 15a-j are connected to electrodes
16a-j respectively of the conventional type and style which are
adapted for connection with selected external portions of a patient
at corresponding contact points 17a-j respectively for the sensing
of body functions thereat and transmission of electrical impulses
from the patient's circulatory system. For these small impulses to
be transmitted with repetitive accuracy to recorder 11, it is
important that a reproducible contact be established at points
17a-j. For this purpose, known procedures such as the application
of conductive adhesive liquids or creams may be used between the
electrode transducers 16a-j and patient 19 before placement.
As shown in FIG. 1, the representation 10 on distribution head 13
can be formed with a planar surface 18 having an outline in the
general shape of the human body and may be of contrasting color to
that of the case itself. Thus, terminals 14a-j are disposed on
surface 18 corresponding to the proper points of application on
patient 19, i.e., the proper patient contact points 17a-j so that
each body terminal is associated with a point 14 on the
representation 10 corresponding to the point 17 on the patient 19
to which the respective wire and electrode should be attached. This
arrangement enables the electrocardiograph technician to instantly
locate and verify the proper one of electrodes 16 for each contact
point 17 on the patient by placing the distribution head on or
adjacent the patient in the same general orientation used with the
primary aid of physical correspondence connecting each associated
electrode to the patient.
As an even further check on the correct placement of the lead
wires, terminals 14 can be labeled according to common designations
used in the industry (e.g., RA for right arm, RF for right foot,
V.sub.1, V.sub.2, V.sub.3 . . . V.sub.6 for particular areas of the
chest, etc.). Color labeling may be used in addition to or in place
of such letter labeling.
In a further verification feature of the present invention, the
distributor box is located in close proximity to the patient and
the lead wires connected to the contact points are of varying
length corresponding to the approximate distances between the
terminals on the box and the contact points on a patient of average
size with only sufficient excess length to accommodate tall
patients. The distributor box can be positioned at any point near
the patient, such as directly on his chest or adjacent to him. By
this arrangement, on a proper mating of body terminals distributor
terminals, each lead wire is of sufficient length for
interconnection with its corresponding terminals. On the other
hand, if a technician mistakenly links a terminal associated with a
long lead (e.g., a leg terminal) with a contact point only
requiring a short lead wire (e.g., a chest terminal), this error
will become apparent with the difficulty encountered in an attempt
to connect the remaining chest terminal, with a short lead wire, to
the leg contact point.
Referring to FIGS. 1-2, indicator means are provided for visually
indicating inadequate coupling between patient 19 and EKG 11 via
lead wires 15 and electrodes 16. The indicator means preferably
takes the form of individual lights 21a-j connected respectively in
each electrode circuit as shown, lights 21a-j are physically
positioned adjacent each respective terminal 14a-j and in this
manner, each respective light is energized next to that terminal of
any lead wire that remains inadequately connected to the
patient.
Since distribution head 13 is mobile, it is usually placed near the
subject. Thus, it is quite convenient to locate the indicators and
terminals directly on head 13. Furthermore, due to the availqbility
of minute transistors and integrated circuits, it is preferable to
also place buffer preamplifier circuitry required to amplify the
electrical impulse received from each point on the patient directly
in the distribution head. In this way, the present arrangement
facilitates the use of one recording system 11 or console with
multiple remote patient examination stations each station employing
its own remotely operated distributor and preamplifier box. And,
the signal emitted from distributor box 13 is then strong enough to
be relatively unaffected by any noise or loading introduced by
cable 12, and accordingly, long arrangements from remote stations
located far from the basic EKG console can be used.
Referring to FIG. 2, there is shown an example of one suitable
logic circuit for a single EKG connection point 17a and associated
terminal such as 14a. It is to be understood that each of the
points 17 is provided with such a circuit constructed and operated
in a similar manner.
As shown in FIG. 2, let it be assumed that the electrode 17a and
associated wire 15a terminate on the input lead 31a of an
operational amplifier used as a bridging amplifier stage 33a
connected as shown. Also assume that the patient is grounded or
referenced to a given potential. When lead 31a and electrode 17 are
not properly connected to the patient, they represent an open
circuit and the potential at lead 31a can follow the input current
of the operational amplifier. For that shown, such an input current
tends to drive the output to full negative voltage (or the reverse
for transistors of opposite polarity).
When electrode 17a is properly connected to the patient, the
resistance across the input (lead 31a) is that of electrode 17a and
the patient, of the order of a few thousand ohms. This is a
sufficient change from the open circuit condition, whereby a
significant and measurable change in the input voltage will occur,
by which the input electrode 31a goes from a negative voltage to a
nearly zero voltage condition.
The output of amplifier 33a is connected to the input of a
transistor amplifier 41a for detecting this change in voltage and
for turning off the signal light 21a whenever the negative voltage
on lead 31a drops below a predetermined threshold level. For, when
the associated electrode is disconnected the full negative voltage
is applied to the base 43 of a pnp transistor 45. Each respective
one of lamps 21a is wired in series in the collector circuit of the
transistor. Thus, negative base voltage turns on the transistor,
permitting current to flow to the grounded emitter. When the
electrode 17 is properly connected the output of the operational
amplifier is nearly zero volts and transistor 45 is thereby turned
off.
FIGS. 3-8 illustrate another preferred form of circuitry for
carrying out the present invention which also incorporates special
trace control and centering circuits as well as driven ground
circuitry as will be hereinafter explained. Thus, as shown in FIG.
3, the distributor 13 contains a plurality of buffer preamplifiers
102-110, a driven ground circuit 112, and a summing amplifier 114.
Each lead from an electrode 16 attached to the patient 19 is
brought through the appropriate distributor terminal 14 and passes
to an input buffer preamplifier (102-110), the circuitry of which
is illustrated in detail in FIG. 4. It is to be understood that
each of the buffer preamplifier circuits could alternately be
substituted by the circuit of FIG. 2, if desired.
Each of amplifiers 102-110 is of the circuitry form shown in FIG. 4
and consists of a field effect transistor (FET) first stage
followed by a bipolar transistor second stage connected such that
the collector of the FET 120 lies in the base circuit of the
bipolar transistor 122. This circuit has the property that is
presents a very high input impedance to the incoming signal and
converts the signal to a low output impedance suitable for being
carried on an extended cable 12 which connects the low impedance
output of the distributor output terminals 17 at the patient to a
remote amplifying and recording means to be hereinafter described.
Such a cable illustrated within the circle labeled 116 (FIG.
3).
A diode 124 is connected across the input to thereby ground the
same through the diode voltage drop so that no long term drift in
open circuit operating potentials can appear at the electrode
before the same is connected to the patient.
The summing amplifier 114 (FIG. 5) receives the RA, LA and LF
outputs representing right arm, left arm and left foot and through
matched input resistance, the sum of these signals appears at the
input of a differential amplifier 125 from which a common signal is
derived via line 115. The common signal on output lead 115 is also
connected to the trace and centering control amplifiers, 141-148.
This common signal via lead 115 is used as a reference signal
against which the signals V.sub.1 -V.sub.6 are compared in the
latter circuits.
The preamplifier section also contains a driven ground circuit 112,
including a filter means 113 for sensing induced 60 and 120 cycle
voltages induced in the patient and for comparing such induced
voltages with a ground potential level supplied by an amplifier
having the same offset characteristics as an associated one of the
buffer amplifiers 102-110. In this way filter 113 prevents
oscillation of circuit 112 while still providing effective
operation in the range of interest, that is up to 180 Hz.
Referring particularly to FIG. 6, there is shown resistances and
capacitances as indicated on the drawing and making up a filter
circuit 113 upstream of the input 117 to a differential amplifier
118. While any of the various voltages from the patient could be
taken as a reference input, the particular input voltage that has
been arbitrarily selected to be taken is from the left arm LA via
amplifier 103.
An FET amplifier 119 supplies a ground reference signal having the
same offset characteristics as the remaining buffer amplifiers
104-110. The output of amplifier 119 is applied to the other input
of differential amplifier 118, the output of which is carried
through a resistance 121 of the value shown and thence to the
electrode attached to the right foot.
In this way, differential amplifier 118 serves to respond to
changes in the induced voltages of the patient to supply a
compensating voltage which drives the patient through the right
foot to a zero potential relative to the ground potentials defined
by the outputs of the various FET amplifiers 120. The remaining
portion of FIG. 6 corresponds to that of FIG. 4 and need not be
again described in detail.
By selecting the values shown for the elements of filter 113, the
input to differential amplifier 118 via line 117 is selectively
sensitive to low frequency signals, such as 60 cycle voltages, and
is relatively insensitive to high frequency signals, such as those
produced by the electrical characteristics of the patient.
Referring now to FIGS. 3 and 7, the various outputs of the
distributor are connected through the extended cable 116 to the
inputs of tracing amplifier and centering control circuits 141-148
as is common in the practice of the electrocardiogram art. Thus,
the left arm and right arm inputs (LA, RA) are applied to one
differential pair (141) while the left arm and left foot (LA, LF)
form another (142). The difference signals being commonly termed as
"I" and "II" outputs from which "III", aV.sub.L, aV.sub.R and
aV.sub.F outputs are derived by standard sum and difference
amplification.
Likewise, signals from the various chest electrodes V.sub.1
-V.sub.6 and from common 114 are differentially compared to derive
six outputs V.sub.1 -V.sub.6 as is known in the art. Each of these
comparisons is preferably made with differential amplifier
circuitry which compares the output of at least two different
buffer amplifier and summing circuits to derive an output signal,
such as differential amplifiers which consist of suitable
integrated circuits as are now commonly available (FIG. 7) and
preferably consist of a pair of series connected operational
amplifiers 127, 128 having a gain of the order of 20K with a
feed-back stabilization loop represented by resistances R6 and R7
and R8 in FIG. 7. The overall amplification is approximately
1,000.
Another feed-back loop is connected between the output of amplifier
128 and one input signal lead 129 and consists of resistors R12 and
R17 connected in series through an oppositely connected pair of
diodes CR1 and CR2 to the high input impedance operational BB3308
amplifier 130. The output of amplifier 130 is taken through R11 to
the input 129 of differential amplifier 127 to provide for DC
voltage offset as will be described.
The junction of R17 and R12 is bypassed to ground through a "ready"
circuit 133 consisting of a 33,000 ohm resistance 131 and a
transistor Q3 and is also bypassed directly to ground through a
"run" circuit 134 consisting of transistor Q2.
In operation, the sensitivity of the circuit is established by the
diode CR1 and CR2 such that whenever the output voltage appearing
at junction of R12 and R17 exceeds .+-. one-half volt, that voltage
is impressed upon the integrating amplifier 130 to thereby cause
the input circuit 129 to receive a compensating voltage. In this
manner, the output 132 is maintained at a DC level somewhere
between .+-. one-half a volt.
When the electrodes have been connected to the patient, and it is
desired to begin an electrocardiogram trace, the "ready" circuit
133 is activated by connecting suitable voltage through resistor
R15, diode CR3 and to the base electrode of transistor Q3. This
causes reduction in the sensitivity of the diode circuit CR1, CR2
because of the low impedance path to ground through Q3 and R9. The
value of the resistance R9 is such that the reduction in
sensitivity permits the draft voltage to be uncentered by as much
as .+-. one and one-half a volt during the "ready" position.
After "ready" circuit 133 has been utilized, the final trace is
taken by actuating the "run" circuit 134 via resistor R14 and
transistor Q2. This circuit effectively grounds the input of the
feed-back loop which is clamped by the action of the voltage drop
across R17 and therefore the offset voltage remains wherever it was
between .+-. one and one-half a volt.
A recorder output circuit 136 is also formed by Q1, R13 and CR5
such that whenever run circuit 134 is actuated, the signal output
is taken from collector 135 for recording output 137. In this way,
any drift in DC potential or from an electrode or anywhere else in
the circuit can only drive the tracing off scale after recording is
commenced and the EKG attendant or interpreter will have no doubt
that there has been no spurious correcting signals applied during
the trace in order to maintain circuit centering.
Generally, the operator actuates the "ready" circuit for a little
while just before the recording commences, by way of example, for a
few heart beats, and during that time the centering action is such
as to permit the entire EKG trace to center up on the graph paper.
In so doing, it should be realized that the base line is permitted
to move anywhere within the range o of the ready circuit, i.e.,
.+-. one and one-half volt. Thereafter, the "run" circuit 134 is
actuated to clamp the setting at a fixed value.
Another embodiment of distributor is shown in FIG. 8 in which a
distribution head 20' is formed in a three-dimensional schematic
representation of the human body in the form of a doll. The
elements 14, 15, 16 and 17 (a-j) of the embodiment of FIG. 8 are of
the same type as the corresponding elements described with respect
to FIG. 1 and are therefore given the same numbers but with the
addition of a double prime mark (").
* * * * *