U.S. patent number 3,776,221 [Application Number 05/130,572] was granted by the patent office on 1973-12-04 for detecting impaired heart mechanical performance and apparatus therefor.
Invention is credited to Kevin M. McIntyre.
United States Patent |
3,776,221 |
McIntyre |
December 4, 1973 |
DETECTING IMPAIRED HEART MECHANICAL PERFORMANCE AND APPARATUS
THEREFOR
Abstract
A pressure-sensitive device contacts the skin of a patient near
an artery noninvasively to provide a signal representative of
systemic arterial blood pressure both before and after a Valsalva
Manoeuvre. This blood pressure signal is differentiated, and the
changes in amplitude before and after the Valsalva Manoeuvre
detected to indicate potential left ventricle failure when the
change is less than a predetermined value. Signals representative
of pulse pressure, the mean systemic arterial blood pressure, heart
rate and left ventricular ejection time are also provided to
facilitate detection of impaired mechanical performance of the
heart.
Inventors: |
McIntyre; Kevin M. (Jamaica
Plain, MA) |
Family
ID: |
22445304 |
Appl.
No.: |
05/130,572 |
Filed: |
April 2, 1971 |
Current U.S.
Class: |
600/485;
600/508 |
Current CPC
Class: |
A61B
5/021 (20130101); A61B 5/7239 (20130101) |
Current International
Class: |
A61B
5/021 (20060101); A61b 005/02 () |
Field of
Search: |
;128/2.5A,2.5E,2.5F,2.5G,2.5M,2.5N,2.5P,2.5Q,2.5R,2.5T,2.05 |
References Cited
[Referenced By]
U.S. Patent Documents
|
|
|
2667159 |
January 1954 |
Goldberg et al. |
3154066 |
October 1964 |
Grindheim et al. |
3400709 |
September 1968 |
Funfstuck |
3412729 |
November 1968 |
Smith, Jr. |
|
Foreign Patent Documents
Other References
George et al., "Medical Research Engineering," 4th quarter, 1967,
pp. 21-24..
|
Primary Examiner: Kamm; William E.
Claims
What is claimed is:
1. A method of detecting mechanical heart impairment which method
includes the steps of,
noninvasively providing a blood pressure signal representative of
blood pressure by placing pressure sensitive means in contact with
the skin of a patient near an artery,
differentiating said blood pressure signal,
subjecting said patient whose blood pressure is characterized by
said pressure signal to a heart straining manoeuvre,
detecting the change in the amplitude of the differentiated
pressure signal after said manoeuvre from its amplitude before said
manoeuvre,
and determining a probable mechanical impairment of the heart when
said change is less than a predetermined value.
2. A method of detecting mechanical heart impairment in accordance
with claim 1 wherein said heart straining manoeuvre is a Valsalva
manoeuvre and said signal representative of blood pressure is
representative of systemic arterial blood pressure.
3. A method of detecting mechanical heart impairment in accordance
with claim 2 wherein said Valsalva manoeuvre is involuntarily
induced in said patient.
4. A method of detecting mechanical heart impairment in accordance
with claim 1 and further including the steps of providing signals
representative of systemic peak pressure, systemic mean pressure,
heart rate, and left ventrical ejection time both before and after
said manoeuvre and sensing the differences between respective
signals before and after said manoeuvre.
5. A method of detecting mechanical heart impairment in accordance
with claim 1 which method includes the steps of,
recording the differentiated blood pressure signal so that its peak
amplitude before said manoeuvre is between a baseline and
predetermined control line and observing the amplitude of said
differentiated blood pressure signal immediately after said
manoeuvre relative to a predetermined normal limit line spaced from
said control line to determine potential mechanical impairment when
the peak amplitude after said manoeuvre is between the control line
and the acceptable level line, mechanical heart impairment when
then below said control line and no mechanical impairment when
above said acceptable level line.
6. Apparatus for practicing the method of claim 1 comprising,
pressure sensitive means responsive to said blood pressure for
providing said blood pressure signal,
means for differentiating said blood pressure signal to provide a
differentiated pressure signal representative of the time
derivative of said blood pressure,
means for detecting the change in the amplitude of the
differentiated pressure signal after said manoeuvre from its
amplitude before said manoeuvre including means for recording said
differentiated pressure signal before and after said manoeuvre to
provide an indication of the changes in the differentiated pressure
signal before and after said manoeuvre,
and means for determining a probable mechanical impairment of the
heart when said change is less than a predetermined value.
7. Apparatus in accordance with claim 6 and further comprising
means responsive to said blood pressure signal for deriving signals
representative of heart rate, pulse pressure and peak pressure,
and means responsive to said differentiated pressure signal, said
heart rate, said pulse pressure and said peak pressure for
providing an indication of mechanical heart impairment.
Description
BACKGROUND OF THE INVENTION
The present invention relates in general to detecting impaired
mechanical performance of the heart and/or cardiac failure, and
more particularly concerns novel apparatus and techniques for
detecting such potential impairment in a reliable manner through
external measurements.
Since the introduction of aortic valvotomy, the assessment of
aortic valve disease has become increasingly important. On approach
to such an assessment involves studying recorded arterial pressure
pulse tracings. Stenosis is the narrowing of a blood passage, such
as the pulmonary artery or aortic valve. One approach to studying
stenosis is the so-called Valsalva Manoeuvre. The patient's blood
pressure is recorded prior to holding his breath. Then the patient
holds his breath and releases it while recording continues.
Reference is made to an article entitled THE VALSALVA MANOEUVRE IN
AORTIC VALVE DISEASE by Doyle and Neilson. The article states that
neither systolic upstroke time nor pulse pressure alone correlates
well with the severity of stenosis and that the shape of the pulse
derived during Valsalva Manoeuvre is an unreliable guide to the
relative dominance of stenosis or incompetence. That article
concludes that variations in pulse pressure during the Valsalva
Manoeuvre or in atrial fibrillation and variations of upstroke time
in the same pulses do not have a linear relationship to the
severity of stenosis when stenosis is present alone.
It is an important object of this invention to provide improved
techniques for detecting left ventricular impairment.
It is a further object of the invention to achieve the preceding
object with techniques and apparatus that permit detection by
relatively unskilled personnel.
SUMMARY OF THE INVENTION
According to the invention, the time derivative of the systemic
arterial pulse pressure is established at a control level in the
subject patient. Then the patient performs a straining manoeuvre,
such as Valsalva manoeuvre, while recording the time derivative of
the systemic arterial pulse pressure signal. Preferably, the
systemic arterial pulse pressure, mean pressure, heart rate and
left ventricular ejection time are also established and may be
interpreted so that the presence or absence of impairment in the
performance of the left ventricle may be detected. Specifically,
the time derivative of systemic arterial pressure responds in a
characteristic fashion in the presence of heart impairment; the
other parameters are useful in defining the expected normal
response of the time derivative of this pressure.
Numerous other features, objects and advantages of the invention
will become apparent from the following specification when read in
connection with the accompanying drawing in which:
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is a graphical representation of stroke volume as a function
of end-diastolic pressure on the left ventricle during a Valsalva
maoeuvre helpful in understanding the phenomenon with which the
invention is assocated;
FIG. 2 is a block diagram illustrating the logical arrangement of a
system according to the invention which includes means for
detecting left ventricle mechanical impairment; and
FIG. 3 is a graphical representation of time derivative of pressure
waveforms helpful in understanding the operation of the
invention.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
With reference now to the drawing, and more particularly FIG. 1
thereof, there is shown a graphical representation of stroke volume
as a function of end-diastolic pressure at the left ventricle
during a Valsalva manoeuvre. Curve 11 illustrates this relationshio
for a normal left ventricle. Point 1 represents the normal stroke
volume and end-diastolic pressure immediately prior to the patient
holding his breath. As the patient holds his breath and makes a
forceful expiratory effort without allowing air to escape from his
lungs (equivalent to straining at stool), both pressure and stroke
volume decrease along curve 11 to point 2 when the patient releases
his breath. Stroke volume and end-diastolic pressure then begin to
increase rapidly until point 3 is reached. This analysis indicates
that the time derivative of the pressure signal of a healthy
patient will increase significantly when he releases his breath.
Since other changes occur during the Valsalva manoeuvre which may
on occasion independently influence the response of stroke volume
and the time derivative of pressure, the influence of such changes
as heart rate and left ventricular ejection time are also
measured.
Curve 12 is the curve illustrating the relationship between stroke
volume and end-diastolic pressure of the left ventricle of a person
having left ventricle mechanical impairment. Point 1' is just
before the patient holds his breath. He then makes a forceful
expiratory effort without allowing air to escape. This initial
pressure (EDP) is somewhat higher and the initial stroke volume
(SV) usually somewhat lower than for a normal person, then
decreases to point 2' shortly before the breath is released. When
breath is released, the blood which was prevented from returning to
the heart does so at an increased rate, causing an increase in
end-diastolic pressure. During the positive pressure phase,
pressure generated in the chest exceeds the pressure of returning
blood.
In a patient with mechanical impairment of the heart, no increase
in stroke volume occurs with a rise in end-diastolic pressure
(position 3'), and this is detectable by a failure of the time
derivative of the systemic arterial pulse pressure to increase. The
range of changes which occur are acceptable in the individual
patient depending to some extent on changes in other parameters,
such as heart rate and left ventricular ejection time.
Referring to FIG. 2, there is shown a block diagram illustrating
the logical arrangement of a system according to the invention.
Basically the invention senses a recovery derivative signal to
indicate left ventricular impairment when this amplitude is equal
to or less than a predetermined value. To this end the invention
may include a number of different sources of a pressure signal. One
such source may be a piezoelectric pulse pick-up 11, an impedance
plethysmograph 12 or a sphygmamanometer 13 whose pressure signal is
converted by transducer 14 into an electrical signal that is
delivered to amplifier means 15. Each of these sources is pressure
sensitive means noninvasive of the human body and derives a signal
from contact with the skin surface near an artery. Amplifier means
15 includes means for amplifying one of the selected pressure
signals and providing the amplified pressure signal to
differentiator 16 that provides a differentiated pressure signal
for analysis.
The apparatus also may include computer analysis control recovery
means 21, which may receive a pressure signal from amplifier means
15 and a computer analysis control recovery means 22 for responding
to the time derivative pressure signal provided by differentiator
16. Computer analysis control recovery means 21 preferably responds
to heart rate, systemic arterial pulse pressure, peak systemic
pressure, systemic mean pressure and left ventricular ejection time
so that changes in these latter parameters may be used to more
accurately define the predicted normal range for the time
derivative of systemic arterial pulse and to provide a 1 signal to
indicate a condition consistent with left ventricular mechanical
impairment and a 2 signal to indicate a signal inconsistent with
left ventricular mechanical impairment. Similarly computer analysis
control recovery means 22 provides a 1 signal consistent with left
ventricular failure and a 2 signal consistent with no failure.
These 1 signals are applied to an AND gate 23 which provides an
output to indicate left ventricular of a second AND gate 24 that
provides an output to indicate no ventricular failure.
The invention may also comprise write-out means 25, which may be a
graphical recorder whose output may be manually analyzed or appear
on calibrated paper that automatically displays the presence or
absence of mechanical impairment.
Referring to FIG. 3, there is shown three pairs of pulses that
might be recorded during the course of a Valsalva manoeuvre. The
first pair of pulses 31 occurs prior to holding the breath. The
gain of amplifier means 15 is then adjusted so that the peak of the
time derivative pressure waveform just reached the control line 32
with baseline adjusted 31A. After the breath is released, if the
pulses have a height, such as that of pair 33, that is less than
level 34, left ventricular mechanical impairment is probable. If
they have a height greater than level 34, such as that of pulse
pair 35, there is no left ventricular impairment.
If the height is less than level 34, such as that of pulse pair 33,
then the heart rate signals, systemic pulse pressure signals, peak
systemic pressure signals, mean systemic pressure signals and left
ventricular ejection time signals are subjected to further computer
analysis to determine the extent to which certain of these
parameters may independently alter the time derivative signal. For
example, if changes in heart rate, the systemic arterial pulse
pressure, mean pressure, systolic peak pressure and left
ventricular ejection time are greater than a predetermined level, a
second independent reanalysis of the pressure derivative signal is
provided which takes into account the possible influence of changes
in the latter parameters on the time derivative of pressure. Such
an analysis is unlikely to be required in routine use but will
improve the accuracy of the instrument.
Details of the various elements of the system represented by the
boxes have not been described to avoid obscuring the principles of
this invention and because such elements are known to those having
ordinary skill in the signal analysis art.
For example, heart rate is readily determined by a digital counter
whose count is compared by known techniques with a predetermined
reference count equal to a control heart rate. The other two
pressures may be readily determined by analog comparison techniques
or by first converting these signals to digital values and making
the comparison digitally.
While the preferred embodiment of the invention contemplates
utilizing both derivatives and other signals in sensing for
mechanical impairment of the heart, the derivative signal itself
provided by differentiator 16 is most significant. Those skilled in
the art might also determine the derivative by analyzing the
pressure signal.
An advantage of differentiating before analyzing is that shifts in
d-c pressure levels are essentially removed so that the resultant
output signal waveform clearly represents a manifestation of the
change in rate of pressure as a function of time to facilitate
diagnosing left ventricular impairment.
There has been described novel apparatus and techniques for
facilitating the detection of mechanical heart impairment by
relatively unskilled personnel. It is evident that those skilled in
the art may now make numerous uses and modifications of and
departures from the specific embodiments disclosed herein without
departing from the inventive concepts. Consequently, the invention
is to be construed as embracing each and every novel feature and
novel combination of features present in or possessed by the
apparatus and techniques herein disclosed and limited solely by the
spirit and scope of the appended claims.
* * * * *