U.S. patent number 3,923,041 [Application Number 05/342,701] was granted by the patent office on 1975-12-02 for cardiac signal augmentation apparatus.
This patent grant is currently assigned to Medtronic, Inc.. Invention is credited to Louis C. Cosentino, Peter Stasz.
United States Patent |
3,923,041 |
Stasz , et al. |
December 2, 1975 |
Cardiac signal augmentation apparatus
Abstract
Apparatus for receiving pacemaker artifact signals and EKG
signals having means for separating the artifact from the EKG,
standardizing the artifact, and recombining the signals for use,
for example, in telephone transmission. The apparatus also includes
means for monitoring the pacemaker rate.
Inventors: |
Stasz; Peter (Minneapolis,
MN), Cosentino; Louis C. (Wayzata, MN) |
Assignee: |
Medtronic, Inc. (Minneapolis,
MN)
|
Family
ID: |
23342918 |
Appl.
No.: |
05/342,701 |
Filed: |
March 19, 1973 |
Current U.S.
Class: |
600/510;
607/27 |
Current CPC
Class: |
A61B
5/0006 (20130101); A61N 1/3702 (20130101); A61B
5/7217 (20130101) |
Current International
Class: |
A61B
5/00 (20060101); A61N 1/37 (20060101); A61N
1/362 (20060101); A61B 005/04 () |
Field of
Search: |
;128/2.5R,2.5T,2.6A,2.6F,2.6T,2.1A,419PG,419PT,419R,421,422,423 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Furman et al., "Journal of Thoracic & Cardiovacular Surgery,"
Vol. 61, No. 5, May, 1971, pp. 827-834..
|
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Schwartz; Lew Sivertson; Wayne
Claims
What is claimed is:
1. In cardiac instrumentation apparatus including electrode means
adapted to be connected to a body to receive cardiac pacer pulses
and EKG pulses, the improvement comprising: input means for
connection to the electrode means to receive the pulses; output
means; EKG channel circuit means; cardiac pacer pulse channel
circuit means; the EKG channel means including first means for
substantially blocking pacer pulses; the pacer pulse channel means
including second means for substantially blocking EKG pulses; means
connecting the first and second means to the input means; third
means for providing uniform pacer pulses in response to pacer
pulses; means connecting the third means to the second means;
summing means connecting the first and third means to the output
means for summing the EKG pulses with the uniform pacer pulses
prior to output; and the output means connected to means for
receiving and displaying pulse information representative of the
input signal.
2. The apparatus of claim 1 in which: the first means comprises
limiter means for preventing undistorted passage of pulses having a
rate of rise over a predetermined rate.
3. The apparatus of claim 2 in which: the limiter means comprises a
slew-rate limiter.
4. The apparatus of claim 1 in which: the second means comprises
filter means for passing cardiac pacer pulses and substantially
blocking EKG pulses.
5. The apparatus of claim 1 in which the third means includes:
absolute value amplifier means; monostable multivibrator means; the
amplifier means connected between the second means and the
multivibrator means; and the multivibrator means connected between
the amplifier means and the summing means.
6. The apparatus of claim 1 including: rate circuit means for
sensing the rate of cardiac pacer pulses; the rate circuit means
including rate display means; and means connecting the rate circuit
means to the third means.
7. The apparatus of claim 6 in which: the rate display means
comprises visual indicator means for providing a signal dependent
on the pacer pulse rate.
8. In cardiac instrumentation apparatus including electrode means
adapted to be connected to a body to receive cardiac pacer pulses
and EKG pulses, the improvement comprising: input means for
connection to the electrode means to receive the pulses; DC
amplifier means, slew-rate limiter means; AC amplifier means;
summing means; means connecting the DC amplifier means between the
input means and the limiter means; means connecting the AC
amplifier means between the limiter means and the summing means;
means connecting the summing means to the output means; high pass
filter means; second AC amplifier means; absolute value amplifier
means; monostable multivibrator means; means connecting the filter
means between the DC amplifier means and the second AC amplifier
means; means connecting the absolute value amplifier means betweeen
the AC amplifier means and the multivibrator means; means
connecting the multivibrator means to the summing means; and output
means connected to the summing means for receiving and displaying
information therefrom.
9. The apparatus of claim 8 including: means connected to the
multivibrator means for sensing cardiac pacer pulse rate; and means
for visually indicating when the rate has changed by a
predetermined percentage.
Description
BACKGROUND OF THE INVENTION
The use of cardiac pacers to sustain life in heart disease cases is
well-known. It is also well-known that cardiac pacers provide an
electrical stimulation pulse to the heart, hereinafter referred to
as pacer artifact pulses or pacer pulses, and that when the heart
beats normally or in response to an electrical stimulation pulse it
provides an electrical wave form called an electrocardiogram pulse,
hereinafter referred to as EKG signals or pulses.
In the prior art, various means of sensing and recording the pacer
artifact and EKG have been available. It has also been found
advantageous to provide equipment which makes the information
concerning the sensed artifact and EKG pulses available to the
patient, and to transmit such information to a remote station such
as a doctor's office, for example by a telephone system. One
example of a telephone transmission system is U.S. patent
application Ser. No. 235,252, filed: Mar. 16, 1972, entitled
EVALUATION SYSTEM FOR CARDIAC STIMULATORS and assigned to the
Assignee of this invention.
It has been discovered that a major problem exists in the recording
and transmission of pacemaker artifacts and EKG signals; the
problem is the result of the large voltage ratio between the pacer
artifact signal and the EKG signal. When this ratio is large, the
EKG signal baseline will be shifted to the discharge baseline of
the pacer artifact signal, thus distorting the EKG pulses. A large
artifact signal can also produce offscale deflection of a recorder
with possible damage to the recording mechanism and dynamic
aberrations due to such problems as amplifier overloads.
To overcome this problem, the apparatus of this invention separates
and separately processes the EKG and pacer artifact signals, and
augments the pacer artifact by providing a uniform or standardized
pacer artifact pulse.
BRIEF DESCRIPTION OF THE INVENTION
Briefly described, the apparatus of this invention provides means
for receiving the cardiac pacer artifact pulses and EKG pulses.
First and second electrical channels are provided: the first
channel having apparatus for substantially blocking pacer artifacts
while passing the EKG pulses; the second channel having means for
blocking the EKG pulses while passing the pacemaker artifact
pulses, and means responsive to the pacemaker artifact for
providing a uniform or standardized pacemaker artifact pulse. In
the preferred embodiment the amplified EKG signal from the first
channel and the standardized pacemaker artifact pulse from the
second channel are recombined or summed prior to output. The output
is then available to be attached to recorder units, or provided to
transmission apparatus such as a telephone system. Also provided in
the preferred embodiment is a rate monitor system for detecting the
rate of operation of the cardiac pacer and providing a signal when
the pacer rate is within predetermined boundaries.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a block diagram of the apparatus of this invention;
FIG. 2 is a schematic drawing of a portion of the apparatus of this
invention referred to as a slew-rate limiter;
FIG. 3 is a combined schematic and block diagram of a portion of
the apparatus of this invention referred to as the rate
monitor.
DESCRIPTION OF THE PREFERRED EMBODIMENT
In FIG. 1 there is shown an input 10 which is adapted to be
connected to means such as electrodes which are in turn adapted to
be connected to or placed in receiving position relative to a body
for the purpose of receiving pacemaker artifact pulses and EKG
pulses. Input 10 is connected to the input of a DC amplifier 11.
The output of amplifier 11 is connected to the input of a slew-rate
limiter 12 and to the input of a high pass filter 18.
Limiter 12 is connected through a capacitor 13 to the input of an
AC amplifier 15. The input of amplifier 15 is connected through a
resistor 14 to ground. The output of amplifier 15 is connected to a
first input on a summing circuit 16. The output of summing circuit
16 is connected to an output 26.
The output of filter 18 is connected through a capacitor 19 to the
input of another AC amplifier 22. The input of AC amplifier 22 is
connected through a resistor 21 to ground. The output of amplifier
22 is connected to the input of an absolute value amplifier 23. The
output of amplifier 23 is connected to the input of a monostable
multivibrator 24. The output of multivibrator 24 is connected to a
junction 25. Junction 25 is connected to another input of summing
circuit 16, and is connected to the input of a rate monitor 28.
Output 26 is adapted to be connected to recording or transmission
apparatus, such as an input 50 connected to the input of a voltage
controlled oscillator 51 which has an audio output device 52 for
use with a telephone transmission system.
In operation of the apparatus of FIG. 1, the cardiac pacer
artifacts and EKG pulses appearing at input 10 will be amplified by
DC amplifier 11 and presented to limiter 12 and filter 18. At this
point the pacer pulses and EKG pulses are separated for individual
processing and augmentation. The EKG pulse channel includes
slew-rate limiter 12 which limits the pacer pulse to a maximum rate
of rise of a predetermined value, selected in the preferred
embodiment to be approximately 10 volts per second. The operation
of slew-rate limiter 12 insures that the large amplitude of the
short, sharp pacer artifact is limited and therefore will not
introduce drastic EKG pulse baseline shifts. Signals will pass
undistorted through slew-rate limiter 12 as long as the signals do
not exceed the amplitude-frequency limits of limiter 12.
The EKG signal which appears at the output of limiter 12 is AC
coupled through capacitor 13 and resistor 14 into AC amplifier 15
for the purpose of bringing the signal up to a level where it can
be used to modulate devices such as voltage controlled oscillator
51. The AC coupling of capacitor 13 and resistor 14 is found to be
highly desirable because if a DC component were present it could
saturate amplifier 15 due to the high gain in the total system.
The pacer pulse and EKG signal also appear at the input of high
pass filter 18. This filter will substantially attenuate the EKG
pulses to substantially block them from this channel. The output of
filter 18 is AC coupled, through capacitor 19 and resistor 21, to
the input of AC amplifier 22. The AC coupling also serves to
differentiate the artifact to give pulse spikes at the output of
amplifier 22, which spikes correspond to the leading and trailing
edges of the cardiac pacer artifact pulse. The output of amplifier
22 is then sent through an absolute value amplifier 23, of a design
well-known to those skilled in the art. Amplifier 23 will provide
an output of positive going pulses regardless of the actual
polarity of the pacemaker artifact. The function of absolute value
amplifier 23 is necessary because it is well-known that the pacer
artifact pulse can be either negative or positive going as
referenced at input 10. Further, the artifact pulse may have only
one sharp leading edge.
The output of absolute value amplifier 23 triggers monostable
multivibrator 24 which provides at its output a uniform or
standardized pacer pulse with predetermined pulse width and pulse
amplitude.
The output of multivibrator 24 and the output of amplifier 15 are
summed or combined in summing circuit 16, in the preferred
embodiment, to provide an output signal at output 26 that is
representative of the input signal at input 10. The output signal
replaces the actual pacer artifact pulse with a standardized pacer
artifact pulse thus providing clear signals capable of transmission
and recording.
As shown in FIG. 1, in the preferred embodiment the combined
signals at output 26 are adapted to be connected to input 50 of
voltage controlled oscillator 51. The combined signals will
frequency modulate oscillator 51, the output of which is
acoustically coupled into the telephone system through apparatus
52. The signals may then be received at a remote station, such as a
physician's office, and be deciphered by any one of many systems
well-known to those skilled in the art. Additional features, such
as a call-back feature may be readily provided.
Again referring to FIG. 1, the output of multivibrator 24, which
constitutes the standardized pacer pulse, is also connected to the
input of rate monitor 28. Monitor 28 will detect a change in pacer
pulse rate and provide a visual indication to the patient if the
rate has changed by a predetermined amount. The rate detection is
done in a manner to be more fully described below in the discussion
of FIG. 3.
In the above description of the apparatus of this invention as
depicted in FIG. 1 it becomes apparent that there are two channels
in the circuitry, one channel for accepting each of the cardiac
pacer artifact pulses or the EKG pulses. In the EKG channel, a
device called a slew-rate limiter is described which substantially
removes the pacer artifact to avoid a baseline shift of the EKG
signal. It is apparent that though a slew-rate limiter is used in
the preferred embodiment, the advantages of applicant's unique
structure can be achieved by using any device which will
substantially block the pacer artifact while passing the EKG pulses
substantially undistorted.
In the cardiac pacer artifact pulse channel a high pass filter is
used to substantially block the EKG pulses while passing the
artifact pulse. Thus each artifact will pass through the channel to
cause a response in the form of a standardized or uniform pulse
representative of the artifact. This uniform pulse is selected to
be of a voltage and pulse width especially adaptable for
transmission and recording. Such a uniform pulse is acceptable for
the purposes of determining operation and rate of the cardiac
pacer. The EKG signal, on the other hand, is preferably passed
undistorted to appear in the truest possible form after
transmission and recording so that a physician may examine the
pulses and have available all of the information normally given in
an electrocardiogram.
Referring now to FIG. 2 there is shown a schematic diagram of the
slew-rate limiter used in the apparatus of this invention. The
slew-rate limiter indicated generally at 12 comprises an input
terminal 30 adapted to receive an input voltage designated
V.sub.in. A resistor 31 is connected between terminal 30 and a
first negative input of an OP-AMP 32. Another positive input on
OP-AMP 32 is connected through a resistor 33 to ground. The output
of OP-AMP 32 is connected to a junction 35. A diode 36 and a diode
37 have their cathodes connected, respectively, to junction 35 and
another junction 40. Another set of diodes 41 and 42 have their
anodes connected, respectively to, junctions 35 and 40. A first
current source I.sub.1 is indicated as having a flow into the
anodes of diodes 36 and 37, and another current source designated
I.sub.2 is indicated as having a current flow out of the cathodes
of diodes 41 and 42. Junction 40 is connected to an output terminal
45 designated as having a voltage output V.sub.out. A capacitor 46
is connected between terminal 45 and ground. A resistor 33 is
connected between the output of OP-AMP 32 and the first mentioned
input of OP-AMP 32. A capacitor 34 is connected across resistor 33,
and a resistor 47 is connected between terminal 45 and the junction
between resistor 33 and the first mentioned input of OP-AMP 32.
The purpose of the slew-rate limiter 12 is to limit the excursion
of input electrical amplitudes to a specified rate of change, once
a predetermined limit has been exceeded. When V.sub.in =O and
I.sub.1 =I.sub.2 the system is in equilibrium and V.sub.out =O
(neglecting the offset of the OP-AMP 32). When a positive going
signal is applied at terminal 30, the output of OP-AMP 32 will go
negative and the current I.sub.2 will be sunk by OP-AMP 32. The
current I.sub.2 will sink current from capacitor 46. As long as
predetermined slewing conditions are not reached, OP-AMP 32 will
force V.sub.out to follow V.sub.in. However, if a positive pulse or
a signal exceeding the predetermined slew-rate limits is applied to
terminal 30, the output of OP-AMP 32 will go negative, its rate
limited only by the slew-rate characteristics of OP-AMP 32. The
voltage across capacitor 46 will now be discharged at a rate
determined by I.sub.2. During this slewing operation, the output of
OP-AMP 32 will go into saturation. The values of the feedback
network comprising resistor 33 and capacitor 34 are selected to
avoid high frequency oscillation. The magnitude of resistor 47 is
chosen such that its current is less than the magnitude of current
sources I.sub.1 and I.sub.2, to avoid loading capacitor 46. The
slewing-rate can be adjusted by proper selection of component
values.
Referring now to FIG. 3 there is shown a schematic and block
diagram of the circuitry of rate monitor 28. There is shown a power
input terminal 60 adapted to be connected to a power source
indicated as V. A Zener diode 61 is connected between terminal 60
and ground to provide stabilization of the power source. Serially
connected across diode 61 are a resistor 62, a potentiometer 63 and
a resistor 64. An amplifier 65 is connected between the wiper arm
of potentiometer 63 and a junction 66. Junction 66 is connected to
ground through serially connected resistors 71, 72 and 73. A switch
75 has its wiper arm connected to move between a calibrate point
connected to the junction between resistor 71 and 72, and a run
point connected between resistor 72 and 73. The arm of switch 75 is
connected to one input of an amplifier 76.
Terminal 60 is connected through a resistor 81 to a first input on
an amplifier 82, which has a second input connected to ground. A
capacitor 83 is connected between the output of amplifier 82 and
the first input of amplifier 82. The output of amplifier 82 is also
connected to an input of an inverting amplifier 87. The output of
amplifier 87 is connected to an input of a comparator 88 and to an
input of a comparator 76. Another input of comparator 88 is
connected to junction 66. The outputs of comparators 76 and 88 are
connected to a logic network 89 which is in turn connected to an
indicator lamp 90.
A normally opened contact 84 of a switch 85 is connected across
capacitor 83. The input switch 85 is connected to junction 25 as
shown in FIG. 1.
Still referring to FIG. 3, the rate indicator is designed in such a
manner that as long as the rate of the cardiac pacer falls within a
predetermined region, a visual indication of this fact is given.
Resistors 71, 72 and 73 set the percentage of excursion for the
rate. On the occurrence of a standardized pacer pulse at junction
25, switch 85 will operate to close contacts 84 and thus discharge
capacitor 83. As soon as contacts 84 open at the end of the
occurrence of the standardized artifact pulse, capacitor 83 will
begin to charge and the output of amplifier 82 will operate as an
integrator providing an increasing voltage ramp. During this
operation, switch 75 will be connected to the run position, and
thus different voltages will appear at one of the terminals of
comparators 76 and 88. The output of the integrator formed by
capacitor 83 and amplifier 82 will be inverted by amplifier 87 and
applied to the other input of each of comparators 76 and 88. As the
output of the integrator rises, amplifier 76 will be the first to
provide a positive output. At a later time, amplifier 88 will
provide a positive output.
As can be seen, each standardized pacer pulse acts as a reset to
the integrator. If this reset occurs while the output of comparator
76 is high and the output of comparator 88 is low, then the pacer
artifact pulse is within preset limits and this will be recognized
by logic circuitry 89 to turn on indicator light 90. If the reset
pulse occurs at a later time, when the outputs of both amplifiers
76 and 88 are high, the logic circuitry will recognize this and not
cause indicator light 90 to turn on. The limits are preset to allow
a desired percentage of change of rate before indicating the
problem.
To set the repetition rate desired, switch 75 is moved to the
calibrate position and potentiometer 63 is rotated until indicator
light 90 starts blinking. Switch 75 is then switched back to the
run position and the system will now be ready to monitor the
patient who is wearing it at the time the calibration occurred.
From the above description of the operation of the apparatus of
this invention and of various circuitry it involves, it becomes
apparent that other circuit designs could be utilized without
departing from the spirit of the invention which includes the
separation of cardiac pacer artifact pulses from EKG pulses, the
provision of a standardized artifact pulse, and the adaptability of
the output for transmission and recordation.
* * * * *