JPH11206728A - Monitor system for heart and monitoring using the same - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a parameter in real time by preparing ECG data from electric signals from plural electrodes arranged on a patient, graphically displaying a part of the body of the patient based on them and displaying the state of the electric signals. SOLUTION: This system is constituted of a central monitoring device 10, a central work station 11 for controlling the system and storing data, a laser printer 12 and bedside monitoring devices 13 arranged for the respective patients. Then, in the system, the bedside monitoring device 13 fetches the electric signals from the electrodes arranged on the patient and the ECG data are prepared. Then, on the central monitoring device 10, the parameter usable for the central work station 11 is displayed as a tendency graph. That is, at least a part of the body of the patient is graphically displayed and an electrode position and an electrode state are simultaneously displayed. In such a manner, the real time parameter is presented.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a heart monitor system, and more particularly to a heart monitor system for analyzing and displaying parameters relating to the condition of an ischemic patient.
It is about the system. The present invention also provides a system for monitoring, analyzing, diagnosing, and / or displaying wirelessly transmitted signals related to cardiac activity and / or displaying the status of signals from leads attached to a patient on a graphical representation of the patient's body. It is about the method.

This application is a continuation-in-part of US application Ser. No. 08 / 320,511, filed Oct. 7, 1994.

[0003]

BACKGROUND OF THE INVENTION Over the past few years, the pharmaceutical industry has brought a number of new thrombolytic agents that allow cardiologists to immediately treat acute ischemic cardiomyopathy using chemoplatelet therapy. However, it is often difficult to properly control and adjust such therapies during the acute phase of myocardial ischemia. Known methods are expensive or have too long a lag time (up to several hours) between myocardial ischemia and presentation of the results.

[0004] Some cardiac monitoring systems and methods utilize a known 12-lead ECG in which ECG (ie, electrocardiogram) signals are displayed directly on a display in real time. Such a 12-lead ECG configuration,
It has the disadvantage that multiple electrodes must be attached to the patient in a position that mainly covers the frontal part of the myocardium. Also, to record all ECG signals from the electrodes,
Large storage capacity is required. However, on the other hand, many physicians are familiar with the 12-lead ECG format.

[0005]

SUMMARY OF THE INVENTION The present invention constitutes a significant improvement in cardiac monitoring systems, and in particular, in a cardiac monitoring system for analyzing and displaying parameters relating to symptoms of an ischemic patient. It is an object of the present invention to overcome the above-mentioned drawbacks of known heart monitoring systems. In particular, it is an object of the present invention to provide real-time parameters indicative of myocardial emergency during platelet therapy in the early stages of myocardial infarction.

Also, the ECG signal is represented by three vertical leads, the signal values of the leads being continuously averaged and stored at equal time intervals and later derived from the stored average. EC in standard 12-lead ECG format
It is an object of the present invention to provide a heart monitor system that displays G. It is an object of the present invention to display in real time a standard twelve lead ECG which continuously stores three vertical lead signals, X, Y and Z, and recalculates and derives those signals.

It is also an object of the present invention to provide an improvement in the methods used in pharmaceutical research to test the real benefits of new drugs. It is another object of the present invention to provide improved monitoring methods used in various coronary surgeries, such as PTCA-coronary balloon dilatation and other therapies that require accurate real-time analysis and monitoring.

[0008] A heart monitor for displaying the state of a signal from a lead wire attached to a patient on a displayed body shape of the patient.
It is yet another object of the present invention to provide a system and method.

[0009]

SUMMARY OF THE INVENTION In a preferred embodiment of the present invention, a method is provided for obtaining "simple" parameter values describing the process of myocardial ischemia (lack of oxygen) and myocardial infarction.
The required information is presented in real time using progressive calculations on the ECG signal. Eight standard ECG surface electrodes are attached to the patient according to the Frank electrode system developed in the 1940's. The signals of the eight leads are processed in a known manner to form an ECG vector which can be described by three vertical leads X, Y and Z. These three leads contain all the information needed to completely describe the ECG.

[0010] ECG changes are continuously analyzed based on vector electrocardiograms to reflect the course of ischemia and infarction. All major heart beats are continuously acquired for analysis at equal time intervals and averaged to form a very smooth heart beat suitable for progressive calculations.
This time interval is between 10 seconds and a maximum of 4 minutes. The first averaged heart beat is used as the initial reference heart beat. All subsequently averaged heart beats are compared to this initial reference heart beat and the changes are plotted.

The heart beat averaged by such processing is analyzed to form a plurality of parameters. ST
Vector value (hereinafter sometimes referred to as ST-VM)
Is a measure of the ST segment offset and is generally accepted as a measure of myocardial ischemia. Also, the change in ST value compared to the initial reference heart beat (i.e., at the start of monitoring) (i.e., STC-VM) is calculated. The QRS vector difference (hereinafter sometimes abbreviated as QRS-VD) measures the change in the QRS complex value compared to the initial ECG and compares the QRS value with the time when monitoring was started.
Reflects the morphological change of the composite value. QRS-VD parameters have been linked to the course of myocardial infarction in several studies.

The present invention displays the results of the progressive analysis at regular time intervals as new points in a very simple trend graph that is continuously updated. Since all calculations are done online, the trend curve is updated immediately. The basic advantage of this method is that any complex and subtle information from the ECG signal is analyzed and processed, ultimately forming simple parameter values displayed in a simple trend. Since the results are displayed over time in a simple form of a trend graph, it is perfect as an online monitor and the curves provide immediate information about the degree of ischemia or the course of ischemia. Even changes in the state of the heart can be seen on the display screen before the patient experiences pain.

Since the average ECG is always stored, the original ECG for all points on the trend curve is either the derived 12-lead ECG, the X, Y and Z lead vector values, or the vector loop. Can always be displayed as. When the patient is monitored, the information obtained is permanently stored on the central workstation of the system. The information is copied onto a recording medium, such as a 3.5 inch floppy disk, and later analyzed for clinical or scientific purposes.

[0014]

DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiment 1 FIG. 7 shows a system configuration in a first embodiment of a system utilizing the present invention. The system comprises at least one central monitor device 10 with a display, a central workstation 11, a central workstation 11 for controlling the system and storing data, a laser printer 12 and a patient. And a bedside monitor device 13. All devices communicate via Ethernet network 14.

The processing function is performed by the central workstation 11.
And each bedside monitor device 13. The distribution of processing functions ensures maximum system reliability and provides powerful traditional monitoring capabilities and advanced ischemia monitoring capabilities. Each of the bedside monitoring devices 13 combines multiple lead arrhythmia analysis with a new advanced ischemia monitoring function, performs all calculations on behalf of the ECG analyst, presents information on a display device, It is transmitted to the central processing unit of the workstation 11 via the network 14. FIG.
1 shows the front of a typical bedside monitor device 13; E
In addition to CG analysis, each bedside monitor 13
Are non-invasive blood pressure, pulse oximetry, and dual invasive blood pressure (dual in
vasive pressures) and dual temperatures
A number of additional measurements, such as those described above, can be used as well, and are operated by simply touching the auto-display menu on the front of the monitor device. An analog ECG output on the back of the bedside monitor device allows connection to other medical devices.

An eight-lead ECG is used to improve the sensitivity of arrhythmia and ischemia analysis. With information from all eight leads, ischemia analysis can reflect changes in ischemia throughout the myocardium. The progress of ischemia over time is presented on the display screen as a continuously updated trend graph. The trend graph can include continuous monitoring for up to eight days. With four trajectories and one trend graph, the waveform, in addition to the required trend graph,
Any physiological parameters can be displayed (four leads without monitoring ischemia can be used for patients without symptoms of ischemia).

The heart beat averaged in the form of X, Y and Z leads is automatically calculated and stored every minute.
Using these signals, a 12-lead ECG is derived,
It can be viewed on the bedside monitor device at any time during the monitoring session. A central workstation is located at each bedside monitor device (eg, MIDA, HR / PVC, SpO2, NIBP, IBP).
Up to six different functions can be automatically identified (such as and Temp), and all of the physiological information obtained by the bedside monitor device can be transferred for examination and storage at the workstation. . Thus, the monitoring functions that can be controlled by the central workstation will vary depending on the configuration of the bedside monitoring device connected to the central workstation.
The central workstation 11 is, for example, a conventional EC.
G monitor, arrhythmia monitor, ischemia monitor with parameters that reflect ECG changes in a clear trend graph, averaged and derived 12-lead ECG display, 24-hour observed arrhythmia of all monitored patients, monitored patients X, Y stored continuously for all
And 12-lead ECG display for 24 hours continuous derived from the lead and Z lead, SpO2, NIBP, BP, Te
Any or all observations of non-ECG functions monitored on a bedside monitor device, such as mp, can be provided.

[0018] The central workstation is preferably
It is a networking personal computer that runs on dedicated menu-type application software. A typical example of a central workstation connecting to other components is shown in FIG. 8, and a typical example of functions that can be performed is shown in FIG. The central workstation provides a simple and clear user interface that is operated by the selection of graphically represented "keys".
Each key has descriptive text or symbols that describe the function of the key. The mouse (or other pointing device) is used to point and select the desired key (in the test function, the mouse is
Also used to point to). The color of the key surface is usually gray. However, active keys are yellowed and invalid keys that are inaccessible are dark gray.

FIG. 9 shows an example of an initial menu displayed at the top of the display screen in the preferred embodiment of the present invention.
There are two rows of keys. The keys in the top row are the number, System, and signal status (Signal
Status) and Stored Patients. The keys in the lower row preferably contain key commands for examining the patient file. For example, keys include Patient Info, Alarm,
Report, Trend, ECG & VCG, Arrhythmia Events, ECG MIDA, ECG Review, All Leads and Setup
And so on. These keys are used to control and select all functions on both the central monitor and the workstation.

If the central monitor is not used,
The signal status message is displayed on the workstation display (if a central monitor is used, the signal status message is always displayed on the central monitor). A red patient key is used to indicate that something is wrong and that the analytical signal quality is poor or problematic or has other errors. If so, the reason is displayed in the signal status function. Keys marked with crosses are used to indicate that analysis has paused. The actual message for a particular patient is displayed at the top of the workstation display to the right of the patient name.

Central Monitor Device All parameters available to the central workstation can be displayed on one or more central monitor devices 10 as a trend graph. The central monitoring device 10 simultaneously displays the "live" status of multiple patients.
The central monitor device is preferably a large (eg, 17 or 21 inch) high resolution computer monitor device as shown in FIG. The software display driver in the workstation takes advantage of the high resolution graphics, and the display preferably has at least 10
24 × 768 pixel resolution. The display can continuously and simultaneously monitor ECG waveforms, essential parameters, alerts and essential ischemic tendency values for each of a number of patients.

The arrhythmia alert is presented in red text on the display, and the full 24-hour arrhythmia monitor feature provides complete control and documentation of all arrhythmias. Also,
Using the central monitoring device 10, an inspection of the derived 12 lead wires ECG monitored every minute can be performed. All other functions are displayed and controlled on the workstation.

The information on the monitoring device is fixed to always present the status of all patients. All interactive functions and examinations of patient data appearing on the monitoring device are controlled from the workstation. The left half of the display screen is
Presents prior art monitor information including heart rate and patient information, waveforms, arrhythmia alerts and other essential signals, and the right side presents an ischemia trend graph. The graph displays the progress of ischemia for each monitored patient starting at a predetermined time, such as patient consent. The graph is continuously updated to always include recent values. Up to six patients can be monitored on each display. When monitoring four or more patients, it is better to add a monitoring device. The network 14 allows any two waveforms from each bedside patient to be selected and displayed on the central monitor. The waveform selected for display on the central monitor need not be the same as the waveform selected for display on the corresponding bedside monitor. An example of a trend graph displayed on a central monitor for a single patient is shown in FIG. The signal status and MIDA messages are identical to those displayed on the central workstation as a signal status summary (described below).

The content of the display (leads, filters, size and speed) of each patient on the central monitor is selected by the central workstation 11 in the manner described below. The same information is always displayed at the same display position to improve the function. Bed number 101 on the left side of the display device,
The information includes a patient name 102, the number of heart beats 103, pacemaker information 104, and a signal status message 105. On the right side of the display are the trend graph 106 and the status message 107
And MIDA that records the

The patient to be monitored is selected by clicking on the number key corresponding to the patient in the key row on the workstation. Setup menu
The keys are selected to adjust the patient display. Monitored ECG leads in the settings menu
When the Lead key is selected, a graphic containing the waveform for each lead line of the patient is displayed, along with the corresponding key and keys for selecting the filtering, curve size and reset speed of the displayed waveform. If the waveforms of the non-ECG leads, such as Spo2 and PA pressure, are monitored, they will also appear on the display screen and be controlled similarly to the ECG leads. The main waveform to be displayed on the central monitor is selected by clicking on the corresponding key.

The setting menu in the first embodiment of the present invention displays three filter keys for filtering in order to enhance the visual impression of the displayed waveform. The first key, "No Filter"("None"), displays the waveform without filtering. The second key is labeled "0.05-100 Hz" and has a baseline variation below 0.05 Hz and a
Slowly filters curves from noise above Hz. Third
The key is labeled "0.5-40 Hz" and softly filters the curve from baseline variation below 0.5 Hz and noise above 40 Hz. The Setup menu in the preferred embodiment of the present invention also displays an ECG size key that sets the size of the displayed waveform. When the Auto key is selected, the size of the displayed curve is continuously adapted to fill 2/3 of the available height for the curve. If the original amplitude of the curve decreases slowly (perhaps due to necrosis), this automatic adaptation is done slowly so as not to affect the curve on the monitor. The "10 mm / mV" key sets the displayed curve amplitude to 10 mm / mV.
Set to mV. The "20 mm / mV" key sets the displayed curve amplitude to 20 mm / mV.

All curves on the central monitor have the same speed. Speed 25m with proper key selection
m / sec or 50 mm / sec. Also, for all patients, a second monitor curve (such as additional ECG, pulse oxygen concentration or blood pressure) can be selectively displayed in addition to the main curve. This function is controlled by selecting an On / Off key that appears under the heading "2nd Waveform" in the setting menu display. Selection of the on / off key activates the second curve. The key marked "Wave 1" is selected to allow control of the top curve (leads, filters, etc.). The key marked "Wave 2" is selected to allow control of the lower curve.

The patient information (Patient Info) key includes a patient name,
Selected to enter ID, first sign and physician comment. This information is typed using a keyboard, like a typewriter, and then the Enter key.
Press to enter each line. The Patient Info menu also includes a pacemaker key that is selected to indicate that the patient is wearing a pacemaker.

The menu also has an Add note function that allows you to enter observations and notes at the workstation at any time. When the Add note key is selected, a field opens at the bottom of the display, the time is automatically displayed, and the Add note key is changed to a Save note key . Note text is entered and edited using the keyboard. Notes are saved by clicking the Save note key. When the patient's waveform is saved for later analysis, the system saves all notes as well. They can be examined and printed at any time.

The Patient Info menu is closed by selecting either the Patient Info key or the Cancel key. When the patient is removed from the bedside monitoring device, the central workstation keeps all records, including observational arrhythmias, for a full 24-hour period, as long as there is storage capacity. When the storage capacity is full, the oldest record is automatically deleted.

Once monitoring of the patient has begun, as described above, the central monitoring device is displayed in the manner described above, and the system is adapted to treat a patient having a myocardial infarction, unstable angina. Or, to monitor patients during and after PTCA, use the on-line Myocardial Ischemia dynamic Analysis and Monitor.
ring, abbreviated as MIDA herein).

Based on the electrical signals from eight normal surface ECG electrodes arranged according to the Frank method, three vertical guide lines (X, Y and Z) are generated in the form shown in FIG. . The method used by the system of the present invention allows for ischemia monitoring based on Frank lead lines,
And Z signals are analyzed to create unique parameters such as ST-VM, QRS-VD and STC-VM, which are displayed in the trend graph.

When the monitor starts in the manner shown in FIG. 5, the heart beat is morphologically classified and a morphological template is defined. If a heart beat matches one morphological template, for example, by selecting a normal ECG heart beat and using it as a template,
A match template is constructed. The heart beat is compared to a morphological template to determine which heart beats are "normal" heart beats to be included in the analysis and which heart beats should be excluded from the MIDA analysis. During the rest of the analysis, the three leads X, Y and Z are "normal"
Scanned continuously for heart beats. When a "normal" heart beat is found, it is matched and, at regular intervals, included in the average of the acquired normal heart beats formed preferably every minute, assuming good signal quality. The ECG from the first average heart beat is the reference composite value
(Reference Complex), which is used as a reference value to compare the ECG from all subsequent heart beats with it and check for relative changes over time.

At equal intervals ranging from 10 seconds to 4 minutes, for the averaged heart beat represented by the averaged X, Y and Z leads, the advanced calculations shown in FIG. Up to thirty different parameters describing the state of are derived. These parameters are stored with the averaged ECG itself. There are two types of parameters, absolute and relative. Absolute parameters are calculated from the actual ECG composite value itself. The relative parameter is calculated from the difference between the current ECG composite value and the initial reference composite value and reflects a value that changes sequentially over time.

Examples of absolute parameters are QRSmax,
QRSmean, ST-VM, ST-VM2, X-S
T, Y-ST, Z-ST, QRS-SpA, HR, QR
time, QStime, QTtime, RRtim
e, T-VM, T-Az, TE1, X-ST, YS
T, Z-ST, and Abnorm. QRSmax
(MV) is the maximum value of the QRS-composite value.

QRS mean (mV) is the average value of the ECG vector during the time from QRS start (set to ON) to QRS end of the QRS-composite value. The ST vector value (ST-VM) is a value obtained by measuring the total offset of the ST segment, and is generally accepted as a measurement value of myocardial ischemia during ischemia. It is measured at the average heart beat 60 ms after point J (end of QRS complex).
The values from the X, Y, and Z leads are substituted into the following equation:

ST−VM = √ (ST _x ² + ST _y ² + S
_Tz ² ) The calculated ST-VM value is plotted on a trend graph. In the course of the calculation, ST elevation in one lead does not neutralize ST depression in another lead. Ascent and descent are detected simultaneously (see FIG. 2). Since the ST segment is measured on both X, Y and Z leads, it is one S covering the entire heart
Provide T measurements.

ST-VM2 (mV) is an ST vector value 20 milliseconds after point J. X-ST (mV) is J
The ST level in the X-lead line 60 ms after the point. Y-ST (mV) is the ST level in the Y lead line 60 ms after point J.

Z-ST (mV) is the ST level in the Z lead 60 milliseconds after point J. QRS-SPA
(NanV2) is a space region drawn by an ECG vector from the initial QRS start point to the QRS end. HR (heart beats per minute) is the average value of the heart rate during the MIDA interval.

QRtime (milliseconds) is the time between the start of QRS and the maximum of the current composite value. QSti
me (milliseconds) is the QR value of the composite value of QRS start and current time
This is the time between the end of S. QTtime (ms)
Is the time between the start of the QRS and the maximum value of the current composite value within the range of the T-wave.

RRtime (millisecond) is the average value of the RR intervals in the averaging interval. T vector value (TV
M) is the maximum value (m) of the current composite value within the range of the T wave.
V). In this regard, the ECG vector is called a T vector. T-Az is the angle of the T vector in the transverse plane from 0 to 180 degrees from left to right, positive if forward and negative if backward. T-
E1 is the angle of the T vector from the vector axis from 0 to 180 degrees from the end to the head.

Abnorm is the number of abnormal heart beats during the average interval. All heart beats that do not fall into the reference class are classified as abnormal. The change in ST value in comparison with the value when the monitor started (STC-VM)
It is calculated as shown in FIG. The difference of ST is substituted into the following equation. STC−VM = √ (STC _x ² + STC _y ² + STC _z
² ) Examples of relative parameters are QRS-VD, QRSI-V
D, QRSA-VA, QRSC-VM, STC-VA,
STC-VM, TC-VA and TC-VM. QR
The S-vector difference (QRS-VD) is the change in the QRS complex compared to the initial ECG and represents the morphological change in the QRS complex due to, for example, necrosis and temporary ischemia compared to at the start of monitoring. reflect. The current QRS composite value is compared to the initial QRS composite value and the melodic difference (Ax in FIG. 1) in the X, Y and Z lead lines is calculated. These values are substituted into the following equation.

QRS-VD = √ (A _x ² + A _y ² + A _z ² ) The calculated QRS-VD is plotted in a trend graph. QRSI-VD (mVs) is the initial QRS vector difference, similar to that for QRS-VD,
The difference is that the Ax, Ay, and Az regions span the range between the start of the initial QRS composite value and 40 ms later.

QRSC-VA is the change in the QRS vector angle, which represents the change in angle between the current and the initial QRS vector. QRSC-VM (mV) is a change in the QRS vector value and represents the interval between the initial and current QRS vectors. STC-VA is a change in ST vector angle, and represents a change in angle between the initial and current ST vectors.

STC-VM (mV) is a change in ST vector value, and represents an interval between the initial and current ST vectors. TC-VA is the change in T vector angle,
It represents the change in angle between the initial T vector and the current T vector. TC-VM (mV) is the change in the T vector value, and represents the interval between the initial and current T vector.

Several parameters from the relative and absolute parameters describing the course of ischemia are selected for display and stippled in a trend graph. QRS-VD (morphological change), ST-VM (ST measurement) and STC-VM
(ST change value) are the three most common parameters. Averaged ECG stored at the end of each time interval
Includes values for each of the X, Y, and Z lead lines.
Since X, Y and Z contain all the information of the ECG, it is possible to use the known algorithm to
It can also be used to calculate a two-lead ECG. Thus, the preferred embodiment of the present invention calculates the average every minute over the entire monitoring period of up to 48 hours and places the 12-lead ECG on the central workstation 11 in a 12-lead ECG format. It can also be displayed in a typical manner. Based on the continuously stored X, Y and Z lead lines, 12 continuously calculated lead lines next to a graph representing the occurrence of arrhythmia over a selectable period of time marked with colored bars An ECG can also be displayed. The preferred embodiment of the present invention includes a plurality of twelve lead wires E
The CGs can be separately printed on one page (see FIG. 14). The MIDA trend graph for each patient can be examined in detail one at a time on a workstation display. All patient trends can be continuously monitored on a central monitoring device using the format shown in FIG.

[0047] Depending on the amount of memory installed, typically MIDA recording will only last about 48 hours at one minute intervals. Then the memory becomes full and recording stops automatically. Table 1 below shows the MIDA
The relationship between the interval and the maximum recording time is shown.

(Table 1) MIDA time interval Maximum recording time 10 seconds 8 hours 15 seconds 12 hours 30 seconds 24 hours 1 minute 48 hours (2 days) 2 minutes 96 hours (4 days) 4 minutes 192 hours (8 days) Always In the case of arrhythmia monitors, this is not the case.
A four hour record is kept in memory.

The settings menu includes a MIDA Relearn key to control the MIDA method. MID
When the MIDA Relearn key is selected, the workstation display device displays the latest acquired ECG signal using a heart beat label (the heart beat label is about 3
Updated every 0 seconds). Once identified as a MIDA type of heart beat (matching the MIDA template), all detected QRS complex values are labeled "M". The current MIDA reference composite value is displayed on the left side of the waveform as scaler X, Y and Z leads. This is the actual, initial averaged heart beat for comparing all subsequent heart beats when calculating the relative propensity parameters.

The system returns the MI to restart the process.
Provide a MIDA restart key during the DA setting display. When the MIDA restart (Restart MIDA) key is selected, a warning message for selecting cancellation (No / Cancel) or continuation (Yes) is displayed. Next, a message "Please select a MIDA template and wait for 20 seconds" is displayed with a cancel option. If the process is not cancelled, the recommended new template will be displayed in a quadrilateral for user consideration with three keys for selection.

When the Yes key is selected, the MI
The entire DA record is erased, the recommended template is incorporated, and the process starts over. The display is reset, but no new reference composite value was formed,
No MIDA reference composite value is displayed. If the No key is selected, the template selection procedure is restarted and a message is displayed asking the user to wait 20 seconds.

[0052] The MIDA system also includes a MIDA Relearn function. The process of its function is
This is the same as the above-mentioned MIDA restart (Restart MIDA) command, except that previously recorded and stored data is not erased. This feature is suitable when the MIDA analysis can no longer track the ECG. MID
A-learning looks for a new template to include ECG composite values in the analysis (ECG changes always refer to the initial reference ECG).

The system also includes, for each patient, FIG.
MIDA status signal included in the display as shown at 0
(MIDA Signal Status) 107 enables the user to observe. When the Signal Status key of FIG. 9 is selected, the signal status for all patients is displayed in the Signal Status table. The following is a list showing various possible MIDA signal status messages in order of priority. The line displaying the highest priority message is displayed with a red background color. 1) MIDA recording is not possible with the current patient cable. Eight lead wire cables are required for MIDA recording.
This message is displayed if a 5-lead cable is used. 2) End of MIDA recording. This is the case where MIDA recording has continued for a maximum time of 48 hours at one minute intervals, for example. When the memory is full, recording stops automatically and this message is displayed. 3) MIDA recording is not possible due to spikes on the signal. Signal spikes are very short signal disturbances of corresponding strength. The source of the signal disturbance may be a spike in the pacemaker, a bad lead wire, or electromagnetic radiation from another device. If the patient has a pacemaker as indicated in the Patient Info, the system will automatically turn off the spike filter. 4) MIDA recording is not possible due to signal noise. Noise can occur for a number of reasons. Poor connection of the patient electrode
This is one of the possible reasons. Interference from other equipment near the patient's cable is also a cause. 5) MIDA recording is not possible due to baseline drift.
If the baseline drift is too large, it will distort the ECG. To prevent this, MIDA recording is stopped. (Baseline drift is a change in offset voltage.) 6) MIDA recording is not possible due to an induction line failure. One of the ECG leads is not working properly. 7) MIDA recording is not possible because there is no heart beat reference type. MIDA before the minimum number of heart beat reference types
If not received in the interval, this message is issued.

Embodiment 2 In another embodiment of the present invention shown in FIG. 15, at least a part of a patient's body is displayed in a graphic form as indicated by reference numeral 150, and state signals corresponding to the electrodes attached to the patient, respectively. The lamp 152 is arranged on the graphic 150. further,
State display means 154 for indicating the state of each electrode by alphanumeric output is provided corresponding to each electrode. The state of each electrode (regardless of whether or not the MIDA test is performed) is, for example, any one of states 3, 4 and 5 described above. Furthermore, the status display means can indicate in the form of a high electrode impedance that the electrode is faulty, that the electrode is not properly connected to the patient's body or that the electrode has peeled off, and the like. Further, the impedance itself can be displayed by the status display means. The status signal lamp flashes, drawing attention to the status display means,
It is possible to accurately indicate which electrode the information transmitted by the status display means belongs to. The display may be any suitable one, such as a CRT (color or black and white), an active LCD
(TFT), passive LCD (SDN), plasma, electroluminescence (EL), or ferroelectric LCD. A projector may be used for display.

The system can also utilize a back position sensor. Due to the relative movement of the heart in the chest, it is natural for the heart to change position in the chest when the patient changes its position in the bed, for example from supine to sideways. Patient movement as described above leads to changes in the ECG as the electrodes record electrical activity on the surface of the chest. This change affects each of the MIDA parameters separately. Since the ST-VM measures the strength of the ST deviation, it is not as sensitive as other "normal" ST measurements, regardless of direction. However, the parameter ORS-VD is very sensitive to these changes. The back position sensor allows to indicate whether the change in trend has been caused by a change in body position.

Back Position Sensor
Are connected to the connection block of the eight-lead ECG cable. Information from the back position sensor is recorded and displayed on a separate line below the trend graph. This line is shown in Table 2 below.
It can be made to have three colors indicating the state of.

(Table 2) Color Status Green Above Back Yellow Not on Back Gray Trend Unusable As described above, the MIDA trend graph is displayed on the central monitor. Using the Trend key, the graph can also be arranged to be displayed on the display of the workstation for viewing. The keys are located on the left and allow the user to select a trend graph to display.

The keys are displayed on the left side of the screen, and the user can select which trend to display by using the keys.
These keys are labeled MIDA and HR / PVC. Up to four different trend curves can be displayed in a trend graph. The curves are displayed in different colors to indicate that they are different. The name of each trend curve is
It is written on the graph in the same color as the curve itself.

The system provides a mouse-controlled cursor, for example, to point to a point of special interest. (Marking points of particular interest in the trend curve will aid in examining the corresponding 12 lead ECG). By pointing and clicking on the trend graph, the cursor moves to the desired time. As an alternative, the cursor can be moved in small increments by pressing the horizontal arrow labeled Cursor at the bottom of the trend graph display. The system displays the time of the trend graph corresponding to the cursor position, both the time of the day and the time since the start of the recording, at the top of the graph. The system also displays the exact value of the parameter on the left and right of the time.

The point is marked by placing the trend cursor at the desired time and selecting the check key displayed between the arrows under the Mark label at the bottom right of the graph. When the trend cursor is placed at the marked time, the system changes the check key to yellow. The user can jump directly between multiple separately marked times by selecting the right and left arrows below the Mark label. The system unmarks the time whenever the user presses the check key again.

[0061] The system also allows the user to change parameters in the trend graph (the user is typically required to change the QRS-VD for display in the trend graph).
And ST-VM parameters. MIDA analysis includes 30 parameters that are calculated and stored continuously). The MIDA trend display includes a key to select the affected axis below the Trend parameter label (Le1 = Left 1 (Left 1), Le2 = Left 2 (Left 2), etc.). Next, a table of different parameters is displayed in response to the selection of the axis. Next, the user selects a key for the desired new parameter whose trend is to be measured. The Return key is selected to return to the graph.

In addition, the system allows the time scale of the trend graph to be adjusted to include the most interesting trend graph portions. To that end, a Zoom key is displayed and, when selected, allows a particular portion of the trend curve to be magnified. The system is set such that the cursor is pointed and clicked with the mouse to center the enlargement around the cursor centered on the portion of interest on the trend curve. If the left zoom ("→ ←") button is pressed, the curve around the cursor is enlarged. The right zoom ("← →") button has the opposite effect,
A wider portion of the curve is displayed.

The system also provides a Scale key. Selecting this key displays a number of additional keys that allow the user to adjust the size of the displayed graph. The height of the trend curve is increased or decreased by selecting the arrows under the Max label on the left and right sides of the graph. The baseline offset can be adjusted by selecting the arrow below the Offset label.

After changing the scale, it can be reset to the system setting at any time by pressing the (Normal) key. Return to return to the graph again
A key must be selected. The system also
Allows you to change the time using the keys displayed at the bottom right. Clock time is the current time (8:30 means 8:30 am), while Relative time is the time elapsed since the start of monitoring (8: 30 means that the patient has been monitored for 8 hours 30 minutes).

The ability to adjust a number of settings that control the MIDA analysis to customize the analysis is also a particular advantage of systems using the above method. The MIDA setting is performed through a MIDA setup (MIDA Setup) key. The different settings will be described one by one below.
Each set value group follows the normal (Norma
l) The key can be reset individually to system settings.

The MIDA interval is the time interval during which MIDA analysis produces a new value. Initial reference EC during each interval
All acquired ECGs with sufficient signal quality to match G
Are averaged to form an ECG with improved signal quality. At the end of the interval, the averaged ECG is used in calculating the MIDA parameters. The averaged ECG and parameter values for each interval are stored in the acquisition module for approximately 3000 intervals.

Short intervals (less than one minute) can result in rapid ECG
The advantage of a quick response to changes is that it is noisy, resulting in a shorter total recording time. Longer intervals (more than one minute) have less noise and result in longer recording times, but respond slowly to rapid ECG changes. Generally, one minute intervals are recommended for CCU monitoring (such as infarction, unstable angina) and 15 second intervals for PTCA use. The system default settings are
Preferably, it is one minute.

To form an averaged ECG at the end of the above interval, a minimum number of heart beats must be included in the average. Too low a lower limit causes poor signal quality. An upper limit that is too high can make it difficult to reach that limit and may result in the absence of a calculated parameter value. As a matter of course,
The minimum number of heart beats required depends on the length of the interval. Recommended setting values are shown in Table 3 below.

(Table 3) MIDA interval Minimum number of heart beats 10 seconds 1 heart beat 15 seconds 1 heart beat 30 seconds 2 heart beats 1 minute 2 heart beats (system set value) 2 minutes 10 heart beats 4 minutes 10 hearts Beating If the signal quality of the acquired ECG is too poor,
Is not used for MIDA analysis. This is to avoid incorrect results. Each ECG signal to be included in the MIDA analysis must undergo the following tests.

Signal spikes are very short signal disturbances of a corresponding intensity. The cause of the signal disturbance may be electromagnetic radiation from other equipment, bad lead wires or pacemakers. The execution of the spike test
Can be turned on and off. When a spike is detected, the MIDA analysis is stopped unless the patient is wearing a pacemaker.

Noise can occur for a number of reasons.
Poor connection of the patient electrode may also be one reason.
Line interference from other equipment near the patient cable may also be a cause. Set the noise threshold to 5, 1
It can be set to 0, 20, 50 or 100 microvolts (micV), but it can also be turned off. If excessive noise is detected, the MIDA analysis is stopped. The system default is 50 microvolts (m
icV).

If the baseline variation is too large, E
May distort CG. The baseline threshold can be set to 25, 50, 100, 200 or 400 microvolts / second, or can be set to off. If a baseline change is detected, the MIDA analysis is stopped. The preferred system initialization is 1
00 microvolts / second.

The initial setting can be selected by the user using an initial setting table opened by selecting a system key and inputting an access symbol. The table can be saved with the Save key and Cancel
l) Includes keys, which when selected, respectively, set defaults or close menus without changes to defaults.

Embodiment 3 A third embodiment of the present invention can be used as a complement to conventional monitoring systems to enhance ECG monitoring and documentation in terms of ischemia, infarction and arrhythmias. . This example also shows that E
CG changes, 12 lead ECG acquisition, storage and display, arrhythmia detection, reflect all 24 hour arrhythmia monitor for all monitored patients, and 24 hour continuous 12 lead ECG stored for all monitored patients It has the advantage of monitoring ischemia using parameters.

However, the monitoring system of this embodiment does not include waveform and arrhythmia alarms. Rather, it is a system for monitoring the course of ischemia and various heart diseases. Waveforms and alerts are controlled and monitored using conventional monitoring systems. This system consists of the elements shown in FIG. 7, but instead of a bedside monitoring device, each patient acquisition module (Acquis) connected to a central server via Ethernet.
sition Module) is used. The server displays and stores data from all connected acquisition modules. This is a complement to the conventional monitoring system, adding the functionality described for the first embodiment.

The acquisition module operates in parallel with the patient monitor of a conventional monitor system. The ECG signal from the patient is supplied to both an acquisition module (Acquisition Module) and a patient monitor. The parallel connection is implemented by an adapter cable between the acquisition module and the patient monitor. The acquisition module acquires the signal and converts it from analog to digital and performs ischemia and arrhythmia analysis. The acquisition module communicates with a central server through an Ethernet connection on the back. It also includes a serial port for connection to other devices, such as the Hewlett-Packard ViewLink interface module.

FIG. 12 shows an acquisition module (Acquisition M).
odule). Element 121 is an E-conductor for use with 8-lead or 5-lead patient cables.
CG input. Element 122 is the signal output to the ECG input of the conventional monitoring device. Element 123
Is a graphical representation of the patient's body, in this example showing only the torso. More or less body parts of the patient may be displayed, for example, limbs may be included in the display. A number of light emitting diodes or other light emitting means are located behind the display graphic of the patient's body, each at a position corresponding to an electrode attached to the patient. Each electrode is individually labeled with a flashing yellow light if the signal quality is poor, or a steady yellow light if the guide wire is faulty. If the signal quality is all good, all electrode indicators are turned off. Alternatively, the electrodes may be turned on and off at different rates or displayed in different colors depending on the state of the electrodes described in the second embodiment. For the graphic display of the patient's body, for example, techniques such as silk screen, wet paint, powder coating, multicolor plastic mold, or overlay film can be used. Element 124 is a MIDA status indicator with green and yellow indicators. If the MIDA analysis is running, the green indicator is lit. If the MIDA analysis has not been performed for anyone for various reasons, the yellow indicator is lit. Element 125 is
It is an indicator of the back position. The back position sensor is a position sensitive device used to record whether the patient is lying on his back. This information is the QRS of the MIDA analysis
It can be useful when examining the most sensitive parameters, such as -VD. If such a sensor is used, the back position indicator is green only when the patient is lying on his back. Element 126 is an event mark (Mark) key. When this key is pressed, an event mark is recorded by the system. Element 127 is paused (P
ause) key. Using this key, recording can be paused and resumed. At the time of suspension, recording and analysis are temporarily suspended. This is indicated by the yellow light behind the stop sign. Element 128 is
A Discharge Patient key. When this key is pressed, the recording in progress is terminated, and the MIDA module is ready to start anew. Element 1
Reference numeral 29 denotes a main power (MainPower) operation indicator.
Green light indicates that the module is operating and running on mains power. The element 130 has a battery power (Bat
tery Power) operation indicator. A yellow light indicates that the module is operating and has been running on internal battery power for a very limited amount of time (warning). The element 120 is an on / off switch. Pressing the switch turns on the module. Pressing this switch again turns the module off.

The patient input of the MIDA acquisition module is C
It is F type. It is a defibrillation certificate (which may remain connected to the patient during myocardial fibrillation) and the anterior patient connector is marked with the appropriate heart symbol. The patient input of the MIDA acquisition module is designed to limit the current through the patient to a few microamps, and to respond to conditions where the leakage is small when connected to a conventional monitoring system. If equipment other than the MIDA acquisition module is connected to the patient, it must be connected to an equipotential ground wire. For this purpose, MID
An equipotential ground terminal is provided on the back of the A acquisition module. The following connections are provided on the back (not shown) of the MIDA acquisition module. AC input: 100-240V + -10%, for connection to a 50-60Hz grounded AC power supply. Equipotential earth terminal: Used to provide an equipotential earth when another electrical device is used with the MIDA acquisition module. Ethernet: For connecting to an Ethernet network. RS-232 serial communication: Hewlett-Packard VueLink
For connecting to other devices such as modules.

The acquisition module has an internal battery that is switched immediately if the AC power is insufficient. The internal battery provides full operation for at least 5 minutes when fully charged. When the MIDA acquisition module runs on an internal battery, a yellow LED is lit in the lower right corner of the front, below the battery symbol. As soon as the AC power returns and the module is turned on, the internal battery is recharged. A
The line power operation is indicated by a green LED in the lower right corner below the C symbol.

The workstation 11 also includes a 17 inch color display for displaying curves and data from one patient at a time for examination. The workstation also includes a graphical interface using a mouse. The mouse is used to control the operation of up to two central monitoring devices. However, when a particular one patient's monitor is controlled or examined at the workstation, the central monitoring device is not interfered at all. All information presented on the workstation can be printed on a laser printer at any time.

A row of keys at the top of the workstation display screen allows for the selection and direct control of each patient's monitor. Keys are provided for each bed (usually 1, 2, 3
). Once a patient is selected, the operator can control the start / stop of the monitor, alarm settings, monitored waveforms, and many other items in a straightforward manner using a graphical interface. The monitoring session can also be examined in detail in terms of ischemia, 12 lead ECG and constant arrhythmia monitoring.

When an ischemic tendency is examined on a workstation, any of the 30 different calculated parameters can be examined over time. The event of interest can be developed on the screen and the exact value corresponding to the event is shown. Although the entire trend covers several days of monitoring, short events of several minutes develop on the display.

The system in the preferred embodiment of the invention reduces the need for an additional 12-lead ECG. The 12 lead ECGs derived every minute are automatically acquired and stored in the system. Several 12 lead ECGs at different time bases are overlaid on each other to plot the evolution. By pointing to the ischemia of interest in the ischemia graph, the corresponding 12-lead ECG is displayed, overlaid, or printed on a laser printer if necessary. In this way, the morphological nature of the change in ischemia is real-time,
It can be examined during platelet therapy or unstable angina.

The workstation 11 has a total of 24
Includes time arrhythmia observation function. An arrhythmia graph showing the arrhythmia drawn as dots or lines colored according to the duration of the arrhythmia is displayed in the lower half of the workstation display screen. The corresponding ECG is displayed in the upper half of the display screen. Any single heart beat for the last 24 hours for each monitored patient can be displayed by specifying the arrhythmia of interest or the desired time.

The system also includes a data store that stores all data from the monitoring session for future inspection. The stored records can be examined on the workstation in exactly the same manner as for the patient currently being monitored. The preferred embodiment of the invention described above can perform the above analysis and monitoring using a complete networking system for a large number of patients. However, the analysis and monitoring methods described above can also be implemented technically using special program code of different hardware, system architecture or different program coding. The method of the invention may be used, for example, in an independent system for a single patient.

[0086] The method may also be used in mobile applications. In such applications, the ECG signal is recorded over a long period of time by a recording device worn or carried by the patient. The recorded signal is later retrieved for printing and analysis. The signal is analyzed according to the method described above. In telemetry applications, a patient carries a small transmitter that transmits the ECG signal to a receiving device that displays the signal in real time. The ECG signal received by the telemetry system is analyzed according to the method described above.

The present invention is not limited to the systems and methods illustrated in the accompanying drawings and described above. Modifications and variations of the present invention are possible within the scope of the inventive concept. For example, besides the electrode lead set described above, the first
6, 17 and 18 three electrode lead set, first
Four-electrode lead set shown in FIGS.
The five-electrode lead set shown in FIGS. 2 and 23 (the EASI lead set and algorithm are included in U.S. Pat. No. 4,850,370 issued Jul. 25, 1989), No. 2
The seven-electrode lead set shown in FIG. 4, the eight-electrode lead set by the Frank method shown in FIG. 25, and the ten-electrode lead set shown in FIG. 26 can be used. further,
Drawing of the patient's body surface (using 48 electrodes) is applicable to the present invention. Therefore, the description of the specification should not be construed as limiting the claims which clearly define the present invention.

[0088]

According to the present invention, it is possible to display on a monitor device in various forms including the prior art 12-lead ECG while using the ECGs of a smaller number of guide wires than the prior art 12-lead. Methods and systems for analyzing and monitoring myocardial ischemia and infarction are provided. According to the present invention,
Significant improvements in cardiac monitoring systems that provide real-time analysis and display of parameters related to symptoms of ischemic patients are provided.

[Brief description of the drawings]

FIG. 1 is a graph showing QRS-VD parameters.

FIG. 2 is a graph showing ST-VM parameters.

FIG. 3 is a graph showing STC-VM parameters.

FIG. 4 is a flow chart showing the steps in which three vertical guide lines (X, Y and Z) are created in a preferred embodiment of the present invention.

FIG. 5 is a flowchart showing the analysis and monitor initialization steps used in the preferred embodiment of the present invention.

FIG. 6 is a flowchart showing the steps in which the averaged heart beat represented by the averaged X, Y and Z lead lines is calculated and parameters describing the ECG status are determined.

FIG. 7 is a diagram showing elements of a system according to the first embodiment of the present invention.

FIG. 8 is a block diagram showing a connection between a central workstation and other components in the apparatus of the present invention.

FIG. 9 shows a top view of a graphic interface display device appearing at a central workstation of a system employing the present invention.

FIG. 10 is a diagram illustrating one example of a system output display format used to monitor each patient on a central monitoring device.

FIG. 11 is a front view of a bedside monitor device used in the first embodiment of the system using the present invention.

FIG. 12 illustrates a front view of a data acquisition module used in another embodiment of a system employing the present invention.

FIG. 13 is a diagram illustrating all possible inputs and outputs in an apparatus using the present invention.

FIG. 14 is a diagram showing an example in which a plurality of ECG signals created by the present invention are printed on one page.

FIG. 15 is a diagram showing a patient's torso displayed on a display device together with an electrode status indicator and a display unit (annunciator unit).

FIG. 16 is a diagram showing an arrangement of a three-electrode lead set attached to a torso of a patient.

FIG. 17 is a diagram showing an arrangement of a three-electrode lead set attached to the torso of a patient with a pacemaker.

FIG. 18 is a diagram showing an arrangement of a three-electrode lead set for a baby.

FIG. 19 is a diagram showing an arrangement of a four-electrode lead set attached to the torso of a patient.

FIG. 20 is a diagram showing an arrangement of a four-electrode lead set attached to a limb of a patient.

FIG. 21 is a diagram showing an arrangement of a five-electrode lead set attached to a torso of a patient.

FIG. 22: 5 attached to the patient's torso for Holter recording
It is a figure showing arrangement of this electrode lead set.

FIG. 23 is a diagram showing the arrangement of a five-electrode lead set attached to the torso of a patient by the EASI lead set method.

FIG. 24 illustrates the arrangement of a seven-electrode lead set applied to the patient's torso for late potential analysis.

FIG. 25 is a diagram showing an arrangement of eight-electrode lead sets attached to the torso of a patient in a flank manner.

FIG. 26 illustrates the placement of a 10-electrode lead set on a patient's torso to obtain a true 12-lead ECG (RA and LA may be on the arm, RL and LL are legs) Attached).

[Explanation of symbols]

 10: Central monitoring device 11: Central workstation 12: Laser printer 13: Bedside monitoring device 14: Ethernet network 101: Bed number 102: Patient name 103: Number of heartbeats 104: Pacemaker information 105: Signal status message 106 : Trend graph 107: MIDA status message 120: Acquisition module 121: ECG input 122: Signal output 123: Torso 124: MIDA status indicator 125: Back position indicator 126: Event mark key 127: Pause key 128: Patient release key 129: Main power operation indicator 130: Battery power operation indicator 150: Display figure of patient torso 152: Status signal lamp 154: Status display means

Continued on the front page (72) Inventor Michael Olgemark Sweden Salzjöbo 43, Es-132, Cocktorpswagen 10 (72) Inventor Johan Ubi Sweden Vaxholm 94, Es-185, Sanderens Vag 27

Claims (21)

[Claims] 1. A system for monitoring, analyzing and / or diagnosing a patient's heart activity, comprising: a plurality of electrical signals disposed at a plurality of locations on a patient's body surface and receiving a plurality of electrical signals from the patient's body. An electrode, an ECG data creation unit connected to the plurality of electrodes, acquiring the plurality of electrical signals from the plurality of electrodes, and creating ECG data in response to the acquired electrical signals; and the ECG data creation unit Display means for displaying at least a part of the patient's body graphically and further displaying on the display graphic the respective positions of the electrodes and the respective states of the electrical signals from the plurality of electrodes. Features system. 2. The display means includes a plurality of electrode status indicators, each indicator on a graphical representation of at least a portion of the patient's body, a patient surface on which any one of the plurality of electrodes is located. The system of claim 1, wherein the system is located at a location substantially corresponding to the upper location. 3. The display means includes a plurality of electrode status display means, each electrode status display means being an alphanumeric indicator,
3. The system of claim 2, wherein the system corresponds to at least one of the plurality of electrode status indicators. 4. The state of each of the plurality of electric signals from the plurality of electrodes includes a first state in which the electric signal is out of the signal acquisition range of the ECG data generating means and a large noise of the electric signal. A second state in which the ECG data generating means cannot generate an appropriate ECG signal in response to the signal, and a third state in which the electric signal exhibits a baseline drift.
And a fourth state in which the electric signal exhibits a spike waveform, wherein the electrode state indicator outputs a graphic signal when the corresponding electric signal is in any of the first, second, third and fourth states. 4. The system according to claim 3, wherein said electrode status display means indicates which of said four states the corresponding electrical signal is in. 5. The state of each of the plurality of electric signals from each of the plurality of electrodes includes a second state in which the electric signal is out of the signal acquisition range of the ECG data generating means, and a large noise of the electric signal. A second state in which the ECG data generating means is unable to generate an appropriate ECG signal in response thereto, wherein each of the plurality of electrode state indicators comprises a first state when the corresponding electrical signal is in the first state. 3. A graphic output for generating a second graphic output when the corresponding electrical signal is in a second state.
System. 6. The system according to claim 2, wherein said display means comprises a cathode ray tube. 7. The system according to claim 2, wherein said display means comprises a plasma display device. 8. The display means comprises a liquid crystal display device.
The system according to claim 2. 9. The system of claim 2, wherein said display means comprises an electroluminescent display. 10. The display means includes a translucent overlay having a graphical representation of at least a portion of a patient's body, and a plurality of light generating means disposed behind the overlay, each of the plurality of light generating means being The system of claim 1, wherein the system is positioned behind an overlay at a location substantially corresponding to a location on the patient's body where one of the plurality of electrodes is located. 11. The system according to claim 10, wherein each of said plurality of light generating means is a light emitting diode. 12. The state of each of the plurality of electric signals from each of the plurality of electrodes includes a first state in which the electric signal is out of the signal acquisition range of the ECG data generating means, and a large noise of the electric signal. A second state in which the ECG data generating means cannot generate an appropriate ECG signal in response thereto, wherein each of the light emitting diodes outputs a first light output when the corresponding electric signal is in the first state. The system of claim 11, wherein the system generates a second light output when the corresponding electrical signal is in a second state. 13. A method of monitoring, analyzing, and / or diagnosing a patient's heart activity, wherein a plurality of electrodes for receiving a plurality of electrical signals from the patient's body are respectively located at a plurality of locations on the patient's body surface. A step of connecting the ECG data creation means to the plurality of electrodes to acquire the plurality of electrical signals; a step of creating ECG data in response to the acquired electrical signals; and Displaying a position on a patient's body surface and a state of each of the plurality of electrical signals on a display connected to the ECG data generator. 14. The display means includes a graphical representation of at least a portion of a patient's body and a plurality of electrode status indicators, each indicator having any one of the plurality of electrodes positioned on the graphical representation of the patient's body. 14. The method of claim 13, wherein the method is located at a location substantially corresponding to a location on the body surface of the patient being treated. 15. The apparatus according to claim 14, wherein said display means includes a plurality of electrode state display means, each of which is an alphanumeric indicator corresponding to at least one of said plurality of electrode state indicators. the method of. 16. The state of each of the plurality of electric signals from the plurality of electrodes may be a first state in which the electric signal is out of the signal acquisition range of the ECG data generating means, and a state in which noise of the electric signal is large. A second state in which the ECG data generating means cannot generate an appropriate ECG signal in response to the signal, a third state in which the electric signal exhibits a baseline drift, and a second state in which the electric signal exhibits a spike waveform. 4
The electrode state indicator generates a graphic output when the corresponding electric signal is in any one of the first, second, third and fourth states, and the electrode state display means outputs the corresponding electric signal. 16. The method of claim 15, wherein indicates which of the four states is in. 17. The state of each of the plurality of electric signals from each of the plurality of electrodes includes a first state in which the electric signal is out of the signal acquisition range of the ECG data generating means, and a large noise of the electric signal. A second state in which the ECG data generating means is unable to generate an appropriate ECG signal in response thereto, wherein each of said plurality of electrode state indicators comprises:
15. The method of claim 14, wherein a first graphic output is generated when the corresponding electrical signal is in the first state, and a second graphic output is generated when the corresponding electrical signal is in the second state. 18. The display means includes a translucent overlay having a graphical representation of at least a portion of a patient's body, and a plurality of light generating means disposed behind the overlay, each of the plurality of light generating means being 14. The method of claim 13, wherein behind the overlay, the one of the plurality of electrodes is positioned at a location substantially corresponding to a location on the patient's body surface where the electrode is located. 19. The method of claim 18, wherein each of the plurality of light generating means is a light emitting diode. 20. The state of each of the plurality of electric signals from each of the plurality of electrodes includes a first state in which the electric signal is out of the signal acquisition range of the ECG data generating means, and a large noise of the electric signal. A second state in which the ECG data generating means cannot generate an appropriate ECG signal in response thereto, wherein each of the light emitting diodes emits fixed light when the corresponding electric signal is in the first state; Emitting a flashing light when the corresponding electrical signal is in the second state;
The method according to claim 19. 21. The system of claim 4, wherein each of said plurality of electrode status display means is adapted to selectively display at least one impedance value of said plurality of electrodes.