US3807392A - Electro-cardiographic patient monitoring and morphology recognition method - Google Patents

Electro-cardiographic patient monitoring and morphology recognition method Download PDF

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US3807392A
US3807392A US00192191A US19219171A US3807392A US 3807392 A US3807392 A US 3807392A US 00192191 A US00192191 A US 00192191A US 19219171 A US19219171 A US 19219171A US 3807392 A US3807392 A US 3807392A
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Warner Lambert Co LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H15/00—ICT specially adapted for medical reports, e.g. generation or transmission thereof

Definitions

  • the phology recognition method utilizing a digital computer which is shared by eight patients.
  • the ECG signal of each patient is sampled at 8-millisecond intervals, with samples of different patients being provided to the computer at l-millisecond intervals.
  • the com- [fi] .1 puter is programmed to recognize atypical characteris 5 i R 2 tics in the ECG signals and to control a 3-second ana- 1 le 52 G 2 l log recording of the ECG signal of any patient for l whom an atypical condition isdetermined.
  • NDP NDP LDP DIFF' NDP- LOP GET OLDEST- DIFF VALUE POINTER FROM 4"WORD BUFFER USING DIFSUM DIFF DIFSUMI INCREME NT POINTER USE POINTER TO INSERT DIFF IN BUFFER,
  • FIGII GET ADP BUFFER POINTER FOR CURRENT PATIENT [GET OLDEST ADP VALUE FROM 4'- WORD BUFFER USING POINTER ADD NEW ADP VALUE TO FILSUM FILSUM '1- 4 FDP USE POINTER TO INSERT NEW ADP VALUE IN B UFFER',

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  • Medical Informatics (AREA)
  • Public Health (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
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Abstract

An electro-cardiographic patient monitoring and morphology recognition method utilizing a digital computer which is shared by eight patients. The ECG signal of each patient is sampled at 8-millisecond intervals, with samples of different patients being provided to the computer at 1-millisecond intervals. The computer is programmed to recognize atypical characteristics in the ECG signals and to control a 3-second analog recording of the ECG signal of any patient for whom an atypical condition is determined.

Description

United States Patent I [191 Harris Apr. 30, 1974 ELECTRO-CARDIOGRAPHIC PATIENT 3,606,882 9/1971 Abe et a1. 128/206 A M TO G AND MORPHOLOGY 3,654,916 4/1972 Nielsen 128/206 A I 3,618,693 11/1971 Nachev et al.... 128/206 A RECOGNITION METHOD 3,434,151 3/1969 Bader et a1 128/206 R [75] Inventor: George J. Harris, Framingham,
MaSS- Primary ExaminerWilliam E. Kamm [73] Assignee: American Optical Corporation Attorney, Agent, or FzrmJoel Wall; Wllltam C.
Southbridge, Mass. Neale [22] Filed: Oct. 26, 1971 [57] ABSTRACT [21] APPI- N04 192,191 An electro-cardiographic patient monitoring and mor- Related US. Application Data Continuation-impart of Ser. No. 820,554, April 30,
1969, Pat. No. 3,616,791.
phology recognition method utilizing a digital computer which is shared by eight patients. The ECG signal of each patient is sampled at 8-millisecond intervals, with samples of different patients being provided to the computer at l-millisecond intervals. The com- [fi] .1 puter is programmed to recognize atypical characteris 5 i R 2 tics in the ECG signals and to control a 3-second ana- 1 le 52 G 2 l log recording of the ECG signal of any patient for l whom an atypical condition isdetermined.
[56] References Cited 5 C 0 Dr UNITED STATES PATENTS aw'ng gums 3,658,055 4 1972 Abe et a1. 128/206 A 3,524,442 8/1970 Horth 128/206 A 12? 14 ON *L E NQP EAYll 1 5, T1
12-0 l4- 0 ON ZSECOND DELAY RECORDER F d 1' 1B ANALOG L ANALOG I I6 AID 32 E06 E MULTIPLEXER CONVERTER 6 38 SIGNALS 7 DATA LINE 5 26 7 46 OMPUTER ADDER INTERBUPT LINE +|1o 1 DA Lni INTERRUPT 30 so LINE 2O \PAHENT KEYBOARD COUNTER ND 4o PRINTER PA'TENTEDAPR 30 1914 SHEET 03 0F '24 STWORD RWORD TTY 3 i ADP A FDP AREA ENLARGED EXECUTIVE Z LFP ARPI ARP2 lMINTMR L1 L% l PENLRGD ZSECTMR RRTMR v l 3SECTMR 256MSTMR NDP V TCPI MAX i r V y DFP HFPI TCP2 TYPE LDP F|LTAR Z THRESH V DIFSUM HEP AVI-EV MoRPH RRTMR I DMAX l MTYPE I Y Y MRP LTYPE DTP2 RWD I UNLRND PUNLRND PENLRGD ENLRGD LEGEND Cp DTHRESH RRNEW STWORD MORPH EVERY R wAvE RWORDY l/RP MORPH EVERY DP RRP VPB L l PENLRGD l l ,7
L D MFP FVP LATE PRE EPRE CP EN Re EVERY STROBE v I EvERY 2 SECONDS MULTIFORM FREQUEN W EvERY 25s MILLISECONDS MULTIPLE PATENTEBAPR 30 I974 I saw on [F 24 DFP START GET DIFFERENTIAL BUFFER POINTER FOR CURRENT PATIENT GET LDP;
GET NDP NDP LDP DIFF', NDP- LOP GET OLDEST- DIFF VALUE POINTER FROM 4"WORD BUFFER USING DIFSUM DIFF DIFSUMI INCREME NT POINTER USE POINTER TO INSERT DIFF IN BUFFER,
005s POINT PAST POINT E OF BUFFER ER ND YES IRESET POINTER TO START OF BUFFER STORE POINTER RETURN PATIENTIEO PATIENT# 7 g1; POINTER 3:5: E DIFF DIFF DIFF DIFF DIFFE RE NTIAL BUFFER DIFFERENTIAL BUFFER PATENTEUAPR 30 I914 3.807; 392
sum "as or 24 was IDIFSUMI+DMAX I RETURN I DTP2 START l [GET DMAX BUFFER POINTER FOR CURRENT PATIENT GET OLDEST DMAX VALUE FROM 8-WORD BUFFER USING I [SUBTRACT OLDEST DMAX VALUE FROM DTSUM l \ADD NEW DMAX VALUE To DTSUM IDTSUM I6 --*MDTH'RESH USE POINTER TO INSERT'NEW DMAX VALUE IN BUFFER; INCREMENT POINTER DOES POINTER POINT PAST END OF BUFFER YES '[RESET POINTER To START OF DMAX BUFFER I I STORE POINTER CLEAR DMAX POINTER IEI] APR 30 1974 P1 8 07 l 392 SHEET :06 0F 24 FIG] ' STRTMR- =0 FoR CURRENT CLEAR YTRYNEG INCREMENT TRYNEG CONVERT PATIENT NUMBER TO BIT POSITION AND SET CORRESPONDING YES BIT IN RWORD I [RRTMR- RRNEW,1:FSTRTMRI v V [iLEAR TRYPos'. CLEAR TRYNERT INCREMENT STRTMR STRTMR I YES V CONVERT PATIENT NUMBER TO snposmou AND SET CORRESPONDING arrm STWORD 0- STRTMRZ 0* MTYPE'; LOAD MOP POINTER WITH ACHK RETURN PATENTEUAPR30 m4 3.807.392
SHEET 07 0F 24 RRP START IRRNEW- RROLDI R RINT YES |+ LATE IE RE I SECPRE I 0- SECPRE l- PRE [l- EPRE] lo v- EPRE1 PATENTEIIAPR 30 I374 SHEET [J8 GET RRINT BUFFER PO NTER FOR cuRRENT PATIENT GET OLDEST RRINT VALUE FRO-M 8-WORD BUFFER USING POINTER I SUBTRACT OLDEST RRINT VALUE FROM INTSUM AND STORE RESULT AS PRTLSUM [ADD NEW RRINT VALUE TO PRTLSUM AND STORE RESULT YES PRTLSUM- INTSUM USE POINTER To INSERT zERo IN BUFFER, INCREMENT POINTER I ovE RFLOW IN NEWSUM POINTER POINT PAST END OF BUFFER AS NEWSUM NEWSUM INTSUM VALUE IN BUFFE I USE POINTER TO INSERT NEW RRINT R, INCREMENT POIN ER I/8 INTSU YES RESET POINTER TO START OF RRINT BUFFER STORE POINTER I HFPI sTART GL r FILTAR NDP +-F|LTAR FIG. I0
[HF V52 0F FILTAR VALUE FoR CURRENT PATIENT? GET HF BUFFER POINTER FOR CURRENT PATIENT IEET OLDEST HF VALUE FROM 8-WORD BUFFER usme PQINTER] I LSUBTRACT OLDEST HF VALUE FROM HFSUM T LADD NEW HF VALUE T0 HFsuMT I USE POINTER T0 INSERT NEW vALuE IN BUFFER, INCREMENT POINTER 7 V8 uFsum- Avu-zvj I YES RESET POINTER TO START. OF HF auFFERI v STORE POINTERI CLEAR FILTAR I LFP START I FIGII GET ADP BUFFER POINTER FOR CURRENT PATIENT [GET OLDEST ADP VALUE FROM 4'- WORD BUFFER USING POINTER ADD NEW ADP VALUE TO FILSUM FILSUM '1- 4 FDP USE POINTER TO INSERT NEW ADP VALUE IN B UFFER',
INCREMENT POINTER DOES POINTER POINT PAST END OF BUFFER YES RESET POINTER TO START OF BUFFER STOR E POINTER RETURN PAT-ENTEOAPR 30 1974 SHEET "11 0F 24 DOES I FDP I+ AREA GIVE OVERFLOW ARPI START YES I I AREA FDP|+AREA I RETURN I ARP2 START ENLRGD-Q PENLRGDI AREA . L25 AAV YES [I ENLRGIZTI GET AREA BUFFER POINTER FOR CURRENT PATIENT GET OLDEST AREA VALUE FROM 8*WORD BUFFER USING POINTER] SUBTRACT OLDE ST AREA VALU E FROM AREASUM AND STORE RESULT AS PRTLSUM :ATENTED R 30 I914 3.8071392 sum 12 0f 2 1 ADD NEW AREA VALUE TO PRTLSUM AND STORE RESULT AS NEWSUM OVERFLOW 7 N0 IN NEWSUM PRTLSUM AREASUM mzwsum AREASUIVI USE POINTER TO INSERT ZERO IN BUFFER; INCREMENT POINTER USE POINTER TO INSERT'NEW AREA VALUE IN BUFFER INCREMENT POINTER DOES POINTER POINT PAST END OF BUFFER YES RESET POINTER TO START OF AREA BUFFER STORE POINTER, CLEAR AREA RETURN we AREASUM --AAvI TC Pl START FIG. I
YES
1| POP *MAX RETURN GET MAX BUFFER POINTER FOR CURRENT PATIENT GET OLDEST'MAX VALUE FROM 8-WORD BUFFER USING POINTER [SUBTRACT OLDEST MAX- VALUE FROM TsuMT.
ADD NEW MAX VALUE TO TSUM USE POINTER TO INSERT NEW MAX VALUE IN BUFFER;
INCREMENT POINTER noes POINTER POINT PAST NO END OF BUFFER YES RESET POINTER TO START- OF MAX BUFFER I STORE POINTER, CLEAR MAX PATENTEUAPR 30 I914 3.807.392
sum n or 24 LEGEND MCP START AZFDP +THRESH BIFDP THRESH CIDIFSUM .-THRESH BRANCH T0 MCP v DIDIFSUN| 'l' THRESH POINTER FOR CURRENT PATIENT w 1 v ACHK DCHKI ADCHK CCHK2 CC HK1 CBCHK DCHKZ RETURN YES I MTYPE RETURN (OOOOOOOI) (TYPE 1) 8" "TYPE v tqooloooo) v (TYPE 5) ccmq. No
ECHKI-HACP- POINTER] YES ocmu:
SHIFT MTYPE RETURN (oooooow) Q .(TYPE 2) @cmu -MCP QINTEFI YES SHIFT MTYPE RETURN (OOIOOOOO) (TYPE 6) PATENTEDAPR so I974 3 sum 15 or 24 CBCHKI ADCHKI ICBCHK MCP POINTER] YES LAocHK+McP POINTER] FIGEGB YEs- SHIFT MTYPE RETURN SHIFT MTYPE (OOOOOIOO) (0:000000) (TYPE 3) (TYPE 7 CCHKZZ DCHKZI YES DCHK2 MCP POINTER] RETURN] YES' SHIFT MTYPE C SHIFT MTYPE 7 00000000) I (00001000) (TYPE 8 (TYP 4 SET MCP POINTER TO RETURN RETUR PATENTEDAPR 30 1914 3.; 807; 392
SHEET 16 0F 24 LRN START BRANCH TO LRN POINTER FOR CURRENT PATIENT LMORPH COUNTDOWN COUNTDOWNI MCREMENT LcouN-rafl LcougTER YES RETURN 0- LCOUNTER o- LTYPE;
LMORPH LR N POINTER LMORPHZ I I RETURN v No LSET 1 IN BIT POSITION OF LTYPE CORRESPONDING TO THE 1 IN MORPH ILNCREMENT LCOUNTER] Lcoug'rsa YES 0 LRN POINTER;
I O- Ml 7 RETURN PATENIEnAPRQmQM' $807392 SHEET 17 [1F 24 MRP START UNLRND PUNLRND DOES LTYPE HAVE A 1 IN BIT POSITION IN WHICH MORPH HAS A 1 O UNLRND 1+UNLRND (MPV START v H619 0- MULTPLE YES 1+ MULTIPLE RETHRN mimfimmwm 3307392 sum 18 0F 24 VRP START v YES LINCRENIENT VPB COUNTER FOR CURRENT PATIENT} N VPB COUNTER 25 YES 1*- FR EQUENT v RETURN emmgmmsomm I 3l807l3-9-2 SHEET, 19 HF 24 M FP START V 0-- MULTIFORM SET VMORPH FOR CURRENT PATIENT DOES VMORPH HAVE A! IN BIT POSITION IN WHICH LAST HAS A 1 YES N0 l- MULTIFORM SET A 1 IN BIT POSITION 0F VMORPH CORRESPONDING TO THE 1 IN LAST1 MORPH-v LAST RETURN

Claims (65)

1. A method to be practiced on a machine for processing digital samples of successive electro-cardiographic waveforms of a patient comprising the steps of: a. generating at least two different series of digital function values from the successive digital samples being processed, b. performing tests on successive function values in each of said at least two series, c. selecting the tests which are performed on said function values in step (b) from a predetermined group of tests to obtain sElected tests that are dependent upon the results of the tests performed on earlier function values, d. registering the sequences of the results of the tests performed in step (b) on the function values generated for the electro-cardiographic waveforms which occur during a learning interval, e. thereafter determining if the sequence of the results of the tests performed in step (b) on the function values generated for a subsequent electro-cardiographic waveform is different from all of the sequences registered during said learning interval, and f. characterizing the morphology of an electro-cardiographic waveform of the patient in accordance with the results of the tests performed in step (b).
2. A method in accordance with claim 1 wherein the tests performed in step (b) are comparisons of said function values with threshold levels associated with respective ones of said series of function values.
3. A method in accordance with claim 2 further including the step of: d. continuously up-dating the threshold levels used in the comparison tests in accordance with predetermined numbers of most recent respective function values.
4. A method in accordance with claim 3 further including the steps of: g. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, and h. operating upon only particular function values in the performance of steps (e) and (f) for each electro-cardiographic waveform, the particular function values being those generated from a group of successive digital samples which occur during a predetermined time interval which brackets and has a fixed time relationship to the time when the presence of the respective R wave is determined.
5. A method in accordance with claim 3 wherein the function values in one series of function values generated in step (a) are proportional to the magnitudes of the digital samples being processed, and the function values in a second series of function values generated in step (a) are proportional to differences between the magnitudes of the digital samples.
6. A method in accordance with claim 3 wherein the function values in one series of function values generated in step (a) are dependent upon differences between the magnitudes of respective digital samples and the average magnitude of a predetermined number of earlier digital samples.
7. A method in accordance with claim 3 further including the steps of: e. computing the sum of a group of function values in one series of function values which are generated for each individual electro-cardiographic cycle, f. computing the average of the sums computed for a predetermined number of most recent electro-cardiographic cycles, and g. determining if the sum computed in step (e) for an individual electro-cardiographic cycle is greater than the average computed in step (f) by more than a predetermined amount.
8. A method in accordance with claim 3 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, g. computing the average of the time intervals computed in step (f) for a predetermined number of most recent R waves, and h. determining if the time interval computed in step (f) is greater than the average computed in step (g) by more than a predetermined amount.
9. A method in accordance with claim 3 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, g. computing the average of the Time intervals computed in step (f) for a predetermined number of most recent R waves, and h. determining if the time interval computed in step (f) is less than the average computed in step (g) by more than a predetermined amount.
10. A method in accordance with claim 3 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, g. computing the average of the time intervals computed in step (f) for a predetermined number of most recent R waves, and h. determining if any time interval computed in step (f) is less than the average computed in step (g) by more than a predetermined amount and the immediately succeeding time interval computed in step (f) is greater than the average computed in step (g) by more than a predetermined amount.
11. A method in accordance with claim 3 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, and g. determining the presence of a premature ventricular beat in accordance with two time intervals computed in step (f) which separate three successive R waves and in accordance with the characterizing in step (c) of the electro-cardiographic waveform associated with the second of the three successive R waves.
12. A method in accordance with claim 11 further including the step of: h. counting the number of premature ventricular beats whose presence are determined during a fixed time interval.
13. A method in accordance with claim 3 further including the steps of: e. computing the sum of a group of function values in one series of function values which are generated for each individual electro-cardiographic cycle, f. computing the average of the sums computed for a predetermined number of most recent electro-cardiographic cycles, g. determining if the sum computed in step (e) for an individual electro-cardiographic cycle is greater than the average computed in step (f) by more than a predetermined amount, h. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, i. computing the time interval between the determinations of the presence of two successive R waves, and j. determining the presence of a premature ventricular beat in accordance with two time intervals computed in step (i) which separate three successive R waves and in accordance with a determination made in step (g) that the sum computed for the electro-cardiographic cycle associated with the second or the third of the three successive R waves is greater than the average by a predetermined amount.
14. A method in accordance with claim 3 wherein each function value in one series of function values generated in step (a) is proportional to the sum of the magnitudes of a predetermined number of most recent digital samples.
15. A method in accordance with claim 1 wherein the tests performed in step (b) are comparisons of said function values with threshold levels associated with respective ones of said series of function values.
16. A method in accordance with claim 15 further including the step of: d. continuously up-dating the threshold levels used in the comparison tests in accordance with predetermined numbers of most recent respective function values.
17. A method in accordance with claim 16 further including the steps of: e. registering the sequences of the results of the tests performed in step (b) on the function values generated for the electro-cardiographic waveformS which occur during a learning interval, and f. thereafter determining if the sequence of the results of the tests performed in step (b) on the function values generated for a subsequent electro-cardiographic waveform is different from all of the sequences registered during said learning interval.
18. A method in accordance with claim 16 wherein the function values in one series of function values generated in step (a) are proportional to the magnitudes of the digital samples being processed, and the function values in a second series of function values generated in step (a) are proportional to differences between the magnitudes of the digital samples.
19. A method in accordance with claim 16 wherein the function values in one series of function values generated in step (a) are dependent upon differences between the magnitudes of respective digital samples and the average magnitude of a predetermined number of earlier digital samples.
20. A method in accordance with claim 16 further including the steps of: e. computing the sum of a group of function values in one series of function values which are generated for each individual electro-cardiographic cycle, f. computing the average of the sums computed for a predetermined number of most recent electro-cardiographic cycles, and g. determining if the sum computed in step (e) for an individual electro-cardiographic cycle is greater than the average computed in step (f) by more than a predetermined amount.
21. A method in accordance with claim 16 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, g. computing the average of the time intervals computed in step (f) for a predetermined number of most recent R waves, and h. determining if the time interval computed in step (f) is greater than the average computed in step (g) by more than a predetermined amount.
22. A method in accordance with claim 16 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, g. computing the average of the time intervals computed in step (f) for a predetermined number of most recent R waves, and h. determining if the time interval computed in step (f) is less than the average computed in step (g) by more than a predetermined amount.
23. A method in accordance with claim 16 further including the steps of: e. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, f. computing the time interval between the determinations of the presence of two successive R waves, g. computing the average of the time intervals computed in step (f) for a predetermined number of most recent R waves, and h. determining if any time interval computed in step (f) is less than the average computed in step (g) by more than a predetermined amount and the immediately succeeding time interval computed in step (f) is greater than the average computed in step (g) by more than a predetermined amount.
24. A method in accordance with claim 16 wherein each function value in one series of function values generated in step (a) is proportional to the sum of the magnitudes of a predetermined number of most recent digital samples.
25. A method in accordance with claim 1 further including the steps of: d. registering the sequences of the results of the tests performed in step (b) on the function values generated for the electro-cardiographic waveforms which occur during a learning interval, and e. thereafter determining if the sequence of the results of the test performed in step (b) on the function values generated for a subsequent electro-cardiographic waveform is different from all of the sequences registered during said learning interval.
26. A method in accordance with claim 1 further including the steps of: d. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, and e. utilizing only particular test results in the performance of step (c) to characterize each electro-cardiographic waveform, the particular test results being those of tests performed in step (b) on a group of successive function values which are generated for a predetermined time interval which brackets and has a fixed time relationship to the time when the presence of the respective R wave is determined.
27. A method in accordance with claim 1 wherein the function values in one series of function values generated in step (a) are proportional to the magnitudes of the digital samples being processed, and the function values in a second series of function values generated in step (a) are proportional to differences between the magnitudes of the digital samples.
28. A method in accordance with claim 1 wherein the function values in one series of function values generated in step (a) are dependent upon difference between the magnitudes of respective digital samples and the average magnitude of a predetermined number of earlier digital samples.
29. A method in accordance with claim 1 further including the steps of: d. computing the sum of a group of function values in one series of function values which are generated for each individual electro-cardiographic cycle, e. computing the average of the sums computed for a predetermined number of most recent electro-cardiographic cycles, and f. determining if the sum computed in step (d) for an individual electro-cardiographic cycle is greater than the average computed in step (e) by more than a predetermined amount.
30. A method in accordance with claim 1 further including the steps of: d. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, e. computing the time interval between the determinations of the presence of two successive R waves, f. computing the average of the time intervals computed in step (e) for a predetermined number of most recent R waves, and g. determining if the time interval computed in step (e) is greater than the average computed in step (f) by more than a predetermined amount.
31. A method in accordance with claim 1 further including the steps of: d. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, e. computing the time interval between the determinations of the presence of two successive R waves, f. computing the average of the time intervals computed in step (e) for a predetermined number of most recent R waves, and g. determining if the time interval computed in step (e) is less than the average computed in step (f) by more than a predetermined amount.
32. A method in accordance with claim 1 further including the steps of: d. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, e. computing the time interval between the determinations of the presence of two successive R waves, f. computing the average of the time intervals computed in step (e) for a predetermined number of most recent R waves, and g. determining if any time interval computed in step (e) is less than the average computed in step (f) by more than a predetermined amount anD the immediately succeeding time interval computed in step (e) is greater than the average computed in step (f) by more than a predetermined amount.
33. A method in accordance with claim 1 further including the steps of: d. performing a special test on successive function values in one series of function values to determine the presence of an R wave in an electro-cardiographic waveform, e. computing the time interval between the determinations of the presence of two successive R waves, and f. determining the presence of a premature ventricular beat in accordance with two time intervals computed in step (e) which separate three successive R waves and in accordance with the characterizing in step (c) of the electrocardiographic waveform associated with the second of the three successive R waves.
34. A method in accordance with claim 33 further including the step of: g. counting the number of premature ventricular beats whose presence are determined during a fixed time interval.
35. A method in accordance with claim 1 wherein each function value in one series of function values generated in step (a) is proportional to the sum of the magnitudes of a predetermined number of most recent digital samples.
36. A method to be practiced on a machine for processing digital samples of successive electro-cardiographic waveforms of each of a plurality of patients comprising the steps of: a. extending to said machine successive groups of digital samples, each group containing a digital sample of each of said patients, b. generating at least two different series of digital function values for each patient from the successive digital samples being processed for that patient, c. performing tests on successive function values in each of the at least two series for each patient, d. selecting the tests which are performed on said function values in step (c) from a predetermined group of tests to obtain selected tests that are dependent upon the results of the tests performed on earlier function values, e. registering the sequences of the results of the tests performed in step (c) on the function values generated for the electro-cardiographic waveform of each patient which occur during a learning interval, f. thereafter determining if the sequence of the results of the tests performed in step (c) on the function values generated for a subsequent electro-cardiographic waveform of each patient is different from all of the sequences registered for that patient during said learning interval, and g. characterizing the morphology of an electro-cardiographic waveform of each patient in accordance with the results of the tests performed in step (c) on that patient''s function values.
37. A method in accordance with claim 36 wherein the tests performed in step (c) for each patient are comparisons of the function values of that patient with respective threshold levels associated with respective ones of the series of function values of that patient.
38. A method in accordance with claim 37 further including the step of: e. continuously up-dating the threshold levels for each patient used in the comparison tests in accordance with predetermined numbers of most recent respective function values of that patient.
39. A method in accordance with claim 38 wherein each function value in one series of function values generated in step (a) for each patient is proportional to the sum of the magnitudes of a predetermined number of most recent digital samples of that patient.
40. A method in accordance with claim 36 wherein the tests performed in step (c) for each patient are comparisons of the function values of that patient with respective threshold levels associated with respective ones of the series of function values of that patient.
41. A method in accordance with claim 40 further including the step of: e. continuously up-dating the threshold levels for each patient used in the comparison tests in accordance with predetermined numbers of most recent respective function values of that patient.
42. A method in accordance with claim 41 further including the steps of: f. registering the sequences of the results of the tests performed in step (c) on the function values generated for the electro-cardiographic waveforms of each pateint which occur during a learning interval, and g. thereafter determining if the sequence of the results of the tests performed in step (c) on the function values generated for a subsequent electro-cardiographic waveform of each patient is different from all of the sequences registered for that patient during said learning interval.
43. A method in accordance with claim 41 wherein each function value in one series of function values generated in step (a) for each patient is proportional to the sum of the magnitudes of a predetermined number of most recent digital samples of that patient.
44. A method in accordance with claim 36 further including the steps of: e. registering the sequence of the results of the tests performed in step (c) on the function values generated for the electro-cardiographic waveforms of each patient which occur during a learning interval, and f. thereafter determining if the sequence of the results of the tests performed in step (c) on the function values generated for a subsequent electro-cardiographic waveform of each patient is different from all of the sequences registered for that patient during said learning interval.
45. A method in accordance with claim 36 further including the steps of: e. performing a special test on successive function values in one series of function values for each patient to determine the presence of an R wave in an electro-cardiographic waveform of that patient, and f. utilizing only particular test results in the performance of step (d) to characterize each electro-cardiographic waveform of a patient, the particular test results being those of tests performed in step (c) on a group of successive function values of that patient which are generated for a predetermined time interval which brackets and has a fixed time relationship to the time when the presence of the respective R wave is determined.
46. A method in accordance with claim 36 wherein the function values in one series of function values generated in step (a) for each patient are proportional to the magnitudes of the digital samples of that patient being processed, and the function values in a second series of function values generated in step (a) for each patient are proportional to differences between the magnitudes of the digital samples of that patient.
47. A method in accordance with claim 36 wherein the function values in one series of function values generated in step (a) for each patient are dependent upon differences between the magnitudes of respective digital samples of that patient and the average magnitude of a predetermined number of earlier digital samples of that patient.
48. A method in accordance with claim 36 further including the steps of: e. computing the sum of a group of function values in one series of function values for each patient which are generated for each individual electro-cardiographic cycle, f. computing for each patient the average of the sums computed for that patient for a predetermined number of most recent electro-cardiographic cycles, and g. determining if the sum computed in step (e) for an individual electro-cardiographic cycle of each pateint is greater than the average computed in step (f) for that patient by more than a predetermined amount.
49. A method in accordance with claim 36 further including the steps of: e. performing a special test on successive function values in one series of function values for each patient to determine the presence of an R wave in a electro-cardiographic waveform of that patient, f. computing the time interval between the determinations of the presence of two successive R waves of each patient, g. computing for each patient the average of the time intervals computed in step (f) for that patient for a predetermined number of most recent R waves, and h. determining if the time interval computed in step (f) for each patient is greater than the average computed in step (g) for that patient by more than a predetermined amount.
50. A method in accordance with claim 36 wherein each function value in one series of function values generated in step (a) for each patient is proportional to the sum of the magnitudes of a predetermined number of most recent digital samples of that patient.
51. A method for processing successive electrocardiographic waveforms of a patient comprising the steps of: a. generating at least two different series of sampled functions from the successive waveforms being processed, the sampled functions in each series being generated at a rate substantially higher than the rate at which successive wave-forms occur, b. performing tests on successive sampled functions in each of said at least two series, c. selecting the tests which are performed on said sampled functions in step (b) from a predetermined group of tests to obtain selected tests that are dependent upon the results of the tests performed on earlier sampled functions, d. registering the sequences of the results of the tests performed in step (b) on the sampled functions generated for the electro-cardiographic waveforms which occur during a learning interval, e. thereafter determining if the sequence of the results of the tests performed in step (b) on the sampled functions generated for a subsequent electro-cardiographic waveform is different from all of the sequences registered during said learning interval, and f. characterizing the morphology of an electro-cardiographic waveform of the patient in accordance with the results of the tests performed in step (b).
52. A method in accordance with claim 51 wherein the tests performed in step (b) are comparisons of said sampled functions with threshold levels associated with respective ones of said series of sampled functions.
53. A method in accordance with claim 52 further including the step of: d. continuously up-dating the threshold levels used in the comparison tests in accordance with predetermined numbers of most recent respective sampled functions.
54. A method in accordance with claim 53 wherein each sampled function in one series of sampled functions generated in step (a) is proportional to the sum of the magnitudes of a predetermined number of most recent samples of an electro-cardiographic waveform.
55. A method in accordance with claim 51 wherein the tests performed in step (b) are comparisons of said sampled functions with threshold levels associated with respective ones of said series of sampled functions.
56. A method in accordance with claim 55 further including the step of: d. continuously up-dating the threshold levels used in the comparison tests in accordance with predetermined numbers of most recent respective sampled functions.
57. A method in accordance with claim 56 further including the steps of: e. registering the sequences of the results of the tests performed in step (b) on the sampled functions generated for the electro-cardiographic waveforms which occur during a learning interval, and f. thereafter determining if the sequence of the results of the tests performed in step (b) on the sampled functions generated for a subsequent electro-cardiographic waveform is different from all of the sequences registered during said learning interval.
58. A method in accordance with claim 56 wherein each sampled function in one series of sampled functions generated in step (a) is proportional to the sum of the magnitudes of a predetermined number of most recent samples of an electro-cardiographic waveform.
59. A method in accordance with claim 51 further including the steps of: d. registering the sequences of the results of the tests pErformed in step (b) on the sampled functions generated for the electro-cardiographic waveforms which occur during a learning intervals, and e. thereafter determining if the sequence of the results of the tests performed in step (b) on the sampled functions generated for a subsequent electro-cardiographic waveform is different from all of the sequences registered during said learning interval.
60. A method in accordance with claim 51 further including the steps of: d. performing a special test on successive sampled functions in one series of sampled functions to determine the presence of an R wave in an electro-cardiographic waveform, and e. utilizing only particular test results in the performance of step (c) to characterize each electro-cardiographic waveform, the particularl test results being those of tests performed in step (b) on a group of successive sampled functions which are generated for a predetermined time interval which brackets and has a fixed time relationship to the time when the presence of the respective R wave is determined.
61. A method in accordance with claim 51 wherein the sampled functions in one series of sampled functions generated in step (a) are proportional to the magnitudes of samples of the waveforms being processed, and the sampled functions in a second series of sampled functions generated in step (a) are proportional to differences between the magnitudes of samples of the waveforms.
62. A method in accordance with claim 51 wherein the sampled functions in one series of sampled functions generated in step (a) are dependent upon differences between the magnitudes of respective samples of the waveform being processed and the average magnitude of a predetermined number of earlier samples of the waveform.
63. A method in accordance with claim 51 further including the steps of: d. computing the sum of a group of sampled functions in one series of sampled functions which are generated for each individual electro-cardiographic cycle, e. computing the average of the sums computed for a predetermined number of most recent electro-cardiographic cycles, and f. determining if the sum computed in step (d) for an individual electro-cardiographic cycle is greater than the average computed in step (e) by more than a predetermined amount.
64. A method in accordance with claim 51 further including the steps of: d. performing a special test on successive sampled functions in one series of sampled functions to determine the presence of an R wave in an electro-cardiographic waveform, e. computing the time interval between the determinations of the presence of two successive R waves, f. computing the average of the time intervals computed in step (e) for a predetermined number of most recent R waves, and g. determining if the time interval computed in step (e) is greater than the average computed in step (f) by more than a predetermined amount.
65. A method in accordance with claim 51 wherein each sampled function in one series of sampled functions generated in step (a) is proportional to the sum of the magntiudes of a predetermined number of most recent samples of an electro-cardiographic waveform.
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