EP0771170A4 - Detection de la variation anormale de la frequence cardiaque et induction d'une variation de frequence cardiaque normale - Google Patents

Detection de la variation anormale de la frequence cardiaque et induction d'une variation de frequence cardiaque normale

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Publication number
EP0771170A4
EP0771170A4 EP95926301A EP95926301A EP0771170A4 EP 0771170 A4 EP0771170 A4 EP 0771170A4 EP 95926301 A EP95926301 A EP 95926301A EP 95926301 A EP95926301 A EP 95926301A EP 0771170 A4 EP0771170 A4 EP 0771170A4
Authority
EP
European Patent Office
Prior art keywords
method defined
heart rate
alarm
user
amo
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP95926301A
Other languages
German (de)
English (en)
Other versions
EP0771170A1 (fr
Inventor
Boris Golosarsky
Nicholas Woos
F Eugene Davis Iv
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
GW Scientific Inc
Original Assignee
GW Scientific Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by GW Scientific Inc filed Critical GW Scientific Inc
Publication of EP0771170A1 publication Critical patent/EP0771170A1/fr
Publication of EP0771170A4 publication Critical patent/EP0771170A4/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/40—Detecting, measuring or recording for evaluating the nervous system
    • A61B5/4029—Detecting, measuring or recording for evaluating the nervous system for evaluating the peripheral nervous systems
    • A61B5/4035—Evaluating the autonomic nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/024—Detecting, measuring or recording pulse rate or heart rate
    • A61B5/02438—Detecting, measuring or recording pulse rate or heart rate with portable devices, e.g. worn by the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36592—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by the heart rate variability
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3904—External heart defibrillators [EHD]

Definitions

  • This invention relates to the detection of normal and abnormal heart rate variability and the induction of normal heart rate variability. More particularly, the invention relates to methods and apparatus for the detection of a user's heart rate variability that we believe is indicative of a user's sympathetic/parasympathetic stress balance, or distress imbalance.
  • the invention also relates to heart monitoring devices used by individuals monitored in hospital intensive care units; by user's after discharge from a hospital intensive care unit; and by users when exercising to let them know that their stress state is optimal for conditioning their bodies.
  • the invention further relates to control of a pacemaker or cardioverter defibri11ator with a pacemaker so that when the user's heart rate is abnormal and distressful, according to the invention, a pacemaker or cardioverter defibril1ator with a pacemaker induces a heart rate with a pseudo-normal or patient recorded variability for each particular user.
  • the invention still further relates to a pacemaker that induces pseudo-normal or patient recorded heart rate variability.
  • the normal heart rhythm is slightly irregular. Generally, normal irregularity of the heart's rhythm reflects the permanent adaptation of the human body to the environment. In this context the first sign of an impaired heart rhythm is either a persistent increase or a persistent decrease in the variability of the heart's rhythm. Sometimes the change in the heart's rhythm alternates between increases and decreases in the variability of the heart's rhythm, and vice versa. Prolonged increases, or decreases, and combinations thereof, can lead to cardiac ectopic events ranging from non-sustained ventricular tachycardia to cardiac arrest.
  • the sympathetic branch increases the heart rate. Its prime function is to prepare the body for stress, the so-called "fight or flight response”.
  • the parasympathetic branch decreases the heart rate as when eating or sleeping.
  • Rhyth ography that is the study of normal and abnormal variations in heart rhythm, was utilized extensively to determine the condition of individuals and their stress state. This was particularly true of cosmonauts. It was determined for example, that the heart rate variability of a conditioned athlete is much greater than that of person with coronary disease, that is the histogram of heart rate variation of a well conditioned athlete exhibits a broad range of variability in the Time Intervals between heart beats and a low relative Amplitude of the Mode. That is the highest number of Time Intervals recorded in a series of Time Intervals. The histogram of a person with a coronary disease exhibits a narrow range of variability and a high relative Amplitude of the Mode, that is the peak of the histogram.
  • Polar Electro Oy of Finland has a patented apparatus comprised of a chest strap with a two lead ECG signal sensor and transmitter, which transmits the heart beat Time Intervals to a wrist mounted unit that can be conveniently used in this invention. See U.S. Patent Nos . 4,625,733, D278,746, and D287,403.
  • Pulse sensors of various types may also be used to detect the Time Interval between heart beats, (Start-of-Systole to Start-of-Systole, SOS), is essentially equal to the Time Interval between RR peaks in an electrocardiogram, (ECG).
  • ECG electrocardiogram
  • ECG ECG
  • SOS Start-of-Systole
  • RR and SOS Time Intervals are used interchangeably to indicate the Time Interval between heart beats. 60 seconds divided by the Time Interval in seconds equals the beats per minute.
  • Time Interval is the duration of time between heart beats, preferably measured to an accuracy of 20 milliseconds, .02 seconds.
  • the accuracy of the Time Interval can range from 15 milliseconds to 30 milliseconds.
  • Time Segment is a series of heart beats can vary in length from 51 Time Intervals to 301 Time Intervals. The preferred default setting is 101 Time Intervals.
  • Mode , ⁇ MQI The Mode is the Time Interval occurring most often in a Time Segment. For each Mode in a Time Segment there are recorded values for UV, AMo, and DX. (See below).
  • a Cluster Mode is a group of Modes occurring in a plurality of adjoining successive Time Segments. For each
  • Amplitude of the Mode, fAMol The Amplitude of the Mode is the largest number of identical Time Intervals occurring in a Time Segment divided by the total number of Time Intervals in said Time Segment, which is expressed as a percentage. (e.g. 70 for 70 Time Intervals out of 101 Time Intervals.)
  • UV l [.5/DX] 2 + [AMo/10] 2
  • the Median is the Time Interval in a Time Segment, in which there are equal number Time Intervals equal to or larger than and equal to or smaller than the Median Time Interval (e.g. the 51st Time Interval in a 101 Time Interval Time Segment.)
  • Time Interval is the Time Interval between two ECG (RR) peaks, or pulse wave Start of Systole to Start of Systole, (SOS) troughs recorded by the user.
  • RR ECG
  • SOS pulse wave Start of Systole to Start of Systole
  • An inferred Time Interval is an a Time Interval that is inferred from recorded or other inferred Time Intervals.
  • the Recorded Baseline values for UV, AMo, & DX are established during the first period monitoring the user. Preferably this a 24 hour time period, but could be shortened when required, e.g. in an emergency room.
  • the Recorded Baseline values should be re-recorded every year. As people age their heart rhythm tends to become less variable.
  • UV, AMo, & DX If time does not permit recording the first 24 hours of UV, AMo, & DX, then at least 35 Time Segments are recorded and the first five Time Segments are discarded since they are part of the calibration and run-in period.
  • the minimum acceptable recorded values for UV, AMO and DX are for three successively occurring Modes, which creates one Cluster Mode.
  • Premature Ventricular Contractions, TPVC'sl A PVC is a Time Interval that is 20% less than the average of the previous eight Time Intervals. PVC's are discarded and new Time Intervals added until 101 Time Intervals are accumulated in a Time Segment.
  • Outliers are the three shortest and the three longest Time Intervals in a 101 beat Time Segment, and are discarded before calculations are made for UV, AMo and D .
  • a user is anyone whose Time Intervals are recorded.
  • Caution The user has a potentially unhealthy stress condition.
  • ALARM 1 is present when the user's current values for UV, AMo or DX indicate sympathetic, parasympathetic, mixed sympathetic/parasympathetic over activity, or PVC's, for a predetermined number of Time Segments or a predetermined period of time.
  • ALARM 2 is present when no pulse is detected for ten or more seconds and the galvanic skin response sensor indicates the ECG electrodes or the pulse sensor is in contact with the user.
  • a transducer detects a range of motions from, no motion, to slight motion, to moderate motion to heavy motion and over load.
  • No motion for a predetermined period of time and a heart or pulse rate indicates a Comatose Caution.
  • Slight motion and a heart or pulse rate indicate sleep.
  • Heavy motion indicates exercise and over load (spike) followed by no motion, indicates a fall.
  • the invention provides for the automatic detection of the user's functional and stress states based on the on-line recording of the Median, [M], one or more Cluster Modes, [CMo], the Amplitude of the Mode, [AMo], and Delta X, [DX], and User Value, [UV], recorded over successive Time Segments.
  • 19 formulas are used to determine the user's stress status and possible ALARM, Caution, and normal OK stress condition.
  • the multiplier factors and time durations of the 19 formulas are programmable by the user's health care provider to suit the individual user.
  • AMo Sympathetic ALARM If the current value for AMo is greater than the user's baseline value for AMo for any Cluster Mode, times a predetermined multiplier factor for a predetermined number of minutes, then this is an AMo Sympathetic ALARM.
  • Any combination of a UV Sympathetic ALARM, [8], and a UV Parasympathetic ALARM, [9], for a predetermined number of minutes is a UV Mixed Sympathetic/Parasympathetic ALARM-Long Term.
  • Any combination of a UV Sympathetic ALARM, [8], and a UV Parasympathetic ALARM, [9] in 101 Time Interval Time Segment, in two or more times in any continuous grouping of ten Time Segments is a UV Mixed Sympathetic/Parasympathetic ALARM-Short Term.
  • the Cardiac Arrest ALARM, Comatose Caution, and the PVC ALARM and the next six formulas for ALARMS and Cautions are absolute, and not dependant on the user's baseline values.
  • Parasympathetic ALARM-Type IV [15] If AMo is equal or less than 10 in two or more Time Segments in any continuous grouping of ten Time Segments, then this is a Parasympathetic ALARM-Type IV.
  • the user's functional and stress states may be displayed to the user or a health care provider in an alphanumeric fashion. This enables the user or health care provider to determine the user's stress status substantially instantaneously at any time or place, and to attain a state of effective cardiovascular fitness .
  • the triangle of the histogram indicated by formulas [8] and [9], e.g. the sharpness, or flatness of the histogram, (is equivalent to the Q of a resonant circuit), is a measure for each Cluster Mode that indicates that the user is in a normal autonomic balance or homeostasis between sympathetic and parasympathetic control of the user's heart rate variability.
  • Detection of abnormal heart rate variability in a series of Time Segments can therefore be used to signal a health care provider, or pacemaker, or cardioverter defibri1 lator with a pace maker, to intervene according to the invention, or to indicate that the heart is being over stressed by the particular activity (e.g. physical, psychogenic) being engaged in.
  • a health care provider or pacemaker, or cardioverter defibri1 lator with a pace maker
  • a pacemaker or a cardioverter defibri11ator with a pacemaker can be programmed to provide a normal, therapeutic heart rate variability rather than an unnatural steady beat as in the prior art. This may be accomplished by, (1) recording the user's normal, variable heart rate, or (2) the normal, variable heart rhythm of an individual most nearly matching the user's age, sex, race, build and athletic condition, or (3) using a random pulse generator that produces a normal, variable histographic heart rate, all in conjunction with an impedance pacemaker, (a pacemaker that detects respiration) and a galvanic skin response detector.
  • Another object of the invention is to provide such apparatus, which allows the user to exercise in a stress state which will bring about a maximum conditioning effect.
  • a further object of the invention is to provide such apparatus and method that the user will be notified of non- optimal or an ALARM or Caution distress state.
  • Still another object of the invention is to detect stress and distress states from simple parameters derived from the recording of a plurality of durations of successive Time Intervals between heart beats.
  • Yet another object of the invention is to detect cardiac distress .
  • Still another object of the invention is to detect abnormal heart rate variability over a relatively short period of time and to signal this abnormality to a health care provider, or a pacemaker or a cardioverter defibri11ator with a pacemaker, to initiate intervention.
  • a still further object of the invention is to cause a pacemaker or cardioverter defibri1lator with a pacemaker, to pace a heart with a normal heart rate variability.
  • the invention accordingly comprises a method comprising several steps and the relation of one or more of such steps with respect to each of the others, and the apparatus embodying features of construction, elements, and arrangements of parts, which are adapted to effect such steps, all as exemplified in the following detailed disclosure.
  • FIGURE 1 is a diagram showing the electrocardiogram recording of a user and the user's pulse waves showing that the RR Time Intervals in the electrocardiogram are substantially equal to the corresponding Time Intervals between start of systole and start of systole;
  • FIGURE 2 is a histogram of the numbers of equal Time Intervals between heart beats recorded from a normal user
  • FIGURE 3 is an overall block diagram of the apparatus according to the invention.
  • FIGURE 4 is a diagram showing how FIGURES 4A, 4B, and 4C may be placed together to form FIGURE 4, which is a flow chart showing the processing of a preselected number of heart beat Time Intervals to determine the seventeen ALARM and Caution conditions utilized in the invention;
  • FIGURE 5 is a detailed block diagram of the apparatus shown in FIGURE 3;
  • FIGURE 6 is a detailed block diagram of a sports watch apparatus according to the invention.
  • FIGURE 7 is a block diagram of a multiple patient monitoring apparatus according to the invention.
  • FIGURE 8 is a detailed view of Screen A of FIGURE 7;
  • FIGURE 9 is a detailed view of Screen B of FIGURE 7
  • FIGURE 10 is a detailed view of Screen C of FIGURE 7;
  • FIGURE 11 is a block diagram of a pacemaker, which also may be part of a cardioverter defibri 11ator with a pacemaker according to the invention.
  • FIGURES 12 through 48 show various displays for FIGURE 5 and FIGURE 6 according to the invention.
  • FIGURE 49 is a diagram showing how FIGURES 49A, 49B, 49C, 49D and 49E may be placed together to form FIGURE 49, which is a flow chart showing the processing of a preselected number of heart beat Time Intervals to determine the user's OK Zone, the Sympathetic ALARM Zone, the Parasympathetic ALARM Zone, and the multiplier factors, which determine an ALARM according to the invention;
  • FIGURE 49A is a diagram showing the recorded values of the user's User Value [UV], Amplitude of the Mode [AMo], and Delta X [DX] of the shortest Mode, the next shortest Mode, and the third shortest Mode of successively recorded Time Segments of 101 Time Intervals each, which comprise a Cluster Mode according to the invention;
  • FIGURE 49B is a diagram similar to FIGURE 49A and includes the next three successively longer Modes according to the invention.
  • FIGURE 49C is a diagram showing how [UV], [AMo], and [DX] for even shorter Modes may be inferred from the measurements indicated in FIGURE 49B according to the invention;
  • FIGURE 49D is a diagram indicating how the average [UV], average [AMo], and average [DX] are calculated for each Cluster Mode according to the invention.
  • FIGURE 49E is a diagram showing how the OK Zone, Sympathetic ALARM Zone and Parasympathetic ALARM Zone for [UV] , [AMo], and [DX] are established using various multiplier factors according to the invention;
  • FIGURE 50 is a diagram of heart rate Time Intervals versus time for 101 Time Intervals for a normal healthy male age 63;
  • FIGURE 51 is a diagram similar to FIGURE 50 for an unhealthy male age 51;
  • FIGURE 52 is a diagram similar to FIGURE 50 which shows how patients are presently paced with a pacemaker using a constant heart rate Time Interval ;
  • FIGURE 53 is a diagram which shows how heart rate variability decreases thus narrowing the OK Zone over a human's life time
  • FIGURE 54 is a diagram, similar to FIGURE 53, which shows how, with variable pacing, the user's OK Zone may be expanded to be similar to that of a younger subject according to the invention.
  • FIGURE 55 is a record of User Values [UV] of a cardiac patient which shows how the [UV] ALARMS indicating an over active sympathetic nervous system were activated three times prior to sudden cardiac death, and how a change from an over active sympathetic nervous system to an over active parasympathetic nervous system occurred approximately 10 hours prior to sudden cardiac death triggering multiple [UV] ALARMS until sudden cardiac death.
  • every heart beat is composed of an electrical wave pattern called the PQRST wave.
  • the letters indicate the important points in the wave pattern, and is generated by an electrocardiogram monitor or ECG.
  • the letter "R” designates the peak of the PQRST wave.
  • the Time Intervals between RR peaks are indicated at 60 to 61, 61 to 62, 62 to 63, etcetera, etcetera.
  • the Time Intervals between the Start of Systole to the Start of Systole SOS.
  • the Time Intervals between SOS troughs are indicated at 70 to 71, 71 to 72, 72 to 73, etcetera, etcetera.
  • the ECG RR Time Intervals have substant all the same time duration as the pulse SOS Time Intervals and occur about a half second later than the RR Time Intervals.
  • FIG 2 is a typical histogram of a 101 Time Intervals in a Time Segment.
  • the outliers e.g. the three longest and the three shortest Time Intervals are deleted.
  • Delta X, [DX] is the difference between the longest Time Interval remaining and the shortest Time Interval remaining.
  • the Mode, [Mo] is the Time Interval occurring most often in a Time Segment.
  • the Amplitude of the Mode, [AMo] is the largest number of identical Time Intervals occurring in a Time Segment divided by the total number of Time Intervals in said Time Segment.
  • the Median, [M] is the Time Interval in a Time Segment, in which there are equal numbers of Time Intervals equal to or larger and equal to or smaller than the Median Time Interval. As shown in FIG 2 of a normal user, the Mode and the Mean are the same.
  • the RR Time Interval data 80 is received from an RR Time Interval sensor and the signal is processed 82, and transferred 84 to a computer 104.
  • SOS Time Interval data 90 is received from an SOS Time Interval sensor and the signal processed 88, and transferred 90 to a computer 104.
  • data from a galvanic skin response sensor 92 is received and the signal processed 94, and transferred 96 to a computer 104.
  • data from a motion sensor 98 is received and the signal processed 100, and transferred 102 to a computer 104.
  • data from a respiratory sensor 97 and the signal processed 99 and transferred to a computer.
  • the results of the computer's analysis is transferred 106 to a display 108.
  • FIG 4 is a diagram of FIGURES 4A, 4B, and 4C.
  • each of the following 17 formulas is assigned a separate memory which stores four hours of ALARM, Caution and OK data in the devices diagramed in FIG 5 and FIG 6, and 48 hours of data in the device diagramed in FIGURES 7, 8, 9 and 10.
  • RR Time Interval data 119 or SOS Time Interval data 119 is analyzed to determine if Time Interval data is being received. Also, galvanic skin response data 111 is analyzed. Motion and non-motion data 113 is analyzed and the results transferred 117 to memory 212.
  • Time Interval data is detected 110 and the galvanic skin response sensor 114 records no contact with the user, then the Time Interval sensor is disconnected from the user 118.
  • Time Interval data is detected 110 and the motion sensor has not recorded any movement for a predetermined period of time 114, then this a Comatose Caution 120. Then 101 Time Intervals are accumulated in a Time Segment for further analysis 122.
  • Formula [1] processes a 101 Time Intervals in a Time Segment. If 20 or more PVC's are detected 124 the data is transferred 125 to memory 212. If 20 or more PVC's per Time Segment occur for a predetermined period of time then a PVC ALARM is detected. If 1 to 19 PVC's are detected, they are discarded and the next succeeding Time Intervals equal to the number discarded, replace the discarded Time Intervals until 101 Time Intervals are accumulated 119.
  • Formulas for AMo [21T31 and DX [41T51 for each current Cluster Mode in which they occur are calculated 128 and compared with the user's recorded baseline values for AMo and DX 130. If one or more ALARMS are detected the data is transferred 132 to the appropriate memory assigned to formulas [2][3][4] and [5] 212. If one or more ALARMS occurs for a predetermined period of time, interrupted by single, non-contiguous OK Time Segments, if any, then one or more of four ALARMS are detected, e.g. An Amo Sympathetic ALARM f21. an AMo Parasympathetic ALARM T31 , a DX Sympathetic ALARM P41. a DX Parasympathetic ALARM f51. as the case may be 130. If an ALARM is detected and if no ALARM is detected 134, the 101 Time Intervals in the Time Segment 122 are analyzed by the next formula [6] 136.
  • a combination of Sympathetic ALARMs, [21 and f41. and Parasympathetic ALARMs, T31 and T51 occur in a single Time Segment, in a predetermined percentage of 10 continuous Time Segments, then a Mixed Sympathetic/Parasympathetic ALARM-Short Term [71 is detected 142. If an ALARM is detected by formula [7], the data is transferred 144 to the memory assigned to formula [7] 212. If an ALARM is detected and if no ALARM is detected 146 the data is transferred 144 to the appropriate memory assigned to formula [7], and the 101 Time Intervals in the Time Segment 122 are analyzed by the next formula [8] 148.
  • UV Sympathetic [81 for each current Cluster Mode in which it occurs is calculated and compared with the user's recorded baseline values for UV 150. If an ALARM occurs for a predetermined period of time, interrupted by single, non ⁇ contiguous OK Time Segments, if any, then an ALARM is detected, e.g. a UV Sympathetic Alarm [81 148. If an ALARM is detected by formula [8], the data is transferred 152 to the memory assigned to formula [8] 212. If an ALARM is detected and if no ALARM is detected 160, the data is transferred 152 to the appropriate memory assigned to formula [8], and the 101 Time Intervals in the Time Segment 122 are analyzed by the next formula [9] 148.
  • UV Parasympathetic T91 for each current Cluster Mode in which it occurs is calculated and compared with the user's recorded baseline values for UV 154. If an ALARM occurs for a predetermined period of time, interrupted by single, non-contiguous OK Time Segments, if any, then an ALARM is detected, e.g. a UV Parasympathetic Alarm [91 148. If an ALARM is detected by formula [9], the data is transferred 156 to the memory assigned to formula [9] 212. If an ALARM is detected and 22
  • the data is transferred 156 to the appropriate memory assigned to formula [9], and the 101 Time Intervals in the Time Segment 122 are analyzed by the next formula [10] 162.
  • UV Sympathetic ALARMs T81 and UV Parasympathetic ALARMs T91 occur for a predetermined period of time, interrupted by single, non-contiguous OK Time Segments, if any, then a Mixed UV Sympathetic/Parasympathetic ALARM-Long Term [101 is detected 162. If an ALARM is detected by formula [10], the data is transferred 166 to the memory assigned to formula [10] 212. If an ALARM is detected and if no ALARM is detected 172, the data is transferred 166 to the appropriate memory assigned to formula [7], and the 101 Time Intervals in the Time Segment 122 are analyzed by the next formula [11] 162.
  • Time Interval of the current Time Segment is calculated 174 and the Time Intervals in the Time Segment 122 are analyzed by the next formula [12] 178.
  • DX divided by the Median, [M] , 174 equals or is less than .125 the data is transferred 180 to the memory assigned to formula [12] 212. If within a Time Segment, DX divided by the Median equals or is less than .125 occurs in a predetermined percentage of 10 continuous Time Segments, then a Sympathetic Type II ALARM T121 178 is detected. Also, if within a Time Segment, DX divided by the Median equals or is more than .125 but less than .425 182, and the data is transferred 180 to the memory assigned to formula [12] 212, and the Time Intervals in the Time Segment 122 are analyzed by the next formula [13] 184.
  • DX divided by the Median, [M] 174 equals or is more than .425 the data is transferred 186 to the memory assigned to formula [13] 212. If within a Time Segment, DX divided by the Median equals or is more than .425 occurs in a predetermined percentage of 10 continuous Time Segments, then a Parasympathetic Type II ALARM [131 184 is detected. Also, if within a Time Segment, DX divided by the Median equals or is more than .125 but less than .425 184 the data is transferred 186 to the memory assigned to formula [13] 212, and the Time Intervals in the Time Segment 122 are analyzed by the next formula [14] 190.
  • DX is transferred 192 to the memory assigned to formula [14] 212. If this occurs in a predetermined percentage of 10 continuous Time Segments, then a Parasympathetic ALARM Type III [141 190 is detected. Also, if within a Time Segment, DX is less than .50, the data is transferred 192 to the memory assigned to formula [14] 212, and the Time Intervals in the Time Segment 122 are analyzed by the next formula [15] 196.
  • AMo equals or is less than 10 196
  • the data is transferred 198 to the memory assigned to formula [15] 212. If this occurs in a predetermined percentage of 10 continuous Time Segments, then a Parasympathetic Type IV ALARM r151 196 is detected. Also, if within a Time Segment, AMo is more than 10 200, the data is transferred 198 to the memory assigned to formula [15] 212, and the Time Intervals in the Time Segment 122 are analyzed by the next formula [16] 202.
  • FIG 4C is the continued analysis of a Time Segment of 101 Time Intervals 122 made by the following formulas:
  • DX is equal or less than .06202
  • the data is transferred 204 to the memory assigned to formula [16] 212. If this occurs for a percentage of a predetermined period of the time, then a Sympathetic Caution-Long Term [161 202 is detected. Also, if DX is more than .06 206, the data is transferred 204 to the memory assigned to formula [16] 212, and the Time Intervals in the Time Segment 122 are analyzed by the next formula [17] 208.
  • the data is transferred 210 to the memory assigned to formula [17] 212. If this occurs for a percentage of a predetermined period of time, then a Caution-Short Term [171 208 is detected. Also, if AMo and DX do not vary directly, the data is transferred 210 to the memory assigned to formula [17] 212, and the count of new Time Intervals in the next succeeding Time Segment commences 213.
  • a microprocessor with a date and time clock 300 gathers Time Interval data from a Time Interval sensor 80 or 86, and from a motion sensor 98 and a galvanic skin response sensor 92.
  • ALARM, Caution and OK stress data is stored in the microprocessor memory and dated and time stamped by the date and time clock 300.
  • the stress data accumulated for the user can be down loaded to a PC 301.
  • the multiplier factors and time durations for the 17 formulas can be programmed and re- programmed by the user's health care provider 324.
  • the user's stress status is displayed on a liquid crystal diode 302. If the battery has less than a 20% charge a buzzer notifies the user 304.
  • the battery power pack 303 supplies electricity to operate the components 80 through 306.
  • the user's stress status is transmitted by a low power RF transmitter 306 to a receiver 308 inside the cellular telephone 312.
  • the strobe light 316 is activated on the cellular telephone 312, and the voice microprocessor broadcasts 318 from the cellular telephone earpiece speaker CPR instructions, and the user's front door light starts to flash 320, and the front door is unlocked by activating an electric door strike 322, and an ALARM message is transmitted by the cellular telephone 312, first by attempting a landline connection 323 to a health care provider 324, and failing a landline connection 325, then on cellular frequencies to 313 to a health care provider 324.
  • a microprocessor with a date and time clock 300 gathers Time Interval data, 80 or 86, from a Time Interval sensor 80 or 86.
  • ALARM, Caution and OK stress data is stored in the microprocessor memory and dated and time stamped by the date and time clock 300.
  • the stress data accumulated for the user can be down loaded to a PC 301.
  • the multiplier factors and time durations for the 17 formulas can be programmed and re- programmed by the user's health care provider 324.
  • the battery power pack 303 supplies electricity to operate the components 80 through 318.
  • the user's stress status is displayed on a liquid crystal diode 302, and the voice microprocessor broadcasts from a micro speaker CPR instructions 318. If the battery has less than a 20% charge a buzzer notifies the user 304.
  • FIG 7 illustrates a single channel ECG apparatus for eight patient users 400 through 414 in hospital critical care units.
  • the RR Time Interval data for each patient user and each signal processed 416 and downloaded to a central PC 418, which analyzes each user's stress status and displays this information on a monitor, FIG 8, Screen A, FIG 9, Screen B, and FIG 10, Screen C.
  • Screen A is the eight patient monitor which displays the user patient's name, room and bed number, and the current values for each user patient's UV, AMo, and DX, the PVC count, and heart rate in Beats Per Minute.
  • Screen A displays each user patient's UV, AMo, and DX ALARM status, the setting in minutes of when an ALARM would be triggered and the number of minutes an ALARM condition, if any, has persisted.
  • the health care provider on duty can display an individual user's recent stress record, as illustrated in FIG 9, Screen B.
  • the user patient's name, room and bed designation In the left hand column are the user patient's name, room and bed designation. Below this information. Below this information are the ALARM Settings comprised of the baseline formulas for UV, AMo, and DX, the multiplier factors used to establish the user patient's Sympathetic and Parasympathetic ALARM Zones, and the values derived, which trigger an ALARM condition. Below this are the ALARM durations, which cause an ALARM to be triggered.
  • the user patient's values for UV, AMo, D , and PVC's together the user patient's heart rate in BPM and the ALARM set.
  • the health care provider can view a graphic illustration of a user's recent stress record illustrated in FIG 10, Screen C. 27
  • the Pace Signal Generator will commence pacing the User's Heart for a predetermined period of time.
  • FIG 12 illustrates a rectilinear digital display format of the wrist unit component described in FIG 5 and FIG 6.
  • the top line displays the date, the second line the time, the third line the user's stress or distress status, the fourth line the type of distress based on one or more of the 17 distress formulas discussed elsewhere, and the fifth line the user's pulse and the symbol for a heart indicating the galvanic skin response sensor is gathering pulse data from the user.
  • the user's stress/distress state is OK.
  • FIG 13 illustrates an alternative round analog/digital standard watch format screen of the wrist unit component described in FIG 5 and FIG 6.
  • FIG 14 illustrates the stress/distress screen on the round analog/digital standard watch format of the wrist unit component described in FIG 5 and FIG 6.
  • the left hemisphere of the screen is for the display of the type of distress based on one or more of the seventeen, [1]-[17], distress formulas discussed elsewhere.
  • the numbers from O at the 12 o'clock position going counterclockwise to -60 at the 6 o'clock position indicate the duration of a parasympathetic alarm in minutes.
  • the numbers from 0 at the 12 o'clock position going clockwise to +60 at the 6 o'clock position indicate the duration of a sympathetic alarm in minutes.
  • At the center of the two hemispheres is the symbol for a heart indicating the galvanic skin response sensor is gathering pulse data. The user's pulse is displayed at the bottom of the screen. In FIG 14 the user's stress/distress state is OK. 28
  • FIG 15 illustrates a user's ALARM in the digital format based on the first, [1], stress formula, discussed elsewhere, and is based on 20 or more premature ventricular contractions, PVC's per Time Segment.
  • This information is displayed on the fourth line of the digital format screen along with the type of activity, which in this example is 20 PVC's per Time Segment, and the duration of the over activity, which in this example is two out of the ten previous Time Segments.
  • FIG 16 illustrates a user's ALARM on the stress/distress screen of the round analog/digi al standard watch based format on the first, [1], stress formula, discussed elsewhere, and is based on 20 or more PVC's per Time Segment. This information is displayed in the center of the two hemispheres of the analog/digital format screen.
  • the type of over activity which in this example is 20 PVC's, and the duration of the over activity, which in this example is two out of the previous ten Time Segments .
  • FIG 17 illustrates a user's ALARM in the digital format based on the second, [2] stress formula, discussed elsewhere, and is based on an over active sympathetic AMo. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is 31 minutes.
  • FIG 18 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the second, [2] stress formula, discussed elsewhere, and is based on an over active sympathetic AMo. This information is displayed in the right hemisphere of the analog/digital format screen.
  • FIG 19 illustrates a user's ALARM in the digital format based on the third, [3] stress formula, discussed elsewhere, and is based on an over active parasympathetic AMo. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is parasympathetic, and the duration of the over activity, which in this example is 31 minutes.
  • FIG 20 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the third, [3] stress formula, discussed elsewhere, and is based on an over active parasympathetic AMo. This information is displayed in the left hemisphere of the analog/digital format screen.
  • FIG 21 illustrates a user's ALARM in the digital format based on the fourth, [4] stress formula, discussed elsewhere, and is based on an over active sympathetic DX. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is 31 minutes.
  • FIG 22 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the fourth, [4] stress formula, discussed elsewhere, and is based on an over active sympathetic DX. This information is displayed in the right hemisphere of the analog/digital format screen.
  • FIG 23 illustrates a user's ALARM in the digital format based on the fourth, [4] stress formula, discussed elsewhere, and is based on an over active parasympathetic DX . This information is displayed on the fourth line of the digital format 30
  • FIG 24 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the fourth, [4] stress formula, discussed elsewhere, and is based on an over active parasympathetic DX. This information is displayed in the left hemisphere of the analog/digital format screen.
  • FIG 25 illustrates a user's ALARM in the digital format based on the sixth, [6], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic AMo and DX.
  • This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is both sympathetic and parasympathet c, and the duration of the over activity, which in this example is 21 minutes of sympathetic and 10 minutes of parasympa hetic over activity.
  • FIG 26 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the sixth, [6], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic AMo and DX. This information is displayed in the center of the two hemispheres of the analog/digital format screen.
  • the type of over activity which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is 21 minutes of sympathetic and 10 minutes of parasympathet c over activity.
  • FIG 27 illustrates a user's ALARM in the digital format based on the seventh, [7], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic AMo and DX within a single Time Segment.
  • This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 28 illustrates a user's ALARM of the stress/distress screen on the round analog/digital standard watch based format on the seventh, [7], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic AMo and DX within a single Time Segment.
  • This information is displayed in the center of the two hemispheres of the analog/digital format screen.
  • the type of over activity, which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 29 illustrates a user's ALARM in the digital format based on the eighth, [8] stress formula, discussed elsewhere, and is based on an over active sympathetic UV. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is 31 minutes.
  • FIG 30 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the eighth, [8] stress formula, discussed elsewhere, and is based on an over active sympathetic UV. This information is displayed in the right hemisphere of the analog/digital format screen.
  • FIG 31 illustrates a user's ALARM in the digital format based on the ninth, [9] stress formula, discussed elsewhere, and is based on an over active parasympathetic UV. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is parasympathetic, and the duration of the over activity, which in this example is 31 minutes.
  • FIG 32 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the ninth, [9] stress formula, discussed elsewhere, and is based on an over active parasympathetic UV. This information is displayed in the left hemisphere of the analog/digital format screen.
  • FIG 33 illustrates a user's ALARM in the digital format based on the tenth, [10], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathet c UV.
  • This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is 21 minutes of sympathetic and 10 minutes of parasympathetic over activity .
  • FIG 34 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the tenth, [10], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic UV. This information is displayed in the center of the two hemispheres of the analog/digital format screen.
  • the type of over activity which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is 21 minutes of sympathetic and 10 minutes of parasympathetic over activity.
  • FIG 35 illustrates a user's ALARM in the digital format based on the eleventh, [11], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic UV within a single Time Segment.
  • This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 36 illustrates a user's ALARM of the stress/distress screen on the round analog/digital standard watch based format on the eleventh, [11], stress formula, discussed elsewhere, and is based on an over active sympathetic and parasympathetic UV within a single Time Segment.
  • This information is displayed in the center of the two hemispheres of the analog/digital format screen.
  • the type of over activity, which in this example is both sympathetic and parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 37 illustrates a user's ALARM in the digital format based on the twelfth [12] stress formula, discussed elsewhere, and is based on an over active sympathetic system. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments .
  • FIG 38 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the twelfth, [12], stress formula, discussed elsewhere, and is based on an over active sympathetic system. This information is displayed in the right hemisphere of the analog/digital format screen. The type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 39 illustrates a user's ALARM in the digital format based on the thirteenth [13] stress formula, discussed elsewhere, and is based on an over active parasympathetic system. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments .
  • FIG 40 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the thirteenth, [13], stress formula, discussed elsewhere, and is based on an over active parasympathetic system. This information is displayed in the left hemisphere of the analog/digital format screen.
  • FIG 41 illustrates a user's ALARM in the digital format based on the fourteenth, [14], stress formula, discussed elsewhere, and is based on an over active parasympathetic system. This information is displayed on the fourth line of the digital format screen, along with the type of over activity, which in this example is parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 42 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the fourteenth, [14], stress formula, discussed elsewhere, and is based on an over active parasympathetic system. This information is displayed in the left hemisphere of the analog/digital format screen. The type of over activity, which in this example is parasympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 43 illustrates a user's ALARM in the digital format based on the fifteenth, [15], stress formula, discussed elsewhere, and is based on an over active sympathetic system. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is two out of the previous ten Time Segments.
  • FIG 44 illustrates a user's ALARM on the stress/distress screen of the round analog/digital standard watch based format on the fifteenth, [15], stress formula, discussed elsewhere, and is based on an over active sympathetic system. This information is displayed in the left hemisphere of the analog/digital format screen.
  • FIG 45 illustrates a user's Caution in the digital format based on the sixteenth [16] stress formula, discussed elsewhere, and is based on an over active sympathetic system. This information is displayed on the fourth line of the digital format screen along with the type of over activity, which in this example is sympathetic, and the duration of the over activity, which in this example is 60 minutes.
  • FIG 46 illustrates a user's Caution on the stress/distress screen of the round analog/digital standard watch based format on the sixteenth, [16], stress formula, discussed elsewhere, and is based on an over active sympathetic system. This information is displayed in the right hemisphere of the analog/digital format screen.
  • FIG 47 illustrates a user's Caution in the digital format based on the seventeenth, [17], stress formula, discussed elsewhere, and is based on the direct ratio of AMo and DX to each other.
  • This information is displayed on the fourth line of the digital format screen along with the type of activity, which in this example is the direct ratio of AMo and DX to each other, and the duration of the over activity, which in this example is 60 minutes.
  • FIG 48 illustrates a user's Caution on the stress/distress screen of the round analog/digital standard watch based format on the seventeenth, [17], stress formula, discussed elsewhere, and is based on the direct ratio of AMo and DX to each other. This information is displayed in the center of the two hemispheres of the analog/digital format screen.
  • the type of activity which in this example is the direct ratio of AMo and DX to each other, and the duration of the activity, which in this example is 60 minutes.
  • each such state is displayed in the appropriate location on the watch face starting with the condition generated by the first, [1], formula and ending with the seventeenth, [17], formula.
  • Each such Caution or ALARM is displayed for five seconds.
  • FIG 49A represents the minimum number, (3), of daytime Modes needed to create a user's recorded Cluster Mode, which begins with the shortest recorded Mode, (Mo 1), and progresses to the next shortest, (Mo 2) and the next shortest (Mo 3). These Modes are .02 seconds longer than the previous Mode.
  • the respective recorded user values for UV, AMo, and DX for each Mode are shown.
  • FIG 49B illustrates two user recorded Cluster Modes and the user values for UV, AMo, and DX.
  • data to be valid in the 2nd Cluster Mode it must contain three or more entries. If this approach fails, then there is a need to infer the values for UV, AMo, and DX using ratio and proportion.
  • values should be inferred for UV , AMo, and DX for shorter Modes so that there is a minimum of three Cluster Modes as shown in FIG 49C.
  • the ALARM levels designated for this Cluster Mode are used. If a Mode is sensed that is not within one of the three minimum Cluster Modes, then the ALARM levels in the Cluster Mode whose values are closest to user's current values are used.
  • FIG 53 At birth and through youth, the heart's OK Zone regarding variability is wide. With the onset of middle age and into old age the heart's OK Zone regarding variability narrows. A deviation m the heart's variability of more than approximately +15% indicates an over stressed sympathetic system in the Sympathetic ALARM Zone, and a deviation of more than -15% indicates an over stress parasympathetic system in the Parasympathetic ALARM Zone.
  • FIG 54 The inventors suggest a user patient's life can be prolonged by first detecting the onset of an arrythmia before it occurs and then, (1) pacing the patient with his/her own naturally variable heart rhythm or (2) pacing the patient using the variable heart rhythm of a healthy individual matched to the patient's age, sex and physical condition, or (3) using a random number generator programmed to emulate the heart rhythm of a healthy individual matched to the patient's age, sex and physical conditi on.
  • pacing a patient with bradycardia treats the symptom and prolongs life
  • the inventors suggest that pacing a user patient with a narrow heart rhythm variability with a wider heart rhythm variability treats the symptom and will prolong the user patient 's life.
  • FIG 55 is a chart of Patient E2 ' s ECG Holter monitor tape as interpreted by FIG 4A, 4B, and 4C using formulas [8] and [9], e.g. User Value.
  • E2's baseline is established for two Cluster Modes. Using a multiplier factor, E2's OK Zone is established between the Sympathetic ALARM Zone at 10.1, and the Parasympathetic ALARM Zone at 6.6. Thus, E2's UV OK Zone is between 10.1 and 6.6.
  • the Pace Signal Generator will commence pacing the User's Heart for a predetermined period of time.
  • pacemakers There at least two types of pacemakers today that pace a user's heart based on the user's respiration, which are incorporated in a cardioverter defibri 11ator or a stand alone pacemaker. These are (1) ransthoracic, or (2) impedance.
  • a transthoracic pacemaker measures the expansion and contraction of the user's chest while inhaling and exhaling.
  • An impedance pacemaker measures the electrical resistance in the air of the user's lungs while inhaling and exhaling. When the user inhales, the heart rate increases, and when the user exhales, the heart rate decreases .
  • pacemaker refers both to a stand alone pacemaker and a cardioverter defibri11ator with a pacemaker, unless otherwise noted.
  • ECG RR ECG RR together with respiratory and galvanic skin response baseline data as follows:
  • the stress formulas [1] through [17] are stored in the memory of the pacemaker.
  • the pacemaker When the pacemaker detects an ALARM, as defined in formulas [1] through [17], then the pacemaker will pace the user's heart using the user's appropriate variable heart rhythm data that occurred at the same time as the user's current respiratory state previously recorded, and, if possible the user's galvanic skin response state, all as described above for a period of 10 minutes .
  • the pacemaker will again pace the user's heart for 100 minutes, again matching the user's heart rate variability with the user's respiratory state, and, if possible, the user's galvanic skin response state.
  • the pacemaker paces the heart for 1,000 minutes and so on in increasing powers of 10, or as programmed by the user's cardiologist.
  • cardioverter defibri11ator with a pacemaker detects tachycardia, then the cardioverter defibri11ator with a pacemaker will respond with a single extrastimulus burst, a double extrastimuli burst, or multiple extrastimuli bursts, as programmed.
  • the user's recorded values for UV, AMo, and DX are down loaded to a PC from the user's pacemaker by telemetry for analysis of sympathetic and parasympathetic trends. All ALARM episodes, if any, as well a single extrastimulus burst, a double extrastimuli burst, or multiple extrastimuli bursts, in a cardioverter defibri1lator with a pacemaker, if any, are date and time stamped.
  • a Holter tape of the user's normal, variable heart rate is not available, then preferably the user is paced with a recording from a subject matched by age, race, sex, and physical condition, and also matched to the user's respiratory rates, and, if possible, to the user's galvanic skin response.
  • the user may be paced at a generated, histographical 1y normal variable rate, matched to the user's respiratory rates, and the generated heart rate varied by the transthoracic or impedance pacemaker matching the user's respiratory rate simulating the wide saw tooth variability patterns of Time Intervals occurring naturally with reference to FIG 50, and, if possible, to the user's galvanic skin response.

Abstract

Un microprocesseur (300) doté d'une horloge donnant la date et l'heure regroupe les données d'intervalles de temps (80, 86). La durée des intervalles de temps dans un électrocardiogramme ou des impulsions est enregistrée. Les données de stress accumulées pour l'utilisateur sont téléchargées sur un ordinateur personnel (301). La batterie d'alimentation (303) fournit de l'électricité permettant le fonctionnement des composants (80 - 318). L'état de stress de l'utilisateur est affiché sur une diode à cristaux liquides (302), et le microprocesseur vocal (318) diffuse des instructions CPR par l'intermédiaire d'un micro-haut-parleur. Si la charge de la batterie (303) est inférieure à 20 %, un ronfleur (304) avertit l'utilisateur.
EP95926301A 1994-07-13 1995-07-13 Detection de la variation anormale de la frequence cardiaque et induction d'une variation de frequence cardiaque normale Withdrawn EP0771170A4 (fr)

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US27432194A 1994-07-13 1994-07-13
US48298095A 1995-06-07 1995-06-07
US482980 1995-06-07
PCT/US1995/008943 WO1996002185A1 (fr) 1994-07-13 1995-07-13 Detection de la variation anormale de la frequence cardiaque et induction d'une variation de frequence cardiaque normale
US274321 2002-10-18

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Families Citing this family (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19609409C2 (de) * 1996-03-04 2000-01-20 Biotronik Mess & Therapieg Therapiegerät
US5690688A (en) * 1996-11-12 1997-11-25 Pacesetter Ab Medical therapy apparatus which administers therapy adjusted to follow natural variability of the physiological function being controlled
US5999851A (en) * 1998-04-15 1999-12-07 Cardiac Pacemakers, Inc. Atrial defibrillation system having patient selectable atrial fibrillation detection
US6301499B1 (en) * 1998-06-08 2001-10-09 Cardiac Pacemakers, Inc. Heart rate variability as an indicator of exercise capacity
US6026320A (en) * 1998-06-08 2000-02-15 Cardiac Pacemakers, Inc. Heart rate variability as an indicator of exercise capacity
US6487442B1 (en) 2000-04-28 2002-11-26 Nicholas Wood Detection of abnormal and induction of normal heat rate variability
JP3852352B2 (ja) * 2002-03-14 2006-11-29 セイコーエプソン株式会社 生体活動計測装置
AU2003257703A1 (en) 2002-08-27 2004-03-19 Dainippon Pharmaceutical Co., Ltd. Vital sign display and its method
US8052611B2 (en) 2007-03-14 2011-11-08 Cardiac Pacemakers, Inc. Method and apparatus for management of heart failure hospitalization
US9079033B2 (en) 2008-01-22 2015-07-14 Cardiac Pacemakers, Inc. Respiration as a trigger for therapy optimization
US9684767B2 (en) 2011-03-25 2017-06-20 Zoll Medical Corporation System and method for adapting alarms in a wearable medical device
EP2689363B1 (fr) 2011-03-25 2022-07-27 Zoll Medical Corporation Système et procédé permettant d'adapter les alarmes d'un dispositif médical portatif
US11617538B2 (en) 2016-03-14 2023-04-04 Zoll Medical Corporation Proximity based processing systems and methods
WO2019246086A1 (fr) 2018-06-18 2019-12-26 Zoll Medical Corporation Dispositif médical pour estimer le risque de détérioration de l'état d'un patient
EP3952981A4 (fr) * 2019-04-12 2022-06-22 Burnam, Michael Stimulateur cardiaque à commande intelligente, continue et physiologique, et procédé de fonctionnement associé

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4018219A (en) * 1975-11-03 1977-04-19 American Home Products Corporation Heart rate variability measurement
WO1988009146A1 (fr) * 1987-05-29 1988-12-01 Electric Power Research Institute, Inc. Procede et moniteur personnel pour mesurer le stress du au travail et a la chaleur
US4827943A (en) * 1986-09-23 1989-05-09 Advanced Medical Technologies, Inc. Portable, multi-channel, physiological data monitoring system
US4862361A (en) * 1985-06-05 1989-08-29 Massachusetts Institute Of Technology Methods and apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis
US5042497A (en) * 1990-01-30 1991-08-27 Cardiac Pacemakers, Inc. Arrhythmia prediction and prevention for implanted devices
US5226425A (en) * 1991-09-10 1993-07-13 Ralin, Inc. Portable ECG monitor/recorder
WO1994006350A1 (fr) * 1992-09-22 1994-03-31 Georgetown University Procede et appareil de depistage de vulnerabilite cardiaque

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4312356A (en) * 1979-03-07 1982-01-26 George Edgar Sowton Pacemakers for tachycardia control

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4018219A (en) * 1975-11-03 1977-04-19 American Home Products Corporation Heart rate variability measurement
US4862361A (en) * 1985-06-05 1989-08-29 Massachusetts Institute Of Technology Methods and apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis
US4827943A (en) * 1986-09-23 1989-05-09 Advanced Medical Technologies, Inc. Portable, multi-channel, physiological data monitoring system
WO1988009146A1 (fr) * 1987-05-29 1988-12-01 Electric Power Research Institute, Inc. Procede et moniteur personnel pour mesurer le stress du au travail et a la chaleur
US5042497A (en) * 1990-01-30 1991-08-27 Cardiac Pacemakers, Inc. Arrhythmia prediction and prevention for implanted devices
US5226425A (en) * 1991-09-10 1993-07-13 Ralin, Inc. Portable ECG monitor/recorder
WO1994006350A1 (fr) * 1992-09-22 1994-03-31 Georgetown University Procede et appareil de depistage de vulnerabilite cardiaque

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of WO9602185A1 *

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CA2195018A1 (fr) 1996-02-01
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WO1996002185A1 (fr) 1996-02-01
JPH10505515A (ja) 1998-06-02

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