JPH10127626A - Ekg data display device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a heart monitor device equipped with the ability of both stethoscope and EKG. SOLUTION: In this device, a miniaturized EKG display 14 is integrated into the standard stethoscope so that a provider for health control can correlate the heartbeats heard through the stethoscope (10, 12 and 18) and an electric event occurring in the heart without distracting his attention from a patient. Plural electrodes for detecting electric activities are integrated into a stethoscope bell 10. When the stethoscope bell 10 is arranged on the surface of a human body, the electrodes detect the electrochemical activities in the heart and these activities are converted to electric signals transmittable through a wire. These signals are next sent through a data link to signal processor. When these signals are completely processed, the signal processor sends a display signal through a 2nd data link to a display 14.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

FIELD OF THE INVENTION The present invention relates generally to an improved heart monitoring device, and more particularly to an improved heart monitoring device having both stethoscope and electrocardiogram (hereinafter "EKG") capabilities. It is about. further,
The present invention relates to an improved heart monitoring device having both stethoscope and EKG capabilities so that the EKG waveform can be viewed at substantially the same time as the stethoscope is positioned. In addition, the present invention provides that the EKG display device is incorporated into the stethoscope body such that the EKG display device is located at or near the bell of the stethoscope so that the EKG waveform can be viewed substantially simultaneously with the positioning of the stethoscope. To the extent possible, the present invention relates to an improved heart monitoring device having both stethoscope and EKG capabilities.

[0002]

BACKGROUND OF THE INVENTION The heart generally has four chambers:
It is described as being composed of the right atrium, right ventricle, left atrium, and left ventricle. There is a one-way valve (tricuspid valve) between the right atrium and the right ventricle. There is a one-way valve (pulmonary valve) between the right ventricle and the arterial system perfusing the lungs. There is a one-way valve (mitral valve) between the left atrium and left ventricle. Finally, there is a one-way valve (aortic valve) between the left ventricle and the aorta.

[0003] In terms of its functional operation, the heart receives oxygen-deficient blood through the vena cava (two large veins that return blood to the heart). These vena cava pour into the right atrium. The right atrium then pumps this oxygen-deficient blood into the right ventricle. The right ventricle then pumps this oxygen-deficient blood into one long, continuous fluid pathway consisting of the pulmonary artery, the capillary bed perfusing the lungs, and the pulmonary veins that pour into the left atrium. The end of this continuous path is the left atrium, ie, there is no valve between the pulmonary vein and the left atrium. Next, oxygen-rich blood that has entered the left atrium is pumped into the left ventricle. Finally, the left ventricle pumps blood into the aorta.

The above-described functional operation is performed by the electrochemical and mechanical actions of the heart as described below. The sinoatrial nerve, the heart's natural pacemaker, emits electrochemical pulses, or action potentials, that result in subsequent electrochemical and mechanical activity of the heart. Since the sinoatrial nerve is located very close to the right atrium, the initial action potential reaches it almost immediately. At the same time, the action potential propagates along a very fast internodal pathway, with the end result being that the atrium (s) are pulsed almost simultaneously. Due to the anatomy of the heart, the atrium initially receives pulses upstream from the atrioventricular valve that separates the atrium from the ventricles. Upon receiving the pulse, the excited muscle fibers first contract. In practice, this means that the atria in the upstream region first contract, causing blood to be pushed downstream. This effect is very similar to the fact that the toothpaste can be most efficiently squeezed out of the tube by first squeezing the closed end of the tube.

At this point, the atria are receiving action potentials, which continue to propagate throughout the heart. At the same time as the just described effects affecting the atrium, the action potential travels across three parallel internodal tracts to the atrioventricular node. The atrioventricular node acts as an analog delay.
This delay provides time to cause atrial contraction (the atrial contracts with more force over time as more muscle fiber is added to the contraction) and enhances atrial function. After leaving the atrioventricular nerve, the delayed action potential is conducted along a neural structure known as the His bundle. After this, the neural structure separates and the action potentials are conducted by the right and left bundle branches to the right and left ventricular regions.
When the action potential reaches the regions of the right and left ventricles, it activates Purkinje fibers, a very fast conducting fiber that conducts the action potential very quickly throughout the ventricle.

When the ventricles are energized (depolarized), they begin to contract. The ventricle contracts much more strongly and more rapidly than the atrium, which is still contracting at this point. Since the ventricular pressure becomes very rapid over the atrial pressure, the mitral and tricuspid valves both slap and close (the pressure upstream of these one-way valves exceeds the pressure downstream. So). When the right ventricle overcomes the pressure of the contracting left atrium, the pulmonary valve opens and blood is pumped into the fluid pathway consisting of the pulmonary artery, capillary bed, pulmonary vein, and left atrium. Subsequently, when the left ventricle overcomes the aortic pressure, the aortic valve opens and blood is pumped into the aorta. When the ventricle drains most of its contents, it begins to relax and both the pulmonary valve and the aortic valve close, but the pulmonary valve closes first because it is generally close to the left atrium, which continues to contract.

When the pressure in the relaxing ventricle drops below the pressure in the atrial, which continues to contract, the atrioventricular valves (tricuspid and mitral valves) open, and the atria pump blood into the ventricles. When the atrium completes this task, it relaxes and the heart enters a waiting state, after which the entire process described above is resumed with the next sinoatrial pulse.

Although not intuitively clear, the occurrence of a mechanical event in the heart (eg, the closing of the mitral valve) actually produces sound energy within the audible range of hearing. A mechanical event in the heart produces four distinct sounds:
Heart sound 1 (hereinafter “S1”) is a low-frequency sound generated by closing of the atrioventricular valve, which is generated immediately after the start of ventricular contraction, and heart sound 2 (hereinafter “S2”) is generated during systole. A relatively high frequency sound caused by the closing of the meniscal (ie, aortic and pulmonary) valves, representing the end and the onset of ventricular contractions, heart sound 3 (hereinafter “S3”) is usually
Heart sound 4 (hereafter "S4") is a sound produced by the viscous friction of blood against blood vessels and the heart wall, which occurs during the rapid filling phase of the ventricle and cannot be heard by adults.
This is the sound produced when the atria contract.

The device used by health care professionals to listen to heart sounds is known as a stethoscope. The latest versions of this instrument, although varied, are all based on the same mechanical principles. A device for collecting and focusing the sound energy of the heart is used (eg, a hollow bell-shaped structure) and the sound energy is transmitted to a second conduit using a sound transmission conduit (eg, a long hollow tube). The transmitted, second conduit transmits the collected sound energy to one or both of the human ears (eg, earpieces).

Over the years, health care professionals have
A great deal of knowledge has been compiled to link heart sound variability to various diseases and heart defects. Formally, this coordination process is known as "auscultation".

As just described, mechanical events in the heart generate sound energy that can be heard by the human ear using a stethoscope. This mechanical event is triggered by the preceding electrochemical activity of the heart (propagation of activity signals). Just as a stethoscope converts a mechanical event of the heart into a form audible to the human ear, a device that converts the electrochemical activity of the heart into a form visible to the human, i.e., the electrochemistry of the heart. There are also electrocardiographs that produce a visual indication of physical activity. This visual display shows an electrocardiogram (“E
KG ”). The following briefly describes the theory and operation of the electrocardiogram, and then discusses the link between the EKG and the heart sound heard using a stethoscope.

The above description of the mechanical action of the heart proves that the mechanical events of the heart are controlled and sequenced by the propagation of an electrochemical pulse known as the action potential. Is not disclosed. A basic understanding of action potentials is essential for understanding the basic theory of EKG.

An action potential is a transient change in cell membrane potential that causes the transmission of information, such as information in a signal that directs myocardial fibers to contract. When the heart muscle is at rest, the potential on either side of any cell membrane is maintained at a constant potential. But,
When the myocardium is electrically, chemically, or mechanically stimulated, a channel opens in the cell membrane that allows properly charged ions across the cell membrane to cross the cell membrane, and these ions work together. In an attempt to reach electrical and thermal neutralization. This event occurs because the polarizability of the system decreases as the ions go to their lowest energy state.
Called "depolarization". When the stimulus is large enough, the change in potential caused by ions crossing the cell membrane
It becomes large enough to depolarize the portion of the cell membrane immediately adjacent to the area of the cell membrane that is depolarized by the stimulus. When this occurs, it is determined that the action potential has begun, and the signal continues to propagate through muscle fibers by the depolarizing mechanism of the portion of the cell membrane immediately adjacent to the depolarized region just described. The propagation of the action potential is such that the first domino repels the second domino, the second domino falls into the third domino,
This is similar to the manner in which a row of dominoes falls, such as the third domino falling into the fourth domino. Action potential
Propagating and passing through an area of the cell membrane,
It is reset by a process referred to as "repolarization". Upon repolarization, the ions are actively pumped back across the cell membrane to restore the polarized state.

In addition to the ions involved in the propagation of the action potential,
There are many other free floating ions distributed throughout the human body. These ions move under the influence of a sufficiently strong electric field. When the action potential in the heart propagates, the electric field in the human body is disturbed by ions passing through the cell membrane. This physiological electrochemical activity can be transmitted to the surface of the human body through the reaction of free-floating ions, which move in response to the effect of the charge across the cell membrane on the electric field.

[0015] In the late 1800's, a Dutch physiologist, Dr. Willem Einthoven, developed a technique for recording the electrical activity of this heart,
He received the Nobel Prize. Dr. Einthoven's basic techniques are still used today. Dr. Einthoven's technique is known as electrocardiography, and in honor of Dr. Einthoven, the EK was spelled out in Dutch spelling.
Also called G.

During EKG, the electrodes are attached to the surface of the human body. The electrodes are handled such that, inter alia, by electrochemical exchange, charge carriers in the electrodes (electrons) can exchange with charge carriers in the human body (ions). By attaching electrodes to the surface of the human body, it is possible to sufficiently amplify the signal and then record the change in voltage within the human body. A strip chart recorder in the EKG machine is used as the recording device. strip·
A chart recorder is used to record the potential difference between two electrodes. The EKG only records the voltage difference between the two electrodes on the body surface as a function of time, and is typically recorded on a strip chart obtained by a strip chart recorder. When the heart is at rest, in diastole, the heart cells are polarized,
No charge transfer occurs. Therefore, the EKG strip
Chart recorders do not record run-out. However, when the heart begins to propagate action potentials, the strip chart recorder uses a depolarized electrode below it to record the potential difference below the human body region below which the heart is not yet polarized. Causes runout.

The complete heart cycle is known as the heartbeat. In EKG, the heartbeat is a characteristic signal. Initially, strip chart recorders exhibit a relatively short duration, curvilinear positive swing (known as a P-wave) that is believed to be caused by atrial depolarization.
This is followed by a small but sharp negative runout (known as the Q-wave). Next, a very large and sharp positive deflection (known as the R-wave) occurs, followed by a sharp and large negative deflection (known as the S-wave). Collectively, these waves are known as QRS complexes. Q
The RS group is believed to result from ventricular depolarization. The QRS complex is followed by a relatively long duration, curvilinear positive deflection (known as the T-wave), which is believed to be caused by ventricular repolarization.

Over the years, health care professionals
A great deal of knowledge has been put together to link EKG variability and EKG data to various diseases and cardiac defects. Formally, this coordination process
Also known as "electrocardiography".

[0019] Relatively recently, health care professionals have begun to collect a large amount of knowledge they are learning to link heart sounds heard through a stethoscope with ECG data from EKG. The utility of linking EKG data with heart sounds is apparent in light of the above description. That is, since heart sounds are caused by and related to mechanical events in the heart,
Also, because mechanical events are initiated and controlled by the electrochemical activity of the heart (and such activities are displayed by the EKG), health care professionals
We are developing a method that can use both auscultation and electrocardiography processes together. At present, the hybrid field has not been given a formal name.

As should be apparent in view of the above, a device that allows a health care practitioner to easily link such techniques, ie, a health care professional, places a stethoscope bell into place. At the same time, there is a need for a device that allows the EKG waveform to be viewed without distraction from the patient. Unfortunately, the prior art does not meet this need.

By Little et al. (US Pat. No. 4,362,164), a stethoscope with the ability to convert (1) the electrical activity of the heart used to generate the EKG waveform, and (2) the audible (heart sound) activity of the heart. A transducer is disclosed. Apparatus and methods for incorporating both an EKG electrode and a microphone required for heart sound detection into a stethoscope bell are disclosed. Once the conversion information is obtained, it is sent via a wire from the stethoscope to the free-standing signal processor along the path. Next, the information is EK
It is processed by a self-contained signal processor so that both G (a pictorial representation of the electrical activity of the heart) and PCG (a pictograph of the heart sound, i.e. the sound waves produced by the heart) are obtained. As disclosed in the reference,
The EKG signal is useful for annotating heart sounds represented by a heart sound diagram. Unfortunately, this reference utilizes a self-contained display remote from the patient; therefore, a health care practitioner can place a stethoscope bell to capture heart sounds, and place and stealth stethoscopes in close proximity. At the same time, it is impossible to view the EKG waveform.

Little et al. (US Pat. No. 4,628,939) disclose a stethoscope transducer and related means for simultaneously representing electrical and acoustic heart sound activity graphically (eg, on a CRT or LCD screen). Have been. Little
The main advance over this prior patent is that in this case the waveforms are displayed simultaneously, and the processing circuitry and the entire display are integrated into a small, rectangular device, in this case with a flip-up screen device. That is to say. The dimensions of the device are 5.5 "x 6" x 7.5 "when the screen is in the down position. Unfortunately, this reference utilizes a free-standing display remote from the patient, thus It is not possible for a health care practitioner to place a stethoscope bell to capture heart sounds and view the EKG waveform almost simultaneously with placement and stethoscope placement.

[0023] Bredesen et al. (US Pat. No. 5,218,969) display heart sounds in the form of pictorial graphs (eg, LCDs).
A stethoscope with a small display device integrated with a stethoscope (producing a heart chart on a screen) is disclosed. A device incorporating all necessary transducers, signal processing devices and display devices is disclosed. In addition, a power supply is included within the stethoscope itself. Further, the device compares the detected PCG with a plurality of PCG profiles for the diseased heart stored in memory and makes a preliminary diagnosis based on the detected PCG,
Display the diagnosis on the LCD screen. Unfortunately, this reference provides an electrocardiogram chart rather than an electrocardiogram representation, so a health care practitioner can place a stethoscope bell to capture heart sounds, place a stethoscope and stethoscope. Almost at the same time, it is impossible to inspect the EKG waveform.

As mentioned above, health care professionals currently use both auscultation and electrocardiography to collect relevant data about patients, and health care practitioners are using these techniques. There is a need for a device that can be easily coordinated. Unfortunately, as just described, the prior art did not meet this need. It is evident in view of this that a device that allows a health care practitioner to easily link these techniques, i.e., a health care professional, places a stethoscope bell and at the same time, There is a need for a device that allows the EKG waveform to be viewed without distraction from the patient.

[0025]

Accordingly, one of the objects of the present invention is to provide an improved heart monitoring device.

Another object of the present invention is to provide a stethoscope and an EK
An object of the present invention is to provide an improved heart monitoring device having both G capabilities.

Yet another object of the present invention is to provide an improved heart monitoring device having both stethoscope and EKG capabilities so that the EKG waveform can be viewed at substantially the same time as the stethoscope is positioned. It is in.

Still another object of the present invention is to provide an EKG
By incorporating the EKG display device into the stethoscope body such that the display device is located at or near the bell of the stethoscope, the auscultation can be performed so that the EKG waveform can be viewed almost simultaneously with listening to the stethoscope. It is an object of the present invention to provide an improved heart monitoring device having both the capabilities of a heartbeat and an EKG.

[0029]

The above objects are achieved as described below. A miniaturized EKG display device is provided so that health care providers can correlate heart sounds heard through a stethoscope with electrical events occurring in the heart without having to distract the patient. A device is provided that is incorporated into a standard stethoscope. The device makes this possible by incorporating an EKG display into the stethoscope so that health care providers can place the stethoscope bell and view the EKG waveform of the heart at about the same time. In that device, a plurality of electrodes capable of detecting electrical activity are incorporated into the stethoscope bell. When the stethoscope bell is placed in contact with the body surface, the electrodes detect the electrochemical activity of the heart and convert that activity into electrical signals that can be transmitted by wires. These signals are then sent over a data link to a signal processor. After processing the signal, the signal processing device sends the display signal to the display via the second data link. In response to the received display signal, EK
The G waveform is displayed. The EKG waveform display is integrated with the stethoscope and is located at or near the stethoscope bell so that health care providers can:
The placement of the stethoscope bell can be performed and at about the same time the EKG waveform of the heart can be viewed, ie there is no need to distribute attention between two independent instruments (stethoscope and EKG recorder).

The above and other objects, features and advantages of the exemplary embodiments will become apparent from the detailed description provided hereinafter.

[0031]

DETAILED DESCRIPTION OF THE INVENTION Referring now to the drawings, and more particularly to FIG. 1, there is shown a high level view of a stethoscope embodying the present invention. FIG. 1 shows a stethoscope bell 10 having one end of an elongated sonic transmission conduit 12 attached thereto, and the other end of the sonic transmission conduit attached to an earpiece 18. An EKG waveform display and electronic module 14 is located near the stethoscope bell 10, as shown. In the preferred embodiment, the EKG waveform display and electronic module 14 includes a stethoscope bell 10
Or it is designed to be located very close to it.

Referring now to FIG. 2, there is shown a first embodiment of a stethoscope having a number of electrodes 20 attached thereto. The electrode 20 is capable of detecting electrochemical activity in the human body and converting the detected activity into a signal that can be transmitted by a wire. FIG. 2 shows several electrodes 20 arranged on the edge of a stethoscope bell 10 so that the electrodes 20 can detect electrocardiogram signals from the human body.

Referring now to FIG. 3, there is shown a high level schematic diagram of a system embodying the present invention. Electrode 2
0 is connected to a conductive cable 30 that conducts an electrical signal sensed by the electrode to a first transmitting device 32.
First transmission device 32 converts the electrical signal received by conductive cable 30 into a form suitable for transmission over first data link 34. The first receiving device 42 receives the signal via the first data link, converts the signal into a form suitable for the electronic circuit 36, and sends it out to the circuit. Electronic circuit 3
When the signal 6 is received from the receiving device 42, the signal is processed to make the signal suitable for the display 40. The electronic circuit 36 then transmits the display signal to the second transmitting device 44.
And the transmitting device transmits the indication signal to the second data
A form suitable for transmission over link 38 is provided. Upon receiving the signal via the second data link 38, the second transmitter 44 converts the signal into a form suitable for the display 40,
Send to display. The display 40 is
When a signal is received from the second transmitting device 44, an EKG waveform display is generated and output in response to the signal.

As will be apparent to those skilled in the art, the data links 34, 38 are not limiting,
Including conductive wires, radio frequency or infrared links,
It can be any one of several communication link types. Thus, as will be apparent to those skilled in the art, both the transmitting device 32 and the receiving device 42 will be of a type suitable for the data links 34, 38 utilized.

While the illustrative embodiments have been shown and described in detail, it will be apparent to those skilled in the art that the embodiments may be modified in form and detail without departing from the spirit and scope of the illustrative embodiments. Various changes can be made.

The embodiments of the present invention will be summarized below. 1. An apparatus for efficiently displaying EKG data, comprising: a stethoscope bell (10) for collecting and focusing sound waves generated from a human body; a first end and a second end; An elongate sound transmission conduit (12) connected at one end to the stethoscope bell (10) for receiving sound waves; and the elongate sound transmission conduit (12).
At least one human wearable earpiece (18) connected to the second end of the body for receiving sound waves; and detecting electrochemical activity in the human body; At least two of the stethoscope bells (10), which convert the activity into electrical signals that can be transmitted over wires
One electrode (20) and said at least two electrodes (2
0) and (30, 32, 34, 36, 38, 4
2, 44), a display (40) for displaying an EKG waveform in response to the electrical signal is included, and the display (40) is close to the stethoscope bell (10), so that health management is performed. Of the stethoscope bell (1)
An EKG data display device capable of performing the arrangement in 0) and simultaneously inspecting the EKG waveform of the heart.

2. The display coupled to the at least two electrodes and further coupled to the at least two electrodes (30, 32, 34, 4).
2) an electronic circuit (36) for receiving an input signal from the at least two electrodes (20) and generating a display signal in response to the received input signal; and the electronic circuit (36).
(38, 44), receiving the display signal from the electronic circuit (36), and responsive to the display signal,
Since the display (40) for displaying the KG waveform is included and the display (40) is close to the stethoscope bell (10), the health care provider can
The EKG data display device according to claim 1, wherein the stethoscope bell (10) is arranged, and at the same time, the EKG waveform of the heart can be inspected.

3. An apparatus for efficiently displaying EKG data, comprising: a stethoscope bell (10) for collecting and focusing sound waves generated from a human body; a first end and a second end;
End of the stethoscope bell (1
0) to receive sound waves,
An elongated sonic transmission conduit (12) and at least one human wearable device connected to the second end of the elongated sonic transmission conduit (12) for receiving sound waves.
Two earpieces (18) and detection means (10, 10) for detecting the electrochemical activity in the human body so that the detected electrochemical activity is represented as an electrical signal that can be transmitted on a wire. 20) and (30, 32, 34, 36, 38, 42, 4) coupled to the detection means (10, 20).
4) a display (40) for displaying an EKG waveform in response to the electrical signal is included, and the display is in proximity to the stethoscope bell (10) so that a health care provider can: An EKG data display device capable of disposing the stethoscope bell (10) and inspecting the EKG waveform of the heart at substantially the same time.

4. The display coupled to the detection means and further coupled to the detection means (10, 20) (30, 32, 34, 42) for receiving an input signal from the detection means, An electronic circuit (36) for generating a display signal in response to the display signal (38, 44) coupled to the electronic circuit (36) for receiving the display signal from the electronic circuit (36); Display for displaying EKG waveform in response to (40)
And the display (40) is
In close proximity to the stethoscope bell (10), the health care provider can place the stethoscope bell (10) and, at substantially the same time, view the EKG waveform of the heart at the same time. An EKG data display device as described in the above.

5. The detection means comprises the stethoscope bell (10) with at least two electrodes (20), and when the stethoscope is placed, the electrodes (20)
4. The EKG data display device according to the above item 3, wherein the electrical activity in the human body can be detected.

6. The EKG data display according to the above item 3, comprising a plurality of electrodes (20) connected to an outer surface of a human body so that the detection means (10, 20) can detect an electric signal in the human body. apparatus.

[0042]

According to the present invention, a health care professional
A stethoscope bell can be placed to capture heart sounds and simultaneously view the EKG waveform without distracting the patient.

[Brief description of the drawings]

FIG. 1 is a high-level diagram illustrating a stethoscope embodying the present invention.

FIG. 2 shows a first embodiment of a stethoscope bell with several electrodes.

FIG. 3 is a high level schematic diagram of a system for implementing the invention.

[Explanation of symbols]

 Reference Signs List 10 Stethoscope bell 12 Sound transmission conduit 14 EKG waveform display and electronic module 18 Earpiece 20 Electrode 30 Conductive cable 32 First transmitting device 34 First data link 36 Electronic circuit 38 Second data link 40 Display 42 First 1st receiving device 44 2nd transmitting device

Claims (1)

[Claims] An apparatus for efficiently displaying EKG data, comprising: a stethoscope bell (10) for collecting and focusing sound waves generated from a human body; a first end and a second end. An elongate sound transmission conduit (12), wherein the first end is connected to the stethoscope bell (10) for receiving sound waves; and the elongate sound transmission conduit (12). At least one human wearable earpiece (18) connected to said second end for receiving sound waves; and detecting electrochemical activity in the human body; At least two electrodes (2) provided on the stethoscope bell (10), which convert the activity into electrical signals that can be transmitted over a wire.
0) and (3) coupled to the at least two electrodes (20).
0, 32, 34, 36, 38, 42, 44) and a display (4) for displaying an EKG waveform in response to the electric signal.
0) is included and the display (40) is in close proximity to the stethoscope bell (10) so that a health care provider can place the stethoscope bell (10) and substantially simultaneously. An EKG data display device capable of inspecting the EKG waveform of the heart.