Abstract:
A non-invasive method, and an apparatus, for determining heart-related parameters in patients. The method and apparatus determine pulse pressure, time constant of the arterial system, systolic and diastolic pressure, peripheral resistance, cardiac output and mean arterial blood pressure.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in-part application Ser. No. 059,520, filed June 8, 1987, which is a continuation-in-part application Ser. No. 807,693, filed Dec. 11, 1985, now abandoned which is a continuation-in-part of parent application Ser. No. 608,955, filed May 10, 1984, now all abandoned. 
    
    
     BACKGROUND OF INVENTION 
     1. Field of the Invention 
     The invention relates to a non-invasive method of measuring arterial blood pressure and cardiac output. The invention also relates to an apparatus for carrying out the method. 
     2. Description of Prior Art 
     Non-invasive methods and apparatus for measuring arterial blood pressure and cardiac output are known in the art. Once such method and apparatus is illustrated in U.S. Pat. No. 4,030,485, Warner, issued June 21, 1977. A second such method and apparatus is taught in U.S. Pat. No. 4,418,700, Warner, issued Dec. 6, 1983. The present invention constitutes an improvement and refinement of the method and apparatus as taught in the latter patent. 
     SUMMARY OF INVENTION 
     The invention relates to a non-invasive method, and an apparatus for determining heart-related parameters in patients. The method and apparatus determine pulse pressure, time constant of the arterial system, systolic and diastolic pressure, peripheral resistance, and cardiac output and means arterial blood pressure. 
    
    
     BRIEF DESCRIPTION OF DRAWINGS 
     The invention will be better understood by an examination of the following description together with the accompanying drawings in which: 
     FIG. 1 is a block diagram of the apparatus for carrying out the inventive method; 
     FIG. 2 is a typical sensor output of the system as illustrated in FIG. 1; 
     FIG. 3 illustrates arterial blood pressure pulses; 
     FIGS. 4, 4a and 4b illustrate a blood volume pulse; 
     FIG. 5 illustrates a blood volume pulse and a blood pressure pulse to illustrate the ratio g; and 
     FIG. 6 is a simplified flowchart for a computer program for performing calculations in accordance with the invention. 
    
    
     DESCRIPTION OF PREFERRED EMBODIMENTS 
     As seen in FIG. 1, an apparatus in accordance with the invention comprises a volume sensor such as a photo-electric plethysmograph S, an amplifier A 1 , an analog to digital converter A 2 , a microcomputer M and a display device D. The plethysmograph sensor S is attached to, for example, the earlobe of a subject. The sensor could also be attached to other suitable parts of the body such as the forehead, fingertips or toes. 
     As is known, the plethysmograph, detects changes in blood volume of the region to which it is attached. A typical sensor output signal is shown in FIG. 2. As seen in FIG. 2, the output signal has a pulsating component and a DC component. 
     The output of the sensor is applied to the plethysmograph amplifier A 1  where it is amplified and filtered and the DC component is discarded. The output of A 1  has a DC component, but this is not directly related to the sensor DC component. 
     The output of A 1  is fed to the analog to digital (A/D) converter A 2  which digitizes the signal. In a preferred embodiment, the sampling rate is 100 per second. 
     Microcomputer M accepts signals from A 2  and processes them according to the instructions it contains. These instructions are schematically represented in the simplified flowchart of FIG. 6. 
     The computer quantities are then displayed on a CRT monitor D or other suitable display means. 
     THEORY 
     Arterial blood pressure pulses are shown in FIG. 3. The shape of these curves vary according to the site where they are measured. The highest pressure reached during a cycle i is called the arterial systolic blood pressure, P si . The lowest pressure reached during the same cycle is called the arterial diastolic blood pressure, P di . The pressure rise from P di  to p si  in the same cycle is the pulse pressure, p pi . 
     By definition 
     
         p.sub.si -p.sub.di =p.sub.pi                               (1) 
    
     To find P pi   
     A plethysmographic pulse is shown in FIG. 4. The minimum value at the beginning of the pulse is V imin . The maximum value of the pulse is V imax . As the pulse volume rises from V imin  to V imax , the time rate of volume change reaches a maximum V imax  at time t iVm . The pulse volume at time t iVm  is V iVm . 
     let ##EQU1## 
     In addition to finding the values of V iVm  corresponding to V imax , see U.S. Pat. No. 4,418,700, Warner, values of V iVm  are also found corresponding to V imax   -1 , V imax   -2 , . . . V imax   -k , where k is a function of V imax . 
     All of the values of V iVm  corresponding to the time rates of volume change lying between and including V imax  and v imax   -k  are averaged and used to compute ΔV iVm . 
     The average value of V iV  m is ##EQU2## where n0=number of values of V iV .sbsb.0 m corresponding to V imax  ##EQU3## nk=number of values of V iV .sbsb.k m corresponding to V imax   -k   
     k=(V imax/m ) (integral values only)+l 
     m=constant . . . a preferred value of m=20 
     l=constant . . . a preferred value of l=1 ##EQU4## K pp  =constant determined by a first calibration r 1  =constant . . . preferably equal to 0 
     r 2  =constant . . . preferably equal to 0 
     0≦α≦1 
     R i1  can now be defined, as per equation (2) above, but using the average value of V iVm  so that equation (2) can be rewritten ##EQU5## 
     From FIG. 4 
     
         ΔV&#39;.sub.i =ΔV.sub.i -ΔV.sub.ivm ##EQU6## wherein 
    
     
         R&#39;.sub.i =1-R.sub.i 
    
     or 
     
         R.sub.i =1-R&#39;.sub.i 
    
     No other calibration should be required with different subjects. However, if desired, K pp  can be determined for each subject. 
     To find mean blood pressure 
     The mean blood pressure P mi  during a cycle i is given by ##EQU7## 
     
         P.sub.mi =P.sub.mmi +P.sub.0                               (6) 
    
     b 3  =exponent . . . the preferred value of b 3  is equal to 0.5 
     K 4  =constant determined at calibration for each subject. It is only necessary to find this constant once for each subject. The measurements carried out at different times on the same subject do not require separate calibration 
     P 0  =constant . . . preferred 25 mmHg ##EQU8## 
     
         P.sub.si =P.sub.mi +(1-g.sub.i)P.sub.pi                    (7) 
    
     where 
     g i  =(ΔV iAV  /ΔV i ) 
     ΔV iAV  =average value of ΔV i  over the time interval T i   
     
         P.sub.di =P.sub.si -P.sub.pi                               (8) 
    
     The variable g i  can take on a constant value g 0  whose preferred value is 0.333. 
     Alternatively, mean blood pressure can be determined using the following expression: ##EQU9## where G(t)=a function of t, in a particular case, 
     G(t)=(φ c  /φ i ) 
     φ c  =((1/Δt c )) Y   
     φ i  =((1/Δt i )) Y   
     Δt c  =(Δt&#39; i φc 
     Δt i  =Δt&#39; i φ 
     where 
     T c  =T at calibration 
     t c  =t at calibration Δt&#39; i φ.sbsb.c (see FIG. 4B) 
     φ c  =(T c  /t c )=(T/t) at calibration 
     y=constant 
     The remainder of the terms in equation 5&#39; are the same as similar terms in equation 5. 
     Determination of ratio R (FIG. 4b) 
     From FIG. 4b, the ratio R is 
     R i  =(ΔV it  /ΔV i ) 
     where 
     ΔV it  =change in volume at predetermined time ti 
     ΔV i  =total volume change during cycle i 
     t i  =time such that Δt i  =K T  Δt&#39; i φ 
     K T  =constant 
     Estimation of pulse pressure, PP ##EQU10## where PP i  =pulse pressure=p s  -P d   
     P s  =systolic blood pressure 
     P d  =diastolic blood pressure 
     k=constant 
     K&#39; T  =constant ≃ K T   
     In FIG. 4B 
     
         ΔV&#39;.sub.i =ΔV.sub.i -ΔV.sub.it ##EQU11## wherein from the above equation: ##EQU12## multiply numerator and denominator by e.sup.kPP i ##EQU13## 
    
     Determination of r 
     From FIG. 4 
     
         r.sub.i =(V.sub.imax /ΔV.sub.i)G(t) 
    
     where 
     V imax  =maximum time rate of volume increase in cycle i 
     ΔV i  =total volume increase during cycle i 
     From FIG. 4b 
     
         r.sub.i =(V.sub.it ΔV.sub.i)G(t) 
    
     where 
     V it  =time rate of increase of volume V i (t) at time t i   
     ΔV i  =total volume increase of volume during 
     Estimation of Mean Blood Pressure 
     (1) P mi  &#39;=K 1  r ic   a   
     K 1  =calibration constant 
     P mi  &#39;=(P s  +P d )/2-P o   
     P si  =systolic blood pressure, in cycle i 
     P mi  =(P s  +P d )/2 
     P di  =diastolic blood pressure, in cycle i 
     a=constant 
     P o  =constant 
     (2) e kp  mi=K 2  R ic   b   
     where 
     K 2  =constant (calibration) 
     b=constant ##EQU14## where P mo  =constant at calibration 
     φ 1i  +φ 2i  =PP i  =pulse pressure during cycle i 
     k=constant 
     j=constant 
     solve equation by making LHS=RHS by varying φ 1i  and φ 2i  (φ 2i  =PP i  -φ 1i ) 
     then 
     P si  =P mo  +φ 2i  +P 0   
     P di  =P mo  -φ 1i  +P o   
     P mi  =(P si  +P di )/2 
     P 0  =constant 
     r i  =ratio of exponentials 
     K 3  =coefficient (variable or constant) 
     Correction for r i   
     r i  (corrected)=r ic  =r i  e m (φ.sbsp.o - φ.sbsp.i) 
     m=constant 
     φ 0  =PP i  at calibration 
     φ i  =current value of PP i . 
     Equation (9) above is only one form which this particular equation can take. By simple mathematical manipulations, the invention may take two other forms as per (10) and (11) below. What follows is the manipulations as well as the two other forms of the equation: 
     As above noted 
     
         φ.sub.2i +φ.sub.1i =PP.sub.i =P.sub.si -P.sub.di 
    
     
         φ.sub.2i +φ.sub.1i =(P.sub.si -P.sub.o)-(P.sub.di -P.sub.o) 
    
     Let 
     P&#39; si  =P si  -P o   
     p&#39; di  =P di  -P 0   
     φ 2i  +φ 1i  =P&#39; si  -P&#39; di   
     add and subtract P mo  on RHS above 
     
         φ.sub.2i +φ.sub.1i =P&#39;.sub.si -P.sub.mo +P.sub.mo -P&#39;.sub.di (A) 
    
     φ 2i  and φ 1i  can take on any values in satisfying the above equation (A) 
     Put φ 2i  =P&#39; si  -P mo   
     and φ 1i  =P mo  -P&#39; di  in equation (9) 
     then ##EQU15## simplifying the denominator ##EQU16## 
     To solve equation 11: 
     (1) Set P&#39; di  =P&#39; si  -PP i  and solve for P&#39; si   
     (2) Set P&#39; si  =P&#39; di  -PP i  and solve for P&#39; di   
     Although particular embodiments have been illustrated, this was for the purpose of describing, but not limiting, the invention. Various modifications, which will come readily to the mind of one skilled in the art, are within the scope of the invention as defined in the appended claims.