Source: https://patents.google.com/patent/US20040082974
Timestamp: 2018-03-19 01:23:09
Document Index: 191981526

Matched Legal Cases: ['art.\n6', 'art.\n10', 'art.\n18', 'art.\n22', 'art.\n28', 'art.\n33']

US20040082974A1 - Heart monitoring device, system and method - Google Patents
US20040082974A1
US20040082974A1 US10630468 US63046803A US2004082974A1 US 20040082974 A1 US20040082974 A1 US 20040082974A1 US 10630468 US10630468 US 10630468 US 63046803 A US63046803 A US 63046803A US 2004082974 A1 US2004082974 A1 US 2004082974A1
US10630468
US7389142B2 (en )
[0028]FIG. 1 shows schematically a heart monitoring system with a heart-monitoring device connected to leads with sensor or electrode positioned in a heart, in accordance with the invention.
[0029]FIG. 2A shows schematically the coronary blood flow.
[0030]FIG. 2B shows schematically the aortic blood flow.
[0031]FIG. 2C shows schematically the blood flow in the coronary sinus.
[0032]FIG. 2D shows schematically the partial pressure of oxygen in the coronary sinus at rest.
[0033]FIG. 2E shows schematically an electrocardiogram.
[0034]FIG. 3 shows a flowchart of the use of a heart monitoring system according to an embodiment of the invention.
[0035]FIG. 4 shows a flowchart of the use of a heart monitoring system according to another embodiment of the invention.
[0039]FIG. 1 also schematically shows a heart with a right atrium RA, a right ventricle RV, a left atrium LA and a left ventricle LV. The first lead 30 with the first sensor 33 is designed such that it can be introduced via the right atrium RA into the coronary sinus region of the heart. The first lead 30 also may be introduced further into the coronary venous system such that the second sensor or electrode 31, 32 is introduced, for example via the great cardiac vein, into the posterior, lateral or anterior vein of the left ventricle. With such a position of the second sensor or electrode 31, 32, it is possible to stimulate the left ventricle LV of the heart. The portion of the first lead 30 that is introduced into the cardiac venous system is here shown with a hatched line.
[0045]FIG. 2A shows schematically the blood flow in ml/mm in the coronary artery.
[0046]FIG. 2B shows schematically the aortic blood flow in l/mm.
[0047]FIG. 2C shows very schematically an example of the blood flow in the direction out from the coronary sinus in ml/mm. It can be seen that during a portion of the heart cycle, primarily during the systolic portion, the blood flow is negative. This means that blood during this portion flows in from the right atrium RA into the coronary sinus. This happens normally during the ventricular contraction.
[0048]FIG. 2D shows very schematically an example of how the partial pressure of oxygen, in kPa, may vary in the coronary sinus during the heart cycle. During the systolic phase, in particular during the latter 70% or the latter half of the systolic portion of the heart cycle, the oxygen partial pressure represents the oxygen partial pressure in mixed venous blood, since, as explained above, the mixed venous blood from the right atrium RA tends to enter into the coronary sinus. Before the start of the systolic portion of the heart cycle, the partial pressure of oxygen in the coronary sinus represents the partial pressure of oxygen in the coronary venous blood.
[0049]FIG. 2E shows an electrocardiogram (ECG) during the heart cycle shown in the figures. P here represents the P-wave, R represents the QRS-complex and T represents the T-wave.
[0052]FIGS. 3 and 4 are flowcharts for the use of a heart monitoring system according to different embodiments of the invention. At the same time, FIGS. 3 and 4 show how the heart-monitoring device according to the invention operates. FIG. 3 thus shows that a sensor, i.e. the aforementioned first sensor member 33, is positioned in the coronary sinus of a living being. How to insert a lead into the coronary sinus is well known to those skilled in the art and therefore need not be explained in more detail. The control circuit 14 determines a first value of the blood constituent during a first portion of the heart cycle. Furthermore, the control circuit 14 determines a second value related to the blood constituent during a second portion of the heart cycle. Of course, the first portion of the heart cycle is always different from the second portion of the heart cycle. The control circuit 14 can operate such that said first value of the blood constituent, in this example the partial pressure of oxygen, is measured during the diastolic portion of the heart cycle. The control circuit 14 may operate such that this first value is measured substantially around the P-wave. The control circuit also measures the second value of the blood constituent during the systolic portion of the heart cycle. Preferably, the second value is measured during the later 70% of the systolic portion of the heart cycle, for example substantially about the time of the occurrence of the T wave. The first value thus is related to the oxygen partial pressure in coronary venous blood and the second value is related to the partial pressure of oxygen in primarily mixed venous blood.
[0055]FIG. 4 shows another example of how the heart-monitoring device according to the invention may operate. The first steps are here the same as in connection with FIG. 3. The loop is performed a number of times. In this case, however, predefined condition is that the first value has decreased more than a first predefined amount Al over a number of heart cycles while the second value has decreased less than the second predefined amount A2 over said plurality of heart cycles. The first predefined amount may be that the partial pressure of oxygen in the cardiac venous blood has fallen more than, for example, 0.2 kPa (or a certain percentage of the original value), while the partial pressure of oxygen in mixed venous blood has decreased less than, for example, 1.0 kPa (or a certain percentage of the original value). This, again, is an indication of the fact that the heart is not working properly. Also in this case, the measure can be that the delivery of stimulation pulses to the heart is controlled, that a drug is released or that a warning signal is delivered. It should be noted that it is of course possible to combine the two manners of operating the device disclosed in FIGS. 3 and 4.
[0056]FIGS. 3 and 4 thus also show manners of using the heart monitoring system according to the invention. The system may thus be used in order to detect a state of overload or ischemia in the heart. As mentioned above, the system may be arranged such that stimulating pulses may be delivered to both the ventricles RV, LV of the heart. The device 10 and the system may of course be arranged such that the delivery of the stimulation pulses is changed in an iterative process based on the detected and monitored first and second values. In this manner, the delivery of the stimulation pulses may be adjusted until a more normally operating heart condition is detected. As mentioned above, the control circuit 14 may also sense the physical activity level of the living being into which the device 10 is implanted. In this manner, a further indication of the activity level of the living being in question is obtained. The control circuit 14 may detect whether the first and second values, or the change of the first and second values, correspond to that which is considered normal when the living being in question is at rest or is at a high activity level.
a first sensor adapted to be disposed in a coronary sinus region of a heart to sense at least one constituent of blood, and supplying a first sensor signal representing said constituent to the control circuit;
said control circuit, from said further sensor signal, identifying first and second portions of a heart cycle of the heart, and from said first sensor signal, determining a first value related to said blood constituent during said first portion and determining a second value related to said blood constituent during said second portion.
2. An implantable heart monitoring device as claimed in claim 1 wherein said control circuit, from said further sensor signal, detects said first value in said first portion during a diastolic portion of the heart cycle, and detects said second value in said second portion during a systolic portion of the heart cycle.
3. An implantable heart-monitoring device as claimed in claim 2 wherein said control device detects said second value in said second portion within a final 70% of said diastolic portion.
4. An implantable heart-monitoring device as claimed in claim 1 wherein said first sensor senses blood oxygen as said blood constituent.
5. An implantable heart-monitoring device as claimed in claim 1 wherein said control circuit detects said first and second values in each of a plurality of heart cycles of the heart.
6. An implantable heart monitoring device as claimed in claim 1 comprising a therapeutic device adapted to executed a measure related to cardiac therapy, wherein said control circuit emits a trigger signal to said therapeutic device upon an occurrence selected from the group consisting of said first value fulfilling a predetermined condition, said second value fulfilling a predetermined condition, and a relationship between said first value and said second values fulfilling a predetermined condition.
7. An implantable heart monitoring device as claimed in claim 6 wherein said occurrence is said relationship between said first value and said second value fulfilling a predetermined condition, and wherein said predetermined condition is said first value being lower than a first predetermined level and said second value being higher than a second predetermined level.
8. An implantable heart monitoring device as claimed in claim 6 wherein said occurrence is said relationship between said first value and said second value fulfilling a predetermined condition, and wherein said predetermined condition is said first value decreasing by more than a first predetermined amount over a plurality of heart cycles while said second value decreases less than a second predetermined amount over said plurality of heart cycles.
9. An implantable heart monitoring device as claimed in claim 6 wherein said therapeutic device is a stimulation pulse generator which emits stimulation pulses adapted to be supplied to the heart, and wherein said measure is controlling delivery of said stimulation pulses to the heart.
10. An implantable heart monitoring device as claimed in claim 6 wherein said therapeutic device is a drug delivery device adapted to deliver a drug to a subject in whom said heart monitoring device is implanted, and wherein said measure is controlling delivery of said drug.
11. An implantable heart-monitoring device as claimed in claim 6 wherein said therapeutic device is a warning signal generator, and wherein said measure is to emit a warning signal.
12. An implantable heart monitoring device as claimed in claim 6 further comprising an activity level sensor adapted to sense a level of physical activity of a subject in whom the heart monitoring device is implanted, said activity sensor supplying an activity level signal to said control circuit, and said control circuit determining whether to emit said control signal dependent on said occurrence and said activity level.
13. An implantable heart monitoring system comprising:
a lead arrangement connected to said control circuit and adapted for implantation in a subject;
a first sensor carried by said lead arrangement and adapted to be disposed in a coronary sinus region of a heart to sense at least one constituent of blood, and supplying a first sensor signal representing said constituent to the control circuit;
14. An implantable heart monitoring system as claimed in claim 13 wherein said control circuit, from said further sensor signal, detects said first value in said first portion during a diastolic portion of the heart cycle, and detects said second value in said second portion during a systolic portion of the heart cycle.
15. An implantable heart-monitoring system as claimed in claim 14 wherein said control device detects said second value in said second portion within a final 70% of said diastolic portion.
16. An implantable heart-monitoring system as claimed in claim 13 wherein said first sensor senses blood oxygen as said blood constituent.
17. An implantable heart-monitoring system as claimed in claim 13 wherein said control circuit detects said first and second values in each of a plurality of heart cycles of the heart.
18. An implantable heart monitoring system as claimed in claim 13 comprising a therapeutic device adapted to executed a measure related to cardiac therapy, wherein said control circuit emits a trigger signal to said therapeutic device upon an occurrence selected from the group consisting of said first value fulfilling a predetermined condition, said second value fulfilling a predetermined condition, and a relationship between said first value and said second values fulfilling a predetermined condition.
19. An implantable heart monitoring system as claimed in claim 18 wherein said occurrence is said relationship between said first value and said second value fulfilling a predetermined condition, and wherein said predetermined condition is said first value being lower than a first predetermined level and said second value being higher than a second predetermined level.
20. An implantable heart monitoring system as claimed in claim 18 wherein said occurrence is said relationship between said first value and said second value fulfilling a predetermined condition, and wherein said predetermined condition is said first value decreasing by more than a first predetermined amount over a plurality of heart cycles while said second value decreases less than a second predetermined amount over said plurality of heart cycles.
21. An implantable heart monitoring system as claimed in claim 18 wherein said therapeutic device is a stimulation pulse generator which emits stimulation pulses adapted to be supplied to the heart, and wherein said measure is controlling delivery of said stimulation pulses to the heart.
22. An implantable heart monitoring system as claimed in claim 18 wherein said therapeutic device is a drug delivery device adapted to deliver a drug to a subject in whom said heart monitoring device is implanted, and wherein said measure is controlling delivery of said drug.
23. An implantable heart-monitoring system as claimed in claim 18 wherein said therapeutic device is a warning signal generator, and wherein said measure is to emit a warning signal.
24. An implantable heart monitoring system as claimed in claim 18 further comprising an activity level sensor adapted to sense a level of physical activity of a subject in whom the heart monitoring device is implanted, said activity sensor supplying an activity level signal to said control circuit, and said control circuit determining whether to emit said control signal dependent on said occurrence and said activity level.
25. An implantable hear monitoring system as claimed in claim 13 wherein said lead arrangement includes a first lead carrying said first sensor, and wherein said implantable heart monitoring system further comprises an electrode also carried on said first lead, said first lead having a distal end and said electrode being carried on said first lead closer to said distal end than said first sensor, and wherein said first lead is adapted to introduce said electrode via the coronary sinus into a cardiac vein.
26. An implantable heart monitoring system as claimed in claim 25 wherein said control circuit includes circuitry for generating stimulation pulses, and wherein said stimulation pulses are delivered via said first lead and said electrode.
27. An implantable hear monitoring system as claimed in claim 25 wherein said lead arrangement includes a second lead carrying a further electrode adapted for positioning in the right ventricle of the heart.
28. A heart monitoring method comprising the steps of:
disposing a first sensor in a coronary sinus region of a heart and sensing at least one constituent of blood with said first sensor, and generating a first sensor signal representing said constituent;
from said further sensor signal, electronically identifying first and second portions of a heart cycle of the heart, and from said first sensor signal, electronically determining a first value related to said blood constituent during said first portion and a second value related to said blood constituent during said second portion.
29. A heart monitoring method as claimed in claim 28 comprising, from said further sensor signal, electronically detecting said first value in said first portion during a diastolic portion of the heart cycle, and electronically detecting said second value in said second portion during a systolic portion of the heart cycle.
30. A heart monitoring method as claimed in claim 29 comprising electronically detecting said second value in said second portion within a final 70% of said diastolic portion.
31. A heart monitoring method as claimed in claim 28 comprising sensing blood oxygen as said blood constituent.
32. A heart monitoring method as claimed in claim 28 comprising electronically detecting said first and second values in each of a plurality of heart cycles of the heart.
33. A heart monitoring method as claimed in claim 28 comprising executing a therapeutic measure related to cardiac therapy, upon an occurrence selected from the group consisting of said first value fulfilling a predetermined condition, said second value fulfilling a predetermined condition, and a relationship between said first value and said second values fulfilling a predetermined condition.
34. A heart monitoring method as claimed in claim 33 wherein said occurrence is said relationship between said first value and said second value fulfilling a predetermined condition, and wherein said predetermined condition is said first value being lower than a first predetermined level and said second value being higher than a second predetermined level.
35. A heart monitoring method as claimed in claim 33 wherein said occurrence is said relationship between said first value and said second value fulfilling a predetermined condition, and wherein said predetermined condition is said first value decreasing by more than a first predetermined amount over a plurality of heart cycles while said second value decreases less than a second predetermined amount over said plurality of heart cycles.
36. A heart monitoring method as claimed in claim 33 comprising emitting to the heart, and controlling delivery of said stimulation pulses to the heart as said therapeutic measure.
37. A heart monitoring method as claimed in claim 33 comprising delivering a drug to the subject in whom said heart monitoring device is implanted, and controlling delivery of said drug as said therapeutic measure.
38. A heart monitoring method as claimed in claim 33 comprising to emit a warning signal as said therapeutic measure.
39. A heart monitoring method as claimed in claim 33 comprising sensing a level of physical activity of the subject in whom the heart monitoring device is implanted, and generating an activity level signal, and electronically determining whether to emit said control signal dependent on said occurrence and said activity level.
US10630468 2002-07-30 2003-07-30 Heart monitoring device, system and method Expired - Fee Related US7389142B2 (en)
SE0202347 2002-07-30
SE0202347-1 2002-07-30
US20040082974A1 true true US20040082974A1 (en) 2004-04-29
US7389142B2 US7389142B2 (en) 2008-06-17
ID=20288661
US10630468 Expired - Fee Related US7389142B2 (en) 2002-07-30 2003-07-30 Heart monitoring device, system and method
US (1) US7389142B2 (en)
DE (1) DE60330632D1 (en)
EP (1) EP1386637B1 (en)
US20070132558A1 (en) * 2005-12-09 2007-06-14 Rowe Meredeth A Method and system for monitoring a patient in a premises
EP2586369B1 (en) * 2011-10-27 2017-07-26 St. Jude Medical AB Ischemia detection
US5231098A (en) * 1987-06-26 1993-07-27 Nihon Bayer Agrochem K.K. Insecticidal nitro-substituted heterocyclic compounds
EP1386637B1 (en) 2009-12-23 grant
DE60330632D1 (en) 2010-02-04 grant
EP1386637A1 (en) 2004-02-04 application
US7389142B2 (en) 2008-06-17 grant
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