Abstract: Systems and methods for management of physiological data, for example data obtained from monitoring an electrocardiogram signal of a patient. In one example use, digital data is obtained and episodes of arrhythmias are detected. Snapshots of the digitized ECG signal may be stored for later physician review. One or more techniques may be used to avoid recording of redundant data, while ensuring that at least a minimum number of episodes of each detected arrhythmia can be stored. The system may automatically tailor its data collection to the cardiac characteristics of a particular patient. In one technique, memory is allocated to include for each detectable arrhythmia a memory segment designated to receive ECG snapshots representing only the respective arrhythmia. A shared memory pool may receive additional snapshots of as the designated memory segments fill.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.

Abstract: Systems and Methods for predicting patient health and patient relative well-being within a patient management system are disclosed. A preferred embodiment utilizes an implantable medical device comprising an analysis component and a sensing component further comprising a three-dimensional accelerometer, a transthoracic impedance sensor, a cardio-activity sensor, an oxygen saturation sensor and a blood glucose sensor. Some embodiments of a system disclosed herein also can be configured as an Advanced Patient Management System that helps better monitor, predict and manage chronic diseases.

Abstract: Systems and methods for management of physiological data, for example data obtained from monitoring an electrocardiogram signal of a patient. In one example use, digital data is obtained and episodes of arrhythmias are detected. Snapshots of the digitized ECG signal may be stored for later physician review. One or more techniques may be used to avoid recording of redundant data, while ensuring that at least a minimum number of episodes of each detected arrhythmia can be stored. The system may automatically tailor its data collection to the cardiac characteristics of a particular patient. In one technique, memory is allocated to include for each detectable arrhythmia a memory segment designated to receive ECG snapshots representing only the respective arrhythmia. A shared memory pool may receive additional snapshots of as the designated memory segments fill.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.

Abstract: Systems, devices and methods for triaging health-related data, such as significant health-related events associated with health-related parameters, are disclosed. One aspect is a method for use in managing a patient's health within a patient management system. In various embodiments of the method, a number of predetermined events are accessed. The events are related to the patient's health and are identified by the patient management system. Each of the predetermined events are classified according to severity using a color-code system. In various embodiments, a red event is an imminent life threatening event, a yellow event is a serious health-related condition that is not imminently life threatening, and a green event is an event that is neither an imminent life threatening event nor a serious health-related condition. Other aspects and embodiments are provided herein.

Abstract: A method and system for calculating an atrio-ventricular delay interval based upon an inter-atrial delay exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may optimize the stroke volume exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may be blended with another atrio-ventricular delay interval that may optimize another performance characteristic, such as left ventricular contractility. Such blending may include finding an arithmetic mean, geometric mean, or weighted mean of two or more proposed atrio-ventricular delay intervals.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.

Abstract: A cardiac rhythm management device predicts defibrillation thresholds without any need to apply defibrillation shocks or subjecting the patient to fibrillation. Intravascular defibrillation electrodes are implanted in a heart. By applying a small test energy, an electric field near one of the defibrillation electrodes is determined by measuring a voltage at a sensing electrode offset from the defibrillation electrode by a known distance. A desired minimum value of electric field at the heart periphery is established. A distance between a defibrillation electrodes and the heart periphery is measured, either fluoroscopically or by measuring a voltage at an electrode at or near the heart periphery. Using the measured electric field and the measured distance to the periphery of the heart, the defibrillation energy needed to obtain the desired electric field at the heart periphery is estimated. In an example, the device also includes a defibrillation shock circuit and a stimulation circuit.

Abstract: A system including an implantable trigger event detector and an implantable ischemia detector. The implantable trigger event detector is adapted to detect at least one first condition and to output a responsive trigger signal including information about whether the first condition has been detected. The implantable ischemia detector is adapted to detect a second condition indicative of one or more physiologic cardiovascular events in a subject that are indicative of ischemia. The ischemia detector is coupled to the trigger event detector to receive the trigger signal, and the ischemia detector is enabled upon the trigger signal indicating that the first condition has been detected.

Abstract: A system including a plurality of implantable sensors, a processor, and a response circuit. Each sensor produces an electrical sensor signal related to physiologic cardiovascular events of a subject. The processor includes an event sequence detector to permit real-time detection of a time-wise sequential cascade of physiologic cardiovascular events related to myocardial ischemia of a subject and a decision module. The time-wise cascade includes at least first, second, and third physiologic cardiovascular events. The decision module declares whether an ischemic event occurred using at least one rule applied to a temporal relationship of the first, second, and third physiologic cardiovascular events. The response circuit provides a specified response if the ischemic event is declared.

Abstract: This patent document discusses systems, devices, and methods for increasing a sensitivity or specificity of thoracic fluid detection in a subject and differentiating between pleural effusion and pulmonary edema. In one example, a thoracic impedance measurement circuit senses a thoracic impedance signal. In another example, a processor receives the thoracic impedance signal and determines whether such thoracic impedance signal is “significant.” A significant thoracic impedance signal indicates the presence of thoracic fluid and may be recognized by comparing the thoracic impedance signal (or variation thereof) to a thoracic impedance threshold. When a significant thoracic impedance signal is recognized, the processor is adapted to detect one or both of: a pleural effusion indication and a pulmonary edema indication using one or a combination of: physiologic information, patient symptom information, and posture information.

Abstract: Described is an implantable device configured to monitor for changes in the intensity and/or duration of a systolic murmur such as mitral regurgitation by means of an acoustic sensor. Such changes may be taken to indicate a change in a patient's heart failure status. Upon detection of a worsening in the patient's heart failure statue, the device may be programmed to alert clinical personnel over a patient management network and/or make appropriate adjustments to pacing therapy.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.

Abstract: An implantable cardiac device is configured and programmed to assess a patient's cardiopulmonary function by evaluating the patient's heart rate response. Such evaluation may be performed by computing a heart rate response slope, defined as the ratio of an incremental change in intrinsic heart rate to an incremental change in measured activity level. The heart rate response slope may then be compared with a normal range to assess the patient's functional status.

Abstract: Systems and Methods for predicting patient health and patient relative well-being within a patient management system are disclosed. A preferred embodiment utilizes an implantable medical device comprising an analysis component and a sensing component further comprising a three-dimensional accelerometer, a transthoracic impedance sensor, a cardio-activity sensor, an oxygen saturation sensor and a blood glucose sensor. Some embodiments of a system disclosed herein also can be configured as an Advanced Patient Management System that helps better monitor, predict and manage chronic diseases.

Abstract: A cardiac rhythm management device predicts defibrillation thresholds without any need to apply defibrillation shocks or subjecting the patient to fibrillation. Intravascular defibrillation electrodes are implanted in a heart. By applying a small test energy, an electric field near one of the defibrillation electrodes is determined by measuring a voltage at a sensing electrode offset from the defibrillation electrode by a known distance. A desired minimum value of electric field at the heart periphery is established. A distance between a defibrillation electrodes and the heart periphery is measured, either fluoroscopically or by measuring a voltage at an electrode at or near the heart periphery. Using the measured electric field and the measured distance to the periphery of the heart, the defibrillation energy needed to obtain the desired electric field at the heart periphery is estimated. In an example, the device also includes a defibrillation shock circuit and a stimulation circuit.

Abstract: A method and system for calculating an atrio-ventricular delay interval based upon an inter-atrial delay exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may optimize the stroke volume exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may be blended with another atrio-ventricular delay interval that may optimize another performance characteristic, such as left ventricular contractility. Such blending may include finding an arithmetic mean, geometric mean, or weighted mean of two or more proposed atrio-ventricular delay intervals.

Abstract: A cardiac rhythm management device predicts defibrillation thresholds without any need to apply defibrillation shocks or subjecting the patient to fibrillation. Intravascular defibrillation electrodes are implanted in a heart. By applying a small test energy, an electric field near one of the defibrillation electrodes is determined by measuring a voltage at a sensing electrode offset from the defibrillation electrode by a known distance. A desired minimum value of electric field at the heart periphery is established. A distance between a defibrillation electrodes and the heart periphery is measured, either fluoroscopically or by measuring a voltage at an electrode at or near the heart periphery. Using the measured electric field and the measured distance to the periphery of the heart, the defibrillation energy needed to obtain the desired electric field at the heart periphery is estimated. In an example, the device also includes a defibrillation shock circuit and a stimulation circuit.

Abstract: A system comprising an implantable medical device (IMD) includes an implantable heart sound sensor to produce an electrical signal representative of at least one heart sound. The heart sound is associated with mechanical activity of a patient's heart. Additionally, the IMD includes a heart sound sensor interface circuit coupled to the heart sound sensor to produce a heart sound signal, and a signal analyzer circuit coupled to the heart sound sensor interface circuit. The signal analyzer circuit measures a baseline heart sound signal, and deems that an ischemic event has occurred using, among other things, a measured subsequent change in the heart sound signal from the established baseline heart sound signal.