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WACP Stress ECG

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1. Select physician Specialty a Add Physician Huub Lupsch Joe Johnson Sarah Sassoon Cancel Help In this window you can select a specialty and then select a physician from the list You can also add a new physician To add a new physician 1 Click on the Ed button next to the physician in the New Exercise ECG window 2 Click on the Add button in the Select physician window 3 Select a specialty and enter the last name Specialty Cardiology sl Title First name Middle name Justin Last name Case Fhone number 1 Phone number 2 Fax number E Mail address Cancel Help 4 Click on the OK button 5 Click on the OK button to return to the New Exercise ECG window Note You can still add or edit the names of the physicians in review mode if the test is not confirmed yet Select Edit test from the action menu A specialty can only be added with the Admin tool DIR 80012335 Ver D 18 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 2 3 Real time monitor You are now ready to record the test In the Real time monitor click the Start button to start recording After the Start button is pressed it will change toa Stop test button Start is Ba Welch Allyn CardioPerfect Exercise ECG automatically starts the first phase and stage of the test protocol and moves automatically to the next stage Go to Recovery according to the test protocol T
2. Soe Ee DIR 80012335 Ver D 69 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 12 Safety and precautions 12 1 Conventions Warning Warning statements describe conditions or actions that can result in personal injury or loss of life Caution Caution statements describe conditions or actions that can result in damage to the equipment or software Notes contain additional information on cardiograph usage Attention Caution Warning Danger Important Note Refer to Accompanying Documentation Ingress Protection ordinary Serial Number Reference Number Type BF Equipment defibrillation protected Manufacture Date CE Mark according to MDD93 42 EEC Temperature Range DIR 80012335 Ver D 70 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Electromagnetic Compatibility When using the CardioPerfect Pro cardiograph electromagnetic compatibility with surrounding devices should be considered and evaluated The CardioPerfect Pro cardiograph complies with IEC 60601 1 2 limits for EMC 12 2 General Safety and Precautions tips Radio Frequency RF interference between the cardiograph and any existing RF transmitting or receiving equipment at the N Caution installation site including electrosurgical equipment in close proximity to the cardiograph should be evaluated before the equipment is operated as they may seriously degrade performance The
3. Stella Jongmans General Test Information Test Observations Interpretation INDICATIONS FOR STRESS a INDICATIONS FOR EXE Chest Pain Dyspnea on Exercise Palpitation Fatique Orthopnea ASHD DM PSV W Tach CHE Fib 4 Flutter Abnormal EKG LBBB RBBB Dld MI HTN Dther CAD RISK FACTORS BASELINE EKG HEARTRATE RESPONSE T BP RESPONSE TO EXERCI sl b aH Cancel Help Note Unconfirmed interpretations can continue to be edited during and after the test Once the interpretation has been confirmed by a physician with the save and confirm button the test can only be edited by a user with confirm interpretation rights For more information see the Administrator Tool 6 Click OK DIR 80012335 Ver D 17 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 2 4 Add Physicians to the test With Welch Allyn CardioPerfect workstation you can link the names of three types of physicians to an exercise test e Referring physician e Ordering physician the physician that ordered the test e Attending physician the physician that is supervising the test You can add the names of the physicians in the New exercise ECG dialog Click on the button to select a name from a list of most recently selected physicians Click on the button and a more extended list of physicians will appear
4. Table of Contents 1 ING STARTED BEE 8 1 1 The Welch Allyn CardioPerfect Exercise ECG window nnsssennnnensnnnnennennnnesnnnnenne 8 152 Stru ct reofanexercise ECG EE 9 2 RECORDING AN EXERCISE ECG sasannnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn 10 2 1 The Real time monttor nne 10 2 2 Record an exercise ECG EE 13 23 Realtime ug e e EN 19 3 VIEWING AN EXERCISE ECG uu cece cece KREE KEN ENER KEEN ENKER KEEN KN 28 3 1 About viewing exercise ECGOGs naoa ne aiae aa A 28 3 2 View an exercise ECG EE 28 3 3 Work with the Summary view 30 3 4 Work with the Averages view 31 3 5 Work with the Full disclosure view 33 3 6 Work with the 2x6 and 4X3 view 35 3 7 Work with the Trends view 36 3 8 Work with the ST table view 37 3 9 Work with the Heart rate view 38 3 10 Work with the ST HR view 39 4 INTERPRETING AN EXERCISE ECG oe ce ceceneececeeeeeeeeeeeeesenenees 40 4 1 Edit save and Confirm interpretation ccccccecccceeeceeceeseeeeceeeceeeeeeeeseeaeesseeeeeeeaees 40 42 VIEW interpretation NIStOTY EE 41 AS Clean up full disclosure vccicci cccsscciccccetseccetssniedaeedeteceseeceedecsdedaaeesnedeh lt as deeencecededectteaniedst 41 5 PRINTING AN EXERCISE ECG cece KN KREE KEREN KKK KEN EN ENER RK 43 5 1 PM SS aaa E 43 5 2 Automatically print an exercise ECO 44 6 MAINTAINING THE RECORDER 0 ccceceeeececececeeeeeececeeeeeeeeeeeeeees 45 6 1 About maintaining the recorder 45 6 2 Cl
5. D General TaD EEN 48 ei tele e NEE 58 ele EEN 49 Summary Teport 55 Welch Allyn CardioPerfect 48 Delete F VO te leie WE 61 ONG E 62 Devices tab EE 53 Display Markers sarriena anin Aien Enn ai 32 RPP EE 36 SelectionS onennenennenennenennenornererrenn 51 ST SIO CS saanane nanain ia 37 ST HR graph EN 39 Switch off message ceeeeeeeeeee eee 54 VES end EEN 36 PIONS ee 66 Duke Treadmill Score nassaan 79 Edit EEN EN Interpretation cccccccsssseeeeeseeeeseeeees 40 WANK GIS ooiuscetvaccnaticuncasemauneseenneetenswoences 33 FY SIC IAS seasea nET 18 Si tele EEN 58 Sele UO BE 50 Ee e E E E EA 62 Template ccccccsssseecseeseeseeeeeeeseees 57 RT 29 Emergency stop 11 Ergometer nennnneennennneonnrensnrnersnneeennne 12 Manual load change 23 ed 01 610 58 EVGA E 29 34 Button EEN 11 Cap E 14 19 Dispatcher ccecceceeeeeeeeeeseeeeeeeeeens 52 e EE 21 INS EE 77 Insert after recording ccceseeeees 34 RE 12 ee ME 49 Exercise ECG Greate NOW eer 19 Interpretation cccccccssseeeeeeeeeeeseeeees 40 NON eea 10 15 SI re 13 SCENE tee eessen 9 VE 28 Exercise ECG settings ccccccceee 50 Favorites button 31 FUNMOISCIOSUN EE 33 GS ND EE 42 EE ER Hearn EE 16 26 30 OTD eS ee 38 81 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual BEE gebeten 36 VCO E 31 Een 38 Wgl EE 13 48 lt
6. Heart rate Rhythm ST table ST trends Summary Each report contains the view and a header that displays additional information Please refer to the Workstation manual for further information on printing exercise ECGs 5 2 Automatically print an exercise ECG Welch Allyn CardioPerfect Exercise ECG can automatically print an exercise ECG directly after recording To automatically print an ECG after recording you need to e Enable automatic printing by selecting Print after recording in the Exercise ECG settings e Define a number of pre selected formats that you want to have printed Select the formats in the Exercise ECG settings menu from the Default report formats list These will be the same formats that the Print Selected Formats button will print DIR 80012335 Ver D 44 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 6 Maintaining the recorder 6 1 About maintaining the recorder To keep your Welch Allyn CardioPerfect recorder in good working condition please observe the following e Remove the battery when you do not use the recorder for a long period of time e Do not expose the recorder to temperatures lower than 15 C or higher than 45 C at a maximum non condensing humidity of 95 e Clean the cables regularly e Replace the battery of the recorder when the power indicator light is red 6 2 Cleaning the Patient cables and PC interface cables When you use electrodes that ne
7. Print button Emergency stop DIR 80012335 Ver D Exercise ECG Module User Manual With the Start stop button you start stop an ECG recording The Next phase button displays the name of the next phase for example Go to recovery With it you move to the next phase in the exercise protocol The Next Stage button displays the name of the next stage With it you move to the next stage of the current phase in the exercise protocol With the Hold stage button you can force the protocol to remain in the current stage With the Change load button you can change the load for the treadmill or bicycle A record of patient perception for several parameters can be added to the test with the Perception button With the Blood pressure button you can enter a blood pressure measurement at any time Blood pressure can be measured manually or automatically This depends on the blood pressure device With the Comment button you can add information to the exercise ECG like a description of an arrhythmia that has occurred With the Event button you can indicate an event like arrhythmia When you click the button Welch Allyn CardioPerfect Exercise ECG inserts a mark in the full disclosure view and adds the event to the event list The Event button functions similar to the Comment button but additional information cannot be added With the Print button you can print a report See 7 3 1 on how to select the report format With
8. 8 5 3 Delete a protocol When you no longer use a protocol you can delete it To delete a protocol 1 Select the protocol that you want to delete 2 Right click on the protocol 3 Inthe shortcut menu click Delete DIR 80012335 Ver D 61 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 8 6 Working with stages 8 6 1 Create a new stage Once you have created a new protocol you can define the different stages for that protocol Each phase in the protocol can have a number of stages When you design these stages take into account that not every test may use all phases and that the protocol needs to be specified accordingly Most Treadmill and Ergometer protocols only have stages in the Exercise and Recovery phase To create a new stage 1 Select the protocol and phase to which you want to add the stage 2 Right click in the right pane of the Protocol editor 3 Inthe shortcut menu click New The Edit stage dialog box is displayed d Enter a name for the stage 5 Enter the duration of the stage in seconds If you select Never expires the stage will continue for an indefinite number of seconds 6 Enter the number of times the stage should be repeated If you select Loop forever the stage will be repeated for an indefinite number of times Note Itis not possible to add a new stage after a forever looping stage 7 Forthe Treadmill and Ergometer stage you can now enter either a value
9. Clicking the option once more switches the filter off Note f accurate ST segment contours are required for ECGs do not use the 0 5 Hz baseline wander filter This filter suppresses baseline wander to the extent that it may alter the ST segment Instead configure your cardiograph to operate without the baseline wander filter Regardless of the filter used the rhythm characteristics of the ECG are accurately recorded Muscle noise filter Muscle noise in an ECG signal hides low amplitude signals that may be important for the interpretation of an ECG You can remove this noise with a muscle noise filter To apply a muscle noise filter e At the top of the Real time monitor click Muscle filter Click again to switch the filter off 2 3 8 Manual load change During recording it is possible to change the load by clicking the Change load button Clicking this button will open the change load dialog window which is always on top lf a treadmill is used the speed and elevation can be changed if an ergometer is used the workload can be changed When the pause the protocol after change option is enabled the protocol will hold at the current load The pause protocol checkbox is linked to the pause button on the monitor form Clicking either one of them will automatically change the state of the other one New values can be entered directly or via the up down buttons It is also possible to increment decrement the value by using
10. Hi D He HEI GIE spe HENG ECG traces 5 Ia SSSR SSP ETIT es 38 Pees Bee Bane hens ALA H i HOH Kan H i h ett Ke ec ead tiie 7 EE TEE Er TEETE Sg D Iau SURE ee kee G ss GE RA Col AE DEES De TE ere Tabs wef fe Ee ee H E u agigegbgsen Amen damt s GE Leem Lt Aa Ga Bomar fans ute oe ECG traces The leads of the ECG You can select different lead configurations 1x12 2x6 4x3 from the shortcut menu With the shortcut menu you can also adjust the chart speed and the sensitivity Dividers The dividers in the ECG traces area can be switched on or off from the shortcut menu Average complexes The area to the right of the ECG traces displays the average complexes Options available form the shortcut menu e Marker option on or off If the Markers option is enabled the ST measurements are displayed next to the Average complex e The Slope option displays the Slope value next to the Average complex if the Markers option is enabled e The reference complex can be displayed on top of the Average complex e The current complex can be set as reference Note If square waves are displayed the signal on one or more of the channels is erroneous see section 2 3 10 on page 25 for more information DIR 80012335 Ver D 10 83 Welch Allyn CardioPerfect Workstation Button bar Start stop button Next phase Next stage Hold stage Change load Perception button Blood pressure button Comment button Event button
11. The General tab contains the following options Lead Preference In this section you can specify your own favorite lead sequence Use the arrows to move a lead up or down The favorite lead sequence is available in the Averages view and the Real time monitor When displaying views with fewer than 12 leads the leads that are shown are selected from the top down from this list thus a 3 lead view shows the top 3 leads ST options Reference Point With this setting you can determine the default point that is taken for ST measurement Possible choices are J 0 J 20 J 40 J 60 J 80 J Dynamic The latter option calculates the ST measurement point based on the actual heart rate as J RR 16 Highest ST With this setting you can specify how the highest ST should calculation be calculated You can choose between Absolute ST deviation for the lead specified the ST event is reported for which the absolute ST value in that lead is maximal Summation the ST event is reported for which the summation of the absolute ST values across all leads is maximal ST depression only for the lead specified the ST event is reported for which the ST value is maximally negative Highest ST lead If you have set the Highest ST calculation option to Absolute ST deviation or ST depression only use the Highest ST lead to specify which lead should be used for this setting Possible choices are Il III aVF aVL aVR V1 V2 V3
12. View an exercise ECG To view an exercise ECG 1 Select a patient The tests that have been recorded for that patient are listed in the test list 2 From the test list select the ECG that you want to see ECGs are indicated with Re Welch Allyn CardioPerfect Exercise ECG is started automatically and the test is displayed in the workspace 3 2 1 Zoom in and out on an exercise ECG If you want to get a closer look at the traces you can adjust the size of the leads by zooming in and out of the exercise ECG You can adjust the size of the leads by zooming in and out of the exercise ECG To see leads in more detail e Inthe View menu click Zoom in To see a larger part of the ECG e Inthe View menu click Zoom out To reset the zoom function and return to the standard size e Inthe View menu click Reset zooming Tips for zooming in and out on an ECG You can also use your right mouse button for zooming 3 2 2 Set chart speed and sensitivity Welch Allyn CardioPerfect Exercise ECG offers a wide range of speed and sensitivity You can adjust the scale of an exercise ECG by adjusting the chart speed and the sensitivity To set the chart speed e Right click on the view point to Speed and select a value To set the sensitivity e Right click on the view point to Sensitivity and select a value The lower the value the lower the lead signal amplitude will be DIR 80012335 Ver D 28 83 WelchAllyn 3 2 3 Navigate thr
13. also affect portions of the summary report Which ever selection is chosen for Averages ST measurements and ECG strips will drive the list which is displayed when the mouse moves over the binoculars as described in section 3 2 3 On page 29 DIR 80012335 Ver D 49 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual You can create a selection in three ways e A selection of events all events of a certain kind are included such as all arrhythmias all start points of a new phase or all user events e A selection of common or similar points in a test for example all blood pressure measurements that were made during the Exercise phase e A selection of points at specific times during the test To create a selection of events for printing or viewing 1 Inthe Exercise ECG settings click on the Viewing tab 2 Inthe Selection area click the Configure button The Configure selections dialog box is displayed 3 Inthe Configure selections dialog box click the Add button The Edit selection dialog is displayed 4 Enter a name for the selection De i gg j Rad naj ke lt n TF g s Ueesp rtgnen l Fees pe h es B S par Sea W Ire p H ze s Bag FE an HE geg TLE E lon ee i ma eee eal Ra 5 Inthe Global events area select the events that you want to include in your selection 6 Inthe Events per phase type area select the events from the phase that yo
14. and all other conductive circuits in the cardiograph This reduces the possibility of hazardous currents passing from the cardiograph through the patient s heart to ground To ensure the patient s safety and your own please observe the following Any system components e g treadmill personal computer ergo meter that require to be connected to an outlet socket shall use only grounded power cords three wire power cords with grounded plugs Also make sure the outlet accepts the plug and is grounded Never adapt a grounded plug to fit an ungrounded outlet by removing the ground prong or ground clip DIR 80012335 Ver D 71 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Multiple portable outlet sockets shall not be placed on the floor Multiple portable outlet sockets or extension cord shall not be connected to the system Do not connect items which are not part of the system The use of multiple non medical electrical equipment connected to the same patient may pose a safety hazard due to the summation of leakage currents from each instrument Any combination of non medical electrical equipment should be evaluated by local safety personnel before put into service Multiple portable outlet sockets use without an isolation transformer is disapproved unless casual access for additional equipment is impeded or prevented Patient cable and Interface cable The patient cable supplied with the CardioPerfect cardiogr
15. and select Edit from the shortcut menu The Edit average complex dialog box is displayed 2 From the list in the left hand corner select the lead you want to be displayed during editing 3 Move your mouse over the markers until the cross hair pointer changes shape 4 Click your left mouse button and keep it pressed and drag the marker to adjust Note You can select an aimer from the right click menu as a positioning aid 3 5 Work with the Full disclosure view 3 5 1 Full disclosure view The Full disclosure view displays the complete 12 lead recording This view is very convenient for reviewing any arrhythmias that may have occurred during the recording Summary Averages Full Disclosure 2x6 Au Trends ST table Heartrate ST HR Selection None DI AA l u IIl aR aL aVF vi V2 v3 V4 vs vE BIER SS DER SE BEEN EE Gi D EE DE GE EE Lu Un a La UA ais Lal e e a ste aime ea oo 3 ES ES ES S ES BE E fiizi fiizi fiizi fiizi AE E E q Fy Pt re E E E E em GE e e KC EE EES E EE E H ee EE BEE EE PP EE EE TE E ES SE E E E EE LS E Ze Ee V SSES ERR E ZS EI T EE E EE E EAE E E a Pl SS E se SS E FE BEE ALA eeh Eng fl el ede eb S ZE EE SZ E E E E E EI EI EE See E EE E E E S S E E p ap E E E E S ae E fiizi fiizi fiizi ES SE S S RS E E AEE fe eS EE sar al ES EE e Fe Ge al ALL Te gt CE SS ES
16. and version number Type of operating system Type of installation network or standalone A copy of the CCW Technical Support Form Complete description of the problem and the steps to reproduce it If applicable we would also like to have the exact error message To print the Technical support form 1 Inthe Help menu click Information 2 Click on the Registration tab 3 Click on the Support button The Welch Allyn CardioPerfect support form is now printed and saved as file MDW txt in the MDW installation directory You can fax the printout or e mail the file DIR 80012335 Ver D 64 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 10 Before installing the Exercise ECG software In this chapter you will find information about the structure of the Welch Allyn CardioPerfect Exercise ECG software 10 1 Structure The workstation consists of two elements e Hardware the recorder and the interface to the computer e Software the Exercise ECG module that runs in the Welch Allyn CardioPerfect Workstation The recorder must be connected to the computer that runs the module Software The Exercise ECG module is automatically installed with Welch Allyn CardioPerfect Workstation For instructions on how to install and configure Welch Allyn CardioPerfect Workstation please refer to the Installation and Configuration manual Hardware Two different types of recorders are available the MD recorder
17. automatically starts the first phase and stage of the test protocol 7 During the test you can Measure the blood pressure Add patient perception parameters Capture an event Add a comment Turn pacemaker mode on or off Apply a baseline filter to filter out baseline wander Apply a muscle filter Change or hold the current load Print a variety of reports 8 To move to the next phase of the test click the button that displays the name of the next phase 9 When you have reached the end of the test click the Stop button to stop the test Welch Allyn CardioPerfect Exercise ECG may ask you to switch off the recorder If a Pro recorder with USB connection is used the recorder will be switched off automatically no message appears Welch Allyn CardioPerfect Exercise ECG automatically saves the exercise ECG and displays it on your monitor 10 Disconnect the patient Important n case of an emergency the test can be stopped with the Emergency Stop button Welch Allyn CardioPerfect will then continue monitoring the patient but all connected exercise devices will be stopped immediately Printouts can still be made and the operator can still enter comment and user events when the Emergency Stop is engaged All other functions are disabled Click the Stop button to stop monitoring the patient Welch Allyn CardioPerfect Exercise ECG automatically saves the exercise ECG and displays it on your monitor DIR 80012335 Ver D 14 83 Welch Al
18. dedicated keyboard keys see table DIR 80012335 Ver D 23 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Load change Change Keyboard Treadmill Increment Ergometer Increment keys decrement decrement CTRL 7 Elevation 1 5 Watt CTRL Elevation 1 5 Watt CTRL Speed 0 1 km h N A CTRL lt Speed 0 1 km h N A When a key combination is pressed e g CT RL t when the load change window is not visible the load change window will pop up and the corresponding load will change e When the Instant manual load changes option is enabled Exercise ECG settings Devices tab changes of the load are instant and confirmed The change workload window will have the following appearance Ergometer Treadmill Welch Allyn CardioPerfect Welch Allyn CardioPerfect g Change curent workload to Change current load of the treadmill Wi CET Pause protocol after change w 4 s Pause protocol after change Close Upon changing the values will immediately be sent to the exercise device e When the Instant manual load changes option is NOT set the form has the following characteristics Ergometer Treadmill Welch Allyn CardioPerfect Welch Allyn CardioPerfect Change curent workload to Walt IT Pause protocol after change Cancel Change current load of the treadmill 2 Ari kmh GES IT Pause protocol after ch
19. event identified by a selection Welch Allyn CardioPerfect Exercise ECG creates the following displays e Inthe 2x6 or 4x3 view there will be a waveform display representing the time when the event occurred e Inthe ST table view the will be a line of ST measurement data associated with the event e Inthe Averages view there will be a set of averages associated with the event 7 3 Exercise ECG settings Printing tab Use the Printing tab to configure the automatic printing settings The Printing tab contains the following options Printing during test These settings can still be changed when you create a new exercise ECG New print protocols can be added using the Protocol editor see page 60 Protocol Here you can select if a report should be printed at the end of each stage manually triggered or according to a user defined protocol Print format From this list you can select the printing protocol that is used for printing during recording Grid From this list you can select the grid style used for the printouts during the test The grid style used for printouts after recording is set separately see the Default report formats section below DIR 80012335 Ver D 51 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Default report formats printing after recording Selected From this list of formats you can select the formats that are printed when automatic printing is enabled These formats are a
20. in different views Status bar The status bar shows important information about the patient and test that are currently selected Additionally the status bar displays the name of the user that is currently logged on to Welch Allyn CardioPerfect 1 2 Structure of an exercise ECG An exercise ECG consists of the following elements e Phases the distinct parts of an exercise ECG In CardioPerfect they are pretest exercise recovery and posttest e Stages the distinct parts of a phase For instance an exercise phase can have different stages with different workloads e Exercise protocol a specific set of rules and conventions that determine how the exercise ECG is performed A protocol consists of a number of phases Each phase consists of a number of stages Welch Allyn CardioPerfect Exercise ECG offers a number of well known protocols that you can use Additionally you can create your own exercise protocols DIR 80012335 Ver D 9 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 Recording an exercise ECG 2 1 The Real time monitor The Real time monitor is displayed when you start a new exercise ECG During the test this window allows you to control and monitor all aspects of the test and review any recorded results Protect es Action l E E A DERA PORDAN 03 00 00 00 75 80 Watt 20 Watt min i PALI Rao me Overview area Se F Muncie We Lo Berebe Se EE Ser Kies Tabs R VT anor
21. instructions include explanations for each operating system 11 1 Connecting the RS232 interface Rest or Stress light versions The RS232 interface is a Unilink for MD recorder or Prolink for Pro recorders The RS232 Interface can be used with all versions of MS Windows To use an RS232 Interface you need a free serial port on your computer You cannot use the RS232 Unilink with the normal Welch Allyn CardioPerfect Exercise ECG module To set up your computer for use of the RS232 Interface 1 Connect the RS232 Interface to one of the serial ports of the computer 2 If aPro recorder is used connect the other end of the interface directly to the recorder If a Portable or MD recorder is used insert one end of the optical fiber into the optical output receptacle at the back of the recorder and insert the other end into the respectable on the interface After you have connected the Interface you need to configure Welch Allyn CardioPerfect Workstation so that it uses the correct port To configure Welch Allyn CardioPerfect Workstation 1 Start Welch Allyn CardioPerfect Workstation and log in as Administrator 2 Inthe File menu click Settings click Exercise ECG and click on the Recorder tab 3 From the Port list select the COM port to which the Interface is connected Most often this is either COM1 or COM2 11 2 Connecting the USB Interface The USB Interface Unilink for MD and Prolink for Pro cannot be used with MS Windows 95
22. interface Default protocol The default workload protocol that is used for the exercise ECG Instant manual When this option is enabled the treadmill soeed and elevation load changes or the ergometer workload will be instantly adjustable in the Real time monitor Blood pressure device Device With this option you can specify which blood pressure device is used for measuring the patient s blood pressure during the exercise test Connected to From this list you can select the COM port to which the blood pressure device is connected Default protocol With this option you can specify which protocol is used by default for measuring the blood pressure during the test Select Manually controlled if the blood pressure protocol will not be used or if the protocol is selected at the start of a test DIR 80012335 Ver D 53 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 7 6 Exercise ECG settings Recorder tab The Recorder tab is only accessible if you have Windows administrator rights Use the Recorder tab to adjust settings for the Welch Allyn CardioPerfect recorder The Recorder tab contains the following options Recorder model Model Sample Frequency AC mains frequency Recorder connection Port type Analog output Channel Recorder options Display switch off message Battery options Enable low battery warning Warn at DIR 80012335 Ver D The recorder model that is us
23. markers e Inthe Averages view click with your right mouse button and select Markers Click once more to hide the markers again Tips for displaying markers e You can change the color of the markers in the exercise ECG settings 3 4 3 Make measurements In each view that displays leads or complexes you can make measurements between two points To make a measurement between two points 1 Move the crosshair pointer to the starting point of your measurement 2 Double click on the starting point Welch Allyn CardioPerfect Exercise ECG inserts a mark 3 Move the crosshair pointer to the end point of your measurement 4 Double click on the end point Welch Allyn CardioPerfect Exercise ECG draws a line between the two points and displays the measured values You can remove these measurements by selecting Refresh from the Action menu or pressing Ctrl R 3 4 4 Set reference complex In the Averages view you can set a reference complex that can be used for comparison To select a reference complex e Select a phase from the Reference complex list If you do not want to see a reference complex select None The reference complex is displayed in the Averages view as a red curve 3 4 5 Compare averages with full disclosure data When the average complexes show unexpected results it is worthwhile to compare the computer generated data in the Averages view with the actual data in the Full disclosure view With Welch Allyn CardioP
24. or MS Windows NT4 To use a USB Interface you need a free USB port on your computer On the Installer menu of the Welch Allyn CardioPerfect Workstation you will find an item called Install Unilink USB CardioPerfect Pro Drivers Please run this install prior to inserting the USB Interface into a USB socket of your computer The installation wizard will prompt you to select whether the USB Unilink drivers or the Prolink USB drivers should be installed To set up your computer for use of the USB Unilink Interface 1 Connect the USB Interface to the USB port of the computer 2 Ifa Pro recorder is used connect the other end of the interface directly to the recorder DIR 80012335 Ver D 66 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 3 Ifa Portable or MD recorder is used insert one end of the optical fiber into the optical output receptacle at the back of the recorder and insert the other end into the receptacle on the Unilink When you connect the USB Interface to a USB port for the first time the system will tell you that it has found new hardware and it is trying to locate the drivers for it provided that you have executed the installation of the drivers from the installer menu the drivers will be detected automatically and correctly setup this may take a few minutes lf at a certain moment the USB interface is inserted into another USB port the driver setup will be repeated automat
25. or an expression for Adjustable items Treadmill Speed Km h or mph Elevation Workload Watt 8 6 2 Edit a stage When you want to change an existing stage you can use the edit function to make those changes To edit a stage 1 Right click on the stage and click Edit in the shortcut menu The Edit stage dialog box is displayed 2 Edit the information 8 6 3 Delete a stage When you no longer use a stage you can delete it To delete a stage e Right click on the stage and click Delete in the shortcut menu DIR 80012335 Ver D 62 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 9 Troubleshooting 9 1 Test recovery Recover a test after a computer crash When a recording is not finished properly for instance due to a computer crash you can still recover the full disclosure of that recording To recover a test after a computer crash 1 Start Workstation 2 Start Welch Allyn CardioPerfect Exercise ECG for instance by opening another exercise ECG 3 Inthe Tools menu click Full disclosure recovery SS Full disclosure recovery E x The following unfinished recording are found on your system Filename Date Time Length Patient 4 Inthe Full disclosure recovery dialog box click on the recording that you want to recover and click Recover full disclosure If the recovery was successful a message Is displayed 5 Inthe Patients tab select the pa
26. recording 1 Inthe Full disclosure view click your right mouse button to display the shortcut menu 2 Inthe shortcut menu click Insert user event The Enter comment dialog box is displayed 3 Select a predefined comment from the list or type a new text 4 Click OK The user event will appear where the crosshair cursor has been positioned 3 5 4 Use filters When viewing full disclosure or any other waveform report the filter settings used during the recording are not automatically applied during review You must choose whether the filters should be applied to the data being reviewed When viewing the full disclosure you can use two filters e Baseline filter e Muscle filter Both filter options can be found in the Action menu Select the appropriate filter to enable it The filter option will be marked with a check To disable the filter simply select it again Note When you enable a filter from the Action menu it will also affect the 2x6 and 4x3 view Note You can tell which filters are enabled in the portion of the full disclosure 2x6 and 4x3 views by looking at the frequency response displayed If the baseline filter is enabled the lower frequency will be 0 5Hz If the muscle filter is enabled the upper frequency will be either 25 or 35 Hz depending on the settings If accurate ST segment contours are required for ECGs do not use the 0 5 Hz baseline wander filter This filter suppresses baseline wander to the exte
27. software in order to allow communication between the program and the PCI CPCOM card To configure Welch Allyn CardioPerfect Workstation Start Welch Allyn CardioPerfect Workstation and log in as Administrator In the File menu click Settings click Exercise ECG and click on the Recorder tab Set the Port setting to CPCOM PCI Click OK to save your settings SCH YS 11 5 Install the PCMCIA CPCOM Card MD recorder only The use of a PCMCIA CPCOM card requires a free type II PCMCIA slot and is not supported on Windows NT 4 The installation of the PCI CPCOM card is relatively easy and can be done by following the instructions below 1 Insert the Card into the PC 2 The operating system will ask you for a driver upon insertion of the card into one of the PCMCIA slots For Select the driver file that is located on the Welch Allyn Windows CardioPerfect Workstation CD in the directory 2000 XP R Drivers CPCOM PCMCIA Win2000 For R substitute the drive letter of your CD_ ROM drive Configuring the Software After installing the card you need to configure the Workstation software in order to allow communication between the program and the card To configure Welch Allyn CardioPerfect Workstation Start Welch Allyn CardioPerfect Workstation and log in as Administrator In the File menu click Settings click Exercise ECG and click on the Recorder tab Set the Port setting to CRCOM PCMCIA Click on OK to save your settings
28. the Emergency stop button you can stop the exercise device The monitoring of the patient will continue See page 15 for important information regarding the Emergency stop function 11 83 WelchAllyn Overview area Overview area CardioPerfect Workstation Exercise ECG Module User Manual In the Overview area you can find the following information about the exercise ECG Phase of the exercise ECG monitoring exercise recovery and the duration of the phase Number and name of the Stage that is currently being recorded The current heart rate of the patient and the current heart rate as a percentage of the maximum predicted heart rate VES the number of VES beats Ventricular Extra Systole per minute The current blood pressure and previous blood pressure are displayed The current workload and the current workload as a percentage of the maximum workload The maximum workload is calculated based on the last valid stage By default the minimum stage duration is 30 seconds The RPM is displayed when an ergometer is used The protocol that you selected at the start of the test The following variables can be set Speed mm sec and sensitivity mm mvV Pacemaker on off ECG traces can contain artificial pacemaker signal indicators You can remove this artificial pacer indicator by disabling the Show Pacer selection To learn how see Exercise ECG settings General tab on page 48 Baseline filter on off ECG tr
29. 00 e r L 2200 0 vg 0 Jra me 0 0 eee i i i i 100 lit Bo 0246 610121 O02 4 6 8 101214 O02 46 8 101214 0 2 4 6 8101214 uj 7 6 a fz ql ghee ale ST x100 ul Slope x100 pzs The trends view displays various trend graphs ST trends For each of the twelve leads the Trends view displays the ST trends as measured from the ST reference point together with the ST slopes You can change the ST reference point Workload graph The Workload graph shows the workload against time The workload is expressed in Watts for an ergometer test and in METS for treadmill tests Heart rate graph The Heart rate graph shows the patient s heart rate against time From the shortcut menu you can also select to display the VES trend in the Heart rate graph Blood pressure The blood pressure graph shows the patient s blood pressure graph against time From the shortcut menu you can also select to display the RPP in the Blood pressure graph 3 7 1 Set a different ST reference point You can change the reference point for the ST calculation both during recording and viewing The values for the ST reference point can be e J 0 J 20 J 40 J 60 J 80 J Dynamic J 1 16 R R To set a different ST reference point e Inthe View menu point to ST Reference Point and select a value DIR 80012335 Ver D 36 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual e You can also change the QRS end J marker yo
30. 000 4 3 80 MHz to 1 GHz 80 to 800 MHz Ei 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W and dis the recommended separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following Le roi symbol NOTE 1 Ar 80 MHz and 800 MHz the higher frequency range applies NOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the Welch Allyn CardioPerfect Pro Cardiograph is used exceeds the applicable RF compliance level above the Welch Allyn CardioPerfect Pro Cardiograph should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the Welch Allyn CardioPerfect Pro Cardiograph Over th
31. 2 interface Rest or Stress light vereoions 66 11 2 Gonnecting the USB INteraCe a visicsonsesccsiecascacecncncdavvcauatedincacis vusunalecacecudeeatandicheeusdest 66 DIR 80012335 Ver D 5 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 11 3 R wave triggering Interface capabilities cccecccccsseececeeeeeecseeeeeeneeeeeeeeeeeeeneeees 67 11 4 Install the PCI CPCOM card MD recorder only 68 11 5 Install the PCMCIA CPCOM Card MD recorder only 69 12 SAFETY AND PREGAU ul el LE 70 12 1 OI e cesura aAa danas eras suewnrs oleae EEE SE 70 12 2 General Safety and Precautions ps 71 13 GUIDANCE AND MANUFACTURER S DECLARATIONG ZA 14 FONGTHON KEY S en eee ene ee eee ee eee T7 15 ADDITIONAL INFORMATION see eEREER KREE KEE R ENEE REEN NEE R KR Kn 19 15 1 D ke Treadmill COS essere arise cc cp a eae eect eee ae E OREA 79 15 2 WEE 80 DIR 80012335 Ver D 6 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Welcome Welcome to the Welch Allyn CardioPerfect Exercise ECG module of Welch Allyn CardioPerfect Workstation This module offers you exciting features and provides everything you expect from an exercise ECG software package This manual provides the necessary information for the installation operation and maintenance of the Welch Allyn CardioPerfect Exercise ECG recording system These instructions must be studied before putting the unit into op
32. CardioPerfect Cardiograph is susceptible to interference from RF energy sources lowered RF immunity which exceed the IEC 60601 1 2 limits such as power line bursts other medical devices cellular products information technology equipment and radio television transmission To reduce EMC interference the cardiograph shall be separated from the emitting source as much as possible If assistance is needed call your local Welch Allyn service representative Artifact on the ECG caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment Like all electronic devices this cardiograph is susceptible to electrostatic discharge ESD Electrostatic discharge typically occurs when electrostatic energy is transferred to the patient the electrodes or the cardiograph ESD may result in ECG artifact that may appear as narrow spikes on the cardiograph display or on the printed report When ESD occurs the cardiograph s ECG interpretation may be inconsistent with the physician s interpretation Welch Allyn assumes no liability for failures resulting from RF interference between Welch Allyn medical electronics and any radio frequency generating equipment when these levels exceed those established by applicable standards Patient and Operational Safety The cardiograph isolates all connections to the patient from electrical ground
33. D 21 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Depending on the type of event the following dialog will appear Dyspnea and Chest pain Perceived exertion Perception x x Event type Event type Dyspnea ll Perceived exertion Enter a value for this event S Enter a value for this event i 0 nothing 6 no exertion E bd 10 almost maximum fi 3 F 20 maximum exertion maximum D DU I D I DU DU DU I I D DU H D DU I AU iby r a ey ee el Ek Alt Cancel 6 8 D 10 14 12 13 14 15 16 17 18 19 20 Cancel The Borg CR10 scale is used to add The Borg RPE scale is used to add Patient dyspnea and chest pain parameters to the Perceived Exertion to the test test 0 Nothing at all 6 No exertion at all 0 3 H Extremely light 0 5 Extremely weak 8 0 7 9 Very light 1 Very weak 10 15 11 Light 2 Weak 12 25 13 Somewhat hard 3 Moderate 14 4 15 Hard heavy 5 Strong 16 6 17 Very hard 7 Very strong 18 8 19 Extremely hard 9 20 Maximum exertion 10 Extremely strong Absolute maximum 2 3 5 Duke Treadmill Score The Duke Treadmill Score DTS is shown in the Summary tab if selected See page 55 for more information on selecting the DTS and section 15 for more information on the DTS calculation Note The Duke Score is not applicable for pharmacological stress testing it is only applicable if the selected exercise device i
34. EE SI S SE EE EE E E EE E eC OG Ee E EE SG SE SE GEET ees EE GET E EE Ep lo EE E EE KO EE opene Ee pE SE SS ei Sek He He SS SS Be ae pH iel Zo ee EEN SR Be SS SR Si 0 SS Be He PRES des SEI SS RSPR gga Gre P EE EE EES Ge SE Ee a EE EES G g To Sn S E E E S E E S EE en dog DEER E E EE E SES Gi Gi S S Gi SS Gi Gi S Gi S SS E SS SS SS SS SS S SS SS SS SS SS Gi E S E E E E E E Bi E E E 4 SS E Sp Op The ZS ZS ZS it W EZ H E SU Sch ZS ZS E ii p E 3 E EL id ST ZS ZS mp oy pis g Ey 33 ZS DIR 80012335 Ver D 33 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual The Full disclosure view displays the following events with a marker Blood pressure measurements Phase or workload changes User events Comments Arrhythmias optionally see 7 2 to configure 3 5 2 View leads To view one lead e Click on the button of the lead you want to view To view workload changes 1 Click your right mouse button to display the shortcut menu 2 Click Workload changes The workload changes are displayed in the view Click once more to hide them again 3 5 3 Insert events after recording When you scroll through the Full disclosure view and want to make note of an arrhythmia or other event you can still insert this after recording To insert a user event after
35. For example see Pacemaker pulse detection on page 25 7 2 Exercise ECG settings Viewing tab Use the Viewing tab in the ECG settings window to configure how ECGs are displayed on your Workstation The Viewing tab contains the following options Colors Here you can specify individual colors for the background axis and grid lines trends superimpose and ST markers Color schemes This list lets you choose from a number of predefined color schemes Selections Here you can define selections A selection is a group of events that appear together on the Averages ST measurements and ECG strips both in print and on the monitor By defining different selections you can customize what should be printed and displayed Averages With this option you can define a selection of events for which you want to print or display the corresponding averages ST table With this option you can define a selection of events for which you want to print or display the corresponding ST values 2x6 With this option you can define a selection of events for which you want to print or display the corresponding 2x6 ECG strips Visible arrhythmia With this option you can select which arrhythmia will be printed or displayed 7 2 1 Selections for viewing and printing A selection is a collection of events which you choose to allow quick navigation through the Averages ST measurements and ECG strips while reviewing on the monitor The selection definition can
36. N E a a E EE E E E a E EES O E age Le e E ae de E E E E a ic ER EE E e HEEB Ee EBB EE EEE ES DS ES de RE o o BEIER EUR IER EA ER ED ER DER E 19 FE Ege Ed eet eee Et Fl ee ele E HA 2 3 10 Signal quality indication Eee AS RL If CardioPerfect Workstation finds the signal from one of the channels to be erroneous for 25 83 H avl a VF V 1V2V3 V4 Y5Y6 Favorites The status information is saved with the test Erroneous leads will show square waves on both the Review and the printout Depending on the duration of the erroneous signal no measurement may be possible and therefore may not be shown Please check the indicated electrodes immediately DIR 80012335 Ver D Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual In the few moments between a lead being disconnected and that event being detected by the software pacemaker spikes may be erroneously detected As a result a group of pacemaker markers may be shown on the trace just before the square waves are shown The pacemaker pulse detection will be suppressed as soon as the square waves are shown and will continue to be suppressed until the erroneous signal is corrected 2 3 11 Printing during recording You can print the following formats while recording an exercise ECG e 2x6 simultaneous or sequential e 4x3 simultaneous or sequential e rhythm To print during recording In the Real time monitor click the Print button It may ta
37. V4 V5 V6 and aVR or Lead with maximum ST Note when lead with maximum ST is used in combination with ST depression only the leads aVR and V1 will not be used in the determination of the lead with the highest ST Rhythm lead Here you can select which lead should be shown as rhythm lead in the 4x3 view Speed unit With this option you can select the unit in which the treadmill speed is expressed You can select either km h or mph DIR 80012335 Ver D 48 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Lead order With this option you can select the order in which the leads are displayed Two ECG lead sequences are provided the standard lead sequence or the Cabrera format Amplitude unit With this option you can select the unit in which the measured amplitudes are expressed You can select either millimeter or microvolt The millimeter setting is dependent on the sensitivity that you use The microvolt setting is sensitivity independent Muscle filter This setting will affect the high cutoff frequency that is used by the frequency muscle filter Minimum last stage Enter the minimum duration of the last stage in seconds duration Show Pacer By checking or unchecking the Show Pacer box you can control whether a test will start with artificial pacemaker signal indicators on or off During the test and during post test review you will also be able to turn the pacemaker marks on or off
38. WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Welch Allyn CardioPerfect Wor FERH a ia Eic l BREE Sh SL ENA eg T European Regulatory Manager Welch Allyn Welch Allyn Ltd 4341 State Street Road Navan Business Park Skaneateles Falls NY Dublin Road 13153 0220 USA Navan County Meath www welchallyn com Republic of Ireland Tel 353 46 90 67700 Fax 353 46 90 67754 CE ccs DIR 80012335 Ver D Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual N US Federal law restricts this device to sale by or on the order of a Caution Physician Copyright Copyright 2010 Welch Allyn All rights are reserved No one is permitted to translate reproduce or duplicate this manual or any part thereof in any form without prior written permission from Welch Allyn Welch Allyn assumes no responsibility for any injury to anyone or for any illegal or improper use of the product that may result from failure to use this product in accordance with the instructions cautions warnings or statement of intended use published in this manual Unauthorized copying of this publication may not only infringe copyright but also reduce the ability of Welch Allyn to provide accurate and up to date information to users and operators alike Welch Allyn CardioPerfect Workstation and SpiroPerfect are registered trademarks of Welch Allyn Software in this product is Copyright 2008 W
39. aces can contain some baseline wander caused by movement You can reduce this wander of the baseline by applying a baseline filter Muscle filter on off Muscle noise in an ECG signal hides low amplitude signals that may be important for the interpretation of an ECG You can remove this noise with a muscle noise filter After switching to the recovery phase the total exercise time the maximum heart rate the maximum workload the protocol name and the current METS values are displayed Tabs below the ECG traces The Trends tab contains the event list and three curves Trends tab DIR 80012335 Ver D Workload against time Heart rate against time The VES ventricular extra systole count can be displayed in the Heart rate graph from the shortcut menu Blood pressure against time The RPP Rate Pressure Product can be displayed in the Blood pressure graph from the shortcut menu 12 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Tabs below the ECG traces History tab The History tab shows the history of all twelve leads Here you can move back in time or print a view while the exercise ECG recording continues Clicking the double arrow buttons moves forward and backward from event to event ST Slope tab This ST slope tab shows the comparison between the actual and referral ST measurement The arrows below give the direction of the slope Test Information General information about the
40. age complex 10 13 28 33 44 View 31 32 37 48 51 EE 31 48 A AE 48 OED EEN 48 Baseline filter cece eeeeeeeee ees 12 23 35 Battery ccceeeee 45 46 47 54 63 74 Bigemini ccccceeeeeceeseeccesseecseeseeesnaeees 21 Blood pressure 11 13 20 31 51 58 DEVICE EE 53 Graph E 36 Drotocol 15 16 20 53 59 61 Cables Cleaning ceeeeeecccceeeeseeessseeeeeeesaeeeeees 45 G2 6 2 eege ee 44 49 Chart speed c csceeceeeeeeeeeees 10 20 28 Clean Cables cccceceeeceecceceeeeceeeeecneeeees 45 Comment POG EE 13 17 21 22 34 BI re 11 VWmdow ceceececceceeceeceeeeceeeeeeeeeeeeeeenaes 52 Compare Averages 0 ccc ceeececceseeecesseeceeeseesseneeeees 32 Heart rate Qrapns ccceeeeeesseeeeeeees 38 Computer Crash 63 GOMIQUIC saiieesncsdscnclesnnmediwaceuiersnannveusleensmeuss 49 Automatic printing cccccseeeeee 26 51 Cvercisedevice 53 Recording settings csesceeesseeeeees 52 Gelechons 50 Software 1 eee ceeeeeceeeceeeeeeeee 63 66 67 69 Connect Blood pressure Device 53 Electrodes a nenenannnnenennnnnnrrennnerrnn nnn 15 ele 53 Sege 54 SAAR In Un 66 USB IMG le 66 Create New Exercise Eco 14 15 New patient See Workstation manual New stage snensnennnenennnnsennrnnnresenennne 62 PO OC O EE 58 Search Pattern ccccccccseeseceeeeeseeeeeeeees 8 Bel SCI OMS EE 49 Customize DIR 80012335 Ver
41. also capture events yourself When you do this a mark is inserted at the place where the event occurred and the event is added to the event list After recording you can edit or expand the description of the event To capture an event 1 Start a recording 2 When an event occurs click the Event button Evert To edit events after recording 1 Inthe Action menu click Edit events The Event list is displayed BER Buedn X Delete i Data 116 71 mmHg 403 43x Blood pressure 149 67 mmHg J 4 06 34 Blood pressure 165 87 mmHg H 4 02 35r Blood pressure 158 76 mmHg H 4 04 35r Blood pressure 132 74 mmHg Cancel Help 2 Inthe Event list select the event that you want to edit and click Modify 3 Select a description from the list or type a new comment 4 Click OK The description is added to the event 2 3 4 Patient Perception Parameters During recording you can add comments about the perceived exertion dyspnea and chest pain using Borg scales These scales developed by Gunnar Borg are general scales to quantify perceptions and experiences To add a perception parameter i 1 Click the perception button Feet in the Real time monitor 2 Inthe add event dialog select one of the following parameters a Dyspnea b Chest pain c Perceived exertion 3 Directly enter the value or use the slider to set the value Click the OK button to add the information to the test DIR 80012335 Ver
42. ame of the technician as well as the names of the referring ordering and attending physicians are also shown in this section Test observations Observations made during the test like symptoms during the test heart rate and blood pressure response to exercise reasons for testing Interpretation If the exercise ECG has been interpreted this section contains the interpretation statements DIR 80012335 Ver D 30 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Trends and Graphs ST table An overview of the ST values as calculated in the ST table view Heart rate trend The heart rate trend as calculated in the Heart rate view ST trend The ST value chart of a predefined lead Blood pressure The blood pressure heart rate and corresponding rate pressure product 3 4 Work with the Averages view 3 4 1 Averages view The Averages view displays the averaged complexes at a number of given points in the exercise ECG These points usually are the ends of each stage and points of interest such as the highest ST deviation See section 7 2 1 for more details about configuring Selections Summary Averages Full Disclosure 2x6 4x3 Trends ST table Heartrate ST HR Selection Reference complex None v Start of exercise X di Favorites Lait viwe HIL VIVE eg E a e Pa SE AE EE Ge GES EE es SIE o GE rarer pd Let Ae Fd EE EAE E ie E EE RB For each point the ave
43. an empty battery it will not function until the battery is recharged or removed After you have replaced or charged Pro the batteries let the Welch Allyn CardioPerfect software run in Monitor mode for a few seconds This verifies that the recorder functions properly DIR 80012335 Ver D 46 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual To charge the battery of Welch Allyn CardioPerfect Pro models The battery compartment is located at the bottom of the unit 1 Pull the battery compartment from the recorder by holding the Welch Allyn CardioPerfect Pro recorder with one hand and pressing on both sides off the battery compartment with your other hand 2 Connect the power adapter to an electrical outlet insert the charger cable into the top of the battery pack Recharge your battery 3 Click the battery compartment back into place when the battery has been recharged DIR 80012335 Ver D 47 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 7 Customizing the Exercise ECG module You can customize Welch Allyn CardioPerfect to your own preferences To open the settings click Settings in the File menu The features that you can customize are located in the Exercise ECG settings In the navigation bar click Exercise ECG P 7 1 Exercise ECG settings General tab Use the General tab to customize general functions of Welch Allyn CardioPerfect Exercise ECG
44. and the Pro recorder The recorder with a patient cable with which you record the ECG is connected to the PC through an interface different types of interfaces are available e The MD recorder communicates with the computer through an optical fiber which is connected to a so called Unilink USB or RS232 only with Stress light or to a so called CPCOM card e The Pro recorder uses a Prolink USB or Prolink RS232 to communicate with the computer Install Unilink or CPCOM A Unilink is a small optical to electrical interface There are two versions of the Unilink the serial or RS232 Unilink only used with Rest ECGs or Stress light versions and the USB Unilink The Welch Allyn CardioPerfect ECG recording system can optionally be supplied with a CPCOM card This is an expansion card which either plugs into a PCI expansion slot or into a PCMCIA socket This card essentially takes over the function of the Unilink but compared to the RS232 version it has an additional capability to buffer the incoming measurements DIR 80012335 Ver D 65 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 11 Installing the Exercise ECG Module Before you can start recording ECGs you need to e Install the hardware e Install the correct drivers when you use a CPCOM card or USB Unilink e Configure the software The installation procedures of the CPCOM cards depend on the operating system of your computer Therefore all sets of
45. ange Cancel When OK is pressed the new values will be sent to the device When Cancel is pressed changes are ignored and the dialog window will close DIR 80012335 Ver D 24 83 CardioPerfect Workstation Exercise ECG Module User Manual Pacemaker pulse detection The Welch Allyn CardioPerfect software is able to display pacemaker pulse spikes detected 2 3 9 When the Pacemaker pulse detection is on the detected spikes are marked on the trace as shown here To learn how to disable this function to remove artificial pacemaker signal by the hardware These spikes are marked with a symbol in the Real time monitor in Review indicators see Show Pacer under Exercise ECG settings General tab on page 48 mode and on printouts WelchAllyn The trace example from a disconnected electrode the monitor will show Bad signal on displays square waves see example below Square waves EE GENEE TEE EE EE EH E ET ZE EE EE EE E ET E E EE EE EE EE EE E EE bl 9 E E E EE ET EES DES E ES ed ee a EE eae E EE EES E EE EE Ee EE EE TEE EE DEE ca LE E EE E EE EE E EE GE DEE EE EE E ee EE E EE eee ee EE EE E ES EE EE EE DE EE EE EE DEE E E EE E E EE EE EE Ge EES DEE E EE E ea ee ea EE DE E ee ea EE DEE E EE EE ee EI EE DE E ae ee EE EE nlc eo le cl Go ele nc co E BE EE SE Ee EG Warning in red E bE ER Rer A SR sl RE ar ected El a Ri BASS EES RSA ES OR Rer JX a EE qS SS SES EE a ee E F lt SEENE
46. aph is an integral part of the cardiograph s safety features Using any N Caution other patient cable may compromise defibrillation protection as well as cardiograph performance The patient cable should be routed away from power cords and any other electrical equipment Failure to do so can result in AC power line frequency interference on the ECG trace Do not touch the patient patient cable PC interface cable Prolink or cardiograph during defibrillation Death or injury may N Warnin occur from the electrical shock delivered by the defibrillator It is g recommended to check the patient cable and PC interface cable Prolink for damage prior to the use of the system If damage exists do not use the cable contact your local Welch Allyn Sales Office or your authorized Welch Allyn dealer or distributor to have the cable replaced DIR 80012335 Ver D 72 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 13 Guidance and Manufacturer s Declarations The Welch Allyn CardioPerfect Pro Cardiograph needs special precautions regarding EMC and needs to be installed and put into Caution service according to the following EMC information provided Portable and mobile RF communications equipment can affect the Welch Allyn CardioPerfect Pro Cardiograph Electromagnetic Emissions The Welch Allyn CardioPerfect Pro Cardiograph is intended for use in the electromagnetic environment specified below The cust
47. divided into four tabs that represent the four phases in a protocol pre test exercise recovery and post test For each phase you can create a number of stages Menu bar Here you find functionality to import and export protocols and to consult the help file DIR 80012335 Ver D 60 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 8 5 Working with protocols 8 5 1 Create a new protocol The procedure for creating a new protocol is the same for treadmill ergometer blood pressure and printer protocols After you create a new protocol continue with defining the stages for that protocol To create a new protocol 1 Select the Protocol editor from the Tools menu 2 Inthe left pane of the protocol editor first left click on the type of protocol that you want to create treadmill ergometer blood pressure or printer Then right click on the selected protocol type 3 Inthe shortcut menu click New A new protocol is added to the protocol list 4 Select the measurement units mph or km hr for the new protocol if a treadmill protocol was selected 5 Enter a name for the new protocol 8 5 2 Import a protocol With the import function you can import protocols that were created with previous versions of Welch Allyn CardioPerfect Exercise ECG To import a protocol 1 Inthe Protocol menu click Import 2 Inthe Open dialog box select the protocol that you want to import and click Open
48. e User Manual 2 3 13 Target Workload If an Ergometer was selected as exercise device the Real time monitor displays the current Workload and the current Workload as a percentage of the Target Workload during recording in the overview area Workload 80 Watt 39 of 203 The Target Workload can be adjusted at the start of a new exercise ECG in the New Exercise ECG window Target workload 203 b watt The Standard Target Workload shown is calculated with the following formula Target Workload 2 Height 2 37 Age 73 1 01 16 6 In case of a female patient multiply the above by 0 8 Units The height is specified in centimeters The Age is specified in years To set the Target Workload Enter a value in the Target Workload field DIR 80012335 Ver D 27 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 3 Viewing an exercise ECG 3 1 About viewing exercise ECGs Welch Allyn CardioPerfect Exercise ECG offers various views on an exercise ECG Each view highlights a different aspect of the ECG You can have a look at all twelve leads in full disclosure 2x6 and 4x3 format but you can also view the test results in a summary report Additionally you can view the average complexes for each lead the ST levels and slopes evolution of the patient s heart rate and a number of trends Each view is presented on a different tab in the workspace and has different functionality 3 2
49. e E 41 NANO EE 13 Import FO OC EE 61 Install E er RE 65 ie 66 Interporetaton nenene Sal PANS VOM E 41 Statements ccceeeceeceeceeceeceeeceeeaeeeees 30 NA e E 13 Lead Drerterence 48 SEU C O ie 49 Maintaining cecececeeeeeeceeeeesseeeeeeneeees 45 Manually print ccccccssseeeeeeeeeeeneeeees 43 VE 10 EENEG 33 EDISON AY eee tinted 32 Measure blood pressure sse1ns001110n 20 Measurements ccceeceeeeeeececeeeeeeeenenee 32 Vleit e 10 19 UE e EE 52 Muscle noise EE eege beer 23 Muscle nose filter 12 New exercise ECG CCAS tien sien E E E 14 New protocol Eege ee 61 New stage EE 62 pacemaker signal indicators 12 25 49 PCI GPGOM card wiciccccivcinsticvcctantsvictwecdes 68 PCMCIA CPCOM anneren 69 Ee 9 58 Precordial electrodes COOC e 15 Si Cl E 26 43 Automatically annnnaannnannnnannnnnennnneannn 58 Button EEN 11 Formats 2cccceccececcececeececeececeeeeeesaeees 44 Drotocol 16 59 Selection asasonsesoenennennrrennnnrrorrnnerrennn 49 E e EE E EEEE AA E 51 FOOCOL aana 9 16 58 De la 53 OR e 31 33 Rate pressure Product ccseeeeeeeeee 37 Real time monitor 10 14 19 23 Record Exercise EG G EE 13 Recorder DIR 80012335 Ver D CONNECTION cee eeeeeecceeceeeeeseeeeeeeeeeees 54 Maintaining sceeceeeeeeeeeeeeeeeeseeeeeens 45 UMS seeren aT 54 HE e E 54 Recover Test after Crash cccccceceesseseeceeeee
50. e frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m DIR 80012335 Ver D 75 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Recommended separation distances between portable and mobile RF communications equipment and the Welch Allyn CardioPerfect Pro Cardiograph The Welch Allyn CardioPerfect Pro Cardiograph is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the Welch Allyn CardioPerfect Pro Cardiograph can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the Welch Allyn CardioPerfect Pro Cardiograph as recommended below according to the maximum output power of the communications equipment Separation distance according to frequency of transmitter Rated maximum A output power of transmitter 150 KHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer NOTE 1 Ar 80 MHz and 800 MHz the separation distance for the higher frequency range applies NOTE 2 These guidelines may not apply in all
51. ead groups Favorites UI af At AE WI V2eVaVa VE VE DIR 80012335 Ver D 19 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To select a different chart speed for the view e Inthe Overview area above the ECG traces select a value mm sec from the drop down list The new speed is immediately displayed To select a different sensitivity for the view e Inthe Overview area point to Sensitivity and select a value mm mvV from the drop down list The new sensitivity is immediately displayed Note The options above are also available from the shortcut menu 2 3 2 Measure blood pressure You can measure the patient s blood pressure during the recording in two ways e Manually you press the blood pressure button yourself measure the blood pressure and enter the values e According to protocol the blood pressure is measured according to a protocol defined in the protocol editor or a default protocol Automatic The Automatic protocol initiates a blood pressure measurement on every load change A blood pressure protocol can either initiate the blood pressure measurement at predefined intervals or by following the exercise protocol for more information see page 59 You select the blood pressure method when you create a new exercise ECG Whether blood pressure values must be entered manually or are measured and saved automatically depends on the type of Blood pressure device tha
52. eaning the Patient cables and PC mtert acecables 45 6 3 Replace the battery of erecorder 45 T CUSTOMIZING THE EXERCISE ECG MODULE ce eeeeee es 48 7 1 Exercise ECG settings General tab 48 7 2 Exercise ECG settings Viewing ab 49 7 3 Exercise ECG settings Printing ab 51 7 4 Exercise ECG settings Monitor ab 52 7 5 Exercise ECG settings Devices Lab 53 7 6 Exercise ECG settings Recorder ab 54 7 7 Exercise ECG settings Summary ab 55 8 CUSTOMIZE EXERCISE PROTOCOLS 0 ccc cecesceeeecesseceseeeeseeeeseens 58 8 1 Protocols phases and stages cccceecccccseeeeceeeceeeeeeeeeaeeeeeeeeeeeeeeesseeeeeeeesseneeeeeeeas 58 8 2 Exercise Protocols overvieW ccceccecceceececeeeeeceeeeeeeceeeeeeeeeeeeeeeeneseeeeenenaesesennenaesenes 58 8 3 Blood pressure and Printer Protocols cccccccccsseseceeceeeeeeeeeeeeeseeeeeeeeeeeeeeeseeeeeenas 59 8 4 Protocol editor WINGOW ceccecceccecceeceeceeceeeneceeeneeneeceeceeceeeeceeseeneeseeseeseeseeeeeseesaeeaes 60 85 EE ed ele Rn teen EE 61 66 VV ONKINIG WIT Sta CS i a E memessaat asso sceeeeonatensseee 62 9 TROUBLESHOOTING cece e cece cece cece ENER RRE EN ENER KREE KEEN EN ENEE EN KN 63 9 1 TEST e E 63 92 Troubleshooting E 63 93 Techical UPOO WEE 64 10 BEFORE INSTALLING THE EXERCISE ECG SOFTWARE 65 10 1 UC O a E E E 65 11 INSTALLING THE EXERCISE ECG MODULE ess KEN KN RK KEEN ENN 66 11 1 Connecting the RS23
53. ed Use the MDX4 option for an MD recorder at 300 600 Hz or 1200 Hz Use the MDXN1 for a Pro recorder The sampling frequency of the recorder 300 600 or 1200 Hz The frequency that is filtered by the AC mains filter You can choose between 50 and 60 Hz The communication port of the PC to which the recorder is connected This can be a CPCOM PCI card a CPCOM ISA card a CPCOM PCMCIA card or an USB port If you use a PCI card or USB with an analog port select the function of the analog output here You can use the output to control an ergometer or to transmit the ECG signal If you set the function of the analog output to transmitting the ECG signal select the channel from which the ECG signal is taken here This option disables the display of the message Switch recorder off after a test has been completed If a Welch Allyn CardioPerfect Pro recorder with USB connection is used this option should be off unchecked This option is only available for the PRO MDXN1 recorder With this option you can enable or disable the displaying of a low battery warning in the monitor In this field you can specify the remaining battery time at which the monitor should display the low battery warning 54 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 7 7 Exercise ECG settings Summary tab In the summary tab of the Exercise ECG settings the contents of the Summary report can be adjusted see View
54. ed electrode gel make sure that the cables and the non disposable electrodes are cleaned regularly Otherwise the gel may build up on the wires Clean the cables and the non disposable electrodes with a soft cloth moistened with a recommended disinfectant or cleaning agent Cleaning cables patient cables plugs and power cords should be kept clean using lukewarm soapy water or a neutral cleaner Disinfecting the cables use chemical disinfectants containing ethanol 70 80 propanol 70 80 or aldehydes 2 4 Do not Clean the patient cable with pure alcohol Pure alcohol can cause the plastic to become brittle and may cause the cable to fail prematurely Caution Do not Autoclave the cable or use ultrasonic cleaners Do not Immerse the patient cable Do not Wet the connectors 6 3 Replace the battery of the recorder 6 3 1 Welch Allyn CardioPerfect MD recorders The Welch Allyn CardioPerfect MD recorders get their power from a 9V alkaline battery or optionally from an AC mains adapter If a 9V battery is used you need to replace it when the power indicator light becomes red instead of green Do not use the recorder when the power indicator led is red DIR 80012335 Ver D 45 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To replace the battery of Welch Allyn CardioPerfect MD models The battery compartment is located at the bottom of the unit Place your fingers in the tw
55. eees 63 Reie E 58 EE 50 62 Reference Complex 10 Eed dE 32 Reference Homt 32 Rl RE 48 Replace baten 45 RPP EEN See Rate Pressure Product RS232 Unilink 0 0 0 eeeeeceeeeeeeeeeees 65 CONNEC EN 66 Selections DENE dees 49 SEIN 20 SNOW bacer 49 e lie 31 36 Brei E 37 Egeter 20 28 Bi 48 Speed elevation cccccccssssseseeceeeeeeeees 53 POG EE 23 ST CGalculatnon 48 Copy measurements o nnnooaannaan 38 Elevation or depnreseion 13 Maximum Ievel 35 e de c RE E T 48 Poi E 13 Reference Homt 36 EED e EIA E eee 37 UK e EEN 13 DEn E 31 37 49 Trend EE 36 Value s aaceciorampasacedsmnsaeuctesenemeuesawmeaaeen 31 ST HR view 39 ST SlOPE ob 13 STAGES eege 9 58 59 Create new 62 RE 62 a IEN 62 Slan DUO EE 19 Stop test button EEN 19 Summary C stomize report 55 RE EE 55 Ee EE 56 EEN 30 Target heart rale 16 26 27 Treadmill Adjust speed elevation n00nn00nnnnaan 23 POLOO EE 59 Be E EE 13 82 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Ee E PTE IE N E E I E ee 12 UA 36 Bi Ile sts nrc ges asec sea ese ce eet sentence 65 REN 14 65 66 View Exercise EG G raciensdicccuvanesteavestveeawaasetues 28 Interpretation history cccceeeeeeees 41 DIR 80012335 Ver D VIC WING TaD E 49 WOKO AO D 12 EE e E 24 Default proiocol 53 EE teuer 36 View changes snenneneeneneneennnnnenen 34 LOO EE 28 83 83
56. elch Allyn All rights are reserved The software is protected by United States of America copyright laws and international treaty provisions applicable worldwide Under such laws the licensee is entitled to use the copy of the software provided on the original distribution medium The software may not be copied decompiled reverse engineered disassembled or otherwise reduced to human perceivable form This is not a sale of the software or any copy of the software all right title and ownership of the software remains with Welch Allyn The information contained in this manual is subject to change without notice All changes will be in compliance with regulations governing manufacture of medical equipment User responsibility This product is designed to perform in conformity with the description thereof contained in this manual and accompanying labels and inserts when assembled operated maintained and repaired in accordance with the instructions provided A defective product should not be used Parts that are broken plainly worn missing or incomplete distorted or contaminated should be replaced immediately Should any repair or replacement become necessary we recommend that service be performed at the nearest approved service center The user of the product shall have the sole responsibility for any malfunction which results from improper use faulty maintenance improper repair damage or alteration by anyone other than Welch Allyn or thei
57. eration This manual contains specific information about the exercise ECG module of the Welch Allyn CardioPerfect Workstation For all general information about the workstation software please refer to the Workstation manual this describes Creating and editing Patient cards General information about printing For further information on installation and configuration or information on servicing please refer to the Installation manual and or the Service and Advanced Installation manual Intended use Using the optional ECG module and associated accessories the user can acquire view store and print ECG waveforms Indications Indications for electrocardiography range from routine screening of cardiac health in the physician office environment to directed diagnostic differentiation in a hospital cardiology department Contraindications and precautions The following contraindications are known for the recording of an exercise ECG e Recent onset of chest pain or a change in the pattern of pain to suggest unstable angina e Acute myocardial infarction within a week after its onset e The presence of congestive heart failure excessive hypertension or severe aortic stenosis in adults e Uncontrolled ventricular arrhythmias e Known critical stenosis of left main or proximal coronary artery Ellestad MH Blohmavist CG Naughton JP Standards for adult exercise testing laboratories AHJ A 421A 30A Since the risk is not negligible t
58. erfect Exercise ECG Sometimes menus are gray This means that you cannot access that functionality at that particular point either because it is not available or because you are not authorized to use it Tool bar The tool bar contains buttons that give you easy access to the most common tasks in Welch Allyn CardioPerfect Search area The search area contains search and display functionality that lets you easily retrieve patients and tests In the search area you can find a patient see which tests were recorded for that patient and see the kind of tests that were recorded You can also create search patterns an easy way of finding information that you need frequently Workspace The workspace is the core part of Welch Allyn CardioPerfect Exercise ECG It displays the exercise ECG in various formats These formats that are also called views are each displayed on a separate tab in the Welch Allyn CardioPerfect Exercise ECG workspace The workspace is the place where you record view compare and measure exercise ECGs DIR 80012335 Ver D 8 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Shortcut In the workspace you can use shortcut menus to access the most common menu tasks You can access these tasks by clicking on the workspace with your right mouse button Shortcut menus only contain those tasks that can be performed in one specific test or part of that test As a result shortcut menus look different
59. erfect Exercise ECG you can move between identical points in time in the Averages view and the Full disclosure view The point that you select in the Averages view is displayed in the Full disclosure view To compare an average with its full disclosure data DIR 80012335 Ver D 32 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 1 Inthe Averages view click your right mouse button on the average that you want to compare 2 Inthe shortcut menu click Go to Full disclosure The Full disclosure view opens at the same point in the recording that you clicked in the Average view To switch from full disclosure data to averages 1 Inthe Full disclosure view click your right mouse button on the point that you want to see in the Averages view 2 Inthe shortcut menu click Go to Averages The Averages view opens and displays the complex that is closest to the point you selected in the Full disclosure view 3 4 6 Change QRS onset and QRS end markers Welch Allyn CardioPerfect Exercise ECG automatically inserts markers at the QRS onset Q QRS end J and J of an average complex You can change the position of these markers so that they are more to your liking in the Averages view The J marker follows the QRS end marker according to the set value for the reference point value in the Exercise ECG settings To change the QRS onset and QRS end markers 1 Inthe Averages view right click on the view
60. escription of the problem e The serial number of your product if applicable e The complete name address and phone number of your facility e For out of warranty repairs or spare parts orders a purchase order or credit card number e For parts order the required spare or replacement part number s Repairs If your product requires warranty extended warranty or non warranty repair service please call first the nearest Welch Allyn Technical Support Center A representative will assist you troubleshooting the problem and will make every effort to solve it over the phone avoiding potential unnecessary return In case the return cannot be avoided the representative will record all necessary information and will provide a Return Material Authorization RMA number as well as the appropriate return address A Return Material Authorization RMA number must be obtained prior to any return Note Welch Allyn does not accept returned products without an RMA Packing Instructions If you have to return goods for service follow these recommended packing instructions e Remove all hoses cables sensors power cords and ancillary products as appropriate before packing unless you suspect they are associated with the problem e Wherever possible use the original shipping carton and packing materials e Include a packing list and the Welch Allyn Return Material Authorization RMA number It is recommended that all returned goods be insured Cla
61. et heart rate O Post tes O Reasons For Stress Test Referring physician O Target workload O Exercise ap O Attending physician Maximum heart rate O Recove TEC Test results O Ordering physician Maximum workload O Duratior pressure O Location Maximum blood pressure O Duratior Insert custom logo Interpretation Highest ST O Duratior Include html file Device Test Duration O Duratior SEA z sao M Protocol C Pre test duration O Stage te Recollect O Registered company gt oO T itle DEES E O Application Recorded C Pharmacological Stress Agents Let O Cardiac Risk Factors C Functional v O Stress Test Type C Symptoms ses Se i O Baseline or Resting ECG Cl up Respo EE Cl Pharmacological Indications O BF Respor O Reasons For Stress Test O Reasons k Next we EE Note Which fields are displayed is optional the location of the fields is fixed 3 Click Next 4 Enter a file name for the new Summary report template Click Next If the file name already exists a warning will appear You can overwrite the old file or select cancel and add a new name 5 Select Yes to change your default summary report to the generated template Select No to leave the settings as previous The generated template will be available for subsequent use 6 Click the Finish button DIR 80012335 Ver D 56 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual The window will close and the now available in
62. formation in the summary report will be shown in the checkboxes Editing existing templates It is possible to edit an existing template a htm file by hand by using Notepad or a html editor For more information see the section on customizing txt files in the Workstation manual Note Do not overwrite the built in default summary file xecg_summary_std htm as this file may be overwritten when updating the software DIR 80012335 Ver D 57 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 8 Customize exercise protocols 8 1 Protocols phases and stages A protocol is a set of predefined rules and conventions of how a test is structured With the Protocol editor you can create protocols for e The structure of a treadmill test e The structure of an ergometer test e The points in time at which the blood pressure is automatically measured or the points in time when a Blood Pressure prompt will appear e The points in time at which a copy of the test is automatically printed The protocol editor is available from the Tools menu when an Exercise ECG is displayed or when Exercise ECG is opened from the File Open menu Phases Each protocol contains four phases e Pre test this phase is normally used to allow the patient to get accustomed to the exercise device and to record reference resting ECGs e Exercise during this phase the exercise portion test takes place e Recovery during this phase t
63. g Angina Index Reason for terminating test used in determining Angina Index Stess Test type if not a standard Exercise test i e Pharmacological or other then no DTS calculation DIR 80012335 Ver D 79 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 1 Mark DB Hlatky MA Harrell FE Jr Lee KL Califf RM Pryor DB Exercise treadmill score for predicting prognosis in coronary artery disease Ann Intern Med 1987 106 793 800 2 Mark DB Shaw L Harrell FE Jr et al Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease N Engl J Med 1991 325 849 53 3 Gibbons RJ et al ACC AHA 2002 Guideline Update for Exercise Testing American College of Cardiology Foundation and the American Heart Association 2002 15 2 Mets Value The METS value is interpolated It gradually changes and attains the value predicted by the load to METS formula after the load change occurs on your stress device 2 minutes on a treadmill 40 seconds on an ergometer DIR 80012335 Ver D 80 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Index E EE 10 28 29 35 49 id GE 26 44 KEE 28 29 35 48 il EEEE EIE E A 26 44 Action menu 18 21 23 29 32 34 Add comment 21 Arrhythmia 0ccceee 7 11 33 34 49 Automatic Blood PreSSUre ccceeeseeeeees 58 59 60 PNUD E 44 51 52 58 59 Aver
64. g the stage intervals defined for that protocol 2 If you select Follow Exercise protocol mode the Blood pressure action prompt or automatic BP start or printout will occur at a fixed time after the start of each stage All stage related fields and menus will then be disabled Any information in the pane above the mode selector will be disregarded 3 You can select a different mode independent or Follow Exercise protocol for each phase 8 4 Protocol editor window Use the Protocol editor window to create and edit protocols and their stages BER File Help Protocols Treadmill a Stage Name Duration ger Bruce 1 180 Naughton Bruce 2 180 New protocol Bruce 3 180 1 1 Ellestad Bruce 4 180 1 Modified Bruce Bruce 5 180 1 Balke y Bruce 6 180 1 Ergometer Bruce 7 Forever 1 20 Watt min D Watt 3 min Asperen New protocol 10 Watt min 25 Watts min Asperen C Constant pulse rats Blood pressure New BP protocol Printer New protocol Pretest Exercise Recovery Posttest Maximum speed 20 0 km h Maximum elevation 25 Protocol list The left hand pane of the Protocol editor window contains a list with all existing protocols These protocols are divided into treadmill protocols ergometer protocols blood pressure protocols and printer protocols Protocol workspace The right hand pane of the Protocol editor window is where you add edit and delete stages The workspace is
65. h 10 0 82 110 67 50 17 50 42 02 30 1 2 7 kmh 10 0 80 120 50 83 33 KH 8 02 45 1 2 7 kmh 10 0 ve 106 42 58 17 58 17 03 00 1 2 7 km h 10 0 80 116 42 42 0 42 25 03 15x 2 4 0 kmh 12 0 84 a E 25 33 0 33 17 03 30 2 4 0 km h 12 0 92 116 50 25 25 33 33 03 454 2 4 0 kmh 12 0 93 123 58 42 8 50 33 04 00 2 4 0 kmh 12 0 95 120 42 33 8 42 25 04 154 2 4 0 kmh 12 0 ER 114 42 25 8 33 17 04 304 2 4 0 kmh 12 0 95 117 42 42 D 42 8 04 458 2 4 0 km h 12 0 97 113 33 42 8 42 17 05 00 2 4 0 kmh 12 0 95 117 50 42 D 42 25 05 15x 2 4 0 km h 12 0 94 110 33 42 8 42 17 05 304 2 4 0 kmh 12 0 94 106 33 33 D 33 8 05 45 2 4 0 kmh 12 0 99 103 33 25 8 25 25 06 00x 2 4 0 kmh 12 0 96 96 25 0 25 8 17 06 154 3 5 4 km h 14 0 104 96 25 8 17 17 17 06 30 3 5 4 kmh 14 0 114 103 33 0 25 17 25 06 454 3 5 4 kmh 14 0 115 103 33 8 25 17 Set O7 00 3 5 4 kmh 14 0 116 100 25 17 D 17 17 te 3 5 4 kmh 14 0 116 107 33 42 83 8 58 Fam 3 SA kee 14 D r 120 a2 17 n A D 17 of 4 gt Note To make the display easier to read select colored bands from the right click menu The ST table view shows points in the recording together with the stage workload or speed elevation blood pressure heart rate rate pressure product the PQ and the QRS duration and the ST values for various leads To select the points in time for which this information is displayed e Inthe Selection list click
66. he appropriate filter to enable it The filter option will be marked with a check To disable the filter simply select it again Note When you enable a filter from the Action menu it will also affect the full disclosure and 4x3 or 2x6 view Note You can tell which filters are enabled in the portion of the full disclosure 2x6 and 4x3 views by looking at the frequency response displayed If the baseline filter is enabled the lower frequency will be 0 5Hz If the muscle filter is enabled the upper frequency will be either 25 or 35 Hz depending on the settings DIR 80012335 Ver D 35 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual lf accurate ST segment contours are required for ECGs do not use the 0 5 Hz baseline wander filter This filter suppresses baseline wander to the extent that it may alter the ST segment Instead configure your cardiograph to operate without the baseline wander filter Regardless of the filter used the rhythm characteristics of the ECG are accurately recorded and do not affect the interpretation algorithm 3 7 Work with the Trends view Trends view Workload E i Ge i 0 pajara 0 2 4 6 6101214 0 2 4 6 6101214 02 4 6 6101214 0246 610121 H aVL V2 HR VES D 10 D 4 4 4 2 2 i 2 O caina e m fl Eeer W Ge ee 2 2 i 2 5 4 D 4 g 4 i jz e D Hee 02 4 6 6 101214 02 46 6101214 02 4 6 6 101214 02 4 6 8101214 02 46 810121 il aVF V3 V6 BP RPP 5 5 5 5 3
67. he patient is allowed to recover from the test monitoring of the patient continues e Post test the phase in which any post test activity measurements take place Monitoring of the patient continues A protocol does not necessarily need to use all four phases Many protocols use only the Exercise and the Recovery phases Regardless of the phases selected every patient heartbeat is recorded from the beginning of the test until the end Stages Each phase in a protocol consists of a number of stages There is no limit as to the number of stages that make up a phase 8 2 Exercise Protocols overview All commands which allow editing or creating a protocol are available through right mouse button menus There are four kinds of protocols e Ergometer protocols e Treadmill protocols e Blood pressure protocols e Printer protocols Normally you will create the exercise device ergometer or treadmill protocol first and then ensure that the blood pressure and printer protocols are consistent with the exercise device protocol The following sections give an overview of the exercise device protocols There are special variables that you can use to make the exercise device protocol quite sophisticated and flexible These variables are also defined in the following sections 8 2 1 Ergometer protocols An ergometer protocol is a collection of stages that together define the ergometer test For each stage in an ergometer protocol you need to specify
68. he right hand pane shows the content of each interpretation plus the interpretation date time and the person who modified the interpretation Interpretation history Date Edited by 4 11 2001 1210 45 Uriknown 11 2 2 10 45 1 11 2001 12 11 05 1 11 2001 12 11 12 Sport test Expected workload met Expected maximum heartrate met Normal test 2 Click on a date to view an interpretation 4 3 Clean up full disclosure An exercise ECG uses a lot of space on your computer To reduce the used space you can delete some or all leads from the full disclosure Important When you remove leads from the full disclosure you cannot use the 2x6 or 4x3 view or the 2x6 or 4x3 report formats any longer DIR 80012335 Ver D 41 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To delete some or all leads from the full disclosure 1 Inthe Tools menu click Full disclosure clean up Full Disclosure Cleanup EN E Remove leads from the full disclosure Remove C Delete all leads Delete specific leads Keep Lat OK Cancel Help 2 Inthe Full disclosure cleanup window select whether you want to delete all leads or specific leads 3 If you selected specific leads click on the lead that you want to delete and use the arrow button to move that lead to the right hand column 4 Click OK DIR 80012335 Ver D 42 83 Welch Allyn CardioPerfect Wor
69. he staff of the exercise laboratory should be trained in cardiopulmonary resuscitation A physician should also be present at all exercise tests in patients with suspected or known heart disease A defibrillator and drugs should be immediately available Due to summation of leakage currents it is possibly hazardous to connect several devices to the patient simultaneously DIR 80012335 Ver D 7 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 1 Getting started 1 1 The Welch Allyn CardioPerfect Exercise ECG window This section will guide you around the various parts of Welch Allyn CardioPerfect Exercise Title bar alil x Potent BUER etpecice ER IR Beroki 73 Someire ri Preview tend Ee sf X fubend Tec F EL Zeng Q Zoom ng inepe he Cot ren a Penis OL Search Er Hall H akant Test date CORVO Mella Jorram am Fh FT 191 Sa WAH AN Search Toolbar Menu bar Workspace S Bee G dee Bee eessen Geen ee Gees Sa Lal Oz tes UNG daie mass S Wi Sage T de max vv ov ES E Fc KH D j Shortcut menu 7 i d L L L d d 8 Status bar Title bar The title bar displays the name of the program The title bar contains three buttons that you can use to maximize minimize and close the Workstation window Menu bar Each menu in the menu bar contains a number of tasks that you can perform with Welch Allyn CardioP
70. hospital environment Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment If the user of the Welch Allyn CardioPerfect Pro Cardiograph requires continued operation during power mains interruptions it is recommended that the Welch Allyn CardioPerfect Pro Cardiograph be powered from an uninterruptible power supply or a battery Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment 74 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Electromagnetic Immunity The Welch Allyn CardioPerfect Pro Cardiograph is intended for use in the electromagnetic environment specified below The customer or the user of the Welch Allyn CardioPerfect Pro Cardiograph should assure that it is used in such an environment Immunity test IEC 60601 Compliance level Electromagnetic environment test level guidance Conducted RF 3 Vrms Portable and mobile RF communications IEC 61000 4 6 150 kHz to 80 MHz equipment should be used no closer to any part of the Welch Allyn CardioPerfect Pro Cardiograph including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance Al EZ a i WMP Radiated RF 3 V m IEC 61
71. ically After you have connected the Interface and installed the driver you need to configure Welch Allyn CardioPerfect Workstation so that it uses the USB port To configure Welch Allyn CardioPerfect Workstation 1 Start Welch Allyn CardioPerfect Workstation and log in as Administrator 2 Inthe File menu click Settings click Exercise ECG and click on the Recorder tab 3 From the Port list select Unilink USB This is the default setting after a new installation 11 3 R wave triggering Interface capabilities The Welch Allyn PRO Link interface cable provides both a TTL and an Analog representation of the QRS complex e The analog output rendered on port 1 is an approximate representation of the signal on lead Il The analog signal output is dependent on the input stimulus and uses a 1 V mV conversion Stimulus ranges from 0 volts to 5 volts peak to peak e The TTL output rendered on port 2 is a digital signal 5V amplitude with a duration of 120ms It is triggered by the rising edge of the R wave This can by used to interface to devices for R wave triggering The delay between R wave peak and TTL output pulse is typically between 30 and 50 ms lt is the responsibility of the user to ensure the compatibility of the output with their device and its intended use This output is not suitable for cardioversion synchronization J N warning p y DIR 80012335 Ver D 67 83 Welch Allyn CardioPerfect Workstation Exercise ECG Mod
72. ims for loss or damage to the product must be initiated by the sender DIR 80012335 Ver D 3 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Limited Warranty Statement Welch Allyn Inc warrants that the Welch Allyn CardioPerfect Workstation computer based product you have purchased meets the labeled specifications of the Product and will be free from defects in materials and workmanship that occur within 1 year after the date of purchase Accessories used with the Product are warranted for 90 days after the date of purchase The date of purchase is 1 the date specified in our records if you purchased the Product directly from us 2 the date specified in the warranty registration card that we ask you to send to us or 3 if you don t return the warranty registration card 120 days after the date on which the Product was sold to the dealer from whom you bought the Product as documented in our records This warranty does not cover damage caused by 1 handling during shipping 2 use or maintenance contrary to labeled instructions 3 alteration or repair by anyone not authorized by Welch Allyn and 4 accidents lf a Product or accessory covered by this warranty is determined to be defective because of defective materials components or workmanship and the warranty claim is made within the warranty period described above Welch Allyn will at its discretion repair or replace the defective Product or acces
73. ing an exercise ECG page 28 The summary tab of the Exercise ECG settings shows which information is currently displayed in the Summary report view To change the Summary report you can select a previously created template or add a new template BER ae Exercise ECG I 1 E General Viewing Printing Monitor Devices Recorder Summary General Select the template to use for the XECG Summary page Browse ECG Add new template ni The selected template contains the following information Test information Observations C Pharmacological Stress Agents IST Changes O Cardiac Risk Factors O Functional Capacity T O Stress Test Type C Symptoms During Stress O Baseline or Resting ECG O HR Response to Exercise C Pharmacological Indications O EF Response to Exercise af O Reasons For Stress Test O Reasons for Termination Exercise ECG Spirometry Ambulatory blood Test results oo Insert custom logo Cl Include html file SE O Current user re O Registered owner O Registered company O Title C pplication Recorded EE Cancel Apply Help Select the template to use for the XECG Summary page Select the preferred template with the Browse button The information available in the template is shown below Add new template With this option you can customize the contents of the summary report Clicking on the Add new template button will open the XECG Su
74. ke some time for the copy to be printed especially with slow printers The Print format that is selected in the settings will be printed Tip for printing during recording If you frequently print during recording you might want to consider Automatic printing With Automatic printing you can configure Welch Allyn CardioPerfect Exercise ECG to print at set times during the recording 2 3 12 Target heart rate The Real time monitor displays the current Heart rate and the target Heart rate during recording in the overview area HR 5 37 of 203 The target Heart rate can be adjusted at the start of a new exercise ECG You can either set the target Heart rate directly or set it as a percentage of the predicted maximum Heart rate By default the target Heart rate value is set as 85 of the predicted maximum HR The predicted maximum Heart rate is calculated with the following formula Predicted Maxium Heart Rate 220 patient s age in years Welch Allyn CardioPerfect displays the Predicted Maximum Heart Rate next to the Target Heart rate field when the new exercise dialog window is opened red Mav HA Target heartrate 185 bpm 85 x 157 To set the target Heart rate Enter a value in the Target Heart rate field To set the target Heart rate as a percentage of the maximum Heart rate Enter a percentage in the corresponding field DIR 80012335 Ver D 26 83 Welch Allyn CardioPerfect Workstation Exercise ECG Modul
75. kstation Exercise ECG Module User Manual 5 Printing an exercise ECG This section holds a brief outline on printing an exercise ECG for a more elaborate description on printing with the Welch Allyn CardioPerfect software please refer to the Workstation manual 5 1 Print an exercise ECG You can make a printout of each view in the exercise ECG Making a printout Print Ctrl P T Prink Preview Print selected Formats Ctrl Alt F Click on the Print button in the toolbar or select Print from the File menu Properties Copies Number of copies i a al W Collate RRE Page range Ce All pages Curent page res Full Disclosure 10 mms Full Disclosure 25 mm Full Disclosure 5 mms Heartrate Select the report you want to print There are two ways of manually printing an ECG e Single view Welch Allyn CardioPerfect prints the view currently showing in the review window e Selected formats Welch Allyn CardioPerfect prints a number of reports simultaneously The views which are printed are selected in File Settings DIR 80012335 Ver D 43 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 5 1 1 Print formats The exercise ECG Module can print the following reports 2x6 Sequential or Simultaneous 4x3 1R Sequential or Simultaneous Averages 2 pages Cabrera Averages 2 pages Averages Full disclosure 25 mm s Full disclosure 10 mm s Full disclosure 5 mm s
76. lso printed when you click Print selected formats in the ECG window Full disclosure From this list you can select the default lead that appears in lead the Full disclosure view and print Grid From this list you can select the grid style used for the printouts after recording is completed The grid styles for printing during test and printing after recording are independent and must be selected separately Print after recording If this option checkbox is selected the ECG is automatically printed when the recording has finished Welch Allyn CardioPerfect Exercise ECG prints the formats that you selected in the Default report formats area 7 3 1 Set selected formats This selection defines which report formats will be printed after recording or when you click the Print selected formats button To print a view of an ECG you need to select its corresponding format in the ECG settings To set the printing options 1 Inthe File menu click Settings The Settings dialog box is displayed 2 Click Exercise ECG and click on the Printing tab 3 Inthe Printing tab a To enable automatic printing click Print after recording b To select formats in which the ECG should be printed select one or more default report templates 4 Click OK to save your changes 7 4 Exercise ECG settings Monitor tab Use the Monitor tab to configure recording settings The Monitor tab contains the following options Predefined comments Here you ca
77. lyn CardioPerfect Workstation Exercise ECG Module User Manual 2 2 1 Place electrodes on the patient When you connect the electrodes to the patient make sure that the electrodes and their connectors also the RL N electrode do not contact other conducting parts including earth Connect the electrodes in the following positions V4 V5 V6 C4 8 l C6 Le i Ne A A ks l i i i Fourth intercostal space at the right border of the sternum Fourth intercostal space at the left border of the sternum Midway between locations V2 and V4 At the left mid clavicular line in the fifth intercostal space At the left anterior axillary line on the same horizontal level as V5 VA C5 At the left midaxillary line on the same horizontal level as V4 V6 C6 and V5 On the right below the clavicle or above the crista scapulae oR On the left below the clavicle or above the crista scapulae Right just above the spina iliaca superior posterior RL ege N or the crista iliaca LL Left just above the spina iliaca superior posterior F or the crista iliaca 2 2 2 Select or create a new patient See the Welch Allyn CardioPerfect Workstation user manual for detailed information on selecting or creating a new patient 2 2 3 Create a new exercise ECG Before you can record an exercise ECG you first need to create a new ECG in Welch Allyn CardioPerfect When you do this you will be able to set the target hear
78. mmary template wizard The selected template contains the following information Displays the sections that are selected and will display in the summary report DIR 80012335 Ver D 55 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual To customize a new summary report template 1 Click on the Add new template button in the Exercise ECG settings Summary tab 2 Select which fields should be included in the Summary report The options button will change with the option selected above the button if no options are available for the selected item the button is disabled For example If Insert custom logo is selected the button changes to Insert custom logo click on the button and you can browse for your own custom logo If Maximum heart rate is selected you can select the settings for the Maximum heart rate with the options button BE Modules ae Exercise ECG E General Viewing Printing Monitor Devices Recorder Summary General Select the template to use for the XECG Summary page xecg_summary bim Browse ECG i ae x gi eegener contains the followir This wizard will quide you though the creation of a summary page template ade a C Pharmacological Stress Agents O Cardiac Risk Factors Step 1 T O Stress Test Type Select which items you would like to have included in the template GE O Baseline or Resting ECG D Pharmacological Indications Technician Targ
79. n define pre entered comments that can be used during the recording of the ECG They become available in the Comment window Use event dispatcher for external applications Use this option to start the event dispatcher during monitoring The event dispatcher can be used to interface to an external application such as a gas exchange system This can only be done if that application uses a compatible interface DIR 80012335 Ver D 52 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 7 5 Exercise ECG settings Devices tab Use the Devices tab to select and configure the exercise devices Important In order to make changes in this section you must have Windows Administration privileges These privileges are set outside of CardioPerfect application and are specific to each computer If a section is grayed out you do not have the necessary privileges and should consult your IT administrator The Devices tab contains the following options Exercise device Type The type of exercise device that is used during the exercise ECG Device Select your exercise device from the pull down list if your exercise device is not in the list or if you do not want your device to be controlled by the CardioPerfect workstation then select manual Connected to From this list you can select the COM port to which the exercise device is connected This is only possible when the selected device has a serial or RS232
80. nes IEC 61000 4 11 Power frequency 50 60 Hz magnetic field IEC 61000 4 8 NOTE DIR 80012335 Ver D CardioPerfect Workstation Exercise ECG Module User Manual Electromagnetic Immunity The Welch Allyn CardioPerfect Pro Cardiograph is intended for use in the electromagnetic environment specified below The customer or the user of the Welch Allyn CardioPerfect Pro Cardiograph should assure that it is used in such an environment Immunity test IEC 60601 Compliance level Electromagnetic environment test level guidance 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV common mode lt 5 Ur gt 95 dip in Ur for 0 5 cycle 40 Ur 60 dip in Ur for 5 cycles 70 Ur 30 dip in Ur for 25 cycles lt 5 U gt 95 dip in Ur for 5 sec 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV common mode lt 5 U gt 95 dip in Ur for 0 5 cycle 40 Ur 60 dip in Ur for 5 cycles 70 Ur 30 dip in Ur for 25 cycles lt 5 Ur gt 95 dip in Ur for 5 sec Ur is the AC mains voltage prior to application of the test level Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or
81. nes the Duke Treadmill Score adds significant prognostic information to the standard clinical data Besides improving diagnostic and prognostic accuracy scores eliminate physician bias and lessen the variability of decision making The Duke Treadmill Score is calculated as follows DTS Exercise timemin 5 ST segment deviationnm 4 Exercise angina index Angina index has a value of 0 for no exercise angina 1 for non limiting angina 2 for exercise limiting angina The Exercise time is originally measured in minutes of the Bruce protocol which can be derived from attained metabolic equivalent The resulting more universal version of this score translates the exercise duration which assumes the Bruce protocol from maximum attained METs making it applicable for any exercise protocol or device type for which METs can be calculated or measured Risk stratification based on the Duke score is estimated as Score Risk gt 5 Low risk 10 lt Score lt 5 Medium risk lt 10 High risk The Duke Treadmill Score DTS is shown in the Summary tab if selected in the Summary template under Test results See page 55 for more information Note The Duke Score is not applicable for pharmacological stress testing it is only applicable if the selected exercise device is physically used The Duke Score is not calculated if the Test type is not Exercise Input variables Symptoms during test used in determinin
82. ng you have to do is make sure the electrodes are placed correctly and switch on the recorder Welch Allyn CardioPerfect Exercise ECG takes care of recording adjusting the ergometer or treadmill making a number of measurements and calculations taking blood pressure readings and saving the recording To record an exercise ECG you need to follow these global steps Each step is explained in more detail on the following pages DIR 80012335 Ver D 13 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To record an exercise ECG 1 Place electrodes on the patient Important Because Welch Allyn CardioPerfect Exercise ECG is a 12 lead electrocardiograph all electrodes must be connected Proper skin preparation abrasion if necessary and proper electrodes are essential for a good signal quality 2 Inthe Workstation select or create a patient 3 Create a new exercise ECG The Real time monitor is displayed Depending on the ECG recorder used Welch Allyn CardioPerfect may ask you to switch on the recorder 4 If prompted switch on the recorder If a Welch Allyn CardioPerfect Pro recorder is used no message will appear the recorder will be switched on automatically The Real time monitor displays the ECG traces 5 Adjust the real time display to your requirements 6 Inthe Real time monitor wait until the signal is stabilized and click the Start button to start recording Welch Allyn CardioPerfect Exercise ECG
83. nt that it may alter the ST segment Instead configure your cardiograph to operate without the baseline wander filter DIR 80012335 Ver D 34 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Regardless of the filter used the rhythm characteristics of the ECG are accurately recorded and do not affect the interpretation algorithm 3 6 Work with the 2x6 and 4x3 view Summary Averages P D ckuug SE acd feel St table Heanate zt ae Deier 2x6 view The 2x6 view displays the 12 leads in two columns and six rows This is a convenient format for comparing leads at specific points in the test such as the end of stages the point where the maximum ST level the highest blood pressure or the highest workload were measured The view can be simultaneous or sequential selectable from the shortcut menu Summary Averages Ful Diockoue 26 Zei Trees ST table Hassel st a lee z D 1 Chee PtH Oi Okan AE F EE EE EE f D D D SE FEE ne 4x3 view The 4x3 view displays a 12 lead ECG strip The leads are shown in a 4x3 configuration with a rhythm strip at the bottom of the view The view can be simultaneous or sequential The rhythm lead can be set in the general XECG settings 3 6 1 Use filters When viewing the 2x6 or 4x3 view you can use two filters e Baseline filter e Muscle filter Both filter options can be found in the Action menu Select t
84. o move to the next phase or stage manually click the button that displays the name of the Next phase or stage Go EMIS a When you have reached the end of the test click the Stop test button to stop the test Welch Allyn CardioPerfect Exercise ECG will ask you to switch off the recorder Welch Allyn CardioPerfect Exercise ECG automatically saves the ECG Stop test In case of an emergency you can also use the Emergency stop bution or F12 to stop the test Welch Allyn CardioPerfect will immediately stop the exercise device The monitoring of the patient will continue and printouts can be made During the test you can Measure the blood pressure Capture an event Add a comment Turn pacemaker mode on or off Apply a baseline filter to filter out baseline wander Change the load Pause the protocol Print a report 2 3 1 Select how you want to view leads Once you have created a new exercise ECG the Real time monitor displays the ECG traces Before you start the actual recording you can select how you want to view the traces Welch Allyn CardioPerfect Exercise ECG offers different views different chart soeeds and different sensitivities To select a different view e Inthe View menu point to Monitor style and click a value You can choose between 3 6 or 12 simultaneous leads The new view is immediately displayed To arrange the leads in 3 lead and 6 lead views e Click on the tabs under the traces to display different l
85. o recesses of the battery compartment Remove the lid by squeezing it Unfasten and remove the battery Insert a new 9V alkaline battery Click the lid back into place So a DY After you have replaced the batteries let the Welch Allyn CardioPerfect software run in Monitor mode for a few seconds This verifies that the recorder functions properly and the optical cable is undamaged It is strictly forbidden to use a non medical approved 9V AC Warning mains adapter because of patient safety Please observe the following We advise you not to use rechargeable batteries because their Caution voltage can drop steeply without warning This can stop the ECG monitoring during a test 6 3 2 Welch Allyn CardioPerfect Pro recorders The Welch Allyn CardioPerfect Pro recorders get their power either via a USB connection or via a rechargeable battery If a USB Prolink is used the Welch Allyn CardioPerfect Pro recorder gets its power from the USB port of the computer the battery pack supplied with the recorder is then a so called dummy If the recorder is connected to the computer by means of an RS232 Prolink the power is supplied by a battery pack in the bottom of the recorder this battery pack needs to be recharged charger is supplied with the system when the indicator turns red lf the recorder is powered from the USB port but also has a battery pack this battery will be drained slowly as well and if the Caution recorder detects
86. of the selection e Point to the binoculars icon A list with times and events is displayed If you click on one of the events you are automatically taken to that point in the recording Tips for making selections e You can configure the items in the Selection list in the exercise ECG settings please refer to page 51 to read how to do this 3 2 4 Copy into other applications A bitmap of the Averages view the Full Disclosure view the 2x6 and 4x3 view and the text of the ST table can be copied into other MS windows applications Select the view you want to use and right click on the view and select copy You can now paste the bitmap for the graphs or the text for the ST table into other MS windows applications 3 2 5 Post test editing of tests The information added in the New Exercise ECG dialog is editable as long as the interpretation is not yet confirmed To edit an unconfirmed test e Select Edit test from the Action menu or click on the Sa Edit test button in the Toolbar Select the Test Information Test Observation or Physicians tab to edit the test information Click save to save the information with the test DIR 80012335 Ver D 29 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual AA Work with the Summary view Summary view The summary view displays a report with the most important information measurements and results The default summary view can be adjusted to your own prefe
87. og will appear Change monitor style to 12 leads Change monitor style to 6 leads Change monitor style to 3 leads how previous lead group in 3 or 6 lead monitor how next lead group in 3 or 6 lead monitor et the ST reference point to J 0 et the ST reference point to J 20 et the ST reference point to J 40 et the ST reference point to J 60 Set the ST reference point to J 80 Set the ST reference point to Dynamic nserts a user event in the recording Esc Exit the Real time monitor cannot exit when recording is active DIR 80012335 Ver D 77 83 Welch Allyn CardioPerfect Workstation Viewing Key CTRL DOWN CTRLJ UP CTRL Z GIRA CTRL H CT RL R ALT 0 ALT 2 ALT 4 ALT 6 ALT 8 Exercise ECG Module User Manual Zooms out Zooms in Reset zooming Opens the Interpretation window Opens the Interpretation History Activates the refresh functionality which clears all user made measuremenis Set the ST reference point to J 0 Set the ST reference point to J 20 et the ST reference point to J 40 et the ST reference point to J 60 Set the ST reference point to J 80 ALT D Set the ST reference point to Dynamic DIR 80012335 Ver D 78 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 15 Additional information 15 1 Duke Treadmill score The Duke Treadmill Score DTS was introduced by DB Mark cs According to the ACC AHA Practice Guideli
88. omer or the user of the Welch Allyn CardioPerfect Pro Cardiograph should assure that it is used in such an environment Emissions test Compliance Electromagnetic environment guidance RF emissions The Welch Allyn CardioPerfect Pro Cardiograph uses RF energy only for its internal function Therefore its RF emissions are very CISPR 11 low and are not likely to cause any interference in nearby electronic equipment RF emissions Class A The Welch Allyn CardioPerfect Pro Cardiograph is suitable for use in all establishments other than domestic and may be used CISPR 11 in domestic establishments and those directly connected to the BE ublic low voltage power supply network that supplies buildings Harmonic emissions Class A ee for ec ese idea the ican warning S heeded IEC 61000 3 2 WARNING This equipment system is intended for use by healthcare professionals only This equipment system may cause radio interference or may disrupt the operation of nearby Voltage fluctuations Complies equipment It may be necessary to take mitigation measures flicker emissions such as re orienting or relocating the Welch Allyn CardioPerfect Pro Cardiograph ro shielding the location IEC 61000 3 3 DIR 80012335 Ver D 73 83 WelchAllyn Electrostatic discharge ESD IEC 61000 4 2 Electrical fast transient burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and voltage variations on power supply input li
89. on a selection 3 8 1 Rate pressure product The rate pressure product gives information about the strain on the myocardial muscle It is calculated as follows DIR 80012335 Ver D 37 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual RPP Systolic blood pressure heart rate The RPP is listed in the Trends view in units of 100 bom mmHg 3 8 2 Copy ST measurements into other applications The ST table can be copied fully or partly into other MS windows applications Select a single measurement row with a left mouse click or select multiple rows with lt Ctrl gt left mouse click and or lt Shift gt left mouse click for a group of contiguous rows Use the copy option available from the shortcut menu to copy and paste the text into other MS windows applications 3 9 Work with the Heart rate view 3 9 1 Heart rate view 0 00 1 00 2 00 3 00 4 00 5 00 6 00 7 00 8 00 9 00 10 00 11 00 1200 13 00 Minutes The Heart rate view displays information about how the patient s heart rate evolved during the test The upper graph displays the patient s heart rate against time The lower graph displays the workload against time Phase changes are indicated with a vertical dotted line 3 9 2 Compare heart rate graphs If a patient has had several exercise ECGs Welch Allyn CardioPerfect Exercise ECG can make a serial comparison of the patient s heart rate during these tests In such a comparison the curve
90. oose from a number of predefined protocols e Select a Blood pressure protocol to indicate how you want to measure the blood pressure during the test e Select a Print protocol to indicate whether reports should be printed automatically or not For more information on protocols see page 58 DIR 80012335 Ver D 16 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 4 Test information and test observations CCHV O01 Siella Jongmans CCHV DUT Siella Jongmans Giria Tas iamma Teit Obceryinhennt Aeertsestn irii Teal biitiin Tei Dtserugiees Irgpieetue DP ferons tole frveetvag CC apsc u HR Pete obese Reaper Io Teeter Hasara Fre Siess Test Die Gi Sees Test Tage ey s Sumetors Dunng Sees C Nowed ST Seet Orsay 01ST Changer Suggestive of Daa effet 0ST Changes Suggestive of lechema Click on the Test information tab to add Click on the Test observation tab to general information about the test add information including for example the reasons for the recording and risk factors Select a keyword from the left pane then select a value from the picklist in the right pane If other is selected free text can be entered in the entry box below the picklist 5 Inthe Interpretation tab you can enter comments by using either the predefined statements in the left hand pane or by simply typing in the right hand pane Click on the save button to save these entries with the test xl CCNV 001
91. ough recording time You can move through the recording time of an exercise ECG in a number of ways CardioPerfect Workstation Exercise ECG Module User Manual ah 00 15pre Interval 00 30pre Interval 00 45pre Interval 01 00pre Interval 01 15pre Interval O1 30pre Interval 01 45pre Interval U2 00pre Interval Scrolling with the vertical scroll bar at the right side of the window you can move through the entire recording Binoculars icon if you move the mouse over the binoculars a selection of global events is displayed If you click on one of these events you are automatically taken to that point in the recording The content of the binocular list is determined by Selections which are configured in File Setting Exercise ECG Viewing See page 49 for more information 00 15 00 30 UU 45 01 00 Interval Interval Interval Interval 01 15 Interval TT hu lhnktar al Select the parts of the test you want to view When you view the exercise ECG you can go through the recording time in a number of ways You can for instance scroll through the entire recording But you can also view the recording time in a summary that only includes a number of events This option quickly takes you through the important parts of the test To select the parts of the test that you want to view e Inthe Selection list that is present on the Averages Full disclosure 2x6 4x3 and ST table views click on a selection To view a part
92. ph with your right mouse button and select Invert from the shortcut menu Click once more to flip the graph back to its original position DIR 80012335 Ver D 39 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 4 Interpreting an exercise ECG Once you have viewed measured and compared the information in the exercise ECG you can add edit and confirm the interpretation 4 1 Edit save and confirm interpretation After test anyone with edit rights can edit an unconfirmed interpretation in the Interpretation editor In this editor you can enter your own texts Alternatively you can use the statement tree to select and enter common interpretation statements Once you edit an interpretation you must save it The test will then be labeled as Unconfirmed Interpretation MD should review Once the interpretation had been confirmed by a physician only a user with confirm interpretation rights can further edit the interpretation For more information on user rights see the Administrator tool To enter text in the Interpretation editor 1 Inthe Tools menu click Interpretation The Interpretation editor is displayed Interpretation editor E EI Save KR Contin ai Cancel H Clear ven Undo Date tinne INDICATIONS FOR STRESS CAD RISK FACTORS BASELINE EKG HESRTRATE RESPONSE TC BP RESPONSE TO EXERCIS FUNCTIONAL CAPACITY REASONS TO TERMINATE T SYMPTOMS DURING STRES sl d Once the inte
93. r authorized service personnel Accessories The Welch Allyn warranty can only be honored if you use Welch Allyn approved accessories and replacement parts Use of accessories other than those recommended by Welch Allyn Caution may compromise product performance DIR 80012335 Ver D 2 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Warranty Service and Spare Parts Warranty All repairs on products under warranty must be performed or approved by Welch Allyn Unauthorized repairs will void the warranty In addition whether or not covered under warranty any product repair shall exclusively be performed by Welch Allyn certified service personnel Assistance and Parts If the product fails to function properly or if assistance service or spare parts are required contact the nearest Welch Allyn Technical Support Center USA 1 800 535 6663 Canada 1 800 561 8797 Latin America 1 305 669 9003 South Africa 27 11 777 7555 European Call Center 353 46 90 67790 Australia 61 2 9638 3000 United Kingdom 44 207 365 6780 Singapore 65 6419 8100 France 33 1 55 69 58 49 Japan 81 3 6383 0852 Germany 49 695 098 5132 China 86 21 6327 9631 Before contacting Welch Allyn it is helpful to attempt to duplicate the problem and to check all accessories to ensure that they are not the cause of the problem When calling please be prepared to provide e Product name and model number and complete d
94. raged complexes of six leads are displayed together with the patient s heart rate the QRS duration the workload in case of an ergometer test or soeed and elevation in case of a treadmill test the phase and the blood pressure The ST levels and slopes are displayed above the complexes To select which six leads you want to view Click the Il aVF button to display the averages of leads to aVF Click the V1 V6 button to display the averages of leads V1 to V6 Click the I IlI V1 V6 button to display the averages of leads to V6 Click the Favorites button to display the lead preference that was set in the exercise ECG settings SCH E d S To display multiple rows with averaged complexes 1 Click the right mouse button on the view to display the contextual menu 2 Click Number of Rows The Rows dialog box is displayed 3 Enter the number of rows you want to see DIR 80012335 Ver D 31 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 3 4 2 Display markers Markers indicate where in the QRS complex the measurement reference points have been set These reference points are automatically calculated but they can be modified You can use a marker as a Starting point for your observations or measurements Markers can only be displayed in the Averages tab Welch Allyn CardioPerfect Exercise ECG shows markers at the following points e Q QRS onset e J QRS end e J x ST measurement point To display
95. rences from the settings menu See page 55 for more information Summa Averages Full Disclose 2x6 A3 Trend ST table Headrate Sr am Exercise ECG Summary EA Patient Information Current user admin Welch Alin CandioP eriari Workstation Humber CONV 001 Name Jongin ans Stella Birth Date STMT Gender Female Test Information Device Team Proteca Pharmacological Stress Agents Cardiac Risk Factors Stress Test Type Baseline or Resting EOG Pharmacological Indications Reasons For Stress Test Test Results Recorded B72411298 10 18 49 AM Target heart rate 193 bpm Maximum heart rate 122 bpm 07 367 6 Maximum Workload 3 4 mph 14 0 10 1 HETS 06 00x Maximum Hood pressure Highest T Test Duration 14 03 Exercise duration oot Recovery duration 03 01 Duration of the fast stage in 00 01 Exercise Number ot stages in Exercise 4 Duke score Medium risk Technician on Sotornnn nbueirian ge Eli The default summary view consists of Patient information The name number birth date gender height and weight of the patient Test information Information about the reasons for the test test type medications and cardiac risk factors Test results Information about the test date duration device the used protocol the length duration and number of stages of the various phases target heart rate maximum heart rate maximum blood pressure and maximum workload The n
96. rpretation is confirmed the save button will be grayed out 2 Inthe right hand pane at the pointer start typing E E E El E El E E 4 To enter a statement from the statement tree 1 From the statement tree click on one of the categories to display all possible statements for that category 2 From a category click on the statement that you want to include in the interpretation The statement is added 3 To delete a statement from the interpretation select the statement text and press BACKSPACE to delete it 4 Click the Save or Confirm if available button to save your comments and to return to the ECG Tips for editing and confirming an interpretation e You can automatically insert the current date and time by clicking the Date time button e You can clear the interpretation editor by clicking the Clear button DIR 80012335 Ver D 40 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 4 2 View interpretation history When you change something in an interpretation Welch Allyn CardioPerfect Exercise ECG does not change the original interpretation but creates a new one This way an audit trail is kept of the interpretation history A copy of all interpretations is kept in the interpretation history To view the interpretation history 1 Inthe Tools menu click History The Interpretation history window is displayed The left hand pane displays the interpretations sorted by date T
97. s are superimposed To compare heart rates 1 Inthe Heart rates view click your right mouse button on one of the graphs to display the shortcut menu 2 Inthe shortcut menu click Comparison The Comparison dialog box is displayed This dialog box contains all other exercise ECGs that have been recorded for this patient 3 Inthe Comparison dialog box select one ECG to which you want to compare the current ECG 4 Click OK The heart rate graph of the selected exercise ECGs is superimposed on the current exercise ECG DIR 80012335 Ver D 38 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 3 10 Work with the ST HR view 3 10 1 ST HR view V5 v V Exercise V R 0 1 S 0 Ke n 0 5 50 55 60 65 70 75 80 85 90 95 100 105110 115120 125 130 135 140 145 150 HR bpm The ST HR view plots the ST segment depression against the heart rate You can display this graph for each lead In the left hand pane the ST HR index is shown More information can be found in Okin PM Kligfield P 1989 Computer based implementation of the ST segment heart rate slope American Journal of Cardiology You can select to show the exercise phase the recovery phase or both by checking the option from the checkbox above the graph To display the ST HR graph for a different lead e Click on a lead in the left hand pane or select the lead from the drop down box To invert the ST HR curve e Click on the gra
98. s physically used The Duke Score is not calculated if the Test type is not Exercise 2 3 6 Add a comment During recording you can make notes about for example the state of the patient You can choose from predefined comments or type in your own comment To add a comment during recording 1 Click the Comment button in the Real time monitor 2 Inthe Comment dialog box either use the arrow to select a comment from the list or type in your own comment DIR 80012335 Ver D 22 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 2 3 Apply filters Baseline filter ECG traces can contain baseline wander that disturbs the signal You can use the baseline filter to filter out this disturbance When you use the baseline filter the recorded signal is not changed You only change the way the signal is displayed and printed To filter out baseline wander during recording In the Real time monitor check the Baseline option in the Overview area or press F3 The filter is immediately applied Clicking the button once more switches the filter off e Alternatively in the Action menu click Baseline to switch on the Baseline filter Clicking the option once more switches the filter off The baseline wander filter introduces a delay of 3 seconds before data are shown on the real time display To filter out baseline wander during viewing e Inthe Action menu click Baseline to switch on the Baseline filter
99. situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people DIR 80012335 Ver D 76 83 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 14 Function keys The Welch Allyn CardioPerfect module is just like all Windows applications designed for working with the mouse However there might be situations in which working with the keyboard can be quicker Therefore a number of functions within the Welch Allyn CardioPerfect module can also be selected directly using the keyboard Here is a list of all available keyboard shortcuts in this module for a more general function key description please refer to the Workstation manual ALT F9 CTRL DOWN CTRL UP CTRL CTRL lt CTRLJ 1 CTRLJ 6 CTRLJ 3 PgUp PgDn ALT 0 ALT 2 ALT 4 ALT 6 ALT 8 ALT D INS Start stop test Baseline filter on off Muscle filter on off Blood pressure measurement nsert comment nsert Perception event rint Go to next stage old stage Go to next phase Emergency stop Change load Change load Decrease load of ergometer or decrease elevation of treadmill The control dialog will appear Change load Increase load of ergometer or increase elevation of treadmill The control dialog will appear Change load Increase speed of treadmill The control dialog will appear Change load Decrease speed of treadmill The control dial
100. sory free of charge You must obtain a return authorization from Welch Allyn to return your Product before you send it to Welch Allyn s designated service center for repair THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE WELCH ALLYN S OBLIGATION UNDER THIS WARRANTY IS LIMITED TO REPAIR OR REPLACEMENT OF PRODUCTS CONTAINING A DEFECT WELCH ALLYN IS NOT RESPONSIBLE FOR ANY INDIRECT OR CONSEQUENTIAL DAMAGES RESULTING FROM A PRODUCT DEFECT COVERED BY THE WARRANTY The CardioPerfect devices are an integral part of a personal computer based diagnostic system The user shall adhere to WARNING poi in order to ensure safe and reliable performance of the e The personal computer non medical electrical equipment shall be situated outside the patient environment reference IEC 60601 1 1 e The personal computer used should be approved to the appropriate safety standard for non medical electrical equipment IEC 60950 or its national variants and use of an isolation transformer is recommended lf there is a requirement for the personal computer to be situated within the patient environment it is the responsibility of the user to ensure the system provides a level of safety that ensures compliance with IEC 60601 1 DIR 80012335 Ver D 4 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual
101. t s being used A number of automatic blood pressure devices can be controlled by the Welch Allyn CardioPerfect Workstation If a device is being used that is not controlled by the Workstation 1 Measure the blood pressure F 2 Click the Blood pressure button oo oessus The Blood pressure dialog box is displayed Enter a new blood pressure Eo Hp OK Cancel 3 Ifa blood pressure protocol is used the dialog box appears automatically so that you know a measurement should be performed Enter the blood pressure values If a device is being used that is controlled by the workstation 1 A measurement is started automatically according to the protocol if selected or by pressing the blood pressure button 2 The values are automatically stored with the test 2 3 3 Capture an event Welch Allyn CardioPerfect Exercise ECG can automatically recognize a number of arrhythmias The arrhythmias that can be detected are e Ventricular fibrillation e Ventricular tachycardia DIR 80012335 Ver D 20 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Bigemini Triplet PVC run Couplet Arrest When Welch Allyn CardioPerfect Exercise ECG detects an arrhythmia an event is created that displays the time of occurrence and a description of the arrhythmia The event is displayed in the event list see 7 2 for more information on configuring which events will be displayed or printed You can
102. t Workstation Exercise ECG Module User Manual When you start a recording you do not see the ECG traces on the screen and you receive a number of errors e Make sure that the setting for the sampling frequency in the Recorder tab of the ECG settings matches the sampling frequency of your recorder The sampling frequency can be either 300 600 or 1200 Hz e Make sure that the correct Recorder model is selected File gt Settings gt Exercise ECG gt Recorder tab Use the MDX4 option for an MD recorder at 300 600 Hz or 1200 Hz Use the MDXN1 for a Pro recorder Some buttons or menu entries are inactive e This is probably caused by the fact that your user role does not allow you to perform the actions of those buttons or menu entries For some advanced settings you have to be logged on as administrator Please contact your system administrator for more information The Service and Advanced Installation manual contains a section specific to Exercise ECG with additional troubleshooting information 9 3 Technical Support If you have a technical question that you cannot answer with the provided tools please contact our Installation amp Support department or contact your local distributor When you contact the Installation amp Support department via phone e mail or fax please provide the following information e Your name company name address phone number fax number and e mail address Product serial number Exact product name
103. t rate and the exercise blood pressure and print protocols You can also identify the physicians associated with the test and enter a variety of test data and information DIR 80012335 Ver D 15 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To create a new ECG 1 Inthe File menu point to New and click Exercise ECG The New exercise ECG dialog box is displayed Click on the General tab xi lt CCNV 001 Stella Jongmans General Test Information Test Observations Interpretation Test Age Pred Max HR Target heartrate Target workload 35 years 185 bpm 35 157 Referring physician None e Sen Target workload dering physician only applicable for ras Ergometers Attending physician None v E Protocol Exercise protocol 20 Watt min Blood pressure protocol None e Print protocol Manual triggered Cancel Help In the Test area enter the target heart rate or enter the target heart rate as a percentage of the predicted maximum heart rate see also page 26 For ergometers you can also enter the target workload see also 2 3 13 Target Workload 2 Inthe Test area select the names of the referring ordering and attending physician see also page 18 3 Goto the Protocol area to select the protocols that you want to use e Inthe Protocol area select the exercise protocol that you want to use You can ch
104. test including for example the reasons for the recording the type of test and cardiac risk factors can be added in the test information tab Test observations Observations made during and prior to the recording including for example the symptoms during stress baseline ECG results and reasons for test termination can be added in the test observations tab Interpretation tab In the Interpretation tab you can add an interpretation and comments like reasons for stopping the test You can start adding comments while the test is still in progress Tabs to the right of the ECG traces ST tab The ST tab displays trends for the measured ST and ST slope against time You can display three leads at a time and select which leads you want to see Table tab The Table tab displays an overview of the last measured ST values the value for the reference ST and the resulting ST deviation for each lead The highest deviation values are displayed in bold red text Below the ST values the lead with the highest ST elevation or depression is displayed Complex tab The Complex tab displays the average complex of a lead You can select which lead should be displayed Shortcut menu The shortcut menu provides a variety of controls depending on the tab which is active including setting the ST point and the display of the Slope values 2 2 Record an exercise ECG Welch Allyn CardioPerfect Exercise ECG records exercise ECGs easily and reliably The only thi
105. the name duration repetition load and maximum load The Protocol editor automatically generates a stage name this name can be changed DIR 80012335 Ver D 58 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Expression Variables You can use an expression to create a stage that is dependent on weight height age etc To create such an expression you can use the following variables ariable Current value Watts km h or KG CM Height of the patient in centimeters Expression Operators You can combine variables into an expression with the following operators Examples Here are some examples of expressions ncrease ergometer load by 40 W 40 ncrease ergometer load by half the weight C 0 5 KG 8 2 2 Treadmill protocols A treadmill protocol is a collection of stages that together define the treadmill test For each stage in a treadmill protocol you need to specify the name duration repetition soeed and elevation The Protocol editor automatically generates a stage number Expression Variables amp Operators Please refer to the similar paragraphs in the previous description on Ergometer protocols Note The speed is always in km h To convert from mph to km h multiply the value in mph with the M factor 8 3 Blood pressure and Printer protocols Blood pressure protocols A blood pressure protocol can be used to automatically take blood pressure measurements d
106. tient for whom you want to recover the exercise ECG 6 The recovered exercise ECG is listed in the test list To delete unfinished recordings 1 Inthe Full disclosure recovery dialog box click on the unfinished recording that you want to delete 2 Click Delete The unfinished recording is deleted To recover a test after the database connection has been lost If during the test the connection to the database is lost for example because of a loose network cable the test will be saved in a file called Emergency saved exercise ECG x MDW x stands for a number which is automatically generated in the My Documents folder After the database connection has been restored this file can be imported into the database by using the import function in the Workstation File Import browse to the My Documents folder and select the correct file 9 2 Troubleshooting The program does not respond when the recorder is switched on e Check the battery and replace or charge Pro recorder it when necessary Make sure that the optical fiber is properly connected e When you work with a RS232 Unilink check whether you have configured the software to use the correct COM port e When you use an ISA CPCOM card make sure that the address on the card matches the setting for the address in the Recorder tab Also make sure that the IRQ you are using is not used by another device DIR 80012335 Ver D 63 83 Welch Allyn CardioPerfec
107. u want to include in your selection You can use both events from the Global events area and the Events per phase type area in one selection 7 Click OK To create a selection that shows information at fixed points of time in the recording 1 Inthe Events per phase type area select intervals for the phases that you want to include in your selection For example if you want to show information from the Exercise and Recovery phase click the Interval check box in the Exercise and Recovery column 2 Inthe Interval seconds area enter the values for the intervals that you selected in the previous step the time between the first display of the event and the next display of the event in seconds 3 Inthe Interval start area enter the start time of the interval display DIR 80012335 Ver D 50 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Examples If you select In phase You see Blood pressure Exercise All blood pressure measurements that were entered during the Exercise phase but no blood pressure measurements that were recorded during the Pretest Recovery or Posttest phases Interval Recovery An event at 3 minutes 180 seconds 5 minutes Start time Interval 120 with interval time added 180 seconds 120 seconds 7 Start at 180 minutes previous 120 seconds etc after the start of the Recovery phase Interval checkbox Display of selections For each
108. ule User Manual ee E ff ge wN See 7 g i Sen Kee K 7 2 y Fi L B SEN ps seggt 4 Note Cables which connect to the Pro Link must be terminated in a mini phone 3 5 mm stereo plug The interfacing cables must follow the connection convention summarized by the following pin assignment diagram Wa No Connection Reference Signal Connector pin assignment bg The TTL and Analog connections are not intended to be used with aution audio IT equipment 11 4 Install the PCI CPCOM card MD recorder only When you want to use a PCI CPCOM card you need to have a free PCI slot on your computer The installation of the PCI CPCOM card is relatively easy and can be done by following the instructions below 1 Open the computer 2 Insert the PCI CPCOM Card in an empty PCI slot and close the computer 3 Start the computer The system will ask you for a driver when logging on to the computer for the first time after you installed the card For Install the driver by running the setup program that is located on Windows the Workstation CD in the directory 2000 XP R Drivers CPCOM PCI Win2000 For R substitute the drive letter of your CD_ ROM drive 4 Restart the computer DIR 80012335 Ver D 68 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Configuring the Software After you have installed the PCI CPCOM card you need to configure the Workstation
109. uring the exercise test For each stage in a blood pressure protocol you need to specify the name duration and repetition The Protocol editor automatically generates a stage number Printer protocols A printer protocol can be used to automatically print copies during the test For each stage in a printer protocol you need to specify the name duration and repetition The Protocol editor automatically generates a stage number 8 3 1 Blood pressure of printer protocol modes Both Blood pressure protocol and Printer protocol can optionally be set to follow the exercise protocol in the protocol editor window To set a Blood pressure or Printer protocol e Select a protocol or enter a new protocol see section 8 3 DIR 80012335 Ver D 59 83 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual e Select a mode see picture Timed mode In timed mode this phase uses the stages as defined above Do action 10 seconds alter stage change Ce Follow exercise protocol mode In follow exercise protocol mode action is triggered on every stage change of the active exercise device protocol 1 Select Timed mode to create a protocol which will run independent of the ergometer or treadmill stages An independent protocol consists of stages each of which has its own duration Regardless of whether you hold or accelerate an exercise device stage the independent BP or print protocol will continue to run usin
110. urself in the Average complex view See page 33 3 2 Display ST slopes Welch Allyn CardioPerfect Exercise ECG not only measures ST levels but can also calculate the value of ST slopes The ST slope value gives additional qualitative information about your ST level measurements The ST slope is calculated as follows ST at J 60 ST at J 40 20 msec To display slopes e Click with your right mouse button on the view to display the shortcut menu Click Slopes to display the slopes Click once more to hide the slopes 3 8 Work with the ST table view ST table view Selection None z Time Stage Workload HR BP FRPP PQ QRS II Il aVR aL a 00 15pre 2 0 kmh 0 0 62 113 42 75 25 58 8 00 30pre 2 0 kmh 0 0 69 120 75 83 8 75 25 00 45pre 2 0 kmh 0 0 73 123 58 83 17 67 25 01 00pre 2 0 kmh 0 0 67 113 67 75 17 KH 25 01 15pre 2 0 kmh 0 0 70 130 67 92 25 75 17 01 30pre 2 0 kmh 0 0 61 103 42 50 0 50 17 01 45pre 2 0 kmh 0 0 58 150 58 83 17 67 25 02 00pre 2 0 kmh 0 0 60 103 42 50 8 50 17 00 154 1 2 7 kmh 10 0 62 103 25 58 33 50 8 00 30 1 2 7 kmh 10 0 74 137 67 83 17 75 25 00 45 1 2 7 km h 10 0 79 106 33 42 0 42 17 01 00x 1 2 7 kmh 10 0 79 116 42 50 D 50 17 01 15 1 2 7 kmh 10 0 80 127 42 58 8 50 17 01 304 1 2 7 kmh 10 0 81 127 42 42 8 42 25 01 45 1 2 7 kmh 10 0 84 116 42 58 8 50 17 02 00 1 2 7 kmh 10 0 86 113 42 58 17 50 17 02 15 1 2 7 km

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