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GE CardioSys - User manual

1. T 4 2 3 Entering the Test Information Library Reason for Test Reason for Test History of chest discomfort ______ j Evaluate effect of we D gt The test information window allows you to make all entries Evaluate effect of PTCA Evaluate functional capacity and settings relevant to the test Stress echo study Stress thallium study Protocol Bruce 4 Rule out confirm CAD pa Post MI study P Target HR 100 B 180 min T hese are Blood Press mmHg sys dia O ees oy m Medication E e cue E the test protocol Physician a Cancel p Technician i Help Referring Physician e i the target heart rate Figure 4 2 4 Tet Information dialog window 1 Thestandard reasons for test _ the blood pressure readings The patient s reason for tes Ea T et protocol themedication s Targa HR in Blood pressure readings M edication D ialog boxes for comments the physician s name and the technician s user s name comments y ooN A WN thenamesof the physician of the referring physician and or user ECG technician 227 498 02 A CardioSys V4 1 85 The Exercise ECG Entering the Test Information A Modify Library Reason for Test Figure 4 2 5 Window for entry of standard reasons for tet Copying Reasons for T est to the Patient Indication Window k Highlight the statement b
2. 5 S H ighlight the line to be copied by clicking on it then Figure 4 5 15 Interpretation click on gt I amp An alternative method is to copy lines by double clicking 18 CardioSys V4 1 227 498 02 A oO Ambulatory Blood Pressure Measurement Confirming T ests A test is considered confirmed when a physician has reviewed the test evaluation and signed it electronically with his her name T ests that have been reviewed and confirmed by a physician are marked with x Click on E lt Figure 4 5 15 to display the window where you can enter your name lt elect the physician s name from the list box click on or enter it via the keyboard 227 498 02 A CardioSys V4 1 187 Ambulatory Blood Pressure Measurement Hellige Ir Pages to Print EA Procedure Date 07 12 1995 14 22 10 Baker Dave Standard Page j F Tabular f Hourly Averages 0 0 3 Statistics Summary Phases ECG Strips Day Time Night Time Wake up Time 0 0 0 4 d Print ECG Grid none Barcode Patient ID ae Cancel EPSON EPL 5600 LPT1 Save Number of Copies 1 lt Modify Help AA ALF Figure 4 5 16 Printer setup screen for documentation of the ambulatory blood pressure measurenent proce dure 1 Number of pages 2 R
3. Interpretation Patient Procedure System Services Help R a n i les ie ASA e 2 Baker Dave 4 ercise Te erpretatio Se RA Ma Ed eae Measu amp ments Summary i C StatemeX Library Interprete tion ARipPemer 4 ie at rest 2 3 4 lax HR 8b 48 of Target HR 179 BPM ux METS 1 00 BP BP at rest 120 90 mmHg Max BP 120 80 mmHg L Events QRS 689 VBIG VPB 38 CPLT 8 Significant ST Change V6 0 00 mV Figure 4 2 38 Interpretation 1 Selection of sytem generated measurements or gatement library 2 Button to edit the tatement library 3 Button to confirm interpretative tatenents 4 Buttonsto edit the report I If your PC is equipped with a sound card and a microphone the program supports voice recording 118 CardioSys V4 1 Interpretation In order to generate the physician s interpretation of the test procedure you can choose both from the systen generated measurements and from the statement library which you entered yourself You can copy statements from both libraries by clicking on the respective lines and on the copy icon gt k Select System Evaluation or Statement Library Highlight the phrase you wish to copy then click the button I Copya line by just double clicking on it Confirming T ests A test is considered confirm
4. 4 6 4 Documenting the Analysis Eoi pe Procedure Date oN em R e S u Its ae Gain Soo Beg ewe al 2 Click on the button to obtain a document of the Speed eia analysis results Medians 100 mm s 4 20 mm mV p The printer setup screen displays Figure 4 6 9 where you can change the signal size and the sweep speed of the vector Interpretation 4 canei diagram and the median complexes before the printout ECG Grid emm 7 Barcode Patient ID aie EPSON EPL 5600 LPT1 save Numpert copies 1 Modit Hep On the same screen you include or exclude the interpretation you select or deselect the ECG grid and you choose the Figure 4 6 9 Printer stup screen number of copies as well as the printer Print will initiate the printer Save will save the printer setup 227 498 02 A CardioSys V4 1 201 Late P otentials Setup Patient Procedure System Services Help 4 6 5 Setup fate Bo le 2 B eas o I 0 Click on to display the second line of control _ Gain mm mv 10 a ASA buttons Cor Lead Check noise level low Noi Cut off Frequency Hz 40 Noise Limit uV 1 0 S 0 1 5 0 S Click on to call up the setup screen Fig
5. Medications Medication Medication Group Drug Name ij gt 4 unknown 4 gt 4 digitalis 4 gt diuretics 4 gt a psychotherap agents 4j E Aj steroids aj gt 4 beta blockers Il 4 gt 4 beta blockers Ill 4 gt 4 antiarrhythmics la 4 gt 4 antiarrhythmics Ib 4 gt 4 antiarrhythmics Ic aj gt 4 antiarrhythmics II 4 gt j tee Ca antagonist verapamil type j gt x Ca antagonist nifedipine type gt 4 Cancel Figure 4 1 11 Assgninga drug to a medication group 50 CardioSys V4 1 Selecting a M edication Assigning a D rug Name to a M edication Group You can select a medication from a list of 14 items x You can also select a second medication and assign specific drugs to the medication groups to include these in the list instead of the group name P M aking a Selection To Click on to open the medication list box Figure 4 1 10 k Sdect one of the medications k If you wish to select a second medication or to assign a drug name to a medication group click on E and select the medication as described above Assigning D rugs to a M edication Group Ye Click on _Mesteations _ A window opens showing 14 items Figure 4 1 11 T here is a drug name window for each of these groups Click on the respective text box if you wish to enter a name T hen type the drug name Furthermore you
6. The Exercise ECG Printing an Exercise Test Report Page 2 Page Figure 4 2 44 Trend report detailed format 122 The ST beats page shows the resting ST beats in the first column the ST beats with the max ST depression in column no 2 and in the following columns the ST beats at max load and for the recovery phase Trend Reports You can choose between Overview and Detail In the overview Figure 4 2 43 all trend graphs are printed on a single page W hen you select D etail you obtain several pages of trend graphs Figure 4 2 44 T he number of pages to be printed changes accordingly Click E and select for mat Check the ST H R box to obtain a printout of the ST HR slope page Arrhythmias Full Disclosure ECG Recording Interval QRS Morphologies Sample C ardiac C ycles You can choose the documents Figures 4 2 45 trough 4 2 48 that you want to print and you determine whether you wish to havea 12 or 6 channd recording window be low In the windows at the bottom of the screen you select the printer printer port the number of copies whether the patient ID no will be annotated in the form of a barcode on the report and whether an ECG grid isto be printed along with the ECG traces If you deselect the grid the printout will
7. LPT1 Help IX Spline Rhythm Lead CABRERA p IX Print after Analysis HIGH Report NEHB IX Save full disclosure ECG Terminate after min loo Number of Leads 12 4 OK Lead Sequence STANDARD aj Modify Cancel Rhythm Lead 11 Figure 4 3 10 Lead sequence election window 227 498 02 A Middle Window 10 sECG Analysis H ere you determine wheter or not an ECG analysis isto be made prior to the recording i yes no An analysis is possible only when all 10 electrodes are applied All adjust ments made in this field only refer to the 10 s ECG analysis e g lead sequence QTC Calculation Equation for calculation of the QT interval HEGGLIN HOLZMANN orBAZETT Lead Sequence In the lead sequence window you can assign the leads to the recording channels Six lead sequences are predefined Four of these sequences 3 to 6 can be modified STANDARD 1 11 III aVR aVL aVF V1 V6 CABRERA aVL 1 aVR Il aVF III V1 V6 HIGH 1 11 1H aVR aVL aVF V1 V6 NEHB 1 11 HI WR aVL aVF D A J D A J LEFT 1 11 I1 aVR AVL AVF V4 V5 V6 V7 V8 V9 RIGHT 1 ILII VR AVL AVF VAR V3R V4 V1 V2 V3 CardioSys V4 1 151 The STAT ECG dify Modify Lead Sequence 5 Speed mm s Gain mm mV QTC Calculation Lead Sequence Rhythm Lead Report Number of Leads Lead Sequence Rhythm Lead
8. 10 08 1998 13 22 01 Spirometry 10 08 1998 12 13 Stress Test 10 08 1998 5 Stress Test _ uw 10 08 1998 3 Stress Test 10 08 1998 11 2 19 Stress Test 3 5 10 08 1998 11 41 42 Rest ECG 10 08 1998 11 32 36 Rest ECG SS 10 08 1998 11 21 07 Stress Test 10 08 1998 11 12 45 Rest ECG L bi Cancel Help Figure 6 12 Patient records section window Copy Patient Records 1 Selected patient 2 Records saved for sdected patient 3 Transfer buttons 4 Storage medium directory 5 Recordsstored on sdected storage medium 224 CardioSys V4 1 6 3 Copying Patient Records to from Storage Medium This function allows you to copy one or more examination procedures from the PC to another storage medium such as magneto optical disks eg for house calls You can also copy data from another storage medium back to your PC database Restore procedures to your PC only if changes were made to them Click B the window showing the System Services opens Figure 6 11 k Click Ea you will see the procedure selection window Figure 6 12 Copying Records from the PC to the Storage M edium k Check that the correct patient is selected o Click rma if you wish to select another patient This opens the patient selection window Select a patient as described in section 3 1 All records of this patient appear in the list below
9. Patient ID Date of Birth Patient ID 8738999 lect Miller Ja 04 1943 5498 Richards Chantal 03 12 1977 7766699 Robert Jennifer 27 1977 387 Shields Stuart 11 11 1912 765321 New Patient Stevengon Robert 11 22 1966 333999 Thompgon Anthony 09 19 1932 665544 Delete next page Di Unnamed Q Hel Cancel Close r New Patient Last Name Master First Name Jim Patient ID 8738999 Date of Birth 10 05 1949 MM DD YYYY Gender Mae Height 176 in Race F Weight 66 0 lb Tq Pacemaker Accept Figure 3 1 Patient selection screen 1 Displays more patients 2 Bar cursor highlighting selected patient 3 Text box for patient s lat name 4 Click to slet highlighted patient and go to the title screen Click to ente new patient data 6 Clearsthe patient data 7 Unnamed button the tet will not be ass gned to a patient 8 Click to display the online hdp screen 9 Clearsthe menu entries are not saved 10 Displays the title scren 11 Click to save the data to the database 12 Pacemaker patient yes x no F 13 Patient data window ul gt Depending on the system configuration you will be working with the local database or with the database of the MU SE CV system 30 CardioSys V4 1 3 1 Retrieving a Patient From the Database An examination procedure can be assigned to a patient only when this patient has been retrieved from the
10. Lead Check noise level IX 10 s ECG Analysis X Print after Analysis IX Save full disclosure Terminate after mi Thermal Writer AR High Lead Lead aVR aVL Pulse EAD OFF Alarm werride IX 40 Hz Filter X 50 Hz Filter IX Spline OK OK Cancel Cancel Hhh hh ip V6 Help Help Figure 4 3 11 M odifying the lead sequence 4 Speed mm s Gain mm mV Lead Check noise le IX 10 s ECG Analysi QTC Calculation Lead Sequence Rhythm Lead X Print after Analys Report IX Save full disclosu Terminate after r Number of Leads Lead Sequence Rhythm Lead Thermal Writer 4 al Pulse LEAD OFF Alarm Override IX 40 Hz Filter IX 50 Hz Filter IX Spline OK Cancel 1 1 f li Al 1l g Me m aVR 4 aVL aVR aVF 5 V1 aVL v2 6 v3 aVF v4 7 v5 vi V6 8 p v2 A i 9 5 ra 10 va J va x 11 V5 af V5 Cancel 12 ve a ve Help t Help Figure 4 3 12 152 M odifying the lead sequence CardioSys V4 1 Modifying the Lead Sequence amp Click the E box to the right of Lead Sequence to open the Lead Sequence selection window Fig
11. A tel Is e e a I Baker Dave 4 R e a Als ci a Mas TE Reason for Test Age 48 years Sex Male Race Caucasian Height 175 cm i 80 0 k Measurements Summary wa ooi supraventr premature SVPB HR 84 BPM because premature beat with same morphology ans 106 m left axis deviation QT 392 ms because QRS angle between 90 and 30 QTc 330 ms Q 180 ms R 136 ms RR 708 ms p 705 ms Sokolov 3 50 mV Medicati Seeing jedication 5 Comment lt QRS 25 ae Physician Dr Williams lt T 50 i lt o Technician Dorothy lt P 25 bone Figure 4 1 20 T et Summary 227 498 02 A CardioSys V4 1 The T est Summary The test summary Figure 4 1 20 provides a survey of Reason for T est from the test information M easurements Summary excerpt from interpretation Figure 4 1 27 M edication C omment Physician T echnician from the test information Patient D ata Blood Pressure from the test information QRS QT QTC PQ RR PP interval from the M easure ments Sokotov Lyon index S V1 R V5 or S V1 R V6 whichever is greater from the M easurements QTD QT dispersion max difference between max QT duration and min QT duration of all leads Vector angles QRS T and P angle from the M easurements X If you wish to add or edit procedure data click on RA Changing the medication will cause the program to reanalyzethe ECG 59 The Resting ECG
12. Quits program MEDITRONIC M 700 ERGOCOMP EC 1200 Start program Call up the exercise test screen Admit new patient or select patient from list Apply electrodes and check signal quality f vamman Enter the test information Select protocol Click button and wait for ST values to be displayed option A Start pedalling Load changes can be made at the ergometer only with M 700 only for the custom programmed protocols Phase gt gt Selects the recovery phase i eter ps Quits program 138 CardioSys V4 1 227 498 02 A The Exercise ECG Short Form Operating Instructions T readmill o Start program Phase gt gt H Activate exercise test mode Stage gt gt Enter new patient data or select patient from list tora Apply electrodes and check signal quality HE f We Enter the tes information Stop Treadmill g Select test protocol Start Treadmill x Record resting ECG supine patient Stage gt gt Stage gt gt Record resting ECG standing patient i Stage gt gt Record ECG of hyperventilating patient Stage gt gt Starts pre test phase Start Treadmill 227 498 02 A CardioSys V4 1 Starts exercise test Advance to the next load stage M aintains the stage M odifies the speed and grade note interrupts automatic program control Stops treadmill without interrupting the test Restarts treadmill Selects t
13. The table below indicates the maximal minimal and mean values D 0 20 0 T 0 lt 110 120 130 140 150 160 170 180 190 200 gt mmHG lt 60 70 80 90 100 110 120 130 140 150 gt The percentage of readings which exceeded the set limits is Minimum Maximum Average sD da BP T EDAD E 14356 1 day BA bs shown at the bottom mn BP 69 15 16 1 day 105 9 18 2 day 84 8 6 7 Heart Rate 62 74 7 6 1 21 of systolic blood pressure readings exceeded 135 mmHg 0 0 of diastolic blood pressure readings exceeded 85 mmH z s Similar report pages exist for the day time the night time and Figure 4 5 14 Statistics ummary the wake up time Interpretation Interpretation Hellige z Patient Procedure System Services Help a M el RA Aico E Measurements Summary C Statement Library 24h Average sys dia mmHg t Ja gu Coo To write the test interpretation you can choose from the a l Aleea system generated measurements or from the Statement Ea SE Library which in turn may be edited as needed Interpretation 101 5 75 1 o Ea Se nies From both libraries the appropriate texts can be copied into the evaluation window at right by clicking diast BP readings above 85 mmHg 0 0 Day Time sys dia mmHg we L k Select M easurements Summary or Statement Library
14. Figure 4 2 16 Program sequence for the treadmill tet 100 CardioSys V4 1 Automatically on completion of last stage or manually 227 498 02 A The Exercise ECG The Elements of an Exercise Test I Pressing the or amp button cancels the automatic program sequence and activates the manual mode phase name M anual The program maintains the current stage for reasons of safety and the and buttons are locked T he test can only be controlled manually with the and keys speed grade When you activate and 1 again after a pause of approx 15 seconds the program displays the next higher stage number With the button you advance to the next test phase o gt If the treadmill is stopped with the button or with the emergency stop button the speed and grade readout is Wait until this readout disappears before restarting the treadmill with sures 227 498 02 A Then you can proceed to the next stage stse gt gt button 5 Figure 4 2 11 to record the ECG of the patient standing upright The next stage is reserved for recording the ECG of the hyperventilating patient Then the warm up stage follows in which the patient gets used to the treadmill exercise k Proceed to the next stage and start the treadmill with the button 8 Figure 4 2 11 Oncethe patient is familiar with walking on the treadmill initiate the actual test by cl
15. Within the framework of a service contract M arquette H elige service representatives would be pleased to carry out these preventive maintenance inspections for you TheT echnical Inspections include visual inspection of the device and accessories for me chanical damage that may impair their function verification of the safety related device labelling for readability verification of the device platform measurement of the resistance of the non fused earthed conductor and of the equivalent leakage current accord ing to the local regulations The system does not require other regular maintenance inspections CardioSys V4 1 235 Cleaning Disinfection and Maintenance For your notes 236 CardioSys V4 1 227 498 02 A Troubleshooting Tips 8 Troubleshooting Tips System M essages Message CORINA not connected not switched on audible alarm sounds Remedy Exit program chapter 5 and start over section 2 4 D edetetheentry load in the window section of the WIN IN I file Implement additional parallel interface for CORINA If the message recurs contact the nearest sales service office Message Internal CORINA malfunction at the same time the system emits 3 beeps Remedy Contact the nearest sales service office Message CORINA malfunction Data transfer Remedy Exit program chapter 5 and start over section 2 4 If the message recurs contact t
16. amp Click the record s to be copied ka Check that the correct drive directory is selected k Click moaity if you wish to select another drive or directory 227 498 02 A System Services Menu gt Error messages may be displayed when the storage medium is write protected the storage medium is unformatted the storage capacity is insufficient the storage medium is defective amp Click i Click 227 498 02 A ok to clear the window E to initiate transfer of the selected file s T he copied record s will appear in the Records on Storage M edium window Restoring Files from the Storage M edium to the PC Proceed as follows to copy modified records or new records to the PC lt k Display the system services menu and the transfer func tion as described above lt Select the patient t Select the appropriate drive directory amp Click ey Click the record s to be copied __ __ to initiate transfer of the selected file s T he copied record s will appear in the Patient Records window Ye Click CardioSys V4 1 to quit the function 225 System Services Menu Hellige System Services Menu Procedure Archiving r Setup 15 SE z a System Copy Patient Compression Configuration Records m Voice from EC
17. ecceceessesesesesssseecssssesesesseseeetereess 262 Spirometry Geida ca ct eke a an dias 155 On screen demonstration occ 164 165 RUNNING ALCS ss cseiieriisdesrueelediisseciesdivescedienas duiiaeieaaies 164 Spline See Cubic spline Square wave PLOFilOS see eeeceeeeceseseeeeeecatstseecetesatanaeeteas 132 ST profile medians exercise test oo 106 SMAR SOPE ensani R 113 261 Standard d Suisei aaa anaia 44 Starting the proGraNiwisscnwidad vies adeiv a a eeds 24 STAT ECG MOGs iana 141 227 498 02 A Index STAT ECG TeCOrding eccranuinnnarn imaa 146 148 Statement library E Xercise OSE anrai arai 118 Late potential Ss cranant aa 200 Reting EC Grenier wading 67 SPIrONEY haneri ainan a teteietiens 159 Statistics summary Amb blood pressure ssie 186 Stored tets VIEW iana iiaaa 33 35 System configuration eee c cece te teteteteteteteeteteteteteneenens 212 System maintenance ose cceeeeeteeeteteteteteteteteeteteteteteneanene 254 System MESSAQES ccecesecececesersteesseeesieeeecieetieeerenees 237 System operating routines eesriie 20 Tabular summary exercise test s n 111 Target H Roia asai ai aeaa aa 87 Technical inSoectiOnS eniinn aaas 235 Technical specifications cece 239 Technician SeeName Test information Ambulatory blood pressure 182 Exercise testiin aran a a aia a 85 ate potentials civescasseseviassveatireas ay oatiendue anaes 193 Resting EGG siiin iarasi 47 SPIPOMICEV ni a e a a adtansiaie 158 STAT EGG ses ain
18. eesesessssessesssssssscsssscetsseseres 124 Expert mode Exercise tes ccscsssccsssssecssssesesssssssreeess 6 External blood pressure Meter oo eects 262 External programs setup ercer 207 Factory settings retrieval seese 231 FAX transmi SOM sionais 257 Fuldi Closure ECG woes eeecccssssescsessssecssessssssseesecesesersesanes 119 SLONAGE E E EE A E A O 126 Function keypad exercise tes 135 FUNGON KEYS naianei aiaa 25 FVC M aSUrQMent pnia naai 165 General information sviss ain insasi 4 General safety information ssscceereereenn 10 Help window call up clear sssr 22 HPLA TENO 2eisicicctcetiitiadiniandtaialedadiie 203 late ikenen e AKS E e E A E 22 H ospital practice name oo tects tenets 212 Icon bar modification ssssssrisirrsisirrrriririrrrrerirnes 215 Installing the program sssssississississisrississrssirinsrsriesiersns 251 Interpretation Late Potentials icsics iscsi cissicsssaatsiedsecmacnvuarieennie 199 Reting EGG anaiai a a 66 JAX DONE n A a 127 227 498 02 A Index Keyboard oc eeeeseessteeseeeeeeens 23 Seealos Function keypad Language selection eieiei 26 Late potential analysis ssseesesssssisrisssesisrisrisrsssrreren 195 Late potential MOJ enccunisiiraririiiiana a 191 Lead check ECG signal qualiy screen 103 Lead check noise leva cessere 76 126 150 203 Lead O ff Alar oiana 76 128 150 203 Lead sequence selection modification EXEC E tEn anai caasateases 129 Indesit a6 ECG soe
19. z To start exerc se Start reco y prepare final repo Figure 4 2 59 T he function keypad repeated 136 Check the ECG signal quality lead check 7 Press close window 11 to clear the window from the screen Freeze and release the ECG signal traces with freeze ECG 7 Display the ST measurement results with ST medians ST profile 8 Press close window 11 to clear the window from the screen Display graphic trends with trends 8 Press close win dow 11 to clear the window from the screen Start and stop the thermal array printer with keys 6 Initiate the recovery phase with start recovery 3 End the exercise test with prepare final report 4 CardioSys V4 1 227 498 02 A The Exercise ECG Short Form Operating Instructions 4 2 10 Short Form Operating Instructions MEDITRONIC M 400 Test Information BE Start program Call up the exercisetest screen Admit new patient or select patient from list Apply electrodes and check signal quality Enter the test information Select protocol Adjust initial load at the ergometer as required by the selected protocol W Phase gt gt tage gt gt E igl Hold Phase gt gt Click lt gt button and wait for ST values to be displayed option Click button and start pedalling Repeat all load changes of the selected program at the ergometer Selects the next stage M aintains the
20. System Configuration amp Click on and choose a name from the list by clicking on it Exiting the T est Information Screen Once you have entered all test information you can either clear the window with and start recording the resting ECG or clear the window with in this case the test information will be ignored and are not assigned to the test CardioSys V4 1 51 The Resting ECG Recording A Resting ECG OK Patient Procedure System Services Help Meal tel is le a 2 N lt Test information Freeze Traces options 85 Once you have entered the test information and cleared the anne HE soz d F fomm e P lt mp F window with ox the signal acquisition screen for the 2 My 130 80 resting ECG Figure 4 1 13 will appear T ake a few seconds to become familiar with the details shown on this screen before proceeding to recording the resting ECG 4 1 4 Recording A Resting ECG K a Y 5 a My o gt W Y The resting ECG signal acquisition screen Lead Sequence This screen Figure 4 1 13 shows Cubic Spline ON Figure 4 1 13 Signal acquistion scremn for the reting ECG thecurrent heart rate 2 and the blood pressure readings 1 Control buttons 3 if entered manually section 4 1 3 2 Current heart rate 3 Blood presure readings
21. j Setup for MUSE x MUSE Web Server MUSE User Name MUSE Password 1 Request MUSE data MUSE site T rrr p Store procedure for MUSE No data transfer to MUSE __ 6 Save MUSE data to medium Drive A yi Data transfer to MUSE via the network MUSE FTP Server MUSE FTP User Name MUSE FTP Password MUSE FTP Proxy Server i Foo Data transfer to MUSE via Shared Directory Shared Directory Directory User Name Delete local test data after transfer to MUSE Start modem connection before transfer Directory Password Location Number 7 64 Cart Number 4 Help _ cance Figure 6 5 MUSE tab panne M To transfer data to the MUSE CV database please contact M arquette H ellige service for advice and for the necessary system setup Caution 03 gt MUSE only accepts ASCII characters A to Z 0 to 9 218 CardioSys V4 1 MUSE Tab On this tab you make all selections for the transfer of data to a MUSE CV database First of all you should obtain the follow ing information M USE server network address login name and password Verify that the network configuration is OK and that the Internet Explorer and Acrobat Reader are prop erly installed The same applies to the modem setup when using RAS 1 Patient data and orders are requested from M USE 2 Entry fields for M U SE database queries 3 Entry fied for M U SE ste number 4 Click radio button
22. t On the setup screen section 4 2 7 select the ERG S ergometer k If you wish to obtain a recording at the end of each load stage only set the ECG Rec Inter El to 00 00 min e Select a protocol Click the E lt button A blood pressure measurement is now taken automatically if configured W ait until the readings are available or until the first ST measurement is displayed option 18 Figure 4 2 10 Ask the test subject to start pedalling W indow 2 in Figure 4 2 10 indicates the remaining time in the current stage while window 1 shows the time elapsed in that phase 98 CardioSys V4 1 During the test you can modify the load at the ergometer but only for your own custom programmed phases advance to the recovery phase with terminate the test with XO EC 1200 This ergometer comes with 7 preprogrammed phases 6 exercise phases 1 recovery phase In addition there are five free phases In the program 10 protocols have been created from these phases You are free to modify these protocols as needed Phase No N ame on Ergometer D isplay 8 OWN PROGRAM 1 9 OWN PROGRAM 2 10 OWN PROGRAM 3 11 OWN PROGRAM 4 12 OWN PROGRAM 5 1 WHO 2 IC SPE 3 ST FRANCE 4 WHO NEW 5 HOLLMANN 6 REHA 7 not available for EC 1200 32 RECOVERY 227 498 02 A The Exercise ECG The Elements of an Exercise Test If you call up an unconfigured phase see above the ergome
23. Evaluating the ECG 4 DataExport g Patient Procedure System Services Help Deal i Is leee 2 i Baker Dave 4 The SH icon allows you to export the most important data Als pertaining to the resting ECG procedure to the clipboard or Reason for Test to any file D ata exported to the clipboard for instance can Age 48 year n 7 S 1 Export Data be inserted in a text file with the Edit gt Paste com Export data to clipboard og man d Measy supra ols BPM a gt Export data to file Cancel P m i bei h ms lo C l ck lt ms S amp P 136 ms RR 708 ms Sproles 3 0 mV d j h u d li b d u d Jaro 20 ms Select ether Export data to clipboard or Export data e Dr Williams a o z a lt 0 to file Technician Dorothy lt P 25 Bap Figure 4 1 21 Data Export window amp Clikon x D ata from the clipboard can be imported in a word process ing program with the Pase command For data exported to a file you will have to specify the target directory and confirm it with x 60 CardioSys V4 1 227 498 02 A The Resting ECG Evaluating the ECG Medians dom M edians dominant subdominant StS 445 0 2 The dominant and if present the subdominant medians of
24. LA Correlation Coefficient 95 Ej 1 99 b ure 4 6 10 HFLA Treshold uV w S 6 99 Number of QRS 200 20 500 Abe g x U se this screen to select your personal system settings T hese r A RS canei settings will be saved Audible LEAD OFF Alarm ieh EN Print after Recording pd Adjustments are made in three different ways Figure 4 6 10 T he defaults menu 1 Thereis an arrow f at the end of a box Clicking this arrow will open a window which offers various options Select the desired setting by clicking the mouse button 2 Thereisatext box next to the respective parameters Click on this box and key in the desired text 3 Thereisacheck box in front of the function Click the box to enable or disable the function check mark function enabled 202 CardioSys V4 1 227 498 02 A Late Potentials Speed selects the trace sweep speed Gain selects the signal size amplitude Lead C heck noise level T his is a measure of the quality of the acquired signal signal to noise ratio W hen there is too much signal noise at the electrode the electrode is displayed yellow on the signal acquisition screen T he setting that you select here low middle high changes the threshold as of which the electrode is displayed yellow high sensitivity to noise low threshold Cut off Frequency Adjustment of the cut off frequency of the high pass fil
25. Moaiy odify Modify Lead Sequence C Page 1 Reo Lat ETAT A window opens showing all channels Figure 4 2 53 T here Sequence a Ii i eae ER 7 is one window for each of the channels indicating the lead Audible LEAD OH 2 1 vp yu nly 4 2 Ba ify _ Audible HR Alary 3 m 4 u m 4 Noaro 4 me currently assigned to that channel Diagram HRin 4 avr aj aVR avn E m ll X Remote View 5 avl aVL av 4 lel uoan X RPP Readout 6 avr E avr are Start clock at prq 7 v1 vi v1 aj BP Monitor Be xl X 2 2 9 v3 aj v3 v3 aj admini Ei wf va vs va 4 coms E 1 vs vs vs 4 mam ee oa OK Cancel Help el Help Figure 4 2 53 M odifying the lead sequence 227 498 02 A CardioSys V4 1 129 The Exercise ECG Exercise Test Defaults 4 NEHB C Page 1 Report Label Screen Sequence Sequence X 1 mV Cal Pulse 1 1 o p 1 aj i Audible LEAD OFF Ala 2 p 1 1 moan aVR odify Audible HR Alarm 3 a m m al p Diagram HRin of 4j aVF aVR avR e II vi 4 LE moaity X Remote View 5 v2 aVL aVL IX RPP Readout 6 ya aVF ave E Start clock at pretest 7 k D D BP Monitor BP I E Js fells H IH Port col ol q 1 i 4 ol Thermal Writer non ml
26. _ Procedure Date X Standard Page Dom Median T 10 sec ECG segment a Interpretation Subdom Median ECG ormat Display Format Leads Page an A System contin ous 10 sec la Measurements 4 12 4 X Physician Gain Gain Gain 10 gt fi mm mV 10 la mm mV 10 mm mV Interpretation Interpretation Speed Physician Program Physician Program 25 1 mm s ia fo e E Print Rhythm Lead I laj Barcode Patient ID 22 chrs Cancel ECG Grid 5mm laj EPSON EPL 5700 LPT1 Save t PN Number of Copies 1 C Hp Figure 4 1 35 Reting ECG print setup scren 1 Number of pages of the entire report Names Date of Birth 2 Document lected for printout 95 Male Caucasian HELLIGE CardioSoft 2 5i HR BPM Hospital 12 e Peli 7 a i H IEEE Indication Therapy ouicor comment we 13085 mmHg Mediation digitalis 01 1997 122805 I0 mava 25 mw Figure 4 1 36 Report page standard format 72 CardioSys V4 1 4 1 6 Printing the Resting ECG The scope of the printed report is determined on the print setup screen Figure 4 1 35 ey Click to call up the print setup screen The report includes the following documents Standard Page Medians 10 second ECG segments Interpretation Clicking the box in front of each
27. in the 5th intercostal space on the left posterior the L electrode to N ax C8 axillary line identical with C8 the F electrode to N ap C4 N a in the 5th intercostal space on the left mid davicular line identical with C4 ES Itisnot possible to record chest leads at the same time as NEHB leads N black E right leg red right arm Ci white C2 white C3 white E gt Please observe the information given in sections 7 1 Artifact D ue to Poor Electrode Application 7 2 ECGs of Pacemaker Patients and 7 3 ECG Recording During Defibrillation in the appen dix st C4 white Nap C8 Nax C5 white C6 white yellow left arm green C1 C2C3 C4 left leg Net Nap c5 Figure 4 1 7 Connecting the patient cable 12 wire Neve leads 46 CardioSys V4 1 227 498 02 A The Resting ECG Entering the Test Information Test Information Library Reason for Test gt Medication msm Blood Press mmHg gt sys dia f LA Comment Technician 4 Reason for Test Help Figure 4 1 8 Tet information screen 1 Reason for T et Library T he patient s reason for test Blood pressure readings M edications ur W N cian sand technician snames 227 498 02
28. Accept Figure 3 2 Patient data entry screen 1 Click to enter new patient data T ext box uo SP W N for patient s lat name Pacemaker patient yes i no Confirmsthe entered data Click to enter patient data via card reader 3 2 Admitting a New Patient k Click 1 Figure 3 2 k Enter the patient s last name and press the em key to move to the next box etc E3 U se the spacebar to apply or remove the checkmark in the Pacemaker checkbox R Click to save the new patient file to the database or press the E key and then the spacebar k To admit a patient with the card reader click and follow the displayed instructions the card reader function must be enabled in the System C onfiguration menu but this function is not supported by all key boards Patient Procedure System Services Help esl ie a Ea Test Information Freeze ECG Options gt Si X 40 Hz X 50 HZ tft fo mmm e gt f mm s w eA E L Thefirst letters of the first and last names are automatically capitalized Enter only ASCII characters and numbers for the MUSE CV system HR bpm 85 SYS DIA mmHg aVR aVL V5 Lead Sequence I STANDARD 4 aur Me Spline ON Figure 3 3 H eadline with the selected patient s name 32 CardioSys V4 1 227 498 02 A Selecting and Admitting a Patient Re
29. Enable or disable the Card Reader function patient data acquired from patient ID card Select the electrode lead label convention IEC or AHA Select the AC line filter frequency 50 60 H 2 Select the language Select the time format Select the date format Select the units for height cm inches and weight kg lb Select the speed unit km h mph Ensure that the same unit is selected at the treadmill 10 Sdect the ST level unit mm mV CardioSys V4 1 227 498 02 A System Services Menu Hellige ki 6 2 The Voice Recorder System Services Menu r Procedure r Archiving r Setup A The voice recorder feature allows you to record comments Ta save them with the date and under a specific heading and coc tm Copy Patient Compression play them back If the program runs in a network environ onfiguration jecords 5 ment you can call up the comments from all connected r gations Voice from ECG Archive Patient Recorder System ECG Records Recorder k Click b the window showing the system services corer ve opens Figure 6 8 a Click the icon you will see a list of all stored voice Figure 6 8 System Services M enu recordings Figure 6 9 Hellige Voice Recorder d Date Time of Recording Category 07 08 19
30. Figure 4 1 18 The result is given in mV for the amplitude in ms for the time interval and in mV s for the slope Figure 4 1 18 ECG measurement t Click the right mouse button to delete a reference point or an entire measurement On the zoomed display the position of the cursor is continu ously indicated in mV at 3 Figure 4 1 17 measured from the grid line at the center amp Click to cancel the zoom display T he original display reappears 227 498 02 A CardioSys V4 1 57 The Resting ECG Evaluating the ECG Displaying O ther ECG Report Pages You can ether scroll through all ECG report pages or access specific pages directly Click to scroll forward or to scroll backward through the report Test Summary ECG Traces Medians dom Medians subd Arrhythmia Review Click to display the table of contents from which you can choose specific report documents for review Figure 4 1 19 Interpretation k Select the desired document by clicking Figure 4 1 19 T able of contents of the reting ECG report gt y 3 The key functions described above are available for all docu ments An explanation of the report pages follows on the next few pages 58 CardioSys V4 1 227 498 02 A The Resting ECG Evaluating the ECG Test Summary e
31. M onitoring of Remote T est Stations ERGM during the exercise test data are continuously sent via the network the following data can be viewed at any of the work stations in the network e station name e 6 lead ECG leads selectable e information on the exercise test and on the ergometer e HR and blood pressure e ST measurement results resting beat current beat 227 498 02 A CardioSys V4 1 Task List OMAN patient selection on task list task list created by host program hospital information system medical rambursement program etc supports BDT format examination results are returned to the requesting system ECG History EC GH requires hardlock display of the median beats from up to 5 selectable resting ECGs for visual comparison or printout 3D presentation of the medians for serial comparison Review M anager REVM requires hardlock users can review and confirm the examination results name of the physician who confirmed the results is automatically entered in the patient file display of examination procedures according to different criteria confirmed unconfirmed all Cardio Mailbox C BO X requires hardlock transmission of multiple procedures via a modem to CardioSys C ardioSoft storage of multiple procedures on storage medium reception of multiple procedures via a modem from CardioSys C ardioSoft or C ardioSmart Introduction to CardioSys 1 2 System Configur
32. V s Aen 4 12 3 4 5 6 7 8 9 1011 12 19 14 15 16 17 18 19 V6 1s ane 2a AR aa FIVC l s 2 63 FIV1 I s 2 23 3 F FIV1 IVC 44 PIF l s 54 MIV75 l s MIV50 l s Bo MIV25 l s 7 4 MWN l min 92 0 Figure 4 4 10 VC measurenent v Patient Procedure System Services Help S ah a Meat tae io let b a gt 2 a Baker Dave 4 piromietny iRecordina l Test Information End Patient Data 188cm Male C V Measure FVC Measure Animation Setup Interpretation Miller Sq 0 Scale Flow Volume Volume Time Normal Values ECCS 0 R R 7 F l s Value Act Norm 64 EVC I 3 14 268 118 5 FEVC I 2 63 FEV1 I 2 25 wo FEVI VC 81 0 34 PEF l s 5 86 2 MEF75 l s 5 35 fl MEF5O l s 3 76 V I MEF25 l s 1 61 ee re re MMF 1 s aay a 12 3 4 5 6 7 8 9 1011 12 19 14 15 16 17 18 19 V6 1s aad 26h w re FIVC l s 2 63 FIV1 l s 2 23 ie FIVI IVC wel PIF I s Ee MIV75 l s MIV50 l s g MIV25 I s 74 MWY l min 92 0 Figure 4 4 11 FVC scren 227 498 02 A k Click and ask your patient to inhale exhale and inhale again as deeply as possible through the sensor when the orange indicator on the sensor lights up T hen your patient may resume normal breathing The maneuver must be concluded within 20 s of clicking J The program terminates the measurement when it does not detect a flow reversal within 4 s of two identified inversion points or after
33. confirm the selection with Selecting a Patient from the M USE CV System D atabase W hen working with the M USE CV system database remem ber the following limitations It is not possible to search the database for a patient by the patient ID number k Patients can be admitted or deleted at the M U SE CV system database only t Patient data can be edited at the M U SE CV system database only Entering Patient ID with the Bar Code W and amp Click on the Patient ID text box k Place the wand on the recording at least 10 bars lt breadths to the left of the bar code Tilting the wand moderately drag it across the bar code at an even pace If necessary use a ruler as an aid 227 498 02 A CardioSys V4 1 31 Selecting and Admitting a Patient Retrieving Stored Examinations Select patient local database ix Search for iss Name Patient ID Last Name First Name Date of Birth Patient ID Select Miller Jan 06 04 1943 65498 Or Richards Chantal 03 12 1977 7766699 Roberts Jennifer 07 27 1977 543876 Shields tual 11 11 1912 765321 Stevenson Robert 11 22 1966 333999 New Patient Thompson Anthony 09 19 1932 665544 next page Delete Unnamed leader Cancel Close r New Patient C Last Name Master FirstName Jim Patient ID 8738999 Date of Birth 10 05 1949 MM DD Gender Male Height 176 in Race x Weight 66 0 Ib Pacem
34. fying onset 6 and offset 7 of the Q RS complex set by the program as well as the resulting measured values 4 The H FLA threshold is a dashed line and the H FLA duration is displayed with a different color k The signal size can be changed with the buttons k The sweep speed can be changed with the but tons Furthermore you can correct the position of QRS onset and offset as follows k Position the cursor on the upper portion of the caliper and press the left mouse button when the cursor turns into a double headed arrow pointer Holding the mouse button depressed drag the caliper to its new position and release the button The corrected values corresponding to the new caliper posi tion appear in the right column 4 of the table CardioSys V4 1 227 498 02 A Late Potentials nT RMS Patient Procedure System Services Help pE mA ad F Baker Dave 4 MASAE RM S 40 ms mean voltagein uV within the most recent 40 ms of the Q RS complex Test Summary 100 mp 20 mm mV X bees Stirs ee Vector Medians i i 1 Interpretation Displaying O ther Report Pages You can display the other report pages either by paging through the report or by accessing them directly amp Click on or to page forward or backward through the report Figure 4 6 6 T able of contents of the
35. k With the check box next to ST values you can select x or deselect display of the ST values 114 CardioSys V4 1 227 498 02 A The Exercise ECG Reviewing the Final Report QRS Morphologies Patient Procedure System Services Help Meal ttle io eae b af _ 2 I 7 QRS Morphologies AlE DAE T he system can save up to 10 different Q RS templates and display them in all acquired leads If more than 10 templates mm Lar i ar o n are encountered in the course of an exercise tes the oldest one A h which occurred infrequently will be overwritten Figure oar o 4 2 35 Above each template the display MOWSME overall WA number of beats belonging to that category incl PVCs The number below indicates the PV Cs only vee ea a eee k Use and to shift the columns to the right Bo ay m and left Figure 4 2 35 QRS M orphologies k Use fl and gj to display the other leads of the same templates 227 498 02 A CardioSys V4 1 115 The Exercise ECG Reviewing the Final Report ECG Strips eat te 10 0mm mv e gt 25 mm s 5S E Figure 4 2 36 ECG recordings 4 x 2 5 s 116 CardioSys V4 1 ECG Strips This document shows the ECG traces as recorded with the selected recording interval or with the setting at the ergo meter Up to 3
36. take less time Cover Page Check to print a cover pagein portrait format CardioSys V4 1 227 498 02 A The Exercise ECG Printing an Exercise Test Report 247 Episode 9 3 16 Episoye 10 Name Dave Baker EXERCISE TEST Arrhythmia Review Name Dave Baker EXERCISE TEST QRS Morphologies Date of Birth 05 05 1955 41 yrs Patient ID 1726712676 Date of Birth 05 05 1955 41 yrs Patient ID 1726712676 Male Caucasian 145 0 Ib 79 in Page Male Caucasian 145 0 1b 79 in HE l QRS 494 28 ves 0 28 E coche v 0870571996 10 14 22 10 mm mV 25 mm s 20 Hz Spline Physician Dr Williams Technician Dorothy RN 08 05 1996 10 14 22 10 mm mV_25 mm s_ 20 Hz Spline Physician Dr Williams Technician Dorothy RN Figure 4 2 45 Arrhythmia review report page Figure 4 2 47 QRS morphologies report page EXERCISE TEST ECG Strips Patient ID 1726712676 EXERCISE TEST Sample Cardiac Cycles Name Dave Bal Date of Birth 05 05 19 Patient ID 1726712676 Male Page 2 in 200 _P Bruce Rest ECG 0 0 km h 85 BPM P Brice Bruce ruce R Bruce T ARPT PPT TP wh Tys Rest ECG Stagel Stage2 Recovery 2 00 3 20 4 49 5 44 fi i 85 BPM 85 BPM 89 BPM 85 BPM 135 80 mmH METS 1 00 METS 1 00 METS 1 00 METS 1 00 e ar e a EE Afam sian Hane STH b d mv 5
37. ter runs idle v O n the setup screen section 4 2 7 select the ERG S ergometer k If you wish to obtain a recording at the end of each load stage only set the ECG Rec Inter El to 00 00 min X Select a protocol Click the lt gt button W ait until the first ST measurement is displayed option 18 Figure 4 2 10 Astrend values are saved at 30 second intervals we recom mend that you wait approx 30 seconds before starting to pedal Ask the test subject to start pedalling Window 2 in Figure 4 2 10 indicates the remaining time in the current stage while window 1 shows the time elapsed in that phase During the test you can lt Modify the load at the ergometer k advance to the recovery phase with k terminate the test with f Pre Test Test Phase Recovery Phase Adjust initial load and load increase stage of selected protocol Test Information Prot 1 af gt Pedal Q Select protocol Check recording interval When analyzing ST segment wait for 1st results to be displayed Interactive load changes only at ergometer with M700 only for user defined protocols Figure 4 2 15 Program quence with MEDITRONIC M 700 ERGOCOMP EC 1200 227 498 02 A CardioSys V4 1 99 The Exercise ECG The Elements of an Exercise Test i gt Thetreadmill can be stopped at any time with the em
38. theapplied electrodes and the signal quality 4 Further 4 Applied electrodes more an arrow 6 points to the leads which are impaired green properly applied by improper electrode application or which cannot be ydlow not properly applied recorded due to disconnected electrodes or dueto a white ste not used break in the patient cable red dectrode off or lead break 5 For selection of the lead sequence theselected lead sequence 5 6 Leadsimpaired by poor sgnal quality 7 Calibration pulse theselected sensitivity the 1 mV calibration pulse 7 is valid for all channels I amp The applied electrodes are shown on the torso only This program allows you to select specific system settings for the Standard and CABRERA lead se similar to a conventional ECG recorder You can enable or quences In all other cases there is only a sche disable muscle and AC line filters select different sweep matic representation of the electrodes The refer speeds and sensitivities etc Furthermore you can set up the ence electrode R red must be applied for the system to suit your personal needs and preferences T hese settings will be retained and are activated each time the systen isturned on section 4 1 7 Setup lead check function to work properly 52 CardioSys V4 1 227 498 02 A The Resting ECG Recording A Resting ECG oe Sang ade tel from te salpina nil be o Click to display the system settings
39. 0 12 0 90 V6 36 28 20 0 05 0 70 0 11 0 03 0 01 0 15 0 20 Figure 4 1 23 M easurenents results obtained with the H EART measurement program 227 498 02 A CardioSys V4 1 61 The Resting ECG Evaluating the ECG Reanalysis Patient Procedure System Services Help eo Hellige z mo F i T a lae 2 e T f Select Reset Measurements Return ECG Analysis E 174 ms 175 ms 132 ms 132 ms 4 1 4 4 Figure 4 1 24 Thereanalyss screen 1 activelead highlighted i gt If the program was unable to locate the begin ning and end of the P wave eg in the presence of atrial fibrillation the reference marks will be dashed In this case the user can click on them with the right mouse button and drag them to the appropriate position T he user selected marks are solid instead of dashed It is possible to restore the original position of the reference marks by double clicking on them 62 CardioSys V4 1 Reanalysis H EART ECG M easurement Program amp Click to call up the reanalysis screen Figure 4 1 24 H ere you see the medians of all leads superimposed T he reference marks determined by the system are located below the ECG baseline those above the baseline can be moved with the mouse A
40. 02 A Late Potentials gt E Patient Procedure System Services Help he i io S a 2 N er Dave 4 Q Test Information Freeze Traces BR Setup Reset QRS 4 t frommimy e gt 2smms 100 QRS 43 1 7 uV Corr Beats 200 SYS DIA mm Hg Corr Beats Noise lt 1 0uV e fl nf Y fin fren fanfare nf nfrenfiinfre Il ae ead Sequence gt lt HFLA Treshold uV 40 XYZ uncorrected Figure 4 6 4 Late potential dgnal acquistion screen ts After every fifth correlating QRS complex the program checks whether the signal noise lies below the limit If so sgnal averaging is terminated even when the set number of QRS complexes has not yet been reached 227 498 02 A Performing a Late Potential Analysis amp Click on to initiate the analysis The signal acquisition screen shows the percentage of correlating beats the selected noise limit in V thenumber of correlating beats abar graph representing the acquired correlating beats as a percentage of the necessary beats You can display the test information screen with exit You can stop the 2nd and 3rd ECG trace with Freeze traces You can enable and disable the 2nd row of control buttons with aa You can display the setup menu section 4 6 5 with You can reject the correlating QRS complexes summed up so far and start over wi
41. 1 19 General Information on System Operation Ee When entering text via the keyboard use the key to move from text box to text box This will save time as your hands can stay on the keyboard all the time Figure 2 1 M ous buttons 2 1 Operating the Program with a Mouse All operating steps required to run the program can be per formed with a mouse T he screen layout permits swift pro gram operation and text entries via the keyboard have been reduced to aminimum T he system allows you to create libraries for various situations which you can copy from the list to the respective text boxes in a dialog window using the mouse If you are already familiar with the functions and handling of aPC mouse you can skip this paragraph Some G eneral Remarks on the PC M ouse An arrow or mouse pointer appears on all screens This mouse pointer moves around on the screen as you move the mouse on the table Sliding the mouse to the right for in stance shifts the pointer to the right The program can be used with a two or a three button mouse Figure 2 1 T he buttons are operated with the index finger and the middle finger T he left button index finger controls almost all functions while the right button middle finger is seldom used 20 CardioSys V4 1 227 498 02 A General Information on System Operation g Patient Procedure System Services Help i I S a 2 a HR BPM Test
42. 137 Reting ECG aust cise cesieattparigteeteav avai dsredeans intake 79 SPIMOMERY asihna oard ai 173 STAMME C Graner iae a A 154 Bronchodilation test ccccesssescesessseecssssesesseseeenes 169 Calibration puleaina 76 128 150 203 Card Teade apinaa ai aa 32 220 227 498 02 A CE MarkKiNO aoira aE ererrerr mcrrite 2 Chart paper lOQding a ccsicnnaa 17 Cleaning and disinfection Instrument surface sissssiesissisissiesisirsrsirinninrsins 233 Patient cable and Electrodes cece 233 Respiration flow sensor LF 501 wo 234 Clinical information sytem sssr 252 Combined report 0 ceesesesesssesceseecssssscessseseseetssetsseseeess 37 Comments entry during Exercise tests aececi 89 during REStING ECG sioiias taisni inoia gaias 51 Comp M edian Dutton oo cscesesesescssssseeesseseseteeses 106 Comparing examinations sssrin 68 Comparing tests SPIM EY iiaia aiaa ia 170 Compression of data cccsssssesssssssecsssseesssesesseesess 229 Configuration of test protocols Ambulatory blood pressure 180 Confirming test results 35 67 118 168 Connecting peripheral devices eneren 258 CONSUMADIES cinoo 248 Copying procedures to from storage Media 224 Correlation coefficient oe ceeeetee eect eeeeeetteeteees 203 Country SELLING eis steisavecsdesdsaubieaessectvasdstecdesiaasscedummecravers 220 CUDIC SPIING cece csseesccesessssesseessssssseesessees 78 126 153 240 Custom setup savgload siessen 231 CULO TEQUENCY o iiini sinnis
43. 227 498 02 A System Services Menu Remote T est Screen System C onfiguration Save Load Print For selection of the network communication protocol to savethe configuration to a floppy N ET BIOS possible only when working in a network instal to load the configuration from a floppy lation to print the configuration Remote C art Name D atabase D esignates the workstation in the network required for As soon as the storage capacity of the selected drive drops to a NETBIOS certain percentage the system displays a warning T he percent age can be entered in this window T est Patient temporary T his feature allows you to view recordings from a test patient for all test procedures T o avoid misunderstandings you must deliberately select this feature each time you call up the pro gram check mark in box Although the word TEST is added to the patient s name it is recommended for reasons of safety to open a new patient file and enter the patient name TEST Anti Aliasing of ECG Waveforms When this function is enabled ik the displayed ECG will be smoothed Enable T est Information Window When you check this box the test demographics window will appear automatically Enable Password Function U ser registration dialog appears at program start yes no Patient Selection prior to STAT ECG H ere you choose whether or not the patient selection window will appear when you start recording a STAT ECG 227 498 0
44. 4 2 38 Figure 4 2 27 Stored 12 leads to select another test protocol To do so click on the label of the current test phase Pretest in Figure 4 2 27 and choose the new protocol from the displayed list box The program will switch to the new protocol when it proceeds to the next phase this function is not possible with the following ergometer treadmill selec tions setup menu ERGA intern remote start EC 1200 227 498 02 A CardioSys V4 1 107 The Exercise ECG Reviewing the Final Report ue The full disclosure ECG takes up an enormous amount of the storage capacity therefore delete it as soon as possible i In the presence of complex ectopy it is advisable to record the full disclosure ECG METS Calculation V m min 0 1 grade 100 1 8 3 5 3 5 METS METS values are interpolated between two stages T he full METS value of atest stage is attained after the test subject has exercised for a period of 2 minutes in that stage 108 CardioSys V4 1 Reviewing the Final Report At the end of the test you will be informed whether complex ectopy has been identified and given the opportunity to delete or store the full disclosureECG If you made the recording without assigning it to a patient Unnamed you can enter a patient name now ka When you click on Yes or No the T est Summary will appear T he complete exercise test report includes the fol
45. 4 2 56 The corresponding values will be displayed at 3 Figure 4 2 56 k Click the value to be modified and type the new value you are free to leave entry boxes open and to delete values k Having made all necessary changes click to clear the window or click the next stage to be modified lt If you wish to add a stage click below the last stage k Enter the new values as described above k Enter a name for the phase and click on to clear the window A test stage suitable for inclusion in atest protocol must comprise the parameters speed grade and stage time You may add any number of stages that consist of a recording interval and a BP interval only Stage names are adopted only when they include all required parameters Upto 120 values can be entered irrespective of the number of stages Blank entry boxes will not be counted 227 498 02 A The Exercise ECG Exercise Test Defaults if your system isnot equipped with a BP monitor and you do not wish to be prompted for a BP measurement set the BP interval for all test stages in thelist to 0 I3 If the basic load or load duration is missing for one of the square wave or treadmill tests the system will skip this stage during the actual stress test Ergometer T readmill Allows you to select the e gometer treadmill mode used for the test Port Allows you to select the communications port to which the ergometer t
46. ECG analysis or not Report M odify H ere you determine the scope of the report printed with the Print after Analysis command T he special configuration screen is described in detail in section 4 1 6 Printing the Resting ECG 40 H z Filter enables or disables muscle filter muscle filter on 50 H z 60 H z Filter enables or disables AC filter m AC filter on Spline Enables or disables the Cubic Spline algorithm automatic baseline correction i Spline on the algorithm causes a signal delay of 4 seconds On the signal acquisition and control screen the algorithm can be disabled temporarily to view the undelayed ECG signal CardioSys V4 1 227 498 02 A The Resting ECG Brief Operating Instructions 4 1 8 Recording a Resting ECG Brief Operating Instructions Turn on system and display the resting ECG screen Enter new patient or retrieve patient from the database A Apply electrodes and check signal quality oK Enter test information m Select procedure parameters sweep speed sensi tivity lead sequence Watch ECG traces and when the most recent 10 seconds are without artifacts start recording Save procedure when patient data were entered the system saves the recording automatically TheECG traces are displayed Scroll through the procedure report pages or call them up directly from the table of contents Print the ECG Proceed to next procedure or B Q uit program 22
47. Information Freeze ECG Options 8 5 Setup X 50 HZ 4 to mmm gt f mm s SYS DIA mmHg T Mla AN z UM MG KE o7 Q aVL V5 STANDARD 4 aVF V6 Spline ON aVR V4 fl Lead Sequence Figure 2 2 Scren with operating controls Select Procedure Patient Baker Dave 41yrs Procedure all 4 Status all la Location Date from to S Show new procedure list 12 04 1996 03 38 17pm 12 04 1996 12 04 1996 12 04 1996 11 20 1996 Display Confirm Send Combined Report 4 ae Cancel BS 0 Exercise Test 03 29 24pm x0 Exercise Test 03 10 13pm 0 Exercise Test 1 03 00 11pm 0 Exercise Test 10 53 39am 0 Exercise Test Figure 2 3 Excerpt from the procedure list 1 movesthe lig down line by line 2 moves the list up line by line 3 allows you to scroll to a general location in thelist 4 clears the window without saving entries 227 498 02 A The icons displayed on the monitor screen resemble the operating controls on a conventional ECG recorder Figure 2 2 To select a function you place the mouse pointer on the respective icon and press the left mouse button You will see that the key on the screen is pressed at the same time Pressing a mouse button is also called clicking When later on in this manual you are asked to double cl
48. O f course you are free to call up any spirogram section 3 3 Editing Stored T ests and compare it with any other spirogram as described below A window will open listing all of the patient s spirograms Figure 4 4 14 k Select a spirogram Xe Click L You will then see a report screen showing the respiration curves and parameter readings from both tests Figure 4 4 15 At the top of the screen you will see the most important results from both tests Click on and to display the other report pages 227 498 02 A The Spirometry Test Setting up the Spirometry System Setup Equation for Normal Value Calculation ECCS C Austrian r Local Settings X Automatic printout after test Enter Ambient Conditions for Spirometry Tests Atmospheric Press 800 1090 hPa 1013 Hl Rel Humidity 10 90 70 lt Resp Air Temp VC Test 30 37 C 31 lt Resp Air Temp FVC Test 30 37 C 34 j Spirometry Sensor Interface com3 4 OK Cancel Help Figure 4 4 16 The stup screen I Check the ambient conditions The program needs these values for the BTPS correction Body T em perature Pressure Saturated i e the values are referred to an ambient pressure and saturation with water vapor at a body temperature of 37 C For BTPS correction click the arrow button to the right of the respective value arrow up selects
49. TCP IP isinstalled and selected System Services gt System Configuration gt Remote T est Screen 134 CardioSys V4 1 I amp S When data are lost while transferred via the net work slow PC you will be alarmed by a red bar 227 498 02 A The Exercise ECG Using the Function Keypad new fient Start exerc se tie paten Start reco y BERR S eo som defaults st so Sit ss window Figure 4 2 59 T he function keypad 227 498 02 A 4 2 9 Using the Function Keypad Start the program Press new patient or retrieve patient 1 and enter the patient data Start the test with D gt Start the exercise phase with 2 start exercise and ask the patient to start pedalling or start the treadmill with start 5 N ow you can Advance to the next stage next stage 5 or continue at the same stage hold stage 5 Start and stop the treadmill with STOP treadmill and start 5 Increase or decrease the speed load speed 5 Increase or decrease the elevation of the treadmill belt grade 5 Display and review the ECG strips stored ECG 9 Press close window 11 to clear the window from the screen Enter BP readings and comments BP comments 7 Press close window 11 to clear the window from the screen CardioSys V4 1 135 The Exercise ECG Using the Function keypad
50. Test Defaults Page 1 Figure 4 2 50 Speed mm s selects the trace sweep speed Gain mm mV selects the signal size amplitude Lead C heck noise level This is a measure of the quality of the acquired signal signal to noise ratio When there istoo much signal noise at the electrode the electrode is displayed yellow on the signal acquisition screen T he setting that you select here low middle high changes the threshold as of which the electrode is displayed yellow high sensitivity to noise low threshold I Please remember that a filter may also suppress diagnostically relevant information as it limits the frequency bandwidth Therefore you should not switch the filters on indiscriminately Filter Enables or disables muscle filter none 20 H z 40 H 2 50 60 H z Filter Enables or disables AC filter x AC filter on Spline Enables or disables the Cubic Spline algorithm automatic baseline correction i Spline on the algorithm causes a signal delay of 4 seconds On the signal acquisition and control screen the algorithm can be disabled temporarily to view the undelayed ECG signal 126 CardioSys V4 1 Save full disclosure EC G Enables or disables continuous storage of the incoming ECG which can be edited retrospectively and deleted for instance to save storage capacity The max storage time is 30 minutes Blood Pressure Limit sys H ere you enter the max systolic blood pressure When dur
51. a 203 Data DAC UP irai a a deed 254 Data compress ONS meias aaia 229 CardioSys V4 1 265 Index D ata export Ambulatory blood pressure 182 Exercise teanen anaia 110 Late potential Srini p 198 Resting EC G iste scatiintins aiid a e a En 60 SPIONE uaina cedar E AT 168 Data transer iusan a iaa 218 Diab TONM aE s aoe i A E 220 Defibrillation ane a e 260 Daging pai iSi 30 D LING tets imasi nnno aa 38 209 Disinfection S Cleaning and Disinfection Displaying EC G Siarusiiiseai minesinin i iiai 55 Displaying tesisinin niiae ie mi 35 EC Declaration of Conformity siir cece 263 ECOS assis divsiaatsiantsastvisinaeseidiiddan aientinuaiiess 171 ECG Interpretation exercise test crnce 118 ECG measurement esisiini asinina 57 ECG Iipr a aa aas 116 Editing tored testSinus itii aa a 33 Electrode application Application tips inaa 259 Exercise testaa a a a ites 83 Late Potentials eset eniai 192 Resting ECG ivevessee diieiesdies ats da csrandetiaspenanianeneien 43 46 STATEC Gav prcrieat Feta ettetiatanciie E 142 Evaluating the resting ECG ween 54 Evaluation Ambulatory blood PreSSUre tceeeettetetenee 186 EXON CSO LOSE E A AA 81 Er LEE E E E E E E 91 with ERGO COMP EC 560 ECB 561 eee 96 266 CardioSys V4 1 with ERG OLIN E 900 900L iniiiiiiizisiiinas 96 with M700 EC 1200 inaani 98 With MEDITRONIC M 40 vuccsccccsesssesssecssseeceesesees 95 with MEDITRONIC M 400 sses 93 with treadmills sanoutui 100 Exercise test control SCreen
52. a higher value arrow down selects a lower value The respiration flow sensor meas ures the ambient temperature so you don t have to enter this value manually 227 498 02 A 4 4 7 Spirometry System Setup Before running the first spirometry test you will have to select several system settings from the setup menu T hese settings are saved and loaded automatically on power up Click to display the defaults screen Figure 4 4 16 First you choose the equation to be used for calculation of the normal values for patients between 18 and 80 years of age either ECCS European Community Carbon amp Steel or the Austrian equation for patients between 7 and 70 years of age If the patients are older they are assumed to have the maximum age H aving selected the ECCS equation the normal values for patients between 7 and 17 years of age will be calculated according to Quanjer and T AMMELING T hereareno normal values for patients lt 7 years Patients between 18 and 25 years of age are evaluated like patients of 25 k Select an equation by clicking the button k Eventually check that the correct interface has been selected T o change the interface click the arrow button E then select the appropriate interface name k Click to terminate the configuration session CardioSys V4 1 171 The Spirometry Test Printing a Spirogram Pineere 4 4 8 Printing a Spirogram Procedure Date 08 07 1994 10 32 38
53. all leads are displayed together on one screen Figure 4 1 22 T he reference marks are shown as well You are free to per form additional measurements as on the zoom display With the 4 4 buttons you can change the signal size default 20 mm mV Figure 4 1 22 M edians 1 Button to change the sgnal ze 2 Button to display the measured values 3 Button to display the reanalysis screen Measurements Hellige e amp Click to display the measured values F igure System Services Help a kA it oa eea amp 4 1 23 un DMAE a ci i i y ci E k Click to display a screen which allows you to R 102 ms P 122ms NB 12 roe Po ice a a a a ae oe adapt the analysis criteria to your needs Figure 4 1 23 QTC H 522ms PP 700 ms E Be ween PQ 178ms Sokolov1 83 mV s aVF Intervals ms Amplitude mV mV s Q Rs Rp P Q R Ss R v J ST T ST I 26 62 50 0 18 0 11 0 90 0 08 0 06 0 09 0 38 I 26 44 16 0 11 0 09 0 33 0 05 0 05 0 08 0 07 Ml 28 74 16 0 08 0 16 0 96 0 05 0 01 0 07 0 15 aVR 18 42 8 0 11 0 06 0 49 0 06 0 05 0 07 0 23 aVL 28 68 54 0 12 0 14 0 90 0 06 0 02 0 07 0 17 aVF 26 76 16 0 90 0 08 0 59 0 01 0 03 0 07 0 12 V1 26 56 14 0 14 0 12 0 71 0 10 0 13 0 37 0 07 v2 46 30 32 0 90 0 98 0 73 0 15 0 30 1 03 2 95 V3 42 34 26 0 07 1 27 0 90 0 09 0 16 0 66 1175 v4 40 44 26 0 09 1 31 0 71 0 00 0 09 0 28 2 00 v5 38 42 22 0 05 1 03 0 32 0 01 0 02
54. by clicking on the list box T hen you can select the desired setting For TONOPORT IVa you can also specify the length of the ECG strips 0 to 10 s and whether an ECG strip isto be recorded for every every second or every third blood pressure measurement I The storage capacity for ECG stripsis limited the longer the strips the less strips can be stored 232 1 second strips or 23 10 second strips k Select to clear the setup menu 227 498 02 A Ambulatory Blood Pressure Measurement ae Hellige Patient Procedure System Services Help T i oo aaea N Baker Dave 4 Ambulatory Blood Pressure Recording Setup Programming Download data Date Time Clear Patient Monitor Status Data stored in patient monitor Date 07 12 1995 Time 14 11 59 Period from to BP Interval min Defl Rate Infl Press QTY 1 07 00 00 21 59 00 exact 30 4 200 30 2 22 00 00 06 59 00 exact 30 4 200 18 Duration 24 00 h Number of BP Measurements 48 Number of ECG Strips 24 ECG Strip Length 3s Ratio of ECG strips to BP measurements 1 2 Figure 4 5 6 Signal acquistion screen D ownload data button Test Summary Brot tle Io lie 5 af 2 E E aE S g Test Information Statistics Intervals Recording eriods Patiefit Data Reason fcX Test Date 07 12 1995 11 19 36 Age 41 years Tot
55. connector defib protected AHA Adhesive electrode for babies 13 mm diameter with 4 mm connector 60 cm lead to be attached with adhesive rings 927 224 00 Adhesive electrode for children 22 mm diameter 4 mm connector to be attached with adhesive rings 217 123 01 Adhesive electrode for children 22 mm diameter with press stud connector to be attached with adhesive rings 217 123 01 Adhesive electrode for adults 35 mm diameter with press stud connector to be attached with adhesive rings 217 123 01 Adapter for electrode with press stud connector to patient cable with 4 mm connector Limb lead electrode for adults stainless steel plate electrode 31 x 40 mm with 4 mm socket 247 Equipment 301 340 00 923 096 47 217 194 01 217 196 01 217 144 01 217 144 02 919 202 32 9033 015 9623 003P 9490 210 Button shaped electrode for adults 30 mm diameter with 4 mm socket Rubber strap for attachment of electrodes 504 648 56 and 301 340 00 Chest electrode for chest belt 30 mm diameter with 4 mm socket Chest strap for electrodes 217 194 01 and 301 340 00 Chest suction electrode 22 mm diameter small suction ball with 4 mm socket Chest suction electrode 22 mm diameter large suction ball with 4 mm socket Clamp electrode for limbs pkg of 4 electrodes red yellow green black Suction electrode small German silver Tab electrode SILVER MACTRODE plus 1000 electrodes C
56. daeaadeaadnes 253 Pacemaker patients ccccccscsssescsssssescssssssssesssseseeseseees 260 Password modification sisssrrrisiririereriririrrerirness 215 Patient cable connection EEE 1 A A E AI A AE E T 83 Reting ECG iudiciaria nnii 43 46 STATEC G anionini urrian die aeni a E 143 Patient data Edie a eee 30 31 EE MQOUING ees carecassawss seteasteahatasa cies A 32 Entering spirometry oo eceeeeetteeeeeeteteteeeeeteeeee 163 Patient deli OMa icsiaie i svecettiedescsnderiasesaaseadesav ceenteeetGaate 30 Patient retrieval from database cccccsescesscsescesssceeeeees 30 Patient Selection WINGOW ccccssscsssscssscssssessssssssessssasesseees 30 PerforMmanC tet coionnan N 15 Peripheral devices connection sesser 258 CardioSys V4 1 267 Index Physician See N ame Physician and user technician name entry wee 51 Printer driver installation oo cece 18 Printer Problems sinnata aa a 18 Printing the test report Ambulatory blood pressure 188 Exercise testiin ae 121 Latepotential Sasoien na 201 Resting ECG caii a A Aa 72 SOIFOMELIY cotairean aa i 172 STATEGG genuine E 149 Procedure list VIEW iiinoinioniiiiiasni annia 33 Programi CNG se tistscdetite desc a tlh waaatdenatnade tend 209 Programi Aa asin EEEN 24 QRS morphologies exercise test sccccesseceseeseeeereess 115 QT C calculai Onise 76 151 Quitting the program sssssessrssisrrssrssesresesrsrsrenerreres 209 ReandlysiS rona ai adaa 62 Reason for test A
57. ee en ee S tae Uy comer Re er es eee Co Figure 4 2 37 When the memory is full the system decides Arrhythmia Review oi EA A oe which episodes to overwrite observing certain priorities Figure4 2 37 Arrhythmia Review k U seka and to display the next two event epi as sodes Arrhythmic Events acc to priority learned QRS complex QRSL amp Click on to delete an episode asystole limit value ASYSTO ventricular fibrillation flutter VFIB nS k Use r and f to display the other leads of the record ventricular tachycardia gt 3 V PBs VTAC ings ventricular run 3 VPBs RUN ventricular couplet 2 V PBs CPLT k Click on lt 5 m to deselect the printout ECG pause of 2 missed beats PAU2 printout no ECG printout pause of 1 missed beat PAU1 ventricular bigeniny VBIG You can perform measurements on the ECGs as described for pacer error PERR the ECG Strips ventricular escape beat ESC premature ventricular contraction PVC gt Manually stored event episodes always have the pacemaker capture PCAP highest priority absolute pause limit value PAUA artifact A learn phase L not on the event window and no episodes full disclosure ECG only 227 498 02 A CardioSys V4 1 117 The Exercise ECG Reviewing the Final Report
58. evices EC 1200 Blood pressure intervals are valid only for external BP meters appendix section 6 BP meters must be connected directly when used with EC 1200 version 3 52 and higher They are controlled by the stage time T he BP intervals are ignored kb On the setup screen section 4 2 7 select ERGA for EC 560 ECB 561 ERG 900 for ERGOLINE 900 900L and EC 1200 V3 52 for EC 1200 version 3 52 or higher k With ERG 900 select the recovery phase recovery ERG 900 25 W 1 minute then 0 W only if you expect to do a low impact test The BP meter will then respond more promptly to the load decrease Select a protocol amp Click the lt button A blood pressure measurement is now taken automatically if configured W ait until the readings are available or until the first ST measurement is displayed option 18 Figure 4 2 10 As trend values are saved at 30 second intervals we recom mend that you wait approx 30 seconds before starting to pedal Ask the test subject to start pedalling Test Information Prot 1 4 lt gt Select protocol Check recording interval When analyzing ST segment wait for 1st results to be displayed Pre Test Test Phase Recovery Phase Pedal Hold Phase gt gt Automatic when last stage is completed or manual Figure 4 2 14 Program sequence with ERGO
59. five full breaths The recording area shows the volumetime curve expiration only and the table lists the parameter readings and percentage deviations from the normal values Click to initiate further measurements T he next curve is depicted with another color and displayed on top of the first one The best results for EVC and IVC which are not necessarily taken from the same test give VC max k Click Scale if you wish to change the curve size k Select Fvc Measure to measure the forced vital capacity You will see a screen similar to Figure 4 4 11 k Demonstrate the FVC procedure as well _asimation Start the procedure when the patient knows what to do k Check the nose clip isin place CardioSys V4 1 165 The Spirometry Test Running and Evaluating a Spirometry Test Click and ask the patient to inhale deeply through the sensor when the orange indicator at the sensor lights up T hen the patient should exhale as quickly and completely as possible and inhale again as deeply as possible Afterwards your patient may resume normal breathing This maneuver too must be concluded within 20 s of clicking J The program terminates the measurement when it does not detect a flow reversal within 4 s of two identified inversion points or after five full breaths The recording area shows the flow volume curve and the table lists the parameter readings and percentage deviations from the normal values The program also
60. if you do not want to transfer data to MUSE 5 Click radio button to transfer data to M U SE via a storage medium floppy disk select disk drive 6 Click radio button to transfer data to M U SE via the network 7 Entry fields for MUSE FTP server M USE version 5 8 Click radio button to transfer data to M U SE via a shared directory 9 Enter the directory names here 10 Check box if data are to be deleted on the local hard drive after transfer to M U SE 11 Check box to establish a modem connection 12 Enter or select the location and cart number 227 498 02 A System Services Menu System Configuration Option Code Tab If you purchased additional software options enter the option code s on this screen to activate the option s The code number is supplied with the purchase If the code numbers are stored on a disk insert the disk and Load The code numbers will automatically be entered in the appropriate field Figure 6 6 Option Code tab A If the Test Patient is enabled the software options can be activated with the code number 61237 227 498 02 A CardioSys V4 1 219 System Services Menu System Cbnfiguratjon aed hee ey Ge Se x heral Modefn MUSE Optjon Code ASA English 24 Hour Format Figure 6 7 Country Settings tab 220 1 Country Settings Tab On this screen you select all country specific system settings Enable or disable the Swedish patient ID
61. late potential analysis amp Click on 2 to display the table of contents and select report a document Figure 4 6 6 227 498 02 A CardioSys V4 1 197 Late P otentials Test Summary Patient Procedure System Services Help w SST Te BSS eA Eg Reason for Test Interpretation Medication Comment Physician Dr Williams Technician Dorothy Age 41 yrs Gender male Race Caucasian Height 178 cm Weight 75 0 kg Blood Pressure 130 80mmHg HR 60 BPM Number of QRS 100 Noise uV 1 6 RMS40 uV if QRS Duration ms 128 HFLA Duration ms 52 Figure 4 6 7 T et summary 198 CardioSys V4 1 Test Summary The test summary Figure 4 6 7 contains the following information Reason for T est from the test information screen Interpretation excerpt of the interpretation M edication from the test information screen Patient data M easured values If you wish to add or edit test demographics click on the icon to display the corresponding dialog window Data Export The icon allows you to export the most important data pertaining to the spirometry test to the clipboard or to any file D ata exported to the clipboard for instance can be inserted in a text file with the Edit gt Paste command Click E Select either Export data to clipboard or Export data to file k Clic
62. lead ST measurement automatic or manual determination of the J X point presentation of the ST medians presentation of the resting ECG complex and of the current ST beat for direct comparison arrhythmia analysis and presentation during the test Storage of the Full D isclosure ECG EGM O continuous storage of up to 12 ECG leads color coded arrhythmias any segment of the full disclosure ECG can be zoomed and stored Exercise T est Expert M ode ERG 3 optional presentation of ST level and slope in the form of abar diagram or ST medians with reference marks manual editing of the E J and J X points scrolling to previous stages during the exercise test direct cross referencing from trends to full disclosure ECG final report 227 498 02 A Introduction to CardioS ys In T est Reports EST A automatic or manual printout during the exercise test via laser printer or thermal printer report formats for laser printer medians 12 lead ECG approx 4 seconds report formats for thermal printer e 10 second segments of the 12 lead ECG in different formats e comparative medians 12 lead ECG e continuous rhythm 6 or 12 leads Late Potential Analysis AVER recording of ventricular late potentials recording of the standard vectors X Y Z uncorrected manual editing of QRS onset and offset D ata Storage on File Server N ET S storage of the procedure data on the network file server
63. leads X Y and Z To obtain these leads chest elec trodes C 1 C3 and C5 must be moved to other sites see below and all 6 electrodes must be carefully applied clean and degrease the skin at the application sites using benzine massage the application sites with EPICONT cream until the perfusion increases reddening of the skin useonly silver silver chloride electrodes after electrode application wait for about 5 minutes before acquiring the ECG signal Apply the electrodes as follows C1 onthe back opposite C2 signal across C1 and C2 Z C3 parasternal site below the clavicula signal across C3 and C4 Y C5 at theright opposite C6 signal across C5 and C6 X 227 498 02 A Late Potentials External Programs Te H ied D 2 m 8 ie Exercise Test a z m 3 ques Monitoring Right Heart Catheterization ra kad Holter ECG a aal lez o External Programs 4 ny 4 6 3 The Late Potential Signal Acquisition Screen The signal acquisition screen for late potential analysis is displayed with the Fas button which is located on the proce dure selection screen unless you have reconfigured the stand t Ad ard icon bar section 6 System Services M enu Ambulatory Blood Late Potentials Pressure mai Entering the T est Information faii Spirometry Bronchodilation k Click on to
64. li 4 AR200P local Aes m e a Figure 4 2 54 M odifying the lead sequence 130 lt Click the box or the arrow 4 to display all available leads Figure 4 2 54 S Select the new lead to be recorded in the respective channa k Enter up to 4 characters in the Label column to label the lead O nce you have assigned a lead to each of the channels you can enter a name for the lead sequence in the headline ka M ovethe cursor to the text box at the top and click ks Enter a name and click on to clear the win dow The Print Sequence column allows you to assign the ac quired leads to the printer channds Protocol A protocol comprises up to three phases T hese are the pre test phase the exercise phase and the recovery phase T he program comes with several preconfigured protocols for the various patient categories for instance BRUCE protocol In the Protocol window you select the default protocol specify anew protocol or modify existing protocols k Click E to open the window then select the protocol T he test phases of this protocol appear in boxes A B and C T his concludes selection of the default protocol CardioSys V4 1 227 498 02 A The Exercise ECG Exercise Test Defaults Modify Modify Protocol Protocol Bruce gt Phases Pretest M Ramping Bruce M Ramping E E e Ramping o Recovery P Bruce Bruce
65. of these documents includes them in or excludes them from the report check mark included T he length of each document and of the overall report is also indicated The Print button initiates the printout The save button saves the current settings Standard Page Figure 4 1 36 For the ECG display you can choose between continuous 10 sec first 5 second segment of the first set of six leads second 5 second segment of the second set of six leads or sync 5 sec sync 2 5 sec synchronized segments of all 12 leads the first 5 seconds or the first 2 5 sec onds 227 498 02 A The Resting ECG Printing the Resting ECG medians the dominant average beats medians will be printed continuous 2 5 sec 3 leads each of second 1 to 2 5 2 5 to 5 5 to 7 5 7 5 to 10 2 x6 ch 50 mm s 2 pages the first set of 6 leads from second 1 to 5 the second set of 6 leads from second 5 to 10 w o Arrhy 25 mm s without rhythm strip w o Arrhy 50 mm s without rhythm strip portrait the standard page is printed in the vertical portrait format H1 12 median complexes V 1 I1 V5 V2 V3 V4 H1 12 median complexes 1 II III V1 wie marae a V2 V5 ages tt etl ep e e e e D om M edian Subdom M edian Figure 4 1 37 T ERE RESEP TASEEN AM d You can print a page with the dominant average medians and mane ba T with the subdominant media
66. other place You may also add any comments Furthermore you can record a spoken comment using the icon provided that a sound card has been implemented in your system and that you have a microphone T his comment will be saved to the corresponding patient file It can be played back by click ing the i icon The interpretation is shown to be confirmed only after it was signed by a physician fka k First select the information to be displayed the program measurements or the statement library Figure 4 1 27 k If you wish to copy phrases to the right highlight the respective passages then click gt f k To enter text directly into the window on the right move the cursor to the desired position click the mouse button and type the text 227 498 02 A The Resting ECG Evaluating the ECG a ient Procedure System Services Help Pati Beale Io et b n gt _ 2 A because QRS angl negative T wave I beceuse Tee 0 1 Physician ar x R S inversion area Cancel L 1 a Dave 4 preta eZ A e Eire ea e te eo alee C Measurements Summary g Statement Library Interpretation suspected left ventr hypertrophy because R S in Revije minor left axis devil Figure 4 1 28 Interpretation screen with confirmation window and ECG 1 Displayst
67. s 2 93 MIV50 l s 3 28 hs MIV25 I s 2 63 144 MW l min 92 0 74 5 8 Figure 4 4 12 Report page 1 Button to call up the tet information 2 Button to display the volumgtime or the flow volume curve Ra ellige X Patient Procedure System Services Help pen M Bea te GS A E Baker Dave 4 pirome Display Te ormatio Male F 188 cm sa E K c J Interpretation Miller Sq 0 Normal Values ECCS Ph ia Interpretation Value Norm Act EVC 2 68 3 14 117 FEVC 2 63 2 93 111 FEV1 I 2 25 257 114 FEVI VC 81 0 76 0 94 PEF I s 5 86 5 62 96 MEF75 l s 5 35 5 56 104 Reason for Test MEF50 l s 3 76 5 25 140 Respiratory problems MEF25 l s 1 61 1 94 120 Shortness of breath ut fia 3 34 4 23 127 S 2 68 3 34 125 FIVC I s 2 63 3 28 125 FIV1 l s 2 23 2 61 117 FIVI IVC 78 0 Medication PIF l s 3 48 MIV75 l s 2 93 comment Om MIV50 W s 3 28 Physician Dr Williams MIV25 I s 2 63 Technician Dorothy MVV I min 92 0 74 5 81 Figure 4 4 13 T et information 227 498 02 A Ye Click to terminate this part of the test and display the report Figure 4 4 12 amp Click to display the test information screen Figure 4 4 13 The test information screen shows the reason for test the interpretation made by the program the patient data medication comments physician techn
68. s 4 t 4 20 a 4 ECG Strip Length 0 to 10 s 0 none 3 s Tok Ratio of ECG strips to BP measurements 1 2 4 Help Number of BP Measurements 48 Number of ECG Strips 9 10 ECG Strip Length JS Ratio of ECG strips to BP measurements nee Figure 4 5 5 Protocol configuration menu 1 Number of BP periods Protocol name Beginning and end of period 1 BP interval period 1 D lation rate period 1 Cuff inflation pressure for initial measure ment period 1 7 Number of measurements taken during pe riod 1 8 Daailsof period 2 9 ECG Strip length for TON OPORT IVa only 10 Ratio of BP measurenantsto ECG recordings for TONOPORT IVa only nM A WwW VY 227 498 02 A In order to view the setup of the recording unit for a specific protocol click on mouity You will then see the setup win dow Figure 4 5 5 showing all the relevant data see Configuring Protocols below Click on to clear the window t Click on ok or cancer to clear the window te Click on bemm to verify the date and the time To correct the displayed values highlight the numbers and enter the correct value g Click on _Prestamming If the date and the time of the recording unit differ from those of the PC they can be corrected via the function This completes the setup of the recording unit k Turn off the recording unit and disconnect it from the PC X Connect it to the patient pl
69. sensor after each measurement This applies on the condition that the patient does not suffer from infections of the respiratory tract and that not more than 15 respirations are measured on the patient W hen atest is performed on a patient with a manifest or suspected infection of the respiratory tract cleaning and disinfection of the sensor is imperative For average use of the sensor i e up to 5 tests of patients with no infections of the respiratory tract per day it is suffi cient to clean and disinfect the sensor once a day Even when the sensor is not in use we recommend that it be cleaned and disinfected once a week The Respiration Flow Sensor LF 501 does not require routine maintenance 234 CardioSys V4 1 227 498 02 A Cleaning Disinfection and Maintenance 7 4 Maintenance Checks Before Each Use Visually inspect the system all cables and electrodes for signs of mechanical damage before each use If you detect defects or malfunctions which may impair the patient s or the user s safety the system must be repaired before being used again T he system does not require other regular maintenance 227 498 02 A Technical Inspections For safety the devices require regular maintenance To ensure functional and operational safety of the system technical inspections should be carried out annually T hese inspections should be referred to independent persons with adequate training and experience
70. table in the top right hand corner lists the time intervals You can perform the same measurements as on the zoomed display amplitudes intervals slopes The amplitude of the cursor position is continuously displayed in the top line of the table For areanalysis of the ECG you can change the following settings You select the leads from which the average beats for determination of the measurement marks are to be derived and which are superimposed soea J From these leads you choose one whose median complex isto be highlighted buttons 4 und m You move the reference marks above the baseline to any desired position mouse You perform a reanalysis Eca anaiysis_ You cancel the reanalysis results Rea J 227 498 02 A The Resting ECG Evaluating the ECG 227 498 02 A First select the leads from which you want to derive the median complex for determination of the reference marks Only those beats will be superimposed ke Click saa 7 A window opens showing all leads Select the leads check mark lead is selected Click to clear the window Click the arrow button or yj to select the lead to be highlighted 1 Figure 4 1 24 T he measurement marks can be moved as follows Position the cursor on the mark to be moved above the basdine k Click the mark and holding the mouse button de pressed drag it to its new position N ow release the mouse button T he ti
71. this matter please con tact M arquette H ellige G mbH or its representatives 227 498 02 A CardioSys V4 1 T he system comes pre installed and is ready for operation All connections for system components and peripheral devices including the patient cable are located under the lid 12 which can be opened with a tool only The program is a Windows application Its scope can be expanded by activation of individual optional programs T his manual describes the program with all options included If you have not purchased one or the other option simply skip the corresponding sections Being familiar with PC programs may be a hdp but in this manual you will find everything you need to know about using a mouse and aPC keyboard Whenever you are unsure about a program function or oper ating step just click on the H elp button to obtain online information Access to the program is restricted to registered users At the time a user is registered the password and the user s rights are assigned user physician with or without the right to make system changes Introduction to CardioS ys 1 3 For Your Safety T he safety information given below is divided into the catego ries D anger Warning and Caution fk CardioSysisa class system Danger indicates an imminently hazardous situation which if not avoided will result in death or serious injury A Warning indic
72. via the table of contents or you can page through the report 227 498 02 A Ambulatory Blood Pressure Measurement Test Summary Graphics Hourly Averages Statistics Summary Day Time Night Time Wake up Time Interpretation S Click on a forward or backward to page through the report X Click on ea to display the table of contents of the procedure report and select the document you wish to see Figure 4 5 9 Figure 4 5 9 T able of contents of the ambulatory blood pressure report 227 498 02 A CardioSys V4 1 183 Ambulatory Blood Pressure Measurement Hellige Mi Patient Procedure System Services Help feat tte o ae 2 E oade f Ls Tabular sys BP 88 dia BP Error 21 HR 106 Date 30 08 1995 Time 07 54 48 300 HR BP 250 200 150 100 for eee i ALR LA ities 50 0 06 00 08 00 10 00 12 00 14 00 16 00 18 00 20 00 22 00 00 00 02 00 04 00 06 00 08 00 10 00 Figure 4 5 10 Graphic represntation of the BP values Tabular Hellige ki Patient Procedure System Services Help Meo ttle 9 ee 0 af _ 2 E 0 Return Betum Time HR sys BP dia BP mn BP Measuring Interva
73. 0 System Services M enu I amp S It isnot possible to save exercise protocols or test phases I Before loading a stored system setup you must save the setup currently active I When reactivating the factory settings the exercise test protocols and phases that you created yourself will be deleted with some ergometer models 6 6 Saving and Loading Custom Setups The program allows you to save setups and text libraries under a user or ward name and to quickly load these settings when ever needed exceptions to this rule are explained at the end of this chapter With this feature you can adjust the system to suit a specific user s requirements in a matter of seconds W hen running in a network environment the program settings including the factory settings can be called up at any connected station amp Click b the window showing the System Services opens Figure 6 20 k Click to save the setup and 7 to load a setup Save 1 Select the drive 2 In the Save As field enter the name for this setup 3 Click the sa button Load 1 Select the drive 2 Click on the setup name 3 Click the button to load the setup 227 498 02 A CardioSys V4 1 231 System Services Menu 232 The following parameters cannot be loaded saved or reset to factory settings exercise test spirometry ambulatory blood pressure system configuration
74. 0 ECG strips may be recorded T he data above the ECG are the corresponding workload and recording time The print formats 4 x 2 55 2 x 5s 1 x 5s are selected on the defaults screen T he format 1 x 5s consists of two windows showing two recordings side by side Formats 2 x 5s and 4 x 2 5s cont consist of only one recording The check box next to the printer icon indicates whether or not the ECG strip will be printed later on The default setting iSix amp Click on xi to deselect the printout ECG printout no ECG printout You can perform measurements on the recorded ECG as described in section 4 1 5 wU skal and to display the next or the previous recording ks Use and gj to change the signal size and and to change the sweep 227 498 02 A The Exercise ECG Reviewing the Final Report Arrhythmia Review Patient Procedure System Services Help Beal tel 95 ie 0 n gt 2 i Dave 4 If one of the events lised in the table on the left occurs during J 2 AECE the test the program records and saves a 5 second ECG 0 15 min Event 1 5 s 0 18 min Event 1 10 s e episode If multiple events occur this period extends by F SSN ON 5 seconds for each event Furthermore a 10 second episode is E yoyo recorded when you press the button during the m A test T he duration of an episode is also indicated a The system can save up to 20 episodes of 5 seconds each oF ae Rae
75. 08 05 1996 10 14 22 10mm mV 25 mm s 20 Hz Spline Physician Dr Williams Technician Dorothy RN mVs mVs 08 05 1996 10 14 22 10 mm mV_25 mm s 20 Hz Spline Physician Dr Williams Technician Dorothy RN Figure 4 2 46 ECG Strips report page 227 498 02 A Figure 4 2 48 Sample cardiac cycles report page CardioSys V4 1 The Exercise ECG Verifying the Exercise Test Settings Cancel Hellige ervices Help 1 P Bruce 50 25 03 00 5 03 00 Modify Bruce Test Information Lead Check Freeze ECG Interpretation Setup EventMark_ ST Medians ECG Strips Ad A 3 TO eel ee ae ae a e a a ae ee TUTE l 5 poor signal quality E altho mm m m s A ee ae ee ee Spline 50 Hz 6 Figure 4 2 49 Exercise tet control screen 124 1 2 3 a ul Selected protocol Control buttons Applied electrodes green properly applied ydlow poor sgnal red eectrode off or lead break white dectrode not used Leads impaired by poor sgnal quality Calibration pulse System settings 4 2 6 Verifying the Exercise Test Settings Clear the test information dialog window with to display the exercise test control screen The control screen Figure 4 2 49 shows the selected protocol 1 the applied electrodes and the signal quality 3 for the
76. 11 12 45 Resting ECG Seewen 10 08 1996 11 07 42 Resting ECG t 10 08 1996 11 40 18 Resting ECG leftaxisdd 10 08 1996 11 35 29 Resting ECG becaust becaust negative T because R S inversi OK Cancel gt e gt Figure 4 1 29 Window for selection of a reting ECG Hellige Patient ao System Services Help id H Mo ee fof o a Baker Dave 4 t Procedure 1 10 08 1996 11 32 51 QA T Procedure 2 11 07 1996 10 30 06 2 ah eek v EE Diz NE Il i d CEC or fore N 3 S mi En Tan it 50 He i e Lry s ary m y 50 ary i X Figure 4 1 30 Comparing two reting ECGs 1 Buttons to sect theECG leads 2 Procedure dates and times 3 Zoom button to display an enlarged ECG segment both traces superimposed 4 Buttonsto display the medians 68 CardioSys V4 1 4 1 5 Comparing Resting ECGs You can compare the following details of two resting ECGs the 10 second ECG themedian complexes dominant and sub dominant theinterpretation At the same time it is possible to compare the median com plexes of at least 3 and up to 6 ECGs Comparing T wo Resting ECG The system offers you to compare the present resting ECG with another one stored in the database For the example below we assume that you wish to compare the recent ECG with an earlier recording of the patient O f course you are free to call up any ECG section 3 3 Editing Stored Examinat
77. 12345 ian 145 0 1b 79 in jive Medians Report P Bruce 00 09 00 09 Total Time 02 33 1 7 mph 10 0 HR BPM 60 BP mmHg Rest Curent Beat ji 7 LAM d ei L 09 11 1996 09 51 09 10 mm mV 25 mm s 09 11 1996 09 53 19 Figure 4 2 22 12 lead report 2 x 5 5 Figure 4 2 24 Comparative medians report Tame Dave Baker Tr Lead Repon Date of Birth 05 05 1955 41 yrs Patient ID 12345 Male Caucasian 145 0 1b 79 in P Bruce 01 37 Total Time 01 38 HR BPM 60 Swine 01 37 0 0 mph 0 0 BP mmHg Ld dn Ta 09 11 1996 09 51 09 Figure 4 2 23 12 lead report 1x55 the sytem saves 1 x5 s but prints1x109 10 mm mV 25 mm s 105 227 498 02 A CardioSys V4 1 The Exercise ECG The Elements of an Exercise Test ST Medians v Exercise Test Baker Dave 41yrs 00 42 Pretest Phase gt gt 9 9 HR BPM 98 of 142 00 42 Supine Hold Stage gt gt 0 0 Start Treadmill eye BP Comment Freeze ECG Interpretation SYS DIA mm Hg Print Rhythm Event Wark sTiMedane ECG Sips t i 3 Stop Teamu ST Profile fa I Figure 4 2 25 ST analydsreults o Tens VPB PACE Level my It 5 20 40 L
78. 2 and the remaining storage time for the full disclosure ECG 3 theapplied electrodes and the signal quality 4 Further more an arrow 6 points to the leads which are impaired by improper electrode application or which cannot be recorded due to disconnected electrodes or dueto a break in the patient cable theselected lead sequence 5 click on to select another lead sequence theselected gain the 1 mV calibration pulse 7 is valid for all channels This program allows you to select specific system settings similar to a conventional ECG recorder You can enable or disable muscle and AC line filters select different sweep speeds and sensitivities etc Furthermore you can set up the system to suit your personal needs and preferences T hese settings will be retained and are activated each time the systen is turned on section 4 3 4 Setup From the setup menu you also choose the format for the in test reports 227 498 02 A The STAT ECG I gt The system can be set up to display the patient selection screen when the STAT ECG is acti vated i gt Please remember that a filter may also suppress diagnostically relevant information as it limits the frequency bandwidth Therefore you should not switch filters on indiscriminately I gt Settings selected from the setup menu will be retained and are automatically activated each time the system is turned on i
79. 2 765321 New Patient Stevenson Robert 11 22 1966 333999 Thompson Anthony 09 19 1932 665544 Delete next pages Unnamed age m height Le gender Close r New Patient es Last Name Master First Name Jim f f i Patientin 8738999 coco MEEA W ithout these data which are adopted from the patient file Gender Mae w Height fize in section 3 Selecting and Admitting a Patient the normal Race y Weight 66 0 Ib Pacemaker Accept P i values cannot be derived H eight age and gender are dis layed on the spirometry procedure screen Figure 4 4 8 Figure 4 4 9 Patient data screen per p yP Fig k If you wish to verify or modify these data click to display the patient data screen Figure 4 4 9 k Change height and or weight by clicking the respective box then enter the new value s via the keyboard k Enter the patient s gender by clicking the arrow and selecting the appropriate option Ta Sdect to terminate entry or modification of the patient data 227 498 02 A CardioSys V4 1 163 The Spirometry Test Running and Evaluating a Spirometry Test I Before each test attach a new mouthpiece with bacterial filter to the sensor Running a Spirometry T est Before conducting the first test specific system settings should be selected from the setup menu section 4 4 7 Spirometry System Setup The test is conducted with the control buttons 1 Figure 4 4 8 You can measure the vi
80. 2 A CardioSys V4 1 213 System Services Menu Technician Password s Cancel Hell Figure 6 3 Dialog window 0 Only the supervisor is authorized to modify the user list User List Viathe user list you define the persons authorized to use the program and their rights k Click on the uens button to display the list of registered users technician physician privileges To register a new user amp Click on tens A user registration form Figure 6 3 will appear lt Enter the user s name or ID 1 In the Group list box choose the T echnician or Physician category 2 k Select the user s personel setup see 6 6 Loading and Saving Custom Setups 3 amp If you wish to assign privileges to the user check the appropriate box Checking Edit D ata means that the user is authorized to retrieve all stored procedures including the interpretative statements and patient data to modify them and to delete them Checking Configure System means that the user is author ized to configure the system 214 CardioSys V4 1 227 498 02 A System Services Menu Password 5 To change the user s password External U ser 6 System users who wish to receive test data from other stations must be registered as External U sers Furthermore the names and passwords of these users must be entered at the sending statio
81. 251 Appendix 2 Operating the Program in Conjunction with a Medical Reimbursement Program Clinical Information System CIS C ardioSys Soft is supplied with a special BDT interface which allows it to be operated in conjunction with a medical rambursement program or clinical information system Please contact the supplier of these programs to find out about the conditions for full compatibility W hen running the program in conjunction with a medical rambursement program the patient data file is handled by the rambursement program whereas the procedure data files are handled by the M arquette H ellige program C ardioSys CardioSoft n this case patients are selected via the raim bursement program T he patient s height and weight should be entered in the reimbursement program but they can also be added in C ardioSys C ardioSoft H aving selected the patient you choose the procedure to be performed T his takes you automatically to the M arquette H ellige program which is handled as described in this manual You can call up previous examinations of the selected patient and compare then or conduct new procedures but you cannot select another patient To do this you have to quit the examination program first Then you can choose a new patient in the rambursement program After the procedure and quitting the examination program the most important procedure results not the signal traces are transferred to the reimbursemen
82. 27 498 02 A Technical Specifications Environment O peration ambient temperature between 10 and 40 C rel humidity between 30 and 75 atmospheric pressure between 700 and 1060 hPa Storage and transport ambient temperature between 30 and 60 C rel humidity between 20 and 95 atmospheric pressure between 500 and 1060 hPa Dimensions and weight height 1150 mm width 680 mm depth 825 mm weight 60 kg w o monitor and printer 227 498 02 A CardioSys V4 1 243 Technical Specifications For your notes 244 CardioSys V4 1 227 498 02 A Equipment 227 498 02 A 10 Equipment Subject to modification Always refer to latest list of accessories 10112106 CardioSysECG analysis system including system cart PC 15 inch monitor keyboard mouse standard software package and exercise test S software Accessories General accessories 227 498 02 Operator s M anual System carts 202 306 40 System cart 230 V version with pump for electrode application system incl Windows NT 4 0 language optional 202 306 41 System cart 230 V version without pump for electrode application system incl Windows NT 4 0 language optional 202 306 42 System cart 230 V version with analog output and pump for electrode application system incl WindowsNT 4 0 language optional 202 306 43 System cart 230 V version with analog output incl Windows NT 4 0 language optional CardioSys
83. 3 e a 06 00 08 00 10 00 12 00 14 00 16 00 18 00 20 00 22 00 00 00 02 00 04 00 06 00 08 00 10 00 Figure 4 5 12 H ourly averages of blood presure and heart rate Tabular Hellige M Patient Procedure System Services Help a heal eee T a le a 2 l i ee CAE Time Period HR sys BP dia BP mn BP 07 00 08 00 80 1 93 080 0 86 0 2 t 08 00 09 00 74 6 94 277 3 84 0 4 09 00 10 00 75 0 98 274 0 81 7 4 10 00 11 00 78 3 101 274 0 83 7 5 11 00 12 00 75 6 98 077 2 84 0 4 12 00 13 00 80 8 111 571 5 84 5 4 13 00 14 00 75 3 100 873 1 81 8 6 14 00 15 00 68 9 107 877 8 88 4 6 15 00 16 00 68 3 115 072 6 86 3 3 08 00 09 00 73 3 91 876 0 84 0 5 09 00 10 00 72 5 105 778 5 95 0 4 7 Figure 4 5 13 H ourly averages of blood pressure and heart rate 227 498 02 A CardioSys V4 1 185 Ambulatory Blood Pressure Measurement Statistics Summary eo Hellige E Statistics Summary Patient Procedure System Services Help ee iH I la a 2 N The statistics summary Figure 4 5 14 shows one histogram G Ra PE each for the systolic values left and the diastolic values Statistics Summary from 7 51 bis 9 46 2 day 47 Blood Pressure Measurement s ri ght as well as the frequency distri bution given i n percent Systolic Blood Pressure 80 8 0
84. 4 1 7 3 ECG Recording During Defibrillation The patient signal input is defibrillation proof T herefore it is not necessary to remove the ECG dectrodes during defibril lation W hen using stainless steel or silver electrodes however the defibrillator discharge current may cause complete polariza tion at the electrode skin interface T his will block acquisition of the ECG signal for several minutes T his can be avoided by using silver silver chloride electrodes If electrodes made of other materials are used we recommend disconnecting the patient cable from the recorder while the shock is applied Disable the C ubic Spline algorithm that would cause a signal delay of 4 seconds if defibrillation will be carried out during ECG recording section 4 2 7 ExerciseT est Setup E gt Useonly silver silver chloride electrodes for ECG acquisition to ensure optimal performance during defibrillation 227 498 02 A Appendix 7 4 ST HR Slope Value TheST HR slope was originally developed by Dr R J Linden at the U niversity of Leeds U nited Kingdom in the late 1970s It is reported to yield more accurate electrocardio graphic determination of the presence and severity of coro nary heart disease W hile originally applied only to bicycle ergometry testing it has recently been adapted for treadmill exercise by D r Paul K ligfidd and colleagues at Cornell U niversity T he criteria are based on the near par
85. 4 4 7 Editing the medication group I Simply press 1 on the keyboard to save the data and clear the window This brings up anew window where you can choose one of the group names Figure 4 4 7 t Click on the drug name box and enter the name g Click on to clear the window Entering Comments If you wish to enter acomment on the test procedure click in the Comment text box and key in the text Physician s T echnician s N ame The names of the physician and technician can either be entered here click in the text box and type the name or they can be selected from the list of the registered system users section 6 1 System Configuration amp Click on and choose a name from the list by clicking on it Exiting the T est Information Screen Once you have entered all test information you can either clear the window with OK or clear the window with Cancel in this case the infor mation will be ignored and is not assigned to the test to display the test control screen 227 498 02 A CardioSys V4 1 161 The Spirometry Test Running and Evaluating a Spirometry Test 5 4 4 4 Running and Evaluating a Patient Procedure System Services Help k kelt e a e E Spirometry Test s Test Information Sash Data A 150cm Male easure C easure Betu Interpretation Miller Sq Measure C FVC Measure _ Armato eS D T he Spirometry
86. 7 498 02 A CardioSys V4 1 79 The Resting ECG For your notes 80 CardioSys V4 1 227 498 02 A The Exercise ECG 4 2 The Exercise ECG This section describes the operating steps necessary to conduct an exercise test You will learn how to apply the electrodes and connect the patient enter the test demographics indication medication comments etc select a protocol and run the exercise test call up the report pages for on screen review print reports specify system defaults that will be activated each time the system is turned on monitor remote test stations conduct an exercise test using the function keypad T he brief operating instructions at the end of the section sum up what you have to do to record an exercise ECG 227 498 02 A CardioSys V4 1 81 The Exercise ECG Some Basic Facts Test Information Library Reason for Test ett Reason for Test History of chest discomfort Evaluate effect of medication Evaluate effect of CABG Evaluate effect of PTCA Evaluate functional capacity Stress echo study Stress thallium study Rule out confirm CAD Post MI study Protocol Target HR Bruce 4 100 180 min Blood Press mmHg oa go sys dia Medication a Ey Comment Physician p cance Technician p Help Referring Physician e Figure 4 2 1 D
87. 94 14 01 00 Info to personnel D o Modify Cancel Help Figure 6 9 List of tored voice recordings 227 498 02 A CardioSys V4 1 221 System Services Menu mm Hellige Patiant _Dranadura i E Standard Categories Category Personal note gt gt Doctor s letter Referral Info to telephone switchboard Info to staff Private Modify ci ol Cancel th Help Figure 6 10 Voice recording window 222 Recording N ew C omments M odifying Existing Comments amp Click to record anew comment The voice recording window appears Figure 6 10 The Standard C ategories box contains up to 6 categories or head ings for standard texts that you may want to record To copy one of these standard headings into the Category box simply double click it in the left hand column It is possible to copy more than one standard heading into the Category box k To edit one of the standard headings highlight it and select wea J Entering M odifying Standard C ategories Display the voice recording window Figure 6 10 Click a k Movethe cursor to the entry point and click k Type the text k Click to clear the window Creating Categories and Recording a Comment k Doubleclick one of the standard categories to copy it to the Cate
88. 96 14 12 45 Spirometr 08 08 1996 11 07 42 Spirometry OK Cancel Ht Help Figure 4 4 14 Spirometry section window OK Patient Procedure System Services Help z an poia T me hei F o lae 2 S Baker Dave 4 pirome ompare easureme Test1 08 07 1994 10 32 54 rants LSS IN Test 2 09 07 1994 11 26 22 Miller Sq 0 Scale Flow Volume C Volume Time Normal Values Eces 0R R 14 F l s Value Norm Act 1 1 Act 2 2 124 EVC I 268 3 14 117 240 78 ae FEVC I 263 2 93 111 188 71 FEV i 225 2 57 114 185 82 e FEVI VC 81 0 76 0 94 86 0 106 6 4 PEF V s 5 86 5 62 96 3 86 66 a4 MEFS V s 5 35 5 56 104 3 82 71 ra MEF50 I s 9 76 5 25 140 340 90 V i MEF25 V s 1 61 1 94 120 217 135 Nes rere e Ae 3 o IVC i s 268 3 34 125 215 80 Aa FVC i s 263 3 28 125 2 22 84 FIV Wis 223 2 61 117 183 82 Ad FIVA IVC 78 0 85 0 84 PIF V s 3 48 235 10 4 MIV7S V s 293 1 92 MIV50 V s 3 28 2 26 ies MIV25 V s 2 68 1 88 144 MW l min 92 0 745 81 537 58 Figure 4 4 15 Comparing T wo Spirograms 170 CardioSys V4 1 4 4 6 Comparing Two Spirograms You can compare the present spirogram with another one recorded earlier For the example below we assume that you wish to compare the recent spirogram with an earlier record ing of the patient
89. A 4 2 4 Running an Exercise Test The signal acquisition screen appears when you have entered the test information and clear the dialog window with x For bicycle ergometers the screen is similar to Figure 4 2 10 for treadmills it is similar to Figure 4 2 11 Please take a few seconds to become familiar with all the details shown on this screen before proceeding to start the test 16 Buttonsto display the ST profiles and medians the trends and the stored ECG 17 Results of the arrhythmia analysis complex ectopy in red and number of VPB min 18 ST median beat window and ST analysis reults resting beat analysis results are shown with a different color 19 Button for selection of another lead 20 Buttonsfor adjustment of theE J and J X point only when M anual has been ected in the D efaults menu 21 Procedure parameters and buttons to modify the sgnal nstivity and to tenporarily disable theAD S anti drift system CardioSys V4 1 91 The Exercise ECG The Signal Acquisition Screen of an Exercise Test Bruce 4 76 gt HR BPM 5 ae 2 Supine 3 D i RPP o bie SYS DIA mm Hg L1 1 Ai Event M nt 3 g 1 6 fends aa TE 25 mm s 21 Figure 4 2 11 Signal acquistion screen for a treadmill exercise tet Time apsed in current phase Time dapsed in current tage Stage number name Current phase and button to modify p
90. A Boxes for entry of comments and of the phys 4 1 3 Entering the Test Information The test information screen offers menus and text boxes for entry of all data relevant for the resting ECG procedure On this screen you can enter the reason for the test enter blood pressure readings select the medication enter comments regier the physician s and technician s names CardioSys V4 1 47 The Resting ECG Entering the Test Information Copying Reason for T est from the Library to the Patient Window The reason for test library contains a list of standard state ments that you can copy easily into the patient s window The library can be expanded or edited as required a Click on a statement to highlight it Ye Click the gt gt button ble dicking amp A Reason for Test can easily be copied by dou k If you wish to delete a copied reason or part of it high light the words in question and click ss eA Modify Library Reason for Test Figure 4 1 9 Editing the Reason for T eg library 48 k The deleted words can be inserted in another position by placing the cursor there and clicking ee k You can enter a reason for test directly by moving the cursor to the desired position and typing the text Expanding or Editing the Reason for T est Library we Click RA This will open the library window Figure 4 1 9 T M ove the cursor to the desired p
91. A a 2 0 24 2 3 J 1 20 4 104 Lay H m b ae oe E onl E 40 02 2 nnan 0 4 4 Ta 0 0 J METS RPP Slope mV s 0 HR min ART Slope mV s 240 100 1204 50 Dd O O 604 m a Da 4 i 4 o i j 1 i 1 ri 1 1 I i r 1 1 1 E 0 5 10 15 20 0 5 10 15 20 0 5 10 15 20 O lel N7 5 0 5 1804 ae t 3 2 i 0 Figure 4 2 26 Graphic trends 1 Heart rate blood pressure speed 2 VPB pacer pulses 3 ST leva dope dope and level of the 2 leads with the mos sgnificant ST changes all other leads are accessble with button 6 4 Heart rate artifact 5 METS RPP 6 Arrow buttons to call up the graphic ST trends of the other leads 7 Button to clear the trend window 106 CardioSys V4 1 review the ST analysis results medians and profile of all leads Figure 4 2 25 with the buttons The first screen shows the medians W ith the button you can toggle to the ST histogram screen clear display with g The comp median OF tinkedmedian button is displayed only when a thermal printer is connected to the system T he button actually shown depends on the system setup section 4 2 7 Exercise T est Setup The button initiates a printout showing theresting beat for reference thecurrent median complex a2 5 second ECG segment for all 12 leads The button initiates a printout showing the current median complex and the corresponding RR interval linked b
92. COM P EC 560 ECB 561 96 CardioSys V4 1 227 498 02 A The Exercise ECG The Elements of an Exercise Test gt When the number of revolutions is low the EC 1200 will automatically activate a load of 15 Watts and increase the load to the old value when the speed picks up again D uring that time the buttons sss gt gt and are inactive and the program will not proceed to the next load stage W indow 2 in Figure 4 2 10 indicates the remaining time in the current stage while window 1 shows the time elapsed in that phase During the test you can k hold the stage with must be pressed 5 s before the end of a stage at the latest k advance to the next load stage with ERGOLINE 900 900L only modify the load in steps of 5 W atts with and Es with EC 1200 V3 52 next stage previous stage but never below initial load S advance to the recovery phase with upon comple tion of the last stage the program automatically activates the recovery phase S X terminate the test with vn 227 498 02 A CardioSys V4 1 97 The Exercise ECG The Elements of an Exercise Test M 700 and EC 1200 M 700 In conjunction with M 700 ergometers too the selected protocol fully controls the test procedure D uring atest load changes are only possible at the ergometer and only for the user programmed phases If you wish to create custom protocols you will have to use the phases stored in the ergo meter
93. CardioSoft computer and or to aM USE CV system Please Figure 6 15 Assigning tranderred ECGs contact M arquette H ellige service for advice 228 CardioSys V4 1 227 498 02 A System Services Menu Hellige 6 5 Data Compression DAGU Services Menu a a Archiving Patient Records r Procedure r Archiving r Setup p al D ata Compression P System Copy Patient Compression onfiguration Records O Ider data files which are seldom used can be compressed to L25 free storage capacity for new data files If you call up the Horea R elt compressed files they uncompress automatically They take only alittle longer than normal files to be displayed ey Click f the window showing the System Services opens Figure 6 16 Figure 6 16 System Services M enu k Click the A icon The compression setup screen appears Figure 6 17 I In a network environment the program must be terminated at all other workstations k Enter the procedure date up to which you want to have the files compressed t Click to initiate data compression As a safety precaution the system asks you if you really wish to proceed Click canei if you decide to abort t
94. CardioSys Operator s Manual Version 4 1 227 498 02 GA e Revision A marqueite A GE Medical Systems Company Revision H istory The product CardioSys bears the CE marking C 0366 indicating its compliance with the provisions of the C ouncil Directive 93 42 EEC about medical devices and fulfills the essential requirements of Annex of this directive The product fully complies with the electromagnetic immu nity requirements of standard EN 60601 1 2 Electroma gnetic C ompatibility M edical Electrical Equipment The device isin radio interference protection class B in accordance with EN 55011 TheEC Declaration of Conformity covers only the accessories listed in the Equipment section This manual reflects software version 4 1 Marquette H dlige GmbH 1999 Postfach 600265 D 79032 Freiburg Germany Tel 49 761 45 43 0 This document is subject to the M arquette H ellige change order system The revision code a letter that follows the document part number changes with every update of the manual Part N o Revision C ode Comment Initial Release MS DOS and Windows are trademarks of M icrosoft Corp CardioSys V4 1 227 498 02 A Contents 227 498 02 A 1 Introduction 2 General Information on System Operation 3 Selecting and Admitting a Patient Retrieving Stored Examinations 4 1 The Resting ECG 4 2 The Exercise ECG 4 3 The STAT ECG 4 4 The Spi
95. ECG even when not all electrodes are ap plied 227 498 02 A CardioSys V4 1 53 The Resting ECG Recording A Resting ECG lt p gt Hellige Patient Procedure System Services Help helie Lo le a 2 M Bake Dave 4 R gnal Acq 0 HR BPM lt gt Test Information Freeze Traces Options gt gt 85 HZ t 1 Vi aam Hoce Bo aft immm ie o s ee STSD l Mig Y M ZR ae Y C S Figure 4 1 14 Reting ECG acquistion scren with control buttons and Analyzing 54 message Recording and Evaluating the ECG The program continually saves 10 second segments of the incoming ECG When you click the lt gt button the most recent 10 seconds of the ECG signal will be analyzed Thus before initiating the analysis you can make sure that the quality of the ECG signal to be evaluated is adequate If you wish to modify the sweep speed or the filter settings muscle AC line filter click on to display the second row of controls Click to freeze and release the signal traces The freeze function does not affect channel 1 Click __ lt __J to initiate the procedure T he message Analyzing which appears in the bottom right hand corner for about 6 seconds tells you that the signal is being analyzed Figure 4 1 14 At the end of the analysis you will automatically see the first page o
96. G Archive Patient Recorder System ECG Records Recorder Cancel Help Figure 6 13 System Services M enu I Some of the patient data are not transferred e g the medication Always verify the records sent from an ECG system recorder I Ifa userID wasnot entered theECG recorders will ocasionally send the record with a number of blanksin place of the ID 6 4 Transferring Resting ECGs from the ECG Recorder The system allows you to transfer ECG recordings made with a M arquette H ellige recorder CARDIOTEST CARDIOGNOST CardioSmart to the PC database Assigning Records to Patients In general the system will automatically assign the incoming records to the appropriate patients if they exist in the data base If the incoming record is without patient ID and without blanks the patient ID 000000 will be entered If the patient ID of the incoming record exists in the database the record will be assigned to that patient The patient data of the record will be updated with those in the database Automatically assign procedure to patient disabled If the patient ID of theincoming record does not exist in the database the record will be registered to the list of received records and the user has to assign it manually to the correct patient Automatically assign procedure to patient enabled If the patient ID of theincoming reco
97. N ETS 1 00 SL Reasons tor f Test Summary Tabular Summary Trend Reports Sample Card Cycles QRS Morphologies ECG Strips Arrhythmia Review Interpretation Full Disclosure ECG miraa o l Reason for Test Pip at rest 120 90 mmHg Max BP Figure 4 2 30 D ocuments of the exerci s tet report 110 CardioSys V4 1 Data Export U sing the export function you can save the relevant test data to the clipboard or to a file When data are saved to the clipboard they can be inserted in a text file for instance Ye Click on SE lt Select either Export data to clipboard or Export data to file k Sdect to confirm your choice W hen you export the data to the clipboard you can insert them in a text file for further editing commands Edit gt Paste If you choose the second option you will have to specify the directory and the file name Confirm the export command with M Displaying the Report Pages You can either scroll through the entire final report or access specific pages directly Click on to scroll forward or on to scroll backward through the report pages k Click on to display the table of contents where you can select a specific document for review Figure 4 2 30 lt Click on the title of the document you wish to display 227 498 02 A The Exercise ECG Reviewing the Final Report T
98. Printers Windows Printing System LPT1 x Interpretation k Click to display the print setup screen X Patient ID as Bar Code Figure 4 4 17 Number of Copies Mel c h k h h ed j ed eck that the correct procedure is selected Print Cancel Help p Figure 4 4 17 Print stup screen k Check the Interpretation box if it is to be included in the printed report k To select another printer click in the printer window and select the new one with the mouse amp Click to initiate the printout or click to quit the print screen 172 CardioSys V4 1 227 498 02 A The Spirometry Test Brief Operating Instructions 4 4 9 Running a Spirometry Test Brief Operating Instructions Turn on system Display spirometry screen Admit new patient or select patient from list Enter test information Attach nose clip O Initiate VC measurement and ask patient to breathe in out and in again as deeply as possible through the mouthpiece Fvemeasure Repeat measurement or end this part of the test with FVC Measure O Initiate FVC measurement and ask patient to breathe in deeply through the mouthpiece T hen the patient is to breathe out and in again as deeply and quickly as possible Repeat measurement or end the tet with D isplay report 227 498 02 A Bronchodilation T est Os D isplay bronchodilation test screen Os Perform VC and FVC measurements as described above
99. R Bruce P ModBruce ModBruce Existing Phases New Cancel Help Figure 4 2 55 Protocol entry window Bee I The program can save up to 10 different test protocols Modify Phase Modify Phase P Bruce Type TM Square Stage Grade Time in Stage ECGRec Int BP Interval 0 0 99 00 00 00 00 00 1 2 3 Stage Supine a Speed SP loo FFt S mph Grade eRloo 880 Time in Stage TS 99 00 min ECG Rec Inter EI oo 00 min Cance BP Interval PI 00 00 min hep Figure 4 2 56 Window for definition of a test phase 1 Phase 2 Phase parameters 3 Entry boxes 227 498 02 A k Click if you wish to modify an existing proto col or to define a new one T his will open the entry window Figure 4 2 55 Click x in the box for phase A then select one of the phases in the window by clicking Select phases B and C in the same way k Select Ramping if you wish the load to increase gradu ally over the specified time of the phase k If you wish to modify specific parameters of one of the phases or create a new phase click moaity Or new T his will open the window allowing you to define a test phase Figure 4 2 56 k Position the cursor on the parameter to be changed and click Enter the new value It is possible to leave a box blank or to remove a parameter Modify the other parameters in the same way I
100. RS 43 Lead Sequence D gt i XYZ uncorrected 5 HFLA Treshold uV 40 Figure 4 6 3 Signal acquistion screm for late potential analysis 1 Control buttons D etails on late potential analysis 2 3 Current heart rate and blood pressure readings 4 Applied dectrodes green properly applied ydlow not properly applied white ste not used red disconnected lead break 5 Lead sequence 6 Lead impaired by poor sgnal quality 194 CardioSys V4 1 T he Signal Acquisition Screen Once you close the test information window the system will display the signal acquisition screen Figure 4 6 3 The signal acquisition screen shows information on the ongoing analysis 2 number of correlating beats in the noise limit as configured the number of correlating QRS complexes a bar graph illustrating the acquired correlating beats as a percentage of the required beats as configured the current heart rate and blood pressure readings 3 if entered manually section 4 1 3 the applied electrodes and the signal quality 4 pro vided the red R electrode is applied Furthermore an arrow 6 points to the leads which are impaired by improper electrode application or which cannot be recorded due to disconnected electrodes or dueto a break in the patient cable the selected lead sequence 5 The functions of the control buttons are explained on the following pages 227 498
101. Selecting a M edication Assigning a D rug N ame to a M edication G roup You can select a medication from a list of medications You can also select 4 more medications and assign specific drugs to the medication groups to include these in the list instead of the group name T he window permits entry of the medication dose M aking a Selection k Click on amp to open the medication list box Figure 4 2 7 ka Select one of the medications lt To sdect additional medications to enter a medication dose or to assign drug names to medication groups click C Assigning D rugs to a M edication G roup k Click on Medications A window opens showing several medication group names Figure 4 2 8 T here is a drug name window for each of these groups Click on the respective text box if you wish to enter a name Then typethe drug name Furthermore you are free to arrange the medication groups any way you want T o do so ka Click on the x at the end of the group name box 227 498 02 A The Exercise ECG Entering the Test Information 5 Medication This brings up a new window where you can choose one of Medication Group Drug Name the group names Figure 4 2 9 none Fa none os unknown J k Click on the drug name box and enter the name medication stopped gt A nitrates E beta blocker
102. T est Screen ejje ee a eee Normal Values Eccs R R 74V 1 2 3 Value Act Norm gt sic os T Once you enter the test information the system will display FEV1 I 2 25 Ve fr j j al cee oe the spirometry test screen Figure 4 4 8 ad 4 MEFS l s 5 35 EF50 I s ENNER a EE ee Chea D Jae l ip 423 4 5 6 7 8 9 1011 1213141516 17 18 19 Neue ae oe a On this screen you see lad FIVC U s 2 63 ES SIRS a 7 K To thecontrol buttons 1 MIV50 I s Fas MIV25 I s eet MVV l min 92 0 thepatient data 2 Figure 4 4 8 Spirometry procedure screen e patient data 2 1 Control buttons 2 Patient data 3 Field for interpretation M ILLer square 4 Respiration trace 5 Parameter table afield for interpretation and the M LLer square 3 awindow for display of the recorded trace 4 atable listing the normal values the actual values and the deviation as a percentage 5 162 CardioSys V4 1 227 498 02 A The Spirometry Test Running and Evaluating a Spirometry Test Patient Data Serec E M odifying Patient D ata Search for as Name Patient ID Ne FirstName Date of Birth Patient ID For calculation of the spirometric normal values the program Miter Nave ce Er Sm needs the following patient data Richards Chantal 03 12 1977 7766699 Roberts Jennifer 07 27 1977 543876 Shields Stuart 11 11 191
103. Technician wj Help Referring Physician p Blood Press immi Sf sys Hi sl dia Medication Comment Physician mi Figure 4 2 6 Protocol sdection window I Click on ai to display and increase the value or click on v to decrease the value 227 498 02 A Selecting a T est Protocol The program defaults to the test protocol specified in the Exercise T est Setup section 4 2 7 On this screen however you can choose another protocol for the present test Click on e lt The protocol list box opens Figure 4 2 6 k Click on the protocol you wish to use Adjusting the T arget H R T he target heart rate that the patient is expected to attain during the test can either be adjusted manually or the system will calculate this value automatically section 4 2 7 Exercise Test Setup Furthermore you can change the calculated or entered value e g 90 of 180 162 This setting will be retained Entering Blood Pressure Readings Blood pressure readings are either entered directly via the keyboard or they are selected and changed in steps of 5 mmH g by clicking on the arrow boxes In the systolic box the values start from 120 mmH g in the diastolic box from 80 mmH g ka M ove the cursor to the sys box and click the left mouse button Enter the value via the keyboard b Proceed in the same manner to enter the diastolic valu
104. V4 1 245 Equipment O ptional PC components 701 180 72 701 249 16 384 018 07 384 018 75 N etwork board Controller for M O or streamer drive 640 MB MO drive 2 4 GB streamer drive Peripheral devices 701 247 02 220 092 07 220 093 07 701 181 34 701 245 03 701 245 11 701 242 79 834 005 09 701 249 25 226 169 01 384 018 92 384 015 80 384 017 33 246 Keyboard English Function keyboard for exercise tests English Function keyboard for exercise tests English with barcode reader M ouse M onitor 15 M onitor 17 Laser printer EPSON EPL 5700 Toner cartridge for EPL 5700 Thermal printer AR 200 Paper for thermal printer AR 200 N etwork option PCI upgrade N etwork option BN C requires system PC with network board 701 180 66 Network option TP requires system PC with network board 701 180 72 O ptional software programs 455 023 01 455 024 01 455 039 01 455 040 01 455 025 01 455 026 01 455 027 01 455 029 01 455 030 01 455 032 01 455 033 01 455 041 01 455 034 01 455 035 01 Resting ECG measurement Resting ECG interpretation Review M anager ECG History Exercise test SW 3 lead ECG Exercise test SW upgrade 12 lead ECG Full disclosure ECG storage data handling data compression M onitoring of remote stress test stations Storage on central file server Exercise test expert mode Exercise test in test reports Cardio mailbox Task list processing Late potential
105. Warning The power socket of the C ardioSys system cart is reserved for a defibrillator for recharging of the defibrillator battery max power 30 VA Warning The device is not intended for intracardiac application Warning All devices of a system must be connected to the same power supply circuit D evices which are not connected to the same circuit must be electrically isolated when operated electrically isolated RS232 interface 227 498 02 A Warning T he device is not suitable for operation in areas where an explosion hazard may occur Explo sion hazards may be caused by the use of flam mable anesthetics skin cleansing agents and disinfectants G reat care must be exercised when the monitor is used in an oxygen enriched atmosphere The atmosphere is considered to be oxygen enriched when the room air contains more than 25 of oxygen or nitrous oxide CardioSys V4 1 11 Introduction to CardioS ys Warning The patient signal input is labelled with the eo symbol indicating that it is protected against damage resulting from defibrillation and electrocautery Nevertheless extreme care must be taken when devices which are directly connected to the patient remain applied during defibrillation The distance between ECG elec trodes and defibrillation paddles should be at least 6 in 15 cm If in doubt disconnect the patient cable from the device while applying the defibrill
106. abular Summary Patient Procedure System Services Help eal ttle is l e 2 l Baker Dave 4 ercise Test Tabula a IK Stages significant ST change default Ti ita BE Phase Stage Time Speed G P Bruce Supine 1 o0 0 Standing 0 0 0 Hypervent iy 0 0 0 Warm Up M0 0 0 0 25 1 Manual Stagel 1 30 rade METS HR Sys Dia RPP V4 VPB 0 0 85 0 07 1 0 1 0 85 0 07 1 0 Tour Figure 4 2 31 Summary T able for treadmill test gt Only the stage format of the Tabular Summary is transmitted to MUSE 227 498 02 A The T abular Summary For each stage of the test the tabular summary Figure 4 2 31 shows Bicycle Ergometer Treadmill phas phase stage time time load sp d RPM grade hert rate METS blood pressure heart rate RPP blood pressure ST level RPP number of VPBs ST level comments if entered number of VPBs comments if entered If the data in the table are to represent intervals of 30 seconds instead of test stages uncheck the Stages check box k Click on the arrows at the top and bottom of the scroll bar to scroll the lines one by one Figure 4 2 31 or drag the scroll box up and down to cover greater distances and scroll to specific data CardioSys V4 1 111 The Exercise ECG Reviewing the Final Report Trend Reports iv Patient Pr
107. al Re Time 9 10h Sr Male Duratio 1 me 2 10h R 3 Caucasian 4 5 Duration _ Time 0 00h He 188 cm Measuring Method auscultatory Weight 77 0 kg Test Information Medication Physician Dr Williams Comment User Dorothy Interpretation 24h Average sys dia mmHg 101 5 75 1 syst BP readings above 135 mmHg 241 diast BP readings above 85 mmHg 0 0 Day Time Average sys dia mmHg 101 5 75 1 Figure 4 5 7 T et Summary 1 Button for data export 2 Button for entry of the tet information 3 Button for entry of the statisticsintervals 4 Buttons to display the other report documents paging 5 Button to directly access the other report documents 227 498 02 A 4 5 3 Data Output D ownloading data to the PC The data stored in the recording unit must be downloaded to the PC for evaluation AY Switch off the patient monitor before connect ing it to the PC Furthermore it is recom mended to delete old data before starting a new ambulatory blood pressure measurement Caution k Connect the recording unit to the PC and turn it on k Display the signal acquisition screen for ambulatory blood pressure measurements Figure 4 5 6 Click on Figure 4 5 6 An icon indicates how the transfer proceeds At the end you will be asked whether you wish to clear the data from the patient monitor It is recommended always to delete old data so that the memory is free for colle
108. allel increase of myo cardial oxygen demand and heart rate with increasing effort Essentially the exercise electrocardiogram is evaluated by linear regression analysis of the rate related change in ST depression as measured at 60 ms post J point O riginally the 12 classical leads and bipolar lead CM 5 were evaluated Changes in leads aVR aVL and V1 have been found to be poorly specific and are currently ignored The addition of lead CM 5 improves sensitivity appreciably A plot of ST segment depression versus heart rate is drawn for all measured leads Linear regression analysis is used to best fit a line beginning at peak exercise and extending backward through at least three points until significance is obtained p lt 0 05 The points are taken from the ST level and heart rate at the end of each 2 minute exercise stage T he slope of this line is then determined and presented in units of uV BPM T he steepest slope of all the leads is reported and graphed 227 498 02 A The large increments in heart rate between stages of the Bruce protocol were found to yield an inadequate number of points for proper slope evaluation A modification of the Bruce protocol half work loads in 2 minute exercise stages more closely approximate the roughly 10 beats per minute incre ments found in ergometry testing T his protocol developed at Cornell U niversity by O kin et al is reproduced here and is strongly recommended for the highest predictiv
109. alysis the button turnsinto the button and the button appears instead of the filter check boxes 148 CardioSys V4 1 4 3 3 Recording a STAT ECG When you click lt gt _J the program starts analyzing the first 10 seconds of the ECG T he analysis results are displayed in the lower portion of the screen Then the program contin ues collecting the ECG at the same time scanning it for arrhythmias such as fibrillation flutter ventricular tachycar dia either until the set time has elapsed or until you click om amp Click the button T he signal acquisition screen appears Figure 4 3 8 In the bottom right hand corner the system informs you of its current activities Below the heart rate you see the time re maining for ECG storage At the end of the analysis the results are automatically displayed Click to freeze and release the ECG trace except channel 1 r Click to display or suppress the results of the ECG analyis k Click OM to terminate full disclosure ECG acqui sition when the set time has elapsed the program stops automatically collecting the ECG Click to display or suppress the second line of control buttons k Click to display a marker 227 498 02 A The STAT ECG amp The statanynm button initiates the thermal writer It will record the ECG displayed on the monitor screen until stopped with the button At the end of the session the program asks you whether or n
110. analysis System cart accessories 915 418 12 915 418 11 919 202 47 701 244 01 CardioSys V4 1 Adapter 9 25 pole D SU B interface Adapter AT keyboard to PS2 M ouse pad Printer cart 227 498 02 A Equipment Cables 919 062 00 919 203 37 401855 107 919 201 81 919 200 37 223 330 03 223 366 03 223 362 03 223 368 01 223 380 01 223 381 01 223 390 01 700609 001 223 372 01 223 298 04 223 363 03 Power cord Euro Power cord UK Power cord CH Power cord USA Potential equalization cable Connection cable for M 700 Connection cable for EC 1200 Connection cable for EC 560 ECB 561 CardioSmart Connection cable for TM 400 E Connection cable for ERGOLINE ERG 900 Connection cable for SUNTECH 4240 Connection cable for T2000 RS 422 Connection cable for T 2000 RS 232 Connection cable for EK 51 EK 56 EK 512 Network connection cable Connection cable for bosotron BP monitor Patient C ables 223 418 01 223 418 02 227 498 02 A Patient trunk cable 10 lead IEC M ulti Link 2 2m Patient trunk cable 10 lead AH A M ulti Link 2 2m 223 418 06 223 418 07 384 018 16 384 018 17 Electrodes 217 225 03 217 110 03 217 320 01 217 32101 303 442 96 504 648 56 CardioSys V4 1 Patient trunk cable 10 lead IEC M ulti Link 45m Patient trunk cable 10 lead AH A M ulti Link 45m Set of 10 leadwires 4 mm connector defib protected IEC Set of 10 leadwires 4 mm
111. are free to arrange the medication groups any way you want T o do so k Click on the at the end of the group name box 227 498 02 A The Resting ECG Entering the Test Information Medication Group Drug Name none H a 4 unknown 2 4 digitalis diuretics 2 a psychotherap agents steroids a al beta blockers II oy I beta blockers III antiarrhythmics la 5 I antiarrhythmics Ib antiarrhythmics Ic 5 4 antiarrhythmics III Ca antagonist verapamil type aS 4 Ca antagonist nifedipine type nitrates eos 4 alpha blockers on 4 cytostatics gt 4 Help o 7 ol gt y Cancel Figure 4 1 12 Editing the medication group I Pressing the key on the PC keyboard also clears the window and saves the entries 227 498 02 A This brings up anew window where you can choose one of the group names Figure 4 1 12 Click on the drug name box and enter the name g Click on to clear the window Entering Comments If you wish to enter acomment on the test procedure click in the Comment text box and key in the text Physician s T echnician s N ame The names of the physician and ECG technician can ether be entered here click in the text box and type the name or they can be selected from the list of the registered system users section 6 1
112. ates a potentially hazardous situation which if not avoided could result in death or serious injury AN Caution Before connecting the device to the power line check that the voltage and frequency ratings of the power line are the same as those indicated on the system s nameplate If this is not the case do not connect the system to the power line Caution indicates a potentially hazardous situation which if not avoided may result in minor or moderate injury and or damage to the equip ment Warning Do not use extension cables with multiple power outlets to connect the system to the power line I provides application tips or other useful informa tion to assure that you get the most from your equipment Danger Before putting the system into operation visu ally inspect all connecting cables for signs of damage D amaged cables and connectors must be replaced immediately 10 Danger W hen disconnecting the system from the power line remove the plug from the wall outlet first Then you may disconnect the power cord from the device If you do not observe this sequence thereisa risk of coming into contact with line voltage by inserting metal objects such as the pins of electrode leads into the sockets of the power cord by mistake CardioSys V4 1 227 498 02 A Introduction to CardioSys Caution CardioSys can be operated on an uninter ruptib
113. ation defibrilla tion proof 227 498 02 A The STAT ECG Electrode Application Points for Nes Leads Figure 4 3 5 shows the application points for the N EH 8 electrodes C onnect the 12 wire patient cable as shown in Figure 4 3 6 N is identical with C4 If necessary disable the anti drift system and the filters muscle and AC line filter to view the unfiltered raw ECG signal sections 4 3 2 and 4 3 4 Asan alternative the N ene leads can also be acquired with the ax 10 wire patient cable In this case select the sequence H igh Right or Left as described in section 4 1 7 M odifying the Lead Sequence and change a l to D s A Map I to A Figure 4 3 5 Electrode application points for N eH leads Ill to J N attachment point of the 2nd rib to the right sernal edge Apply the R electrode to N st N in the 5th intercostal space on the left posterior the L electrodeto N ax C8 axillary line identical with C8 the F electrode to N ap C4 N in the 5th intercostal space on the left mid davicular line identical with C4 ES It isnot possible to record chest leads at the same time as NEHB leads N black right leg red aap il I amp Please observe the information given in sections C3 white 7 1 Artifact D ue to Poor Electrode Applica cm S tion 7 2 ECGsof Pacemake
114. ation and Function Setting Up the PC CardioSys is a system cart centering around aPC and software programs Figure 1 1 shows the CardioSys system cart elelelelelelelelele Se F ar OMN Figure 1 1 CardioSys system cart 1 2 ONO uh W M onitor Supports for dectrode application system or respiration flow sensor M onitor support T ray for PC keyboard T ray for function keyboard and mouse T ray e g for printer Accessory drawer Power button floppy disk drive and drive bays streamer M O drive CardioSys V4 1 9 Shaf with power connector for defibrillator 10 Conductive castors front castors locking 11 M onitor retaining strip 12 Connection pand unde lid 13 Lid lock 14 Powe switch removes power from the systen 15 Powe input with instrument fuses 16 Potential equalization pin 227 498 02 A Introduction to CardioS ys The lid should only be opened by M arquette H ellige staff or by factory trained personnd Warning Biocompatibility T he parts of the product described in this operator manual including all accessories that come in contact with the patient during the intended use fulfill the biocompatibility requirements of the applicable stand ards If you have questions in
115. ation pulse Warning If the system cart is installed in the patient envi ronment only the special printer modified by Marquette H ellige and equipped with an addi tional protective earth connection potential equalization may be operated O bserve the as sembly instructions supplied with the printers Danger For stress test examinations a defibrillator and a pacemaker regularly checked for proper functioning must be readily accessible Warning Magnetic and electrical fidds are capable of interfering with the proper performance of the device For this reason do not operate the system in the vicinity of equipment emitting strong electromagnetic radiation X ray equip ment diathermy systems or MRI devices Warning Only use the original Marquette H ellige pa tient cable D o not connect other signal sources to the cable Warning With all peripheral devices connected CardioSys represents a medical system It fulfills the requirements of the system standard IEC 60601 1 1 The entire system may be operated in the patient environment Warning Extreme care must be exercised when using medical electrical equipment Many parts of the man machine circuit are conductive such as the patient connectors electrodes trans ducers It is very important that these conduc tive parts do not come into contact with other grounded conductive parts when connected to the isolated patient
116. att J External Procedure Summar Interpretation summary no pathological findings l Detailed Report Cancel Figure 3 8 Summary 38 For examinations made with an external program you will see a procedure summary Figure 3 8 when you press the button D elete Stored T ests The button allows you to remove the highlighted test s from the database Sending T est D ata to the MUSE CV System Use only standard ASCII letters A through Z and numbers 0 through 9 when entering information for the M U SE CV system Once transferred to the M U SE CV system the tests cannot be edited any more Data sent to M USE can be viewed with the M U SE Browser and printed N ote Before printing always set the printer to the landscape format If you enable Start modem connection before transfer on the M USE tab of the System Configuration menu the system may still find an active modem connection while it tries to establish a new connection Windows NT will inform you of this condition T erminate the existing connection H angup and resend the data CardioSys V4 1 227 498 02 A The Examination Procedures Select patient local database xi Search for a Name Patient ID Last Name First Name Date of Birth Patient ID Master Jim 10 05 1949 8738999 Select Mill
117. buttons retained and are automatically activated each k Select setup to display the setup menu section time the system is turned on 4 1 pe pa p k The buttons t and allow you to change the display of the ECG leads either you see 5 second segments of all 12 leads at a time or you see 10 second segments of groups of 6 leads g Patient Procedure System Services Help om id T Eee EEST r fai L w iaa k The 40 Hz box switches a muscle filter on and off lt gt Test Information Freeze Traces Options gt Gola 8 5 Setup P sonz som 4 Thoma ef pfesmms k The 50 Hz check box switches an AC filter on and off im AC filter on k The arrows at mm mV select the gain 2 5 5 10 20 40 mm mV av mK k The arrows at mm s select the sweep speed 25 or i V6 Analyzing 50 mm s Figure4 1 14 Resting ECG acquistion screen with control The entire ECG recording is controlled with the four buttons buttons and Analyzing message Test Information Freeze Traces Options gt gt I Please remember that a filter may also suppress diagnostically relevant information as it limits the frequency bandwidth T herefore you should not switch filters on indiscriminately oe If Manual Override is enabled in the Setup menu section 4 1 7 the system starts recording the
118. cation of disconnected electrodes and broken leads Individual monitoring of each electrode Interfaces PS 2 mouse Serial interface COM1 COM2 ergometer treadmill COM3 Respiration Flow Sensor LF 501 COM4 unassigned free for ECG recorder for instance Parallel interface LPT1 printer LPT 2 CORINA Printer EPSON EPL 5700 with at least 4 M B of memory HP 6P with at least 5 M B of memory only the printer modified by M arquette H elligeis allowed to be installed on the system cart Keyboard CHERRY keyboard G 81 3000 with card reader CHERRY G 80 1501 M arquette H ellige function keypad for routine operation during exercise test 242 CardioSys V4 1 Monitor 15 inch or 17 inch monitors can be connected only the monitor models supplied by M arquette H ellige are allowed to be installed on the system cart Power supply from the power line system design in compliance with IEC 60601 protection class Version for 230 V rated voltage range 220 to 240 VAC 50 60 Hz operating voltage range 198 to 264 V 49 to 63 Hz rated current with 17 inch monitor 1 5 A power consumption w o monitor 60 W with 15 inch monitor 130 W with 17 inch monitor 140 W Version for 115 V rated voltage range 110 to 120 VAC 50 60 Hz operating voltage range 98 to 132 V 49 to 63 Hz rated current with 17 inch monitor 2 5 A power consumption w o monitor 60 W with 15 inch monitor 130 W with 17 inch monitor 140 W 2
119. comments and or BP readings To do so OK Cancel Figure 4 2 18 Dialog box for entry of comments and blood Click on to open the dialog box Figure pressure 4 2 18 amp Click on a comment then click on to copy the comment to the text box or double click on a comment Lead Check amp Enter the blood pressure readings by clicking on the Baker Dave 41yrs Exercise Test 00 24 Pretest Phase gt 0 0 E arrows systolic value TAB diastolic value top Treadmil of 00 24 Supine Hold Stage gt gt 0 0 H Start Treadmil im cee eee eee eet J Click on Tea to cer the dialog box k Click on to display the lead segments for verification of the signal quality Figure 4 2 19 gf eco f itea T SS E E S R E The recan J and trea buttons are displayed only when the thermal array printer is connected T hese buttons are used to initiatean ECG printout T he print format is defined in the setup section 4 2 7 Exercise T est Setup In T est Reports Figure 4 2 19 Lead check screen 227 498 02 A CardioSys V4 1 103 The Exercise ECG The Elements of an Exercise Test cheer 1x5s Figures 4 2 21 4 2 22 4 2 23 Click on HI to clear the lead check screen prints the most recent 10 seconds of the ECG 3 py 6 or 12 leads Figure 4 2 20 ata EE prints the 10 second ECG acq
120. ction of the new data Then you will see the T est Summary Figure 4 5 7 I When you see the message Inconsistent data in patient monitor Procedure cannot be saved turn off the patient monitor before downloading data CardioSys V4 1 181 Ambulatory Blood Pressure Measurement Test Information Library Reason for Test Ra Reason for Test BAe Medication o Cancel _ if Technician Figure 4 5 8 T et information 182 CardioSys V4 1 On the test summary page you find the test information reasons for test medications and patient data as well as the statistics intervals night time wake up time button Xe Select aia The tes information entry screen will be displayed Figure 4 5 8 Enter the procedure data as described in section 4 1 3 D ata Export The icon allows you to export the most important data pertaining to the spirometry test to the clipboard or to any file D ata exported to the clipboard for instance can be inserted in a text file with the Edit gt Paste command J Click RR k Select either Export data to clipboard or Export data to file k Click on cK D ata from the clipboard can be inserted in a text file For data exported to a file you will have to specify the target directory and confirm it with o All other report documents can be accessed directly
121. ctrode connection for 1 kO hm termination referred to N lt 50 nA patient leakage current rms values according to IEC class CF in normal condition lt 10 uA in single fault condition eg patient in contact with line voltage lt 20 pA non destructive load at pick up electrode connections and N connection referred to N 50 V referred to chassis 1500 V 227 498 02 A pulse voltage resistance of all pick up electrode connec tions and N connection referred to chassis of either polarity eg defibrillation 5000 V ECG signal output ECG signal output for synchronization of ultrasonic units not for diagnostic purposes The initialization that takes place each time a test mode is started briefly blanksthe ECG signal at the analog output The medical system created by connection of external devices must fulfill the requirements of standard IEC 60601 1 1 EN 60601 1 1 ECG lead selectable electrically isolated 1500 V referred to chassis input signal of 1 mV results in 1 V olt output signal Uyuma 10 V offset accuracy lt 300 mV typical full scale accuracy over entire width lt 3 typical Ry min 2kOhms deday lt 10 ms pacing pulses removed by filtering T he low pass characteristic of the input stage of the con nected trigger detection circuit should be f 500 H z ECG ground CardioSys V4 1 241 Technical Specifications Lead fail detection Visual and audible indi
122. database or when the patient is admitted to the system first Similarly you have to select a patient from the database before recalling one of the procedures stored for this patient U nnamed allows you to run aprocedure without assigning it to a patient amp Click on i to display the patient selection screen Local D atabase Figure 3 1 k Typethe last name or ID number of the patient whose record you wish to retrieve it is sufficient to enter the first letters or numbers amp Click at 1 to display a new page of patient records k Check the patient data If it needs to be changed type over the old text and click Accent k To select the highlighted patient record click s or press k Asan alternative you can select a patient record by double clicking on the name 227 498 02 A Selecting and Admitting a Patient Retrieving Stored Examinations i Refer to chapter 6 for instructions on configuring the system for communication with the MUSE CV system database In a network environment do not access the same patient file from more than one workstation Use only standard ASCII letters A through Z and numbers 0 through 9 when entering infor mation for the MUSE CV system E Do not activate the Shift Lock key on the key board when using the bar code wand If you are working with the keyboard only enter the patient name press the ii key twice and
123. dem must be set up inside the medically used room but outside the patient environ ment 14 CardioSys V4 1 Literature M edical D evice Directive EN 60601 1 1990 A1 1993 A2 1995 M edical electrical equipment G eneral safety standards EN 60601 1 1 9 1994 and Al 12 95 General safety stand ards Standards for the safety of medical electrical systems IEC Publication 513 1994 Fundamental aspects of safety standards for medical equipment ROY O Z Summary of cardiac fibrillation thresholds for 60 H z currents and voltages applied directly to the heart M ed amp Biol Engn amp Computing 18 657 659 1980 227 498 02 A Introduction to CardioSys 1 4 Putting the System Into Operation Testing the Performance Before using the system for the first time please read the information given in section 1 3 For your Safety Turn on power with the main power switch 14 Switch on the system with the power button on the front panel press for approx 1 second U pon power up the PC runs automatic self tests W hen the program detects any malfunctions an error message is dis played If no problem exists you will see the usual Windows screen TheECG program too runs a self test when a signal acquisi tion screen is called up If you do not see any error messages the program and the computer are intact Error messages may also appear during program operation Do not run more than on
124. display the procedure selection menu Figure 4 6 1 Figure 4 6 1 Procedure selection menu k Click on to display the signal acquisition screen for late potential analysis W hen you have selected a patient the test information dialog window opens Figure 4 6 2 Ye Enter the test information as described in section 4 1 3 Test Information Test arsi aa Reason for Test TE TA RA oo Library Reason for Test Figure 4 6 2 Test information entry xren 1 Reason for Tet library 2 Allowsyou to edit the Reason for T et library 3 Patient indications A 5 6 4 Blood presure readings Blood Press mmHg E sys E dia 5 M edi cati on section Medication O BE 6 Allowsyou to sdect another medication and to Comment ees asi gn drug names to medication groups ad i 7 E 7 Boxes for entry of comments and of the phys daca moe d cian sand technician s names 227 498 02 A CardioSys V4 1 193 Late P otentials Noise lt 1 0 uV 1 7 pV Corr Beats 200 P7 Vp rtm pli aalth lth tthe fhe fe 6 Hellige Patient Procedure System Services Help Bea te E o c a 2 i Baker Dave 4 ate Potentia gnal Acq 0 Test Information Freeze Traces Options BB 6 0 Set Resetars 4fthomm o V 25mms eee A 2 OI 3 SYS DIA mm Hg a gt Corr Beats 10
125. e CardioSys V4 1 87 The Exercise ECG Entering the Test Information Test Information Library Reason for Test History of chest discomfort Evaluate effect of medication Evaluate effect of CABG Evaluate effect of PTCA Evaluate functional capacity Stress echo study Stress thallium study Rule out confirm CAD Post MI study Reason for Test Protocol Bruce 4 Target HR 100 Le 180 min Blood Press mmHg Ea el sys E el dia Medication 4 an Comment none aa unknown Physician medication stopped e Cancel ale nitrates Technician beta blockers el e Referring Physician wj Figure 4 2 7 List of medication groups I The physician is responsible for assigning drugs to a medication group Medications edication Medication Group Drug Name 1 v none I v unknown 1 v medication stopped 1 v nitrates I v beta blockers diuretics I v anti hypertensives 1 v digitalis 1 v Ca antagonists antiarrhythmics gt OK I v Eel e E e El E e E e l E Figure 4 2 8 Asi gning a drug to a medication group 88 CardioSys V4 1
126. e 4 2 58 M onitoring of a remote exercise tet sation 1 Durations phas name tagenumbe Speed and grade H rt rate blood presure RPP Key to call up further ECG leads Buttons to call up further remote stress test gations Button to terminate the monitoring function 7 ST measurement results resting beat current beat ur WN e2 4 2 8 Monitoring Remote Exercise Test Workstations The program allows you to monitor exercise tests at remote stations from your PC Click to call up the monitoring screen Figure 4 2 58 T he function is available only when you have entered a station name in the systen setup menu at both stations section 6 Click on al to display the procedure selection menu Q Select the remote exercise test monitoring screen button GG k In the selection window click the station you wish to monitor Then click to clear the window The remote station screen is made up in the same way as the exercise test acquisition screen durations phase name and stage number 1 speed and grade 2 heart rate blood pressure 3 buttons to display more ECG leads 4 buttons for selection of other remote exercise test stations 5 and the button which is used to quit the monitoring function 6 3 Conditions for monitoring of remote exercise test workstations are a station name was entered the monitoring function is enabled the correct communication protocol netbios exe or
127. e D isplay You can choose among three different formats for presenta tion of the ECG 2x6 leads Figure 4 1 15 1x6 leads Figure 4 1 16 3x4leads Depending on the selected format and sweep speed the entire ECG 10 seconds may take up several screens T he default format is the presentation of all 12 leads Figure 4 1 15 M easurements can be performed on all EC Gs amplitude intervals slope refer to the next section entitled Zooming and M easuring the ECG ke Click 5 forward or backward 7 to display another time window Click m 2 to select another signal size k Click 5 and 2 to select another sweep speed k Click fe and 1 to display the 6 leads screen format Figure 4 1 16 CardioSys V4 1 55 The Resting ECG Evaluating the ECG Patient Procedure Hellige System Services Help Pac tae Ii at b al 2 M 14 eS cata lee or my 40 i 200mm s eu 1516 lel i i i i i i i i 0 2 0 3 0 4 0 5 0 6 0 7 gt Figure 4 1 17 56 Zooming the ECG 1 Buttons to display the same segment in another channd 2 Button to obtain a hardcopy of the displayed screen 3 Measured amplitude 4 Button to quit the zoom display 5 Buttons to display the other report pages scrolling page by page 6 Button to directly access specific pages 7 Scr
128. e accuracy Exercise Stage Speed Grade min mph 2 IL 0 2 id 5 2 Lod 10 2 2 11 2 25 12 2 3 0 13 2 3 4 14 2 3 8 15 2 4 2 16 2 4 6 17 2 5 0 18 2 55 19 Table 1 Corndl Treadmill Protocol for ST H R Slope CardioSys V4 1 261 Appendix I amp If the systolic pressure is expected to exceed 200 mmH g increase the deflation rate at the sphygmomanometer to reduce the measuring time The bosotron 2 device aborts measurements after 90 s 7 5 External Sphygmomanometers CardioSys supports blood pressure measurement with the following sphygmomanometers SunT ech 4240 BP M eter 1 specially suitable for treadmill applications bosotron 2 BP M eter 2 specially suitable for bicycle applications T he sphygmomanometer is connected to a serial interface Select the appropriate port on page 2 of the defaults menu section 4 2 7 Exercise T est Setup T he sphygmomanometer must be ready for use before the exercise test is activated If thisis not done the system will not recognize the BP meter and prompt you to take a manual blood pressure measurement If the system takes longer than 60 seconds to complete a measurement the readings may appear at the next stage or phase You can avoid this problem by waiting at least 40 sec onds after display of the BP readings before starting the exercise test If an external sohygmomanometer is not co
129. e is properly connected Check that power switch is on Does not print and green LED labeled Powe is lit Check if the CardioSys system power is on Check cables between CardioSys system and printer M ay need to re boot the system Check if the printer is out of paper Check if there are any paper scraps caught under the print head Paper moves paper but recorder does not print Paper is incorrectly loaded Check that paper has correct pagination mark 18 CardioSys V4 1 Reinstalling the T hermal Printer D river U sually the printer driver is installed If it needs to be rein stalled proceed as follows Exit the application to Windows From the Program M anager screen call up Main Group Control Pand Printers Select Add Printer Select Install unlisted or updated driver Select Install Place the disk with the printer driver into the diskette drive and click on OK Check the D efault printer box Sdect Close Restart the application 227 498 02 A General Information on System Operation 2 General Information on System Operation This section describes some basic facts on program opera tion You will learn how to use the program with a mouse how to enter data via the PC keyboard how to start the program how to select the language 227 498 02 A CardioSys V4
130. e manually selected leads will be added to the linked medians report as the rhythm lead T o change the lead select M anual and choose the lead Afterwards you may reactivate the Scan mode J X Point T he measurement point J X for ST analysis may be deter mined by the program or manually by the user W ith manual you can make a preliminary adjustment of the J X point on this screen and then shift the E J and J X points during the exercise test In the automatic mode the X point is calculated in dependence of the heart rate for H R of 60 BPM X 60 ms X becomes smaller with increasing heart rates For calcuation of the ST H R slope the manual method must be selected and the reference point should be set at J 60 ms 227 498 02 A HR Limit The max heart rate is either entered by the user or calculated automatically by the program The automatic calculation is performed according to one of the following rules WHO 80 max HR 180 age WHO 90 max HR 200 age WHO 100 max HR 220 age AHA max HR 160 for patients under 25 years of age or 115 for patient over 75 years of age or 160 age 25 x 45 50 for patients between 25 and 75 years of age W e recommend using WHO 100 and modifying the target HR on thetest demographics screen if required CardioSys V4 1 127 The Exercise ECG Exercise Test Defaults Page 2 Figure 4 2 51 1 mV Cal Pulse Display o
131. e not to strangulate blood vessels in the process CardioSys V4 1 43 The Resting ECG Applying the Electrodes Applying Suction Electrodes T horax Shave application points if necessary Moisen electrode paper with tap water and place it between skin and electrode Electrode cream or gel can be used here instead of the paper Especially when the chest is alittle hairy cream or gel helps to seal Electrode Application Points for Standard Leads I I1 III aVR aVL aVF V1 to V6 Four limb and six chest electrodes must be applied for acquisi tion of the standard leads Attach the limb electrodes above a 5 the wrists and ankles Figure 4 1 3 shows the chest lead C3R C1 C2C3 C4 application points Figure 4 1 3 Chest dectrode application points C C1 inthe 4th intercostal space at the right sternal edge C2 in the 4th intercostal space at the left sternal edge C3 at thelevel of the 5th rib midway between C2 and C4 C4 in the 5th intercostal space on the left midclavicular line C5 on theleft anterior axillary line between C4 and C6 C6 onthe mid axillary line at the level of C4 C7 in the 5th intercostal space on the left posterior axillary line N black R red right leg E right arm C1 white C2 white C8 in the 5th intercostal space on the left scapulary line C3 white ZA a C3R oppasig GA on the rignt oe of the thorax La CAR opposite C4 on th
132. e other W indows application at the same time as C ardioSys Do not activate a W indows screen saver Run adaily backup of your data Appendix sec tions 3 1 Quit the program in the prescribed manner Chapter 5 D deing Examinations Quitting the Program before switching off the system with the power button 8 Turn off power with the main power switch 14 only when the C ardioSys cart will not be used for a prolonged period of time 227 498 02 A CardioSys V4 1 15 Introduction to CardioS ys i 1 5 Putting the Thermal Printer AR 200 Into Operation Controls and indicators of the thermal printer are shown in Figure 1 2 Top View Rear Panel View Figure 1 2 Controlsand indicators of the thermal printer 1 Green indicator islit when the printer is 5 Specification labds connected to the power line 6 Instrument fuses Y dlow indicator islit to indicate a problem 7 Powe button printer isturned on with the 2 Paper guide system s main power switch Paper tray door latch lift latch to open door 8 Powe input Paper tray door the printe tops when the door 9 Potential equalization pin is opened 10 Paralld port When the door is open take care to cwn iNnSUreno small objects enter the printer 16 CardioSys V4 1 227 498 02 A Introduction to CardioS ys Explanation of Symbols as U sed on the Printer KQ printer problem ky interface fuse Chart Paper Loading Before loadin
133. e pati ent Peas eee sys dia mmHg 4 15 12 1995 15 17 95 Resting ECG ae sapna atene mene 4 to Sdect multiple tests by holding either L2 J or J jecause R S ani angle lt 15 peer 5 down when clicking on a test because QR Aangie vetween 30 and 0 Print oe A eed T cin eee o Click on a Figure 3 7 Combined report 1 Arrow buttons and scroll boxes to reposition the text up down right left Button to ddete text Button to reinsert text Button to initiate a printout of the combined report Button to cancel the combined report Figure 3 7 shows an example of a combined report A combined report can be edited and printed but it can not be saved om Se W N k If you wish to add text position the cursor at the appro priate position and click Then type the text k If you wish to delete text highlight it then click on eal k D deed text can be inserted in any desired position To do so place the mouse cursor at the appropriate point and click Then click on ee kT he arrow buttons and scroll boxes 1 can be used to reposition the text up down right left k The button is used to initiate the printout of the combined report 227 498 02 A CardioSys V4 1 37 Selecting and Admitting a Patient Retrieving Stored Examinations Hellige ki e T Holter ECG 19 10 1995 13 00 30 P
134. e right side of the thorax C6 white os letar m Connect the 10 wire patient cable as shown in Fig F reer left leg ure 4 1 4 C5 C1 C2C3 C4 Figure 4 1 4 Connecting the patient cable 10 wire tandard ECG leads 44 CardioSys V4 1 227 498 02 A The Resting ECG Applying the Electrodes Arrange the patient cable as shown in Figure 4 1 5 and connect it to the system type CF signal input highly isolated suitable for intracardiac application defibrilla tion proof correct incorrect Figure 4 1 5 Arranging the patient cable 227 498 02 A CardioSys V4 1 45 The Resting ECG Applying the Electrodes Electrode Application Points for N ens Leads Figure 4 1 6 shows the application points for the N EH 8 electrodes Connect the 12 wire patient cable as shown in Figure 4 1 7 N n is identical with C4 If necessary disable the anti drift system and the filters muscle and AC line filter to view the unfiltered raw ECG signal sections 4 1 4 and 4 1 7 Asan alternative the N ens leads can also be acquired with the ar 10 wire patient cable In this case select the sequence H igh Right or Left as described in section 4 1 7 M odifying the Lead Sequence and change a l to D s A Map Io to A Figure 4 1 6 Electrode application points for N eH8 leads Ill to J N attachment point of the 2nd rib to the right sernal edge Apply the R electrode to N st N
135. e scroll bar at the right jumping from one event to the next with the cursor keys and select ing a specific event category from the event list button 4 Figure 4 2 39 You can also zoom important sections of the ECG and save them as episodes T his allows you to pick particularly interesting segments from the full disclosure EC G and save them discarding the rest because it takes up too much storage capacity button 9 Furthermore you can mark segments of special interest and print them out k Click on the beginning of the trace segment which will then be marked by a flag k Click on the end of the trace segment which will also be marked by a flag lt amp A printout of the segment is obtained by clicking on Ea k Click on 4 if you wish to return to the trend display 119 The Exercise ECG Reviewing the Final Report pcedure System Services Help ee i ss l e 2 ay Ce ce AGE SS eae C1 ae 2 ee 3 4 5 sce Gs comcast E E aia Daa seat Figure 4 2 40 Display of a zoomed segment 1 Buttonsto display the other leads of the same segment 2 Button to quit the zoomed segment and return to the full disclosure ECG Button to open the event selection window Button to save the segment asan episode Button to print the zoomed segment Buttonsto display another ti
136. e signals from the modem inform you of the transfer procedure After the transmission the program hangs up automatically 4 Only modems complying with the requirements of IEC 60950 or UL1950 may be connected to the system Furthermore the regulations applicable in the respective countries must be observed The modem must be set up inside the medically used area but outside the patient environment Warning CardioSys V4 1 257 Appendix 6 Connecting Peripheral Devices Connecting the SunT ech 4240 Sphygmomanometer T he sphygmomanometer needs to be configured once When the program screen is displayed select Change T ect Parameters You move the cursor with the and i keys You confirm entries with 1 Confirm your selection with i Select Set BP Reading Interval and press A to confirm the selection Se PRE TEST and POST toMAN using the i or y key 1 to 90 minutes M AN Display the program screen again press gt twice and select Utilities Confirm your selection with i Select Select System Interface and push A i Sdect SUNTECH with A ory Display the program screen again press gt twice Connecting the ERGOLINE 900 900L Ergometer Adjust the following settings at the ergometer EKG mode P10 baud rate 4800 The ergometer software must be version V 436 or higher or version V 236 call in an ERGO LIN E specialist to
137. ease refer to the TONOPORT IV IVaoperator s manual k Turn on the recording unit and initiate the first meas urement CardioSys V4 1 179 Ambulatory Blood Pressure Measurement Configuring Protocols The two protocols can be configured to suit the clinical picture of the patient to be monitored T he recording unit retains these modifications even when switched off X Display the setup screen as described above Figure 4 5 5 k First of all select the number of blood pressure periods for the protocol The day can be subdivided into up to 4 different periods and different measuring intervals can be selected for each of these periods Furthermore you can choose whether the measure ments are to be taken at exactly or at approximately the selected intervals Selecting the approximate intervals is advis able for apprehensive patients who may be stressed knowing when a measurement is being taken T he deflation rate and the cuff inflation pressure are also adjusted in this menu The deflation rate can be set to any value between 1 and 8 mmH g between oscillations T he deflation rate is fixed for auscultatory measurements The inflation pressure is the maximal pressure for cuff infla tion If you wish to modify the intervals or pressures click on zai to increase the value or on i to decrease the value 180 CardioSys V4 1 k The BP interval exact approx and the deflation rate can be changed
138. ecording date 3 Document included in the printout 4 Sdected printe Standard Page Recording periods medication reason for test comments BP graph Tabular BP table H ourly Averages Printout of the hourly averages in the form of tables and graphs Statistics Summary Printout of the procedure statistics in the form of histograms minimum maximum and average values 188 CardioSys V4 1 4 5 4 Documenting the Ambulatory Blood Pressure Measurement Procedure You can determine the scope of the printed report by selecting or deselecting the individual documents T hisis done on a special screen Figure 4 5 16 Click on to display the setup screen If you want to include a document in the report click on the check box next to the respective title so that a check mark is displayed Click again to deselect a document At the same time the little text box at the top indicates the number of pages to be printed 1 Figure 4 5 16 T he printout is initi ated with the print button will save the printer setup Phases Same as Statistics Summary but subdivided into day time night time and wake up time ECG Strips All ECG strips consecutively To select another printer click on moai T he printer setup window will open and you can click on another printer 227 498 02 A Ambulatory Blood Pressure Measurement 4 5 5 Ambulatory Blood Pressure Measurement Brief Operating Instructions Start program Act
139. ect the test type tests that were confirmed by a physician or unconfirmed tests 9 Figure 3 5 Confirmed tests are marked with an x tests that were recorded at a special location 4 Figure 3 5 This could be an external ECG recorder or a particular test lab Please refer to section 6 1 System Configuration for details on how to set the location number tests that were recorded in a specific time range 3 Figure 3 5 Enter the beginning of the range in the box at left and the end in the box at right click in the box first observing the date format D D M M YYYY or MM DD YYYY W hen you have set all filters either press lt on the PC keyboard or click the button Tests marked with an asterisks are stored on an external storage medium Follow the instructions displayed on the screen to restore these test data fk You can select multiple procedures by clicking on the procedure and holding the key depressed at the same time CardioSys V4 1 227 498 02 A Selecting and Admitting a Patient Retrieving Stored Examinations D gt D oubleclicking on a test isa quick method to select it from the database I When workingin a network environment it is not possible to display the same test at more than one workstation at a time I If multiple tests are highlighted when you first display the test records list these are records that were sent from an ECG recorder and the
140. ed when a physician has reviewed the test interpretation and signed it electronically with his her name T ests that have been reviewed and confirmed by a physician are marked with x k Click on i to display the window where you can enter your name 3 Figure 4 2 38 k Select the physician s name from the list box click on or enter it via the keyboard 227 498 02 A The Exercise ECG Reviewing the Final Report Full Disclosure ECG Patient ee System Services Help i aie gt g EEF 5 re oe Figure 4 2 39 Full DiscloureECG 1 Buttons to call up additional leads Buttons to sdect the sweep peed Button to activate the zoom function Button opening the event selection window Button to delete the full discloure ECG Button to print out a trace segment Button to cross reference to the trend display sn HOU RP WwW NY L Typing the first letter of an event eg P for PVCs takes you from one occurrence of this event to the next 227 498 02 A CardioSys V4 1 Full Disclosure ECG Each lead of the stored 3 6 or12 channd full disclosure ECG can be displayed T he events identified by the rhythm analysis algorithm are highlighted T he times are shown in the left margin Figure 4 2 39 You can choose between perusing the entire recording by dragging the scroll box in th
141. eference beat at rest option 18 Figure 4 2 10 and Figure 4 2 11 As trend values are saved at 30 second intervals we recom mend that you wait approx 30 seconds before starting to pedal k Then press the Phase gt gt button and ask the test subject to start pedalling 227 498 02 A CardioSys V4 1 93 The Exercise ECG The Elements of an Exercise Test W indow 2 in Figure 4 2 10 4 2 11 indicates the remaining time in the current stage while window 1 shows the time elapsed in that phase At the end of the load stage the load increase displayed by the program must be adjusted at the ergometer As a general rule you are required to repeat all load changes at the ergometer as demanded by the program During the test you can lt advance to the next load stage with k continue at the same load with k Modify the load in steps of 5 Watts with E and 280 advance to the recovery phase with upon comple tion of the last stage the program automatically activates the recovery phase k terminate the test with f Pre Test Test Phase Recovery Phase Adjust initial load Change load as of selected required by protocol protocol Test Information Prot 1 KOJ Phase gt gt Pedal Stage gt gt Hold Phase gt gt Select protocol When analyzing Automatic when Check recording ST segment wait last stage is inter
142. en Chapter 3 Selecting and Admit tinga Patient explains how to retrieve a patient from the database 24 CardioSys V4 1 227 498 02 A General Information on System Operation Explanation of the Function K eys T he function keys are used to call up the different program functions O pens a window for patient selection or for admission of a new patient section 3 1 3 2 Calls up further examination procedures Recording of aresting ECG section 4 1 O pens a window for selection of stored procedures Recording of an exercise ECG section 4 2 O pens the printer menu and allows you to print the displayed procedure Recording of aSTAT ECG section 4 3 Allows you to compare the current procedure with another one E3 Ei Initiates a pulmonary function test section 4 4 Allows you to delete the displayed procedure PEERE Calls up system services chapter 6 2v0 Initiates the ambulatory BP program for program ming of the BP monitor and data evaluation section 4 5 Calls up the online help function Initiates the late potential analysis program sec tion 4 6 Allows you to quit the program Be IW Initiates a bronchodilation test section 4 7 le 227 498 02 A CardioSys V4 1 25 General Information on System Operation Selecting the Language System Services Menu The program offers different languages for the user interfac
143. end End measurement Os Administer medication and display bronchodilation test screen again lt gt Repeat VC and FVC measurements C m End test CardioSys V4 1 173 The Spirometry Test For your notes 174 CardioSys V4 1 227 498 02 A Ambulatory Blood Pressure Measurement 4 5 Ambulatory Blood Pressure Measurement In this section you will learn how to perform ambulatory blood pressure measurements i e how to set up the recording unit how to configure the recording protocols how to download data from the recording unit to the PC and which report documents you may view how to print out the examination report T he brief operating instructions at the end of this section sum up what you have to do to perform ambulatory blood pressure measurements 227 498 02 A CardioSys V4 1 175 Ambulatory Blood Pressure Measurement Figure 4 5 1 Displays controls and connectors of the recording Oo o Ny ooun A 176 units left TONOPORT IV right TONOPORT IVa ON button to turn on the recording unit After the sf tet this button is used to tart and stop a meaurenent OFF button to turn off the recording unit TEST button to recall the most recently measured values The values will be displayed in the following order gysolic diastolic mean pressure pulserate This button is also used to program the recording unit when it is set up without a PC Liqu
144. ent depression Hypertensive BP response Hypotensive BP response Modify Reasons for Termination Selected Reasons for Termination Lal te Figure 4 2 29 Reasonsfor T emination window I Enter the reasons for termination in the same manner as the test information section 4 2 3 Entering the T est Information 227 498 02 A CardioSys V4 1 T he T est Summary The Tes Summary Figure 4 2 28 includes thetest data date time test duration the patient data thetest information theinterpretation A window in the middle is provided for entry of the reasons for terminating the test k Click on Reasons tor Termination This brings up a window where you select the reasons by clicking Figure 4 2 29 If you have entered the test information as described in sec tion 4 2 3 Entering the T est Information these will be shown here along with the reason for test If required they can be modified k To do s click on the test information button 109 The Exercise ECG Reviewing the Final Report HELLIGE rocedure System Services Help i Del sia eat n a A Test Data Date Time Total Exercise Test Duration Preset Dauer Bruce Dauer Recovery Artifact Time Reasons for Terminati Interpretation HR RPP METS He at rest 85 BPM x HR 86 P ue 8 a of Target HF PM a
145. enu section 4 4 7 Setting up the Spirometry System The factory set interface is COM 2 For detailed user instructions and specifications please refer to the LF 501 operator s manual 227 362 02 Figure 4 4 1 Repiration Flow Sensor LF 501 156 CardioSys V4 1 227 498 02 A The Spirometry Test The Basics ach i 4 4 2 The Basics ECG External Programs TAES SITES ETE ae Click to display the spirometry procedure screen You atheterization jolter a oo _ ace will find this icon on the procedure selection screen unless i la aa i i 1 L PETEN F i you have configured the icon bar to include that symbol External Rrograme section 6 System Services a A n T E ke Click to display the procedure selection screen Pa Figure 4 4 2 bii oF Spirometr Bronchodilation i p prenon a amp Click to display the spirometry procedure screen Figure 4 4 2 Procedure Selection screen Once you select a patient the system will display the test information entry screen Figure 4 4 3 227 498 02 A CardioSys V4 1 157 The Spirometry Test Entering the Test Information Test Information 4 4 3 Entering the Test Information Library Reason for Test g The test information screen provides space for entry of impor tant informati
146. er Jane 06 04 1943 654987 A Richards Chantal 03 12 1977 7766699 Roberts Jennifer 7 27 1977 543876 Shields Stuart 11 11 1912 765321 New Patient Stevenson Robert 11 22 1966 333999 Thompson Anthony 09 19 1932 665544 Delete next page pag Unnamed Help Cancel Close r New Patient Last Name Master First Name Jim Patient ID 8738999 Date of Birth 10 05 1949 MM DD YYYY Gender Male YJ Height 176 in Race x Weight 66 0 lb f Pacemaker Accept Figure 4 0 1 Patient sdection screen 227 498 02 A 4 The Examination Procedures The following sections describe the different examination procedures possible with C ardioSys resting EC Gs exercise tests STAT ECGs etc in detail W hen you click on one of the procedure selection buttons the patient selection screen opens allowing you to retrievea patient from the database or to enter a new patient sections 3 1 and 3 2 The advantage of this approach is that you can immediately select the examination procedure without having to choose a patient first On the patient selection screen the bar cursor is always on the patient selected last So if you wish to perform multiple tests on the same patient all you have to do is click on the sett button or press il If you prefer to run an unassigned procedure click on Choose to display the title screen If you run the program in conjunction with a hospital infor mation system H IS the button will a
147. ergency stop button I When using the treadmill model TM 400E it is important to adjust the same unit of speed meas urement at the ergometer and at the C ardioSys system km h or mph i gt If the speed is 0 in one of the stages the tread mill switches off and can only be restarted with the button I If the treadmill is stopped with the button or with the emergency stop button the speed and grade readout is Wait until this readout disappears before restarting the treadmill with sarneni J Treadmills k From the setup menu section 4 2 7 item Ergom Treadmill select Internal Treadmill for treadmills without digital interface Series 2000 for treadmills 1800 1900 T 2000 TM 400E for Trackmaster treadmillsTM 310 TM 400E k Select a test protocol k Click on QT At the beginning the program invokes the first stage supine of the pretest phase At this stage the resting ECG of the supine patient is re corded Continue collecting the ECG signal until you see the first ST analysis results 18 Figure 4 2 11 or the results of the first BP measurement Pre Test Exercise Phase Recovery Phase Test Information Select protocol When analyzing Check recording ST segments or measuring interval the blood pressure wait for 1st results to be displayed
148. es and for the printed reports To select one of the languages proceed as follows k Click the p button The window showing the system services opens Figure 2 6 ko Select E You will see Figure 2 7 T his paragraph describes language selection only O ther settings to be made in this window are nfiguration discussed in section 6 1 N k Select the Country Settings tab arrow Figure 2 7 C OC E black yellow antial 5n NETBIOS Protocol Figure 2 7 Sytem configuration menu General tab 26 CardioSys V4 1 227 498 02 A General Information on System Operation A screen similar to Figure 2 8 appears System Configuration we Select your language from the Language list box and click ___ 9x to quit the menu 24 Hour Format Figure 2 8 Sytem configuration menu Country Settings tab 227 498 02 A CardioSys V4 1 27 General Information on System Operation For your notes 28 CardioSys V4 1 227 498 02 A Selecting and Admitting a Patient Retrieving Stored Examinations 3 Selecting and Admitting a Patient Retrieving Stored Examinations In this section you will find information on how to select a patient from the database how to admit a new patient to the system how to retrieve examinations stored for a specific patient 227 498 02 A CardioSys V4 1 29 Selecting and Admitting a Patient Retrieving Stored Examinations
149. es annotated check m stvatues Another useful function is the presentation of alarge scale single median complex together with the same ST beat of the other leads in the form of a so called 3D graph k First click on fe then on the ST beat you wish to see A display similar to Figure 4 1 33 will appear CardioSys V4 1 227 498 02 A The Resting ECG Comparing Resting ECGs Patient Procedure e g System Services Help eat tle eSa eA E F 3D graph 08 iad Figure 4 1 33 Zoomed display 1 For display of the median complex as shown from the other leads 2 Toreurn totheST comparison screen 3 To print out the sreen display 4 Toactivate the 3D presentation Patient Procedure System Services Help eo tie Lo let A E ravers e d pem 227 498 02 A On this screen you can check m sp arapn 4 Figure 4 1 33 to view a threedimensional presentation of the beat Figure 4 1 34 Figure 4 1 34 3D presentation 1 For display of the same beat as shown from the other leads 2 Toreurn totheST comparison screen 3 To increase or reduce the ditancebewem the waveforms 4 Tordurn to the zoomed display 5 To Sect anothe viewing angle CardioSys V4 1 71 The Resting ECG Printing the Resting ECG Pages to print Print
150. f 1 mV calibration pulse yes or no 1 yes Audible LEAD OFF Alarm Audible signal when an electrode is disconnected yes or no m yes Audible HR Alarm Audible signal when heart rate limit is exceeded yes or no m yes Diagram HR in of max HR Do you wish to have this diagram displayed on the exercise test screen section 4 2 4 Running an Exercise T est Remote View Enables or disables transfer of the procedure data from a remote exercise test station to the local station section 4 2 8 M onitoring Remote Exercise T est Workstations RPP Readout Display of the RPP rate pressure product Select or deselect Start clock at pretest Check this box if you want the clock to start with the pretest phase 128 CardioSys V4 1 BP Monitor For selection of BP monitor to be used no no blood pressure monitor available you will be asked to take the blood pressure manually in ergometer a monitor isintegrated in the ergometer BP Meter 1 the SunT ech 4240 monitor is connected in this case you have to select the interface Port COM 1 through COM 4 BP Meter 2 Marquette H elige bosotron 2 if your system is not equipped with a BP monitor and you do not wish to be prompted for a BP measurement set the BP interval for all test stages in the list to 0 Thermal W riter For selection of the interface where the thermal printer is connected LPT 1 through LPT 4 After the configuration restart
151. f the procedure report showing the 10 second ECG strips Figure 4 1 15 The resting ECG report includes the following documents which are described in detail on the following pages theECG traces Figure 4 1 15 4 1 16 thetest summary Figure 4 1 20 medians dominant subdominant Figure 4 1 22 arrhythmia review Figure 4 1 25 interpretation Figure 4 1 27 CardioSys V4 1 227 498 02 A The Resting ECG Evaluating the ECG Patient at System Services Help q v Bea tle Sa A E pj GEF of mms elica Role PE SoA HE eal Ny 2 000 i eh 7 AL 7 Spe Peat ae ee eet oe ee ee ee gt Figure 4 1 15 ECG trace display 2 x 6 leads 1 Button to call up the optional 6 lead display 2 sreng Buttons to change the gain and sweep speed Button to zoom the ECG Buttonsto call up the other report pages scrolling page by page Button to directly access specific pages Procedure parameters Buttons to display other time intervals xn HOU RP WwW NY Patient ies System Services Help ft eel tte I S a 2 a t E ef gt mms oJ Sf te PE E a a ee OC NT EC E ae ey pie aVF i ir aie Yeo a a Yo agi AG Yao g af Y el bi Figure 4 1 16 ECG display 6 leadysre n 227 498 02 A ECG Trac
152. f you wish to create a new phase enter a new name under which the phase will be saved X Click on to clear the window A modified phase stored under anew nameis not automati cally included in a test protocol For this it must be selected from the list CardioSys V4 1 131 The Exercise ECG Exercise Test Defaults Modify Phase Phase P Bruce Type TM Square Stage 5 Grade Time in Stage ECGRec Int BP Interval lt 99 00 00 00 00 00 1 2 3 Stage Supine a Speed SP foo 8Ft S mph Grade cRj0o 0 Time in Stage TS 99 00 min L ax ECG Rec Inter EI 00 00 min Cancet__ BP Interval PI 00 00 min hep Figure 4 2 56 Window for definition of a tet phase 1 Phas 2 Phase parameters 3 Entry boxes I Some of the test phases such as WHO cannot be modified When you change any of its parameters you must save it under a new name Do not specify BP intervals lt 2 min This may result in wrong values and may damage the tissue Warning i gt The results of BP measurements that take longer than 60 sto complete are entered in the next line of the table You can avoid this effect by selecting a shorter interval for the first BP measurement which will then start earlier Example measurement duration 90s interval 3 min 1st BP interval 2 30 min 132 CardioSys V4 1 M odifying Square W ave T ests k Click the stage to be modified reverse video 2 Figure
153. g chart paper make sure that the printer is switched off button 7 Figure 1 2 The indicators will go off after a few seconds Caution Pulling upward on the paper tray door latch 3 Figure 1 2 open the paper tray door Remove the cardboard backing of the old pad When inserting the new pad be aware of the following points the last sheets of the paper pad have a red stripe so this side of the pad should be at the bottom of the tray the black squares should be facing down and lo cated on the side of the printer nearest the paper tray door latch place the pad including the cardboard backing on the tray and remove the cardboard on the top Pull the first sheet of the pad straight out over the paper guide at the same time closing the paper tray door Turn on the printer Caution Do not attempt to operate the printer without thermal paper Do not pull on the sheets to remove them from the printer After loading a new pad press keys ou ne to ensure that the next printout starts at the top of the page Caution The thermal printer AR 200 does not require an additional protective earth connection devicein compliance with IEC 60601 227 498 02 A CardioSys V4 1 17 Introduction to CardioS ys Printer Problems T hermal Printer Problem Does not print and green LED labeled Power does not light Remedy Check that power cabl
154. g interference free ECGs The signal acquisition screen immediately gives you a visual indication of your electrode technique and of the signal quality provided the red R electrode is applied For quick reliable and trouble free application of the elec trodes we recommend our Electrode Application System refer to the Electrode Application System operator s manual Asan alternative you can use the conventional plate elec trodes on the limbs and the suction electrodes on the thorax Applying Plate Electrodes Limbs Plate electrodes are applied by means of a rubber strap eec trode paper is the recommended contact medium for this type of electrode Moisen the electrode paper with tap water and place it between skin and electrode Secure the electrode with the rubber strap Figure 4 3 1 so that it cannot shift during the recording take care not to strangulate blood vessels in the process 227 498 02 A The STAT ECG C Applying Suction Electrodes T horax Shave application points if necessary Moisten electrode paper with tap water and place it between skin and electrode Electrode cream or gel can be used here instead of the paper Especially when the chest is a little hairy cream or gel helps to seal Electrode Application Points for Standard Leads I I1 III aVR aVL aVF V1 to V6 Four limb and six chest electrodes must be applied for acquisi tion of the standard leads Attach
155. general CardioSys V4 1 ergometer model ergometer port remote view BP monitor model BP monitor port thermal printer port ambient conditions respiration sensor port BP monitor port access password default mode trace background screen diagonal station name physician user patient selection with card reader only test patient icon bar configuration option codes W indows configuration baud rate electrocardiograph interface 227 498 02 A Cleaning Disinfection and Maintenance 227 498 02 A 7 Cleaning Disinfection and Maintenance 7 1 Instrument Surface Before cleaning and disinfecting the device disconnect it from the power line Clean the instrument surface with a cloth moistened in a cleaning solution T ake care that the solution does not enter the device All hospital grade cleaning solutions and disinfectants containing up to 70 alcohol are suitable Disinfectants with a phenol base or peroxide compounds are not suitable for disinfection of the instrument sur face 7 2 Patient Cable and Electrodes D isconnect the cable from the device before cleaning or disinfecting it To do this pull on the plug not on the cable itself Rub the cable clean with a cloth soaked in soapy water To disinfect the cable rub it down with disinfectant D o not immerse the cable in liquids In addition to the information below observe the instructions for use enclosed with the electrodes D
156. gory box CardioSys V4 1 227 498 02 A System Services Menu 227 498 02 A t Asan alternative you can also write a category directly into the Category box or add something to an existing category via the keyboard k Click the icon and follow the instructions displayed on the screen Click the icon if you wish to verify the recording Click to quit the screen You will now see the table of contents including the new recording Playing Back or D eleting Recordings Click B the window showing the System Services opens a Click the icon you will see a list of all saved speech recordings amp Highlight the desired recording by clicking ey Click Ey or fa as required k Click cance to quit the voice recorder function CardioSys V4 1 223 System Services Menu Hellige bd System Services Menu Procedure Archiving Setup 7S 2 Be i z System Copy Patient Compression Load Configuration Records iB 2 Fela is Voice from ECG Archive Patient Save Recorder System ECG Recorder Cancel Help Figure 6 11 System Services M enu Hellige ki H Haln r Patient r Medium Directory 4 E Jane Miller 42 yrs 1 Patient Records Records on Storage Medium
157. gram from the procedure selection menu the program in question must have been set up first refer to section 4 7 2 Setting U p External Pro grams perform the examination eg H olte ECG sonography return to the M arquette H adlige program adopt proce dure summary and assign it to the patient s procedure list 227 498 02 A External Programs ie Procedure Selection Menu HM i ECG a Rest ECG amp P Exercise Test q ETI y Ambulatory Blood Pressure r Spirometry STAT ECG Right Heart Catheterization Een Monitoring l Late Potentials Spirometry 5 ip Bronchodilation External Programs Holter ECG la aa a 2 e External Programs Help Figure 4 7 1 Procedure selection menu Setup ECG BE External Programs Ultrasound Stress Echocardiography X Ray Cardiac Catheterization Cath Lab Data External Program Program path and name External Programs c lecg holter exe OK Cancel Help Spirometry Bronchodilation Help Figure 4 7 2 Setup of external programs 227 498 02 A CardioSys V4 1 4 7 2 Setting Up External Programs ka Click on to display the procedure se
158. gt The test information screen appears automatically when you check the Patient Selection Prior to STAT ECG box in the system setup menu The same screen can also be displayed by clicking on the button k Click to display the system settings but tons o Select to display the setup menu section 4 3 4 The 40 Hz box switches a muscle filter on and off S The 50 Hz check box switches an AC filter on and off AC filter on k The arrows at mm mV select the gain 2 5 5 10 20 lt 40 mm mV lt Thearrowsat mm s select the trace sweep speed 25 or 50 mm s The entire ECG recording is controlled with the four buttons xh Test Information Freeze Traces Options gt gt T he following pages explain the operating steps required to record aSTAT ECG 227 498 02 A CardioSys V4 1 147 The STAT ECG Hellige z Patient Procedure ystem Services Help me lel T o lee 2 A HR BPM lt Measurements Freeze Traces Options gt gt Setup jx 40 HZ X 50 HZ altho mm mV 25 mm s Pee Shel u y vi aA ee aa thay v Kenana ECG Storage min s 19 29 A O lt e Analyzing Figure 4 3 8 STAT ECG acquistion screen I The system may be configured to display the patient selection screen before the signal acquisi tion screen 1 amp At the end of the an
159. he procedure Compress Exercise Test STAT ECG procedure data that are older than the date shown 01 01 1999 Compress Cancel Help Figure 6 17 Data compression stup screen amp Click on to terminate data compression ue Run a backup of all data Appendix 3 before compressing or exporting it 227 498 02 A CardioSys V4 1 229 System Services Menu Hellige System Services Menu Procedure Archiving Setup m E al Compression Load System Copy Patient Configuration Records iB ee z la Gs Voice from ECG Archive Patient Save Recorder System ECG Recorder Cancel Help Figure 6 18 System Services M enu gt In a network environment the program must be terminated at all other workstations ords Archive lmpot Export Import all patient records from Export all patient records that are older archive than the date shown Cancel 01 01 1999 Figure 6 19 D ata export stup screen I In the Virtual memory window the 32 bit access must be disabled 230 CardioSys V4 1 Archiving Patient R ecords e g to a magneto optical disk An even more efficient way to free storage capacity is t
160. he export of data to external storage media T hese files are still included in the table of contents but they are marked with an asterisk If you select one of these files for display the program tells you where they are stored Before archived records can be transferred to M USE they must be restored to the system o Click b the window showing the System Services opens Figure 6 18 k Click the icon T he archive setup screen appears Figure 6 19 k Enter the date up to which you want to have the files exported e Click E k Insert the storage medium and after the archive proce dure label it with the number displayed Select the target drive e g d Do not export data to the root directory but to the subdirectory d data for instance amp Click to initate file transfer and observe the instructions displayed on the screen ka Proceed in a similar manner to import files into the PC system using the L meet functions 227 498 02 A System Services Menu Hellige Lain System Services Menu r Procedure r Archiving r Setup ue T a System Copy Patient Compression Configuration Records T Voice from ECG Archive Patient Recorder System ECG Records Recorder Cancel Help Figure 6 2
161. he printer is connected Barcode Patient ID The patient ID no can be annotated on the report in the form of a barcode T his allows you to scan the code with a barcode reader and thus assign the report to the correct pa tient CardioSys V4 1 227 498 02 A The Resting ECG System Defaults Setup Hellige Speed mm s Gain mm mV Lead check noise level ca 10 4 IX 1 mV Cal Pulse a Audible LEAD OFF Alarm low 4 Manual Override QTC Calculation Lead Sequence Rhythm Lead Print after Analysis Report Hegglin Holzmann aj STANDARD m _ p 4 Modify 40 Hz Filter 50 Hz Filter F Spline OK Cancel al Help Figure 4 1 40 Setup menu 227 498 02 A 4 1 7 Setup From the setup menu you can select a number of system settings to suit your personal needs and preferences T hese settings will be retained T hey are automatically activated each time the system is turned on k Click setup to display the setup menu screen Figure 4 1 40 Use this screen to select your personal system settings Adjustments are made in three different ways 1 Thereis an arrow at the end of a box 4 Clicking this arrow will open a window which offers various options Select the desired setting by clicking the mouse button 2 Thereisacheck box in front of the function Click
162. he lig of registered physicians 2 Disgplaysthe othe ECG leads 3 RemovestheECG leads Confirming an Interpretation The interpretation of a recorded ECG is confirmed only after it has been reviewed and electronically signed by a physician marked with a X in the procedure list X Click on 2 Figure 4 1 28 to display the window for entry of the physician s name k Select the name from the list open the list box with x or enter aname via the keyboard Editing the Statement Library The A icon becomes active as soon as you display the statement library 1 Figure 4 1 27 amp Click on to open the window for entry of interpre tative statements 3 K ey in new text or edit the existing phrases Select to clear the window Adding the ECG Waveforms The icon can be used to display the ECG waveforms in the bottom half of the interpretation screen Figure 4 1 28 Three leads are always displayed at atime T he other leads can be viewed with 2 Figure 4 1 28 Click on Xj or to clear theECGs 227 498 02 A CardioSys V4 1 67 The Resting ECG Comparing Resting ECGs l a ge Patient P Compare Test ram olen a I Procedure 1 im ELLGAPENG 10 08 1996 11 32 23 Procedure 2 P PE 10 08 1996 11 32 51 Resting ECG Measur ET WT RETT
163. he nearest sales service office 227 498 02 A CardioSys V4 1 237 Troubleshooting Tips M alfunctions Interference regular AC interference 50 60 H z Cause interference from the power line Remedy Ground bed and system verify electrode placement Switch on AC filter if necessary Figure 8 1 Regular AC interference Interference irregular interference signals Cause muscle artifact due to patient movements trembling hiccough coughing Remedy The patient should be warm enough and rest comfortably place cushions under patient s knees or arms Figure 8 2 Irregular AC interference Divert patient s attention or distract him her Switch on muscle filter if necessary 238 CardioSys V4 1 227 498 02 A Technical Specifications 9 Technical Specifications ECG Processing Lead selection manual selection of individual lead sequences or automatic lead sequencing ead sequences EINTHOVEN GOLDBERGER WILSON N EHB CaBrera lead sequence and custom configured sequences Automatic functions assist and simplify system operation with automatic blocking function formatted reports automatic baseline adjustment cubic spline algorithm for compensation of variations in polarization voltage H eart rate readout derivation of the heart rate from all ECG signals display range 30 to 300 BPM measurement and interpretation up to 240 BPM displa
164. he recovery phase Q uits program 139 The Exercise ECG For your notes 140 CardioSys V4 1 227 498 02 A The STAT ECG 4 3 The STAT ECG The STAT ECG function allows you to record a resting ECG and save an ECG of up to 30 minutes duration T he first 10 seconds of the recording will be analyzed and you will obtain the same report on screen and via the printer as for the resting ECG This section describes the operating steps necessary to record a ST AT ECG namely how to apply the electrodes to the patient and connect the patient record the ECG call up the report pages for on screen review select the default system settings Printing the report and comparing two EC Gs is de scribed in sections 4 1 5 4 1 6 and 4 1 7 this is identi cal with the resting ECG In these sections you will also be informed on how to display the stored full disclosure ECG T he brief operating instructions at the end of this section sum up what you have to do to record aSTAT ECG 227 498 02 A CardioSys V4 1 141 The STAT ECG N m we Figure 4 3 1 Applying plate dectrodes I Thered R electrode is the reference electrode Placement and signal quality of all other elec trodes can be assessed on the signal acquisition screen only when this electrode is applied 142 CardioSys V4 1 4 3 1 Applying the Electrodes Careful application of the electrodes is a prerequisite for obtainin
165. hen the system starts signal acquisition The recording ends automatically when the selected time has elapsed or when you press the OME button The 10 sECG segments are displayed Scroll through the report or access documents directly Proceed to next procedure or Quit program 227 498 02 A The Spirometry Test 4 4 The Spirometry Test A spirometry test includes measurement of the expiratory and inspiratory vital capacity VC plus presentation of the expiratory volume time curve measurement of the expiratory and inspiratory forced vital capacity FVC plus presentation of the volume time and flow volume curves A parameter table lists all measured values the normal values and the percentage deviation of each parameter You can also run two procedures as a so called broncho dilation test For this purpose two tests one before and one after medication are compared This section tells you how to connect the respiration flow sensor enter the test information and patient data reason for test medication comments etc conduct a test call up and print the report pages compare two tests set up the system to suit your needs setup menu 227 498 02 A CardioSys V4 1 155 The Spirometry Test Connecting the Respiration Flow Sensor LF 501 4 4 1 Connecting the Respiration Flow Sensor LF 501 The respiration flow sensor is connected to the interface selected from the setup m
166. heslope thenumber of points N thecorrelation quotient r thecorrelation quotient r for p lt 0 05 error probability less than 5 For details on the ST H R slope please refer to section 7 4 in the Appendix CardioSys V4 1 113 The Exercise ECG Reviewing the Final Report Sample Cardiac Cycles Patient Procedure System Services Help fat Io lekb d N Sample C ardiac C ycles A The Sample C ardiac Cycles page presents the median beats g EE paie Es RIE including the ST measurement points and ST results U p to Supine 0 30 Stage2 3 39 METS 1 00 METS 4 90 ee 6 leads are displayed per screen The beats on the far left are en hs the QRS complexes at rest those following to the right are the l kA Ap 03 Doo median beats for each load stage Figure 4 2 34 T he pro gram can display up to 20 median beats W hen this number is reached the program proceeds as follows T he beat on the far left is retained while the latest beat overwrites the oldest beat r i 10 00 0 01 0 23 0 00 p lt 5 5 S a SS es T 0 ooo in the section on the right T he last beat before a phase arpi oi change is not overwritten 10 13 0 00 PigiG eee sample E ardiei yele paged Click m or to display the next set of 6 leads ie Click p or en to move to the next or to the previ ous load stage
167. hysician s name from the list box click on or enter it via the keyboard 227 498 02 A The Spirometry Test The Bronchodilation Test 4 4 5 The Bronchodilation Test The bronchodilation test always consists of two measure ments one before and one after medication k Click to select the bronchodilation procedure The screen for VC measurement before medication will be displayed Perform the measurement as described in section 4 4 4 amp M easure FVC in thesame manner Click to terminate the measurement T hese tests are saved and annotated as measurement before bronchodilation S Administer the medication and select the bronchodilation procedure again 227 498 02 A CardioSys V4 1 T he screen for VC measurement after medication will be displayed k Perform measurement of VC and FVC again k Click to terminate the measurement You will now see both examinations on one screen so that you can compare the effects of the medication section 4 4 6 Comparing T wo Spirograms If you decide to run a bronchodilation test on a patient whose spirogram was recorded earlier that day you will be asked whether the first spirogram is to be taken as the reference test 169 The Spirometry Test Comparing Two Spirograms Patient P EELGAPELG Compare Procedure Procedure 1 10 08 1996 11 32 23 Procedure 2 10 08 1996 11 32 51 Spirometry 09 08 19
168. i Cancei channels indicating the lead currently assigned to that 12 ve Te ve Hen Hen channel To select another lead click to display all TEn available leads Figure 4 1 43 Figure 4 1 42 M odifying the lead sequence Select the new lead to be recorded in the respective channel E Lead Sequence l a Enter up to 4 characters in the D esignation column to label the lead Speed mm s Lead Sequence Gain mm mV i E d Alarm ered ec l O nce you have assigned a new lead to each of the channds Mt java A you can enter a name for the lead sequence in the headline QTC Calculation 4 ae aVR Al eR Lead Sequence 5 u out 50 Hz Filter F ee sjy aVF N k Move the cursor to the text box and click 7 v5 v1 Print after Analysis v Report 8 p v2 it te k Enter a name and select ox to clear the window nfv e v Cance Cancei k Click modifications are saved or jve a ve Hep Hen modifications are ignored to clear the configuration Figure 4 1 43 M odifying the lead sequence mat 227 498 02 A CardioSys V4 1 77 The Resting ECG System Defaults Rhythm Lead rhythm or reference lead Print after Analysis Do you wish to print the report set up on the screen men tioned above immediately after the
169. ialog window for entry of the tet information 82 CardioSys V4 1 4 2 1 Some Basic Facts I Before recording your first exercise ECG go to the defaults screen and choose the basic sytem settings section 4 2 7 Exercise T est Setup T hese set tings will be retained and are automatically activated each time the system is turned on k Click on to start the program After you have selected the patient the system displays the dialog window for entry of the test information Figure 4 2 1 unless this option was deselected in the System configura tion We recommend applying the electrodes to the patient following the instructions given in section 4 2 2 before entering the test demographics 227 498 02 A The Exercise ECG Applying the Electrodes Cc Figure 4 2 2 Electrode application points C1 _ inthe 4th intercostal space at the right gernal edge C2 in the 4th intercostal space at the left ternal edge C3 atthelevd of the 5th rib midway bawen C2 and C4 C4 inthe5th intercostal space on the left midclavicular line C5 _ on theleft anterior axillary line between C4 and C6 C6 on the mid axillary lineat thelevd of C4 C7 in the 5th intercostal space on the left posterior axillary line C8 in the5th intercostal space on the left scapulary line R L on theright and let shoulders N F abovetheright and left kidneys 227 498 02 A 4 2 2 Applying the Electrodes Careful applicati
170. ician t You can enter your own interpretation in the Interpre tation window by placing the cursor in the window and typing the text You can record a spoken comment button and play it back later button Ey For this feature you need a micro phone and a sound card must be implemented in your PC If you wish to enter or edit the test information click on to display the corresponding dialog window CardioSys V4 1 167 The Spirometry Test Running and Evaluating a Spirometry Test Data Export The S icon allows you to export the most important data pertaining to the spirometry test to the clipboard or to any file D ata exported to the clipboard for instance can be inserted in a text file with the Edit gt Paste command Click BE k Select either Export data to clipboard or Export data to file Click on x D ata from the clipboard can be inserted in a text file For data exported to a file you will have to specify the target directory and confirm it with x 168 CardioSys V4 1 Confirming T ests A test is considered confirmed when a physician has reviewed the test evaluation and signed it electronically with his her name T ests that have been reviewed and confirmed by a physician are marked with x S Click on lka Figure 4 4 13 to display the window where you can enter your name Select the p
171. ick this means that you should press the left mouse button twice in rapid succession On many screens you will see windows offering various selections Figure 2 3 To select an option move the mouse pointer to the item and press the left mouse button T his selects the item and the window disappears W hen alist of selections is too long to fit in the window the window has a scroll bar at its right edge Clicking the arrow at the upper end of the scroll bar moves the list down one by one 1 Figure 2 3 clicking the lower arrow moves the list up 2 Figure 2 3 A so called scroll box between the two arrows allows you to move quickly through the list by clicking the scroll box holding the mouse button depressed and dragging the box up or down 3 Figure 2 3 CardioSys V4 1 21 General Information on System Operation Select Procedure Patient Baker Dave 41yrs Procedure all Status all 4 Location Date from to Display Confirm Send Combined Report 4 ETA Cancel Show new procedure list 03 38 17pm 0 Exercise Test 03 29 24pm x0 Exercise Test 03 10 13pm 0 Exercise Test 1 03 00 11pm 0 Exercise Test 10 53 39am 0 Exercise Test 12 04 1996 12 04 1996 12 04 1996 12 04 1996 11 20 1996 Figure 2 3 Excerpt from the procedure list 1 moves thelist down line by line 2 moves the lis up line by line 3 allo
172. icking on or by pressing the start exercise button on the function keypad From now on the program controls the entire test including the recovery phase You can abort the test at any time by clicking the button CardioSys V4 1 101 The Exercise ECG The Elements of an Exercise Test See ae Pe During the test you can SEE EEG SPE the reference numbers refer to Figures 4 2 10 and 4 2 11 1 1 t t forebrain atin fp ben Jen mh 4 cao Aoi of PSC ERE ada ae CN a odin IE RRRDEARZAGERAURARMREARRESLERGERRRRRE AUR EAERRREEA increase or decrease the speed and grade 7 if you sid ANG Edd 140 1S Ra LGN UM a ae 1am LEY i interrupt the automatic program the ie and E check A ch cee ch chet buttons are disabled and you have to control the rest of a r eT ce ee the test manually or prevent an automatic increase or EEE E E E E EE decrease with raa 5 sc auc thud hac 14nd Func a 05d Gung hua maciaaa an Ee enn Ae F F nee re nee ton at a e E EER EE AES EA proceed to the next stage with Sase55 5 1 SR E L ae de FE Popri Sek hehe ob ob de bd bb proceed to the next phase with MENEN 6 Figure 4 2 17 Example of a 12 lead rhythm report initiated with thermal printer briefly stop thetreadmill during the test and restart it with Stop Treadmill and start treadmill 8 abort thetest with 10 initiate a printou
173. id crystal display Patient cable connection microphone ECG Cuff connection Battery compartment cover Port for connection of PC printer or power supply unit M icrophone senstivity switch TONOPORT IVa 4 5 1 General Information The recording unit employed for ambulatory blood pressure measurement isthe TONO PORT IV IVa unit While the TONOPORT IV units only use the oscillometric measuring method TONOPORT IVa units also offer the auscultatory method M oreover TONO PORT IVa units store the heart rate and ECG strips For information on how to set up and operate the recording unit please refer to the TONO PORT IV Vla operator s manual 1S Disconnect TONOPORT from the patient when it is connected to the PC I When you see the message Inconsistent data in patient monitor Procedure cannot be saved turn off the patient monitor before downloading data Switch off the patient monitor before connect ing it to the PC Furthermore it is recom mended to delete old data before starting a new ambulatory blood pressure measurement Caution CardioSys V4 1 227 498 02 A Ambulatory Blood Pressure Measurement ea Procedure Selection Menu rf r ECG External Programs a el a Rest ECG STAT ECG Right Heart w Catheterization Holter ECG d Ga EE Exercise Test Mo
174. ified in IEC and AHA recommendations lt 2 5 uV rms common mode rejection for 50 or 60 H z signals depending on model with AC filter enabled gt 140 dB ECG calibration automatic recording of a defined voltage jump valid for all channels calibration voltage referred to the ECG signal input 1mvV Baseline automatic adjustment to the optimal writing range in dependance of signal amplitude Cubic Spline automatic compensation of baseline fluctuations caused by variations of the polarization voltage at the pick up electrodes Blocking automatic rapid charge reversal of the coupling capacitors in the preamplifiers upon electrode application 227 498 02 A Technical Specifications ECG signal input isolated patient connection type CF according to IEC all pick up electrode connections and N connection high voltage proof electrodes are monitored for signal quality and lead breaks electrode connections for R L F N C1toC6 Nax N st Nap C 4 input impedance for differential signals between any two electrodes at 10 Hz gt 10 M Ohms input impedance for common mode signals referred to N up to 60 Hz gt 50 M Ohms dynamic range for differential signals between any electrode connections 10 mV for AC voltage 600 mV for superimposed DC voltage polarization voltage dynamic range for common mode signals referred to N 1V referred to chassis 264 V rms quiescent input current via any ele
175. indow Remote Cart N ame is enabled only when the system is connected to a network For entry or selection of the physician and technician infiguration names appear on Test Information screen or their ID General Modem MUSE Option Code Country Settings Institution Name and Address Name n E DaB D efault Procedure ciy e H ere you select the procedure which the system selects auto ee oe matically when turned on Click the arrow E then click the ysician Vv cao User List me wi D desired procedure Default Procedure yi Windows control menu ee Se Restart program for changes to become Trace Background black yellow antial yi effective T race B ackgrou n d Screen Diagonal 15in v Meru labels nerea ne You can select various colors for the background on which the T Test Patent temporary 7 Enable Password Function signal traces are displayed Click the arrow E then click the m Anti Aliasing of morer Patient Selection prior to STAT ECG d esi r ed c ol or Y Enable Test Information Window System Configuration Icon Bar Save Load Screen D iagonal For Service only Helo Select the screen size of your PC system s monitor to assure Cancel that the traces are displayed true to scale Click the arrow Figure 6 2 Sytem configuration screen then click the dimension 212 CardioSys V4 1
176. ing the test the blood pressure exceeds this value the pressure reading is highlighted with a different color CORINA analog output To select the lead for the analog output In T est Reports H ere you select the printer for reports generated during the test in test reports You can choose among thermal array writer laser printer and no printer For the thermal writer you can specify and create your own automatic report format Mody button This button brings up a window where you choose the format of the 12 lead report 4 x 2 55 2 x 5s 1 x 5s The format selected here also determines the way the ECG Strips report page is presented With Recall and Rhythm you determine the report format of the printouts initiated with the and buttons section 4 2 4 Running an Exercise Test The menu item M edian Report allows you to choose whether the comparative medians or the linked medi ans will be printed 227 498 02 A The Exercise ECG Exercise Test Defaults Auto Report Format H ere you select the report generated at the selected recording interval 12 lead or comparative medians possible only with the thermal writer M anual Recording H ere you choose whether a manual recording will be printed saved or printed and saved Arrhythmia Lead Select T he two leads used for arrhythmia analysis are selected either by the system Scan or by the user M anual The first of th
177. input of the device Such contact would bridge the patient s isolation and cancel the protection provided by the isolated input In particular there must be no contact of the neutral electrode and ground 12 CardioSys V4 1 227 498 02 A Introduction to CardioS ys Warning Devices may only be interconnected with each other or to parts of systems when it has been made certain that there is no danger to the patient the operators or the environment asa result In those instances where there is any element of doubt concerning the safety of connected devices the user must contact the manufacturers concerned or other informed experts as to whether there is any possible danger to the patient the operator or the environment asa result of the proposed combi nation of devices Standards IEC 60601 1 1 EN 60601 1 1 must be complied with in all cases I amp S Medical technical equipment such as the CardioSys system must only be used by persons who have sufficient knowledge who have received adequate training in the use of such equipment and who are capable of applying it properly Before using the system the operator is obliged to verify that it isin correct working order and operating condition Warning The operator must be familiar with the opera tion of the system Caution Danger Liquids must not be allowed to enter the de vices D evices into which liquids have pen et
178. install the latest version The round plug of the connecting cable is inserted in the 10 RS232 connector at the ergometer T he other connec tor is plugged into CardioSys or the PC The setup is now complete make a backup copy of the setup disk From now on the M arquette H ellige program will start the sphygmomanometer 258 CardioSys V4 1 227 498 02 A Appendix 7 Application Tips 7 1 Artifact Due to Poor Electrode Application This program is equipped with state of the art electronic utilities to insure artifact free recording Among these are the automatic baseline adjustment and the cubic spline algo rithm At the beginning of the recording the automatic baseline adjustment verifies the incoming signal and adjusts the baseline position accordingly D uring recording the cubic spline algorithm continuously checks the baseline position and returns the baseline to its normal level if it wanders W hen electrodes are not properly applied these measures may not fully compensate for artifact H igh polarization voltages induced by electrodes applied without conductive gel may cause the amplifier to overrange so that a straight line will be recorded instead of the ECG Cubic spline will return this line to its normal position and a baseline ensues for approx 1 second message Excess DC O ffset 227 498 02 A Remedy Apply the electrodes according to instructions Do not apply the electrodes on to
179. ions and compare it with any other ECG as described below A window will open listing all of the patient s resting ECGs Figure 4 1 29 k Select a recording and click to clear the window The comparison screen appears Figure 4 1 30 fk Itis possible to sdect multiple ECGs at the same time To do so hold the _ key down while clicking on the procedures 227 498 02 A The Resting ECG Comparing Resting ECGs Q Patient Procedure System Services Help le a alee oe d Procedure 2 T t Procedure 1 a 10 08 1996 11 32 51 oN ta 10 08 1996 11 32 51 T 7 1 j se F Figure 4 1 31 Comparing two zoomed ECG segments 1 Displaysthe same QRS complexesin other leads 2 Displays the average beats returns you to the 10 sECG or to the interpretation 3 MovesECG 2 up and down 4 MovesECG 2 totheright and left 227 498 02 A For each ECG the screen shows 3 leads at a time 25 mm s 10 mm mV ECG 1 is displayed in the top half ECG 2 below Click buttons F and w to display the other ECG leads The button allows you to select a portion of the ECG and display it at a larger scale Identical segments of the two procedures are superimposed Click AY k Move the cursor to the region of interest the cursor becomes a magnifying glass and click You will seea display similar t
180. iscard disposable electrodes immediately after use to prevent their being reused Clean reusable electrodes immediately upon removal from the patient Peg off the adhesive foil before cleaning them residual adhesive can be removed with benzine Use warm water and a small brush to remove electrode cream Do not use pointed metal objects to remove solid particles of dirt from the electrodes Disinfect the electrodes with alcohol free disinfectants M ake sure that plugs and sockets do not become wet Use only gas to sterilize the electrodes frequently steriliz ing the electrodes with ethylene oxide shortens the life of the plastic material For information on cleaning disinfection and steriliza tion of other sensors and transducers please refer to the instructions for use included with these devices CardioSys V4 1 233 Cleaning Disinfection and Maintenance 7 3 Respiration Flow Sensor LF 501 Please refer to the O perator s M anual of the Respiration Flow Sensor LF 501 for more details on cleaning and disinfection Cleanliness and hygiene of the sensor is of the utmost import ance as the patients breathe in and out through the sensor during the test Use anew mouthpiece for each new patient T he use of mouthpieces with bacteria filters is imperative W hen using mouthpieces with bacteria filter in compliance with their instructions for use it is not necessary to clean and disinfect the
181. iswill open the library window Figure 4 4 4 k Move the cursor to the desired position in the list and click the mous button k Enter the statement and press lt on the keyboard T he cursor moves to the beginning of the next line a In this manner you may enter all reasons for test C lick to clear the window 227 498 02 A CardioSys V4 1 159 The Spirometry Test Entering the Test Information Test Information Library Reason for Test Reason for Test Respiration problems Shortness of breath Pain Follow up none beta blockers betamimetics xanthine derivates corticoids atropine cromoglycinic acid fenoterole amiodarone unknown see Comment Medication _ Comment Physician al Technician la Figure 4 4 5 Lig of medication groups 1 Allowsyou to asign a drug to a medication group I amp S The physician is responsible for assigning drugs to a medication group Medications Medication Group Drug Name none beta blockers betamimetics xanthine derivates corticoids atropine cromoglycinic acid fenoterole amiodarone unknown see Comment Help OK Cancel MOM MONN N Vi ENAN N Figure 4 4 6 Asig
182. it ALL applica tions Insert the CardioSoft CD intheCR ROM drive Select Start gt Run At the command line enter X setup X CD ROM drive letter Click OK Select N ext to confirm the suggested directory when reinstalling the program be sure to select the same drive CardioSoft will now be installed on your computer Restart Windows W e recommend to disable the W indows Print M anager to speed up printouts 227 498 02 A Select Start gt Settings gt Control Pand Doubleclick Printer Select the printer you will use Select File gt Properties gt Scheduling Select Print directly to the printer and confirm with K W e recommend a resolution of 800 x 600 15 monitor or 1024 x 768 17 monitor For resolutions of 1024 x 768 or better we recommend to select large font in Windows Setup Display I amp S ThefileV24 DLL is protected under the provi sions of the copyright law Copyright 1992 1996 Langner G mbH All rights reserved Permis sion is granted to use the file V24 DLL only in combination with the CardioSoft program and not in combination with any other program Copying and making the fileV24 DLL available to third parties is prohibited CardioSys V4 1 Be sure to properly terminate the program before switching off the PC
183. ivate ambulatory blood pressure measurement mode Admit new patient or select patient from database Connect recording unit to PC Display the setup menu and select a measurement protocol _Fesamning Program the recording unit Connect recording unit to patient and initiate measurement eana Connect recording unit to PC and download data Test Information E nter the test information tal Review the report documents 227 498 02 A CardioSys V4 1 189 Ambulatory Blood Pressure Measurement For your notes 190 CardioSys V4 1 227 498 02 A Late Potentials 4 6 Late Potentials In this section you will learn some general facts about late potentials how to apply the electrodes and acquire the signals for late potential analysis how to enter procedure data reason for test medica tion blood pressure which report documents can be displayed how to print out the examination report T he brief operating instructions at the end of this section sum up what you have to do to record late potentials 227 498 02 A CardioSys V4 1 191 Late P otentials 4 6 1 General Information Having an amplitude in the microvolt range late potentials occur in the terminal QRS complex and in the early ST segment Proof of the existence of late potentials is obtained by signal averaging For this method the correlating Q RS complexes are summed up Since signal noise is the non correlating portion thi
184. k C 0366 The designated product has been designed manufactured and tested under a quality management system according to DIN EN ISO 9001 EN 46001 and Annex II Section 3 2 of Directive 93 42 EEC concerning medical devices The conformity of the quality management system has been certified by VDE Testing and Certification Institute Freiburg 27 June 1997 Marquette hb Dr Matthias Weber Director The technical documentation Marketing amp Engineering is filed infhe RA QA Dept esy_30_e doc Appendix For your notes 264 CardioSys V4 1 227 498 02 A Index Index 3D presentati sauia an 71 AC line filter reguenCynn arininn 220 A CCOSSONES ss ccS sss xtra teal atedsivies anan all dtasevhs leery 245 Acitvate program Options sesers 219 Admitting new patients ccc 32 Ambulatory blood pressure measurement 175 Arrhythmia episodes c cscesssescsssssscsessssessstssssessseesesaees 117 Arrhythmia results csccccesssssscscssssstsescssceeeseessseseeeesssases 64 Assigning records to patients 0 0 cece 226 BackUPS 254 Bar code Wand siiri uiariaas siirinsesi 31 Baud rate selecti Nieri 216 227 Blood pressure Graphic presentation Amb blood pressure 184 H ourly averages diagram cece 185 Blood pressure readings BUY cassis cesses E E aida 49 Entry during exercise test eerren 87 103 Brief operating instructions Ambulatory blood pressure 189 Bronchodilation tes essesi 173 Exerci Eteo an iaraa
185. kon D ata from the clipboard can be inserted in a text file For data exported to a file you will have to specify the target directory and confirm it with x 227 498 02 A Late Potentials Interpretation Patient Procedure System Services Help a im Ee a 5 J fi o lt A zie E Measurement Results Jed gt RMS QRS C tatement Library NunNer of QRS 43 4 Noise fu VI 1 6 HFLA Duration ms 52 se Interpretation EAE n ms 128 gt L a lt l Figure 4 6 8 T heinterpretation screen 227 498 02 A Interpretation The interpretation screen is split into two windows The one on the left shows the interpretation as derived by the system H ere you can choose between the program s measurement results and the statement library see below The window on the right is reserved for the physician s interpretation O nly when the procedure is assigned to a patient can the physician s interpretation be entered W hen writing the physician s interpretation you can copy the measurement results or statements from the library to the right window Then you may edit these statements again using the e icon to cut text and the icon to reinsert the text in any other place You may also add any comments Furtherm
186. l 1 from 07 51 13 bis 12 50 13 auscultatory a 07 51 48 106 88 Error 21 07 53 48 75 98 80 86 08 07 48 74 89 76 80 75 82 Error 15 78 109 79 89 73 97 vg 83 73 116 79 91 71 89 79 82 09 37 48 72 92 68 76 09 52 48 83 96 70 78 10 07 48 76 99 73 81 10 16 48 87 101 70 80 10 22 48 80 124 81 95 10 39 48 76 88 Error 15 10 55 48 79 94 72 79 11 07 48 76 105 74 84 11 23 48 80 89 Ta 81 11 38 48 69 92 79 83 11 53 48 74 106 79 88 12 07 48 69 105 75 85 12 22 48 84 123 74 90 4 Figure 4 5 11 Tabular representation of the BP values 184 CardioSys V4 1 BP Graph The blood pressure graph Figure 4 5 10 shows all blood pressure values measured during the monitoring period For measurements taken with TONO PORT IVa theECG strips are displayed as well k By clicking on you can display the other ECG strips one by one or you can cross reference to an ECG strip by clicking on the corresponding BP measure ment on the graph amp The button takes you to the BP table Fig ure 4 5 11 227 498 02 A Ambulatory Blood Pressure Measurement Hourly Averages y g Hellige Graphic Representation of the H ourly Averages Patient Procedure System Services Help eal tte 9S lee 0 af _ 2 E Figure 4 5 12 shows the hourly averages of all measurements ci ta PE taken during the monitoring period 250 amp Click on to display the same values in a tabular form Figure 4 5 1
187. le power supply UPS The UPS should not be disconnected from the power line for prolonged periods of time to prevent deep discharging of the battery For this reason switch the CardioSys system off and on with the system s own power switch and do not use the switch of the U PS or the main power switch of the office Asa general rule the UPS must first be con nected to the power line and switched on then you may switch on CardioSys Do not switch on the CardioSys system during a power outage Only the C ardioSys system may be connected to the UPS The UPS must be installed within the medi cally used room but outside the patient envi ronment Observe the information given in the UPS user manual Caution Set up the device in a location which affords sufficient ventilation The ventilation openings of the device must not be obstructed The ambient conditions specified in the T echnical Specifications section must be ensured at all times 03 gt The system should be set up to provide the opera tor an unobstructed view of the control panel AN Danger Devices intended for emergency application must not be stored or transported at tempera tures which cause moisture condensation at the application site Wait until all moisture con densation has evaporated before using the device Warning If the system is used as an emergency device a second ECG recorder must be available
188. lection menu Figure 4 7 1 All icons of the external programs are dimmed which means that they are inactive T o activate an icon the corresponding program must be set up first k Display the setup screen with Figure 4 7 2 k In the list box click on the program to be configured then type the program path and name in the text box below e g c ecg holter exe For External Program you will have to add a name for the examination under which it will be saved kb Select ok or Cancel to clear the window I When changing the external program setup please pay attention to the compatibility with archived procedures 207 External Programs For your notes 208 CardioSys V4 1 227 498 02 A Deleting Examinations Quitting the Program 5 Deleting Examinations Quitting the Program D eleting Examinations An examination can be deleted only when it is currently displayed T his will be either the examination that you have just concluded or the examination that you have just called up from the database 3 3 Editing Stored T ests k To delete an examination click n As as safety precau tion you will be asked if you really wish to delete this examination Select Yes or No as required S Marquette HELLIGE CardioSoft 4 1 Authorization Q uitti ng the Program User Name Supervisor l Select Passwo
189. lip adapter for SILVER MACTRODE 10 adapters NEHB Accessories 223 403 03 384 017 65 384 017 66 248 Patient trunk cable 12 lead N EH B IEC Set of 10 leadwires IEC with 4 mm connector Set of 2 leadwires N EH B IEC with 4 mm connector in addition to 384 017 65 Exercise T est Accessories 223 418 01 Patient trunk cable 10 lead IEC M ulti Link 2 2m 223 418 02 Patient trunk cable 10 lead AHA M ulti Link 2 2m 223 418 06 Patient trunk cable 10 lead IEC M ulti Link 45m 223 418 07 Patient trunk cable 10 lead AHA M ulti Link 45m 384 01808 Set of 10 leadwires IEC M ulti Link for electrodes with press stud 384 018 09 Set of 10 leadwires AHA M ulti Link for electrodes with press stud 923 096 72 Exercise test bdt 303 441 61 Patient cable hanger for ergometer 919 200 31 Disposable electrodes for adults 200 electrodes ECG Accessories C ava C atheter 223 408 04 Patient trunk cable 5 lead for cava catheter 384 017 78 Set of 5 leadwires IEC for electrodes with press stud Consumables 21712301 Adhesive rings pkg of 500 for electrodes 217 110 217 320 and 217 321 927 22400 Adhesive rings pkg of 500 for electrodes 217178 CardioSys V4 1 227 498 02 A Equipment 21708318 Electrode cream 250 ml refill bottle Spirometry 21708314 Electrode cream 5 liter container 20801901 Respiration Flow Sensor LF 501 930115 82 Dispenser 30 ml 928 056 62 Support for Respiration Flow Sens
190. lowing documents T hey are described in detail on the following pages Test Summary Figure 4 2 28 Tabular Summary Figure 4 2 31 Trend Reports Figure 4 2 32 Sample Cardiac Cycles Figure 4 2 34 QRS Morphologies Figure 4 2 35 ECG strips Figure 4 2 36 Arrhythmia Review Figure 4 2 37 Interpretation Figure 4 2 38 Full DisclosureECG Figure 4 2 39 227 498 02 A The Exercise ECG Reviewing the Final Report HR at rest 85 BPM Max HR 86 PBI 48 of Target HR 179 BPM Max METS 1 00 BP at rest 120 90 mmHg Max BP HELLIGE F Patient Procedure System Services Help lA tel To a e 2 M Baker Dave 4 ercise Test Te a Reasons for Termination Test Information Test Data Patient Data Reason for Test Date Time 12 06 04 54 53pm Age 41 years Total Exercise Test 35 28 min Sex Male Duration Preset 15 00 min Race Caucasian Dauer Bruce 20 00 min Height 188 Dauer Recovery 0 00 min Weight 90 0 kg Artifact Time 0s BP Reasons for Termination Test Information Medication Physician Dr Bouvier User Claudine Comment Interpretation HR RPP METS Events QRS 689 VBIG VPB 38 CPLT 8 Significant ST Change Figure 4 2 28 T et Summary Library Patient fatigue Leg dicomfort Chest discomfort Syncope Dyspnea Target HR attained Frequent ectopy ST segm
191. lso appear enabling you to display a list of requested procedures this function requires the optional O rder List module refer to Appendix 2 O peration in Conjunction with a M edical Reimbursement Program H ospital Information System CardioSys V4 1 39 The Examination Procedures For your notes 40 CardioSys V4 1 227 498 02 A The Resting ECG 4 1 The Resting ECG This section describes all operating steps necessary to apply the electrodes to the patient and connect the patient enter the test information indication medication comments etc record the ECG call up the report pages for on screen review print the report pages compare two resting ECGs set up the system T he brief operating instructions at the end of this section sum up what you have to do to record a resting ECG 227 498 02 A CardioSys V4 1 41 The Resting ECG The Basics Wa Library Reason for Test A Reason for Test EA Blood Press mmHg E sys el dia uoco Geese eee Comment BAC OK Cancel Help tt Figure 4 1 1 T et information window 42 4 1 1 The Basics Choose the icon to activate the resting ECG mode After selection of a patient the window for entry of the test information will open Figure 4 1 1 if you have chosen this feature in the system configuration refer to section 6 1 Sys tem C
192. mbulatory blood pressure 182 Lat potentialSisnosaniniosiindnuuninioiiar 193 Reason for test library Exerci Se testisima a E herd 86 Late potentials sci sceieiesadviein iai aiai 193 Resting ECG sirinin a ina 48 SHri 158 Recording from ECG recorde ssssccrssrererereere 226 Recording problems sssssssissssesresesresesresesresesreresrereerens 259 Registered sytem USES aisissssseiisrisresrssrisrisresnssirnnrsrennnsn 214 Remote exercise test workstations monitoring of 134 REDOTS a isian ain 104 112 122 268 CardioSys V4 1 Respiration flow sensor LF 501 oo cece 156 234 Reting ECG MOG ccessesssscssessssscecsssssseeesvssseeeeseseees 41 Resting ECG Signal acquisition seese 52 Retrieving patients scnradasininia ani 30 Retrieving the factory settings ccccssssssssseesessseees 231 Revision NiStOLY eeesccesescsessescseseseesessssssesseeseseseecesesesersnes 2 Safety INfOrMation airasia oiiaaie 10 Sample cardiac cycles exercise test eccer 114 Screen diagonal adjustment oo essere 212 Selecting stored tests ccccssssssssecsssesseesssesescsssesesreeess 34 Self tebia tial anand beatin 15 Sending PLOCEMUIES oo eect ee cetetseeeetetetetanetetetenetanetees 36 Setup Ambulatory blood pressure 178 Exercise testina o a E i 125 Late potential Sirsopsiuisnuiinasa aa 202 Reting ECG arssniniceiiinsaimiuaa a 75 SPITOMEY aiani a riii aa 171 STAT ECG puguin EE 150 Software Options surisu a eae 6 SPAYGMOMANOMELES
193. me interval is updated in the table ks When all marks arein the correct position click for a reanalysis of the ECG Ye Click and then _ee anaysis_ if you wish to restore the original analysis results CardioSys V4 1 63 The Resting ECG Evaluating the ECG Arrhythmia Review Patient Procedure System Services Help Bee la Sae 2 S Baker Dave 4 t ARE Determine HR QRS Complexes 13 a 2 HR 82 BPM l i i r i Omm s 40 Hz 50 Hz 1 EE TRE 3 Mean RR Interval 726 ms 800 800 Z 760 700 700 700 700 700 700 700 700 i l i l Kom gt Figure 4 1 25 Arrhythmia review 1 number of identified QRS complexes 2 HR 3 displayed lead 4 mean RR interval Arrhythmia Review On the arrhythmia review screen Figure 4 1 25 you seea 10 second segment of one lead at atime including the identi fied events such as PVC or PSVC A bar diagram below the signal trace indicates the deviation of the RR interval from the mean RR interval W hen first called up the display shows the lead that you selected in the configuration menu All other leads can be selected with the arrow buttons F and w Furthermore you can determine the heart rate Measuring the H eart Rate in aN ormal ECG a Click on the QRS complex at the beginning of the interval to be measured the system automatically posi tions the cursor in the co
194. me window a U A Ww I On the zoomed display the ECG is shown with 4 times the original speed amp Manually stored event episodes always have the highest priority 120 CardioSys V4 1 Displaying Zoomed Segments You can choose regions of special interest and display then at a larger scale H ere too you can jump from one event to the next Click Figure 4 2 39 k Movethe cursor which turns into a magnifying glass to the trace segment of interest and click Figure 4 2 40 will appear k The cursor keys will take you to the neighboring episode before or after the present one If you drag the scroll box 6 you can quickly select any segment of the entireECG gt button allows you to save the segment as an event episode 227 498 02 A The Exercise ECG Printing an Exercise Test Report Print 4 2 5 Printing an Exercise Test ages to Print EB lt 1 Procedure Date IX Standard Page Trend Reports Sample Card Cycles Report fo table I Survey a 2 smi l 5 The scope of the printed report is determined on the print T T setup screen Figure 4 2 41 Arrhythmia Review ECG Strips QRS Morphologies 6 lines a 1 Ti 3 k Click to call up the print setup screen naw mn cove rae RE a The report includes the following sections Gain 10 0 mm mV E Epson EPL 5700 LPT se Number of Co
195. n the O rder List button At the end of the examination the clinical information systen will adopt the data of the examination procedure and the patient will be renoved from the task list I Marquette Helligeis not in a position to guaran tee full compatibility of all medical reimburse ment programs CIS with CardioSys Soft 227 498 02 A CardioSys V4 1 253 Appendix 3 System Maintenance The backup procedure described in the text below refers to the M arquette H ellige program only T he data of external programs however can be backed up in the same way 3 1 Data Backup with Tape Streamer W e recommend making one backup of the operating system Select the backup method for backups of the operating and making daily backups of the C ardioSys Soft program and system normal for the first backup of C ardioSys Soft patient files data normal for subsequent backups differential W hen making a differential backup select append Use the W indows backup application and refer to the online for normal backups select replace help for instructions Clickthe o button Insert the tape The backup session begins After the session the backup will On the Windows screen select Start gt Programs be verified gt Administrative T ools C ommon gt Backup Click the button to clear the window Sedect driveC o
196. ninga drug to a medication group 160 CardioSys V4 1 Selecting a M edication Assigning a D rug N ame to a M edication G roup You can select a medication from a list of 14 items You can also assign specific drugs to the medication groups to include these in the list instead of the group name Making a Selection amp Click on to open the medication list box Figure 4 4 5 k Select one of the medications k If you wish to select a second medication or to assign a drug name to a medication group click on aj and select the medication as described above Assigning D rugs to a M edication Group k Click on Medications A window opens showing medication group names Figure 4 4 6 T here is a drug name window for each of these groups Click on the respective text box if you wish to enter a name Then type the drug name Furthermore you are free to arrange the medication groups any way you want T o do so k Click on the at the end of the group name box 227 498 02 A The Spirometry Test Entering the Test Information Medication Medication Group Drug Name none none beta blockers betamimetics xanthine derivates corticoids atropine cromoglycinic acid fenoterole amiodarone unknown see Comment Help a Cancel Move IEEE N N N N N N A Figure
197. nitoring External Programs a Z4 Ambulatory Blood Late Potentials Pressure p Spirometry i Spirometry Bronchodilation Help Figure 4 5 2 Procedure selection menu Hellige D Patient Procedure System Services Help z ka M E a E Setup Programming Download data Date Time Clear Patient Monitor Status Data stored in patient monitor Date 07 12 1995 Time 14 11 59 1 Period from to BP Interval min Defl Rate l Press Qty 1 07 00 0 21 59 00 exact 30 4 200 30 2 22 00 0 06 59 00 exact 30 4 200 18 Duration 24 00 h Number of BP Measurements 5 48 Number of ECG Strips 24 ECG Strip Length 3s Ratio of ECG strips to BP measurements 1 2 Figure 4 5 3 Ambulatory blood pressure measurenant signal acquisition screen 1 Control buttons 2 M esageindicating the memory status 3 Dateand time of downloading from the record ing unit 4 Memory status details 5 Summary of the tored data 227 498 02 A CardioSys V4 1 4 5 2 Setting Up the Recording Unit T he Signal Acquisition Screen Connect PC and recording unit with the cable provided and turn on the recording unit Before using the recording unit for the first time you should specify the PC interface to which it is connected T his can be done via the signal acquisi tion screen The signal acquisition screen is displayed with the key This key in turn is found on the procedure selection me
198. nnected select the blood pressure meter integrated in or connected to the ergometer from the defaults menu 262 CardioSys V4 1 227 498 02 A marquette HELLIGE MEDICAL SYSTEMS EC Declaration of Conformity Document No 7 97 Marquette Hellige GmbH Munzinger Strasse 3 D 79111 Freiburg Germany We herewith declare that the product ECG analysis system cardiograph CardioSys product status Version 3 0 fulfills the requirements of the following directives standards and normative documents 1 Council Directive 93 42 EEC of 14 June 1993 concerning medical devices 2 EN 60601 1 1990 DIN VDE 0750 Teil 1 12 91 IEC 601 1 2 Ausgabe 1988 EN 60601 1 1 1993 DIN VDE 0750 Teil 1 1 09 94 IEC 601 1 1 1992 E DIN IEC 62 Sec 73 1995 02 IEC 62 Secretariat 73 1994 TEC 601 2 25 1993 E DIN IEC 601 2 25 Klassifikation VDE 0750 Teil 2 25 1994 11 3 EN 60601 1 2 1993 DIN EN 60601 1 2 1994 09 IEC 601 1 2 1993 EN 55011 1991 DIN VDE 0875 Teil 11 1992 07 CISPR 11 1990 modified device group 1 class B Compliance of a representative sample of the designated product with the essential requirements of Annex I of the Directive 93 42 EEC has been certified by the Notified Body VDE Testing and Certification Institute Merianstr 28 D 63069 Offenbach Germany EC Type Examination Certificate No 1009 of 4 April 1995 The medical device has been assigned to class IIb as specified in Annex IX of the Directive 93 42 EEC It bears the mar
199. ns Windows control menu You can choose to display the Windows control menu and the minimize arrow which allows you to quit the program and to shrink the window to an icon M enu labels Above the icons you can display the menu labels which allows you to click the words and select options from the drop down menus Icon Bar H ere you choose the icons that will appear in the icon bar and the order of icons 227 498 02 A CardioSys V4 1 215 System Services Menu System Configuration AT amp FMO amp E7X3VO amp Q1S ATDT ATHO Figure 6 4 M odem stup AN Warning Only modems complying with the requirements of IEC 60950 or UL1950 may be connected to the system Furthermore the regulations appli cable in the respective countries must be ob served The modem must be set up inside the medically used room but outside the patient environ ment AN Caution For baud rates higher than 19200 an interface component with buffer 16550 must be in stalled and activated in Windows 216 Modem Tab If you wish to send data via a modem select the port the baud rate and the moden model here set sender and receiver to the same baud rate For M ultitech and ELSA modems the system automatically enters all other necessary data If you choose another modem you will have to enter them yourself Init string for M ultiT ech modem 14400 AT amp FM 0 amp E7X3V 0 amp Q1S0 1 Init st
200. ns if these were found as well Acrct M HA For more information you may add ether the measurements 7 or the ST profile 001 003 008 Figure 4 1 37 Report page medians 227 498 02 A CardioSys V4 1 73 The Resting ECG Printing the Resting ECG Eaa bt dekr fe aves hh TERS E 09011997 12 2805 E 25 mms Fry icin Dr Wilian on paired 1 38 Report page 10 sECG C 7 REST ECG Interpretation Analysis Program iii i fies Sek teen ee cee eae eee BNA PENE See es BEA ee Se MOE Physician De Wia User Dorothy Figure 4 1 39 Report page interpretation 74 10 second ECG segment Figure 4 1 38 H ere you set up the system for printout of the full 10 second ECG You can choose to print either 6 or 12 leads page and you select the gain and paper speed T he resulting number of pages to be printed is indicated Interpretation full Figure 4 1 39 In this window you set up the system for printout of the full interpretation interpretation as derived by the system and or physician s interpretation Rhythm Lead The standard page and the interpretation page include the 10 second ECG strip of the rhythm lead H owever you can select another channel to be printed Printer Selection of the printer model and port LPT to which t
201. ns uamn ea N a ADERE 76 Lead sequence selection modification STATEC G muinn ena e a 151 Endan Ralls arose 113 261 Linked Medias siririn arien aiiai 106 126 Maintenan Cessne aa aaa 235 Malf ncti ONS nanna inn a 238 M easurement and analysis programs sss ereere 256 M easurement Of the ECG cenere 57 M easurements result tabular fOrm ssssccccrecrrss 61 M edian complexes dominant subdominant cscesee 61 MICU ANS set setecteidinciactieassaehs heaton n a 106 M edical reimbursement program oo eee 252 M edication Ambulatory blood pressure 182 EIEE E A A 88 Late potentials tii nicsannnanona 193 Resting E C Giv it cars cneartel dite inant 50 SOMEY renine aa ied anin aceon 160 METS calculati OMaria 108 M odem SOUP issii ananena aiaiai 216 227 498 02 A Tran OI aiei nna Muaeds wedbeieaenee 257 MOUSE ainakaan ianei a iaa riia 20 M U SE COMMUNICALION nonan aa 218 Selecting patients from M USE database cceeeeees 31 Sending test data to cenere 38 Name physician technician user s 51 89 161 214 NERD aa ssid gaieneentah ancitiaeanacs 46 145 N ew patient admission oo ccccsestsestsssssseseessssseeerseseees 32 Normal value calculation spirometry sscsecsseeeeceesseees 171 Option Code CNY wcrc 219 Optional software MOdUIES isisisi 6 Options activates srecssiccsteccives elas clibscssednseadseininiureieen 219 Order informati OM esse asses devesdorstnie ete alma ae 245 Order E e ainsin aa arin
202. nt ms oiManual 80 Save full disclosure ECG Auto X i Blood Pressure Limit sys 300 sd at to display page 1 of me mE E rye C Manual 180 E pred HR a CORINA analog output 1 Auto WHO100 aj F igure 4 2 50 Lo o ce fE nee f Adjustments can be made in four different ways Figure 4 2 50 Exercise T et Setup page 1 1 Thereis an arrow E at the end of a box Clicking this arrow will open a window which offers various options B 2 Test O UUU U U D Select the desired setting by clicking the mouse button C Page 1 Page 2 IX 1 mV Cal Pulse Monitored Leads 12 4 Audible LEAD OFF Alarm Displayed Leads 6 m rean 2 Thereisatwo ended arrow j to the right of a box ree LUE Clicking one of the arrowheads increases or decreases a Diagram HR in of max HR Remote View ieee _ ee numeric value x RPP Readout Phases A P Bruce Start clock at pretest gg Bruce C R Bru Se Co nm 3 Thereisacheck box n front of the nana C ligk on port comz E TE el TG the box to enable or disable the function js function or Thermal Writer en abl ed ni AR200P local nong w Library Comments oes ee 4 Click on the box and proceed as described for Figure 4 2 51 Exercise T et Setup page 2 each individual case 227 498 02 A CardioSys V4 1 125 The Exercise ECG Exercise
203. nu unless you have configured the icon bar to include this icon section 6 System Configuration amp Click on al to display the procedure selection menu Figure 4 5 2 ky Click on r to display the signal acquisition screen for ambulatory blood pressure measurements Once the you have selected the patient the signal acquisition screen Figure 4 5 3 will be displayed On thesignal acquisition screen you will see thecontrol buttons 1 information on whether or not the recording unit con tains data 2 aseparate field for details of the memory status 3 a summary of the memory status 4 The memory status field indicates the configuration of the recording unit 177 Ambulatory Blood Pressure Measurement Patient Procedure System Services Help A Beal tte SS a A E Baker David 4 Ambulatory Blood Pressure Recording Paton o m Interface COM 2 4 Patient M ient monitor Date Protocol Program0 4 Period _ ss Qty ry _ Stat Night Time 22 00 00 until 06 00 00 30 2 Wake up Time 04 00 00 until 06 00 00 18 BP Limits sys dia 135 gt 85 s OK Cancel Help Duration Number of BP Measurements 48 Number of ECG Strips 24 ECG Strip Length 3s Ratio of ECG strips to BP measurements JE Figure 4 5 4 Window for entry of the interface and for
204. o that shown in Figure 4 1 31 k You can move ECG 2 up down right left using buttons lt E ano I lt You can perform measurements on the ECG ampli tudes intervals slopes as described in section 4 1 4 M easuring the ECG amp Clicking returns you to the 10 second ECG seg ments k The median complexes and the interpretation can be compared in the same way Click and to display them CardioSys V4 1 69 The Resting ECG Comparing Resting ECGs Patient Procedure System Services Help ae i Is lair 5 a 2 12 10 1996 11 08 14 6 12 10 1996 10 13 09 08 10 1996 10 43 43 a ae ele omm WY APC ave stvalues LAI Ez l g aVF Figure 4 1 32 Comparing median complexes 70 1 Changes the sgnal ize 2 Displays the other 6 leads 3 Displaysrenovesthe ST values 4 Activates the zoom function 5 Printsthe scren 6 Procedure date Comparing M edian C omplexes from M ultiple Resting ECGs k Click f A window opens showing all resing ECGs of the patient in question Figure 4 1 29 kb Select 2 to 5 ECGsand click on to clear the window The next screen shows the median complexes of the selected procedures Figure 4 1 32 The signal size amplitude can be changed with F a 1 Figure 4 1 32 O ther leads can be selected with 4 w 2 If you wish to have the ST valu
205. ocedure System Services Help ae Sed Baker Dave 41 yrs Exercise Test Trend Reports Total Exercise Time Duration P Bruce Duration Manual min Level Imin Slope Figure 4 2 32 Trend Reports page 1 With Ra and E you scroll through the report With if and f you scroll through the selected document of the report I amp S The system automatically selects the leads with the most significant ST changes and labels them with an asterisk except leads 1 aVR aVL V1 and V2 You are free however to select any other two leads place cursor on arrow click and select lead The leads that you select yourself do not have the T he leads also appear in the Tabular Summary 112 CardioSys V4 1 The Trend Reports Figure 4 2 32 shows page 1 of the trend reports H ere you see heart rate blood pressure and speed 1 V PBs and pacer pulses 2 ST amplitude and slope of the two leads with the most significant ST changes 3 heart rate and artifacts 4 METS and RPP 5 The program will show you the exact values for any point on the trend graph When in the selected trend period the system could measure neither ST level nor slope both values are set to zero Move the cursor which turns into a cross to the region of interest on the trace and click A vertical time line appears T he values corresponding to thi
206. ogram Enter frequently used fax numbers in the telephone direc tory Select the high printer resolution the A4 format and the landscape orientation If the same image is transferred between 2 PC s more than twice you must select the portrait orientation after the second transfer If the modem is reserved for communication with the fax there isno need for any special programming H owever if it is also used for transmission of data from the ECG recorder to the PC the init string should be modified accordingly menu fax program setup fax modem example for the ELSA modem AT amp FX3 amp C1 amp D 0S0 3 Q 3 X 0 D 1 for tdephone systems with extensions AT amp F amp C1 amp D 0S0 3 Q 3 X 0 D 1 for direct dialling 227 498 02 A Explanations AT command start amp F default setting X3 for tdephone systems with extensions amp C1 identify connection amp DO ignoreDTR status change S 3 fax answers after 3rd ring Q3 RTS CTS handshake bidirectional Sending the FAX Display the image to be printed Initiate the printout The program converts the ECG into an image file D epend ing on the computer model this procedure may take several minutes T he printer status box indicates the page currently being converted T he fax software is activated automatically after the conversion Select the addressee entries in telephone directory Select Send T he status window and the audibl
207. oll box to move the trace segment Zooming and M easuring the ECG Zooming The zoom function allows you to display a portion of the ECG at alarger scale Click AY k Movethe cursor to the region of interest that you want to zoom and click Your display looks similar to the one shown on Figure 4 1 17 k Click to display the same time window in an other lead T he label of the selected lead is shown below the arrow buttons Figure 4 1 17 X Drag the scroll box 7 Figure 4 1 17 along the scroll bar to displace the trace segment vertically and horizontally k To obtain a true to scale hardcopy of the displayed screen click on the icon the hardcopy includes the caliper marks CardioSys V4 1 227 498 02 A The Resting ECG Evaluating the ECG AJ Hellige Measuring the ECG Patient Procedure System Services Help iei io lS 2 i D On all zoomed ECG displays you can measure amplitudes z l al rely SE mV intervals ms and slopes mV s 40 mm mV 200mm s 40 Haech f X Assoon as you place the cursor in the ECG area it becomes a caliper 1 1 1 1 1 Reference Point 1 Reference Point 2 i i i i i Postion the cursor on the first reference point and click A green caliper now marks reference point 1 Then position the cursor on the second reference point and click again A yellow line connecting these two points appears along with the measured value
208. on of the electrodes is a prerequisite for obtaining an interference free ECG T he signal acquisition screen immediately gives you a visual indication of your electrode technique and of the signal quality provided the red R electrode is applied For quick reliable and trouble free application of the elec trodes we recommend our Electrode Application System refer to the Electrode Application System operator s manual Asan alternative you can use our disposable electrodes 919 200 31 pkg of 200 Skin Preparation Shave the electrode application points if necessary Carefully degrease the application points with a cotton swab soaked in benzine Prep the application points with skin prepping paste EPICONT To do so apply a small amount of paste to the tip of a cotton swab Place the tip against the skin at the electrode site and twirl the swab 4 to 5 times between your thumb and index finger lightly pressing on the swab Connect the electrode leads to the electrodes Remove the backing paper from the electrodes and press the electrodes firmly into place Secure each electrode lead with surgical tape CardioSys V4 1 83 The Exercise ECG Applying the Electrodes N black R red F above right kidney on right shoulder C2 whit C3 whit e e e Ee white _ C5 white e C6 whit L yellow on left
209. on pertaining to the spirometry test T hese are thereasons for test themedication 3 stn ee Comment Ps i the technician s and the physician s names prsia EEE 4 T ee L Technician D j ee Copying Statements from the Library to the Patient Figure 4 4 3 T hetet information entry screen Window 1 Standard reasons for test 2 Thepatient sreason for test T he system provides a library whose statements can be easily 3 Medication copied to the patient s window You can add statements or 4 Boxes for entry of comments and of the phys edit existing ones as required cian s and technician s names i k Highlight a statement by clicking To Click the button k If you wish to delete a copied statement or part of it highlight the words in question and click gt e k The deleted words can be inserted in another position by placing the cursor there and clicking g Ac To You can enter a statement directly by moving the cursor to the desired position and typing the text 158 CardioSys V4 1 227 498 02 A AB Z Modify Library Reason for Test The Spirometry Test Entering the Test Information Respiratory problems Shortness of breath Pain Follow up x Cancel Help Figure 4 4 4 Editing the Reason for T et i A statement is easily copied to the window at right by double clicking Editing the Library Click RA Th
210. onfiguration W e recommend that you apply the electrodes to the patient as explained in section 4 1 2 prior to entering the test information CardioSys V4 1 227 498 02 A The Resting ECG Applying the Electrodes N Pa Figure 4 1 2 Applying plate electrodes I Thered R electrode is the reference electrode Placement and signal quality of all other elec trodes can be assessed on the signal acquisition screen only when this electrode is applied 227 498 02 A 4 1 2 Applying the Electrodes Careful application of the electrodes is a prerequisite for obtaining interference free ECGs The signal acquisition screen immediately gives you a visual indication of your electrode technique and of the signal quality provided the red R electrode is applied For quick reliable and trouble free application of the elec trodes we recommend our Electrode Application System refer to the Electrode Application System user manual Asan alternative you can use the conventional plate elec trodes on the limbs and the suction electrodes on the thorax Applying Plate Electrodes Limbs Plate electrodes are applied by means of a rubber strap dec trode paper is the recommended contact medium for this type of electrode Moisen the electrode paper with tap water and place it between skin and electrode Secure the electrode with the rubber strap Figure 4 1 2 so that it cannot shift during the recording take car
211. ons to display the ST profiles and medians the trends and the sored 12 lead ECG Results of the arrhythmia analysis complex ectopy in red and number of VPB min ST median beat window and ST analyss reults resting beat analysis results are shown with a different color Button for selection of another lead Buttons for adjustment of theE J and J X point only when M anual has been sected in the D efaults menu Procedure parameters and buttons to modify the sgnal nstivity and to tenporarily disable the AD S anti drift system 227 498 02 A The Exercise ECG The Elements of an Exercise Test The Elements of an Exercise Test Ergometers without D igital Communication Interface eg MEDITRONIC M 400 W ith these ergometers the test follows the stored test phases Thisis to say that the initial load and load increase displayed in the protocol have to be adjusted manually at the ergometer M anual modifications of the protocol load increase or selec tion of the next test phase must also be repeated at the ergo meter S O n the setup screen section 4 2 7 select the internal ergometer k If you wish to obtain a recording at the end of each load stage only set the ECG Rec Inter El to the duration of the load stage k Select a protocol and adjust the required initial load at the ergometer k Click thel_ lt J button Wait for the first ST meas urement to be displayed which is to be saved as the r
212. or 21708306 Electrode gel pkg of 10 tubes 100 ml each 303 440 83 Disposable respiration filters 100 pcs 21708305 Electrode cream 10 tubes 100 ml each Ambulatory Blood Pressure M easurement SLIT 01 Elegtode conte pray 200mm bottle 701217 36 Connection cableTONOPORT IV to PC 217 30705 Electrode contact spray 2 I bottle 25 pin 21700701 Electrode paper 200 sheets for electrode 70121737 Connection cableTONOPORT IV to PC 504 648 56 9 pin 21714801 Electrode paper 200 sheets for electrode 71021731 TONOPORT IV recording unit 217 144 01 02 710 217 32 TONOPORT IVa recording unit 217 04302 ECG Filing Cards 50 pcs Electrode Application Systems 21612101 Electrode Application System KISS 10 10 lead without pump 21612201 Electrode Application System KISS 12 12 lead N EH B without pump 303 44377 Swive arm for KISS 384015 84 Tabletop clamp with pole 384 013 30 Wall fixture for swivel arm 303 444 21 Clip adapter for adhesive electrodes 227 498 02 A CardioSys V4 1 249 Equipment For your notes 250 CardioSys V4 1 227 498 02 A Appendix 1 Installing the Program On A Stand Alone PC Do not install C ardioSoft on your PC if you are not familiar with theWindowsNT operating system Prerequisite for operation in conjunction with M USE Install the Internet Explorer 4 0 and the Acrobat Reader if you want to view test data stored in the M USE CV database Switch on the PC and the monitor Ex
213. ore you can record a spoken comment using the icon provided that a sound card has been implemented in your system and that you have a microphone T his com ment will be saved to the corresponding patient file It can be played back by clicking on the icon l First of all select the information to be displayed the M easurement Results or the Statement Library 1 Figure 4 6 8 If you wish to copy information to the right highlight the respective passages then click on gt k To enter text directly into the window on the right move the cursor to the desired position click the mouse button and type the text CardioSys V4 1 199 Late P otentials Confirming T ests A test is considered confirmed when a physician has reviewed the test evaluation and signed it electronically with his her name T ests that have been reviewed and confirmed by a physician are marked with x l Click on FJ Figure 4 6 8 to display the window where you can enter your name Select the physician s name from the list box click on or enter it via the keyboard Editing the Statement Library When you display the statement library 1 Figure 4 6 8 the icon becomes active X Click on to open the window for editing the statement library amp Enter new texts or edit existing statements via the key board a Click on to clear the window 200 CardioSys V4 1 227 498 02 A Late Potentials
214. osition in the list and click the mous button k Enter a standard statement and press a on the key board T he cursor moves to the beginning of the next line CardioSys V4 1 227 498 02 A The Resting ECG Entering the Test Information k In this manner you may enter all reasons for a test When you re done click on to clear the window Entering Blood Pressure Readings Blood pressure readings are either entered directly viathe keyboard or they are selected and changed in steps of 5 mmH g by clicking the arrow boxes When you first click the arrows you will see default pressures of 120 mmH g sys and 80 mmH g dia I Click Cai to display and increase the value or click to decrease the value k Move the cursor to the sys box and click the left mouse button Enter the value via the keyboard b Enter the diastolic value in the same manner 227 498 02 A CardioSys V4 1 49 The Resting ECG Entering the Test Information Test Information Library Reason for Test Blood Press mmHg Medication Physician Technician Figure 4 1 10 List of medication groups I amp S The physician is responsible for assigning drugs to a medication group
215. ot you wish to save the results select a patient You obtain the same report documents as those described in section 4 1 4 Recording a Resting ECG as well as the full disclosure ECG as described in section 4 2 4 Running and Assessing an Exercise T est Figures 4 2 39 and 4 2 40 I However in the STAT ECG modeit is not poss ble to save episodes It is possible to compare two or moreSTAT ECG recordings section 4 1 5 Comparing Two ECGs 227 498 02 A CardioSys V4 1 149 The STAT ECG Setup Hellige 4 3 4 Setup Speed mm s 2s p X 1 mV Cal Pulse Gain mm mV 10 aj T Audible LEAD OFF Alarm X Click to call up the setup menu Figure Lead Check noise level low l F Manual Override 4 3 9 IX 10 s ECG Analysis QTC Calculation Hegglin Holzmann aj IX 40 Hz Filter Lead Sequence STANDARD Modify IX 50 Hz Filter U se this screen to select your personal system setti ngs Rhythm Lead 1 X Spline IX Print after Analysis 7 Repot M Adjustments are made in three different ways IX Save full disclosure ECG Terminate after min 20 S Muina yt e 1 Thereisan arrow at the end of a box E sextet STANDEED o moiy cane Clicking this arrow will open a window which offers m Lea 4 Mm ae ue z Hep various options Select the desired setting by clicking the m
216. ouse button Figure 4 3 9 The stup menu 2 Thereisa check box in front of the function Click the box to enable or disable the function function enabled 3 Click the moaity button for instance to select the Lead sequence Top Window Speed 1 mV Cal Signal selects the trace sweep speed display of 1 mV calibration pulse yes or no im yes Gain Audible LEAD OFF Alarm selects the signal size amplitude i mp audible signal when an electrode is disconnected yes or no Lead C heck noise level im yes This is a measure of the quality of the acquired signal signal to noise ratio When there istoo much signal noise at the Manual O verride electrode the electrode is displayed yellow on the signal W hen the function is enabled the program will start the acquisition screen T he setting that you select here low signal acquisition even if not all electrodes are applied middle high changes the threshold as of which the electrode is displayed yellow high sensitivity to noise low threshold 150 CardioSys V4 1 227 498 02 A The STAT ECG a Hellige Speed mm s 25s o e al IX 1 mV Cal Pulse Gain mm mV 10 a Audible LEAD OFF Alarm Lead Check noise level low 4 Manual Override IX 10 s ECG Analysis QTC Calculation Lead Sequence Hegglin Holzmann IX 40 Hz Filter STANDARD STANDARD 4 Modify IX 50 Hz Filter Thermal Writer AR200P
217. p If you select to clear the window the entries just made will be assigned to the present test procedure and the preacquisition screen will appear In the next section we will explain how an exercise test is conducted CardioSys V4 1 227 498 02 A The Exercise ECG Running an Exercise Test Exercise Test Ww HR BPM PL6 gt oE gt J RPN 7 5 Freeze E 5 Interpretation 25 mm s 21 Figure 4 2 10 Signal acquistion screen for a bicycle exercise tet 1 Time dapsed in current phase 2 Timedapsed in stage 3 Stage number 4 Current phase and button to modify the protocol 5 Buttonsto hold the tage and to proceed to the next stage 6 Button to proceed to the next phase 7 Current load and revolutiondminute buttons to increase or decrease the load in steps of 5 W atts 8 Windows indicating the heart rate and the rate presure product RPP H R in red when max H R is exceeded diagram of the of the max HR 9 Blood presure values with some e gomeers the cuff pressure isindicated here during a BP measurement 10 Button to abort the test 11 Button toinitiatea printout laser printer or thermal array printer 12 Button for entry of comments and blood presure 13 Button to mark an event episode the episode is saved at the same time 14 Button to verify theECG sgnal quality all leads 15 Button to freeze and rdease the sgnal traces 227 498 02
218. p of clothing Usea contact agent electrode cream spray etc Wait approx 10 s before initiating a recording After the 10 s period the automatic functions are enabled and the polarization voltages have stabilized provided that all electrodes are properly applied If it becomes necessary to verify the unprocessed raw ECG signal switch off the Cubic Spline algorithm and all filters 40 Hz AC filter refer to Setup in section 4 1 7 CardioSys V4 1 259 Appendix 7 2 ECGs of Pacemaker Patients It isnot possible to display pacing pulses directly At a sweep or paper speed of 50 mm s and a pulse duration of just 0 5 ms the width of the recorded pacing pulse would bea mere 0 025 mm For this reason the device reduces the pulse amplitude and expands the pulse width so that the pacing pulse is easier to identify T he pulse is displayed with the correct polarity and a width of 5 ms depending on the polarity of the pacing pulse in leads and II the pacing pulse in lead III may be sup pressed Figure 7 1 shows an ECG recording with pacing pulses Figure 7 1 Display of pacing pulses I amp If several adverse conditions exist at once the possibility of pacing pulses being interpreted as QRS complexes should be considered At the same time however QRS complexes might be sup pressed in certain situations For safety always watch pacemaker patients closely 260 CardioSys V
219. pies E _ Standard Page Trend Reports Figure 4 2 41 Exercise ECG print stup screen Sample Cardiac Cycles 1 Number of pages of the entire report Arrhythmia Review 2 Document slected for printout ECG Strips 3 Dialog boxes appear only when 1 x 5s has QRS Morphologies been selected in the In T et Report menu Clicking the box in front of each of these documents includes them in or excludes them from the report check mark included The length of each document and of the overall report is also indicated Name Dave Baker EXERCISE TEST Test Summary Date of Birth 05 05 1955 41 yrs Patient ID 1726712676 Male Caucasian 145 0 Ib 79 in Page Medication 08 05 1996 10 14 22 beta blockers 6 18 min pin initiates the printout swe stores the print setup so that the next time the screen is retrieved the settings will be the same 2 04 mi 2 49 min Standard Page terpretation HI The standard page Figure 4 2 42 shows at left the patient data reason for test reasons for termination medication comments and ECG interpretation The right side of the page shows either the table of all measured data or the ST beats as 08 05 1996 10 14 22 Physician Dr Williams Technician Dorothy RN sel ect ed l Figure 4 2 42 Standard page 227 498 02 A CardioSys V4 1 121 R HI M 66 of Target Max RPP 114 Max METS 1 00 BP
220. presents an interpreta tion obstruction restriction and marks the results in the M iller square Figure 4 4 11 Click to initiate further measurements T he next curve is depicted with another color and displayed on top of the first one The best results for FEVC are used T he inter pretation the mark in the M iller square and the results in the parameter table are always those of the most recent measure ment The best result is the measurement giving the highest sum of FEVC FEV1 k Click Scale if you wish to change the curve size 7 ka Select volumertime to return to the volume time curve of the FVC measurement 166 CardioSys V4 1 227 498 02 A The Spirometry Test Running and Evaluating a Spirometry Test Patient Procedure System Services Help ir S Mee ttle Is l e 2 a Baker Dave 4 pirometry Displa easureme 188cm Male mD 1 re Interpretation Miller Sq i 0 Scale Obstruction Flow Volume Volume Time Normal Values Eccs R 14 4F l s Value Norm Act 124 EVC I 2 68 3 44 117 ind FEVC I 2 63 2 93 111 2 FEV1 I 2 25 257 114 Us FEVI VC 81 0 76 0 94 64 PEF s 5 86 5 62 96 a4 MEF75 l s 5 35 5 56 104 MEF50 l s 3 76 5 25 140 2 V I MEF25 l s 1 61 1 94 120 a a a a E e 2 a GP ow g OU AG IVC 1 5 2 68 3 34 125 a FIVC l s 2 63 3 28 125 FIV1 1 s 229 261 117 Hs FIVI IVC 78 0 8 PIF I s 3 48 104 MIV75 l
221. protocol Section I The recording unit can be programmed only when it contains no data 178 CardioSys V4 1 Specifying the Interface Click on sa Figure 4 5 4 will appear k Click on amp to open the interface list box lt gt elect the interface k Click on or to clear the window Setting U p the Recording U nit k Before setting up the recording unit click on to delete all data stored in the memory Figure 4 5 3 You can choose between two protocols to set up the recording unit T he protocol is selected with a mouse click Both protocols can be edited to suit your patient s symptoms X Click on geie Figure 4 5 4 will appear k Open the protocol selection window by clicking on e k Select one of the protocols k Enter the blood pressure limits 1 to increase the value IJ to decrease the value After evaluation of the procedure data the percentage of measurements which exceeded these limits is shown on the statistics summary page 227 498 02 A Ambulatory Blood Pressure Measurement 4 atient Procedure System Services Help eo No of BP Periods Co C1 2 C3 C4 Protocol Program0 J Period from to 1 BP Interval min Defl Rate 2 Press Qty f 1 07 00 00 21 59 00 Jexact al 30 E 4 a 200 p 2 sans al 06 59 00 j vaf a 30
222. r Patients and 7 3 B a y ECG Recording D uring D efibrillation in the ee oy appendix C6 white L yellow ia J7 green eft leg e c2c3 Nap Figure 4 3 6 Connecting the patient cable 12 wire N ens leads 227 498 02 A CardioSys V4 1 145 The STAT ECG Patient Procedure System Services Help eae i Ss Sae 2 Fy RD measurements Freeze Traces Options gt gt wale 81 00 00 antenna Ey I pram 1 T A J I 3 Poor Signal Quality E Lead Sequence j j l 5 yp NAR Spline ON Figure 4 3 7 Signal acquistion screen for theSTAT ECG 1 Control buttons 2 Current heart rate 3 Remaining full dixloure ECG storage time 4 Applied dectrodes green properly applied ydlow not properly applied white ste not used red electrode off or lead break 5 For Section of thelead sequence 6 Leadsimpaired by poor sgnal quality 7 Calibration pulse gt The applied electrodes are shown on the torso only for the Standard and CABRERA lead sequences In all other cases there is only a schematic representation of the electrodes The reference electrode R red must be applied for the lead check function to work properly 146 CardioSys V4 1 4 3 2 The STAT ECG Acquisition Screen Click on to display the STAT ECG signal acquisi tion screen The signal acquisition screen Figure 4 3 7 shows thecurrent heart rate
223. r driveD Click the Cem button Enter the tape name Check the V erify after backup checkbox Enter some kind of information such as Backup date 254 CardioSys V4 1 227 498 02 A Appendix Restoring D ata from a T ape Streamer Inset the tape On the Windows screen select Start gt Programs gt Administrative T ools C ommon gt Backup Open theT apes window icon in the bottom left hand corner of the screen Select the appropriate tape Click the Fest button Select the target drive When restoring the operating system select Restore registry and Restore file authorization W hen restor ing CardioSys Soft and patient files select Restore file authorization Clickthe button After the restore click the button to clear the window 227 498 02 A 3 2 Formatting Optical Disks Before saving data to an optical disk the disk must be formatted Insert the disk On the Windows screen select Start gt Programs gt Administrative T ools Common gt Disk Administrator The disk administrator displays symbols for the different drives drive 0 hard drive drive 1 optical disk with free storage capacity Click the Drive 1 box In the Partition menu select Create and confirm the max storage capacity shown wi
224. r of Leads Selection of the number of leads to be stored 6 or 12 227 498 02 A Lead Sequence H ere you determine the lead sequence for the ECG saved online Rhythm Lead Selection of the rhythm or reference lead Save FD ECG Thermal Writer Selection of the thermal printer port for printout of the online ECG refer to section 4 3 4 Recording a ST AT ECG Select none when no printer is connected Audible LEAD OFF Alarm Audio signal when an electrode is disconnected yes no 10 sECG Analysis ECG analysis at the beginning of the recording i yes no Possible only when all 10 electrodes are connected Report M odify H ere you determine the scope of the printed report T he special configuration screen is described in detail in section 4 1 6 Printing the Resting ECG Print after Analysis Do you wish to print the report configured on the screen mentioned above after each STAT ECG recording or not CardioSys V4 1 153 The STAT ECG 154 4 3 5 Recording a STAT ECG Brief Operating Instructions Test Information W F mM CardioSys V4 1 Turn on system and activate the STAT ECG program Apply electrodes and check signal quality Select procedure parameters sweep speed gain lead sequence Enter the test information W atch ECG traces and when the most recent 10 seconds are without artifacts start recording the first 6 s are analyzed t
225. rated must be checked by a service technician before being used again Verify the performance of the system once a month Caution Dispose of the packaging material observing the applicable waste control regulations and keeping it out of children s reach Warning Danger Chemicals required for the application or maintenance of the devices must under all circumstances be stored prepared and kept at hand in the containers provided by the manu facturer Failure to observe this instruction may result in severe consequences for the pa tient At the end of its service life CardioSys and its accessories must be disposed of in compliance with the applicable waste control regulations If you have any questionsin this matter please contact M arquette H ellige G mbH Caution Warning CardioSysis not intended for use asa vital signs physiological monitor 227 498 02 A Only use bicycle ergometers and treadmills that fulfill the applicable IEC 60601 1 require ments CardioSys and the associated bicycle ergometer or treadmill must be connected to the same power supply circuit via separate wall outlets Warning CardioSys V4 1 13 Introduction to CardioSys Warning Only modems complying with the requirements of IEC 60950 or UL1950 may be connected to the system Furthermore the regulations appli cable in the respective countries must be ob served The mo
226. rd does not exist in the database a new patient file will automatically be generated with the patient data of the incoming record and the record will be assigned to that patient 226 CardioSys V4 1 227 498 02 A System Services Menu CUA l Pa System ECG Device Z k Click the window showing the System Services ECG system connected to modem port a 2 C ECG recorder connected to modem port opens F igure 6 13 J Automatically assign procedure to patient ECG recorder connected to serial interface Click the icon you will see the transfer setup Baud Rate 1920 iv Port cov W window Figure 6 14 C Data from storage medium o i m First of all select the transfer system ECG system C ardioSys Soft Cancel_ Help ECG recorder M arquette H elige electrocardiograph Figure 6 14 Transfer stup window from ECG recorder k Select the appropriate baud rate 19200 if possible refer to section Specifications in the ECG recorder manual I A device number eg number 12 can be entered for ECG recorders by writing H ospital 12 Select the communications port x in the H ospital P ractice box Select the directory if you wish to transfer data from a storage medium d k Click to initiate file transfer and observe the instructions displayed on the screen k Press the C opy key on the ECG recorder Click canes to terminate ECG transfer Figu
227. rd l ET The dialog box shown in Figure 5 1 will appear Start program Quit program Figure 5 1 Identification window amp Click on Camas to exit 227 498 02 A CardioSys V4 1 209 Deleting Examinations Quitting the Program For your notes 210 CardioSys V4 1 227 498 02 A System Services Menu 6 System Services Menu This section explains how to configure the system how to use the voice recorder how to copy procedures to other storage media e g for house calls how to transfer resting ECGs from an ECG recorder how to compress data how to archive data how to save your preferred system setting under your name and how to load it 227 498 02 A CardioSys V4 1 211 System Services Menu Hellige KI 6 1 System Configuration System Services Menu r Procedure r Archiving r Setup K f A lt Click i the window showing the system services a T opens Figure 6 1 System Copy Patient Compression Load Configuration Records ey you will see the system configuration screen z z7 E SS Voice from ECG Archive Patient F Igu re 6 2 Recorder System ECG Records Recorder General Tab Cancel Help Institution N ame and Address For entry of the hospital practice name and address Figure 6 1 System services section w
228. re 6 15 will be displayed where you can assign the transferred ECG s to the patient s concerned d Click on ECG e g Resting ECG Baker D ave Click on to select the patient or admit a new patient if the name does not yet exist in the database amp Click on to assign the ECG to the patient 227 498 02 A CardioSys V4 1 227 System Services Menu EL Hellige x If thesame resting ECG is repeatedly transmitted from i AssignirecordsifromiECGIsystemMECGIrecorden CardioSmart an error message is displayed when you attempt Patient AAA to assign the ECG In this situation the redundant ECG can Baker Dave 41 yrs be del eted Patient Records Records from ECG system ECG recorder 09 11 1998 13 48 14 Resting ECG 05 12 1998 10 25 40 Resting ECG Baker Dave lt x a7 logis anite oe menn Ee ECG T ransfer via Communication Server 27 10 1998 08 45 44 Resting ECG 26 10 1998 15 14 47 Resting ECG 26 10 1998 14 46 45 Stress Test 26 10 1998 12 43 17 Stress Test 26 10 1998 11 02 36 Stress Test i ea ead Eco It is possible to simultaneously send the ECGs from several 25 10 1998 15 25 48 Stress Test Ab Ais tie 2 tems et 7 o ECG recorders max 4 via modem to C ardioSoft C ardioSys Se ep To utilize this features an extra PC is required as the commu nication server This server is part of the network through which the ECG can be transferred to the C ardioSys or
229. readmill is connected default COM 2 Comments Library H ere you may enter or modify comments to be added to the procedure during the test section 4 2 4 Running an Exerise T est Modify Setup Exercise Test k Select moaity A window opens showing the library of C Page 1 Page 2 existing comments Figure 4 2 57 IX 1 mV Cal Pulse bra Smm Ze During Test Moaity _ Move the cursor to the item you wish to change and click Audible HR Alarm Chest discomfort S Diagram HR in of max Hi ieee on moan K i ae ibs ee eae sss k Enter the modification X RPP Readout Syncope 7 F Start clock at pretest Contrast agent administered BP Monitor BP Meter 1 k Select to clear the window Port com2 ARZOGP Toca eRe Lie Le Ee oK Cancel Help Figure 4 2 57 Standard comments entry window 227 498 02 A CardioSys V4 1 133 The Exercise ECG Monitoring Remote Exercise Test Workstations Cardio Sys Supervisor 41yrs Remote Exercise Test Screen 01 2F 4 ruce 01 25 Stage 2 a 4 Hli m s 6 am E A A A A A Station Stress Lab 1 Il ad aad aad ee ee Il EN N N N oN 0 15 mV s 0 01 mV v4 aVR are 7 0 15 mV s 0 01 mV 63 mV Values at rest aVL feka n N M N lalt hio mm mV aVR PA EN er poy tlt hes mm s Figur
230. ring for ELSA modem AT amp FM O X1X3V0S0 1 The init string must include the following commands 1 factory defaults 2 response code in digital form 3 for telephone system with extensions display additional BUSY message 4 modem answers after 1st ring Please observe the information given in the modem s user manual CardioSys V4 1 227 498 02 A System Services Menu H ere are some of the important commands AT precedes each command D Start dialling in sender mode The following parameters may be used in a dial command 0 9 A D P pulse dialing T touch tone dialing Wait for 1 s eg to obtain an outside line dial tone flash wait for silent answer W wait for dial tone amp F fetch configuration profile copies factory defaults from theROM to theRAM HO disconnect MO speaker always off M1 speaker on until connection is established amp D0 ignoreDTR on to off transition amp Q1 usestandard AT commands Q0 modem sends response codes Q1 modem will not send response codes S0 1 modem will auto answer call after first ring VO modem will display response codes in digital form required setting X1 modem displays CONN ECT response disables dial tone and BU SY message X3 asX1 but modem displays BU SY message for dialling from extensions 227 498 02 A CardioSys V4 1 217 System Services Menu System Configuration General Modem MUSE Option Code Country Settings
231. rometry Test 4 5 Ambulatory Blood Pressure Measurement 4 6 Late Potential Analysis 4 7 External Programs 5 Deleting Examinations Quitting the Program 6 System Services Menu 7 Cleaning Disinfection and Maintenance 8 System Messages and Troubleshooting Tips 9 Technical Specifications 10 Equipment List Order Information Appendix Index CardioSys V4 1 hb oa amp amp A A pA A A pM AM AMA pM A A A A A General information General Information This manual is an integral part of the instrument and describes its normal use It should always be kept close to the equipment O bservance of the manual is a prerequi site for proper instrument performance and correct Operation and ensures patient and operator safety Thesymbol A denotes Refer to O perator s M anual It serves as an indicator for important facts to be noted when operating the instrument Information which refers only to certain versions of the instrument is accompanied by the catalog number s of the instrument s concerned T he catalog number is given on the instrument nameplate For detailed safety information please refer to section 1 3 For your safety Patient safety specified measuring accuracy and interfer ence free operation can be guaranteed only if original M arquette H ellige devices are interconnected e g basic units and plug in modules Only use acce
232. rotocol Buttons to hold the stage and to proceed to the next tage Button to proceed to the next phase Current speed and grade buttons to increase or decrease the speed and the grade Buttonsto start and sop the treadmill protocol continues 9 Windows indicating the heart rate rate pressure product RPP and the blood pressure 10 Button to abort the test 11 Button to initiate a printout las printer or thermal array printer 12 Button for entry of comments and blood pressure 13 Button to mark an event episode the episode is saved at the same time 14 Button to verify the ECG sgnal quality all leads 15 Button to freeze and rdease the sgnal traces nN HOU PWN oo 92 CardioSys V4 1 The Signal Acquisition Screen of an Exercise Test The signal acquisition screen Figure 4 11 of the exercise test presents the following information the current load and RPM or speed and grade 7 the current stage 3 and the time elapsed in that stage 2 the current phase 4 and the time elapsed in that phase 1 the heart rate RPP and blood pressure 9 the results of the arrhythmia analysis complex ectopy in red and number of VPB min 17 the ST analysis results compared with the resting beat analysis results 18 Scan indicates that the lead with the most prominent ST depression is displayed leads aVR aVL V1 and V2 are not considered various procedure parameters 21 16 17 18 19 20 21 Butt
233. rrect place k Click on the QRS complex at the end of the interval A line marks the measured interval and the resulting heart rate is displayed 64 CardioSys V4 1 227 498 02 A The Resting ECG Evaluating the ECG Arrhythmia Review M easuring the H eart Rate in the Presence of Patient Procedure System Services Help 0 ie olee 7 Atrial Fibrillation or Flutter a cles gt gt a P P i A E maea In this situation you will have to define a cardiac cycle your QRS Complexos 13 HR 85 BPM sel f Mm i i i i i 1 10mm s 40Hz 50 Hz PVC Click E Mean RR Interval 726 ms A window opens where you can enter the number of cycles 800 800 i over which you want to measure the heart rate I I I I I I I i t Click above N umber to adjust the number of cycles N Calculating the heart rate k Position the cursor at the beginning of the interval to be measured and click amp Count the number of cardiac cycles position the cursor at the end of the interval and click again The interval is marked with a yellow line and the heart rate for this interval is displayed Figure 4 1 26 k Click the right mouse button to delete a single reference point or an entire measurement 227 498 02 A CardioSys V4 1 65 The Resting ECG Evaluating the ECG Interpretation Patient Procedure System Ser
234. s diuretics a aaa ss LS lick on to cl ear the window Ca antagonists gt antiarrhythmics alycoside Entering Comments gt gt z If you wish to enter a comment on the test procedure click in gt the Comment text box and key in the text Figure 4 2 9 Editing the medication group Physician s U ser s N ame The names of the physician and user can either be entered here click in the text box and type the name or they can be selected from the list of the registered system users section 6 1 System Configuration amp Click on and choose a name from the list by clicking on it Exiting the T est Information Screen Once you have entered all test information you can either clear the window with and start conducting the exercise test or clear the window with in this case the test demographics will be ignored and are not assigned to the test to display the preacquisition screen 227 498 02 A CardioSys V4 1 89 The Exercise ECG Entering the Test Information 90 From the preacquisition screen you can check the signal quality return to the test information screen access the system setup screen temporarily modify the selected phase with enter test information before modifying the test phase otherwise the changes will be lost Please refer to section 4 2 7 for a detailed explanation of the preacquisition screen and the exercise test setu
235. s point in time are displayed in the bottom part of the screen As soon as you select another point on any of the trend curves the old time line disappears and a new one is dis played The bottom line shows comments that you have entered at the selected time W hen no comment exists for the new selected time the previous one is displayed k With the icon you can cross reference to the segment of the full disclosure ECG which corresponds to the position of the time line on the trend graph with E you can return to the trend graphs A dash in the upper margin of the trend windows indicates the change to the next test phase 227 498 02 A The Exercise ECG Reviewing the Final Report M Patient Procedure System Services Help F r E F A N inl F 4 ae a aA ES A EI Baker Dave 41yrs Exercise Test Trend Reports re _ ST HR Slope Ga ST HR 2 027 Slope N r p lt 0 05 180 HR EFM 240 Figure 4 2 33 ST HR dope according to R J LINDEN 227 498 02 A k Click or to display the other trend graphs T hey show the ST trends from all recorded leads Thereis a total of three graphic trend reports Page number 4 shows the ST H R slope according to R J Linnen Figure 4 2 33 H ere you will automatically see the lead with the most signifi cant slope except leads I aVR aVL V1 T he graph indi cates t
236. s method assures the required high sensitivity A correlation coefficient can be set to any value between 1 and 99 default 95 thus determining the accuracy of the measurement T he higher the coefficient the more accurate is the measurement Furthermore an upper noise limit for the averaged signal is preset W hen the noise drops below thislimit averaging stops and the measurement begins The analysis method used isthe SIMSON method A SIMSON algorithm is also used for determination of the QRS offset TheECG leads are the uncorrected orthogonal leads X Y and Z they are acquired via chest electrodes attached at the corresponding pick up points After the analysis the vector diagram is displayed showing the measured values and the average beats Also included is the procedure summary comprising the patient data meas ured values interpretation and medication The overall gain of the vector representation is 20 V cm which is equivalent to a50 fold gain of the standard sensitiv ity of 10 mm mvV Alternative settings selectable on the vector screen are 5 10 20 and 40 W 192 CardioSys V4 1 4 6 2 Electrode Application Due to the small size of late potential signals a very careful electrode technique is required In most cases a resting ECG will be recorded before the ECG is analyzed for late potentials T herefore the electrodes for the 12 standard leads are applied Late potential analysis is performed on the uncor rected
237. saserteses ctietaacvtis ais a 147 Test patient iaiia iinan aae 213 Test protocol selection modification eceereeen 87 Tes results confirming ccsscccseccesessescstsstsseestssssseesceseseres 35 Test summary Exerci SE tEn ana aaeain ainia 109 Reting EC G icici aai i 59 Thermal Printe iiser a a a ia 16 Time fonat crpcsnnnienananun na an 220 227 498 02 A CardioSys V4 1 TONOPORT IV IVA ansin namna 176 Trace background color selection sesser 212 Transfer of resting ECG S sssssssseeserieseriereriererrerereerens 226 E E a E E E A A A T 106 112 TroUBIESNOOUINO riisiin riisiga unsi a tae 237 U nits of measurement s r 220 SEL SE E E E E E 214 VC measurement a soniniiciriuniiiimi airidas ddia a 165 AY elie ON G rentin e a A 196 Voice Teor E aiaiai aaia 221 Zoom display Exerci e testaa inna aai 120 Resting ECG upueiiioniiignoiinn a ee ialetiacis 56 269 Index For your notes 270 CardioSys V4 1 227 498 02 A marquetie A GE Medical Systems Company World Headquarters GE Marquette Medical Systems 8200 West Tower Avenue Milwaukee WI 53223 e USA Tel 1 414 355 5000 800 558 5120 US only Fax 1 414 355 3790 Europe Region Marquette Hellige GmbH A GE Medical Systems Company Postfach 60 02 65 D 79032 Freiburg Germany Tel 49 761 45 43 0 Fax 49 761 45 43 233 Asia Region 26 F Catic Plaza 8 Causeway Road Causeway Bay Hong Kong Tel 852 2804 2320 Fax 852 2804 1776
238. shoulder F green c6 E above left kidney C5 C1 C2C3 C4 Figure 4 2 3 Connecting the patient cable 10 wire tandard ECG leads D gt Please observe the information given in sections 7 1 Artifact D ue to Poor Electrode Application 7 2 ECGs of Pacemaker Patients and 7 3 ECG Recording During Defibrillation in the appen dix I amp S Thered R electrode is the reference electrode Placement and signal quality of all other elec trodes can be assessed on the signal acquisition screen only when this electrode is applied Secure the patient cable with a holder 303 441 61 bicy cle ergometer or with a strap 923 096 72 treadmill Electrode Application Points for Standard Leads I II H1 AVR aVL aVF V1 to V6 Four limb and six chest electrodes are usually required for the acquisition of the standard leads In stress testing however we recommend attaching the limb electrodes on the shoulders where there are no muscles or above the kidneys Figure 4 2 2 Connect the patient cable as shown in Figure 4 2 3 Secure the electrode distributor of the patient cable chest strap or holder Connect the patient cable to the device type CF signal input highly isolated suitable for intracardiac applica tion defibrillation proof 84 CardioSys V4 1 227 498 02 A The Exercise ECG Entering the Test Information
239. sition even if not all electrodes are applied QTC Calculation Equation for calculation of the QT interval H EGGLIN HoOLZMANN Or BAZETT Lead Sequence In the lead sequence window you can assign the leads to the recording channels Six lead sequences are predefined Four of these Sequences 3 to 6 can be modified STANDARD L111 aVR VL aVF VIVE a og CABRERA aVL I aVR Il aVF Ill V1 V6 HIGH 1 11 Hl aVR aVL aVF V1 V6 N EHB 1 11 III aVR aVL aVF D A J 1 11 IH RIGHT 1 11 Hl WR AVL AVF V4R V3R V1 V2 V3 V4 LEFT 1 11 I1 WR WL AVF V4 V5 V6 V7 V8 V9 CardioSys V4 1 227 498 02 A The Resting ECG System Defaults Modify pa S Lead Sequence M odifying the Lead Sequence HIGH Speed mm s Lead Sequence _ Click 4 to the right of Lead Sequence to open the lead Alarm 1i sequence selection window Figure 4 1 41 Gain mm mV Lead check noise le QTC Calculation T 40 H2 Filter k Click the sequence that you wish to modify lead se E a l e Lead Sequence 50 Hz Filter ce wr E ave Sean quences 3 to 6 only vi a vr Print after Analysis pcre v 8 ve k Click to open a window showing all channels i okl w Figure 4 1 42 There is a window for each of the ake z F care
240. sk drive a data will be saved to the hard drivec 36 CardioSys V4 1 Sending Procedure D ata You can transmit one or several procedures via a modem or save them to a storage medium k Select the procedure s multiple procedures can be highlighted by holding either jj or down when clicking on them k Click on to clear the window Figure 3 6 will appear k If you wish to send the data via modem select T rans mission via modem and enter the tdephone number name and password of the external user at the receiving end Then select to clear the window X If you wish to save the data to a storage medium select Save procedure to storage medium T hen select to clear the window You can change the directory by clicking on moaity a win dow opens showing the available directories 227 498 02 A Selecting and Admitting a Patient Retrieving Stored Examinations SE Hellige Z Combined Report 2 m Combined Report i peaa ranan Seca maaa l You can select several tests of one patient compile these in a No Respiratory Problem ee or P SEPA aoe nse 1 Na combined report and print it out T his function is not avail 22 59 Ambulator 001 ressure n ae eine and able when the records of all patients are displayed 24h Average sys dia mmHg 3 eras eae above 135 mmHg T BP readings above 85 mmHg k Sel ect th
241. ssories which are listed in this manual and which have been tested in combination with the device eg patient cables electrodes transducers sensors consumables etc If you use accessories or consumables from other manufacturers M arquette H ellige does not guarantee safe operation or functioning of the device T he warranty does not cover damages resulting from the use of accessories and consumables from other manufac turers M arquette H ellige is responsible for the effects on safety reliability and performance of the equipment only if assembly operations extensions readjustments modifications or repairs are carried out by M arquette H ellige or by persons authorized by M arquette H ellige if the instrument is used in accordance with the instructions for use All publications are in conformity with the instrument specifications and IEC publications on safety of electro medical equipment valid at printing date All rights are reserved for instruments circuits techniques and names appearing in the manual On request M arquette H elige will provide a service manual T he M arquette H ellige quality management system complies with theDIN EN ISO 9001 and EN 46001 Standards 4 CardioSys V4 1 227 498 02 A Introduction to CardioS ys 1 Introduction to CardioSys In this section you will find an overview of the C ardioSys features and capabilities and of the available software options a sur
242. stage 35 M odifies the load in 5 W att increments Selects the recovery phase Quits program 227 498 02 A MEDITRONIC M 40 Test Information 7 3 Phase gt gt Phase gt gt 3 Phase gt gt CardioSys V4 1 Start program Call up the exercisetest screen Admit new patient or select patient from list Apply electrodes and check signal quality Enter the test information Select protocol Adjust initial load and load increase stage as required by the protocol selected at the ergo meter Click button and wait for ST values to be displayed option Click button and start pedalling Interactive load changes 5W and adjustment of load for recovery phase ms M odifies the load in 5 W att increments Selects the recovery phase Quits program 137 The Exercise ECG Short Form Operating Instructions ERGOCOMP EC 560 ECB 561 ERGOLINE 900 900L EC 1200 V3 52 Start program Call up the exercise test screen Admit new patient or select patient from list Gee Apply electrodes and check signal quality tamoman Enter the test information Select protocol Start pedalling be displayed option gt Click J button and wait for ST values to Hoa M aintains the load stage Si Stage gt gt Switches to the next load stage only with ERGO LIN E 900 900L Es M odifies the load in 5 W att increments Phase gt gt Selects the recovery phase
243. standard and Casrera leads on the body as shown on the picture at left for all other leads there is a schematic representation of the electrodes Furthermore an arrow 4 points to the leads which are impaired by improper electrode application or which cannot be recorded due to disconnected electrodes or due to a break in the patient cable the selected gain the 1 mV calibration pulse 5 is valid for all channels the most important system settings 6 O ther operations possible on the control screen are temporary modification of the test phase with enter the test information before changing the phase otherwise the changes will be lost verification of the ECG signal quality with display of the setup menu section 4 2 7 with System settings and operating steps are explained on the following pages CardioSys V4 1 227 498 02 A The Exercise ECG Exercise Test Defaults 4 2 7 Exercise Test Setup Speed mm s 25 Aj In Test Reports lean TE o gt Before running the first stress test select several system set Lead Check noise level Tow E auto Report Format ESET tings on the setup screen T hese settings are saved and loaded none E Filter H3 Manual Recording automatically on power up T he setup menu is displayed from Print 50 Hz Arrhythmia Lead Select S2 mi the exercise test control screen section 4 2 6 ae Scan Ve aj X Spline J X Poi
244. t program Some of the rambursement programs automatically suggest a bill 252 CardioSys V4 1 Communication between reimbursement program and examination program start of the reimbursement program selection of a patient display of file card selection of a procedure start of the examination program new procedures ECG spirogram etc termination of examination program data transfer to reimbursement program W hen the M arquette H ellige program runs in conjunction with a reimbursement program the following functions are disabled selecting another patient admitting a new patient The following patient data are adopted by the reimbursement program last name first name patient ID date of birth height weight 227 498 02 A Appendix CIS Order List Contact the supplier of the clinical information system to find out whether the program fulfills the requirements of the special M arquette H ellige data interface BDT interface and whether the program is capable of generating the so called task list Also please contact M arquette H ellige to see whether the compatibility of the CIS has been determined by M arquette H ellige If so patients from the CIS database can be added to the task lists for the respective examination procedure types U pon activation of a procedure type C ardioSys Soft will then allow you to select one of the patients from the corre sponding task list click o
245. t with 11 the laser printer will print 1 page with approximately 4 seconds of ECG data and the median beats the thermal array printer will print continuous rhythm Figure 4 2 17 until stopped again with storim verify the ECG signal quality 14 freezethe ECG 15 the screen display only one real time lead continues to be displayed for monitoring display an event marker 13 an event episode is stored at the same time comprising a segment 5 seconds before and 5 seconds after the mark 102 CardioSys V4 1 227 498 02 A The Exercise ECG The Elements of an Exercise Test BP Comment display ST measurement results of the other acquired Baker Dave 41yrs Exercise Test Pretest Phase gt gt 0 0 F Broo reson Sa 85 leads 19 Scan indicates that the lead with the most Supine Hold Stage gt gt 0 0 E RPP significant ST depression is displayed automatically lw BP Comment Freeze ECG Interpretation REMSU in thn Evam Mare sYMediane Tents eoastipe leads aVR aVL V1 and V2 are ignored t y H VPI 3 ahanta adjug the reference points E J and J X if the corre i sponding option was set to M anual in the setup menu Chest discomfort Dyspnea BP Leg discomfort Fatigue sys dia Nausea E El Syncope modify the sensitivity 21 g ente
246. tal capacity VC and the forced vital capacity FVC and combine both to form a bronchodilation test section 4 4 5 Click to select the bronchodilation test or to select a standard spirometry test If the first procedure of a bronchodilation test was run as a normal spirometry test the program asks you before the second test whether the first one is to be taken as the refer ence measurement Before the test we recommend that you give the patient an idea of the test by demonstrating the animation k Click to start the demonstration W hen the patient is familiar with the test procedure you can start the test k Attach the nose clip so that the entire tidal volume flows through the sensor 164 CardioSys V4 1 227 498 02 A The Spirometry Test Running and Evaluating a Spirometry Test lt b Patient Procedure System Services Help e eae gt Balt lel io lee b 0 gt 2 E Baker Dave 4 pirometry Recording lt l gt Test Information End Patient Data 188cm Male VC Measure C FVC Measure Animation Setup Interpretation Miller Sq 0 Scale E Normal Values ECCS Ore K 74v Value Act Norm 64 EVC I 344 268 118 5 FEVC I 2 63 FEV1 I 2 25 4a FEV1 VC 81 0 34 PEF l s 5 86 al MEF75 l s 5 35 MEF5O l s 3 76 ey t s MEF25 l s 1 61 gp aa MMF
247. tentials For your notes 204 CardioSys V4 1 227 498 02 A External Programs 4 7 External Programs This section explains general points to note when running external programs howto install external programs for activation from CardioSys Soft 227 498 02 A CardioSys V4 1 205 External Programs 4 7 1 General Information The M arquette H elige program has a special BDT interface for communication with external programs i gt Marquette H ellige is not in a position to guaran tee the correct communication between the Marquette H ellige program and the external program in all cases In situations where the external program and the M arquette H ellige program are operated together the patient file is handled by the M arquette H elige program while the proce dure data are managed by the external program At the end the M arquette H ellige program only adopts a summary of the external procedure and assigns it to the procedure list of the patient concerned Prior to calling up an external program you should select a patient in the M arquette H ellige program If you wish to change to another patient during an external procedure you have to leave the external program to select the new patient in the M arquette H ellige program 206 CardioSys V4 1 Dialog between M arquette H ellige program and external program start M arquette H ellige program select patient select external pro
248. ter 25 Hz 40 H z default 40 H 2 N oise Limit H ere you can enter an upper limit value for signal noise of the ECG after averaging and filtering Any value between 0 1 and 5 0 uV is possible default 1 0 uV When the signal noise falls below this limit the system starts measuring the Q RS complexesif at the same time at least 50 complexes have been collected Correlation C oefficient T he correlation coefficient entered in is a measure of the congruence of the QRS complexes settings between 1 and 99 default 95 227 498 02 A H FLA Threshold For entry of the H FLA threshold high frequency low ampli tude Any value between 5 and 99 uV is possible default 40 uV In the vector diagram this threshold is marked by a dashed line T he H FLA duration is the period of time from the end of the QRS complex towards the middle during which the signal amplitudes were below the selected thresh old Number of QRS N umber of QRS complexes to be averaged also refer to N oise Limit Possible settings 20 to 500 default 200 1 mV Cal Pulse Display of 1 mV calibration pulse yes or no check mark yes Audible LEAD OFF Alarm Audible signal when an electrode is disconnected yes or no check mark yes Print after Recording Printout immediately at the end of the analysis X Click on modifications are saved or modifications are ignored to clear the defaults menu CardioSys V4 1 203 Late P o
249. th _Resetars You can change the signal size with the yj buttons 2 5 5 10 20 40 mm mV You can change the sweep speed with the ej 5 buttons 25 50 mm s CardioSys V4 1 195 Late P otentials Q Hellige i 1 Number 0 J43 AoE ee arn a a ul 3 J iPS io Soest ee a RM SAGES 7 Pee ssened e eee es SID urat onl nns o A i HFLA Duration ms z Patient Procedure System Services Help eas tt el l o ae 2 P aal 500 uV em e gt 400 are Pel 1 et Sacre ee 2 ee in TEEN Figure 4 6 5 Vector diagram 1 Buttonsto adjug the gain Buttons to adjust the sweep speed Buttons to display other report documents M edians non amplified QRS onst 2 3 4 Parameter table 5 6 7 QRS offset I amp This noise value 4 may differ from the one shown on the signal acquisition screen asit is calculated over all acquired beats 196 TheECG signal acquisition stops automatically ather when the signal noise drops below the preset noise limit or when the specified number of correlating complexes has been reached The first report screen displayed is the vector diagram Figure 4 6 5 Other documents of the procedure report are the interpreta tion Figure 4 6 7 and the tes summary Figure 4 6 8 Vector D iagram Figure 4 6 5 shows the vector diagram with the marks identi
250. th OK The fied for drive 1 now says unformatted xxx M B In the Partition menu select M ake changes now and click OK The field for drive 1 now shows the drive letter e g E Check that the correct drive is sdected drive E in our example because the formatting process will clear all data on the disk In the O ptions menu select Format CardioSys V4 1 255 Appendix At File system sdlect NTFS 4 The ECG Measurement and Analysis Programs Enter a name for the optical disk Refer to the following publications Click Start to initiate the formatting process ECG Interpretation Program H EART Click OK to confirm the message All data will be cleared Marquette 12 SL Physician s G uide Formatting takes about 5 minutes A progress bar illustrates the process Click Close to end the session Close the Disk Administrator window 256 CardioSys V4 1 227 498 02 A Appendix 5 Direct FAX Transmission of Printer Documents T he documents usually sent to the printer can be directly routed to another PC or to a fax machine Required accesso ries are amodem recommended model ELSA M icrolink 14 4T Q and the WIN FAX Pro 4 0 fax software W hen installing the fax software from the program disk you can configure the fax port as the standard printer With this setting every print command is sent to the fax pr
251. the box to enable or disable the function x function enabled 3 Click the button for instance to select the Lead sequence Speed selects the trace sweep speed Gain selects the signal size amplitude CardioSys V4 1 75 The Resting ECG System Defaults m Speed mm s Hellige 25 X 1 mV Cal Pulse Lead Sequence Rhythm Lead Print after Analysis Report STANDARD la Modify STANDARD CABRERA HIGH NEHB RIGHT Gain mm mV 10 4 Audible LEAD OFF Alarm Lead check noise level low a Teuh Ci QTC Calculation Hegglin Holzmann T 40 Hz Filter 50 Hz Filter F Anti Drift System LEFT OK Cancel Help Hee Figure 4 1 41 Lead sequence election window 76 Lead check noise level This is a measure of the quality of the acquired signal signal to noise ratio W hen there is too much signal noise at the electrode the electrode is displayed yellow on the signal acquisition screen T he setting that you select here low middle high changes the threshold as of which the electrode is displayed yellow high sensitivity to noise low threshold 1 mV Cal Pulse display of 1 mV calibration pulse yes or no i yes Audible LEAD OFF Alarm audible signal when an electrode is disconnected yes or no l yes Manual O verride W hen the function is enabled the program will start the signal acqui
252. the ergometer Click the lt button W ait for the first ST meas L amp advance to the recovery phase with upon comple t to be displayed opti 18 Fi 4 2 10 ii i a a GDH ae l tion of the last stage the program automatically activates 4 2 11 the recovery phase k terminate the test with f Pre Test Test Phase Recovery Phase Adjust initial load Interactive load and load increase change 5 W and stage of selected adjust load for protocol recovery phase Test Information Prot 1 I Select protocol Check recording interval When analyzing Automatic when ST segment wait last stage is for 1st results to completed or be displayed manual Figure 4 2 13 Program sequence with MEDITRONIC M 40 227 498 02 A CardioSys V4 1 95 The Exercise ECG The Elements of an Exercise Test Ergometers with D igital Communication Interface ERGOCOMP EC 560 ECB 561 ERGO LIN E 900 900L EC 1200 V3 52 TheEC 1200 will display the version number when turned on The following explanations refer to version 3 52 or higher upgrade if possible For older versions see section M 700 and EC 1200 W ith these ergometers the selected protocol fully controls the test procedure The ergometer operating controls are inopera tive Only blood pressure measurements can be taken manu ally Refer to Appendix 6 Connecting External D
253. the Windows program Monitored Leads Allows you to select the number of leads to be monitored 3 6 12 Displayed Leads Allows you to select the number of leads to be displayed 3 or 6 227 498 02 A The Exercise ECG Exercise Test Defaults 4 Setup Exercise Test Lead Sequence deea Oe T he lead sequences change with the number of recorded eee HOU Ma I channels 3 6 or 12 You can choose from 6 different se Audible LEAD OFF Alarm Displayed Leads 6 _Moaity _ y Audible HR Alarm Lead Sequence STANDARD quences T wo of these sequence 1 and 2 are fixed The a i f STANDARD t ae F ae in of max HR Protocol Brucg CABRERA B modity others can be modified as follows also you can differentiate X IX RPP Readout Phases A p HIGH between the sequence on screen and on the printout Start clock at pretest fea Bruce C R Bruce BP Monitor m A Ergometer Model Internal Treadmill S Click the arrow w to the right of Lead Sequence to Port com2 kori com e open the lead sequence window Figure 4 2 52 ARZOUP local none w Library Comments ok J cance J He k Select the sequence that you wish to modify any se Figure 4 2 52 Lead sequence election window quence except 1 and 2 M dif S Select
254. the limb electrodes above the wrists and ankles Figure 4 3 2 shows the chest lead 4R C5 bia cat C3R C1 C2C3 C4 application points Figure 4 3 2 Chet dectrode application points N black R red C1 whi e C2 white e C3 whit EY 1__F C4 whi a e C5 white C6 white L yellow F green C1 inthe 4th intercostal space at the right sternal edge C2 inthe 4th intercostal space at the left sternal edge C3 at thelevel of the 5th rib midway between C2 and C4 C4 in the 5th intercostal space on the left midclavicular line C5 on theleft anterior axillary line between C4 and C6 C6 onthe mid axillary line at the level of C4 right leg C7 in the 5th intercostal space on the left posterior axillary right arm line C8 in the 5th intercostal space on the left scapulary line C3R opposite C3 on the right side of the thorax _ CAR opposite C4 on the right side of the thorax left arm y Connect the 10 wire patient cable as shown in Fig left leg ure 4 3 3 cS C1 C2Cc3 C4 Figure 4 3 3 Connecting the patient cable 10 wire standard ECG leads 227 498 02 A CardioSys V4 1 143 The STAT ECG correct Figure 4 3 4 Arranging the patient cable 144 incorrect CardioSys V4 1 Arrange the patient cable as shown in Figure 4 3 4 and connect it to the system type CF signal input highly isolated suitable for intracardiac applic
255. the search filter only reting ECGs only STAT ECGs only exercise tets k Click on 2 Figure 3 4 and select all 227 498 02 A CardioSys V4 1 33 Selecting and Admitting a Patient Retrieving Stored Examinations Select Test Patient Date from to Location Show new list 04 12 1998 04 12 1998 15 14 53 0 Right Heart Catherization 11 40 43 0 TAT EC Confirm ransfer to MUSE Send Delete Cancel Help Figure 3 5 Window for sdection of stored tests 34 1 e w o N oo wo 10 Sdeted patient only this patient s records are displayed Choose all if you want to see all stored tests Sdection of the search filter date range Sdection of the search filter tests recorded at a special location Displays lit when all search filters were set Sdected test Click arrow to scroll through list Control buttons Displays the sdected test Displays a combined report Allows the sdected test to be confirmed Saves the tes for M USE to the database or storage medium as configured Allowstransmisson of procedures Clearsa tet Sdection of the search filter confirmed uncon firmed or all tests Sdection of the search filter only reting ECGs only STAT ECGs only exercise tets You can set various filters to display only those tests that meet specific criteria teg type only resting ECG only spirometry tests only STAT ECGs click 10 Figure 3 5 then sel
256. trieving Stored Examinations 3 3 Editing Stored Tests Tests stored in the database can be retrieved Select Test Patient Date from to MM h Asl to be revi ewed ou to be assessed n 0 Right Heart Catherization i R to be transmitted ee ee ee z for creation of a combined report to be deleted Delete Cancel Selecting a T est Help Figure 3 4 Window for section of stored tess Before you are able to edit test data you will have to select a 1 Sdected patient only this patient s records are test from the database You can either display a list of all displayed stored tests or of the tests stored for a specific patient 2 Choose all if you want to see all tored tests 3 Sdection of the search filter date range k Select the patient 4 Sdection of the search filter tests recorded at a special location Click on a 5 Displays lit when all search filters were st 6 Sdected test A list appears showing all the examination procedures stored 7 Click arrow to scroll through list for the selected patient Figure 3 4 If you wish to see all 8 Control buttons stored procedures Displays the sdected test Displays a combined report Allows the sdected tet to be confirmed Saves the tet for M USE to the database or storage medium as configured Allowstransmisson of procedures Clearsa tet 9 Sdection of the search filter confirmed uncon firmed or all tests 10 Sdection of
257. uired after clicking PEE on the button in the preconfigured format 4x2 5s 2x5s Name Dave Baker Recall Report Date of Binh 05 08 1958 41 yrs Patient ID 12345 Male Caucasian 145 0 tb 79 in PBace 01 17 Total Time 01 17 HR BPM 60 Supine 01 17 00 mph 0 0 BP mmHg j Ht NERI aA ton i i fed ih Ne eee eo ore coer H E a A in a S A ar L L L A cua a Cie HEE BrE Kio ai AREE Ex eee AVR h r aN Nef ice Soe i ETET lavi l H O ees mw ht JAVF di H re myc tee Bee Ci Kaaka ie ie Cy y CTY EEE E a qn afl esas aan cane i An L AEA Z aaa ET al ne eer ner EER 0911 1996 09 51 09 TO mmvinV_25 mm s Figure 4 2 20 12 lead recall report i gt Recall and 12 L ead reports are printed only when option print or print amp save is selected for Manual Recording in the Setup menu To Lead Report Patient ID 12345 HR BPM 60 BP mmHg aVR l aaa ij l hekin ape app E biki vi An tnt he fp A opt Ja toi a a coeds i Elida Mbt FA JR SLA Sk shore pote e T 09 11 1996 09 51 09 10 mm mV 25 mm s Figure 4 2 21 12 lead report 4 x 2 5 5 104 CardioSys V4 1 227 498 02 A The Exercise ECG The Elements of an Exercise Test fame Dave Baker a Name Date of Birth Dave Baker 05 05 1955 41 yrs Male Caucasi Comparative Mer Patient ID
258. ure 2 4 clears the characters from left to right one by one The cursor keys 5 Figure 2 4 are used to move the cursor up down right and left to any desired position in the text for instance to insert text Ins key or to delete text D el key 3 Figure 2 4 TheH omeand End keys 2 Figure 2 4 move the cursor to the first and last position in the text With Return 4 and on Windows screens with TAB 6 you move the cursor to the beginning of anew blank line Figure 2 4 The keyboard 227 498 02 A CardioSys V4 1 23 General Information on System Operation Start program Marquette HELLIGE Cardiosoft Supervisor ie ee ee J eN 2 3 Starting the Program Explanation of the Function Keys and Selecting the Language Starting the Program Turn on the system and start the program by double clicking on as The title screen Figure 2 5 appears When the password function is enabled in the System Configuration tab G eneral you will see the user registration window Figure 2 5 Title sree k Enter the name and password and click on the L When the password function is enabled section button 6 1 System Configuration gt G eneral enter the user name and password first I The program may be configured to default to an operating mode such as reting ECG In this case you will see the patient selection screen instead of the title scre
259. ure 4 3 10 Click the sequence that you wish to modify lead se quences 3 to 6 only k Click to open a window showing all channels Figure 4 3 11 There isa window for each of the channels indicating the lead currently assigned to that channad To select another lead Click the arrow to display all available leads Figure 4 3 12 k Select the new lead to be recorded in the respective channel k Enter up to 4 characters in the Label column to label the lead Once you have assigned a lead to each of the channels you can enter aname for the lead sequence in the headline kb M ove the cursor to the text box and click k Enter a name and select to clear the window 227 498 02 A The STAT ECG Rhythm Lead Selection of the rhythm or reference lead Print after Recording After analysis of the 10 s ECG a report is printed automati cally yes no T he scope of the printout is determined with menu item Report M odify 40 H z Filter enables or disables muscle filter i muscle filter on 50 H 2 60 H z Filter enables or disables AC filter i AC filter on Spline enables or disables the Cubic Spline algorithm automatic baseline correction Spline on the algorithm causes a signal delay of 4 seconds Bottom Window Save full disclosure ECG T erminate after min You can choose a time interval after which the program automatically stops collecting the ECG signal 30 min max N umbe
260. val for 1st results to completed or be displayed manual Figure 4 2 12 Program quence with MEDITRONIC M 400 94 CardioSys V4 1 227 498 02 A The Exercise ECG The Elements of an Exercise Test Ergometers without D igital Communication Interface but with R emote Start C apability e g MEDITRONIC M 40 As above but there is no need to select the next phase manu Astrend values are saved at 30 second intervals we recommend ally at the ergometer as this is done by the remote start signal that you wait approx 30 seconds before starting to pedal k Then press the Phase gt gt button and ask the test subject to start pedalling If your ergometer sends a remote start impulse when the patient starts pedalling there is no need to click the Prase gt 5 button On the setup screen section 4 2 7 select the intern remote start ergometer k If you wish to obtain a recording at the end of each load stage only set the ECG Rec Inter El to 00 00 min W indow 2 in Figure 4 2 10 indicates the remaining time in the current stage while window 1 shows the time elapsed in k For Timein stage TS enter a time which is consider that phase ably longer than the corresponding value at the ergometer PON ii 9 j D uring the test you can k Select a protocol and adjust the corresponding initial k Modify the load in steps of 5 W atts with E85 and load at the ergometer do not forget to make the same adjustments at
261. vey of the C ardioSys system components points to note during system operation instructions on putting the system into operation 227 498 02 A CardioSys V4 1 5 Introduction to CardioSys 1 1 Program Features CardioSys is a PC based system for ECG recording spiro metry tests and ambulatory blood pressure examinations The following options are available to enhance the program func tions Basic Software Package RESB 12 lead ECG acquisition resting ECG STAT ECG recording of spirometry tests downloading of data from TON OPORT IV IVa am bulatory blood pressure downloading of data from electrocardiographs EK 53 EK 56 EK 512 CardioSmart data management for all operating modes BDT interface Resting ECG M easurement RESM measurement of 12 ECG leads acquired simultaneously tabular presentation of the measured values editing of measuring marks direct comparison of 2 resting ECGs Resting ECG Interpretation RE SI interpretation of the measured resting ECG with detailed explanations medication and the patient s age are taken into account reanalysis after modification of the measuring marks 6 CardioSys V4 1 3 Lead ExerciseECG ERG1 3 lead recording and display control of all M arquette H elige ergometers creation of custom protocols and phases depending on ergometer model U Ia for 12 Lead Exercise ECG ERG2 optional recording of 3 6 or 12 ECG leads 12
262. vices Help F k iH Sna 2 a Baker Dave 4 R erpretatio amp FS EA Aj Ede aller Fil ta ca Measurements Summary C Statement Library Interpretation suspected left ventr hypertrophy because R S in V5 and QRS angle lt 15 d minor left axis deviation m because QRS angle between 30 and 0 negative T wave lateral because T lt 0 1 mV in V6 R S inversion area between V1 and V2 L gt gt Figure 4 1 27 Interpretation screen I You can copy individual lines by double clicking 66 CardioSys V4 1 Interpretation The interpretation screen is split into two windows T he one on the left shows the interpretation as derived by the systen or the library of interpretative statements while the one on the right is reserved for the physician s interpretation T he physician s interpretation has priority over the system inter pretation for printing or in the procedure summary O nly when the procedure is assigned to a patient can the physician s interpretation be entered W hen writing the physician s interpretation you can first of all choose between the interpretation from the analysis pro gram and the statement library then you can copy parts or all of these statements to the right window In the window at the right you can edit these statements again using the icon to cut text and the icon to reinsert the text in any
263. wsyou to scroll to a general location in the lit 4 clears the window without saving entries I You clear the HELP window by clicking File and Exit 22 CardioSys V4 1 The scroll box also indicates which section of the list is cur rently displayed If the box is just below the upper arrow you see the top portion of the list if the box isin the middle of the scroll bar the middle portion of the list is on display etc W hen you see an horizontal scroll bar below a picture the two arrows and the scroll box allow you to shift the picture left or right Some screens which offer various selections can be cleared by two methods either with or with Figure 2 3 When you select ok the program accepts the selec tions made with canei J the selections will be ignored If you wish to highlight text click the first letter of the text block hold the left mouse button down and drag the pointer to the last letter Then release the mouse button T he marked text is displayed in reverse video To obtain information on program operation click the button or a 227 498 02 A General Information on System Operation 2 2 The Most Important Keyboard Controls Use the keyboard to enter text and numbers T he following is a description of functions which you do not know from a conventional typewriter If you are already familiar with a PC keyboard you may skip this section The Backspace key 1 Fig
264. y clicking To Click the button k If you wish to delete a copied statement or part of it highlight the words in question and click lt 5 k The deleted words can be inserted in another position by to the right window by double clicking i A reason for test is easily copied from the library placing the cursor there and clicking gp Ac Ye You can also enter a reason for test directly by moving 86 the cursor to the desired position and typing the text Editing the Library Click RA This will open the library window Figure 4 2 5 k Movethe cursor to the desired position in the list and click the mouse button k Enter a reason for test and press J on the keyboard T he cursor moves to the beginning of the next line a In this manner you may enter up to 12 standard reasons W hen the window is full it will not accept any more entries Click to clear the window CardioSys V4 1 227 498 02 A The Exercise ECG Entering the Test Information Test Information Library Reason for Test Reason for Test History of chest discomfort Evaluate effect of medication Evaluate effect of CABG Evaluate effect of PTCA Evaluate functional capacity Stress echo study Stress thallium study Rule out confirm CAD Post MI study Protocol Bruce Target HR ModBruce Naughton Ellestad ModBalke EUs USAFSAM SlowUSAFSAM e L coren 7
265. y may not be assigned to the correct patient or a record was repeatedly sent and assigned to different patients 227 498 02 A Displaying T ests Select a test and clear the window with vw The test report will be displayed For details on the individual report documents please refer to section 4 1 4 Confirming T ests A test is considered confirmed when a physician has reviewed the test evaluation and signed it electronically with his her name It is possible to confirm tests more than once i3 Select a test and clear the window with contrm The screen automatically displays the report page with the interpretation statements Please refer to section 4 1 4 for details on how to evaluate a test CardioSys V4 1 35 Selecting and Admitting a Patient Retrieving Stored Examinations im Send procedures Number of selected procedures 2 Transmission via modem Telephone Number External User Name External User Password Save procedure to storage medium Medium Directory a Modify Cancel Figure 3 6 Send procedures window gt The addressee must be registered as External user at the receiving system section 6 1 System Configuration 03 gt When sending data via the modem please verify the modem settings section 6 1 System C onfigu ration D gt If the system cannot access the selected di
266. y the computer to form a computer synthesized rhythm strip for all 12 leads The raw data of an additional rhythm lead are also printed for reference this will be the first manually selected rhythm lead item Select Arrhythmia Lead in the Setup menu If the system is not able to analyze the ST segment it will output the 12 lead report instead of the linked medians Click on FH to clear the ST screen display trends Figure 4 2 26 with the button gt Thedisplayed ST analysis results and graphic trends are updated every 30 seconds 227 498 02 A The Exercise ECG The Elements of an Exercise Test ECG Strips iil Baker Dave 41yrs Exercise Test 01 02 Pretest Phase gt gt Aia Teaami HR BPM 85 p Stage1 Hold Stage gt gt kp Start Treadmill oe er 20 80 The recordings are annotated with time and load The first Print Rhythm Event Mark st Medians Trends EcGStrips Moc recording represents the 0 W att level With mim you can display the other recordings T he Ell button allows you to ve massa access the current segment directly Click on EI to clear the v 2AE E window display segmentsof thestored 12 leads Figure4 2 27 with 8 07 i 10 0 l J Je60ms L lick on Interpretation KO si gt ai gt S Click 0 gt 10 mm mV 25 mm s to view the Statement Library page refer to Figure
267. y update with every heart beat or every 2 s 227 498 02 A CardioSys V4 1 239 Technical Specifications Signal transmission Patient signal input to recording simultaneous transmission of all electrode signals to digital signal processing system after lead derivation and digitization a muscle filter and an AC filter can be activated simultane ously for all leads pacing pulse detection automatic or manual sensitivity adjustment automatic baseline adjustment drift compensation by cubic spline lower cut off frequency 3 dB limits 0 04 H z corre sponding to a time constant of 4 s upper cut off frequency 3 dB limits reting ECG STAT ECG 150 Hz IEC AHA stress test 75 H z IEC signal sampling rate 1000 s resolution referred to the input 5 uV sensitivity simultaneously adjustable for all leads 40 20 10 5 mm mvV 3 dB drop of the amplitude frequency response with active muscle filter low pass at about 40 H z with active AC filter identification and compensation of regular 50 H z or 60 H z frequency components depend ing on frequency of power line attenuation gt 40 dB non linear distortion better than specified in IEC and AH A recommendations 240 CardioSys V4 1 identification of pacing pulses in C2 or another C electrode and marks in all channels for signals referred to patient input duration gt 0 1 ms amplitude gt 5 mV noise of signal transmission path less than spec

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