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IQstress - Midmark

1. Button Keyboard Key Description Starts the treadmill at the current speed setting if Start eae the button label indicates Start Treadmill Treadmill F1 Stops the treadmill if the button label indicates Stop Treadmill Stop Treadmill Reduces the treadmill speed by 0 1 MPH or 0 1 slower EALEN ATTON KPH if the treadmill is running Increases the treadmill speed by 0 1 MPH or 0 1 F aoe P RENEA OW KPH if the treadmill is running ae lower W dow Arrow Decreases the treadmill grade by 0 5 if the treadmill is running Increases the treadmill grade by 0 5 if the Hiene TEP Ano treadmill is running ANOTE There is an auto Stage Hold feature When one of the following treadmill commands keys is pressed the software automatically enters Stage Hold state e Slower left arrow e Faster right arrow e Lower down arrow e Higher up arrow Manual Treadmill Control during Hookup or Pre Exercise Manually control the treadmill during Hookup or Pre Exercise phases in order to restore the grade to zero or to demonstrate proper walking technique to a patient that is not familiar with walking on a treadmill among other reasons Click Start Treadmill F1 and the treadmill will start at the minimum speed setting 0 5mph Use the treadmill speed and grade controls to adjust the speed and or grade of the treadmill A NOTE Be sure to stop the treadmill before starting the Exercise test Manu
2. Preview Print Page Setup Help Exit mS ag R D kx EN V Reports A Overview The software provides the following reports e Cover Page Report Summary Table Report Average Beat Report Summary or Detailed Trend Report Resting ECG Report Rhythm Strip Report Summary or Detailed By default the software prints all reports except the Trend Report Customize report printing to include only the reports required B Cover Page Report The Cover Page Report provides a single page summary of the Stress test This report consists of patient data test related data test summary data and interpretation text 69 IQstress Operation Manual Patient Data The Patient Data area shows the patient s name ID number sex age in years calculated from the date of birth medications weight and height as drawn from the IQmanager Patient Data screen Test Related Data This data pertains to the Stress test and includes the name of the requesting physician the name of the person performing the test the name of the physician that supervised the test and the indication or reason for performing the test This area also shows the test date and time the test was completed the test type and the exercise protocol used Heart Rate Measurements Heart rate measurements include the Pre Exercise phase HR the maximum HR during the Exercise or Recovery phases the target HR the percentage of the target HR and the Recovery phase
3. Resting mm Resting mm Change mm Change mm LA A A 0 0 0 0 Current mm 0 2 Resting mm 0 2 Slower Faster Protocot Stage Hold eee ee F7 r Stop Treadmill sg t F1 Enter BP Lower Higher f F5 Filter Controls ECG Display Controls Controls Top Bar Display The upper portion of the Exercise Test Screen displays test phase information exercise level heart rate METS blood pressure and VE min 44 Stage Up F4 Test Controls Trend Displays Average Beat DIRENE IQstress Operation Manual Test Phase Information The Test Phase Information display shows the name of the phase Hookup Pre Exercise Exercise or Recovery the phase time in minutes and seconds the stage name and the stage time in minutes and seconds If the current test phase does not have any stages then the Stage Name display area will be blank and the Stage Time display will not update The phase time and stage time increment once per second Exercise Level Information The Exercise Level display area displays the current treadmill speed and grade e For pharmacological Stress tests this area displays the current dosage and dosage units The software updates the exercise level information automatically when the exercise stage changes or when the exercise level is manually changed Heart Rate Display The Heart R
4. 2 Interpretation Display List Control 3 General Measurements Static Text ECG Displays the phase name stage name and stage 4 Phase and Stage Static Text time when the resting ECG analysis was performed 5 Displ th t f the filt t the ti th 5 Muscle AC Drift Static Text le ee eee resting ECG sample was taken 6 Gain Buton Displays the gain setting for the Waveform display and allows the user to change the gain 7 Add Button Displays the Add a Statement dialog box to add a statement to the interpretation 3 Delete Butto Deletes the selected statement from the Interpretation display Displays the Modify a Stat t dialog b dit 9 Modify Button isplays the Modify a Statement dialog box edit a selected statement Clears the list of interpretative statements and 10 Clear Add Button displays the Add a Statement dialog box 65 IQstress Operation Manual Editing the Interpretation To add a statement to the list of interpretation statements click Add AIt A To clear the list of statements and add a new statement click Clear Add Alt C The following Add a Statement dialog box appears Add a Statement x BBB Ric oundle branch bloc p bundle branch block Each interpretative statement has an associated abbreviation Type the first letter of an interpretative statement s abbreviation and the full statement will appear in the drop down list C
5. A Appendix A Troubleshooting IQstress This Troubleshooting Guide provides a list of solutions or recommendations to situations that may be encountered with IQstress Before calling Midmark Technical Service please refer to the following table for help Error messages may be displayed at the center or at the bottom right corner of the screen A NOTE For errors that occur during the management of Stress report files refer to Troubleshooting Section in the Qmanager Operation Manual IQstress Troubleshooting Guide The software detects a computer performance issue that causes the SOM to stop responding Alert System Issue Stress Output Module is not r nding es ecuie ts not respaneing e Make sure all unused applications are closed e To reset the SOM disconnect and reconnect the SOM from the computer The computer does not meet the minimum requirements for display color resolution Message appears during a Stress test Change the display color resolution as follows 1 Right click on the Windows desktop 2 Select Properties 3 Click on the Settings tab of the Display Properties dialog box 4 Select a higher color resolution from the Colors list 5 Click OK 6 Run the software again Color resolution must be 16 bits pixel or greater Message appears when starting a new Stress test 102 IQstress Operation Manual IQstress Troubleshooting Guide The software could not ope
6. Preparation of the instrument prior to operation e Verify proper instrument operation e Check that all cable connections are safe and secured e When in use with additional equipment such as a computer request the assistance of personnel familiar with the additional equipment if needed Observe the patient and instrument closely during use If any abnormality is observed immediate proper action such as stopping the operation of the instrument should be taken for the safety of the patient Keep the instrument clean to ensure trouble free operation for the next use In case of a malfunction call a Midmark Technical Service at 800 624 8950 option 2 and describe the problem precisely Inspect the instrument and accessories regularly Do not make any modifications to the instrument Environmental operating limits Operation e 59 to 95 F 15 to 35 C e 30 to 75 humidity non condensing e 760mm Hg 20 Storage Shipping batteries removed e 4to120 F 15 to 50 C e 30 to 95 humidity non condensing e 760mm Hg 20 DANGER There is a possible explosion hazard if used in the presence of flammable anesthetics 4 WARNING The Trackmaster Medical Treadmill s Owner s Manual contains important safety information User must become familiar with the safety vi x CAUTION x CAUTION Z CAUTION Z CAUTION Z CAUTION IQstress Operation Manual features and operations of the stre
7. e Lower down arrow e Higher up arrow 77 IQstress Operation Manual VIII Stress Output Module SOM A Configuration The Stress Output Module SOM is an optional component of the Midmark stress test diagnostic software that provides digital and analog outputs to auxiliary equipment such as echocardiographs for stress echocardiography procedures automatic blood pressure measurement devices and other auxiliary equipment IQstress Stress Output Module Each SOM comes with two sets of connection kits consisting of a BNC male to BNC male cable a BNC female to RCA male adapter and a RCA female to Mono Plug adapter These adapters account for the most common types of connectors found on echocardiographs automatic blood pressure devices and other auxiliary equipment as me amp BNC to BNC Cable BNC to RCA Adapter RCA to 1 4 Mono Plug A NOTE Some auxiliary equipment may require an additional upgrade or proprietary connection kit from the manufacturer Please check the device manual to ensure the equipment is set up to connect to any standard exercise stress device 78 Block Diagram IQstress Operation Manual The diagram below illustrates the role of the SOM within the stress test setup 1 lead patient connection Patient Cable ol Windows PC Windows PC running Printer lQecg Digital ECG Module Echocardiograph Automatic Blood Pre
8. Operation Manual Troubleshooting Guide Error Message or Problem An error message appears ERROR THE STRESS OUTPUT MODULE IS NOT CONNECTED Solution or Recommendation Exit the software connect the SOM to a USB port of the computer and run the software again No output signals detected by the auxiliary equipment e Check the connections between the SOM and the auxiliary equipment e Verify the SOM is enabled on the Hardware Settings tab of the Stress Settings dialog box e Verify the channel settings in the SOM are correct for the auxiliary equipment The green LED on the SOM does not turn on when a Stress test is started The LED should turn on in the Hookup phase when starting a new Stress Test e Make sure that the SOM is connected to a USB port of the PC e Verify that the SOM is enabled on the Hardware Settings tab of the Stress Settings dialog box The green LED on the SOM does not turn on when the module is initially plugged into a USB port The device drivers have not been properly installed e Reinstall the device drivers as described in Section VI A The green LED on the SOM turns on but does not blink The green LED will start to blink once the software detects QRS complexes normally about ten seconds after pressing the Stage Up F4 button in the Hookup phase to start learning e If the LED does not start blinking about ten seconds after learning begins verify that vali
9. Profile Settings for User Profil Exercise Recovery HR METS R po Rhythm Strip Format Resting FCG Repos C 6x2 12 lead G 6x2 12lead C Custom leads 12 lead 3 lead rhythm Rhythm Leads V4 V5 V6 F C 12lead simultaneous 12lead 1 lead rhythm C 12lead 1 lead rhythm Rhythm Lead fil gt RhythmLead il z Real Time Rhythm Strip Save ECG Grid Color 10 seconds rhythm strip C Save 12 lead Black 30 seconds rhythm strip Print 12 lead C Red Continuous rhythm strip The Rhythm Strip Format section determines the print format for the following e Timed or pre programmed rhythm strips through User Profile Settings e Printed ECG by clicking 2 button in the Freeze ECG window 19 IQstress Operation Manual The Resting ECG Report setting determines the ECG format for Resting ECG performed during pre exercise phase The Real Time Rhythm Strip section dictates the printout when the Print Scrn button is used during live test The ECG leads used for rhythm strip printing are the same as the leads displayed on the real time screen No average beats will be printed e 10 seconds rhythm strip default e 30 seconds rhythm strip e Continuous rhythm strip The page number for the rhythm strips will be printed as Page1 Page 2 ANOTE For best performance a high speed laser printer is recommended A slow printer will take more than 10 seconds to print a 10 second rhyt
10. Select from the following choices e Print the Entire Report 5 Print Button e Print the Current Page e Print Preview the Entire Report e Print Preview the Current Page e Page Setup Displays the Qstress Settings dialog box to 3 Settings Bitton change the configuration settings create and edit exercise protocols and create and edit user profiles 4 Help Button Displays the Help screen Closes the Review Details screen and returns to 5 Exit Button the Summary Review screen 58 IQstress Operation Manual C Summary Table Screen The Summary Table screen shows the same data as the Summary Table Report See Section V Reports There is no editable data in this screen D Average Beat Screen This screen allows the user to view each average beat stored for the report edit the report by rejecting noisy average beats and automatically generate a new report 1Qstress John Smith ID 12131415 DOB 01 01 1955 Sex Male Test Date 10 16 2008 21 56 18 Phase Pre Exercise Phase Time 00 05 Stage Supine Stage Time 00 05 Speed MPH Grade METS HR 61 BPM BP 120 80 h Average Beat Controls H j i Nr im Prev Beat Next Beg Accept Reject Select ST Leads ST Level mm 0 3 0 9 0 6 04 0 1 0 0 ST Slope mv s 0 2 1 0 04 03 0 0 0 5 QRS Amp mv 1 0 16 08 1 15 15 Gain 1X Trend m 3497 LS ko S aS ED faa RE
11. connect a Windows compatible printer Refer to the printer manual for information 4 Connect the Stress Output Module SOM if included to a USB port on the computer Hardware Configuration Settings lIQmanager can be customized by using the configuration settings Access the Configuration Settings by one of the following ways IQstress Operation Manual Qmanager I Double click the shortcut installed on the desktop Cenfisuration or Click on the SETTINGS button in the upper right side of the IQmanager opening screen a This will display the Qmanager Configuration Settings dialog box 1 Click Stress Settings to display the Stress Settings dialog box P lemanager Configuration Setings a m Institution Address Serial Port Database Settings List Management ECG Settings Holter Settings Default Fax Printer el Stress Seting D Default Help Select Institution Name r Units r Date Format DD MM YY MM DD YY YY MM DD English Metric Line Frequency 60Hz C 50Hz Time Format 24 Hour Clock 12 Hour Clock Cancel 2 3 Select Trackmaster Model TMX425 from the Treadmill list ANOTE Trackmaster Model TMX425 v Serial Port Com1 ECG Module USB Version Serial Port Version Serial Port com Auto Detect Stress Output Module Enable lt None gt A Serial Port COM2 7 Automatic BP Module lt None gt
12. program shall use the following equation to estimate METS 0 1x S 1 8x Sx G 3 5 3 5 METS If the treadmill speed is greater than 3 7 mph the software shall use the following equation to estimate METS 0 2x 0 9XSxXG 3 5 3 5 METS S is speed in meters per minute G is the treadmill grade represented as a fraction for example a grade of 10 0 1 8 a ACSM s Guidelines for Exercise Testing and Prescription 6 Edition American College of Sports Medicine Lippincott Williams amp Wilkins Philadelphia 2000 110 IQstress Operation Manual D Appendix D Safety and International Symbols The following symbols are used on Midmark products These symbols appear on products when applicable Refer to this directory for details concerning the symbols used on equipment Description gt Follow instructions for use M Year of manufacture YYYY 5V 80mA DC VOLTAGE USB CONNECTION ECG DEVICES This device uses 5 Volt power and consumes 80mA when in use 3V 80mA DC VOLTAGE SERIAL CONNECTION ECG DEVICES This device uses 3 Volt power and consumes 80mA when in use i asme BATTERY ORIENTATION SERIAL CONNECTION ECG DEVICES The serial port version of the ECG module uses 2 AA alkaline batteries The 1 ros l icon indicates the orientation of batteries to be installed IEC 601 Defibrillator Proof Type CF equipment 1 I Equipment displaying this symbol contains an F type isolated floating
13. select the type of ECG module being used r IQstress Settings Treadmill Bicycle Ergometer Trackmaster Model TMX425 v lt None gt X Serial Port Com Serial Port Com 2 Automatic BP Module ECG Module USB Version lt None gt bd Serial Port Version Serial Port COM 2 Serial Port Gou 1 a Stress Output Module Enable s ANOTE The Midmark lQstress systems support Trackmaster Medical Treadmill models TMX 425 and TMX 428 The Trackmaster Model TMX425 selection supports both these models A NOTE There are no bicycle ergometer selections available because this version of the software does not support an interface to bicycle ergometers If using the USB version of the ECG module select the USB Version radio button which prevents the software from running an auto detection sequence that searches all of the serial ports if the ECG module is not yet attached to the computer A NOTE For the best system performance the USB version of the ECG module is recommended Controls Stress Output Module The Stress Output Module SOM group of controls allows the user to configure the system for operation with the SOM a separate box that interfaces to the computer running the software and provides digital and analog outputs for interfacing to auxiliary equipment such as echocardiographs for Stress echo procedures and
14. the software varies the ST measurement point relative to the J point according to the current heart rate by using the following equation t 2 4 RR e tis the interval in milliseconds between J point and the ST measurement point e RR is the average RR wave interval calculated from the average heart rate The above equation sets the ST measurement point J t at about 10 ms for a heart rate of 250 BPM and at about 63 ms for a heart rate of 60 BPM Clicking Select ST Leads displays the Select ST Leads to Exclude dialog box to select which ECG leads to ignore in the ST measurement calculations ST measurements for the selected leads will be excluded from the report vi Tr vi roi T v2 Til M v3 M aR T v4 M aL T v5 M ave T ve OK Cancel The ECG leads selected in this dialog box define the default lead selections and those that will not be included in the reported ST measurements each time a Cover Page Report or a Summary Table Report is created These settings can be overridden for an individual report in the Average Beat Review screen after the report is saved 14 IQstress Operation Manual Pre Exercise Settings Access the Pre Exercise Settings tab to add edit or delete Pre Exercise stages Profile Settings for User Profi User Prompt No Prepare the patient for the supine restin Prepare the patient or the standing stage Click Add or Edit to display the Pre Exercise Stage Setting
15. 100 indicates that the target HR is equal to the predicted maximal HR maximal Stress test A value less than 100 specifies a sub maximal Stress test For example a setting of 80 sets the target HR to 160 BPM if the predicted maximal HR is 200 BPM The Target METS setting specifies how the software calculates the target METS from the predicted maximal METS for patients 18 IQstress Operation Manual Report Printing Settings The settings on the Report Printing tab determine which Stress report pages are printed To print report pages automatically at end of test check the Auto Print At End Of Test checkbox r Profile Settings for User Profil I General ST Pre Exercise Exercise Recov Report Pages To Print Cover Page M Print I Auto Print At End Of Test Summary Table Report W Print I Auto Print At End Of Test T Auto Print At End Of Test Rhythm Strip Report sek W Print I Print IT Auto Print At End Of Test Summary C Detailed Resting ECG Report I Print T Auto Print At End Of Test IT Auto Print At End Of Test OK The Rhythm Strip Report section describes the Summary and Detailed Rhythm Strip Report formats The Average Beat Report section describes the Summary and Detailed Average Beat Report formats Report Page Settings This tab contains settings for the waveform reports which affect the Rhythm Strip Resting ECG and Average Beat Reports
16. Click on Start Treadmill F1 to start the treadmill at the minimum speed of 0 5mph 2 Step onto the slowly moving treadmill belt and demonstrate the proper walking technique 3 If needed increase the treadmill belt speed by clicking Faster right arrow 4 Stop the treadmill belt and prepare the patient for exercise 38 IQstress Operation Manual e If the treadmill speed for the first stage of exercise is too fast for the patient start the patient at a lower speed during the Pre Exercise phase using the manual treadmill controls then click Stage Up F4 to start the exercise protocol D Exercise Phase Operation During the Exercise phase the software e Analyzes the patient s ECG e Updates HR and ST measurements on the screen e Controls the treadmill according to the pre programmed exercise protocol e Calculates average beats performs ST level and slope measurements based on the calculation and saves the measurements as part of the report e Stores ECG rhythm strips at pre programmed times during each test stage The average beats ST measurements and rhythm strips will be available for review after the test is completed and the report has been stored in the database The typical activities during the Exercise phase consist of 1 Monitor the patient for changes in HR ECG ST segment and blood pressure 2 Measure and enter BP 3 Print and or save rhythm strips optional 4 Terminate exercise and enter the recovery pha
17. DTS calculations performed are intended for use by clinically competent health professionals in a clinical environment The DTS calculation results should supplement but not replace the physician s decision process These results should be used in conjunction with the results of the Stress test knowledge of the patient s history and other clinical findings The Duke Treadmill Score is a point score that can be used to classify patients into low moderate or high risk categories of coronary artery disease DTS Exercisetime 5xS T deviation 4xTAI e Exercise time is in minutes using the Bruce protocol If the Bruce protocol was not used then the software calculates the exercise time relative to the Bruce protocol from the work level achieved e ST deviation is in millimeters and is calculated as the difference between the resting ST level and the minimum ST depression or maximum elevation If the ST deviation is less than 1 0 mm then a value of 0 is used If the ST slope is positive the software sets the ST deviation to 0 If the ST deviation is less than 1 5 mm i e greater than 1 5 mm of depression then the software uses the ST deviation even if the ST slope is positive e The Treadmill Angina Index TAI is calculated as follows Level Of Chest Pain Entered as Reason For Termination 0 No Angina 1 Angina Occurred During Test 2 Test Limited By Angina The DTS point score is then used to classify the risk
18. F5 is red click on it to display the Enter BP dialog box for more details about the error Enter BP F5 is color coded as follows Enter BP Button Color Green The Tango BP device is idle Yellow The Tango BP device is performing a measurement Red The BP measurement timed out because a measurement took longer than 90 seconds or some other error occurred Manually Starting a BP Measurement from IQstress Whenever the Tango device is idle manually start a BP sample by pressing Enter BP F5 The software will immediately start a BP sample and display the following dialog box Systolic jo Diastolic lo Automatic BP Start Stop F Correct Last Measurement Cancel The Status display area will indicate Busy and turn yellow When the Tango device completes the measurement the software automatically closes the dialog and displays the new BP reading at the top of the display When the Tango device is busy stop the reading by clicking Stop When the Tango device stops start a reading by clicking Start Status Conditions of the Enter BP Dialog Box Status Text Background Foreground Description Automatic BP module is connected and Ready Green White ready Busy ellow Black Automatic BP module is measuring BP COM Error Red White Software could not open the serial port specified in the Hardware Settings The automatic BP module is not connected or turned off
19. HR The percentage target HR is the ratio of the maximum HR to the target HR for the patient The report shows the Recovery phase heart rate in the following format Recovery 2 02 185 BPM 71 BPM Minutes seconds into the Recovery phase the heart Difference between the maximum rate was measured usually around 2 minutes HR and the Recovery phase HR The software displays the HR at two minutes into the Recovery phase even if it s longer than two minutes If the Recovery phase is less than two minutes the software shows the heart rate at the end of the Recovery phase If there is no Recovery phase for the test this display will indicate Not Available METS Measurements The METS measurements area shows the maximum number of METS achieved based upon the exercise level the target METS for the patient and the percent target METS The percent target METS is the ratio of the maximum METS achieved to the target METS 70 IQstress Operation Manual ST Level and Slope Measurements These display areas show the following information e ECG lead on which the worst ST depression occurred e Pre Exercise phase ST level and slope for this lead e Maximum ST level depression and slope e Phase name and phase time minutes seconds at which the maximum ST depression occurred e Change in ST level and slope between the Pre Exercise phase value and the maximum ST depression Blood Pressure and Double Product The measurements displa
20. Physician List test from the drop down list or type in a name 9 Review Details Button Displays the Review Details screen Displays the Test Data dialog box to enter the reason 10 Test Data Button for terminating the test the Borg scale and the level of chest pain 56 IQstress Operation Manual Summary Review Screen Controls 11 Control Display Re analyze Button Description Re analyzes the test results based on changes to the patient data and or to the report data amp NOTE If a report is re analyzed the software will overwrite any changes that were made to the interpretation text 12 Settings Button Displays the Qstress Settings dialog box to change the configuration settings create and edit exercise protocols and create and edit user profiles 13 Summary Display Static Text Displays a summary of test results which appears on the Cover Page Report 14 Summary Edit Box Enter a conclusion or interpretation of the test results 15 IQmanager Controls Buttons Perform various file print and save operations Refer to the Qmanager Operation Manual for a description of these controls 16 Test Type Static Text Displays the type of exercise used for the test Treadmill or Pharmacological 17 Sign Check Box The Sign checkbox is used for signing off the report If the Sign checkbox is unchecked it indicates the rep
21. SELECT button Use the UP or DOWN buttons to select Utilities and click the menu button 3 Use the arrow buttons to select Device and click the MENU SELECT button to edit 4 Choose SUNTECH using the arrow buttons and click the select button to confirm the choice 5 Select ECG trigger and click the select button to edit Choose DIGITALT and click the select button to confirm the choice 6 Select Exit twice to return to the operating screen Configuring the IQstress Software To configure the software to communicate with the Tango device 1 Display the Qstress Settings dialog box and click on the Hardware tab 2 Select SunTech Tango from the drop down list in the Automatic BP Module control group 3 Select the COM port that the Tango device is connected to from the Serial Port drop down list The software may be configured to control the Tango device in the following ways e Automatic measurements initiated by the software at each stage of the Pre Exercise phase e Automatic measurements at timed intervals of the Exercise phase 87 IQstress Operation Manual e Automatic measurements at timed intervals of the Recovery phase Each user profile may be programmed for different Tango configurations Select the Profiles tab of the Qstress Settings and double click on the profile in the list to configure each phase of the exercise test Automatic BP during the Pre Exercise Phase 1 Click on the Pre Exercise tab of t
22. ST Siope i Pre Exgre ge 7 41 Ci vere e Change pat Double Product 100 Pr ercise Reason For Termination iummary The Duke Treadmill Score DTS of 2 4 indicates moderate risk a This screen shows summary test results that appear on the printed Cover Page of the report Edit the interpretation or test data reanalyze or print the report or display the Review Details screen to view more detailed data from this screen Summary Review Screen Controls Control Display Type Description 1 Report Selector Drop Down Displays the date and time of report and allows the List user to select another report from a drop down list 5 Serial Button Opens a dialog box to select Stress reports for viewing Comparison or printing the Serial Comparison Report Drop D lect th f the physici 3 Requested By rop own Select the name of the p ysician that requested the List test from the drop down list or type in a name 4 Reviewed By Drop Down Select the name of the reviewing physician from the List drop down list or type in a name 5 Review Date Static Text Displays the date on which the report was reviewed ies Drop Down Select the name of the technician that conducted the 6 Technician List test from the drop down list or type in a name 7 Protocol Static Text Displays the exercise protocol used 3 Supervising Drop Down Select the name of the physician that supervised the
23. The software provides a set of standard protocols and provides tools to create customized protocols o Exercise protocols are managed independently of user profiles To use a new exercise protocol first create the new protocol then select that protocol for use in the Exercise phase of the user profile When running Stress tests connect the ECG module and exercise device i e treadmill to the computer running the test The Hardware Settings allow the user to configure the computer to communicate with these components The Hardware Settings are not required for computers to be used only for review and edit functions To configure the software display the Qmanager Settings dialog box e From the Qmanager Configuration utility click Stress Settings e From Summary Review screen of a Stress report click Settings e From the Pre Test Settings dialog box click Settings The Settings dialog box contains four tabs e Profiles Manage user profiles e Protocols Manage exercise protocols e Hardware Manage devices and computer configuration e Reasons Manage the Reasons for Termination list A NOTE Selection for a bicycle ergometer is provided however this version of the software does not support an interface to bicycle ergometers 11 IQstress Operation Manual F Managing User Profiles Settings Manage user profiles through the Profiles tab of the Settings dialog box Available Profiles Default Dobutamine Current Profile Defau
24. Time m 00 mm ss OK Cancel Help 2 Check the Enable box in the BP Entry control group if timed BP measurements are wanted during the Recovery phase 3 Enter the start time of the first measurement in the First Prompt edit box 4 If more than one timed BP measurement is wanted during the Recovery phase then enter the measurement interval in the Repeat Interval edit box If only one BP measurement is wanted during the Recovery phase then enter 00 00 in the Repeat Interval edit box B Using the SunTech Tango Device with IQstress The software will automatically display BP readings acquired from the SunTech Tango device on the screen and include these readings in the test report There is no need to manually enter BP readings into the software In the Pre Exercise phase the software will initiate an automatic BP reading by clicking on Stage Up F4 the acquired BP measurement will be stored for the Pre Exercise stage that has just started During the Exercise and Recovery phases the software will initiate automatic BP measurements at the times that are programmed for the current phase and stage 90 IQstress Operation Manual During the pre programmed automatic measurement Enter BP on the Exercise Test screen turns yellow then returns to green upon completion of the measurement the software displays the new BP reading in the blood pressure display area at the top of the screen If Enter BP
25. at 1 800 624 8950 option 2 Z Precautions Read the following precautions to ensure proper operation of this instrument 1 Exercise Stress testing should be performed by properly trained and qualified personnel under the supervision of a physician If the user is new to exercise Stress testing see Section XV References for links to the following guidelines concerning best practices contraindications and additional resuscitation equipment defibrillator medications etc that the facility may require e ACC AHA 2002 Guideline Update for Exercise Testing e AHA Exercise Standards For Testing And Training e Guidelines for Clinical Exercise Testing Laboratories 2 The following contraindications are known to exist for exercise Stress testing e Acute myocardial infarction e High risk unstable angina e Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise 1 Gibbons R J Balady G J Bricker J T Chaitman B R Fletcher G F Froelicher V F et al 2000 ACC AHA 2002 Guideline Update For Exercise Testing A Report of the American College Of Cardiology American Heart Association Task Force On Practice Guidelines Committee on Exercise Testing Retrieved from American College of Cardiology www acc org clinical guidelines exercise dirlndex htm Fletcher G F Balady G J Amsterdam E A Chaitman B R Eckel R Fleg J et al 2001 Exercise Standards for Testing and Training A Sta
26. automatic blood pressure measurement systems e ifa SOM is connected to the computer on which Stress tests will be performed then the Enable box should be checked otherwise this box should be cleared 27 IQstress Operation Manual e Click Setup to configure the SOM See Section VIII A Stress Output Module Configuration for instructions A NOTE To maintain best system performance the SOM only works with the USB version of the ECG module Controls Automatic BP Module The Automatic BP Module group of controls configures the software for use with an automatic BP measurement device such as the SunTech Tango or Tango device e Select the device type from the drop down list currently the selections are None default and SunTech Tango If using a SunTech Tango or Tango device select SunTech Tango and select the serial port in the drop down list otherwise select None See Section IX B Using the SunTech Tango Automatic BP Unit with IQstress for instructions on how to configure and use the software with the SunTech Tango device Reasons for Termination List Customization At the end of a Stress test select the reason for terminating the test from a list of statements The Reasons tab of the Qstress Settings dialog box allows the user to customize this list IQstress Settings Proigcols Hardware F Customize the on ating esTby adding editing or deleting items in the list Hypotensi
27. contains the following selections e Treadmill e Ramp Treadmill e Pharmacological When the Protocol Type changes the list changes to show all stored protocols for that test type The Protocol Settings group controls apply to the selected protocol The Type Display indicates the type of the protocol Default protocols may not be edited or deleted user defined protocols may be edited or deleted To add a new protocol select a protocol from the list to use as a template and click Add The Add a Protocol dialog box appears fa Add A Protocol E Protocol Type Treadmill New Protocol Name o Cmo _ Hoe A NOTE Adding a new protocol or selecting a protocol from the list does not mean that the new protocol will be used when performing a Stress test To select a protocol that has been created specify that protocol in the Exercise Phase Settings tab of the selected user profile 23 IQstress Operation Manual To edit a protocol select it from the list then use the controls in the Protocol Settings group to change the stages of the selected protocol e For treadmill and pharmacological protocols clicking Insert Above Insert Below Edit or Delete allows the user to edit the stages of the selected protocol e Ramp This Protocol applies only to treadmill protocols and causes the software to gradually increase the workload from one stage to the next instead of stepping the workload Programming Trea
28. digital outputs become active approximately ten seconds after pressing the Stage Up F4 button in the Hookup phase of the test All outputs will remain active until the stress test is terminated and the Midmark stress test diagnostic software is exited If the computer performance is slow and causes the SOM to be out of synchronization the following alert message will be displayed Stress Output Module SOM is not responding Disconnect and reconnect the module to reset Close all unused applications before continue IQstress Operation Manual To re synchronize the computer and the SOM take one of two actions A Use the Reset Button on the SOM 1 Click OK in the alert message box 2 Push the red Reset button firmly once 3 The SOM will be activated within seconds Reset Button SOM with Reset button B If the SOM does not have a reset button 1 Click OK in the alert message box 2 Disconnect the SOM s USB cable from the computer 3 Wait for a couple of seconds then reconnect the USB cable to the computer 4 The SOM will be activated within seconds amp NOTE Midmark software will continue to perform e g displaying live ECG and vitals saving and printing rhythm strips controlling the treadmill even when the SOM appears not to be responding However to prevent this please call Technical Service and we can help improve the performance of your computer 84 E Troubleshooting the SOM IQstress
29. greater Memory Minimum 2GB of system memory Input Output Two 2 USB ports and one 1 serial port or one 1 USB port and Ports two 2 serial ports e One RS 232 COM Serial Port for the treadmill e One Universal Serial Bus USB port for the software security key e One USB or serial port for the IQecg module IQstress Operation Manual An additional USB port is required if a Stress Output Module is used USB to Serial port adapters are not recommended as a replacement for any of the components listed above The above computer interfaces are required for new stress test acquisition They are not required to review and or edit a test Additional USB ports as needed for keyboard mouse printer etc Pointing Device Windows compatible mouse Keyboard Windows compatible keyboard 1024x768 or higher resolutions for the real time acquisition screen Display 16 bit color Wide screen 1680x1050 is highly recommended Printer Microsoft Windows compatible inkjet or laser printer Note A high speed laser printer is highly recommended for continuous rhythm strip printing Surge Protector One 1 hospital grade power surge protector for the computer system Stress Output f Module SOM IQstress controls version 8 6 1 ANOTE DO NOT USE in a thin client environment The above is the minimum computer requirement specification for operating the IQstress through IQ
30. include ECG models Midmark IQecg or IQmark Digital ECG Future references of IQstress in this document may include the following components Kit P Model ECG i Device Part Number ook Connection Number 4 000 0332 B 1 100 1325 4 000 0334 Midmark lQstress i A 4 000 0336 with Midmark IQecg Serial 1 100 1305 ee 4 000 0334 IQmark EZ Stress with USB 1 100 1320 a lQmark ECG Serial 1 100 1300 T000 01a No longer in production A NOTE This manual is intended for IQmanager Diagnostic Workstation Software Version 8 6 1 users If using the IQstress through an EMR please contact Midmark Technical Service for assistance with installation setup and operation lQstress is a software component of Qmanager IQstress acquires twelve leads of ECG from the IQecg module via a Universal Serial Bus USB or a Serial Port COM 1 IQstress Operation Manual analyzes the data displays real time ECG and ST measurements on the computer display and controls the treadmill during a Stress test Qstress uses a Windows compatible laser or ink jet printer for printing ECG rhythm strips during the Stress test and for printing final Stress test reports Upon completion of the Stress test Qmanager stores the Stress test report in the patient database Users may then review edit and print the report Other Midmark products can also be accessed from IQmanager such as IQecg IQho
31. remove rhythm strips that contain excessive amounts of noise it does not affect the ST measurements or the report interpretation F Resting ECG Screen The Resting ECG screen displays the results of the interpretations of the resting ECG that was stored during the Pre Exercise phase of the Stress test This screen allows the user to zoom in on selected parts of stored ECG waveforms and to edit the interpretation A NOTE The Resting ECG Screen will be visible only if the resting ECG report was stored during the Stress test 64 IQstress Operation Manual 1Qstress Tom Stevens Summary Table Average Beats Trends Resting ECG ythm Strips ID 08072011 DOB 02 08 1966 Sex Male TestDa 5 Sinus Rhythm Rate 81 BPM Phase Pre Exercise WITHIN NORMAL LIMITS PR 156 msec Sage Sue ar 368 msec Stage Time 00 32 QTc 404 msec QRSD 86 msec P Axis 39 QRS Axis 51 Muscle 20Hz AC Off Drift On Gain 1X Add Delete Modify Clear Add T Axis 41 E 1 avi v4 ALA LMA L Description Displays all twelve leads of the ECG stored for the Waveform resting ECG report each lead group displays a display different two second portion of the 10 second sample Displays the interpretation of the resting ECG Edit by using Add Delete Modify and Clear Add Displays general measurements for the resting 1 Waveform Display
32. the patient to continue exercising manually set the treadmill speed and grade during the Recovery phase Click Start Treadmill F1 and adjust the speed and grade as described above E Recovery Phase Operation During the Recovery phase the software continues to perform average beat calculations and stores average beats and timed rhythm strips Operations during the Recovery phase are similar to the Exercise phase except that the patient is in a supine position The typical activities during the Recovery phase are 1 Monitor the patient for changes in HR ECG ST segment and blood pressure 2 Measure and enter BP 3 Print rhythm strips option 4 Terminate the Stress test and save the report 42 IQstress Operation Manual To end the Stress test click Exit F12 The Reasons for Termination dialog box appears Reasons For Termination Reasons For Test Termination Level Of Effort Borg Scale L Arrhythmias 4 C 0 Nothing at all C Chest pain C 0 5 Extremely light just noticeable C Dyspnea O 1 Very light O Fatigue O 2 Light C Frequent VE beats C 3 Moderate C Hypertensive BP response O 4 Somewhat heavy C Hypotensive BP response O 5 Heavy strong O Leg pain os E Protocol completed C 7 Very heavy C Signs of poor perfusion Cyanosis o8 C ST segment depression og C ST segment elevation C 10 Extremely heavy almost maximal C Syncope Maximal C Target HR attained C Target METs attained C Unabl
33. then click OK 46 IQstress Operation Manual The new lead selection will remain in effect until lead groups are changed or the exercise test is terminated Lead Selection p Select a Lead cy OV Cl C v2 Cm C v3 C avR C v4 Cal CVS C MF CVE Cae Sweep Speed Next to the Lead Selection drop down list the Sweep Speed Selector rotates the sweep speed of the ECG tracing area to one of the following sweep speeds e 12 5 mm sec e 25 mm sec default e 50mm sec Clicking on the button or pressing Alt S rotates through the available sweep speeds Changing the sweep speed of the ECG tracing area does not affect the display characteristics of the average beats Gain Setting The Gain setting rotates the display gain for both the ECG tracing area and the average beats The gain settings are e Gain 1 2X 5 mm mv e Gain 1X 10 mm mv e Gain 2X 20 mm mv Clicking on the button or pressing Alt G rotates through the available gain settings Filter Controls The Filter option controls the Muscle AC and Drift filters There are three options for the Muscle filter Off 20Hz and 40Hz The AC and Drift filters have the option of being On or Off A NOTE The AC filter setting is inactive until the software has calculated the average beats A NOTE When using the Muscle filter the AC filter is not required and should be turned off 47 IQstress Operation Manual Exercise Device Controls Device Controls
34. three average beats There are two formats of the Average Beat Report The Summary Average Beat Report is a one page report that shows the average beats for Pre Exercise phase peak Exercise phase and Recovery phase This is the default report format The Detailed Average Beat Report is a multi page report showing all average beats stored for the Stress test report Select which type of report to print in the configuration settings described in Section Il E Configuration Settings E Trend Report The Trend Report is a single page printed version of the Trend screen See Section IV G Trends Screen for a description of the trended data 72 IQstress Operation Manual F Resting ECG Report The Resting ECG Report shows the interpretation general measurements and twelve leads of ECG data The software provides the following printing formats for the Resting ECG Report e 6x2 12 lead format default e 12 lead plus 3 lead rhythm e 12 lead simultaneous 12 lead plus 1 lead rhythm G Rhythm Strip Report Each stored rhythm strip in the Stress report contains ten seconds of ECG and ST level and slope measurements for all leads The format and amount of ECG shown on each page of the Rhythm Strip Report depends on the report page format that is selected The report page formats are three lead six lead twelve lead 6x2 twelve lead plus average beats and twelve lead plus one rhythm lead default Except for the twelve lead plus o
35. treadmill is by using Stop Treadmill F1 40 IQstress Operation Manual A NOTE The Trackmaster TMX428 treadmill is equipped with an emergency stop button ESB To stop the treadmill during an emergency press the big red button The treadmill belt will stop but the incline grade position will remain the same The treadmill is not operational while the ESB is in the down position To release the ESB from the stop position turn the red knob clockwise until it pops up The treadmill will automatically reset itself to 0 grade once the ESB is released A NOTE The Trackmaster TMX428 is equipped with an ESB as well as a Stop Tether lanyard see image below that the patient wears on the wrist during testing If the Stop Tether lanyard is pulled the treadmill belt will stop and lock to prevent slipping for approximately 3 minutes The treadmill belt will stop but the incline grade position will remain the same The treadmill will not be operational until the C shaped clip of the Stop Tether is restored to the small red stop button The treadmill will automatically reset itself to 0 grade once the Stop Tether lanyard is replaced Stop Tether lanyard attached to patient A NOTE The IQstress software will continue to display the patient s ECG as long as the patient is still hooked up to the ECG The user may continue to monitor save print the ECG proceed to the Recovery phase or exit the test Printing and Saving Rhythm
36. without changing its grade Gradual Stop provides a user defined gradual decrease in treadmill speed and grade Regular Stop stops the belt at a preset rate while the treadmill declines to 0 grade 17 IQstress Operation Manual o Stop Belt option is useful for stress echo procedure which the patient needs to move quickly to an exam table as soon as the exercise phase is completed e Check the Enable check box in the Cool Down control group to add a cool down stage to the Recovery phase Cool Down option is available only when Regular Stop is selected o Enter the duration of the cool down stage in the Time edit box and the desired treadmill speed and grade e Check the Print End of Recovery Strip box to automatically print the last ECG strip of the Recovery phase HR METS Settings The HR METS tab allows the user to specify the equations to use for the predicted maximal HR the target HR and the target METS r Profile Settings for User Profile General ST Pre Exercise Exerce Recovery HR METS Report Printing Jepo Maximal Predicted HR MPHR Target M 220 i 100 of Predicted Maximal METS C X age X fi 100 300 Y 09 0 1 2 0 The Predicted Maximal HR group of controls determines how the software calculates the predicted maximal HR for patients The Target HR setting determines how the software calculates target HR from the predicted maximal HR for patients A value of
37. 6 Purple Brown At the horizontal level of V4 at the midaxillary line Connecting Electrodes ACAUTION Use only Ag AgCl silver silver chloride snap type electrodes designed for Stress monitoring Electrodes must comply with the AAMI ANSI EC 12 Disposable ECG Electrode standard WACAUTION Do not mix electrode types Use only electrodes of similar type Electrodes of dissimilar metals can cause excessive offsets and may interfere with correct operation of the ECG module e Connect the lead wire of the ECG module to the appropriate electrode site with the snap on lead wires Ensure that each connection is secure e Loop the lead wire once to create a stress loop Tape the loop to the patient s skin and ensure that there is no tension between the lead wire and the electrode connection e If the lead wires are too long tape them down so that they do not move around during exercise Lead wire movement can potentially degrade the quality of the ECG tracing during exercise e Using the ECG module pouch attach the ECG module to the handrail of the treadmill or around the patient s waist with the belt provided e Verify the quality of the ECG tracings on the Hookup screen When satisfied with the quality of the ECG tracings click Stage Up F4 to start the Pre Exercise phase e The phase status indicator in the Hookup screen will indicate Learning and the message prompt will read Learning ECG please wait The software requires appr
38. Disconnected Red White 91 IQstress Operation Manual C Troubleshooting the Tango BP Device The following table lists recommended solutions to some problems may be encountered The SunTech Tango Operator s Manual provides additional troubleshooting tips Error Message or Problem Check ECG Message appears on the Tango display screen SunTech Tango BP Troubleshooting Guide Possible Solution or Recommendation The Tango device is not receiving any QRS trigger pulses from the software via the SOM Verify that the coaxial cable between the SOM and the device is connected at both ends Verify that the green LED on the SOM is blinking If the ECG signal quality is good and the software is displaying a valid heart rate value and if the green LED on the SOM is not blinking see Section VIII E Troubleshooting the SOM ANOTE If the initiated a BP reading from the device s front panel controls while the software is in the Hookup phase or is still in the process of learning the ECG signal then the software has not started to send QRS pulses to the device yet Make sure that the software has completed the learning process before attempting to start a BP reading COM Error Message appears in the Enter BP dialog The COM port for the Tango device is not configured correctly Terminate the test exit the Exercise Test screen display the IQstress Settings dialog box and open
39. IQstress OPERATION MANUAL Version 8 6 1 MIDMARI NOTICE The information in this manual is subject to change without notice Midmark Corporation shall not be liable for technical or editorial omissions made herein nor for incidental or consequential damages resulting from the furnishing performance or use of this operation manual This document contains proprietary information protected by copyright No part of this document may be photocopied or reproduced in any form without prior written consent from Midmark Corporation Qmark IQecg IQholter IQvitals Qstress Qnanager and IQspiro are registered trademarks of Midmark Corporation Windows and Microsoft are registered trademarks of Microsoft Corporation in the United States and other countries Intel and Intel Core are trademarks of Intel Corporation in the United States and other countries Trackmaster is a registered trademark of Full Vision Inc SunTech and Tango are registered trademarks of SunTech Medical Inc Part Number 3 100 1110 Rev C IQstress Operation Manual Table of Contents RELATED DOCUMENTS e secede ccsciaiecdacecdodeeavgcdeweecan das iectaceesesast coach aeaa ss ccceacSoussseddeniceadbaesdeadeceeesdasvisece Vv PRECAUTIONS 50 ccs scovefcns50 sscesticccssacevssceaccesnseddeyacecdsovisedicasectaveed sseinceacceiverisceticcentuacesiscedcenssecivesseseseeasectiew V l GENERAL INFORMATION ee e eare a anes eese arae n eaaeo ea Tare aE aaa ao
40. Leads tab just above the average beat waveform display area To zoom in on an individual lead click the waveform of an average beat The expanded average beat display will appear When selecting a lead for the expanded average beat the software also changes the trend display to show the ST level and slope trends for the selected lead 52 IQstress Operation Manual Single Average Beat Display Current mm 1 5 Resting mm 0 2 Change mm Isoelectric Point Current ST Level Resting ST Level Change Current Resting Each Average Beat window shows the current average beat in blue superimposed on the resting average beat in gray The display also indicates the isoelectric point J point and ST measurement point for the current average beat If the ST segment slope is horizontal or down sloping the Current ST Level display is color coded e If the change in ST depression is less than 1 0 mm the display characters are black e If the change in ST depression is between 1 0 mm and 2 0 mm the display characters are orange e If the change in ST depression is greater than or equal to 2 0 mm then the display characters are red Expanded Average Beat Display The Expanded Average Beat Display shows the same information as the Average Beat Display for a single lead as well as the current resting and change in ST slope The current ST level display is color coded similarly to Single Ave
41. Qstress Operation Manual XV APPENDICES 7 REFERENCES isc ssecssciecsisessecestcaissdasvesacesvanssvissaedeccsccsdeasevaase ctavessacdesacsecdascadssdedestacs 102 A APPENDIX A TROUBLESHOOTING IQSTRESS ssscccsssseceessscecessececesssececssssecceesaseeceesaececssseceesaeeceeaaes 102 B APPENDIX B PHYSICIAN S GUIDE TO THE DUKE TREADMILL SCORE 108 G APPENDIX C METS CALCULATIONS 2 svecictsccenceacavsedacsesens sass inasedendedsaaavendaveedendcadexedaaaecdenssasbdanssdenienss 110 D APPENDIX D SAFETY AND INTERNATIONAL SYMBOLS 0ssccccccecessesececeeceeseeaeseccescseeeasaeseeseeesesaaeseeees 111 REEERENGES sires Sis eveseteret O A Cond udoutetecs shed cadet AA bee E N A TEA 112 IQstress Operation Manual Physician s Responsibility The measurements and test data provided by the Midmark IQstress are for the exclusive use of licensed physicians or personnel under their direct supervision The numerical and graphical results should be examined with respect to the patient s overall clinical condition recording preparation quality and general recorded data quality which can affect the accuracy of reported data In addition the interpretations provided by the Midmark IQecg are for the exclusive use of licensed physicians or personnel under their direct supervision Not all ECG abnormalities can be detected by a computerized or automated ECG analysis algorithm The suggested interpretation including numerical
42. Strip screen allows the user to view all of the rhythm strips stored in the report Rhythm Strip Screen Controls Control Display Type Description Displays the ECG for the selected rhythm strip 1 Waveform Display Me zoom in and expand selected portions of the ECG Shows the average beat at the time that the 2 Average Beat Display Waveform rhythm strip was stored Also shows the ST display level STL and ST slope STS measurement for the average beat Splitter Window Control Splitter control Resizes the Average Beat display 4 Measurement Display Static text Shows the ST level and ST slope for each lead 5 Exercise Status Display Static text Displays the phase and time and stage number and times as well as the treadmill speed and grade at the time that the displayed rhythm strip was stored 6 HR BP Display Static text Shows the heart rate and blood pressure measurements at the time that the rhythm strip was stored 7 Prev Strip Next Strip Button Displays the previous next rhythm strip 8 Accept Reject Radio button Saves or deletes the displayed rhythm strip 63 IQstress Operation Manual Displays the current gain setting for waveform display and allows the user to change the gain Shows the displayed lead group and allows the user to select the lead group to display The 10 Leads Drop down list defa
43. Strips Click Print Scrn F7 to print a 10 second 30 second or continuous rhythm strip The format of the printout is determined by the Report Settings in the User Profile Settings All rhythm strip printouts will include the last ten seconds of ECG and will be saved as part of the final report 41 IQstress Operation Manual Save 12 Ld Print 12 Ld F6 saves or prints and saves depending on the Report Settings in the User Profile Settings the last ten seconds of ECG as part of the report The 12Ld ECG is printed in 12 lead 1 rhythm lead format and can be printed during and after the test Ending Exercise Click Recovery F9 when it is time to end the Exercise phase of the test The treadmill belt will come to a gradual stop and the treadmill will return to 0 elevation if the Regular Stop in the Recovery phase was selected in Profile Settings If there is a cool down stage or gradual stop programmed for the Recovery phase the treadmill speed and grade will automatically change to the preprogrammed settings A NOTE If the Stop Belt option was selected in the Recovery phase setting the treadmill belt will stop quickly without changing its elevation Use this setting only for stress echo procedure The phase display will indicate Recovery A NOTE Once in the Recovery phase it is not possible to return to the Exercise phase Be careful not to click Recovery F9 inadvertently If Recovery F9 is clicked on by accident but want
44. The software adjusts the treadmill speed and grade automatically Places and releases a stage hold mode on the treadmill control F3 Stage Hold logic The button label alternates on each click The treadmill Stage Release remains at the current stage until one of the following buttons are clicked on Stage Release Stage Down or Stage Up Advances the protocol to the next stage The software F4 Stage Up gt automatically changes the treadmill speed and grade F5 Enter BP Displays the Enter BP dialog box to enter a new BP reading Saves or prints and saves as determined by the Report Settings Save 12 Ld f f F6 in the User Profile Settings the last ten seconds of the ECG in Print 12 Ld 5 twelve lead plus one rhythm strip lead format with the report Prints and saves a 10 second 30 second or continuous rhythm F strip Printout format is determined by the Report Settings in the F7 Print Scrn i f mae User Profile Settings All printouts will include the last ten seconds of ECG and will be saved as part of the final report F8 Freeze Unireeze Displays and closes the Freeze Display The button label alternates on each click Stops the treadmill and starts the Recovery phase If there is a Resting ECG F9 cool down stage programmed for the Recovery phase the speed or Recovery i and grade will change to the pre programmed settings F10 Adjust ST Displays the Adjust ST dialog that allows the user to adjust the isoelectric and J points fo
45. V System Maintenance and Obtaining Service The IQecg module is a portable device and requires little maintenance To ensure the best performance of the device the following procedures are recommended e Keep the patient cable clean e Do not unplug the patient cable from the ECG hardware e When the device LED turns red or the computer screen displays low battery 45 Series RS232 version only replace the batteries inside the device before continuing The IQmark and IQecg Digital ECG acquisition modules contain no user adjustable or serviceable parts and are designed to operate without adjustment for the lifetime of the product However electronic equipment can be subject to wear and damage that can cause malfunctions A certification policy is the responsibility of the end user and is subject to the end users business practices which may require it Certification provides peace of mind that the device continues to work within factory specifications Certifications can be purchased directly from Midmark Please contact Technical Service at 800 624 8950 option 2 with questions or to make arrangements for the certification of an Qmark Digital ECG or IQecg Digital ECG device A NOTE Return authorization is required prior to the return of the device Midmark Technical Service will issue a Return Materials Authorization RMA number prior to shipment 101 IQstress Operation Manual XV Appendices References
46. a Zoom on a selected graph by clicking on the desired parameter s window an expanded view of the trend graph appears To return to the normal view click on the expanded trend view 1Qstress John Sm 1 56 18 Ws 1 B 01 01 1955 10 16 2008 ummary Table Average Beats Trends Rhythm Strips Lead Il 20 15 10 4 2 0 44 5 o 34 8 0 n 14 16 BI Lead aVR 4 N g 10 i Fe x A ei A a as 3 e a a g Es og o4 a o E ib Ed p 8 2 y S 4 14 2 10 J 10 15 4 Lead v2 34 wo 10 5 a 4 i o og ba iS 5 SS 10 H 5 8 3 10 12 13 14 15 16 10 Stage Stage 2 10 54 13 54 10 15 Lead V5 Demo Simulated Data 67 IQstress Operation Manual The trends do not show the data from the Pre Exercise phase due to the limited display area for each trend Each phase is color coded with vertical boundary lines marking each stage Move the mouse cursor over an area of interest to view its phase and stage time The stage and or phase time will appear in the lower right corner of the trend s window H Serial Comparison The software provides a serial comparison feature for side by side comparison of two three or four Stress test reports Click Serial Comparison on the Summary Report screen and the Select Stress Reports dialog box appears The Stress Reports list shows all of the Stress reports stored in the database The most
47. acing lQstress Operation Manual METS Target 14 Blood Pressure phe ala eC als nes Pe ne Eare ERR SERRE HAJ Chest Leads Limb Leads Expanded Beat Speed mph Grade VE Min 00 28 HOoKap Heart Rate JJ MPHR 192 85 MPHR 163 MPHR Heart Rate BPM Blood Pressure 300 aay Current mm Current mm Current mm Resting mm Resting mm Resting mm Change mm Change mm Change mm EW aVL EM Current mm f Current mm Current mm H FE Resting mm f aun aus MENA AnA ARNI J i f _Change nm _ _Change mm pcos ONC h Resting mm Resting mm LENEN ee Protocol Im ter N j i 4 Lower Higher f I Leads _25mmisec Gain 1X__ muscie 40Hz MAC m Dritt gt gt inst _Status F When satisfied with the ECG tracing quality click Stage Up F4 to allow the software to learn the ECG which requires approximately 30 seconds The phase indication will show Learning 32 Average Beat Displays Prompt Status Message Display Stage Up Button IQstress Operation Manual B Patient Preparation Skin Preparation Careful preparation of the patient s electrode sites is essential for obtaining an interference free ECG and accurate result especially in exercise stress testing The skin is naturally a poor conductor of electricity and
48. admill speed and grade automatically Places and releases a stage hold mode on the treadmill control logic The button label rotates with each click The Stage Down F2 Pi is F3 treadmill remains at the current stage until onf of the 8 following buttons are clicked Stage Release Stage Down or Stage Up Advances the protocol to the next stage The software stage Up m automatically changes the treadmill speed and grade Enter BP F5 Displays the Enter BP dialog box so the user can enter a new blood pressure reading Saves or prints the last ten seconds of ECG as a rhythm Save 12Ld F6 strip in the report using 12 lead plus 1 rhythm lead Print 12Ld format as defined in the Report Settings in the User Profile Settings 49 Button Print Scrn Keyboard Key F7 IQstress Operation Manual Test Controls Description Prints and saves a 10 second 30 second or continuous rhythm strip Printout format is determined by the Report Settings in the User Profile Settings All rhythm strip printouts will include the last ten seconds of ECG and will be saved as part of the final report Freeze Unfreeze F8 Displays and closes the Freeze Display The button label rotates with each click Recovery F9 Stops the treadmill and starts the Recovery phase If there is a cool down stage programmed for the Recovery phase the treadmill speed and grade will automatically change to the preprogrammed se
49. aeaaiaee 1 A INTRODUCTION sscc3ccccdeccunswecee easz eel ch tcc A A E E A Su tadseedetate 1 B NECESSARY COMPUTER SKILLS viia ais Eea ienne edeccecees secacd eabiadedecewnnescbesbbuad lowe raa i aiaa S EE ia seenenauee 2 C SYSTEM CONFIGURATION svevsctaccesiccsceenssdechesechensecolhabbedecbesbeasacechesachececedadechebe ch eudaeecdes ects ch cedeeseneceabactececs 2 D SYSTEM SPECI OAT O NO a A aaa a a a a a r a a a aie 3 ll SYSTEM SETUP AND INSTALLATION lt 00c ss0cs ccscececcosssdssdseeccoovsssssscctececosvsessdeotsoonsseesscacectonosasossece 5 A MINIMUM COMPUTER REQUIREMENTS ssssssssssssssssssesseeeseseeeseeeeeseaeseseeeeeeeeseseseseseseeesesesesesaeaeaeasaeaeaes 5 B COMPUTER SETUP AE AE ATE AE E E ATE 7 Windows Taskbar Screen Saver C SOFTWARE INSTALLATION ce000e D HARDWARE SETUP scseseseseseseseseseseeeeeeeeeeeees Hardware Configuration Settings E CONFIGURATION SETTINGS eseists cocevedceseces Gucoeds duh eo a eves axlenedoceesGuesudesd e a aaa aa a ae aiia taadaa ds F MANAGING USER PROFILES SETTINGS sccccccecsesssscececesesesaececccecseseaeesseseescecseseeaeseesceeseseseseesceeseeuaeees G MANAGING EXERCISE PROTOCOLS sessscccccecsesessecececsesesaeseeececeeeseseeseseesceesesesaeseeeceseasaeseeseeesesaeaeees H HARDWARE SETTINGS ERNEA EA A A S A EEO A Controls Stress Output Module oicicecccccccesssssscesecesesssssecesecssneseascessceseessassseseceseeesesseaeseeses Controls Automatic BP Mo
50. age appears only if using the serial port version of the ECG module e Disconnect the Spirometer and connect the ECG module to the serial port or change the serial port assigned to the ECG module in the Hardware tab of the Settings dialog box Error Unknown device connected Message appears in the message prompt The software was able to read data from the COM port but it could not identify the connected device e Disconnect the device connected to the serial port and connect the serial port version of the ECG module 105 IQstress Operation Manual IQstress Troubleshooting Guide Exercise protocol complete Press Recovery F9 to begin recovery Message appears in the message prompt This is not an error This message indicates that the Exercise phase has ended Continue to allow the patient to exercise Click Recovery F9 to end the Exercise phase and begin Recovery IQstress Security Key Not Found Message appears when starting a new Stress test The software cannot find the security key because it is not installed or there is a conflict with the parallel port e Verify that the security key is installed directly on the parallel printer port and that the printer cable is connected to the back of the security key Ensure that the printer is on and ready or online e Print from Windows Notepad or any text file to verify the parallel port is working properly with the security key in
51. al Treadmill Control during Exercise During the Exercise phase the software automatically controls the treadmill during execution of the pre programmed exercise protocol To stop the treadmill during exercise click Stop Treadmill F1 To restart the treadmill click Start Treadmill F1 48 IQstress Operation Manual W ACAUTION The treadmill will start at the displayed speed settings never start the treadmill while the patient is standing on the treadmill belt Treadmill Status Indicator The treadmill Status display is located at the bottom of the screen When the treadmill is connected and operating correctly the Status display will indicate Ready If the status display indicates Disconnected check the treadmill s power cable and that the power is on Also check the connection between the treadmill and the computer If still experiencing difficulties see Section XV Appendix A Troubleshooting Qstress Pharmacological Controls If performing a pharmacological procedure such as Dobutamine the treadmill controls will be replaced with the following ose vile Less left arrow reduces the Dose indication by one unit More right arrow increases the Dose indication by one unit A NOTE These controls apply to the Dose display NOT a drug delivery device Test Controls Test Controls Button Keyboard Key Description Returns to the previous protocol stage The software adjusts the tre
52. allation to complete then 2 disconnect the SOM and reconnect it to the computer IQstress Operation Manual 1 Insert the Qmanager Installation CD into the CD ROM or DVD ROM drive The installation starts automatically If the installation does not start automatically double click My Computer on the desktop and double click the CD ROM icon to start 2 Follow the instructions on the screen For detailed installation setup and detailed operation instructions please refer to the Qmanager Operation Manual Once the software has been installed the user will be able to review and edit Stress test reports In order to perform new Stress tests connect the hardware components to the computer and configure the software to operate with the appropriate hardware configuration as described in the following sections D Hardware Setup This section describes how to connect hardware components only to the computer to be used for performing Stress tests computers used only for reviewing editing and printing Stress reports do not require any special hardware See Figure 1 1 Stress Testing System Configuration Using the IQstress Software 1 Connect the ECG module to a USB port on the computer 2 Connect the security key to the USB port on the rear panel of the computer 3 Connect the treadmill Trackmaster Model TMX425 or TMX 428 to a serial port on the computer ANOTE To print rhythm strips or the final report from this computer
53. amplified with a gain of 125 and DC offset to 1 25Volt 99 IQstress Operation Manual Analog to Digital Conversion The AD converter used is ADC12138 from National Semiconductor The AD converter is 12 bit plus sign serial I O A D converter with MUX and Sample Hold The amplified and filtered 8 channel ECG signals are passed to the 8 channel inputs of the AD converter The sampling rate for each channel is 500Hz The digitized ECG data are sent to the microcontroller through the serial interface Microcontroller The microcontroller is a PIC16LC67 chip from Microchip Technology This chip has 8Kx14 OTP 33 1 O lines and built in serial interfaces for A D converter and RS232 The microcontroller receives the digitized ECG data from the AD converter and encodes the data with packets and sends out to the computer through serial interface circuitry The setting for the RS232 is 8 bit data 1 bit stop no parity and 115 000 baud rate and is usually handled automatically Settings for the USB version are automatic and are not user selectable Isolated Serial Interfaces To provide the maximum safety for the patient the ECG module and the computer are isolated with an optical coupler and or isolated DC to DC converters The serial signal sent out by the PIC microcontroller is coupled optically to the computer either through the RS232 or USB interface There is no electrical connection between the patient and the computer The isolation circuit c
54. an withstand up to 1000Volts Lead Off Detector The ECG module has a built in lead off detection circuit The lead off circuit senses the lead off condition and reports to the PIC microcontroller The PIC microcontroller sends out the lead off condition to the computer through the serial interface Pacemaker Detector The pacemaker detection circuit in the ECG module ensures the device s capability of printing the ECG signal in the presence of pacemaker pulses with amplitudes between 2 and 250 mV duration between 0 1 and 2 0 ms recommended by AAMI EC 11 DC DC Power Converter The IQecg module 45 Series RS232 uses two AA batteries to supply its power The IQecg module 46 Series USB does not require the use of batteries The USB port of the host computer provides the operating power A step up DC DC converter is used to provide a 4 5Volt power source Two 3 3Volt regulators are used to provide two 3 3Volts power source for the analog circuits and digital circuit for the device There is also a negative voltage converter used to generate a 3 3Volt power source for the analog circuit A Linear Technology 1 25Volt micropower shunt reference regulator provides precision 1 25Volt reference voltage The IQecg module 46 Series USB 100 IQstress Operation Manual power is switched on or off by the ECG program through the USB port Isolation is provided for signals entering the ECG module and can withstand up to 1000Volts XI
55. and graphical results should be examined with respect to the patient s overall clinical condition Proper administration of the test is the physician s responsibility as is making a diagnosis obtaining expert opinions on the results and implementing the correct treatment if indicated The lQstress test has been designed to create a patient baseline during the Learning Phase Patients with abnormal or irregular heartbeats may have difficulty or may not be able to pass the Learning Phase of the stress test These patients may not be suitable for the stress test ECG RECORDS MUST ALWAYS BE REVIEWED BY A QUALIFIED PHYSICIAN DO NOT USE COMPUTER ECG ANALYSIS FOR THE PRESCRIBING OF EITHER TREATMENT OR NON TREATMENT OF PATIENTS ACAUTION Federal Law restricts this device to sale by or on the order of a physician IQstress Operation Manual Related Documents The following documents may be needed in order to operate Midmark diagnostic devices and software products with IQstress e Qmanager Software Operation Manual Part number 4 100 1200 e Qecg Operation Manual Part number 3 100 1115 e Trackmaster Medical Treadmill Owner s Manual that was included with the treadmill All Midmark product Operation Manuals are located on the Midmark Operation Manuals CD part number 3 100 1000 included with every device and can also be downloaded from midmark com For additional information contact Midmark Technical Service
56. applied part that provides a high degree of protection against electrical shock and is suitable for use during defibrillation ETL Listing Mark l Equipment displaying this symbol has been tested and complies with the following safety standards Intertek Conforms to UL Std 60601 1 idii Certified to CAN CSA Std C22 2 No 601 1 Do not dispose of this product as unsorted municipal waste Dispose this product in accordance with national requirements per EC Directive 2002 96 111 IQstress Operation Manual References American College of Sports Medicine 2000 ACSM s Guidelines for Exercise Testing and Prescription 6th edition ed Philadelphia Lippincott Williams amp Wilkins Ellestad M H 1986 Stress Testing 3rd edition ed Philadelphia F A Davis Company Fletcher G F Balady G J Amsterdam E A Chaitman B R Eckel R Fleg J et al 2001 Exercise Standards for Testing and Training A Statement for Healthcare Professionals From the American Heart Association Retrieved from Circulation www circ ahajournals org cgi content full 104 14 1694 Froelicher V F 1994 Manual Of Exercise Testing 2nd edition ed St Louis Mosby Froelicher V F amp Meyers J N 2000 Exercise And The Heart 4th edition ed Philadelphia WB Saunders Company Gibbons R J Balady G J Bricker J T Chaitman B R Fletcher G F Froelicher V F et al 2000 ACC AHA 2002 Gu
57. ardware tab IQstress Settings PEtocols Hardware Reasops Treadmill Trackmaster Model TMX425_ gt Serial Port Com ECG Module USB Version Serial Port Version Serial Port Eou7 Stress Output Module I Enable 3 Checking the Enable box enables the Setup button Click Setup to display the SOM Settings dialog box Sres oupa aie S e Digital Output Channel Settings Settings For Channel 4 Pulse Width 100 40 150 msec Delay 0 0 100 msec Analog Output Channel Settings Settings For Channel 1 Output Lead V5 X OK Cancel Help x 4 The SOM Settings dialog box consists of two groups of controls Digital Output Channel Settings allows the user to set the two digital output channels Analog 81 IQstress Operation Manual Output Channel Settings allows the user to setup the four analog output channels a Digital output channel Select the channel in the Settings for Channel list in the Digital Output Channel Settings control group enter the pulse width for the channel in the Pulse Width edit box then enter the pulse delay in the Delay edit box b Analog output channel Select the channel from the Settings for Channel list in the Analog Output Channel Settings control group select the desired signal from the Output combo box and repeat for each channel A NOTE The pulse width setting determines th
58. are modules Some new features for the IQecg module include e Built in defibrillation protection circuit e Hardware lead off detection circuit e Hardware pacemaker detection circuit e Analog bandwidth from 0 05Hz to 150 Hz e Digital sample rate of 500 Hz e USB computer interface model specific e RS 232 COM port interface model specific e Pocket computer compatible interface model specific Lead Off p Pacemaker DC DC Power Detector Detector Circuit 10 Le dwire Filters and Patient ECG Buffer Instrumentation Patient e gt ne 6e gt roe o gt Gain Cable with Amplifiers Amplifiers ive amplifiers Defib Protection 0 8 Channel A Isolated Serial Microcontroller e PC System D Converter Interface System Block Diagram 98 IQstress Operation Manual 10 Leadwire Patient Cable The ECG module uses the special Midmark 10 Leadwire patient cable for its 12 lead ECG data acquisition The patient cable has 10 conductor shielded lead wires There is a 1Kohm 10 resistor embedded inside each lead wire Together with the voltage clamping circuit built into the ECG front end the ECG module provides the built in defibrillation protection capability required by AAMI EC 11 and IEC 60601 ECG Buffer Amplifiers The patient ECG signa
59. are options than before making each computer almost unique Midmark wants to make sure that your IQstress is installed and configured as quickly and easily as possible Midmark Technical Service can be reached at 1 800 624 8950 option 2 A Minimum Computer Requirements This section describes the minimum computer resources and hardware components needed when using new Midmark devices and software As is the nature of technology to change often these requirements will be evaluated and modified periodically We suggest always referring to the most recent Minimum Computer Requirements document at www midmark com or contact Midmark Technical Service at 1 800 624 8950 option 2 for additional information ANOTE If updating existing computer systems currently being used with older Midmark devices and software please contact Midmark Technical Service before doing so The following computer minimum requirements represent the IQstress being operated without the Stress Output Module SOM IQstress Minimum Computer Requirements Requirement Windows 8 Professional and Enterprise 32 bit and 64 bit Operating Systems Windows 7 Professional and Enterprise 32 bit and 64 bit Hardware Windows compatible personal computer Desktop model Requirements recommended CPU Intel Core 2 Duo Processor E4300 2M Cache 1 80 GHz 800 MHz FSB x86 or 64 bit x64 processor or faster Disk 2 GB of free disk space or
60. ate display shows the current heart rate the target heart rate percentage of the target heart rate and a progress bar that represents the percentage of the target heart rate The software updates the Heart Rate display once per second The heart rate calculation is based on sliding window of the previous eight beats METS Display The METS display shows the current exercise level in METS the target METS the percentage of the target METS and a progress bar See Section XV Appendix C METS Calculations for additional information Blood Pressure and Double Product DP The Blood Pressure display shows the last entered blood pressure value as systolic over diastolic If no BP measurement has been entered the display indicates The software automatically updates the Double Product DP display when a new BP measurement is entered The DP also called rate pressure product displayed is the systolic BP times the current heart rate divided by 100 The color of the BP and DP displays changes to yellow if the displayed BP measurement is older than 90 seconds 45 IQstress Operation Manual VE Min Display The VE Min display shows the number of ventricular ectopic beats in the last sixty seconds This display is updated once per second ECG Display Controls The ECG Display Controls configure the displayed lead groups change the sweep speed and change the display gain of the ECG Lead Group Selection The displayed
61. cal stress ECG Acquisition Uses the Midmark IQecg module Treadmill Interface Trackmaster TMX425 428 ST Measurements ST level and slope ST Measurement Points J 60 default J 80 J user defined interval J HR variable interval User adjustable isoelectric and J points Heart Rate Eight beat sliding average Range 30 250 BPM VE count per minute VE min ECG Display 3 6 or 12 lead plus average beats Rhythm Strip Formats 6x2 3 6 or 12 leads plus average beats 12 leads plus 1 rhythm lead 10 seconds 30 seconds or continuous rhythm strip matches leads display Software Filters Muscle filter AC filter Drift filter ECG Lead Configurations Standard 12 lead Cabrera 12 lead Treadmill Exercise Protocols Bruce Modified Bruce Balke Ware Ellestad Naughton Ramp user programmable Pharmacological Protocols Dobutamine user programmable Reports Cover page summary table average beats Summary or detailed rhythm strips Summary or detailed resting ECG report trend report Configuration Profiles Qstress has five default configuration profiles which store user preferences profiles can be customized to tailor the system to individual preferences IQstress uses the IQecg Digital ECG module The following are the physical and performance specifications for the IQecg module IQstress Operation Manual Performan
62. ce Specifications Category Specification e Noninvasive device 12 lead electrocardiogram e 3 5 88mm x 5 7 145mm x 1 2 30mm W x L x H e 10 20z 289 2 g USB type ECG module without batteries Physical Characteristics Anatomical Sites e Noninvasive device 12 lead electrocardiogram e Patient electrically isolated from main current supply Safety Parameters e Patient leakage current not to exceed 10 uA Ground leakage current not to exceed 50 uA 12 lead simultaneous Input impedance gt 100M ohm Frequency response 0 05 150 Hz 3 dB Sensitivity 5 10 20 mm mV 10 Dynamic range 10 mV ADC resolution 13 bits at 2 44 uV bit Acceptable electrode offset 300 mV per AAMI EC 11 specifications e A D 500 samples sec ECG Acquisition e 10 lead patient cable with RFI filter defibrillator Patient Connection i ia protection and patient isolation ECG Analysis amp e Midmark 12 Lead Resting Electrocardiogram Analysis Measurement Program Printer e Windows supported ink jet or laser printer Paper e Plain 8 5 x 11 Letter size A NOTE For treadmill specifications refer to the Trackmaster Owner s Manual included with the treadmill IQstress Operation Manual Il System Setup and Installation A NOTE Contact Midmark Technical Service before installing and setting up the IQstress Computers today are more complex with more software and hardw
63. ckage Dimensions H x W x D 1 5 x 4 5 x 4 5 Signal Range O 5V QRS Pulse Width Setting Range 40 150 ms 10 ms software controlled QRS Pulse Delay Setting Range 0 100 ms 10 ms software controlled Phase Delay Relative To Input lt 40 ms Short Circuit Protected Yes Connector Type BNC Analog Output Specifications Signal Range 5V Output Signals ECG Leads Il V1 V2 V3 V4 V5 V6 Analog Voltages heart rate treadmill speed treadmill grade ergometer watts ergometer RPM ECG Lead Sensitivity 1 volt mv Heart Rate Output Sensitivity 60 BPM volt Treadmill Speed Output 3 MPH volt Sensitivity Treadmill Grade Output Sensitivity 5 grade volt Analog Amplitude Accuracy 5 ECG Delay Relative to Input lt 40 ms Short Circuit Protected Yes Connector Type BNC IQstress Operation Manual B Setup Once the Qmanager or IQstress software has installed successfully connect the Stress Output Module SOM to a USB port C Operation Hardware Configuration Settings Midmark stress test diagnostic software provides various settings that allow the user to configure the digital and analog outputs of the SOM 1 The SOM must be configured prior to starting a stress test To begin click Settings which is available on the Review and Edit screen or the Pre Test Settings dialog box of the Midmark stress test diagnostic software 2 Click the H
64. d ECG signals are displayed on the screen e fthere isa lead disconnected or if the heart rate display indicates correct the problem and exit the software e Restart the software and verify that the hookup is good e Press Stage Up F4 to restart learning 85 IQstress Operation Manual IX SunTech Tango Automatic BP Device with lQstress A NOTE In order to use the Tango device with IQstress a Stress Output Module SOM is needed See Section VIII Stress Output Module SOM for instructions on how to connect and configure the Stress Output Module Prior to using the Tango BP device connect it to the computer and configure the software if your Tango BP device has already been connected and configured A Configuring Qstress for Use with the SunTech Tango Device The following block diagram shows the Tango Automatic Blood Pressure Device connected to the IQstress system A NOTE The SOM requires the USB version of the ECG module The digital QRS synchronization pulse from the SOM will not be available if using the serial port version of the ECG module 10 lead lQmark patient Digital ECG Serial Cabh connection Module i e A Patient Cabl iir Blood Pressure atient Cable S UsB Output Device E l ee Module Lal a Windows PC _ _ a Windows PC running Printer lQmark EZ Stress Software Digital Output Ch 1 of 2 Coaxial Cable Treadmill The SOM provides a digi
65. ded parameters Displays two trended parameters one plotted against the left vertical axis and one plotted against the right Trend vertical axis against the test time 11 IT Displ rend Display Graph The default trend parameters are HR on the left axis and the ST level of the worst case lead on the right axis Click Trend to change the trended parameters Expanding a Lead To show a selected lead in the expanded average beat window Click the waveform display window of the desired lead the trend display will also show the ST parameter for the selected lead Rejecting Average Beats Clean up beats that are consider too noisy by removing it from the report Click the Reject radio button to remove the displayed beat from the report and repeat for all the beats to be removed The software will re calculate the ST measurements displayed in the report and produce a new interpretation when the report is saved 60 IQstress Operation Manual Selecting ST Measurement Leads The Average Beat Review screen has a feature that allows the user to filter out possibly noisy leads to ignore for ST measurement Click Select ST Leads on the Average Beat Review screen and the Select ST Leads to Exclude dialog box will appear ST measurements for the selected leads will be excluded from the report Vv cv ma M v2 ri T v3 IV R M v4 Vv ave M vs M avr M ve OK Cancel Select the ECG leads to exclude and click OK The software aut
66. display a different average beat e Click the desired time in the trend display the software will move the vertical marker and update the average beat displays to show the nearest average beat e Click and drag the vertical marker to the time of the average beat that to view then release the left mouse button Changing Trended Parameters Click Trend to show the Trend Parameters Selection dialog box p Lekt Trend gt _ Right Trend A Parameter Heart Rate x Parameter ST Level Lead with Worst ST Level Depression Lead With Worst ST Level Depression Select Lead Select A Lead led f led ff Cancel Help Select the parameters to show from the drop down lists The available choices are e Heart Rate e QRS Amplitude e ST Level e ST Slope If selecting ST Level or ST Slope the user will have the option to display the lead with the worst ST level depression or a selected lead If checking the Select A Lead option choose the lead in the associated drop down list Click OK to update the trend display 62 E Rhythm Strip Screen lQstress Operation Manual Phase Pre Exercise Phase Time 03 50 Stage Supine Stage Time 03 50 Speed MPH Grade Rhythm Strip Controls Prey Strip Next Strip Accept C Reject m View Control Leads finavFv2v4ve Gain Gain 1X The Rhythm
67. dmill Protocols When editing the stages of a treadmill type protocol the Treadmill Stage dialog box allows you to enter the speed grade and stage duration minutes seconds Stage ff Speed 0 0 mph Grade Do Duration 03 00 mm ss Programming Ramp Protocols When selecting a Ramp Treadmill protocol from the Protocol Type drop down list the Protocol Settings control group appears pe fa Ramp protocols increase the work load on the patient by gradually increasing the treadmill grade and or speed to a maximum value that is customized for each patient 24 IQstress Operation Manual Ramp protocols consist of an optional warm up stage and a ramping stage In the warm up stage the software runs the treadmill at a fixed speed and grade to allow the patient to warm up before beginning to exercise The Stage 1 Setting group contains the settings for the warm up stage and the Stage 2 Settings group contains the settings for the ramping stage If there will be no warm up stage set the Duration edit box to 00 00 in the Stage 1 Settings group The Duration setting in the Stage 2 Settings group sets the desired test time This value is typically between 8 and 12 minutes There are two different types of ramping stages depending upon the Stage 2 Settings e f Fixed Speed is selected the software sets the treadmill to the value shown in the Speed edit box and gradually increases the treadmill
68. dule Reasons for Termination List Customization ccccscsssceseceseensesecesesssensssscesscesesssasseasseeess 28 II STRESS TEST OPERATION ioro roei cesssssdeeceevcdeas ssescsceesccundeessdeetecosdevseei ogee duossdevsestsedecdsesevvecssceseesees 30 A STARTING A NEW STRESS TEST B PATIENT PREPARATION 000000 C PRE EXERCISE PHASE OPERATION D EXERCISE PHASE OPERATION 0 ccecesssseseesececssseeesesecesssseseseesecceeessesanausesecsssesaaesaeseessesnaasaeseesseesaeananss E RECOVERY PHASE OPERATION x aisetecoseszsazeazcacact AENT aA e Opa STR EEEE p apaes ersi IV REVIEW AND EDIT OPERATIONS amp 5 cc5cssec iaccadcassscsscedecccsecdsedssealeccosesdsedsseccocsesecssecseeadousasesdoocsccassusss 55 A OVERVIEW A aviv dobsoderenusysterevavas baesiadabves Ady webbie siveshevedeestitvoededaasnbasnieantdbedtasbeshistiedsbesesteshiasteesbaebs B REVIEW DETAILS SGREEN ic escsaccnccecccseuscatdetesvous cotudvensedvesedeundecntdatededatanecededeouseanlicces coUesavenstleccdceeessenseaetes C SUMMARY TABLE SCREEN 35 260Scch oann srat a aaae aaa aidaa aa ai sia aiea taaa o aiaia D AVERAGE BEAT SCREEN mdee ea etana a a a are aa a a oea ar adete Expanding LOG ec ienaiiino i a aei a E Wines eeu busca O i a vee Rejecting Average Beats a aaa aiaia aaraa a EA NAA A A AA Aa aih Aa aAa aii iaia Selecting ST Measurement Leads TV ENG DI DIG EEE EEE E NE E E EEE EEEE EE TETA Navigating within the Trend DisPlOY ccsscssccccceseesssssce
69. e to use exercise device yl al gt a gt I f Level Of Chest Pain C Norgna e Angina Docuned Duind Test Limited By Angina Other Reason Help con Enter the reason s for stopping the test checking the box next to an item from the Reasons for Test Termination list If reason is not included in list enter text into Other Reason box Ask the patient to rate the perceived exertion and check an item in the Level of Effort Borg Scale list Ask the patient about chest pain experienced during the test and select one of the choices in the Level of Chest Pain control group This information is required to calculate the Duke Treadmill Score Click OK to exit the Exercise Test screen and save the test Click Cancel to close the above dialog box and remain in the Exercise Test screen 43 IQstress Operation Manual Exercise Test Screen Displays and Controls Top Bar Display Exercise Test for Jose Sanch Heart Rate 192 80 iR 163 5 Heart Rate BPM E 5 10 o o 100 5 r 10 METS 00 23 Sree mp 0023 1 7 F crcise Stage 1 10 0 SHE gt JEE 0 5 10 0 5 10 o Pi ChestLeads Limb Leads Expanded Beat Current mm Current mm Resting mm Resting mm E tte SS IER Eo 0 2 0 3 Current mm 0 1 Resting mm 0 1 Change mm 0 0 Change mm Change mm 0 0 0 0 aVR aVL Current mm Current mm
70. e to use the standard lead ordering for showing ECG data Il III aVR aVL aVF V1 V2 V3 V4 V5 V6 The Cabrera setting configures the software to use the Cabrera representation of the ECG leads aVR is inverted aVR the lead order is aVL I aVR Il aVF IIl V1 V2 V3 V4 V5 V6 Disable Quick Edit This setting determines how the Add New Statement dialog box is used in the Resting ECG screen When Disable Quick Edit is checked the software defaults to free text entry for adding diagnostic statements instead of the drop down list on the Add a Statement dialog box The default is for the Disable Quick Edit box to be unchecked Exercise Test Screen Display Leads The Display Leads drop down list of the Real Time ECG Display control group determines the default View Control Leads setting displayed on the Exercise Test screen once the test enters the Pre Exercise phase Note that during the Hookup phase this screen initially shows all 12 leads for easy verification of ECG quality 22 IQstress Operation Manual G Managing Exercise Protocols The Protocols tab of the Settings dialog box allows the user to manage exercise protocols il Protocol Type Treadmill Protocol List PCTEL z s N r Insert Above Insert Below Edit Delete Daet I Ramp This Protocol The Protocol Type drop down list displays the type of protocol selected from the list The drop down list
71. e width of the digital pulse output for each QRS pulse detected The default setting is 100 milliseconds ms The delay setting determines how long the software delays the pulse relative to when the QRS complex is detected The default setting is 0 ms A NOTE Each analog output channel may be individually configured to output different signals 82 Digital Output Channel Settings Control Settings For Channel lQstress Operation Manual Stress Output Module Dialog Controls Control Type Combo Box Description Selects the digital channel to which the settings will be applied the choices are 1 or 2 Pulse Width Edit Box Displays the pulse width setting The allowable range is 40 150 ms The default setting is 100 ms Delay Edit Box Displays the pulse delay setting The range is 0 100 ms The default setting is 0 ms Analog Output Channel Settings Settings For Channel Combo Box Selects the analog output channel to which the settings will be applied The choices are 1 2 3 and 4 Output Combo Box Selects the output signal The choices are e Lead Lead Il Lead V1 Lead V2 Lead V3 Lead V4 Lead V5 default for all analog output channels Lead V5 Lead V6 Heart Rate Treadmill Speed Treadmill Grade Ergometer watts Ergometer RPM D Stress Test Operation The analog outputs of the SOM become active when starting a new stress test The
72. ears Exercise Profile Bruce Treadmill v Settings Help 4 Select an Exercise Profile from the drop down list Profiles store pre programmed settings that determine how the Stress test procedure is conducted along with a variety of user preferences 5 Click Settings to change system configurations and to program or edit user profiles See Section II E Configuration Settings for more information 6 Click Next to proceed to the Hookup phase of the test and begin patient preparation The Hookup Screen appears o If performing a Ramp protocol the software will display the Patient Activity Questionnaire dialog box Enter the patient s level of physical activity and click Next to display the Hookup Screen and begin patient preparation for the test 30 IQstress Operation Manual Ramp Protocol Patient Activity Questionnaire For the Ramp exercise protocol the Patient Activity Questionnaire dialog box appears Patient Activity Questionnaire Activity Level C Eating getting dressed working at a desk Taking a shower shopping cooking walking down 8 steps C Walking slowly on a flat surface for 1 or 2 blocks Light yard work fie raking leaves weeding sweeping or pushing a power mower painting or light carpentry C Walking briskly C Play 9 holes of golf carrying you own clubs Heavy carpentry mow lawn with a push mower C Carrying 60 pounds perform heavy outdoor work ie digging spading soil etc Walking uphil
73. eas Demo Simulated Data 59 Control Display IQstress Operation Manual Average Beat Screen Controls Type Description 1 Individual Lead Waveform Displays the QRS for each lead of the current average Displays display beat gt Measurement Static Text Shows the ST level ST slope and QRS amplitude for each Display lead Shows the QRS for a selected lead of the current average i d 2X f t Th fault vi Expanded Lead Waveform beat in an expande 2X forma e defau view l 3 Displa displa shows the lead with the worst case ST depression click p ay p ay on the waveform for any lead to show that lead s average beat Exercise Status Displays the phase name phase time stage and stage 4 Displa Static Text time as well as the treadmill speed and grade for the Play displayed average beat i Shows the heart rate and blood pressure measurements gt HREP Display State TEN at the time that the average beat was stored Prev Beat 6 Next Beat Button Displays the previous next average beat Radio 7 Accept Reject Button Saves or deletes the displayed average beat Displ ial that all th to sel hich 3 Select ST Leads Button isplays a dialog box that allows the user to select whic leads to use for ST measurements 9 Gain Button Displays and edits the gain setting for the waveform display 10 Trend Suite Displays the Trend Parameters Selection dialog box to change the tren
74. ed during the stage 3 Enter the start time of the first measurement in the First Prompt edit box 4 If more than one timed BP measurement is wanted during the stage enter the measurement interval in the Repeat Interval edit box If only one timed BP measurement is wanted during the stage enter 00 00 in the Repeat Interval edit box 5 Click Make All Like This if you want all stages in the Exercise phase to be the same as the displayed settings The times specified in this dialog will be the times at which the automatic BP sample is started Bear in mind when setting the times the Tango device requires between 40 and 60 seconds to complete the measurement 89 IQstress Operation Manual Automatic BP during Recovery 1 Click on the Recovery tab of the Profile Settings dialog box to display the Recovery Settings Profile Settings for User Profile General ST Pre Exercise Exercise HR METS Report Printing Repc_4 J Timed Phase Phase Duration Joo 00 mm ss Rhythm Strips BP Entry T Enable Tl Enable First Strip Time Joo 00 mmss First Prompt oo COR Alms STi Repeat Interval foo 00 mm ss Repeat Interval foo 00 mm ss F Print Strip i J Print End of Recovery Strip M Stop Treadmill Stop Belt Regular Stop C Gradual Stop Cool Down J Enable Step Speed Cut Grade Cut _ Time mm ss 0 7 Manual Cool Down Speed 1 mph Grade 10 0
75. ed to cracks cuts discoloration or oxidation If a cable or other accessory exhibits any of these symptoms replace it immediately prior to using the ECG module Storage To prevent damage to the ECG module due to battery leakage or oxidation remove all batteries if the ECG module is not to be used for a long period of time Avoid extreme humidity and heat during storage ANOTE The USB version of the ECG module does not use batteries X CAUTION Electronic devices can be damaged by exposure to liquids Do not use or store the IQecg or any other components of the IQstress system near any type of liquids 94 IQstress Operation Manual Radio and Television Interference This equipment generates and uses radio frequency energy If not installed and used properly in strict accordance with the manufacturer s instructions it may cause interference to radio and television reception This equipment has been tested and proved to be in compliance with the standards for medical devices and in accordance with the IEC 601 1 rules which are designed to provide reasonable protection against such interference in a medical or hospital environment 95 IQstress Operation Manual XI Customer Support and Warranty Information For help diagnosing problems by phone with this product contact Midmark Technical Service at 800 624 8950 option 2 between 6 00 AM to 4 00 PM Pacific Standard Time To contact Midmark Technical Serv
76. esessseueeses 86 Configuring the TANGO Device cccccsssccceessececsssceceesssseceessecesuceceessssecesseseessssecesesssseesaaes 87 Configuring the IQstress Software cccccesssccceesceceessssecesssesscussesessssecessesscssseecesesssseceaaes 87 B USING THE SUNTECH TANGO DEVICE WITH IOSTRESS cscecsessscescceceeseesssceeseeseseeesesesceseessaueseeenees 90 TROUBLESHOOTING THE TANGO BP DEVICE ccccseeesccscceceesessceccecsesseusesecesceeseeeesseesceuseeseseeeseeseeanes 92 X MAINTENANCE AND STORAGE cccccssssccccsssccccessccccecsecccecsecccessecccecsecccessecececessccensccceessseceesesseeens 94 85 0 1411419 ROE Ree ORT TCE EPCOT PIR TROT COUP TECTED CORTE TPT CTP ESE EE EPEC a e TPAC OTR ERECT Preventative INS POCtiON EPE A A E bite sacasiaveasvacsbdbedbesiaves Storage neiii iiaei iaaii aAA aA iaia aa laaa EAA aAA aA Aaaa Nea PAAA PCE PET EP EETTETET PPT a aiana iiaia Radio and Television Interference XI CUSTOMER SUPPORT AND WARRANTY INFORMATION sssccsssssesseseeesseeeeseeeeeeeeeseeeeeeeeeeeeeeeeeees 96 XII CONTACT INFORMATION cccccccccsscseseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeseeeneeeeenen 97 XI TQECG SERVICE MANUAL 5y ccsccescescsssenanesovecencossecosssesacneeseserssosobessoesouevesssoserssecpserevesesevssetesesssecsie 98 XIV SYSTEM MAINTENANCE AND OBTAINING SERVICE ccsssssssssseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeseeeeseeeeeeenen 101 I
77. first prompt is to appear in the First Prompt edit box e To prompt for BP periodically enter the prompt interval in the Repeat Interval e Enter a value of 00 00 to prompt only once in the stage Click Make All Like This to apply the respective settings to all stages in the Exercise protocol Recovery Settings The Recovery tab shows the settings for system operation during the Recovery phase Profile Settings for User Profile ae ee ee eT I Timed Phase Rhythm Strips I Enable I Enable First Strip Time 0000 mm ss First Prompt Repeat Interval 9000 mm s Repeat Interval 00 00 m r I Print End of Recovery Strip Stop Treadmill C Stop Belt Regular Stop C Gradual Stop Cool Down Step Speed Cut Grade Cut Time mm ss I Enable 1 30 30 00 10 2 Check the Timed Phase box to make the Recovery phase a timed phase and enter the duration in the Phase Duration edit box The Rhythm Strips group of controls determines if and when the software saves and or prints rhythm strips during the recovery phase These controls operate the same as the Rhythm Strip settings for Exercise phase The BP Entry group of controls determines if and when the software prompts the user for BP entries These controls operate the same as the BP Entry settings for Exercise phase The Stop Treadmill option adjusts the speed at which the treadmill will slow down Stop Belt immediately stops the treadmill belt
78. frequently creates artifact that distorts the ECG signal due to dry or dead epidermal cells oils sweat and dirt Well managed skin preparation will reduce the resistive barrier that causes muscle noise and baseline wander ensuring high quality signal and test data 1 Shave the electrode sites to remove body hair 2 Gently scrub the skin with an abrasive pad lint free gauze pad or fine sandpaper enclosed in the preparation kit This loosens and removes dead skin 3 Wipe the scrubbed area with a clean alcohol pad and ensure the entire electrode site is free of oil Repeat for all sites Allow these areas to air dry naturally before attaching electrodes 4 Apply the electrodes to the sites indicated below 5 Forma stress loop see examples below with each electrode lead then tape the loop to the skin This reduces artifacts caused when leads are pulled or tugged by patient movements Electrodes Stress loops Examples of stress loops If acquiring a resting ECG tracing during the Pre Exercise phase prepare both the resting limb electrode sites and the exercise limb electrode sites Initially place the limb electrodes on the resting ECG sites You can then move them to the exercise sites after acquiring the resting ECG strip ANOTE The live ECG acquisition screen will show the signal tracings after all limb leads have been connected When the right leg RL lead becomes detached the system behaves as if all electrodes were di
79. ge Release F3 Click Stage Down F2 Click Stage Up F4 Enter the Recovery phase by clicking Recovery F9 ANOTE There is an auto Stage Hold feature When one of the following treadmill commands keys is pressed the software automatically enters Stage Hold state e Slower left arrow e Faster right arrow e Lower down arrow e Higher up arrow Stopping and Starting the Treadmill When the treadmill is running Start Stop Treadmill F1 indicates Stop Treadmill indicating that pressing it will immediately stop the treadmill The treadmill belt will stop but the elevation will remain at its current setting While the treadmill is stopped the speed indicator will show zero and grade displays will show the current grade Start the treadmill again by clicking Start Treadmill F1 WACAUTION When the treadmill resumes it gradually increases to the current setting care must be taken to ensure patient safety Never start the treadmill with the patient standing on the treadmill belt Have the patient stand on the treadmill and straddle the treadmill belt Start the treadmill then allow the patient to step on the belt once it starts to move Emergency Stop The treadmill should be equipped with a mechanical stop button for use in emergency situations usually a red button labeled Stop or Emergency Stop that is mounted on or near the treadmill Use the emergency stop button only in emergencies The normal method of stopping the
80. grade e If Increase To Maximum is selected the software increases the speed to the value shown in the Speed edit box and gradually increases the treadmill grade Programming Pharmacological Protocols The Protocols tab allows the user to program pharmacological protocols IQstress Settings Enter the name of the medication in the Medication edit box and the Dosage Units in that edit box e g mcg kg min for micro grams per kilogram per minute r saro Protocol Type Pharmacological New Protocol Name Dobutamine Cancel Help 25 IQstress Operation Manual To edit a medication protocol to an existing stage The Pharmacological Stage dialog box allows the user to enter the dose for that stage and the stage duration Highlight the medication prototol type to be edited click the Edit button Profiles Protocols Hardware Reasons Protocol Type Pharmacological x User defined protocol Protocol Settings Medication home id Dosage Units fmeg kg min 30 03 00 40 03 00 rr Ge Cancel Hep Make the changes needed Click OK when done Stage fi Dose E megkgmin Duration 03 00 mm ss 26 IQstress Operation Manual H Hardware Settings The Hardware tab of the Qstress Settings dialog has controls to select the type of treadmill to be used specify the serial port that the treadmill is connected to and to
81. he Profile Settings dialog box to display the Pre Exercise Settings Profile Settings for User Profile General ST Exercise Recovery HR METS Report Printing Repc4 gt Prepare for standing ECG press Stage Prepare for exercise Press Stage Up F OK Cancel Help 2 Select a Pre Exercise stage from the list and click Edit to display the Pre Exercise Stage Settings dialog box Stage Name Supine Print Rhythm Strip C Yes No Prompt For BP Yes C No User Prompt Message Prepare for standing ECG press Stage Up F4 when OK Cancel Help 3 Select Yes next to Prompt For BP program the software to initiate an automatic BP reading for the Pre Exercise stage otherwise select No 4 Repeat the above procedure for each Pre Exercise stage 88 IQstress Operation Manual Automatic BP during Exercise 1 Click on the Exercise tab of the Profile Settings dialog box to display the settings for the Exercise phase of the test General ST Pre Exercise Exercise Recovery HR METS Report Printing Repo 4 gt a e IV Enable Make All Like This First Strip Time 03 00 mm ss Repeat Interval 00 00 mm ss J Print Strip BP Entry F Enable First Prompt 02 00 mm ss Repeat Interval 00 00 mm ss I Print Peak Exercise Strip 2 Select a stage from the list and check the Enable box in the BP Entry control group if timed BP measurements are want
82. hm strip which result in the rhythm strips being printed out of real time However all 10 second rhythm strips will be printed eventually from the printer queue The 10 second rhythm strips will also be saved in the Stress test report for reviewing editing and printing The Grid Color setting determines the printed grid color for all three of the waveform reports Miscellaneous Settings The Miscellaneous tab contains various settings such as Borg scale and ECG lead system Profile Settings for User Profile Exercise Recovery HR METS Report Printing Report Settings Wisc Borg Scale Selection ECG Lead Type 10 Point Borg Scale Standard 12 Lead 20 Point Borg Scale Cabrera Resting ECG Review I Disable Quick Edit Display Leads Chest Leads x Real Time ECG Display 20 IQstress Operation Manual Borg Scale Selection The Borg Scale radio buttons choose between the 10 point and the 20 point Borg scale Ten Point Borg Scale Points Perceived Effort Nothing at all Extremely light just noticeable a Very light oo a Somewhatheavy SSS Peo O ae re Very heavy Extremely heavy almost maximal po Maximal S O 20 Point Borg Scale Perceived Effort Very very light a ce po Verytight o r a S a e E ard Very hard Very very hard 21 IQstress Operation Manual ECG Lead Type The Standard 12 Lead setting configures the softwar
83. ice via email techsupport midmark com Self help knowledge base and live can be accessed at kb midmark com Warranty Midmark warrants lQecg module associated with the IQstress System to be free from manufacturing and material defects for 12 months from the date of purchase Accessories for IQstress are warranted for 90 days The treadmill and computer if applicable are covered by the manufacturers warranty Any misuse or abuse of a Midmark product voids all applicable warranties Please refer to midmark com for the full and current Warranty Terms and Conditions Return Materials Authorization To return any product for repair a Return Materials Authorization RMA number must be obtained from Midmark Technical Service This RMA number should be referenced on the package s containing the items to be returned and in any correspondence regarding the return Shipping Before shipping any unit to Midmark be certain that an RMA number has been issued and that all guidelines regarding this authorization are followed We highly recommend following all guidelines for the shipment of medical products set forth by the shipping company you choose to use If a question should arise regarding the appropriate method of shipment please feel free to ask when calling for your RMA number It is ultimately the responsibility of the customer when shipping a product to ensure that all packages and their contents get to Midmark safely Midmark will
84. ideline Update For Exercise Testing A Report of the American College Of Cardiology American Heart Association Task Force On Practice Guidelines Committee on Exercise Testing Retrieved from American College of Cardiology www acc org clinical guidelines exercise dirlndex htm Meyers J N Brader D Madhavan R amp Froelicher V F 2001 Validation of a Specific Activity Questionnaire To Estimate Exercise Tolerance in Patients Referred For Exercise Testing American Journal of Cardiology 142 6 1041 1046 Pina L Balady G J Hanson P Labovitz A J Madonna D W amp Meyers J 1995 Guidelines for Clinical Exercise Testing Laboratories A Statement for Healthcare Professionals from the Committee on Exercise and Cardiac Rehabilitation Retrieved from Circulation http circ ahajournals org cgi content full 91 3 912 112 VA LT AV AN oe Midmark Corporation 2014 Because we care
85. ion limb extremities to the torso positions for the Exercise phase Wait for the ECG tracing in the real time display area to stabilize before proceeding Acquire the Supine Rhythm Strip Click Stage Up F4 to acquire the supine rhythm strip and proceed to the Standing stage of the Pre Exercise phase Pressing Stage Up F4 automatically saves a rhythm strip for the Supine stage Prepare the Patient for Exercise Test Have the patient stand up Obtain and enter a BP measurement If the patient is not familiar with a treadmill Stress test explain the procedures If the medical treadmill is equipped with a Stop Tether lanyard the patient must always wear the Stop Tether lanyard wrist strap before operating the treadmill and throughout the entire testing procedure Have the patient stand on the treadmill with his or her feet placed to either side of the treadmill belt Do not stand on the belt prior to starting the treadmill Click Stage Up F4 to start the treadmill The software will save the rhythm strip for the Standing stage prior to starting the treadmill A confirmation to start will appear j Start the treadmill now Click Yes Enter to start the treadmill 37 IQstress Operation Manual Have the patient step onto the moving treadmill belt to begin exercise The test phase will automatically change to the exercise phase and the software will execute the pre programmed exercise protocol Cautionary Notes for T
86. ion aanne aaia i aAa a EAEL E E E a a iaa Eais C SUMMARY TABLE REPORT EE E A E E A D AVERAGE BEAT REPORT csswoncenscesecne suetnstenseeiedevecdeevecevciceiocenaveverstersversveteves sievetecedsvelevssscesovsusterea AA EEEO E TRENO RE OR T A Ge eae a s E a vege as Vas uve eae Wace as Slt agen a E F Aal E AON EAA A A EAE TEE A A E EN A G RHYTHM STRIP REPORT ioa a a seed a a eos a aa oes aaa ae oon Daas ea bob vos EENEN Real Time Rhythm Strip Printing H ASINA ALEHA O E SAE EAE EAE EE EAEE E EAEE A A OE Vi OPERATIONS ATA OLAN CE a ea e a aa a o a ae a s aiae ENSE 75 VII FUNCTION AND SHORTCUT KEY SUMMARY ccccsssssscccsssecccssssccccessccceeseccceesescceeseseeeeseseccseseesens 76 VIII STRESS OUTPUT MODULE SOM ssssssessssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssseseee 78 A GONFIGURATION EE A A N AEE A E des A E E A E E N 78 Specificato S T a a aaa aa a a a r A A iaia 79 B oI AO E E E EEN E EA T A A E E E E E R 81 C OPERATION atama a a a a a a a a a a a tbnests 81 Hardware Configuration SCttingS ccsccccccccccssessssscecccsssessascesecssessesssesscsssesseaesassesseseseaaes 81 STRESS TEST OPERATION morissen escini eneee seie TEs e EE EE a E ENE EE i aa E TROUBLESHOOTING THE SOM IX SUNTECH TANGO AUTOMATIC BP DEVICE WITH IQSTRESS sssssscsccsssssssssssscceeecesssssessesenees 86 A CONFIGURING IQSTRESS FOR USE WITH THE SUNTECH TANGO DEVICE ccccseccssesecessessssscesce
87. kA Serial Port comz The Trackmaster Model TMX425 selection supports both the TMX425 and TMX428 medical treadmill models IQstress Operation Manual 4 Select the version ECG module being set up by selecting either USB Version or Serial Port Version e If using the serial port version of the ECG module and do not know which serial port it is connected to click Auto Detect The software will search the serial ports on the computer and determine the correct serial port setting ANOTE For best system performance it is recommended that to use the USB version of the ECG module 10 IQstress Operation Manual E Configuration Settings The software provides an extensive number of configuration settings that allow the user to customize the software to operate in accordance with specific preferences e Customizable user profiles contain a full set of configuration settings specific to each user s requirements and determine system operation for the Pre Exercise Exercise and Recovery phases as well as settings for customization of ST measurements HR and METS report printing report settings and miscellaneous items e Create new exercise profiles for treadmill Ramp treadmill and pharmacological tests e Exercise protocols specify the manner in which a Stress test proceeds during the Exercise phase of the test i e Bruce protocol with the work level of each stage determined by the treadmill speed and grade
88. l C Canying groceries upstairs move heavy furniture Jog slowly on a flat surface climb stairs quickly Bicycling at a moderate pace sawing wood jumping rope slowly C Brisk swimming bicycle up a hill jog 6 miles per hour C Cary a heavy load fie a child or firewood up 2 flights of stairs Running briskly continuously level ground 8 minutes per mile Any competitive activity including those that involve intermittent sprinting Running competitively bicycle riding Questionnaire METS fs Predicted METS fi Target METS 11 Select an item in the list then click on Next lt lt Back Next gt gt Query the patient about their daily level of physical activity and select the appropriate item in the dialog box The software calculates the Target METS according to the selection in the dialog box then uses the Target METS to determine the work increment for the treadmill Click Next to proceed to the Hookup Screen and begin patient preparation Click Back to return to the Pre Test Settings dialog box A NOTE The Patient Activity Questionnaire dialog box appears only when using a Ramp protocol Hookup Screen In the Hookup phase prepare the patient for the test by connecting the electrodes and verifying the ECG tracing quality See Section IIl B Patient Preparation for more instructions During the Hookup phase the Average Beat displays will remain blank 31 Phase Indication Real Time ECG Tr
89. leads in the ECG tracing area are changed by using the Lead Selection list in the lower left hand corner of the screen Select an item from the drop down list and the display will automatically update When switching from chest leads to limb leads the software also changes the displayed leads in the average beat display area to match the ECG tracing area There are several key combinations that can be used to quickly change the displayed leads quickly Lead Selection Shortcut Key Combinations Shortcut Key Real Time Display Average Beat Display Alt C Chest leads Chest leads Alt L Limb leads Limb leads Alt A All leads No change h Alt R Rotates to the next lead Nochange group h h for th Alt E N change Shows the expanded average beat for the last selected lead A Note The up and down arrow keys are dedicated to controlling treadmill elevation and cannot be used to select lead groups from the drop down list Individual Lead Selection It is possible to display any ECG lead in the display area of any channel in the scrolling display area of the Exercise Test screen This feature allows the user to align ECG leads in ways that are not available from the standard lead group selections To assign an ECG lead to a display channel position click on the green lead label located to the left of the display channel in the scrolling display area and the Lead Selection dialog box opens Select the lead to display
90. lick OK Enter to add the statement to the list If the desired statement does not appear immediately press the first letter again to move to the next available choice Select from the drop down list To modify or edit a statement in the interpretation list select the statement in the list then click Modify Alt M The following Modify a Statement dialog box appears Type a new statement or modify the existing statement then click OK Enter to save 66 IQstress Operation Manual G Trends Screen The Trends screen displays trend graphs for HR METS blood pressure and double product DP 100 VE min ST level and ST slope for each lead mith 0 5 c 08 21 56 18 Summary Table Average Beats Trends Rhythm Strips HR METS Double Product VEIMin 300 sg 2 250 w 200 2 150 105 100 i 50 o 0 10 15 10 12 14 16 8 10 12 4 16 Lead Lead it Lead Ill Lead aVR 10 10 10 10 4 4 ae 5 5 5 5 ai z2 z2 aa afg 4 aig siz 4 o o gij So o gif So og o og 5 ge Bug ge 3 5 2 5 2 Pe ES 5 B s 4 4 4 4 10 10 10 10 10 15 10 15 10 15 10 15 Lead aVL Lead aVF Lead v1 Lead V2 10 10 10 10 4 4 3 Sails S alls S wils2 5g o ogi o o eff o o gf o og 5 fE E E 345 ba pi 2 ga a m a be 4 4 4 4 10 10 10 10 10 15 10 15 10 15 10 15 Lead V3 Lead v4 Lead V5 Lead V6 rm 10 Demo Simulated Dat
91. lly jumps to the Diastolic edit box so the user can continue to enter data If entering only two digits in the Systolic edit box press the Tab key and enter the diastolic BP If BP requires correction click the Correct Last Measurement box and enter the correct BP Click OK Enter to enter the BP into the report Save the Resting ECG Report To acquire a resting ECG report the electrode positions should be positioned as indicated in Section III B Patient Preparation If using the exercise limb lead placement for the resting ECG please recognize the fact that this placement will distort the ECG by shifting the axis to the right increasing the voltage in the inferior lead group This may cause Q waves to disappear for patients with documented Q wave inferior myocardial infarction 36 IQstress Operation Manual To acquire the resting ECG click Resting ECG F9 The Resting ECG dialog box appears value Units Sinus Rhythm 83 BPM P QRS 1 1 Normal P axis H Rate 84 PORET Inferolateral ST elevation possible repolarization variant PROBABLY NORMAL 350 msec 393 msec 110 msec Print Re acquire the resting ECG report as many times as needed during pre exercise The software will overwrite the previous report Click Print in the Resting ECG dialog box to print the resting ECG report Click OK to close the dialog box and proceed with Pre Exercise phase operations Move the limb electrodes from the resting ECG posit
92. ls are first fed to the 8 ECG buffer amplifiers These buffer amplifiers provide high input resistance for the patient interface with low output resistance to the instrumentation amplifiers Instrumentation Amplifiers There are eight differential instrumentation amplifiers used in the ECG module providing eight output signals from CHO to CH7 Each differential amplifier has two inputs one positive and one negative The following table lists the positive and negative inputs for each channel Channel Number Positive Input Negative Input CH1 Wilson Center Wilson Center Wilson Center Wilson Center Wilson Center Wilson Center The Wilson Center is a reference point combined with the three limb leads The purpose of the instrumentation amplifier is to provide a high Common Mode Rejection Ration CMRR rejecting common mode signals such as 60 Hz line noise Filters and Gain Amplifiers After the instrumentation amplifiers the 8 channel ECG signals are passed into two stages of filters The first stage consists of eight first order high pass filters with a cutoff frequency of 0 048Hz The second stage consists of eight low pass filters with a cutoff frequency of 159Hz The ECG signals are also amplified to match the AD converter input dynamic range of 0 2 5V There are eight test points provided on the PCB board The test points are labeled as CHO CH1 CH2 CH3 CH4 CH5 CH6 and CH7 The signals measured on these test points are
93. lt Ergometer Eai Bruce Treadmill Default Treadmill Bruce Treadmill To add a new profile select an existing profile from the list to the left then click on Add To edit an existing profile select the profile in the list then click on Edit or double click on the profile name The Default profiles cannot be edited or deleted The Current Profile drop down list indicates the currently selected user profile The software uses these settings to determine system operation during a new Stress test review and edit operations and for printing reports To edit an existing user profile click on the profile in the list then click Edit or double click on the name Profile Name Bruce Treadmill Profile Type User Defined Test Type Treadmill Risk Assessment py Enable Duke Treadmill Score OTS To add a new profile select a profile in the list to use as a template then click Add The Profile Settings dialog box appears New Profile Name Based On Profile Bruce Treadmill Test Type Treadmill cme __ tt 12 IQstress Operation Manual The Test Type determines the type of test for the new profile i e selecting the Default Treadmill profile applies to a treadmill type of test The available test types are treadmill Ramp and pharmacological The Default profiles cannot be changed although the settings can be viewed by selecting the profile and clicking Edi
94. lter IQspiro Qvitals IQvitals PC and Weight Scale Interfaces Contact the Midmark Sales Department for the latest information on available Midmark products or visit midmark com B Necessary Computer Skills This manual is intended for a user capable of using Microsoft Windows based applications has some understanding of PC operations and is familiar with the basic operations of Windows It is designed as a comprehensive guide to educate the user on the operation and functions that are available with IQstress C System Configuration The block diagram below illustrates the standard configuration of the IQstress system The primary components are a Windows based PC a printer and the IQecg acquisition module Please refer to this diagram when setting up your IQstress system ANOTE DO NOT USE ina thin client environment 1Qecg Windows Based Module D Computer r 10 Lead Connection Printer optional Figure 1 1 Stress Testing System Configuration Using lQstress IQstress Operation Manual D System Specifications The following are the software performance specifications for the IQstress lQstress Software Specifications Category Intended Use Specification IQstress is to be used under the supervision of a physician to monitor the patient s electrocardiograms from the human body surface during stress induced from exercise devices such as a treadmill or drug induced pharmacologi
95. manager A faster CPU and or more Memory may be needed if planning to operate the IQstress through an EMR or install additional software tAll in one desktops laptops and tablet computers are NOT recommended for performing live Stress test due to the resources demand of the application A 110VAC Uninterruptible Power Supply UPS in place of the hospital grade power surge protector is highly recommended to protect the computer system from power spikes surges and brown outs In the event that there is an interruption to the power an UPS can provide a few minutes of reserve so you can exit and save the test immediately It is recommended that the ECG module and treadmill be connected directly to the computer instead of a USB hub if one is used USB ports contacts can become worn with repeated use The IQstress test may not function with this specific USB port IQstress Operation Manual B Computer Setup A NOTE If IQmanager is already installed on the computer and are now either upgrading or adding a new Midmark product please skip this section and refer to the Qmanager Operation Manual for installation information Before installing Qmanager on a computer it is important to understand and carry out the following tasks Windows Taskbar lIQmanager is designed to run as a full screen program For best results the Windows Taskbar should not be displayed in order to provide maximum display area Place the mouse
96. ments will be stored Click Exit F12 to end the test A minimum of 128M bytes of memory is required Message appears when starting a new Stress test The software will not start a new Stress test if the computer has less than 128MB of memory e Either add memory to the computer or install the software on a computer that has more memory Operating system version must be Windows 2000 or later Message appears when starting a new Stress test The software requires Windows 2000 or later to run a new Stress test e Install the software on a computer that has one of these operating systems installed The minimum display resolution required is 1024x768 Message appears when starting a new Stress test The computer being used does not meet the minimum requirements for display resolution Change the display resolution as follows 1 Right click on the Windows desktop 2 Select Properties 3 Click on the Settings tab of the Display Properties dialog box 4 Adjust the display resolution using the Screen Area slider control to at least 1024x768 For best results use 1280x1024 or higher 5 Click OK 6 Run the software again 107 IQstress Operation Manual B Appendix B Physician s Guide to the Duke Treadmill Score The ACC AHA Exercise Testing Guidelines and the AHA Exercise Standards For Testing and Training documents recommend using the Duke Treadmill Score DTS ANOTE The
97. n the COM port specified for the treadmill e The COM port is in use by another device Select a different COM port for the treadmill if one is available If no more serial ports are available uninstall the device using the COM port COM Error e The specified COM port does not exist on the computer Display the Hardware tab of the Treadmill status display Settings dialog box and select the correct COM port If the available COM ports are not known use the Windows Device Manager open My Computer select Properties from the pop up menu slick on the Hardware tab then click Device Manager Click the plus next to Ports COM amp LPT in the device list to view the list of available COM ports CPU clock speed must be greater than 600M Hz The computer does not meet the minimum speed requirements for the software Message appears when starting a new e Install the software on a faster computer Stress test The treadmill is not connected to the computer it is powered down or its mechanical emergency stop button ESB is engaged e Verify the connection between the treadmill and the computer check that the serial port selection is correct in the Hardware tab of the Qstress Settings dialog box e Check that the treadmill is plugged in e Check the treadmill s power switch is on e Check that the ESB is released To release the ESB turn the red knob Disconnected Treadmill status display amp NOTE t
98. ne rhythm lead format the others may include the average beats depending upon the configuration settings Specify the lead groups for the three lead and six lead page formats There are two report formats The Summary Rhythm Strip Report is the default typically consists of four or five printed pages with the following stored rhythm strips e All Pre Exercise phase rhythm strips e Peak Exercise phase rhythm strip e Recovery phase rhythm strip The Detailed Rhythm Strip Report prints all stored rhythm strips including continuous rhythm strips This report may contain up to twenty or more printed pages depending upon the configuration settings for rhythm strip storage Real Time Rhythm Strip Printing The software provides the following options for printing the rhythm strip from the real time display screen The ECG leads used for rhythm strip printing are the same as the leads displayed on the real time screen No average beats will be printed e 10 seconds rhythm strip default e 30 seconds rhythm strip e Continuous rhythm strip ANOTE For better performance a fast laser printer is recommended A slow printer will take more than 10 seconds to print a 10 second rhythm strip which 73 IQstress Operation Manual result in the rhythm strips being printed out of real time However all 10 second rhythm strips will be printed eventually from the printer queue The 10 second rhythm strips will also be saved in the Stress test report fo
99. not assume responsibility for damage due to improper packaging shipment or product use Such actions will void all applicable warranties Midmark Corporation 690 Knox Street Suite 100 Torrance California 90502 Tel 310 516 6050 USA 800 624 8950 option 2 Fax 310 516 6517 96 XII Contact Information Midmark Corporation 690 Knox Street Suite 100 Torrance California 90502 Phone 310 516 6050 USA 800 624 8950 option 2 Fax 310 516 6517 Email techsupport midmark com Website midmark com Knowledge base kb midmark com 97 IQstress Operation Manual IQstress Operation Manual XIII IQecg Service Manual Introduction The Midmark IQecg is a computer based diagnostic instrument that converts any Windows based computer to a 12 lead electrocardiograph with interpretative and data storage capabilities A complete IQecg system consists of the ECG data acquisition module the computer system which includes the monitor and the printer the Microsoft Windows operating systems Windows 8 7 or IQmanager software program This manual is provided to assistance primarily with service of the IQecg module For information regarding the operation of the Qecg module refer to the Qecg Operation Manual For information about the service and operation of the computer system please consult your computer s documentation Theory of Operation The IQecg module is an improved version of previous hardw
100. o Trackmaster TMX425 and TMX428 users The Trackmaster treadmill has a built in safety feature that prevents the computer from controlling treadmill when the mechanical emergency stop button ESB is pressed 103 IQstress Operation Manual IQstress Troubleshooting Guide ECG Module Low Battery Message appears in the message prompt Replace the batteries in the ECG module ECG Module Not Responding Message appears in the message prompt This message appears in the prompt display of the Hookup or Exercise Test screens for both the USB and serial port version of the ECG module See above if using the USB version of the ECG module If using the serial port version of the ECG module the Auto Detect dialog box will appear connect the ECG module to a COM port then click Start on the Auto Detect dialog box to have the Auto Detect software scan the COM ports and determine which port the ECG module is connected to The dialog will close if the software successfully detects the ECG module If unsuccessful the Auto Detect dialog will display further instructions ECG module not responding Connect the ECG module to the USB port Click OK to try again Message appears when starting a new Stress test or during the Stress test This message appears only if using the USB version of the ECG module Connect the ECG module to a USB port on the computer and click OK Click Cancel then click Exi
101. odes and lead wires be firmly secure Follow the instructions in Section III B Patient Preparation for best performance e Verify the electrodes are fresh moist and sticky not dry or hard check the electrode expiration date e Verify that the patient lead wires and cables are not damaged or worn out e Inspect connections between the electrodes clips lead wires lead cable and the ECG module e The exam room should not be too cold the patient may shiver causing a noisy signal e If any of Il Ill aVR aVL and aVF on the screen are noisy or flat lined always check the limb lead electrodes for proper contact in this order RL LL RA and LA If a precordial lead is noisy or flat lined check the limb lead electrodes first and then check the corresponding chest lead electrode for proper contact Once identified discard and replace the used electrode Prepare the problem site again or try a new electrode site in close proximity to the original site Note any site variance on test report e If after the above steps noise or artifact still occurs in the ECG try the filter settings on the ECG screen Turn the AC filter ON if 50 60Hz noise is detected Verify that the Muscle filter ON Verify that the Drift filter is ON if the ECG baseline is drifting While these digital filters can improve signal quality they cannot correct hookup problems ANOTE As with any ECG measuring device turning on the Muscle filter may alter mea
102. of CAD according to the following Gibbons R J Balady G J Bricker J T Chaitman B R Fletcher G F Froelicher V F et al 2000 ACC AHA 2002 Guideline Update For Exercise Testing A Report of the American College Of Cardiology American Heart Association Task Force On Practice Guidelines Committee on Exercise Testing Retrieved from American College of Cardiology www acc org clinical guidelines exercise dirlndex htm Fletcher G F Balady G J Amsterdam E A Chaitman B R Eckel R Fleg J et al 2001 Exercise Standards for Testing and Training A Statement for Healthcare Professionals From the American Heart Association Retrieved from Circulation www circ ahajournals org cgi content full 104 14 1694 4 Meyers J N Brader D Madhavan R amp Froelicher V F 2001 Validation of a Specific Activity Questionnaire To Estimate Exercise Tolerance in Patients Referred For Exercise Testing American Journal of Cardiology 142 6 1041 1046 108 IQstress Operation Manual DTS Score Range Risk DTS gt 5 11 lt DTS lt 5 DTS 11 109 IQstress Operation Manual C Appendix C METS Calculations lQstress program calculates the estimated number of METS based upon the current work level when using a treadmill The ACSM s Guidelines for Exercise Testing and Prescription describes two equations for METS calculation If the treadmill speed is less than or equal to 3 7 mph the
103. omatically recalculates the reported ST measurements if the ST lead selections are changed and will store the new ST lead selections with the report data Review and change excluded ECG leads at any time from this screen A NOTE Changing the ST lead selections in the Average Beat Review screen does not affect the user profile configuration settings Trend Display The Trend display at the bottom of the Average Beat Review screen plots two trended parameters on the vertical axes left and right by the test time on the horizontal axis By default the software plots the heart rate on the left vertical axis and the ST level of the lead with the worst case depression on the right vertical axis Each point on the graph represents a stored average beat Phases are color coded e The Pre Exercise phase is light orange e The Exercise phase is light green e The Recovery phase is light blue Vertical lines mark the beginning and ending of each stage within a phase Hover the mouse over a point on the graph to display the stage information of that point the stage information appears in the lower right corner of the trend display aw amp ZA 12487 LS Stage information 1 amp N 16 47 8 13 Stage Stage 6 16 12 17 57 61 IQstress Operation Manual Navigating within the Trend Display The red vertical marker in the Trend display indicates the time of the displayed average beat There are two ways to use the trend to
104. ort has not been signed by a physician and can still be edited If the Reviewed By box is filled in with a physician s name and the Sign checkbox is checked and saved when the review screen is exited the report becomes read only 57 IQstress Operation Manual B Review Details Screen 1955 Sex Male Test Date 10 16 2008 21 Summary Table Average Beats Trends Rhythm Strips 25618 Pre Exercise 02 52 Supine 02 52 60 120 80 4 01 05 03 07 54 Standing 05 02 61 120 80 72 02 05 04 Exercise 01 00 Stage 1 01 00 17 100 5 69 01 04 01 02 00 02 00 1 7 10 0 66 0 0 04 02 03 00 03 0 VF 100 5 64 120 80 4 0 1 06 03 04 00 Stage 2 01 00 25 120 7 86 130 80 89 10 oo 05 05 00 02 00 25 120 7 99 og 03 03 06 00 03 00 25 120 7 101 132 88 133 04 EE 08 07 00 Stage 3 01 00 34 14 0 10 107 08 AS 14 07 33 01 33 34 140 10 105 08 18 12 Recovery 01 00 01 00 114 04 13 09 oat ont 122 144790 172 01 04 01 p Il Worst Case Lead Pri it Settings Demo Simulated Data Review Details Screen Summary Table The Review Details screen allows the user to select and view the following reports e Summary Table Average Beats Trends Rhythm Strips Resting ECG available only if a resting ECG analysis was performed during the Pre Exercise phase of the test Review Details Screen Controls Control Display Description 1 Screen Selector Tab Control Select the review screen to view
105. oximately 30 seconds to learn the ECG signal e Once complete the program will automatically enter the pre exercise phase of the test and display the initial average beats 35 IQstress Operation Manual C Pre Exercise Phase Operation During the Pre Exercise phase the following operations are typically performed 1 Obtain and enter a supine blood pressure BP measurement optional Acquire a resting ECG report optional Acquire a supine rhythm strip Acquire and enter a standing BP measurement Prepare the patient for exercise Acquire a standing rhythm strip save it and start the treadmill ae ge oe The above sequence of pre exercise actions is typical but may not be the exact sequence performed at the facility If this is the case the user may customize the software to meet you requirements as described in Section II E Configuration Settings The lQstress test has been designed to create a patient baseline during the Learning Phase Patients with abnormal or irregular heartbeats may have difficulty or may not be able to pass the Learning Phase of the stress test These patients may not be suitable for the stress test Enter Blood Pressure Measurements Click Enter BP F5 to display the Enter BP dialog box and enter the systolic and diastolic blood pressure Systolic 120 Diastolic s0 I Correct Last Measurement Cancel If entering three digits in the Systolic edit box the cursor automatica
106. pointer on the blank portion of the Taskbar on the bottom of the screen then right click and select Properties Check the Auto hide the taskbar box to hide the taskbar when it is not in use to display the taskbar when it is hidden move the cursor over the area where the taskbar is normally set and it will reappear Screen Saver If a screen saver or any energy saving feature is enabled on the computer make sure that it does not activate and interfere with data acquisition during patient care Refer to your computer or software manual for these settings C Software Installation A NOTE The following software installation information refers to Qmanager only If using an IQstress through an EMR please contact Midmark Technical Service for assistance with installation and setup The medical diagnostic application IQstress uses I Qmanager to manage patient records When installing or upgrading the IQstress IQmanager is automatically installed or upgraded accordingly Refer to the Qmanager Operation Manual for further information A NOTE Close all Windows programs before installing this software Do not interrupt the installation program while it is running The installation should take less than five minutes A NOTE If using the Stress Output Module SOM be sure it is not connected to the computer during this software installation If the SOM was connected to the computer during the installation 1 wait for the inst
107. protocol from the drop down list A NOTE A user cannot edit an exercise protocol from the Exercise Settings tab To edit an existing protocol or to create a new one go to the Protocol tab of the Qstress Settings dialog box The list on the left side of the dialog box shows the stages for the selected protocol Configure individual settings for rhythm strips and BP entry for each stage of the protocol or configure the same settings for all stages To enable automatic print of the peak exercise ECG strip immediately after the exercise phase check the Print Peak Exercise Strip box The Rhythm Strips group of controls is for setting rhythm strip storage and printing parameters for an Exercise stage e Check the Enable box to enable storage of rhythm strips e Enter the when during the stage to begin storing rhythm strips in the First Strip Time edit box e To store or print more than one rhythm strip during the stage enter an interval in the Repeat Interval edit box o To save or print only one strip in the stage enter a value of 00 00 in the Repeat Interval edit box e To print a rhythm strip at the specified time check the Print box o Leave this box un checked to save a rhythm strip without printing it 16 IQstress Operation Manual The BP Entry group of controls determines if and when to prompt for blood pressure readings e Check the Enable box to display a prompt dialog for BP entry e Enter when during the stage the
108. r reviewing editing and printing The page number for the rhythm strips will be printed as Page1 Page 2 H Resting ECG Report The Resting ECG Report shows the interpretation general measurements and twelve leads of ECG data The software provides the following printing formats for the Resting ECG Report e 6x2 12 lead format default e 12 lead plus 3 lead rhythm e 12 lead simultaneous e 12 lead plus 1 lead rhythm 74 Vi IQstress Operation Manual Operations at a Glance The following is a quick start guide for creating a Stress test report for a new patient Select a patient or and click New Patient from the opening screen Complete the fields on the Patient Data screen as accurately as possible The patient s name and ID are required to perform a test and the program uses the patient s date of birth and sex for the test results Start a new exercise test by clicking New Test on the patient data screen New Patient Patient List View Report 10 11 Select the Stress test and enter relevant information Click OK Prepare the patient and attach the electrodes Refer to the Quick Reference User s Guide included with the IQstress kit for patient hook up or refer to Section lll B Patient Preparation for details Wait for the ECG tracings to stabilize When the signal quality is good and the baselines are stable click Stage Up F4 The phase display will indicate Learning The software req
109. r average beats F11 Settings Displays the Qstress Settings dialog box in the Hookup phase F12 Exit Ends the test and saves the report left Slower Reduces the treadmill speed by 0 1 MPH KPH arrow gt righ right Faster Increases the treadmill speed by 0 1 MPH KPH arrow V down Lower Decreases the treadmill grade by 0 5 arrow M up arrow Higher Increases the treadmill grade by 0 5 Alt C Displays the chest lead group V1 V6 in the ECG tracing window and the average beat display Alt L Displays the limb lead group I Il Ill aVR aVL aVF in the ECG tracing window and the average beat display 76 IQstress Operation Manual Shortcut Function Description Displays all twelve leads in the ECG tracing window Does not Alt A change the average beat display Rotates to the next lead group in the ECG tracing window Does Alt R y not change the average beat display Displays the expanded average beat display for the last selected Alt E lead Alt S Sweep Speed Rotates the sweep speed 12 5 25 or 50 mm s in the ECG Selector tracing window Alt G Gain Setting Rotates to the gain 1 2x 1x 2x in the ECG tracing window and the average beat display ANOTE There is an auto Stage Hold feature When one of the following treadmill commands keys is pressed the software automatically enters Stage Hold state e Slower left arrow e Faster right arrow
110. rage Beat Display Chest Leads LimbLeads Expanded Beat ST Level mm Current 1 9 Resting Fib Change AT ST Slope mvisec Current 0 2 Resting 0 1 Change 0 1 To return to the Average Beat Display click on the waveform area or click on the Chest Leads or Limb Leads tabs to show the Standard Average Beat Display for the chest leads or the limb leads 53 IQstress Operation Manual Trend Displays The Trend Display shows trend graphs for the heart rate ST measurements and blood pressure for the current phase of the test The horizontal axis represents the phase time in minutes The ST measurements trend shows a graph for the ST level and the ST slope ST level is plotted against the left axis and ST slope is plotted against the right axis of the trend The graphs are plotted in different colors Change the lead selection for the ST measurement trend by selecting a lead from the drop down list located above the ST measurement trend The software also changes the ST measurement lead selection when selecting an ECG lead for viewing in the expanded average beat view by clicking on the waveform area of an Average Beat Display 54 IV A IQstress Operation Manual Review and Edit Operations Overview Upon completion of a Stress test the software displays the Review and Edit screen showing a summary of the test results and allowing the user to do the following functions Vie
111. readmill Testing Thoroughly read the owner s manual included with the medical grade treadmill that will be used prior to operating it Each user should be familiar with the safety features and operation of the treadmill and always exercise the following precautions e Ifthe treadmill has a Stop Tether lanyard the wrist strap must be attached to the patient s wrist before operating the treadmill and throughout the entire test procedure e Never start the treadmill with the patient standing on the belt Always have the patient straddle the belt then start the treadmill and verify that the belt starts at an acceptably safe speed Have the patient step onto the slowly moving belt e Never allow the patient to step off the treadmill while the belt is moving or the elevation is changing e The patient should hold onto the side handrails but should not grasp the rail tightly as this will cause fatigue and introduce muscle artifact into the ECG signal ANOTE The treadmill may come with front and side handrails Gently holding to the side handrails has demonstrated less motion artifact than holding on to the front handrail e The patient should walk in an upright position and take long easy strides e Ensure that the ECG module cable is clear of the patient s legs and the treadmill apparatus e If the patient is unfamiliar with using a treadmill demonstrate the correct walking technique during the Pre Exercise phase as follows 1
112. recent report appears at the top of the list Select Stress Reports x Report Selection Stress Reports 1 08 14 04 12 44 55 Ph Select From List View Report Print Report Cancel Select Most Recent 4 to compare the four most recent Stress reports or select the Select From List radio button to select two three or four reports to compare Select View Report to view the report on the screen or Print Report to print the serial comparison report Click OK to view or print the report 68 IQstress Operation Manual parison Report John Smith ID 123 Sex Male Age 53 Test Date 10 21 2009 06 11 05 PM 08 28 2009 03 05 27 PM Protocol Bruce Bruce Reviewed By Review Date Heart Rate Pre Exercise 70 BPM 60 BPM Maxamum 118 BPM Exercise 04 33 184 BPM Exercise 05 16 Percent Target 70 110 Recovery Not Available 184 BPM 0 BPM Recovery 02 00 __Maximum 11 7 __ Percent Target 100 63 ST Level Max Lead y V6 Pre Exercise 08mm 0 1mm Maimum 1 5 mm Exercise 02 29 0 0 mm Exercise 03 26 Change 22mm 0 1mm ST Slope Max Lead Il V6 Pre Exercise 0 7 mvisec 0 2 msec Maximum 2 6 mvisec at max ST Level 0 1 mvisec at max ST Level Change 2 0 mvisec 0 1 mvisec Blood Pressure Pre Exercise Not Available 156 84 Maximum Not Available 156 84 Pre Exercise 00 20 Summary The Duke Treadmill Score DTS of 6 1 indicates moderate risk The Duke Treadmill Score DTS of 5 0 indicates low risk
113. s Hide the Freeze Display by clicking Hide 3 or Unfreeze F8 51 IQstress Operation Manual Freeze Display Controls Control Description Slide Bar Quickly moves to different phases and stages Previous d Displays the previous four to six seconds of the ECG Next b Displays the next four to six seconds of the ECG Refresh Updates the Freeze Display with the most recent ECG data Hide gt Hides the Freeze Display Prints and saves a rhythm strip containing the ECG displayed in the Print i Freeze Display Saves a rhythm strip containing the ECG displayed in the Freeze Save Display Adjusting ST Reference Points Click Adjust ST F10 to adjust the ST reference points for the average beats The Adjust ST Points dialog box will appear in the lower right hand corner of the display Isoelectric Point J Point Reset Cancel e Use lt lt lt to move the isoelectric or J Point to the left of its current position e Use gt gt gt to move the isoelectric or J Point to the right of its current position e Reset restores the reference points to their original positions Click OK to accept the new reference point positions or Cancel to ignore the changes Average Beat Display The Average Beat Display shows the average beats for six leads at a time Toggle between the chest leads and the limb leads by clicking on the Chest Leads tab or the Limb
114. s dialog box Pre Exercise Stage Settings Stage Name Print Rhythm Strip C Yes No Prompt For BP C Yes No User Prompt Message Prepare for standing ECG press Stage Up F4 when OK Cancel Help Change the name of the stage by typing it in the Stage Name edit box To configure the software to automatically print a rhythm strip when leaving the stage select Yes next to the Print Rhythm Strip option A NOTE The software automatically saves a rhythm strip at the end of each Pre Exercise stage even if it is not printed Select Yes next to the Prompt For BP option to automatically display a BP prompt dialog box at the beginning of the Pre Exercise phase The User Prompt Message text appears in the message prompt area of the Exercise Test screen at the beginning of the Pre Exercise stage 15 IQstress Operation Manual Exercise Settings The Exercise tab configures the settings for the Exercise phase of the Stress test T Profile Settings for User Profile General ST TS Report Printing Repo 4 gt Rhythm Strips Enable _ Make All Like This First Strip Time 03 00 mm ss Repeat Interval 03 00 mm ss I Print Strip BP Entry Enable _ Make All Like This 700 mm ss First Prompt Repeat Interval 03 00 mm I Print Peak Exercise Strip Cancel The Exercise Protocol drop down list configures how the software will control the exercise device Select any
115. sconnected 33 IQstress Operation Manual Limb Lead Placement For Resting ECG RA White White Right Arm electrode is placed on a distal portion of the right lateral side of the upper arm below the shoulder LA Black White Left Arm electrode is placed on a distal portion of the left lateral side of the upper arm below the shoulder RL Green White Right Leg electrode is placed on the inside calf midway between knee and ankle LL Red White Left Leg electrode is placed on the inside calf midway between knee and ankle Limb Lead Placement for Exercise Test RA White White On or just below the clavicle bone avoiding muscular areas LA Black White On or just below the clavicle bone avoiding muscular areas RL Green White On or below the ends of rib cage avoiding flabby areas and the belt LL Red White On or below the ends of rib cage avoiding flabby areas and the belt Precordial Lead Placement RA LA V3 l l a 4 v2 A r v4 n NS EY v5 g3 4 ve wry S N Y RL LL 34 IQstress Operation Manual V1 Red Brown Fourth intercostal place at the right margin of the sternum V2 Yellow Brown Fourth intercostal place at the left margin of the sternum V3 Green Brown Midway between V2 and V4 on top of the 5 rib V4 Blue Brown Fifth intercostal place at the left midclavicular line V5 Orange Brown At the horizontal level of V4 at the anterior axillary line V
116. se Measure and Enter Blood Pressure After measuring the blood pressure click Enter BP F5 and enter the measurement into the dialog box as described in Section III C Pre Exercise Phase Operation Enter the BP at any time during the Exercise phase Manual Treadmill Control The software automatically controls the treadmill and changes the speed and grade according to a pre programmed exercise protocol i e Bruce protocol Manually control the treadmill speed and grade as well as change the exercise stage to increase or decrease the work level Control the treadmill speed or grade with the following commands e Slower left arrow decreases the treadmill belt speed by 0 1 mph e Faster right arrow increases the treadmill speed by 0 1 mph e Lower down arrow decreases the grade by 0 5 e Higher up arrow increases the elevation by 0 5 e Stage Up F4 advances to the next exercise stage causing the treadmill speed and grade to change to the settings for the next stage 39 IQstress Operation Manual e Stage Down F2 retreats to the previous exercise stage decreasing the treadmill speed and grade according to the exercise protocol in use e Stage Hold F3 prevents the software from advancing to the next stage when the stage timer expires o When pressed the button label changes to Stage Release The treadmill speed and grade will remain at the current settings until one of the following actions is performed Click Sta
117. secsesessssecscessessasssessesseeeseseasseeees 62 Changing Trended PALAMELteLS scscccccccseessnssseseceseesssecesecsssesesssecscessesuaascesscsseeesesseasseeees 62 E RHYTHM STRIP SCREEN srira enara eaa E Ea aaa dE AE a EAA ue wine EEEa paa EEEE EA EEEO 63 Navigating in the Waveform Area uisscccccceceessssscececeseessssscesecsseeeassececeesessaassessenseesseaseassesees 64 Rejecting Rhythm Strips a a aa ar aE A E a LESE EEE AREE 64 F RESTING ECG SCRE N senos entendan aiie ae ai a eia ao niii a n aradt 64 Editing th Interpretati n msen inari a a a a e aaa 66 G VRENDS SGREEN E E AA E EA E EEE 67 IQstress Operation Manual H SERA COM PARISO N e a a a a a a a a a a a A 68 Vin e EEEE A E E N E EEE N E T E E E E EE 69 A OVERVIEW i eai CC lode ts BN a ae a a Aa a e a rata IP B COVER PAGE REPOR Feanen aeaaeae aea a EES SETAE cklecasecswareadeecGaudsenaneenlscsneasuareadenccatueanacecteseiete POtiONt DA A e Teds a a a a a ee T st Rel ted Data meien aai aiai aa iaa aaea aa i aaa aaraa ange Heart Rate MCASULCMENES cccccsseccccsssscecseneecseeeesessencesseecesseeseesessensessaneesseaessssansessaneeees METS Measut ments zonier anaa e ste ePesdecoe a O diea ase a aa ST Level and Slope Measurements Blood Pressure and Double Product VentriculaRACtIVIt Vin aei a e e a pa aaea eei e ieaie ia a baad RA Ro A A 5 18 A EEE B E E A A ban Gace ocstee gan daaead REASON for Terminati mrien dira ia iaai i aiaia aiian Interpretat
118. ss system including the treadmill before patient use Replace the patient cable with Midmark patient cables equipped with built in defibrillation protection Contact Midmark Technical Service for cable replacement Windows operating systems are multi tasking operating systems that allow the user to simultaneously run multiple applications During a Stress test never allow another application to obscure the display of the software as this may impair the ability to monitor the patient lQmanager or electronic medical record applications will not interfere with the test software if the computer used meets the minimum requirements specified in Section General Information Do not proceed with a Stress test if the software appears sluggish or the scrolling waveform display appears slow If this is experienced stop the software close all unrelated applications and try again Contact Midmark Technical Service if difficulties persist Refer servicing to qualified service personnel only Electronic devices can be damaged by exposure to liquids Do not use or store the IQecg or any other components of the IQstress system near any type of liquids vii IQstress Operation Manual l General Information A Introduction lQstress with Trackmaster TMX428 lQstress with Trackmaster TMX425 The info in this Operation Manual is provided for users of Stress system models Midmark IQstress and IQmark EZ Stress which may
119. ssure Device Other auxiliary lQmark EZ Stress Software The SOM interfaces via a Universal Serial Bus USB port to a Windows based PC running the stress test software The SOM provides two digital outputs for use as QRS triggers and four analog output signals Specifications Intended Use General Specifications e For use with Midmark stress test diagnostic software as a component of an exercise stress testing system e The digital outputs provide real time QRS pulses for interfacing to ultrasound equipment for stress echo procedures automatic blood pressure measurement devices or other equipment requiring a digital QRS synchronization pulse e The analog outputs are intended for use with auxiliary monitoring devices that collect information produced by Midmark stress test diagnostic software 44 CAUTION This device is not intended for use with defibrillators or other automatic resuscitation devices A NOTE The ECG analog output signals are not intended for diagnostic ECG use they are intended for reference or monitoring purposes only A NOTE The SOM is intended for use with the USB version of Midmark digital ECG diagnostic modules and is disabled if using a serial port PC Interface Full speed USB Number of Digital Outputs 2 Number of Analog Outputs 4 Power Supply USB powered Current Requirements lt 50ma 79 IQstress Operation Manual Pa
120. stalled Internal Treadmill status display This status indicates that the software is not controlling the treadmill because None is selected for the treadmill type This may be acceptable if using a treadmill that does not interface to the software and wish to use a manual controller To have the software control the treadmill select Trackmaster TMX425 Model treadmill in the Hardware of the Settings dialog This setting controls both the TMX425 and TMX428 treadmill models Internal Bicycle ergometer status display This status indicates that the software is not controlling the bicycle ergometer because None is selected for the bicycle ergometer type This is currently the only option available in this version of the software Midmark may add interfaces to selected bicycle ergometer devices in future releases of the software 106 IQstress Operation Manual IQstress Troubleshooting Guide Lead Off Message appears in the message prompt and the lead indicators for one or more ECG leads turn red Electrode leads are disconnected e Connect the electrode lead wire of the ECG module to the electrode Max Test Time Exceeded Data Storage Disabled Message appears in the message prompt This is not an error the software stores ECG data and measurements for a maximum time of 100 minutes starting in the Pre Exercise phase Continue to monitor the patient but no measure
121. surements which in turn may affect the test results e Click INST to reset the baselines or reset the ECG module e Verify patient or examination room is not susceptible to energy interference such as electromagnetic fields from high power equipment like X ray machines power generators power compressors etc ECG signal quality problems such as a low amplitude wandering baseline noisy signal etc 93 IQstress Operation Manual X Maintenance and Storage Cleaning CAUTION Do not use aromatic hydrocarbons rubbing alcohol or chlorinated solvents for cleaning the ECG module Do not use alcohol or acetone on lead wires or cables as they can stiffen and crack the insulating plastic Clean the outside of the ECG module with a mild solution of detergent and water using a soft cloth Avoid using excessive amounts of solution which may infiltrate the connectors battery compartments or the ECG module If necessary use a mild sterilizing detergent with low alcohol content that is generally used in hospitals Verify that all equipment including accessories is completely dry before using Preventative Inspection A preventative inspection should be done prior to each use of the ECG module This is done to verify that there is no visible damage to the device that may cause it to malfunction Visual inspection should include the module and all cables for signs of damage and deterioration including but not limit
122. t Changes will not be saved for these profiles Generel sT Pre Exercise Exercise Recovery HR METS Report Printing Repo 4 gt Profile Name Bruce Treadmill Profile Type User Defined Test Type Treadmill Risk Assessment v Enable Duke Treadmill Score DTS OK Cancel Help General Settings On the General tab type in the name of the profile in the Profile Name edit box Check the Enable Duke Treadmill Score DTS box if the Duke Treadmill Score is to be included in the final report See Appendix B Physician s Guide to the Duke Treadmill Score for more information ST Settings The ST Settings tab specifies the units to use for ST level and slope and the measurement point to use when displaying ST level and slope The software calculates the ST level and slope for each average beat at all four of the following measurement points e J 60 msec default e J 80 msec J HR Variable J User Defined Interval 13 IQstress Operation Manual Recovery HR METS Report Printing Repo4 gt ST Measurement Point J 60 msec C millivolts C J 80msec C J HR Variable C J User Defined ST Slope Units User Defined Interval gg msec 0 120 msec mvisec mmisec Select ST Leads The setting in the ST Measurement Point determines which measurement points are shown in the screens and reports When using the J HR Variable ST measurement point
123. t F12 to exit the software if you are unable to resolve the problem 104 IQstress Operation Manual IQstress Troubleshooting Guide ECG Module Serial Port Error Message appears in the message prompt This message only appears if you are using the serial port version of the ECG module The software could not open the COM port specified for the ECG because e The COM port is in use by another device e The specified COM port does not exist on the computer e The Auto Detect dialog box will appear connect the ECG module to a COM port then click Start on the Auto Detect dialog box to have the Auto Detect software scan the COM ports and determine which port the ECG module is connected to The dialog will close if the software successfully detects the ECG module If unsuccessful the Auto Detect dialog will display further instructions Error PC ECG I device connected Message appears in the message prompt The software detected that a Brentwood PC ECG module is connected to the specified serial port this message appears only if using the serial port version of the ECG module e The software cannot operate with a Brentwood PC ECG I module Acquire a Midmark IQecg module to use the software Please contact Midmark Technical Service Error Spirometry device connected Message appears in the message prompt A Spirometer device is connected to the serial port assigned to the ECG module this mess
124. tal QRS synchronization pulse to the Tango device The software controls the Tango device and receives BP measurements from it via the serial cable The required cables are available from SunTech as follows Cable SunTech Part Number Description Serial RS 232 91 0013 00 91 0011 00 1 Connect the SOM to one of the USB ports on the computer 86 IQstress Operation Manual 2 Connect one end of the coaxial cable to the channel 1 or 2 digital output BNC connector of the SOM Connect the other end to the BNC connector on the Tango device 3 Connect one end of the serial cable to one of the COM ports on the computer and the other end to the serial RS 232 connector on the rear of the Tango device A NOTE If there are no available COM ports on the computer then it will be necessary to use a USB to serial port adapter for the Tango device Install the USB adapter according to the manufacturer s instruction then connect the USB adapter to the computer and the Tango device to the serial port connector of the USB adapter Configuring the Tango Device A NOTE The Tango device may be a newer model than described below Follow the installation and setup instructions that come with the Tango device The following instructions describe how to configure the Tango device 1 Turn on the device using the switch at the rear top left corner of the device 2 Once the operating screen is displayed click the WENU
125. tement for Healthcare Professionals From the American Heart Association Retrieved from Circulation www circ ahajournals org cgi content full 104 14 1694 3 Pina L Balady G J Hanson P Labovitz A J Madonna D W amp Meyers J 1995 Guidelines for Clinical Exercise Testing Laboratories A Statement for Healthcare Professionals from the Committee on Exercise and Cardiac Rehabilitation Retrieved from Circulation http circ ahajournals org cgi content full 91 3 912 4 Gibbons R J Balady G J Bricker J T Chaitman B R Fletcher G F Froelicher V F et al 2000 Ibid V 10 11 12 IQstress Operation Manual e Symptomatic severe aortic stenosis e Uncontrolled symptomatic heart failure e Acute pulmonary embolus or pulmonary infarction e Acute myocarditis or pericarditis e Acute aortic dissection Become familiar with the operations and procedures of the instrument prior to use Thoroughly read the Trackmaster owner s manual included with the medical grade treadmill that will be used before operating it Installation and maintenance of the instrument e Install and keep the instrument away from splashing water e Do not install the instrument where humidity ventilation direct sunlight or air containing dust salt sulfur etc might affect it e Protect the instrument from shock and vibration while transporting it e Do not install the instrument in a chemical storage area or where gas is generated
126. the Hardware tab Verify that the Automatic BP Module Serial Port drop down list displays the correct COM port setting To display a list of COM ports available on the computer display Windows Device Manager expand the Ports COM amp LPT list by clicking on the symbol Disconnected Message appears in the Enter BP dialog Verify that the serial cable is connected to both the device and the computer Verify that the correct serial port is selected in the Automatic BP Module Serial Port drop down list of the Hardware Settings tab of the Qstress Settings dialog box Verify that the device is plugged in and is powered on Examine the Tango display to see if there are any error messages displayed Refer to the device s operations manual for explanation of the Tango error messages The Tango device does not start a BP sample during the Stress test Verify that the software is properly configured for operation with the Tango device See Section IX B Using the SunTech Tango Device with IQstress Verify that the Tango device is properly configured for use with the software See Section IX B Using the SunTech Tango Device with IQstress 92 IQstress Operation Manual SunTech Tango BP Troubleshooting Guide Error Message or Problem Possible Solution or Recommendation To have good ECG signal quality the patient must be properly prepared the lead placements be correct the electr
127. ttings Adjust ST F10 Displays a dialog that allows the user to adjust the ST reference points for the average beats Exit F12 Ends the test and saves the report Freeze Display The Freeze Display has a full disclosure feature that allows the user to review the previous ECG data going all the way back to the beginning of the Pre Exercise phase Click Freeze F8 to view the Freeze Display 50 IQstress Operation Manual Freeze Display Exercise 1044 stage 4 01 44 EFEFEF 7 Ins eae Rees Ie aA m ve RHH J sj x a al The upper portion of the Freeze Display shows the phase name phase time stage name and stage time The information will change as the slide bar at the bottom of the screen is moved The ECG data for that phase and stage time will be shown at the top of the screen Use the Previous q and Next p buttons to fine tune the ECG to review Depending on the screen size and resolution clicking the d or p button allows moving backward or forward four to six seconds e Click on the Refresh button to update the Freeze Display with the most recent ECG data e Click on the Print button to print and save a rhythm strip containing the ECG displayed in the Freeze Display e Click on the Save lal button to save a rhythm strip containing the ECG displayed in the Freeze Display The vertical scroll bar allows the user to display all 12 ECG lead
128. uires about 30 seconds to analyze and learn the ECG pattern ANOTE If artifacts or noise occur in the ECG signal see Section XV Appendix A Troubleshooting IQstress When the program finishes learning the ECG it automatically enters the Supine stage of the Pre Exercise phase Follow the instructions in the message prompt for each Pre Exercise phase When ready to start the Exercise phase and the message prompt shows Prepare for exercise Click Stage Up F4 to start have the patient stand on the treadmill s side panels so as to straddle the belt Press F4 to start the treadmill Instruct the patient to step onto the moving treadmill belt To terminate the Exercise phase click Recovery F9 After the treadmill has come to a stop have the patient move to the exam table and lie down Continue monitoring during the Recovery phase until the patient s cardiac condition returns to the Pre Exercise condition 75 IQstress Operation Manual 12 End the Stress test by clicking Exit F12 Enter the reason for termination required the level of chest pain required and the Borg scale optional 13 Reports are automatically saved and can be viewed after clicking Exit Vil Function and Shortcut Key Summary F1 Start Stop e Start Treadmill Starts the treadmill at the current setting Treadmill e Stop Treadmill Stops the treadmill F2 Saps Dow Returns to the previous protocol stage
129. ult is determined by the Display Leads setting on the Misc tab of the Configuration dialog box 9 Gain Button Navigating in the Waveform Area Perform the following actions on the waveform area to control the display e Zoom in to display a selected portion of the waveform in an expanded format Click the Waveform display when the cursor is a magnifying class with a plus sign in the center the display will magnify the ECG by a factor of two The cursor will change to a magnifying glass with a minus sign in the center which allows the user to zoom out e Scroll the Waveform display by using the horizontal and vertical scroll bars The vertical scroll bar is present only if the waveform display window is not large enough to contain all of the ECG data such as when displaying all twelve leads or in an expanded view e Pan the Waveform display by pressing the Shift key while clicking and dragging the mouse up down left or right Release the Shift key and the mouse when finished with moving the Waveform display e Resize the Average Beat display by clicking and dragging the splitter window control e Select different lead groups to view using the Leads drop down list Rejecting Rhythm Strips Delete a rhythm strip from the report by selecting the Reject radio button the rhythm strip will be deleted when the report is saved Deleting rhythm strips allows the user to reduce the number of pages in the report and or to
130. ve BP response Leg pain Protocol completed Signs of poor perfusion Cyanosis or pallor ST segment depression ST segment elevation Syncope Target HR attained Target METs attained Unable to use exercise device Cancel Help To add an item to the list click Add which displays the Add a Reason for Termination dialog box Add A Reason For Termination Reason Cen tt 28 IQstress Operation Manual To edit a reason select an item from the list and click Edit to display the Edit Reason dialog box Edit Reason on For Termination P Reason cme To delete an item select it from the list and click Delete 29 IQstress Operation Manual lll Stress Test Operation A Starting a New Stress Test 1 Click New Test the New Test dialog box appears xi Test Type Technician Tina May F ina May RN x l C ECG Requesting Physician lt Indication X l C Holter Supervising Physician X C Spirometry CJ cscs Co ca tee 2 Select a Stress test by clicking Stress Enter the name of the technician performing the test the requesting physician the indication or reason for performing the test and the name of the supervising physician Select these items from pre programmed lists Refer to the IQmanager Operation Manual for information on how to customize these lists 3 Click on OK to proceed The Pre Test Settings dialog box app
131. w and edit the report o View the test summary and edit the results o View all stored average beats and delete noisy beats from the report o View all stored rhythm strips o View tabular and trend data o View the resting ECG report and edit the interpretation Clicking File or Print allows the user to o Print or print preview the report o Fax or email the report o Save the report to a file Refer to the Qmanager Operation Manual for information on File and Print The review and edit screens are comprised of the following Summary Review view and edit the test summary and results Average Beat view and delete average beats stored with the report Summary Table view a spreadsheet style summary of HR ST BP exercise level and other measurements Trend view trends for the HR and the ST level and slope for all twelve leads Resting ECG view the resting ECG report including the interpretation Rhythm Strip view all of the rhythm strips stored in the report 55 i E Reports For John Smith ID 12131415 DOB 01 01 1955 ECG RR Variability Holter Spir lQstress Operation Manual Summary Review Screen Stress Vitals 1 10 16 08 21 56 18 J F Requested By Technician Reviewed By Supervising Physician Test Type ReviewDate r sign Review Details Heart Rate BPM Pre Exercise 61 BPM 4 121 BPM Recovery 01 33 Ventricular Activity Counts Min Max VE
132. yed here include the Pre Exercise phase BP the maximum BP and the double product DP for each of the BP measurements The Pre Exercise phase BP is the last BP reading entered prior to the start of the Exercise phase The DP is shown as the product of the systolic BP times the heart rate at the time of the BP reading divided by 100 Ventricular Activity The Ventricular Activity display area shows the maximum VE min that occurred during the test along with the phase name and phase time minutes seconds into that phase Level of Effort The Level of Effort consists of the total exercise time minutes seconds and the Borg Scale entry entered at the end of the test Reason for Termination This area shows the reason for terminating the test as entered before saving the report Interpretation This portion of the report shows the interpretation text as entered by the physician 71 IQstress Operation Manual C Summary Table Report The Summary Table Report shows e Phase and stage times e Exercise level speed grade and METS e HR e BP e DP e VE min e ST level for the three leads with the worst ST depression for each Pre Exercise stage and each minute of the Exercise and Recovery phases D Average Beat Report The Average Beat Report shows the phase name and stage time exercise level HR the averaged QRS complex for each lead and the ST level slope and QRS amplitude for each lead Each page of the report contains up to

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