A Novel Point-of-Care Smartphone Based System for Monitoring the Cardiac and Respiratory Systems

Kwanghyun Sohn,Rajiv Doddamani,Jagmeet P. Singh,Antonis A. Armoundas,Omid Sayadi,Dheeraj Puppala,Ashish Sahani,Eric M. Isselbacher,E. Kevin Heist,Faisal M. Merchant

doi:10.1038/srep44946

Abstract

Cardio-respiratory monitoring is one of the most demanding areas in the rapidly growing, mobile-device, based health care delivery. We developed a 12-lead smartphone-based electrocardiogram (ECG) acquisition and monitoring system (called “cvrPhone”), and an application to assess underlying ischemia, and estimate the respiration rate (RR) and tidal volume (TV) from analysis of electrocardiographic (ECG) signals only. During in-vivo swine studies (n = 6), 12-lead ECG signals were recorded at baseline and following coronary artery occlusion. Ischemic indices calculated from each lead showed statistically significant (p < 0.05) increase within 2 min of occlusion compared to baseline. Following myocardial infarction, spontaneous ventricular tachycardia episodes (n = 3) were preceded by significant (p < 0.05) increase of the ischemic index ~1–4 min prior to the onset of the tachy-arrhythmias. In order to assess the respiratory status during apnea, the mechanical ventilator was paused for up to 2 min during normal breathing. We observed that the RR and TV estimation algorithms detected apnea within 7.9 ± 1.1 sec and 5.5 ± 2.2 sec, respectively, while the estimated RR and TV values were 0 breaths/min and less than 100 ml, respectively. In conclusion, the cvrPhone can be used to detect myocardial ischemia and periods of respiratory apnea using a readily available mobile platform.

Highlights

Given the increasing prevalence of chronic disease in the United States, together with the pressure to curtail health care costs, more efficient and cost effective methods of evaluating and monitoring patients will be essential
Assessments of respiratory rate (RR) and tidal volume (TV) are important to determining the frequency of Cheyne-Stokes respiration (CSR) in HF10, so real-time access to such data could be of great value in clinical practice
It has been recognized that when managing patients with coronary heart disease, relying on symptoms of angina leads to a significant underestimation of the true frequency of myocardial ischemia, as

Summary

Introduction

Given the increasing prevalence of chronic disease in the United States, together with the pressure to curtail health care costs, more efficient and cost effective methods of evaluating and monitoring patients will be essential. There is an increased availability of new technologies and an ever-improving health information technology infrastructure To this end, mobile-health technologies are expected to function as monitoring devices, but as essential components in the healthcare delivery[1], especially among patients with chronic conditions[2,3,4,5]. Among the chronic diseases that affect the US population, cardiovascular conditions are among the most prevalent and costly to manage. Silent ambulatory ST-segment depression is associated with an increased incidence of coronary events in asymptomatic men, so routine assessment of such ST-segement depression could be used to better stratify populations are risk[12]

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Conclusion