Insertable heart monitor with myocardial infarction detection

Abstract

Systems and methods for a signal processing device for a patient management system are disclosed. In one embodiment, a signal processing apparatus includes a communication circuit configured to receive a cardiac signal from an AMD, where the received cardiac signal is a frequency filtered cardiac signal generated from a wider band cardiac signal sensed using the AMD; and signal processing circuitry configured to restore the received cardiac signal to a wider band cardiac signal; detecting an elevated ST segment in the recovered wider band cardiac signal; and generating an alert of myocardial infarction in response to detecting the elevated ST segment.

Description

CLAIM OF PRIORITY

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 526,092, filed July 11, 2023, which is incorporated by reference in its entirety. TECHNICAL FIELD

[0002] This document relates generally to medical devices, and more particularly to systems, methods, and devices for detecting myocardial infarction. BACKGROUND

[0003] Ambulatory medical devices (AMDs), including implantable, subcutaneous, wearable, or one or more other medical devices, can monitor, detect, or treat various conditions, including, among others, heart failure (HF), fibrillation, and myocardial infarction (MI). Myocardial infarction is a condition caused by a decrease or complete stoppage of blood supply to the myocardial tissue of the heart. Ambulatory medical devices can include sensors for sensing physiological information from a patient, and one or more circuits for detecting one or more physiological events using the sensed physiological information or communicating the sensed physiological information or the detected physiological events to one or more remote devices. Patient monitoring can provide early detection of patient condition deterioration, including MI. SUMMARY

[0004] Systems and methods for detecting ST-segment elevation myocardial infarction (STEMI) in a patient are disclosed. Pairing STEMI detection with patient-indicated symptoms, such as chest pain, improves the specificity of device-based STEMI detection.

[0005] Example 1 includes subject matter for a signal processing device, such as a patient management system, the device comprising: a communication circuitry and a signal processing circuitry. The communication circuitry is configured to receive a cardiac signal from an AMD, wherein the received cardiac signal is a frequency filtered cardiac signal produced from a wider band cardiac signal sensed using the AMD. The signal processing circuitry is configured to restore the received cardiac signal to the wider band cardiac signal; detect an elevated ST segment in the restored wider band cardiac signal; and generate an alert of a myocardial infarction in response to detecting the elevated ST segment.

[0006] In Example 2, the subject matter of Example 1 optionally includes the signal processing circuitry configured to inverse filter the frequency filtered cardiac signal to produce the restored wider band cardiac signal.

[0007] In Example 3, according to the subject matter described in Example 1, a signal processing circuit system may optionally be included, which is configured to inversely filter the frequency-filtered cardiac signal to produce an inversely filtered signal; and to perform phase correction on the inversely filtered signal to produce a recovered wider-bandwidth cardiac signal.

[0008] In Example 4, the subject matter according to one or any combination of Examples 1 to 3 may optionally include a memory for storing one or more baseline ST segment elevation measurements, and the signal processing circuitry system is configured to: compare the ST segment elevation of the recovered cardiac signal with one or more baseline ST segment elevation measurements; and detect ST segment elevation of the recovered cardiac signal based on the comparison.

[0009] In Example 5, the subject matter described according to one of Examples 1 to 4 or any combination thereof may optionally include a signal processing circuit system included in the server of the patient management system.

[0010] In Example 6, the subject matter according to one or any combination of Examples 1 to 5 may optionally include: a communication circuit configured to receive a sensed heart sound signal from an AMD; and a signal processing circuit system configured to detect an indication of myocardial infarction in the sensed heart sound signal; and to generate an alert when an elevated ST segment is detected in the recovered wider-band cardiac signal and an indication of myocardial infarction is detected in the sensed heart sound signal.

[0011] In Example 7, the subject matter described in one of Examples 1 to 6 or any combination thereof may optionally include a signal processing circuit system configured to generate a wider bandwidth cardiac signal based on a high-pass filtered cardiac signal received from the AMD.

[0012] In Example 8, the subject matter described in one of Examples 1 to 7 or any combination thereof may optionally include communication circuitry configured to exchange information with the AMD during a communication session initiated by the AMD; and to receive frequency-filtered cardiac signals from the AMD during the communication session.

[0013] Example 9 includes a subject matter (such as a method of operating a patient management system) or may optionally be combined with one of Examples 1 to 8 or any combination thereof to include a subject matter comprising: receiving a patient’s cardiac signal by a signal processing circuitry system of the patient management system, wherein the received cardiac signal is a frequency-filtered cardiac signal generated from a wider-bandwidth cardiac signal sensed using AMD; recovering the received cardiac signal to the wider-bandwidth cardiac signal using the signal processing circuitry system; and generating an alert of myocardial infarction when an elevated ST segment is detected in the recovered wider-bandwidth cardiac signal.

[0014] In Example 10, according to the subject matter described in Example 9, the system may optionally include: a signal processing circuitry system that reverse-filters the frequency-filtered cardiac signal to produce a recovered wider-bandwidth cardiac signal.

[0015] In Example 11, according to the subject matter described in Example 9, the system may optionally include: a signal processing circuitry system that inversely filters a frequency-filtered cardiac signal to produce an inversely filtered signal, and performs phase correction on the inversely filtered signal to produce a recovered wider-bandwidth cardiac signal.

[0016] In Example 12, the subject matter described in one or any combination of Examples 9 to 11 may optionally include: comparing the ST segment of the recovered cardiac signal with one or more baseline ST segments for the patient; and detecting that the ST segment of the recovered cardiac signal is elevated from one or more baseline ST segments.

[0017] In Example 13, the subject matter according to one or any combination of Examples 9 to 12 may optionally include: receiving a heart sound signal sensed using AMD by a signal processing circuitry system; using the sensed heart sound signal to detect myocardial infarction by the signal processing circuitry system; and generating an alert when an elevated ST segment is detected in the recovered wider-band cardiac signal and myocardial infarction is detected using the sensed heart sound signal.

[0018] In Example 14, the subject matter described in one or any combination of Examples 9 to 13 may optionally include: initiating sensing of a wider bandwidth cardiac signal by the AMD in response to a patient trigger received by the AMD.

[0019] In Example 15, the subject matter described in one or any combination of Examples 9 to 14 may optionally include: receiving a high-pass filtered cardiac signal having low-frequency signal components removed from a sensed wider-bandwidth cardiac signal; and recovering the low-frequency signal components in the cardiac signal.

[0020] In Example 16, the subject matter described in one or any combination of Examples 9 to 15 may optionally include: a signal processing circuitry system of a remote device located away from the AMD receiving a frequency-filtered cardiac signal from the AMD via a communication link; and restoring the received cardiac signal to a wider frequency band cardiac signal.

[0021] In Example 17, according to the subject matter described in Example 16, it may optionally include: the server’s signal processing circuitry receiving frequency-filtered heart signals from the AMD via a communication link.

[0022] In Example 18, based on the subject matter described in one or both of Examples 16 and 17, it may optionally include: transmitting a frequency-filtered cardiac signal from the AMD to a remote device during a communication session initiated by the AMD in response to a patient trigger.

[0023] Example 19 includes the subject matter of a computer-readable storage medium (or may optionally be combined with one of Examples 1 to 18 or any combination thereof to include such subject matter), the computer-readable storage medium including instructions that, when executed by one or more processors of a medical device, cause the medical device to perform operations including: receiving a patient’s cardiac signal by a signal processing circuitry system of a patient management system, wherein the received cardiac signal is a frequency-filtered cardiac signal generated from a wider-bandwidth cardiac signal sensed using a mobile medical device (AMD); restoring the received cardiac signal to the wider-bandwidth cardiac signal using the signal processing circuitry system; and generating a warning of myocardial infarction when an elevated ST segment is detected in the restored wider-bandwidth cardiac signal.

[0024] In Example 20, according to the subject matter described in Example 19, instructions may optionally be included that, when executed by one or more processors of a medical device, cause the medical device to perform operations including: inverse filtering a frequency-filtered cardiac signal to produce an inversely filtered signal; and phase correction of the inversely filtered signal to produce a recovered wider-bandwidth cardiac signal.

[0025] The present invention is intended to provide an overview of the subject matter of this patent application. It is not intended to provide an exclusive or exhaustive interpretation of this disclosure. Detailed descriptions are included to provide further information about this patent application. Other aspects of this disclosure will be apparent to those skilled in the art upon reading and understanding the following detailed descriptions and consulting the accompanying drawings, which form a part of it, and none of these detailed descriptions and drawings should be considered limiting. Attached Figure Description

[0026] In the accompanying drawings, which are not necessarily drawn to scale, the same reference numerals may describe similar parts in different views. The same reference numerals with different letter suffixes may indicate different instances of similar parts. The accompanying drawings illustrate, by way of example and not limitation, the various embodiments discussed in this document.

[0027] Figure 1 An example patient management system is shown.

[0028] Figure 2 An example of a mobile medical device (AMD) as an implantable medical device is shown.

[0029] Figure 3 This is a block diagram of AMD's electronic circuitry.

[0030] Figure 4 This is a block diagram of the external devices included in the patient management system.

[0031] Figure 5 This is a diagram of the PQRST complex on an electrocardiogram.

[0032] Figures 6A-6B It is a graphical representation of an electrocardiogram (ECG) chart.

[0033] Figure 7 This is a flowchart illustrating an example of operating a patient management system.

[0034] Figure 8 This is a diagram illustrating the inverse filtering of cardiac electrical signals.

[0035] Figure 9 A block diagram of an example machine on which any or more of the technologies discussed herein can be executed is shown. Detailed Implementation

[0036] Mobile medical devices may include one or more sensors located inside, on, or near a patient's body, or configured to receive physiological information from such sensors. The patient's physiological information may include (among other things): respiratory information (e.g., respiratory rate, respiratory volume (tidal volume)); cardiac acceleration information (e.g., cardiac vibration information, pressure waveform information, heart sound information, endocardial acceleration information, acceleration information, activity information, posture information, etc.); impedance information; cardiac electrical information; body activity information (e.g., activity, steps, etc.); posture or location information; pressure information; plethysmography information; chemical information; temperature information; or other physiological information of the patient.

[0037] The inventors have recognized (among other things) a device-based system and method for providing detection of ST-segment elevation myocardial infarction (STEMI) in patients. Device-based monitoring can improve the timing of interventions for managing STEMI.

[0038] Figure 1 An example patient management system 100 and a portion of the environment in which the patient management system 100 may operate are shown. The patient management system 100 can perform a range of activities, including remote patient monitoring and diagnosis of disease conditions. These activities can be performed close to the patient 101, such as in the patient's home or office; via a central server, such as in a hospital, clinic, or doctor's office; or via a remote workstation, such as a secure wireless mobile computing device.

[0039] The patient management system 100 may include one or more medical devices, an external system 105, and a communication link 111 providing communication between the one or more mobile medical devices and the external system 105. The one or more medical devices may include mobile medical devices (AMDs), such as implantable medical devices (IMDs) 102, insertable cardiac monitors (ICMs), wearable medical devices 103, or one or more other implantable, wireless, subcutaneous, external, wearable, or medical devices configured to monitor, sense, or detect information from the patient 101, determine physiological information about the patient 101, or provide one or more therapies to treat various conditions of the patient 101, such as one or more cardiac or non-cardiac conditions (e.g., dehydration, sleep apnea, etc.).

[0040] In the example, Figure 1 The IMD 102 may include one or more cardiac rhythm management devices implanted in the chest of a patient, having a lead system including one or more transvenous, subcutaneous, or non-invasive leads or catheters to position one or more electrodes or other sensors (e.g., heart sound sensors) within, on, or around the heart of the patient 101, or in one or more other locations in the patient's chest, abdomen, or neck. In another example, the IMD 102 may include, for example, a monitor implanted subcutaneously in the chest of the patient 101. The IMD 102 includes a housing containing a circuit system and, in some examples, includes one or more sensors, such as temperature sensors.

[0041] Cardiac rhythm management devices (such as insertable cardiac monitors, pacemakers, defibrillators, or cardiac resynchronization devices) include implantable or subcutaneous devices having an airtight, sealed housing configured for implantation in a patient's chest. Cardiac rhythm management devices may include one or more leads to position one or more electrodes or other sensors at various locations in or near the heart, such as in one or more of the atria or ventricles of the heart. Thus, cardiac rhythm management devices may include aspects located subcutaneously (albeit close to the patient's skin surface) and aspects such as leads or electrodes located near one or more of the patient's organs. In addition to or as a supplement to the one or more electrodes or other sensors in the leads, cardiac rhythm management devices may include one or more electrodes or other sensors (e.g., pressure sensors, accelerometers, gyroscopes, microphones, etc.) powered by a power source within the cardiac rhythm management device. The one or more electrodes or other sensors in the leads, the one or more electrodes or other sensors in the cardiac rhythm management device, or combinations thereof, may be configured to detect physiological information from the patient or to provide the patient with one or more therapies or stimulations.

[0042] The implantable device may additionally or separately include a leadless pacemaker (LCP), which is a small (e.g., smaller than a conventional implantable rhythm management device, having a volume of about 1 cc in some examples), self-contained device comprising one or more sensors, circuitry, or electrodes configured to monitor physiological information from the heart (e.g., heart rate), detect physiological conditions associated with the heart (e.g., tachycardia), or deliver one or more therapies or stimulations to the heart without the complications of conventional leads or implantable rhythm management devices (e.g., required incisions and pockets, complications associated with lead placement, breakage, or migration, etc.). In some examples, the leadless pacemaker may have more limited power and processing capabilities than a conventional rhythm management device; however, multiple leadless pacemakers may be implanted in or around the heart to detect physiological information from one or more chambers of the heart, or to deliver one or more therapies or stimulations to one or more chambers of the heart. Multiple leadless pacemakers may communicate with each other or with one or more other implantable devices or external devices.

[0043] IMD 102 may include assessment circuitry configured to detect or determine specific physiological information of patient 101 or to determine one or more conditions or to provide information or alerts to users such as patient 101 (e.g., a patient), clinicians, or one or more other caregivers or processes, as described herein. The implantable medical device 102 may alternatively or additionally be configured as a therapeutic device for treating one or more medical conditions of patient 101. Therapies may be delivered to patient 101 via a lead system and associated electrodes or using one or more other delivery mechanisms. Therapies may include delivering one or more medications to patient 101, such as using the implantable medical device 102 or one or more other mobile medical devices. In some examples, the therapy may include a cardiac reflex (CRT) for correcting asynchrony and improving cardiac function in patients with heart failure. In other examples, the implantable medical device 102 may include a drug delivery system, such as a drug infusion pump for delivering medication to a patient for managing arrhythmias or complications arising from arrhythmias, hypertension, hypotension, or one or more other physiological conditions. In other examples, the implantable medical device 102 may include one or more electrodes configured to stimulate the patient’s nervous system or to provide stimulation to the muscles of the patient’s airway.

[0044] Wearable medical device 103 may include one or more wearable or external medical sensors or devices (such as automated external defibrillators (AEDs), Holter monitors, patch-based devices, smartwatches, smart accessories, wrist-worn or finger-worn medical devices such as finger-based photoplethysmography sensors, etc.).

[0045] External system 105 may include dedicated hardware / software systems, such as a programmer, a remote server-based patient management system, or alternatively, a system defined primarily by software running on a standard personal computer. External system 105 may manage patient 101 via implantable medical device 102 or one or more other mobile medical devices connected to external system 105 via communication link 111. In other examples, IMD 102 may be connected to wearable medical device 103 via communication link 111, or wearable medical device 103 may be connected to external system 105 via communication link 111. For example, this may include programming IMD 102 to perform one or more of the following: acquiring physiological data, performing at least one self-diagnostic test (such as a self-diagnostic test for device operational status), analyzing physiological data, or optionally delivering or adjusting therapy for patient 101. Additionally, external system 105 may send or receive information from IMD 102 or wearable medical device 103 via communication link 111. Examples of this information may include real-time or stored physiological data from patient 101, diagnostic data (such as detection of patient hydration status, hospitalization status, and response to therapy delivered to patient 101), or device operational status (e.g., battery status, wire impedance, etc.) of implantable medical device 102 or wearable medical device 103. Communication link 111 may be an inductive telemetry link, a capacitive telemetry link, or a radio frequency (RF) telemetry link, or wireless telemetry based on standards such as “Strong” Bluetooth or IEEE 602.11 Wireless Fidelity “Wi-Fi” interface standards. Other configurations and combinations of patient data source interfaces are possible.

[0046] External system 105 may include an external device 106 located near one or more mobile medical devices, and a remote device 108 located relatively far from the one or more mobile medical devices, communicating with external device 106 via communication network 107. Examples of external device 106 may include a medical device programmer. Among other possible functions, remote device 108 may be configured to evaluate collected patient or patient information and provide alert notifications. In an example, remote device 108 may include a centralized server acting as a central hub for storing and analyzing collected data from multiple different sources. The combination of information from multiple sources may be used to make decisions and update individual patient status, or to adjust one or more alerts or decisions for one or more other patients. The server may be configured as a single, multiple, or distributed computing and processing system. Remote device 108 may receive data from multiple patients. This data may be collected by one or more mobile medical devices other than other data acquisition sensors or devices associated with patient 101. The server may include a memory device for storing data in a patient database. The server may include alert analyzer circuitry for evaluating the collected data to determine whether specific alert conditions are met. The fulfillment of alert conditions can trigger the generation of alert notifications, such as alert notifications to be provided by one or more human-perceptible user interfaces. In some examples, alert conditions may alternatively or additionally be evaluated by one or more mobile medical devices, such as implantable medical devices. By way of example, alert notifications may include web page updates, telephone or pager calls, emails, SMS, text or "instant" messages, as well as messages to patients and direct notifications to emergency services and clinicians simultaneously. Other alert notifications are possible. The server may include alert priority sorting circuitry configured to prioritize alert notifications. For example, alerts for detected medical events can be prioritized using a similarity metric between physiological data associated with the detected medical event and physiological data associated with historical alerts.

[0047] Remote device 108 may additionally include one or more locally configured clients or remote clients securely connected to the server via communication network 107. Examples of clients may include personal desktop computers, laptops, mobile devices, or other computing devices. System users (such as clinicians or other qualified medical professionals) can use the clients to securely access stored patient data compiled in a database on the server, and to select and prioritize patients and alerts for healthcare provision. In addition to generating alert notifications, remote device 108 (including the server and interconnected clients) may also implement follow-up protocols by sending follow-up requests to one or more mobile medical devices, or by sending messages or other communications to patient 101 (e.g., patients), clinicians, or authorized third parties as compliance notifications.

[0048] The communication network 107 can provide wired or wireless interconnectivity. In this example, the communication network 107 may be based on the Transmission Control Protocol / Internet Protocol (TCP / IP) network communication standard, although other types or combinations of networking implementations are possible. Similarly, other network topologies and arrangements are possible.

[0049] One or both of external device 106 and remote device 108 can output detected medical events to a system user (such as a patient or clinician) or to a process (including instances of computer programs executable, for example, in a microprocessor or other processor). In examples, the process may include the automated generation of recommendations for antiarrhythmic therapy or recommendations for further diagnostic testing or treatment. In examples, external device 106 or remote device 108 may include a corresponding display unit for displaying physiological or functional signals, or alerts, alarms, emergency calls, or other forms of warnings to signal the detection of an arrhythmia. In some examples, external system 105 may include an external data processor configured to analyze physiological or functional signals received by one or more mobile medical devices and confirm or deny the detection of an arrhythmia. Computationally intensive algorithms (such as machine learning algorithms) may be implemented in the external data processor to retrospectively process data to detect arrhythmias.

[0050] One or more portions of a mobile medical device or external system 105 may be implemented using hardware, software, firmware, or a combination thereof. One or more portions of a mobile medical device or external system 105 may be implemented using dedicated circuitry that may be built or configured to perform one or more functions; or they may be implemented using general-purpose circuitry that may be programmed or otherwise configured to perform one or more functions. Such general-purpose circuitry may include a microprocessor or a portion thereof, a microcontroller or a portion thereof, or programmable logic circuitry, memory circuitry, network interfaces, and various components for interconnecting these components. For example, a “comparator” may include (among other things) an electronic circuit comparator that may be built to perform a specific function of comparing two signals, or a “comparator” may be implemented as part of a general-purpose circuitry that may be driven by code instructing a portion of the general-purpose circuitry to perform a comparison between two signals. A “sensor” may include electronic circuitry configured to receive information and provide an electronic output representing such received information.

[0051] The treatment device 110 can be configured to send or receive information from one or more of the mobile medical devices or external systems 105 using communication link 111. In the example, one or more mobile medical devices, external devices 106, or remote devices 108 can be configured to control one or more parameters of the treatment device 110. The external system 105 can allow programming of one or more mobile medical devices and can receive information about one or more signals acquired by the one or more mobile medical devices, such as information that can be received via communication link 111. The external system 105 may include a local external implantable medical device programmer. The external system 105 may include a remote patient management system, which can, for example, monitor patient status from a remote location or adjust one or more therapies.

[0052] Figure 2 An example of an AMD as IMD 102 is shown. IMD 102 is electrically coupled to heart 110, such as via one or more wires coupled to IMD 102 via one or more wire ports, such as a first wire port 241, a second wire port 242, or a third wire port 243 in header 202 of IMD 102. In the example, IMD 102 may include an antenna, such as an antenna in header 202, which is configured to enable communication with external systems and one or more electronic circuits in hermetically sealed housing (CAN) 201. IMD 102 illustrates an example medical device (or medical device system) as described herein.

[0053] IMD 102 may be an implantable cardiac monitor (ICM), pacemaker, defibrillator, cardiac resynchronizer, or other subcutaneous IMD or cardiac rhythm management (CRM) device configured to be implanted in the chest of a subject, having one or more leads to position one or more electrodes or other sensors at different locations in or near the heart 110, such as one or more of the atria or ventricles. Separate from or in addition to one or more electrodes or other sensors in the leads, IMD 102 may include one or more electrodes or other sensors (e.g., pressure sensors, accelerometers, gyroscopes, microphones, etc.) powered by a power source within IMD 102. The one or more electrodes or other sensors in the leads, IMD 102, or combinations thereof may be configured to detect physiological information from the patient or to provide the patient with one or more therapies or stimuli.

[0054] IMD 102 may include one or more electronic circuits configured to sense one or more physiological signals, such as electrograms or signals representing the mechanical function of the heart 110. In some examples, CAN 201 may function as electrodes, such as for sensing or pulse delivery. For example, electrodes from one or more leads may be used in conjunction with CAN 201, such as for unipolar sensing for electrograms, or for delivering one or more pacing pulses. Defibrillation electrodes (such as first defibrillation coil electrode 228, second defibrillation coil electrode 229, etc.) may be used in conjunction with CAN 201 to deliver one or more cardioversion / defibrillation pulses.

[0055] In the example, IMD 102 can sense impedance, such as the impedance between electrodes located on one or more of the wires or on CAN 201. IMD 102 can be configured to inject current between a pair of electrodes, sense the resulting voltage between the same or different pairs of electrodes, and determine the impedance, such as using Ohm's law. The impedance can be sensed in the following configurations: a bipolar configuration, in which the same electrode pair can be used for both current injection and voltage sensing; a tripolar configuration, in which the electrode pair used for current injection and the electrode pair used for voltage sensing can share a common electrode; or a quadrupole configuration, in which the electrode used for current injection can be different from the electrode used for voltage sensing, and so on. In the example, IMD 102 can be configured to inject current between the electrodes on one or more of the first wire 220, the second wire 225, the third wire 230, or the fourth wire 235 and CAN 201, and sense the resulting voltage between the same or different electrodes and CAN 201.

[0056] Figure 2Example lead configurations include a first lead 220, a second lead 225, and a third lead 230 in conventional lead placements in the coronary veins 216 (e.g., the coronary sinus) above the right atrium (RA) 206, right ventricle (RV) 207, and left atrium (LA) 208 and left ventricle (LV) 209, respectively; and a fourth lead 235 positioned in the RV 207 near the His bundle 211, between the AV node 210 and the right bundle branch 212 and left bundle branch 213, as well as the Purkinje fibers 214, 215. Each lead can be configured to position one or more electrodes or other sensors at different locations in or near the heart 110 to detect physiological information or provide one or more therapies or stimulations.

[0057] The first lead 220 located in RA 206 includes a first end electrode 221 located at or near the distal end of the first lead 220; and a first loop electrode 222 located near the first end electrode 221. The second lead 225 (dashed line) located in RV 207 includes a second end electrode 226 located at or near the distal end of the second lead 225; and a second loop electrode 227 located near the second end electrode 226. The third lead 230 located in the coronary vein 216 above LV 209 includes a third end electrode 231 located at or near the distal end of the third lead 230; a third loop electrode 232 located near the third end electrode 231; and two additional electrodes 233 and 234. The fourth lead 235 located in RV 207 near His bundle 211 includes a fourth end electrode 236 located at or near the distal end of the fourth lead 235; and a fourth loop electrode 237 located near the fourth end electrode 236. End electrodes and loop electrodes may include pacing / sensing electrodes configured to sense electrical activity or provide pacing stimulation.

[0058] In addition to the tip electrode and the loop electrode, one or more leads may include one or more defibrillation coil electrodes configured to sense electrical activity or provide cardioversion or defibrillation shock energy. For example, the second lead 225 includes a first defibrillation coil electrode 228 located near the distal end of the second lead 225 in RV 207; and a second defibrillation coil electrode 229 located at a distance distal to the second lead 225 (such as for placement in or near the superior vena cava (SVC) 217).

[0059] Different CRM devices include different numbers and placements of leads. For example, some CRM devices are single-lead devices with one lead (e.g., RV only, RA only, etc.). Other CRM devices are multi-lead devices with two or more leads (e.g., RA and RV; RV and LV; RA, RV and LV, etc.). CRM devices suitable for His bundle pacing typically use lead ports designated for the LV or RV lead to deliver stimulation to the His bundle 211.

[0060] Figure 3 This is a block diagram of a portion of the electronic circuitry of the implantable AMD 302. The AMD 302 can be coupled to multiple implantable electrodes, such as... Figure 2 The electrode arrangement is described in the example. The AMD 302 includes cardiac signal sensing circuitry 304, treatment circuitry 306, communication circuitry 312, and control circuitry 308. Communication circuitry 312 can be used to wirelessly transmit information with a separate device. When the pacing electrode is operatively connected to the system, treatment circuitry 306 provides electrical pacing stimulation energy to the patient's heart. The pacing electrode may include... Figure 2 Any pacing electrode, such as those configured to be placed in or near the RA, RV, LV, His bundle or left bundle branch, and the electrodes of CAN 201.

[0061] The cardiac signal sensing circuit 304 includes one or more sensing amplifiers to sense one or both of a voltage signal or a current signal at the electrodes. The patient's cardiac electrical information can be sensed using the cardiac signal sensing circuit 304. Timing measures between different features in the sensed electrical signals (e.g., a first cardiac feature and a second cardiac feature) can be determined, for example, by the signal processing circuitry system 310 of the control circuitry 308. In some examples, the timing measures may include the interval or measure between a first cardiac feature and a second cardiac feature of a patient's first interval (e.g., the duration of the cardiac cycle or interval, QRS width, etc.), or the interval or measure between corresponding first and second cardiac features in successive first and second cardiac intervals of the patient. In examples, the first and second cardiac features include equivalent detected features in successive first and second cardiac intervals, such as successive R waves (e.g., RR interval, etc.) or one or more other features of the cardiac electrical signal. Far-field cardiac signals can be sensed using the electrodes of the CAN. In some examples, the AMD 302 is a diagnostic-only device (e.g., an ICM) and does not include treatment circuitry 306.

[0062] Control circuitry 308 may include a digital signal processor, application-specific integrated circuit (ASIC), field-programmable gate array (FPGA), microprocessor, or other type of processor for interpreting or executing instructions in software or firmware. In some examples, control circuitry 308 may include a state machine or sequencer implemented in hardware circuitry. Control circuitry 308 may include any combination of hardware, firmware, or software. Control circuitry 308 includes an electronic circuitry system (e.g., signal processing circuitry system 310) for performing the functions described herein. Circuitry may include software, hardware, firmware, or any combination thereof. For example, the circuitry may include instructions in software executed on control circuitry 308. Multiple functions may be performed by one or more circuits of control circuitry 308.

[0063] Figure 4 Is it included in external systems (e.g.) Figure 1 A block diagram of device 406 in the external system 105. Device 406 may be an external device of the external system (e.g., Figure 1 External device 106) or a remote device of the external system (e.g., Figure 1 The device 406 also includes a storage device 418 and a signal processing circuitry system 416. In some examples, the device includes a user interface 420. The signal processing circuitry system 416 may be implemented using an application-specific integrated circuit (ASIC) configured to perform one or more functions or general-purpose circuitry programmed to perform those functions. The general-purpose circuitry may include, among other things, a microprocessor or a portion thereof, a microcontroller or a portion thereof, and programmable logic circuitry or a portion thereof. The storage device 418 may be a memory integrated with the signal processing circuitry system 416 or a separate storage device.

[0064] In some examples, device 406 includes communication circuitry 422 for transmitting information with another device. Communication circuitry 422 can use near-field inductive wireless signals or far-field radio frequency signals to communicate with... Figure 3 The AMD 302 wirelessly transmits information. Device 406 can be used to program pacing therapy parameters and other information within the AMD 302. In some examples, device 406 is located remotely from the AMD 302, and communication circuitry 422 transmits information via a network (such as a cellular phone network or the Internet) to another device wirelessly transmitting information with the AMD 302.

[0065] Myocardial infarction (MI) is caused by a blockage in a coronary artery. This blockage reduces or completely stops blood flow to a portion of the heart muscle. Symptoms of MI include chest pain, fatigue, and shortness of breath. There are two types of MI: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).

[0066] Figure 5 This is a diagram of the PQRST complex on an electrocardiogram (ECG) that includes the S wave, T wave, and ST segment. In myocardial infarction (MI), the changes in the ST segment are caused by the flow of a current called the "injury current" generated between ischemic and non-ischemic myocardial tissue. Figure 6A and Figure 6B This is a chart showing ECG 605 with a normal ST segment and ECG 610 with an elevated ST segment. For individuals without a history of heart disease, such as... Figure 6A As in ECG 605, the level of ST segment 620 is essentially the same as the level of PR segment 615 or the subsequent TP segment 625 (i.e., isoelectric or plateau period). Figure 6B In ECG 610, the ST segment 620 was elevated above the isoelectric or plateau level. Systematic detection of the elevated ST segment, combined with the patient's chest pain symptoms, can improve STEMI detection.

[0067] Figure 7 It is the operation of the patient management system (e.g.) Figure 1 A flowchart illustrating an example of method 700 of a patient management system 100. At box 705, the signal processing circuitry of the patient management system (e.g., Figure 4 The signal processing circuitry system 416 in the system receives the sensed cardiac signals from the patient. The cardiac signals can be processed using the AMD cardiac signal sensing circuitry of the patient management system (e.g., Figure 3 The heart signal sensing circuit 304 in the AMD is used to sense the heart signal. The signal processing circuit system can be included in an external device and receive the sensed heart signal from the AMD via a wireless communication link, or the signal processing circuit system can be included in a remote device (e.g., a remote server) and receive the sensed heart signal from a device different from the AMD (e.g., from an external device).

[0068] The AMD can initiate sampling and recording of cardiac signals in response to a trigger from the patient. For example, a patient can trigger recording of one or more cardiac signals in response to chest pain. The patient can hold a personal device (such as a handheld communicator or smartphone) capable of communicating with the AMD. The personal device can run an application (or app) that allows the patient to send triggers to the AMD. In a variant, the AMD is a wearable medical device, and the patient can trigger signal recording by pressing a button or otherwise interacting with the user interface of the wearable medical device.

[0069] The AMD can initiate a communication session with an external device to send one or more recorded signals to the external device. In some examples, the patient triggers the reception by the external device, and the external device initiates a communication session with the AMD to send a command to the AMD to start recording cardiac signals and send the recorded cardiac signals to the external device.

[0070] The cardiac signal sensed by the AMD is a frequency-filtered cardiac signal generated from the raw, unfiltered, and unamplified signal. For example, the cardiac signal sensed by the AMD may be high-pass filtered or band-pass filtered. In some examples, the cardiac signal sensed by the AMD is band-limited to a 3-40 Hz signal. The AMD records the cardiac signal for a predetermined duration (e.g., several minutes) and sends the recording to the signal processing circuitry of the patient management system.

[0071] At block 710, the signal processing circuitry recovers the received cardiac signal to a wider bandwidth than the original cardiac signal. In some instances, the signal processing circuitry performs inverse filtering on the filtered cardiac signal to produce the recovered wider bandwidth cardiac signal. For example, Figure 3 The amplifier circuit and filter circuit of the cardiac signal sensing circuit 304 can detect known transfer functions (e.g., This is applied to the input of the cardiac signal sensing circuit 304 to generate a frequency-filtered cardiac signal at the output. The signal processing circuitry of the patient management system can utilize the inverse of this transfer function (…). The frequency-filtered cardiac signal is processed to produce a recovered wider-bandwidth cardiac signal. In some examples, the 3-40Hz cardiac signal sensed by the AMD is recovered to a 0.5-40Hz signal by the patient management system's signal processing circuitry. Thus, the lower frequencies of the original signal are recovered.

[0072] When the cardiac signal from the AMD is recovered, the signal processing circuitry system then analyzes the recovered cardiac signal for the elevated ST segment. It generates and analyzes a cardiac signal closer to the original signal to ensure that any elevated ST segment is physiological and not a product of AMD filtering. Figure 8 This diagram illustrates the reverse filtering of the 3-40Hz frequency range to generate a 0.5-40Hz signal. Figure 8 As can be seen, the reverse filter used to recover low frequencies affects the ST segment.

[0073] In some examples, the inversely filtered signal is phase-corrected by a signal processing circuitry system to produce a recovered, wider-bandwidth cardiac signal. The cardiac signal sensing circuitry may introduce phase distortion when processing the raw signal input to it. The signal processing circuitry system can perform phase correction on the cardiac signal. For example, the system can invert or flip the inversely filtered signal and utilize the transfer function of AMD's cardiac signal sensing circuitry to process the flipped signal.

[0074] After the cardiac signal is restored, the signal processing circuitry system examines the restored cardiac signal in response to ST-segment elevation. According to some examples, the signal processing circuitry system is operatively connected to a storage device (e.g., Figure 4 The storage device 418 stores one or more baseline cardiac signals or measurements of ST segment elevation of the baseline signal previously recorded for the patient. The signal processing circuitry compares the ST segment of the recovered wider-bandwidth cardiac signal with one or more ST segments of the baseline signal recorded for the patient. The signal processing circuitry can detect ST segment elevation when the amplitude of the ST segment is higher than one or more baseline ST segments by more than a predetermined (e.g., programmed) threshold amplitude.

[0075] Return to Figure 7 At box 715, a device with a signal processing circuitry system generates a warning of myocardial infarction when an elevated ST segment is detected in the recovered wider-bandwidth cardiac signal. In response to the detection, one or more warnings may be provided, such as to the patient, a clinician, or one or more other caregivers (e.g., using the patient's smartwatch, cellular or smartphone, computer, etc.). The warning may instruct caregivers to take actions such as administering an anticoagulant to the patient or initiating reperfusion therapy.

[0076] As explained earlier in this article, combining ST-segment elevation detection with the patient's chest pain symptoms can improve the specificity of STEMI detection. The specificity of STEMI detection can be further improved by incorporating systems-based analysis of the patient's heart sounds. Heart sounds are recurring mechanical signals associated with the vibrations or accelerations of the heart caused by blood flow through the heart or other cardiac motions during each cardiac cycle or interval, and can be isolated and classified according to the activity associated with such vibrations, accelerations, motions, pressure waves, or blood flow. Heart sounds include four main characteristics: the first through fourth heart sounds (S1 through S4, respectively). The first heart sound (S1) is a vibration sound produced by the heart at the beginning of systole (or ventricular systole) during the closing of the atrioventricular (AV) valves (mitral and tricuspid valves) and the opening of the aortic valve. The second heart sound (S2) is a vibration sound produced by the heart at the beginning of diastole (or ventricular diastole) during the closing of the aortic and pulmonary valves. The third heart sound (S3) and the fourth heart sound (S4) are related to the diastolic filling pressure of the left ventricle. A sudden cessation of early diastolic filling may cause the third heart sound (S3). Vibration caused by atrial kick during late atrial systole may cause the fourth heart sound (S4).

[0077] The closure of valves in the heart, along with changes in blood flow and pressure, can cause acceleration, vibration, or motion of the heart walls, which can be detected using heart sound sensors such as accelerometers or microphones, thus generating heart sound signals. In the example, the value of a portion of the heart sound signal or a corresponding heart sound signal for a specific interval can be detected by comparing it to a sensed cardiac signal. For example, the value and timing of the S1 signal can be detected using the amplitude or energy of a heart sound signal occurring at or near the R wave of the interval. The S4 interval can be defined as a set time period within the interval relative to one or more other cardiac electrical or mechanical features, such as preceding one or more features of the R wave, T wave, or heart sound waveform (such as the first heart sound (S1), the second heart sound (S2), or the third heart sound (S3)); or following one or more features of the subsequent R wave or the detected S1 of a subsequent interval. In some examples, the length of the S4 window can depend on heart rate or one or more other factors. In the example, the temporal measure of cardiac electrical information can be the temporal measure of the first cardiac interval, and the S4 signal portion can be the S4 signal portion of the same first cardiac interval.

[0078] In the examples, heart sound parameters may include information about multiple identical heart sound parameters or different combinations of heart sound parameters within one or more cardiac cycles. For example, heart sound parameters may include, for instance, a composite S1 parameter representing multiple S1 parameters over a time period (e.g., multiple cardiac cycles, a representative time period, etc.). In the examples, heart sound parameters may include a ensemble average of specific heart sounds within a heart sound waveform, such as those disclosed in commonly assigned U.S. Patent No. 7,115,096 entitled "THIRD HEARTSOUND ACTIVITY INDEX FOR HEART FAILURE MONITORING" by Siejko et al., or in commonly assigned U.S. Patent No. 7,853,327 entitled "HEART SOUND TRACKING SYSTEM AND METHOD" by Patangay et al., each of which is incorporated herein by reference in its entirety, and whose disclosures include ensemble averaging of acoustic signals and determining specific heart sounds within a heart sound waveform.

[0079] AMD may include a heart sound sensor (e.g.) Figure 3 The heart sound sensor 314 in the system generates heart sound signals. The AMD can record the heart sound signals in response to patient triggering. The signal processing circuitry of the patient management system receives the recorded frequency-filtered heart signal and the recorded heart sound signals from the AMD, and uses the recovered wider-bandwidth heart signal and heart sound signals to detect STEMI.

[0080] For example, the signal processing circuitry can detect STEMI when an elevated ST segment is detected in the recovered cardiac signal and the S4 heart sound begins to appear in the heart sound signal. In another example, the signal processing circuitry can detect STEMI when an elevated ST segment is detected in the recovered cardiac signal and a decrease in the intensity of the S1 and S2 heart sounds is detected, and one or both of the S3 and S4 heart sounds begin to appear in the heart sound signal. An alert can be generated when an elevated ST segment is detected in the recovered wider-bandwidth cardiac signal and an indication of MI is detected in the sensed heart sound signal.

[0081] When collecting ST segment and heart sound information, AMD can switch from a low-power mode to a high-power mode. High-power mode may include one or more of the following: enabling one or both of the cardiac signal sensing circuitry and the heart sound sensing circuitry; increasing the sensing frequency, sensing resolution, or storage resolution; increasing the amount of data to be collected, transmitted (e.g., to a second medical device), or stored; triggering the storage of currently available information or increasing the storage capacity or time period of the loop recorder; or otherwise altering device behavior to capture additional or higher-resolution physiological information or perform further processing. After sensing, recording, and transmitting the information, AMD returns to low-power mode.

[0082] Figure 9 A block diagram of example machine 900 is shown, on which any or more of the technologies (e.g., methodologies) discussed herein can be executed. Parts of this description can be applied to the computational framework of one or more of the medical devices described herein, such as mobile medical devices, external programmers, remote servers, etc. Furthermore, as described herein with respect to medical device components, systems, or machines, such components, systems, or machines may require regulatory compliance that is not available with general-purpose computers, components, or machines.

[0083] As described herein, examples may include logic or multiple components or mechanisms in, or operable through, a machine 900. A circuit system (e.g., a signal processing circuit system, etc.) is a collection of circuits implemented in a tangible entity of machine 900 that includes hardware (e.g., simple circuits, gates, logic, etc.). The membership of a circuit system can be flexible over time. A circuit system includes members that can perform a specified operation individually or in combination when operated. In the examples, the hardware of the circuit system may be immutably designed to perform a specific operation (e.g., hardwired). In the examples, the hardware of the circuit system may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) including machine-readable media that are physically modified (e.g., magnetically, electrically, movable placement of particles with invariant mass, etc.) to program instructions for a specific operation. When physical components are connected, the underlying electrical properties of the hardware components change, for example, from an insulator to a conductor or vice versa. Instructions enable embedded hardware (e.g., execution units or loading mechanisms) to create members of a circuit system in the hardware via variable connections to perform a specific operation when operated. Therefore, in this example, a computer-readable medium element is part of a circuit system, or is communicatively coupled to other components of the circuit system when the device is in operation. In this example, any of the physical components can be used in more than one member of more than one circuit system. For example, in operation, an execution unit may be used at one point in time in a first circuit of a first circuit system, and reused at different times by a second circuit in the first circuit system or by a third circuit in the second circuit system. Additional examples of these components of machine 900 are as follows.

[0084] In alternative embodiments, machine 900 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, machine 900 may operate as a server machine, a client machine, or both in a server-client network environment. In the example, machine 900 may act as a peer-to-peer (P2P) (or other distributed) network environment. Machine 900 may be a personal computer (PC), tablet PC, set-top box (STB), personal digital assistant (PDA), mobile phone, network appliance, network router, switch, or bridge, or any machine capable of executing instructions (sequentially or otherwise) specifying actions to be taken by that machine. Furthermore, while only a single machine is shown, the term "machine" should also be considered to include any set of machines that individually or jointly execute one or more sets of instructions to implement any or more of the methods discussed herein, such as cloud computing, Software as a Service (SaaS), or other computer cluster configurations.

[0085] Machine 900 (e.g., a computer system) may include a hardware processor 902 (e.g., a central processing unit (CPU), graphics processing unit (GPU), hardware processor core, or any combination thereof), main memory 904, static memory 906 (e.g., memory or storage device for firmware, microcode, basic input / output (BIOS), unified extensible firmware interface (UEFI), etc.), and mass storage device 908 (e.g., a hard disk drive, tape drive, flash storage device, or other block device), some or all of which may communicate with each other via interconnect link 930 (e.g., a bus). Machine 900 may also include a display unit 910, an input device 912 (e.g., a keyboard), and a user interface (UI) navigation device 914 (e.g., a mouse). In the example, display unit 910, input device 912, and UI navigation device 914 may be a touch screen display. Machine 900 may additionally include a signal generation device 918 (e.g., a speaker), a network interface device 920, and one or more sensors 916, such as a global positioning system (GPS) sensor, a compass, an accelerometer, or one or more other sensors. Machine 900 may include output controller 928, such as serial (e.g., Universal Serial Bus (USB)), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connections, to communicate with or control one or more peripheral devices (e.g., printers, card readers, etc.).

[0086] The registers, main memory, static memory, or mass storage device 908 of the hardware processor 902 may be or include a machine-readable medium 922 on which one or more data structures or instructions 924 (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein are stored. Instructions 924 may also reside wholly or at least partially within any one of the registers, main memory, static memory, or mass storage device 908 of the hardware processor 902 during execution by the machine 900. In the example, one or any combination of the hardware processor 902, main memory 904, static memory 906, or mass storage device 908 may constitute a machine-readable medium. Although the machine-readable medium 922 is shown as a single medium, the term "machine-readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) configured to store one or more instructions 924.

[0087] The term "machine-readable medium" can include any medium capable of storing, encoding, or carrying instructions that are executed by machine 900 and cause machine 900 to perform any one or more techniques of this disclosure, or capable of storing, encoding, or carrying data structures used by or associated with such instructions. Examples of non-limiting machine-readable media can include solid-state memory, optical media, magnetic media, and signals (e.g., radio frequency signals, other photon-based signals, sound signals, etc.). In examples, non-transitory machine-readable media includes machine-readable media having a plurality of particles having invariant (e.g., rest) masses, and thus being a composition of matter. Therefore, a non-transitory machine-readable medium is a machine-readable medium that does not include transiently propagating signals. Specific examples of non-transitory machine-readable media can include non-volatile memories such as semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices; disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0088] Instruction 924 may further use a transmission medium to transmit or receive over a communication network 926 via network interface device 920 using any of a variety of transmission protocols (e.g., Frame Relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), Hypertext Transfer Protocol (HTTP), etc.). Example communication networks may include local area networks (LANs), wide area networks (WANs), packet data networks (e.g., the Internet), mobile phone networks (e.g., cellular networks), conventional telephone (POTS) networks, and wireless data networks (e.g., the IEEE 802.11 standard series (known as Wi-Fi®), the IEEE 802.16 standard series (known as WiMax®)), the IEEE 802.15.4 standard series, peer-to-peer (P2P) networks, etc. In the example, network interface device 920 may include one or more physical jacks (e.g., Ethernet jacks, coaxial jacks, or telephone jacks) or one or more antennas for connection to communication network 926. In the example, network interface device 920 may include multiple antennas for wireless communication using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) technologies. The term "transmission medium" should be considered to include any intangible medium capable of storing, encoding, or carrying instructions executable by machine 900, and includes digital or analog communication signals or other intangible media to facilitate communication of such software. The transmission medium is a machine-readable medium.

[0089] Various embodiments are illustrated in the accompanying drawings above. One or more features from one or more of these embodiments may be combined to form other embodiments. The method examples described herein may be implemented at least in part by a machine or computer. Some examples may include a computer-readable or machine-readable medium encoded with instructions operable to configure an electronic device or system to perform the methods described in the examples above. Implementations of such methods may include code, such as microcode, assembly language code, high-level language code, or similar code. Such code may include computer-readable instructions for performing various methods. The code may form part of a computer program product. Furthermore, the code may be tangibly stored on one or more volatile or non-volatile computer-readable media during execution or at other times.

[0090] The above detailed description is intended to be illustrative and not restrictive. Therefore, the scope of this disclosure should be determined by referring to the appended claims together with the full scope of their legally recognized equivalents.

Claims

1. A signal processing device for a patient management system, the device comprising: Communication circuitry configured to receive cardiac signals from an AMD, wherein the received cardiac signals are frequency-filtered cardiac signals generated from wider-bandwidth cardiac signals sensed using the AMD; and Signal processing circuit system, the signal processing circuit system being configured as follows: To recover the received cardiac signals to a wider frequency band cardiac signals; Detect elevated ST segments in the recovered wider-bandwidth cardiac signal; and A warning of myocardial infarction is generated in response to the detection of the elevated ST segment.

2. The apparatus according to claim 1, wherein, The signal processing circuitry is configured to reverse filter the frequency-filtered cardiac signal to generate a recovered wider-bandwidth cardiac signal.

3. The apparatus according to claim 1 or claim 2, wherein, The signal processing circuit system is configured as follows: The frequency-filtered cardiac signal is then reverse-filtered to generate a reverse-filtered signal; and The reverse-filtered signal is phase-corrected to produce the recovered wider-bandwidth cardiac signal.

4. The apparatus according to any one of claims 1 to 3, comprising: The memory is used to store one or more baseline ST segment elevation measurements; and The signal processing circuit system is configured as follows: The ST-segment elevation of the recovered cardiac signal is compared with one or more baseline ST-segment elevation measurements; and The comparison was used to detect ST segment elevation in the recovered cardiac signal.

5. The apparatus according to any one of claims 1 to 4, wherein, The signal processing circuitry is included in the server of the patient management system.

6. The apparatus according to any one of claims 1 to 5, in, The communication circuit is configured to receive sensed heart sound signals from the AMD; and The signal processing circuit system is configured as follows: Detect indicators of myocardial infarction in the sensed heart sound signals; and The alert is generated when the elevated ST segment is detected in the recovered wider-band cardiac signal and an indication of myocardial infarction is detected in the sensed heart sound signal.

7. The apparatus according to any one of claims 1 to 6, wherein, The signal processing circuitry is configured to generate a wider bandwidth heart signal based on a high-pass filtered heart signal received from the AMD.

8. The apparatus according to any one of claims 1 to 7, wherein, The communication circuit is configured as follows: During a communication session initiated by the AMD, information is exchanged with the AMD; and The frequency-filtered cardiac signal is received from the AMD during the communication session.

9. A method for operating a patient management system, the method comprising: The patient management system's signal processing circuitry receives the patient's cardiac signals, wherein the received cardiac signals are frequency-filtered cardiac signals generated from wider-bandwidth cardiac signals sensed using a mobile medical device (AMD). The received cardiac signal is recovered to the wider bandwidth cardiac signal using the signal processing circuit system. as well as A warning sign of myocardial infarction is generated when an elevated ST segment is detected in the recovered wider-band cardiac signal.

10. The method according to claim 9, wherein, Recovering the received cardiac signal to the wider bandwidth cardiac signal includes: the signal processing circuit system performing reverse filtering on the frequency-filtered cardiac signal to generate the recovered wider bandwidth cardiac signal.

11. The method according to claim 9 or claim 10, wherein, Recovering the received cardiac signal to the wider bandwidth cardiac signal includes: the signal processing circuit system performing reverse filtering on the frequency-filtered cardiac signal to generate a reverse-filtered signal, and performing phase correction on the reverse-filtered signal to generate the recovered wider bandwidth cardiac signal.

12. The method according to any one of claims 9 to 11, wherein, The elevated ST segment detected in the recovered wider-bandwidth cardiac signal includes: The ST segment of the recovered cardiac signal is compared with one or more baseline ST segments for the patient; and The ST segment that detects the restored cardiac signal is elevated from the one or more baseline ST segments.

13. The method according to any one of claims 9 to 12, comprising: The signal processing circuit system receives the heart sound signal sensed using the AMD. The signal processing circuit system uses the sensed heart sound signals to detect myocardial infarction; and The warning for the myocardial infarction includes generating the warning when the elevated ST segment is detected in the recovered wider-band cardiac signal and the myocardial infarction is detected using the sensed heart sound signal.

14. The method according to any one of claims 9 to 13, comprising: In response to a patient trigger received by the AMD, the AMD initiates the sensing of the wider bandwidth cardiac signal.

15. The method according to any one of claims 9 to 14, in, Receiving the cardiac signal includes receiving a high-pass filtered cardiac signal having low-frequency signal components removed from the sensed wider-bandwidth cardiac signal; and The process of restoring the received cardiac signal to the wider bandwidth cardiac signal includes restoring the low-frequency signal components in the cardiac signal.

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