Norav Medical 1200WR WIRELESS ECG RECORDING SYSTEM User Manual PCECG1200WR Revised UserMan

Norav Medical Ltd. WIRELESS ECG RECORDING SYSTEM PCECG1200WR Revised UserMan

Contents

USERS MANUAL 2

Resting ECG NV-54/PCECG1200W 39To do this Click this icon Or use this short-cut keyOr select this menu Description Scroll between displays from different leads — View > Leads Format > Next leads Double function: Scrolls for all leads in the 3X1 display Points to the requested lead Start/stop ECG F2 ECG > Start/Stop Controls start and stop of ECG recording. Record a 10 second segment F3 ECG > 10 Sec Start 10-sec timer for recording ECG data. Start/stop 50/60 Hz filter — ECG > Filters > 50/60 Hz ON/OFF for line interference filter. Set Options for 50 or 60 Hz prior to operation. Start/stop EMG filter — ECG > Filters > EMG ON/OFF for muscle noise filter. Compare View > Compare TestsSelect two or more Rest tests from the Database interface and click Compare. This option is only available when you check Setup > ECG Recording > Use ECG Database. Click Compare again to end Compare mode and display the Rest test. * ECG data can be set up as limited amplitude or unlimited amplitude, which can cause one lead data to overlap a neighboring lead. Table 8: Recording Resting ECG Using the Matlab Feature within PC-ECG 1200 1. Record a rest study and apply the MATLAB function under the File menu. A file with extension LIB is created in the default data folder. The file has the following structure: 10,000 bytes X 12 Leads (I, II, III, AVR, AVL, AVF, V1, V2, V3, V4, V5, V6); 1sec = 1000 bytes = 500 samples. 2. Start Matlab (not included in PC-ECG software) and perform the required operation.
Instructions for Use and Technical Description Norav Medical Ltd. 40Example of ECG Display with MATLAB 1. Open a file: handle = fopen('c:\default_\ patient_name.lib,'r') 2. Choose from which lead and which second to display the ECG: fseek(handle, (Lead-1) * 10000 + (Sec-1) * 500,-1) where Lead (1,2,3,...,12) and Sec (1,2,3,...10) For example, if lead AVR (number 4) from the second 3 is requested: fseek(handle,3*10000+2*500,-1) t = fread(handle, [sec * 500 ,1], 'int16') where sec(1,2,3,4,...,10) 3. Type: plot(t) The graph is displayed.
Stress ECG NV-54/PCECG1200W 41CHAPTER 8: STRESS ECG (This option is available with S0, S1, and S2 licenses) Figure 8: Stress ECG Results Screen To Customize the Display Click and drag the separating bar between two sections with the mouse cursor. To Lock Screen Window Borders If you want to keep the display in its present format: 1. Click Setup > View tab. 2. Check Lock Splitter. Multiple lead display Selected display: ST trends, 12 averages, Single QRS (current)Numerical display HR/BP trend Separating bars Current protocol Enter blood pressure
Instructions for Use and Technical Description Norav Medical Ltd. 42Quick Start To Perform a New Test 1. Click F1 (or the New button on the toolbar). 2. Insert patient details in the dialog box. 3. Click OK. The preliminary Rest phase begins. 4. Click F3 (or Stress button) to start the Stress phase. 5. Insert blood pressure and/or remarks (if relevant) in the dialog box and click OK. 6. Click F5 (or Recovery button) to begin the Recovery phase. 7. Enter blood pressure and/or remarks (if relevant) in the dialog box and click OK. 8. Click F4 (or Stop button) to stop the test. To Print an ECG 1. Select Print ECG from File menu. 2. Select Current Stage\Entire Study from the Print ECG submenu. 3. Select the printer from the print dialog box. 4. Click OK to close the dialog box and start printing. To Print a Report 1. Click Print on the toolbar. 2. Select the report/s to print. 3. Click OK to start printing to the default printer. Or 1. Select Print Reports item from the File menu. 2. Select the report. 3. Define the printer in the Print dialog box. 4. Click OK to start printing the report. For an example of a printed report, see Appendix C: page 111.
Stress ECG NV-54/PCECG1200W 43Leads Placement You can place the leads on the patient in various ways. The usual method is to place the leads in the standard positions on the chest (V1-V6). To identify the placement of the leads, the channels are renamed. One option for standard lead placement is V7-V9. Another is the Right chest Lead system. To Define the Lead System 1. Click Setup > Lead. 2. Select the lead system to use (the default is Standard). Operation with Function Keys F1 New recording F2 Run/stop pre-test monitoring F3 Begin stress test F4 Stop test F5 Begin Recovery phase F6 Set Event F7 Freeze stage F8 Next stage F9 Manual control F10 Previous stage F11 Open saved study F12 Stop treadmill or ergometer in emergency Table 9: Stress Function Keys Note Before using the stress test package define preferred parameters in Setup. Otherwise the program will operate according to the factory setup.
Instructions for Use and Technical Description Norav Medical Ltd. 44Toolbar Overview Main Toolbar (Easy Toolbars Mode) This toolbar is displayed at startup. Use it to open an existing test or to begin a new one. Figure 9: Main Stress Toolbar Stress Test Commands This toolbar is displayed at the start of a new test. Figure 10: Stress Test Commands Toolbar New Change protocol About Open saved study Setup Add remarks Run/stop pre-test monitoring Begin recovery Set eventPrevious stage Manual control Zoom heart rate Setup Begin stress testStop test Freeze stage Next stageEmergency stop treadmill
Stress ECG NV-54/PCECG1200W 45Views and Filters Toolbar The toolbar controlling views filters appears beneath the main toolbar. Figure 11: Stress ECG Views and Filters Toolbar Average Viewer Toolbar The toolbar displaying various post processing views appears to the right of the Views and Filters toolbar. Figure 12: Stress ECG Post Processing Display Toolbar Select leads to display Select filters Select horizontal/vertical scale Display next leads Display ECG only Select leads to display Select next leads Display QRS
Instructions for Use and Technical Description Norav Medical Ltd. 46Post Processing Options Toolbar When the test is complete you can review it using the Post Processing Options Toolbar. Figure 13: Stress ECG Playback Toolbar Open saved study Print results Add remarks Display next leads Display ECG test in new window Play current event Save results Show patient details Setup Display stages/events as table Skip to previous event Skip to next event
Stress ECG NV-54/PCECG1200W 47Stress ECG Setup Printer Definition: Printer definition is very important because of the high data rate during real time printing. If the printer has about 8–10 MB RAM, set the graphic resolution at 600 dpi. If the printer has about 2 MB RAM, reduce the resolution to 300 dpi. Click Setup on the Toolbar to access the following parameters: Tab & Secondary Tab Option Description ECG Recording Default filters Defines the filter’s initial status in ECG recording. Save format Defines the amount of data to be saved on the disk. Auto Save Select this option to save the ECG test automatically at the end of the test. The test will be saved into the defined directory or to the database (if used). Save Options Set File Name by To add the Patient ID or Patient Last Name to the file name, select the required option. Simulator ECG When cleared (default), ECG recording is performed from the PC-ECG unit. When checked, the ECG recording is performed from the demo file included in the software package. In this case, the recording unit is not needed. Alert Signal OFF There is an alert (beep) when reach the target\warning zone of HR. If this option is marked, there is no alert. Beep on QRS When marked, beep is heard every time QRS is detected. ECG Leads When using the standard 12 lead patient cable, select the “12 Leads” option to read and display up to 12 leads (default). When using a 6 lead cable, select the “6 Leads” option to read and view up to 6 leads. Use ECG Database Select this option to connect to the default ECG database. If this option is selected (checked) the ECG tests are saved in the database. Data Directory Allows the user to define a directory for saved ECG recordings (if ECG database is not used). Use a secondary hard disk, if one is available. Lead Systems Default 3 leads Define the 3 leads that are displayed as default when using 3x1 view format. Default 6 leads Define the 6 leads that are displayed as default when using 6x1 or 3x2 view format. Strip Lead 10 sec lead to appear in 4x3 and 6x2 formats. View Count Recovery Time Separately from Stress Check this option to have separate times for the Stress phases and the Recovery phases. Clear this option to have the time displayed on screen (in Real time and in Review Screen) as the overall test time including the Stress and the Recovery phases.
Instructions for Use and Technical Description Norav Medical Ltd. 48Tab & Secondary Tab Option Description Default Colors To define the default colors for background, traces, grid, light grid, text, and base average, click the appropriate button and select the color from the color palette. To restore the default colors click Restore Default in the frame. Default ECG View Select the default on screen lead display from the list in the combo box. When “6 Leads” is defined in the ECG Recording tab, the maximum view is 6 leads. Easy Toolbar mode Check this option to display fewer icons. Text Labels Check this option to add text labels to the toolbar buttons. Separate Leads Check this option to have the leads separated by borders. Clear this option to have the leads not separated by borders. Draw over Leads Border Check this option to have high signals (exceeding the channel display) drawn beyond the lead border. Clear this option to have high signals cut off. Draw Grid Check to display grid lines. Uncheck to hide gridlines. Cabrera Display Check this option when using a Cabrera lead system. When using the standard LEDs system, clear this option. Lock Splitter When this option is checked, the splitters cannot be moved and the sections in the viewer cannot be resized. To resize the different sections in the viewer, clear this option. Horizontal scale Sets the default value for the horizontal scale window on screen (mm/sec). Vertical scale Sets the default value for the vertical scale window on screen (mm/mV). Ergometer METS/Watt Applies to an Ergometer test. The selected units (METS or WATT) are displayed for the Workload on the Review Screen (post-processing). Installation Saves user data (hospital and physician). This data is recorded on any print out and sent as email. Measurement Standard Define whether measurements are calculated according to the metric or the USA standard. The default is metric. Magnetic Card Reader Select this option to use a magnetic card with bar-code to insert patient details. Select the magnetic card type. Environment Connection If an automatic blood pressure monitor (Tango) is to be connected to the system, checks for the appropriate COM port. Display Size Choose between 14/15-inch screen (default) and 17-inch screen. This setting is required in order to display the ECG and grid in the correct scale. Measure BP by Automatic Device If a blood pressure monitor is used, define whether automatic measurements should be performed in addition to manual measurements. Automatic BP COM Port Set the COM Port that the BP device (optional) is connected to. Exercise Device COM Port Select the COM port that the exercise device is connected to from the list.
Stress ECG NV-54/PCECG1200W 49Tab & Secondary Tab Option Description Advance Cards R wave trigger (requires D1-t board) should be ticked if a blood pressure monitor is used or if external synchronization is needed. If analog out (requires D/A board) for metabolic or exercise device control is needed, select the appropriate options. The software is compatible with a metabolic chart manufactured by Ganshorn, Germany. USB Check R wave trigger option (when using USB connection with BNC output) if a blood pressure monitor is used or if external synchronization is needed. Select the required R-wave trigger width from the option list. Check ECG option for analog ECG signal. Use Transfer file “Trnsf.txt”Check this option to use Trnsf.txt file (see page 58). Exercise device Type Set up for PC-ECG connection, the external device (treadmill or ergometer) connection, and type. The factory default setup for the external device type is "None". In this mode, the software does not control an external device. Define the type of ergometer or treadmill that is being used. Exercise Device Default protocol Valid for S1, S2 options. Choose one of the available protocols or define your own protocol. Exercise Device Speed unit Set up for MPH or KPH. This option refers to treadmills only. Exercise Device Emergency STOP Select the procedure for Emergency STOP. Select “Immediately” for abrupt stop of the treadmill or “Slow Down” for gradually slowing down the treadmill until final stop. Metabolic Card Control Metabolic Card Control Check this option to control an external metabolic testing device for blood gas content. If this option is cleared (default) no communication is made with the metabolic testing device. Metabolic Card Manufacturer Select the metabolic card manufacturer from the list. Auto Print (Print Report) Check this option to print the metabolic test report automatically at the end of the test. Printouts Auto Print Default Reports on End Test Check this option to automatically print the default reports at the end of each test. Default Reports Define the default reports. Paper Size for ECG PrintingSet paper size, either conventional printer or 4-inch thermal printer. Use Large fonts for Remarks Enables large font for user entered free text. Shadow/Frame for Area of Interest Allows the user to choose between shadow and frame to highlight the area of interest . Load Printer Drivers Ahead Check this option to save time by reading the driver before sending the print action. ECG Line Define the line width in the printouts, either Normal or Bold. Event Format Set Event format for printout to either 3 lead or 12 leads format.
Instructions for Use and Technical Description Norav Medical Ltd. 50Tab & Secondary Tab Option Description Tabular Results Format Check this option to print out results in a tabular format. Graph Paper When set to On, prints 1mm and 5 mm squares on printouts. Regular Grid works with any printer. Improved Grid shows a fine grid but may not work on some printers. Color printout Select this option for colored printouts. Blending out ST values Select this option to print results without ST values. GDT/BDT Format Automatic Options Setup automatic options for saving and/or importing files in GDT/BDT format. File Format Select the file format: GDT or BDT. Import Codepage 437 Check this option to import Code page 437. Export Codepage 437 Check this option to export Code page 437. Edit Labels Click this button to open a dialog box with an editable list of the field labels used in the GDT and BDT files. GDT/BDT Data Directory Define the directory path where the GDT/BDT files should be maintained. Token for PCECG The default is PEKG. Token for Practice EDP The default is EDV1. Text File Auto Save Test Data in Text File Check this option to save the test data automatically to a text file at the end of the test (according to the naming and directory defined in this tab). Set Text File Name by Define the naming convention of the text file, created automatically or on demand. Text File Data Directory Define the directory where the text files will be maintained. Target HR/METS Target HR Set the maximum male and female HR for to be allowed for use in the Target HR equation . The target HR is affected by the age of the patient. Target HR warning zone % Set the percentage of target HR for warning. Above this level, the HR trend is displayed in a different color. If the percentage value is reached during the test and “Switch to Recovery when reaches HR Warning zone” option is checked, the stress test stops automatically and recovery phase begins. Stop Stress and start Recovery Check this option to stop stress test when HR reaches the target HR or warning zone and start the recovery phase. When “Switch to Recovery when reaches HR Warning Zone" is cleared, the Stress test continues according to the test protocol. METS/VO2 Formula selection Set the formula to calculate the METS/VO2 values: • To use a single formula check “single formula for any speed”. • To use one formula for speed up to 3.7 m/h and a second formula above that speed, set the option “Two formulas (Up to and from 3.7 m/h)”.
Stress ECG NV-54/PCECG1200W 51Tab & Secondary Tab Option Description METS/VO2 Updating Method Select the method for updating the METS/VO2 values. The values can: • remain constant through the entire stage • switch to the current METS value 1 or 2 minutes after the stage begun • have values vary during the stage (at every quarter of the stage time). ST.VPB Options ST Measurements After J Choose the number of milliseconds after the J point at which the ST is measured. The factory set up is 60 Ms. Detect ST Event Define the mm level for elevation and depression. This option also allows the user to save only deteriorated ST episodes. Real Time Printing Set the events to print (including ST/VPB/SVPB). Any checked event will be printed. Cleared events will not be printed (9 events). Show Dialog Check events to display a dialog box at the beginning. Clear events to prevent display of dialog box. Print Page Format Check the required option for printout format. Print Scale Format Select the scale for printout format. St, Slope Printing Select this option to print the ST and ST slope values. Clear to prevent printing. Switch to Review Automatically Check this option to switch automatically to the Review screen at the end of the test. When cleared, the realtime screen remains Remarks Defines statements that can be entered during the test. It is divided into five sets of statements used during real time and post processing. Remote View Valid for option S2. Enables viewing a study that takes place in any of the network stations, across the whole network. Enables a physician to view a study remotely. Table 10: Stress ECG Setup Options
Instructions for Use and Technical Description Norav Medical Ltd. 52Toolbar and Menus: Main To do this Click this icon Or use this short-cut key Or select this menu Description Start a new study F1 File > New Creates a new study Open an existing study F11 File > Open Opens an existing study Save a recording Ctrl+S File > Save Saves the active study Print results Ctrl+P File > Print Report or Print ECG Prints the active study Recover file to Monitoring format File > Recovery File to Monitoring Format Enables saving and viewing data if the Stress application crashes. Select this option in the main frame. In the dialog box, provide a name and path for the file (*.TMP). To view the ECG open this file with the Monitoring application (main frame menu). Import demographic data from HIS to PC-ECG File > GDT/BDT Format For details see Import from GDT/BDT, page 105 This file always contains the last patient data. Export the GDT/BDT file from PC-ECG to HIS File > GDT/BDT Format For details see Save Test in GDT/BDT page 105 This file always contains the last patient data. Create a text file File > Create Text File Saves ECG data in text format. Restore default window size View > Set Default Window Size Restores the default window size of the sections in the window. (Available in realtime) Set/change patient data View > Patient Sets or changes patient data Add/view remarks Ctrl+R View > Remarks Allows you type free text during or after the ECG recording. It is printed and saved together with the ECG traces. Select a different protocol View > Change current protocol Changes the protocol Set preferences Ctrl+T View > Setup Displays the setup dialog box To display information Help > About Stress… Displays program information, version number, and copyright Table 11: Main Stress Toolbar and Menus
Stress ECG NV-54/PCECG1200W 53Toolbar and Menus: Stress Test Commands To do this Click this icon Or use this short-cut key Or select this menu Description Start/stop monitoring F2 Test > Run/stop monitoring Runs/stops monitoring Start stress test F3 Test > Stress test begin Starts stress test Start recovery phase F5 Test > Recovery begin Starts recovery phase Stop test/recovery phase F4 Test > Stop test Stops stress test or recovery phase Set an event F6 Test > Set event Sets events and prints according to options Measure blood pressure Test > Measure BP Activates the blood pressure monitor Freeze the current stage F7 Test > Freeze stage Freezes the current protocol stage Return to the previous protocol stage F10 Test > Previous stage Returns to the next protocol stage Advance to the next protocol stage F8 Test > Next stage Advances to the next protocol stage Control the exercise device manually F9 Test > Manual management Manually controls the exercise device Stop the treadmill or ergometer in an emergency F12 Test > Stop exercise device Emergency stop for treadmill or ergometer Display enlarged heart rate Ctrl+H View > Zoom up heart rate Enlarges display of heart rate window Display study results Test > Review Displays study results Table 12: Stress Test Commands
Instructions for Use and Technical Description Norav Medical Ltd. 54Toolbar and Menus: Average Viewer To do this Click this icon Description Display 3 lead average Averages of 3 leads and ST trends Display 12 lead average 12 leads averages Display single QRS Single QRS Scroll between lead displays Double function: a) scroll for all leads in the 3X1 display b) point to the requested lead Display QRS Base line QRS in white and current QRS in yellow Table 13: Average Viewer Toolbar Toolbar and Menus: Post Processing (Right hand side of tool bar) To do this Click this icon Or use this short-cut key Or select this menu View 12 leads ST trends results View > 12 Leads ST View 3 leads ST trends results View > 3 Leads ST View next ST trends Triplet View > Next ST Leads View numerical results Ctrl+V View > Properties Undo the last action Ctrl+Z View ECG 10 sec data Enter View > Open ECG Data (requires I1 or I2 license). Move marker to previous event Ctrl+ View > Event > Previous Event Move marker left 10 sec  View > Event > Left Play back results View > Play ECG Data Move marker right 10 sec  View > Event > Right Move marker to next event Ctrl+ View > Event > Next Event Add (create) a new event View > Add New Event Delete the current event View > Delete Current Event
Stress ECG NV-54/PCECG1200W 55To do this Click this icon Or use this short-cut key Or select this menu Set preferences Ctrl+T View > Setup Print the study File/Print ECG This enables you to print the entire study or a single stage Position the ST marker View/Recalculate STThis enables you to position the ST marker for the entire study Table 14: Post Processing Toolbar and Menus To Start the Stress Recording Program Double click the stress icon. The initial screen is displayed. To Start a New Test 1. Define the exercise machine (Treadmill/Ergometer). (See page 49.) 2. If necessary, click the Change Protocol icon to select a test protocol. Figure 14: Change Test Protocol 3. Click the white page icon. The Stress working screen and patient data entry screen are displayed.
Instructions for Use and Technical Description Norav Medical Ltd. 56 Figure 15: Patient Data Entry 4. Enter patient data and click OK. Monitoring of 12 leads begins. After about 15 sec the average QRS is displayed. 5. Inspect the protocol label in the lower right hand corner. To choose another protocol, click the Change Protocol icon (or select View > Change Protocol), select the requested protocol, and click Change. 6. Enter blood pressure for rest. You can print a Rest printout using the EVENT icon without starting the Stress program. This enables multiple Rest printouts. 7. To start the stress session, click the Stress icon (running man). The stress time is displayed in the lower left-hand corner. The following options are available: ◊ Define events ◊ Go to Manual ◊ Freeze Stage ◊ Advance Stage ◊ Go to Recovery phase. Recovery Phase When you switch to recovery phase, the recovery phase elapsed time is counted as well as the total elapsed time. Wait for recovery phase to finish according to protocol or stop it using the stop icon. Both TEST time and RECOVERY time are fixed. Patient monitoring continues. Click and disable Go to stop it. Viewing Results There are two options for completing a stress test. • Display the post-processing data screen (Review Screen) automatically • Remain in ECG display.
Stress ECG NV-54/PCECG1200W 57To View Study Results Click the Post Processing icon. This enables display and printout of the entire study. Note that before saving the study to disk, the entire ECG is kept for review. To Display the Review Screen Automatically In Setup, click the Real-Time tab and check Switch to Review Automatically. At the end of the test protocol, or after clicking F4, the display switches automatically to the Review Screen, and the post-processing information is displayed. To Display the Review Screen Manually If Switch to Review Automatically is not enabled: 1. Click F4 The test (exercise device) stops but the ECG signal continues to run. 2. Click F2 The ECG signal stops and a Review button is displayed on the tool bar. (The Review button is not displayed if Switch to Review Automatically is enabled). 3. To review the post-processing information, click Review. The Review Screen is displayed with the post processing data. It provides the following options: ◊ Print reports automatically. ◊ Save and display ORIGINAL Data with real time filters (with removal option). ◊ Print All Events in REVIEW. ◊ Print on an additional page if necessary. ◊ Print ST Measurements optionally. To Save Study Results 1. Click Setup > ECG Recording. 2. Select options for saving the study and click OK. 3. Click File > Save, define the file name and path, and click OK.
Instructions for Use and Technical Description Norav Medical Ltd. 58Metabolic Stress Estimation (METS) A very important feature of the software is the estimation of Metabolic Equivalency (METS). This estimates how many ml of oxygen the body produces for every kg of weight per minute. The results are shown in units of METS or VO2 Max. (One unit of VO2 is 3.5 units of METS.) 1 METS corresponds to a person at rest. A higher METS indicates a higher fitness level. Transfer File “Trnsf.txt” Use this option when the PC-ECG 1200 shares the same PC with another application in real time. To Transfer a File 1. Click Setup > Environment. 2. Click the Advance tab. 3. Check Use transfer file “TRNST.TXT” A transfer file is created in the directory containing the Stress application file. The default is C:\Program Files\Pc-ecg. The transfer file receives real time data from the Stress application, such as: current Heart Rate, Workload, Speed, and Grade of external device. It is a text file, updated every 5 seconds. The format is as follows: Each text line starts with a descriptive header and a parameter that always starts at character number 13. The value of each parameter may change during the study. Parameter Current Value Range (not included in text file) HR : 86 (0-200) Speed(mph): 3.3 (0- 25) Grade(%) : 1.0 (0 – 30) Workload : 10.1 (0 – 1000) Table 15: Transfer File Format Note A Sharing Violation error may occur if the file is read while the Stress Application is updating it. Wait until updating is completed (a second or two).
Stress ECG NV-54/PCECG1200W 59Additional Features To Define Max. HR 1. Open a test in a Review Screen (post processing). 2. Click Properties on the toolbar The Properties dialog box is displayed. 3. Select the cell with the highest HR value. 4. Click Define Max HR. The cell is highlighted and the background color of the cell is changed. To Define Worst ST 1. Open a test in a Review Screen (post processing). 2. Click Properties on the toolbar The Properties dialog box is displayed. 3. Select a cell in one of the channels with the worst ST. 4. Click Define Worst ST. The cells in the 12 channels of the same event are highlighted and the background color is changed.
Instructions for Use and Technical Description Norav Medical Ltd. 60RS232 Controlled Treadmill Types Vendor Model Vendor’s Fax RS232 Connector on the TM RS232 Wiring Type Trackmaster TM425 +1-316-283-3350 D-9 female Straight Trackmaster TMX425 +1-316-283-3350 D-9 female Straight Parker PM +1-334-8213221 D-9 female Straight RAM 770 +39-049-8703388 D-9 female Straight Woodway PPS55-MED D-9 male Crossed Powerjog GM, J +44-121-4333035 System Biomedical +91-22-4963147 HP COSMOS All models +49-8669-864249 QUINTON TM-55 D-9 female Straight QUINTON ST-55 D-9 female (RS422) Q422* D-9 female (RS422) M422* Marquette 2000 series DIN 5 pin female Tx –5 Rx – 4 GND - 2 KIP Machines KIP Series +5411-4327-2963 +54341-464-7302 +54341-463-7919 DB9 Male Lines: RX, TX, GND standard place in DB9 Male connector BONTE MACHINEFABRIEK B.V. + 31 038-4554030 DB9, crossed Treadmill (SUB-D 25) <----> PC (SUB-D 25) 2 ---------- 3 3 ---------- 2 7 ---------- 7 * Requires a special adaptor, supplied by Norav Medical Table 16: Controlled Treadmills
Stress ECG NV-54/PCECG1200W 61RS232 Controlled Bicycle Ergometers Vendor Model Vendor’s Fax RS232 Connector on the Ergometer RS232 Wiring Type Ergoline ER900 +49-7431-989427 DIN 5 pin SECA CT100 +49-40-20000050 D-9 male Crossed Dimeq 770 +49-30-72376240 LODE EXCALIBER ELMED Table 17: Controlled Ergometers
Late Potential Signal Averaging NV-54/PCECG1200W 63CHAPTER 9: LATE POTENTIAL SIGNAL AVERAGING (This option is available with the L1 license) Figure 16: Late Potential Signal Averaging Screen Signal averagesFiltered averagesVector magnitudeNumerical results Heart trends
Instructions for Use and Technical Description Norav Medical Ltd. 64Quick Start To Start a New Test 1. Click F1 (or the New button on the tool bar). 2. Insert patient details in the dialog box. 3. Click OK. 4. Click F3 or F4 to start the LP averaging test. 5. Enter the interval name and/or remarks as appropriate in the dialog box and click OK. 6. Click F3 or F4 (or Start/Stop Averaging button) to stop the LP averaging test (or wait until it terminates). To Print 1. Click F6, or select Print item from the File menu. 2. Select the printer from the Print dialog box. 3. Click OK to close the dialog box and print the display (the LP averaging report or the ECG test).
Late Potential Signal Averaging NV-54/PCECG1200W 65Operation with Function Keys F1 New recording F3/F4 Start/stop F6 Print F11 Open saved study Table 18: LP Signal Averaging Function Keys For an example of a printed report, see Appendix C:, page 111. Leads Recording is performed for leads X, Y, and Z (orthogonal) using the regular 12 lead cable. Arrange the leads as follows: 12 Lead Orthogonal Lead (position) V2 X+ left side of the chest V1 X- right side of the chest V4 Y+ lower side of the chest V3 Y- upper side of the chest V6 Z+ middle of the chest V5 Z- middle of the back RA,LA,LL,RL Same position as in 12 leads Table 19: LP Signal Averaging Leads Placement
Instructions for Use and Technical Description Norav Medical Ltd. 66LP Signal Averaging Setup Click Setup on the Toolbar to access the following parameters: Tab Option Description ECG Recording Auto Save(Save Options) When Auto Save is ON, the file is stored by Last name or by ID. When Auto Save is OFF, the program requests a filename. Set File Name by (Save Options) Set the naming convention for saving files (by Patient Last Name or ID) Simulator ECG When cleared (default), ECG recording is performed from the PC-ECG unit. If checked, the ECG recording is performed from the demo file included in the software package. The recording unit is not required. Stop to confirm QRS When ON, the user can choose the Normal QRS. When OFF, the program chooses the Normal QRS automatically. Template Correlation Defines the QRS percentage match during signal averaging. A higher number corresponds to a better match. Target Number of Beats Number of typical heartbeats that will be counted during the averaging stage. Use ECG Database Check this option to connect to the default ECG database. ECG tests are saved in the database. Data Directory Defines the directory for saved ECG recordings. View ECG’s Colors To modify the ECG colors, click the appropriate button and select the color from the color palette. Averages Color To modify the colors in the Averages window, click the appropriate button and select the color from the color palette. HR Trend’s Color To modify the colors in the HR Trend’s window, click the appropriate button and select the color from the color palette. Restore Defaults Click to restore the default factory colors Installation Saves hospital and physician data. This data is included in print out and email. Measurement Standard Define whether measurements will be calculated according to the metric or the USA standard. The default is metric. Magnetic Card Reader Select this option to use a magnetic card with bar-code to insert patient details. Select the magnetic card type.
Late Potential Signal Averaging NV-54/PCECG1200W 67Tab Option Description Environment Connection Use the option button (COM port/USB) to select the port for device connection. If COM port is selected, select the serial input for the PC-ECG unit from the COM port list. If the USB connection is selected, the COM PC-ECG selection list is disabled. (Default at installation is USB). Graph paper If ON, prints 1mm and 5 mm squares on printouts. Regular grid prints from all printers. Improved grid shows a fine grid but may not work on some printers. Use Large Fonts for Remarks Enlarges font for free typed text. Color printouts Clear this option to force B/W printing on color printer. Display Size Choose between 14/15-inch screen (default) and 17-inch screen. This setting is required in order to display the ECG and grid in correct scale. GDT/BDT Format Automatic Options Define automatic options for saving and/or importing files in GDT/BDT format. File Format Select the file format: GDT or BDT Import Codepage 437 Check this option to import Code page 437. Export Codepage 437 Check this option to export Code page 437. Edit Labels Click this button to open a dialog box with an editable list of the field labels used in the GDT and BDT files. GDT/BDT Data directory Define the directory path where the GDT/BDT files will be maintained. Token for PCECG Default is PEKG. Token for Practice EDP Default is EDV1. Holter File Path Download Flash Card Program Define the path for the flash card program directory. Download Directory Define the directory to maintain the downloaded Holter files. Table 20: LP Signal Averaging Setup
Instructions for Use and Technical Description Norav Medical Ltd. 68Toolbar and Menus To do this Click this icon Or use this short-cut key Or select this menu Description Start a new study F1 File > New Starts a new XYZ recording. The patient’s demographic data can be entered prior to ECG recording (optional). The three channels are displayed on the screen for quality assurance. If the results are unsatisfactory, check skin preparation and disposable electrode contacts. Then click Start/Stop Averaging. Open an existing study F11 File > Open Opens an existing study Save a recording Ctrl+S File > Save Saves recording to disk (default file name: REST). Send data via email File >Send... Sends recording data via email, if present on the computer. Print results F6 File > Print Prints the active study Import demographic data from HIS to PC-ECG File > GDT/BDT Format For details see Import from GDT/BDT, page 105 This file always contains the last patient data. Export the GDT/BDT file from PC-ECG to HIS File > GDT/BDT Format For details see Save Test in GDT/BDT page 105 This file always contains the last patient data. Set/change patient data View > Patient Data Adds this data to the recording. It is printed together with the ECG traces. If the recording is saved, then the PATIENT DATA is saved together with the ECG traces. Use the Previous option if the same patient undergoes a second study. Add/view remarks View > Remarks Allows you type free text during or after the ECG recording. It is printed and saved together with the ECG traces.
Late Potential Signal Averaging NV-54/PCECG1200W 69To do this Click this icon Or use this short-cut key Or select this menu Description Set preferences Ctrl+T View > Setup Displays the setup dialog box and allows the user to tailor operation preferences. To display information Help > About… Displays software version number (which should be quoted on any inquiry regarding the software). Also displays memory size and disk free space. Start/Stop Averaging F3/F4 ECG > Start/Stop Averaging Allows the user to start the averaging period. The averaging period default is 200 beats. It can be changed in OPTIONS, ECG RECORDING, and TARGET NUMBER Display/Hide the grid View > Grid Optional display of 5mm raster. Print outs are always with 1mm raster. Start monitoring. F2 ECG > Start/Stop Monitoring Starts monitoring. Stop monitoring F2 ECG > Start/Stop Monitoring Stops monitoring. Activate Onset Marker Ctrl+ ECG Onset marker Allows the user to move the Onset Marker using the direction arrow icons. Activate Offset Marker Ctrl+ ECG Offset marker Allows the user to move the Offset Marker using the direction arrow icons. Move the On and Off markers / Allows the user to move the ON/OFF markers. Table 21: LP Signal Averaging Toolbar and Menus
Instructions for Use and Technical Description Norav Medical Ltd. 70Interpreting Results When the signal-averaging phase is complete, the result screen is displayed: Figure 17: LP Signal Averaging Review Screen Numerical results
Late Potential Signal Averaging NV-54/PCECG1200W 71Numerical Results Averaged Beats Displays the number of averaged normal beats captured during the study. HR Average in beat/min High Frequency QRS Duration in Milliseconds from ONSET to OFFSET Displays the width of the filtered QRS containing only high frequencies. A higher number indicates higher patient risk. RMS LASTS 40 milli-seconds in Microvolts Displays the total activity for the last (40ms) portion of the QRS. A lower number indicates higher patient risk. DURATION UNDER 40 Microvolts in Milliseconds Shows the period in ms from offset of the QRS till the first point of 40uV activity. A higher number indicates higher patient risk. H.F. Noise: in Microvolts Quality assurance. A lower number corresponds to higher result accuracy. The maximum number should not exceed 1 µV. Table 22: LP Signal Averaging Numerical Results The results are calculated automatically. You can overrule the automatic positioning of the ONSET/OFFSET markers with the direction keys.
Instructions for Use and Technical Description Norav Medical Ltd. 72
Monitoring NV-54/PCECG1200W 73CHAPTER 10: MONITORING (This option is available with the M1 license) This option enables long-term recording and storage to disk. The user decides which leads and at which sample rate to monitor on screen and save to disk. During the study, you can print in real time on a thermal printer. Figure 18: Monitoring Screen Horizontal scale (mm/sec) Vertical scale (mm/mV) Toolbars Heart rate (beats/min) Slider time Total study time
Instructions for Use and Technical Description Norav Medical Ltd. 74Quick Start To Start a New Test 1. Click F1 (or the New button on the tool bar). 2. Insert patient details in the dialog box. 3. Click OK. 4. Click F2 (or Start/Stop button) to stop data collection or wait until end time. To Print 1. Click F6, or select Print item from the File menu. 2. Select the printer from the Print dialog box. 3. Click OK to close the dialog box and print the display. Print Study (print a selected time range and leads) 1. Click Print Study on the toolbar or select Print Study Item from the File menu. 2. Define the time range and select the leads to print from the dialog box. 3. Click OK to acknowledge selection and close the dialog box. 4. Select the printer in the Print dialog box. 5. Click OK to start printing. Monitoring ECG Setup Click Setup on the Toolbar to access the following parameters: Tab Option Description Sample Rate\Leads Selection Leads Allows the user to select leads. To select all leads, click Select All. To deselect all leads click Unselect. Sample rate Allows the user to choose requested samples per second per channel. X,Y,Z Check this option to monitor X, Y, and Z axis. Clear the option to select the other leads to be displayed and monitored on screen. With this option, monitoring other leads is not possible (default is cleared).
Monitoring NV-54/PCECG1200W 75Tab Option Description 12 Leads View Default 3 leads This function is available only if 12 lead monitoring is selected. 3 leads appear if 3X1 format is used. Strip Lead 10 sec. lead appears in 4X3 and 6X2 formats. ECG recording Filter 50/60Hz When checked, the default status of 50/60Hz filter is ON (according to the checked frequency 50 or 60). Default is cleared. EMG Filter When checked, the default status of the EMG filter is ON. Default is cleared. Baseline filter When checked, the default status of the Baseline filter is ON. Default is cleared. Save options If Auto Save is ON the file is stored by last name or by ID. If Auto Save is OFF the program requests a filename. Simulator ECGIf cleared (default), ECG recording is performed from PC-ECG unit. If checked, ECG recording is performed from the demo file included in the software package. The recording unit is not needed. ECG Recording time (h:m) Determines study duration in minutes. Data Directory Defines the directory for saved ECG recordings. Use secondary hard disk if available. View Draw Over Lead Borders If checked (default), does not limit the extreme high amplitude ECG pulses from exceeding the borders. If cleared, chops the pulses at the borders. Horizontal Scale Sets the default value for the Horizontal scale window on the screen. Vertical Scale Sets the default value for the Vertical scale window on the screen. Slider step size Off line function. Sets the default value for slider steps when moved by mouse or arrow keys. Colors Allows the user to choose colors. Restore Defaults Restores factory defaults. Installation Saves hospital and physician data. This data is included in print out mail. Measurement Standard Define whether measurements will be calculated according to the metric or the USA standard. The default is metric.
Instructions for Use and Technical Description Norav Medical Ltd. 76Tab Option Description Magnetic Card Reader Select this option to use a magnetic card with bar-code to insert patient details. Select the magnetic card type. Environment Connection Select the option button (COM port/USB) to choose the port for device connection. If the COM port option is selected, select the serial input for the PC-ECG unit from the COM port list. Disabled if the USB connection is selected. (Default at installation – USB) Display Size Choose between 14/15-inch screen (default) and 17-inch screen. This setting is required to display the ECG and grid in correct scale. Graph paper If set to On, it prints 1mm and 5 mm squares on printouts. Regular Grid is guaranteed to fit any printer. Improved Grid shows a fine grid but may not work on some printers. Large Remarks font Enlarges printed text. Color Printout Forces B/W printing on color printer. Thermal Plotter Sets LPT port for optional thermal paper. GDT/BDT Format Automatic options Setup automatic options for saving and/or importing files in GDT/BDT format. File Format Select the file format: GDT or BDT Import Codepage 437 Check this option to import Code page 437. Export Codepage 437 Check this option to export Code page 437. Edit Labels Click this button to open a dialog box with an editable list of the field labels used in the GDT and BDT files. GDT/BDT Data directory Define the directory path where the GDT/BDT files will be maintained. Token for PCECG Default is PEKG. Token for Practice EDP Default is EDV1. Table 23: Monitoring Setup Options
Monitoring NV-54/PCECG1200W 77Toolbar and Menus To do this Click this icon Or use this short-cut key Or select this menu Description Start a new study F1 File > New Test Starts a new monitoring session. Patient data can be entered prior to ECG recording (optional). The recording time is set in SETUP for ECG RECORDING. The user can stop recording by clicking the GO/STOP icon. Open an existing study F11 File > Open Shows recordings saved on disk. Save a recording Ctrl+S File > Save Saves recording to disk. Print results F6 File > Print Off line printing. Determine the time range to be printed. The acquired ECG is printed in miniature format horizontal: 6.25mm/sec and vertical: 2.5 mm/mV. Export to Rest File > Export to Rest A 10 sec segment containing original leads I,II,V1-V6 and calculated leads III, aVR, aVL, aVF is transferred into Rest format (up to 12 leads 10 sec). Calculated leads are performed only if I and II are acquired. Export to MATLAB File > Export to MATLAB A 10 sec segment containing acquired leads is transferred into MATLAB format. Import from ISHNE File > Import from ISHNE Long-term high resolution ECG recorded on Holter can be transferred into a monitoring study Plot in real time Real time printing on a thermal printer. Can print continuously while monitoring up to 8 leads. Set/change patient data View > Patient data Displays patient demographic information. Add/view remarks View > Remarks Allows the user to enter free text during or after the ECG recording. This is printed and saved together with ECG traces. Set preferences Allows the user to tailor operation preferences. To display information Help > About… Software version number. Quote this for any software inquiry. Also shows memory size and free disk space. The HASP ID number is the ID of existing software keys. This ID number is used for adding software options.
Instructions for Use and Technical Description Norav Medical Ltd. 78To do this Click this icon Or use this short-cut key Or select this menu Description Display/Hide the grid View > Grid Optional display of 5mm raster. Start ECG Recording. F2 ECG > Start/Stop Starts ECG recording. Stop ECG Recording F2 ECG > Start/Stop Stops ECG recording. Display 3X4 Leads Ctrl+1 View > Leads format > Windows Classical format. Displays 12 lead ECG of 2.5sec ECG + 10sec trace.* Display 12X1 Leads Ctrl+2 View > Leads format > All leads Displays 12 lead ECG of 10sec ECG.* Display 3X1 Leads Ctrl+3 View > Leads format > Lead group Displays 3 lead ECG of 10sec ECG.* Display the next leads Ctrl+0 View > Leads format > Next leads Allows the user to scroll through all leads in the 3X1 display Set 50/60 Hz filter ECG > Filters > 50/60 Hz ON/OFF for line interference filter. Set OPTIONS for 50 or 60 Hz prior to operation Set EMG filter ECG > Filters > EMG ON/OFF for muscle noise filter Set base line filter ECG > Filters > BaseLine ON/OFF for baseline filter on ECG data Table 24: Monitoring Toolbar and Menus * ECG data can be set up as limited amplitude or unlimited amplitude, which can cause one lead data to overlap a neighboring lead.
Heart Rate Variability (HRV) NV-54/PCECG1200W 79CHAPTER 11: HEART RATE VARIABILITY (HRV) (This option is available with the H1 license) Time and frequency domain analysis is designed for short studies in which one or more time segments are measured, as in a Tilt study. Measured/reported parameters are according to NASPE/ESC Guidelines. Histogram P.S.D. Tachogram Slider HRV results
Instructions for Use and Technical Description Norav Medical Ltd. 80 Key: Histogram The histogram relates to the active part (yellow) of the tachogram P.S.D. The power spectrum distribution Tachogram The tachogram trend shows all intervals. Each beginning of an interval is checked with a red line followed by the interval’s name. To activate an interval, click it. To activate several neighboring segments, press SHIFT and move the slider. Slider Use the slider at the bottom to: • Define new intervals • Change interval duration, and • Activate several intervals HRV results The HRV results pane displays the results in numerical format. Table 25: HRV Screen Quick Start To Start a New Test 1. Click F1 (or the New button on the tool bar). 2. Insert patient details in the dialog box. 3. Click OK. 4. Click F3 or F4 to start the HRV test. 5. Enter the interval name and/or remarks as appropriate in the dialog box and click OK. 6. Click F3 or F4 (or the Start/Stop HRV button) to stop the HRV test (or wait until it ends). To Print an HRV Report 1. Click Print on the toolbar or select Print from the file menu. 2. Select the printer from the print dialog box. 3. Click OK and the report is printed. For an example of a printed report, see Appendix C:, page 111.
Heart Rate Variability (HRV) NV-54/PCECG1200W 81To Print an ECG 1. Click the Print ECG button on the toolbar or select Print ECG from the file menu. 2. Select the beats and leads to print from the dialog box and click OK. 3. Select the printer from the print dialog box. 4. Click OK to close the dialog and print the ECG. HRV Setup 1. Click the HRV icon. The HRV window is displayed. 2. Click the Setup icon (hammer). The following folders are displayed: Tab Option Description Sample Rate\Leads Selection Leads Choose leads and sampling rate. Select up to four neighboring leads for calculations. ECG Recording Filters Set filters as active. Test Duration Define the test duration either by target number of beats or by the ECG recording time. Select the preferred parameter and define the value for the test duration. Save Options Set the Preferred saving options: To save test automatically at the end of the test, check the Auto Save option. When this option is cleared, the test is saved only on demand. Define the saving format either as No ECG Data or Full Disclosure. Define the file naming convention of the saved files, either by Patient Last Name or ID. Use ECG Database Select this option to connect to the default ECG database. When this option is checked, the ECG tests are saved in the database. Data Directory Define a directory for saved ECG recordings (if ECG database is not used). Use a secondary hard disk, if one is available. Simulator ECGWhen cleared (default), ECG recording is performed from the PC-ECG unit. When checked, the ECG recording is performed from the demo file included in the software package. In this case, the recording unit is not needed. View Change default colors for ECG and for graphs.
Instructions for Use and Technical Description Norav Medical Ltd. 82Tab Option Description Restore Defaults Restores factory default color definitions for ECG display and graphs. Installation Saves hospital and physician data. This data is included in print out and mail. Measurement Standard Define whether measurements will be calculated according to the metric or USA standard. The default is metric. Magnetic Card Reader Select this option to use a magnetic card with bar-code to insert patient details. Select the magnetic card type. Environment Connection Select the option button (COM port/USB) to choose the port for device connection. If the COM port option is selected, select the serial input for the PC-ECG unit from the COM port list. The option is disabled if the USB connection is selected. Default at installation is USB. Display Size Choose between 14/15-inch screen (default) and 17-inch screen. This setting is required to display the ECG and grid in correct scale. Graph Paper (Print options) When set to On, prints 1mm and 5 mm squares on printouts. Regular Grid works with any printer. Improved Grid shows a fine grid but may not work on some printers. Large Remarks Font Enlarges font for free typed text. Color Printout Clear the check-box to force B/W printing on color printer. GDT/BDT Format Automatic Options Define automatic options for saving and/or importing files in GDT/BDT format. File Format Select the file format: GDT or BDT Import Codepage 437 Check this option to import Code page 437. Export Codepage 437 Check this option to export Code page 437. Edit Labels Click to open a dialog box with an editable list of the field labels used in the GDT and BDT files. GDT/BDT Data directory Define the directory path where the GDT/BDT files will be maintained. Token for PCECG Default is PEKG. Token for Practice EDP Default is EDV1.
Heart Rate Variability (HRV) NV-54/PCECG1200W 83Starting a Study 1. Click New. 2. Enter patient data in the Patient Data field. The ECG leads are monitored on the screen for quality check. If you are satisfied with the quality check, click the R-R icon. The display comprises three sections: ◊ The ECG leads are displayed on the upper part of the screen ◊ The tachogram trend display is built up in the middle strip. ◊ A slider shows the study status and time at the bottom During the study, define a new time segment (interval) by clicking the flag icon (interval). Name each interval during the study to retain it as a valid interval. When all predefined beats are completed, or if terminated by clicking the R-R icon, the HRV screen is displayed: To Add or Subtract an Interval 1. Select the interval with the slider. 2. Click + or – at the top of the HRV results pane. To Edit Interval Names Use the pencil icon. To Import or Save GDT/BDT Format See Import from GDT/BDT and Save Test in GDT/BDT, page 105.
Instructions for Use and Technical Description Norav Medical Ltd. 84Results Display The AVERAGE HEART RATE is displayed in the lower left side. All results are for the chosen segment (check the yellow selection or the From-To bits number). Other results are shown in the right hand side as follows: RR no. Number of beats in the active interval max RR Longest R-R period min RR Shorter R-R period Average RR Average of interval in active interval SDNN Standard deviation of all R-R periods in interval SDANN Standard deviation of the averages of R-R periods in all 5 min segments of the active interval RMSSD The square root of the mean of the sum of the squares of differences between adjacent NN intervals Time Domain HRV triangular Index Total number of all R-R intervals divided by the height of the histogram of all R-R intervals measured on a discrete scale ULF Power of the ultra low frequency range VLF Power of the very low frequency range LF Power of the low frequency range Frequency Domain HF Power of the high frequency range Figure 19: HRV Results HRV Interval Measurement A QRS detector measures the interval between any two valid beats. It calculates a sliding N-N average and compares each interval to it. When a significant change occurs, the current beat is either a premature beat (as in PVC) or a prolonged one, which may indicate either a compensatory pause following a PVC or a missing beat. A premature interval and a following prolonged interval (compensatory pause) timed in the range of twice the current N-N interval are averaged. This methodology maintains a consistent time axis in the presence of PVCs. If a prolonged interval follows a normal interval, but at twice the current N-N interval, it indicates the presence of a missing beat. Accordingly, the missing beat is computed as present. This last event is very rare, because the recording is made in rest condition and the software detects the QRS efficiently under such conditions.
Measurements/ Interpretation NV-54/PCECG1200W 85CHAPTER 12: MEASUREMENTS/ INTERPRETATION (This option is available with the I1 or I2 license) Measurements is not an autonomous application. The Measurements application is used for calculations of QRSs and interpretation of the ECG signal. The user can manually change the QRS identification parameters. 10 seconds of data are calculated. Figure 20: Measurements—Tabular Screen Menu bar Toolbar Wave type Marker name Add/Remove ECG Wave Markers
Instructions for Use and Technical Description Norav Medical Ltd. 86Quick Start To Start Measurements Click the ruler icon in the Rest, Stress, and Monitoring applications, or click View > Measurements The application has four view formats: • Measurements Table (default display) • ECG Averages • QRS Signal • Caliper To Print Reports 1. Click the printer icon or select File > Print Reports. 2. Select the reports to print and click OK. Performing Changes in Calculations To Move the QRS Marker (Averages and QRS views only) 1. Click and drag the marker to the required position (between the previous and next markers). 2. The calculations are modified accordingly. To Add or Remove a Wave Marker 1. Click the Add/Remove ECG Wave Markers icon on the toolbar (or select File > Add/Remove ECG Wave Markers). 2. Check or clear wave markers in the dialog box displayed. 3. Click OK to save the selection, close the dialog box, and display the change.
Measurements/ Interpretation NV-54/PCECG1200W 87To Move the Wave Marker (Caliper view only) 1. Select a wave from the wave list on the left hand side of the viewer (or from the Wave Type combo box). 2. Select the marker from the Marker Name combo box in the toolbar or by clicking the marker. 3. Use the Left/Top/Right/Bottom arrows on the toolbar or drag & drop the marker to the required position. The calculations are modified accordingly. Features View all calculated parameters on every QRS, on every channel and average calculations in tabular format. The upper table displays measurements for a channel. The lower table displays measurements values for a QRS. To View the Measurements on a QRS Select a QRS from the upper table and view the results on the lower table. To View the Measurements on a Channel Select a channel from the lower table and view the values on the upper table. To View the Measurements on All Channels for QT Click “>” (between the two tables) to view measurements for All Leads for QT on the lower table. Tabular Screen The Tabular screen (see page 85) displays calculations of the QRS parameters in all the leads in a tabular format. Original calculations or changes performed in the other screens (Averages, QRS, or Caliper) are displayed in a tabular format and can be printed out.
Instructions for Use and Technical Description Norav Medical Ltd. 88Averages Display Figure 21: Measurements—Averages Display The Averages screen displays the average QRS in each of the leads and the average ECG of the Strip lead. Each QRS identified is marked with a red marker in the strip lead (The marker actually marks the R wave of every QRS). The QRS markers can be moved to the left and right (between the previous and the next marker). Changes in marker positions are recalculated and displayed in the tabular screen and the QRS screen.

Navigation menu