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Cardioperfect Workstation Stress Software, User Manual

1. 4 desde mn sere oe TEE LED GEB l ee mw 1 23 Hie Eid Li Shortcut menu LA LEM LOR ed LEAL E PPM ed eee Bee breed Fette Perel reeset PEIUS beers PETS BS lits r ra sadfuhs tutes ciii Status bar The title bar displays the name of the program The title bar contains three buttons that you can use to maximize minimize and close the Workstation window Each menu in the menu bar contains a number of tasks that you can perform with Welch Allyn CardioPerfect Exercise ECG Sometimes menus are gray This means that you cannot access that functionality at that particular point either because it is not available or because you are not authorized to use it The tool bar contains buttons that give you easy access to the most common tasks in Welch Allyn CardioPerfect The search area contains search and display functionality that lets you easily retrieve patients and tests In the search area you can find a patient see which tests were recorded for that patient and see the kind of tests that were recorded You can also create search patterns an easy way of finding information that you need frequently The workspace is the core part of Welch Allyn CardioPerfect Exercise ECG It displays the exercise ECG in various formats These formats that are also called views are each displayed on a separate tab in the Welch Allyn CardioPerfect Exercise ECG workspace The
2. se 36 ODONIS cuore beu cieds Siounme A 47 m9 ARCET Rr 14 Reference Point 37 ODES ae ne eee REE ere 38 ToD m 14 p 32 38 48 ll I 37 IN NO 32 STAR VIEW sisanacntccammetntsondeniirdieentiorardenian 40 ST slope tab 14 SAGES PRETERITO 10 57 58 Create new cccccceeececeseeeeeeeeteeeenens 61 Delete urinae E 61 OM oe ta isukte ied bei UNDE 61 SLAM DUTON sccctctatiestaccsstacedesteetaSacashiaddines 20 Stop test button ssssssee 20 Summary Customize report 54 oom P 54 VAD E E EEEE E E ETEA 55 EINER 31 Target heart rate 17 27 28 Treadmill Adjust speed elevation 24 FE FOVO CO RE 58 Trends irate arinpiensesnnanentomdaswccheniatintaieenmnt 14 AD m 13 ic e 37 ES BD E A E A E 15 View Exercise EOQ asceseequetileti vicina 29 Interpretation history 42 Viewing TAD svenaccivsisiusancitiaceeurmectanaesuawnain 48 Workload sososcicinernernerrerrerrerrerrrrrerreenns 13 Change RR 25 Default protocol 52 i me 37 View changes cccseeeeeeseeeeeeeeeeeeeeeees 35 LOO e DN ES sS Or DU 29 80 80
3. sseeeseesssssssssessseeeeeeeennnnnn nennen nnns 66 11 3 R wave triggering Interface capabilities sseeeeeseeesseeeeeereeeeen 66 DIR 80012335 Ver F 6 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 12 SAFETY AND PRECAUTIONS eere nennen nnne 68 12 1 Sen i es NUNT 68 12 2 General Safety and Precautions tiPS ccccccccssseeceeeeeeeeeeeeeeeeseeeesseaeeeeeesaaeeeees 69 13 GUIDANCE AND MANUFACTURER S DECLARATIONS 71 14 FUNGTION KEY cee eee eee eee ee AER 15 15 ADDITIONAL INFORMATION eere rrr nnne nnn 77 15 1 Duke Treadmill SCOME RRRRRRRTRTT 77 15 2 MIEIS NN os sets spe naz RR 78 DIR 80012335 Ver F 7 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Welcome Welcome to the Welch Allyn CardioPerfect Exercise ECG module of Welch Allyn CardioPerfect Workstation This module offers you exciting features and provides everything you expect from an exercise ECG software package This manual provides the necessary information for the installation operation and maintenance of the Welch Allyn CardioPerfect Exercise ECG recording system These instructions must be studied before putting the unit into operation This manual contains specific information about the exercise ECG module of the Welch Allyn CardioPerfect Workstat
4. 13 26 48 millc RETENIR 10 57 Precordial electrodes CODIGO Gcetetaictatesasitecissiatinatadeasioratattin 16 ms NR 27 44 Automatically ccccseseeeeseeeeeeneeeeeens 57 T Ore 12 meld TNR TM 45 misce MEM 17 58 Selecto cured venn erii fada ediitedagax edades 48 50 FOO CO le RNC 10 17 57 BLU me 52 Q liM 32 34 Rate pressure product 38 Real time monitor 11 15 20 24 Record Exercise EC G aeaa E 14 Recorder MAMANI METRE TR 46 DING INS caries cet E 53 WA 59 Recover Test after crash esee 62 RECOVELY ccccccceseeecceeseeeceeseeeceeneeesseaes 57 PRAGE areon EEN 49 61 Reference complex 11 DNE 33 Reference Point 33 DIR 80012335 Ver F 1M 47 APE dns See Rate Pressure Product oelections DOUNO oerna 48 Sensitivity sseeeeeeseseeeeeeeeenee 21 SNOW PACS sisse vicubutwi crai aa Sad bw d Ert E 48 vies A bein 32 37 IS NAY 38 S 8131516 NC TRO TENEO 21 29 dM Em 47 opeed elevation 52 n m 24 ST CalCulation ccccesccccsseeeeeseeteneeenens 47 Copy measurements 39 Elevation or depression 14 Maximum level
5. When OK is pressed the new values will be sent to the device When Cancel is pressed changes are ignored and the dialog window will close DIR 80012335 Ver F 25 80 CardioPerfect Workstation Exercise ECG Module User Manual Pacemaker pulse detection The Welch Allyn CardioPerfect software is able to display pacemaker pulse spikes detected 2 3 9 by the hardware These spikes are marked with a symbol in the Real time monitor in Review When the Pacemaker pulse detection is on the detected spikes are marked on the trace as shown here To learn how to disable this function to remove artificial pacemaker signal indicators see Show Pacer under Exercise ECG settings General tab on page 48 mode and on printouts WelchAllyn The trace tl eae etl cl eGo iG ER MEE ele Gc can or Gl el PEEP qb R da EE EP example from a disconnected electrode the monitor will show Bad signal on displays square waves see example below Square waves DO CGnG Gennes cemeeo ene EE ER ER le EE E E E ee lee EE EE ER ER ERE cs ELE GE BIER E E E SE Erde n esi ON He a pe pe Warning in red Eg Eg E Eg E ooo o mena a EEE ie e E 1 GG Ea eb P EA E PES EEER Go A E E EE ie E a ERE ee eee EUER EE aed ae EA E ea ee ee E EE EE A EE ER E ER EE ER E ER ER RE E EE EE EE EE EE E EE E n ee ea ee ERE IEEE a ERR ESPERE ee ae ee ee ea RH lg ete eee eet Ef E E eee EE RE ee E EEEE E S ERES aE ES ERES ERSTER EREG VEE SES ED REB E
6. CardioPerfect Workstation Exercise ECG Module User Manual Welch Allyn CardioPerfec EC REP Regulatory Affairs Welch Allyn Inc Representative 4341 State Street Road Welch Allyn Limited Skaneateles Falls NY Navan Business Park 13153 USA Dublin Road www welchallyn com Navan County Meath Republic of Ireland 901047 CARDIOPULMONARY ECG SYSTEM CE DIR 80012335 Ver F Revision date 2015 05 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual N US Federal law restricts this device to sale by or on the order of a Caution Physician Copyright Copyright 2015 Welch Allyn All rights are reserved To support the intended use of the product described in this publication the purchaser of the product is permitted to copy this publication for internal distribution only from the media provided by Welch Allyn Welch Allyn assumes no responsibility for any injury to anyone or for any illegal or improper use of the product that may result from failure to use this product in accordance with the instructions cautions warnings or statement of intended use published in this manual Unauthorized copying of this publication may not only infringe copyright but also reduce the ability of Welch Allyn to provide accurate and up to date information to users and operators alike Welch Allyn CardioPerfect Workstation and SpiroPerfect are registered trademarks of Welch Allyn Software in this produ
7. Cancel Full Disclosure 10 mms Full Disclosure 25 mms Full Disclosure 5 mm s Heartrate Select the report you want to print There are two ways of manually printing an ECG e Single view Welch Allyn CardioPerfect prints the view currently showing in the review window e Selected formats Welch Allyn CardioPerfect prints a number of reports simultaneously The views which are printed are selected in File Settings DIR 80012335 Ver F 44 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 5 1 1 Print formats The exercise ECG Module can print the following reports 2x6 Sequential or Simultaneous 4x3 1R Sequential or Simultaneous Averages 2 pages Cabrera Averages 2 pages Averages Full disclosure 25 mm s Full disclosure 10 mm s Full disclosure 5 mm s Heart rate Rhythm ST table ST trends Summary Each report contains the view and a header that displays additional information Please refer to the Workstation manual for further information on printing exercise ECGs 5 2 Automatically print an exercise ECG Welch Allyn CardioPerfect Exercise ECG can automatically print an exercise ECG directly after recording To automatically print an ECG after recording you need to e Enable automatic printing by selecting Print after recording in the Exercise ECG settings e Define a number of pre selected formats that you want to have printed Select the formats in the Exercise ECG setti
8. None Target workload Ordering physician nl a ica bl e fo r None v O y pp TOR Ergometers Attending physician None v Protocol Exercise protocol 20 Watt min Blood pressure protocol None Print protocol Manual triggered Cancel Help In the Test area enter the target heart rate or enter the target heart rate as a percentage of the predicted maximum heart rate see also page 27 For ergometers you can also enter the target workload see also 2 3 13 Target Workload 2 Inthe Test area select the names of the referring ordering and attending physician see also page 19 3 Go to the Protocol area to select the protocols that you want to use e Inthe Protocol area select the exercise protocol that you want to use You can choose from a number of predefined protocols e Select a Blood pressure protocol to indicate how you want to measure the blood pressure during the test e Select a Print protocol to indicate whether reports should be printed automatically or not For more information on protocols see page 58 DIR 80012335 Ver F 17 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 4 Test information and test observations CCNV 001 Stella Jongmans lt CCNV 001 Stella Jongmans General Test Information Test Observations Interpretation General Test Information Test Observations Interpretation Changes
9. When the average complexes show unexpected results it is worthwhile to compare the computer generated data in the Averages view with the actual data in the Full disclosure view With Welch Allyn CardioPerfect Exercise ECG you can move between identical points in time in the Averages view and the Full disclosure view The point that you select in the Averages view is displayed in the Full disclosure view To compare an average with its full disclosure data DIR 80012335 Ver F 33 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 1 In the Averages view click your right mouse button on the average that you want to compare 2 Inthe shortcut menu click Go to Full disclosure The Full disclosure view opens at the same point in the recording that you clicked in the Average view To switch from full disclosure data to averages 1 Inthe Full disclosure view click your right mouse button on the point that you want to see in the Averages view 2 Inthe shortcut menu click Go to Averages The Averages view opens and displays the complex that is closest to the point you selected in the Full disclosure view 3 4 0 Change QRS onset and QRS end markers Welch Allyn CardioPerfect Exercise ECG automatically inserts markers at the QRS onset Q QRS end J and J of an average complex You can change the position of these markers so that they are more to your liking in the Averages view The J marker follows
10. e Right click on the view point to Sensitivity and select a value The lower the value the lower the lead signal amplitude will be DIR 80012335 Ver F 29 80 WelchAllyn 3 2 3 Navigate through recording time You can move through the recording time of an exercise ECG in a number of ways CardioPerfect Workstation Exercise ECG Module User Manual d 00 15pre Interval 00 30pre Interval 00 45pre Interval 01 00pre Interval 01 15pre Interval 01 30pre Interval 01 45pre Interval 02 00pre Interval Scrolling with the vertical scroll bar at the right side of the window you can move through the entire recording Binoculars icon if you move the mouse over the binoculars a selection of global events is displayed If you click on one of these events you are automatically taken to that point in the recording The content of the binocular list is determined by Selections which are configured in File Setting Exercise ECG Viewing See page 49 for more information 00 15 00 30x 00 45x 01 00 Interval Interval Interval Interval 01 15x Interval fM 2 flo Inbar al Select the parts of the test you want to view When you view the exercise ECG you can go through the recording time in a number of ways You can for instance scroll through the entire recording But you can also view the recording time in a summary that only includes a number of events This option quickly takes you through the important parts of th
11. Average complexes The area to the right of the ECG traces displays the average complexes Options available form the shortcut menu e Marker option on or off If the Markers option is enabled the ST measurements are displayed next to the Average complex e The Slope option displays the Slope value next to the Average complex if the Markers option is enabled e The reference complex can be displayed on top of the Average complex e The current complex can be set as reference Note f square waves are displayed the signal on one or more of the channels is erroneous see section 2 3 10 on page 26 for more information DIR 80012335 Ver F 11 80 WelchAllyn Button bar Start stop button Next phase Next stage Hold stage Change load Perception button Blood pressure button Comment button Event button Print button Emergency stop DIR 80012335 Ver F CardioPerfect Workstation Exercise ECG Module User Manual With the Start stop button you start stop an ECG recording The Next phase button displays the name of the next phase for example Go to recovery With it you move to the next phase in the exercise protocol The Next Stage button displays the name of the next stage With it you move to the next stage of the current phase in the exercise protocol With the Hold stage button you can force the protocol to remain in the current stage With the Change load button you can change the load for th
12. ST measurements and ECG strips both in print and on the monitor By defining different selections you can customize what should be printed and displayed Averages With this option you can define a selection of events for which you want to print or display the corresponding averages ST table With this option you can define a selection of events for which you want to print or display the corresponding ST values 2x6 With this option you can define a selection of events for which you want to print or display the corresponding 2x6 ECG strips Visible arrhythmia With this option you can select which arrhythmia will be printed or displayed 7 2 1 Selections for viewing and printing A selection is a collection of events which you choose to allow quick navigation through the Averages ST measurements and ECG strips while reviewing on the monitor The selection definition can also affect portions of the summary report Which ever selection is chosen for Averages ST measurements and ECG strips will drive the list which is displayed when the mouse moves over the binoculars as described in section 3 2 3 on page 30 DIR 80012335 Ver F 49 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual You can create a selection in three ways A selection of events all events of a certain kind are included such as all arrhythmias all start points of a new phase or all user events A selection of common or similar p
13. The patient cable should be routed away from power cords and any other electrical equipment Failure to do so can result in AC power line frequency interference on the ECG trace Do not touch the patient patient cable PC interface cable Prolink or cardiograph during defibrillation Death or injury may Warnin occur from the electrical shock delivered by the defibrillator It is g recommended to check the patient cable and PC interface cable Prolink for damage prior to the use of the system If damage exists do not use the cable contact your local Welch Allyn Sales Office or your authorized Welch Allyn dealer or distributor to have the cable replaced DIR 80012335 Ver F 70 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 13 Guidance and Manufacturer s Declarations The Welch Allyn CardioPerfect PRO Cardiograph needs special precautions regarding EMC and needs to be installed and put into Caution service according to the following EMC information provided Portable and mobile RF communications equipment can affect the Welch Allyn CardioPerfect PRO Cardiograph Electromagnetic Emissions The Welch Allyn CardioPerfect PRO Cardiograph is intended for use in the electromagnetic environment specified below The customer or the user of the Welch Allyn CardioPerfect PRO Cardiograph should assure that it is used in such an environment Emissions test Compliance Electromagnetic environment guidanc
14. V3 V4 V5 VB V1 v2 DIR 80012335 Ver F 20 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual To select a different chart speed for the view e Inthe Overview area above the ECG traces select a value mm sec from the drop down list The new speed is immediately displayed To select a different sensitivity for the view e Inthe Overview area point to Sensitivity and select a value mm mV from the drop down list The new sensitivity is immediately displayed Note The options above are also available from the shortcut menu 2 3 2 Measure blood pressure You can measure the patient s blood pressure during the recording in two ways e Manually you press the blood pressure button yourself measure the blood pressure and enter the values e According to protocol the blood pressure is measured according to a protocol defined in the protocol editor or a default protocol Automatic The Automatic protocol initiates a blood pressure measurement on every load change A blood pressure protocol can either initiate the blood pressure measurement at predefined intervals or by following the exercise protocol for more information see page 59 You select the blood pressure method when you create a new exercise ECG Whether blood pressure values must be entered manually or are measured and saved automatically depends on the type of Blood pressure device that s being used A number of automatic b
15. 20 J 40 J 60 J 80 J Dynamic The latter option calculates the ST measurement point based on the actual heart rate as J RR 16 Highest ST With this setting you can specify how the highest ST should be calculation calculated You can choose between Absolute ST deviation for the lead specified the ST event is reported for which the absolute ST value in that lead is maximal Summation the ST event is reported for which the summation of the absolute ST values across all leads is maximal ST depression only for the lead specified the ST event is reported for which the ST value is maximally negative Highest ST lead If you have set the Highest ST calculation option to Absolute ST deviation or ST depression only use the Highest ST lead to specify which lead should be used for this setting Possible choices are Il IIl aVF aVL aVR V1 V2 V3 V4 V5 V6 and aVR or Lead with maximum ST Note when lead with maximum ST is used in combination with ST depression only the leads aVR and V1 will not be used in the determination of the lead with the highest ST Rhythm lead Here you can select which lead should be shown as rhythm lead in the 4x3 view Speed unit With this option you can select the unit in which the treadmill soeed is expressed You can select either km h or mph DIR 80012335 Ver F 48 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Lead order
16. Allyn CardioPerfect 47 DIR 80012335 Ver F Delete miielsco NRETRHENNENRCHRETTTT TE 60 SE e ME NER RIT TR 61 Devices tab iii desscancdvcsdsnewteaasateetedoenceens 52 Display Markers ccceceeceececceeeeceeceeeeeeeceeeeeees 39 RPP orepescdte esent petidU E FEN ERES 37 Selections eeeeeennne 50 ST SIO DSS cxixeietitieieceecieinnu ratu huneies 38 ST HB graph icinneco nett rino nei 40 Switch off message 53 VES reels cerise tre rta red Rari 37 Duke Treadmill Score 76 Edit EVIL o oio useze E E NICE AER 22 Interpretation esessseeesss 41 Markers eeeeeenmHHH 34 Physicians esses suxivesstetsev xe iu ripbr ddr day 19 gioco Tx 57 SClSC HOM oui iiccibLodbiradd e bers iiias 49 vj V 61 Template eeeeeeeeeeees 56 TOS aseene E 30 Emergency stop cccsssceeesseeeeeeeeeeeeens 12 Ergometer cccceeseeeceeseeecceeseeeseseeeees 13 Manual load change 24 mies TTR 57 mh TRIER 30 35 PUO eenn arrain ied teienia tuu RI ERE 12 Capture erriei 15 20 Dispatcher RT 51 c8 e 22 liz DER a A E ET 74 Insert after recording 35 EM 13 Selection RM 48 Exercise ECG Create new eccceeeceecceccecceeceeeeeeeeeeeens 20 Interpretation sssseeesss 41 Ml meT P 11 1
17. ECG Module User Manual Recommended separation distances between portable and mobile RF communications equipment and the Welch Allyn CardioPerfect PRO Cardiograph The Welch Allyn CardioPerfect PRO Cardiograph is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the Welch Allyn CardioPerfect PRO Cardiograph can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the Welch Allyn CardioPerfect PRO Cardiograph as recommended below according to the maximum output power of the communications equipment Separation distance according to frequency of transmitter Rated maximum m output power of transmitter 150 KHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz W 35 a ee T For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer NOTE 1 At 80 MHz and 800 MHz the separation distance for the higher frequency range applies NOTE2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people DIR 80012335 Ver F 74 80
18. Es BBH E A DIR 80012335 Ver F 34 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual The Full disclosure view displays the following events with a marker Blood pressure measurements Phase or workload changes User events Comments Arrhythmias optionally see 7 2 to configure 3 5 2 View leads To view one lead e Click on the button of the lead you want to view To view workload changes 1 Click your right mouse button to display the shortcut menu 2 Click Workload changes The workload changes are displayed in the view Click once more to hide them again 3 5 3 Insert events after recording When you scroll through the Full disclosure view and want to make note of an arrhythmia or other event you can still insert this after recording To insert a user event after recording 1 Inthe Full disclosure view click your right mouse button to display the shortcut menu 2 Inthe shortcut menu click Insert user event The Enter comment dialog box is displayed 3 Select a predefined comment from the list or type a new text 4 Click OK The user event will appear where the crosshair cursor has been positioned 3 5 4 Use filters When viewing full disclosure or any other waveform report the filter settings used during the recording are not automatically applied during review You must choose whether the filters should be applied to the data being reviewed When viewing the full disclosu
19. File Import browse to the My Documents folder and select the correct file 9 2 Troubleshooting When you start a recording you do not see the ECG traces on the screen and you receive a number of errors e Make sure that the setting for the sampling frequency in the Recorder tab of the ECG settings matches the sampling frequency of your recorder The sampling frequency can be either 300 600 or 1200 Hz e Make sure that the correct Recorder model is selected File Settings Exercise ECG gt Recorder tab Use the MDXN1 PRO Recorder DIR 80012335 Ver F 63 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Some buttons or menu entries are inactive e This is probably caused by the fact that your user role does not allow you to perform the actions of those buttons or menu entries For some advanced settings you have to be logged on as administrator Please contact your system administrator for more information The Service and Advanced Installation manual contains a section specific to Exercise ECG with additional troubleshooting information 9 3 Technical Support If you have a technical question that you cannot answer with the provided tools please contact our Installation amp Support department or contact your local distributor When you contact the Installation amp Support department via phone e mail or fax please provide the following information e Your name company name address pho
20. TRES ESESIEHIET SE eee feel eee ee ae eae eae EP ED es ee E See ee Be Bee Bees ESS ERES ERES e E E EE EE CES ERE ERE HETEER Ge ES ER EE E ERE QE EE Ed Ed 1 ERES ERE ERE ER Ed ERE EE d PE eee eee eee Bad signal on V5 2 22 ee 2 22 2 btt titti kitti EFE RH EE BER CE ER aVR avL avF 1V2V3 v4 v5 vb 2 3 10 Signal quality indication If CardioPerfect Workstation finds the signal from one of the channels to be erroneous for EB EH EH EH ER V EH EH EH EH EH Fa n E EH EH EB BH ey Bf EB EH EB HE Favorites BGG aun rane Been E 26 80 The status information is saved with the test Erroneous leads will show square waves on both the Review and the printout Depending on the duration of the erroneous signal no measurement may be possible and therefore may not be shown Please check the indicated electrodes immediately DIR 80012335 Ver F WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual In the few moments between a lead being disconnected and that event being detected by the software pacemaker spikes may be erroneously detected As a result a group of pacemaker markers may be shown on the trace just before the square waves are shown The pacemaker pulse detection will be suppressed as soon as the square waves are shown and will continue to be suppressed until the erroneous signal is corrected 2 3 11 Printing during recording You can print the following formats
21. WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 14 Function keys The Welch Allyn CardioPerfect module is just like all Windows applications designed for working with the mouse However there might be situations in which working with the keyboard can be quicker Therefore a number of functions within the Welch Allyn CardioPerfect module can also be selected directly using the keyboard Here is a list of all available keyboard shortcuts in this module for a more general function key description please refer to the Workstation manual ALT F9 CTRL DOWN CTRL UP CTRL CTRL CTRL 1 CTRL 6 CTRL 3 PgUp PgDn ALT 0 ALT 2 ALT 4 ALT 6 ALT 8 ALT D INS Start stop test Baseline filter on off Muscle filter on off Blood pressure measurement nsert comment nsert Perception event rint Go to next stage Hold stage Go to next phase Emergency stop Change load Change load Decrease load of ergometer or decrease elevation of treadmill The control dialog will appear Change load Increase load of ergometer or increase elevation of treadmill The control dialog will appear Change load Increase speed of treadmill The control dialog will appear Change load Decrease speed of treadmill The control dialog will appear Change monitor style to 12 leads Change monitor style to 6 leads Change monitor style to 3 leads Show previous lead group in 3 or 6 l
22. With this option you can select the order in which the leads are displayed Two ECG lead sequences are provided the standard lead sequence or the Cabrera format Amplitude unit With this option you can select the unit in which the measured amplitudes are expressed You can select either millimeter or microvolt The millimeter setting is dependent on the sensitivity that you use The microvolt setting is sensitivity independent Muscle filter This setting will affect the high cutoff frequency that is used by the frequency muscle filter Minimum last stage Enter the minimum duration of the last stage in seconds duration Show Pacer By checking or unchecking the Show Pacer box you can control whether a test will start with artificial pacemaker signal indicators on or off During the test and during post test review you will also be able to turn the pacemaker marks on or off For example see Pacemaker pulse detection on page 26 7 2 Exercise ECG settings Viewing tab Use the Viewing tab in the ECG settings window to configure how ECGs are displayed on your Workstation The Viewing tab contains the following options Colors Here you can specify individual colors for the background axis and grid lines trends superimpose and ST markers Color schemes This list lets you choose from a number of predefined color schemes Selections Here you can define selections A selection is a group of events that appear together on the Averages
23. cccccccccssssseeeeeeeeeeeeeeseeeeeeeeesaeeseeeessaaaeeeees 54 7 7 Exercise ECG settings Summary tab eeeesssssseseeeeeeeeenennen nenne 55 8 CUSTOMIZE EXERCISE PROTOCOLS eese 58 8 1 Protocols phases and stages ccccsseeeccccceeeeeceeccseeeceeeeseeeceeeeseeeeeeeessaeeeeessaaneeeees 58 8 2 Exercise Protocols overview cccccccsssccccesscecccenseccsaseecceuseeecsagseesseuseeessaseeessaeees 58 8 3 X Blood pressure and Printer Protocols cccccccccseseeeeeeceeeeeeeeeeseeeeeeeesaaeeeeeeesaaeeeess 59 8 4 Protocol editor window ssessesssssesssseseseee nennen nnne nnne nnne nnne nnne nnns 60 8 5 Working with protocols sseseessssesseseeeen nennen nnne nnne nnns 61 8 6 Working with stages sseeesssseseseeeeee nennen nennen nnn nnn nnne nnn nnne nnn rsen nis 62 9 TROUBLESHOOTING a eiierarkisvotunstuencuskauEr curtis aaa 63 SMEMEENI dieci SMEs 63 9 2 Troubleshooting MN niaren i ana iee aiaiai irea 63 So Tecnica SUDO OI saat doe sec encete esate ctis esumtatdystunt ate omen te dantes da a aai adana 64 10 BEFORE INSTALLING THE EXERCISE ECG SOFTWARE 65 10 1 AIC HONS DRM TERRE 65 11 INSTALLING THE EXERCISE ECG MODULE 66 11 1 Connecting the RS232 interface Rest or Stress light versions 66 11 2 Connecting the USB Interface
24. click and or Shift left mouse click for a group of contiguous rows Use the copy option available from the shortcut menu to copy and paste the text into other MS windows applications 3 9 Work with the Heart rate view 3 9 1 Heart rate view 0 00 1 00 2 00 3 00 4 00 5 00 6 00 7 00 8 00 9 00 10 00 11 00 1200 13 00 Minutes The Heart rate view displays information about how the patient s heart rate evolved during the test The upper graph displays the patient s heart rate against time The lower graph displays the workload against time Phase changes are indicated with a vertical dotted line 3 9 2 Compare heart rate graphs If a patient has had several exercise ECGs Welch Allyn CardioPerfect Exercise ECG can make a serial comparison of the patient s heart rate during these tests In such a comparison the curves are superimposed To compare heart rates 1 In the Heart rates view click your right mouse button on one of the graphs to display the shortcut menu 2 Inthe shortcut menu click Comparison The Comparison dialog box is displayed This dialog box contains all other exercise ECGs that have been recorded for this patient 3 In the Comparison dialog box select one ECG to which you want to compare the current ECG 4 Click OK The heart rate graph of the selected exercise ECGs is superimposed on the current exercise ECG DIR 80012335 Ver F 39 80 Welch Allyn CardioPerfect Workstation Exercise ECG Modul
25. duration and number of stages of the various phases target heart rate maximum heart rate maximum blood pressure and maximum workload The name of the technician as well as the names of the referring ordering and attending physicians are also shown in this section Test observations Observations made during the test like symptoms during the test heart rate and blood pressure response to exercise reasons for testing Interpretation If the exercise ECG has been interpreted this section contains the interpretation statements DIR 80012335 Ver F 31 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Trends and Graphs ST table An overview of the ST values as calculated in the ST table view Heart rate trend The heart rate trend as calculated in the Heart rate view ST trend The ST value chart of a predefined lead Blood pressure The blood pressure heart rate and corresponding rate pressure product 3 4 Work with the Averages view 3 4 1 Averages view The Averages view displays the averaged complexes at a number of given points in the exercise ECG These points usually are the ends of each stage and points of interest such as the highest ST deviation See section 7 2 1 for more details about configuring Selections Summary Averages Full Disclosure 2x6 4x3 Trends ST table Heartrate ST HR Selection Reference complex None Start of exercise d Favorites kaVF V
26. e You can automatically insert the current date and time by clicking the Date time button e You can clear the interpretation editor by clicking the Clear button DIR 80012335 Ver F 41 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 4 2 View interpretation history When you change something in an interpretation Welch Allyn CardioPerfect Exercise ECG does not change the original interpretation but creates a new one This way an audit trail is kept of the interpretation history A copy of all interpretations is kept in the interpretation history To view the interpretation history 1 In the Tools menu click History The Interpretation history window is displayed The left hand pane displays the interpretations sorted by date The right hand pane shows the content of each interpretation plus the interpretation date time and the person who modified the interpretation Interpretation history E3 History Edited by El Interpretations Date 200 1 11 2001 12 10 45 Unknown 1 11 2001 12 10 45 1 11 2001 12 11 05 1 11 2001 12 11 12 Sport test Expected workload met Expected maximum heartrate met Normal test 2 Click on a date to view an interpretation 4 3 Clean up full disclosure An exercise ECG uses a lot of space on your computer To reduce the used space you can delete some or all leads from the full disclosure Important When you remove leads from the full disc
27. explosion hazard Do not operate the electrocardiograph in the presence of a flammable anesthetic mixture with air oxygen or nitrous oxide in oxygen enriched environments or in any other potentially explosive environment To prevent the spread of infection take these precautions e Dispose of single use components for example electrodes after using them once e Regularly clean all components that come in contact with patients e Consult your facility s equipment cleaning procedures when performing ECG testing on patients with open infectious sores Ensure the location of the electrode and associated cables provides maximum separation away from all sources of high frequency energy The best way to ensure patient safety is to completely remove all electrodes and cables from the patient when exposed to high frequency energy No modification of this equipment is allowed DIR 80012335 Ver F 5 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Table of Contents l AGEITINGOSIARTED aries ese M IMMUNE eee 9 1 1 The Welch Allyn CardioPerfect Exercise ECG window eeesessssssse 9 1 2 Structure of an exercise ECG cc eecccccccsssseccccceeseeeeeeeeegeeceesseeeeeeesseeeeeeesesaaseeeeeeeas 10 2 RECORDING AN EXERCISE ECG ee ceceeeeeeeeeeeeeeeeeeeeeeseneees 11 21 The ASAPUME MOM Ol vevatsreniizincesevetbendntannieaiaieanaalintadinah ies peer Ri RERA RAE ERER Ri 11 2 2 R
28. for each lead the ST levels and slopes evolution of the patient s heart rate and a number of trends Each view is presented on a different tab in the workspace and has different functionality 3 2 View an exercise ECG To view an exercise ECG 1 Select a patient The tests that have been recorded for that patient are listed in the test list 2 From the test list select the ECG that you want to see ECGs are indicated with ae l Welch Allyn CardioPerfect Exercise ECG is started automatically and the test is displayed in the workspace 3 2 1 Zoom in and out on an exercise ECG If you want to get a closer look at the traces you can adjust the size of the leads by zooming in and out of the exercise ECG You can adjust the size of the leads by zooming in and out of the exercise ECG To see leads in more detail e Inthe View menu click Zoom in To see a larger part of the ECG e Inthe View menu click Zoom out To reset the zoom function and return to the standard size e Inthe View menu click Reset zooming Tips for zooming in and out on an ECG You can also use your right mouse button for Zooming 3 2 2 Set chart speed and sensitivity Welch Allyn CardioPerfect Exercise ECG offers a wide range of speed and sensitivity You can adjust the scale of an exercise ECG by adjusting the chart speed and the sensitivity To set the chart speed e Right click on the view point to Speed and select a value To set the sensitivity
29. instance due to a computer crash you can still recover the full disclosure of that recording To recover a test after a computer crash 1 Start Workstation 2 Start Welch Allyn CardioPerfect Exercise ECG for instance by opening another exercise ECG 3 Inthe Tools menu click Full disclosure recovery Full disclosure recovery E x The following unfinished recording are found on your system Filename Date Time _ Length Patient 4 Inthe Full disclosure recovery dialog box click on the recording that you want to recover and click Recover full disclosure If the recovery was successful a message is displayed 5 Inthe Patients tab select the patient for whom you want to recover the exercise ECG 6 The recovered exercise ECG is listed in the test list To delete unfinished recordings 1 In the Full disclosure recovery dialog box click on the unfinished recording that you want to delete 2 Click Delete The unfinished recording is deleted To recover a test after the database connection has been lost If during the test the connection to the database is lost for example because of a loose network cable the test will be saved in a file called Emergency saved exercise ECG x MDW x stands for a number which is automatically generated in the My Documents folder After the database connection has been restored this file can be imported into the database by using the import function in the Workstation
30. please be prepared to provide e Product name and model number and complete description of the problem e The serial number of your product if applicable e he complete name address and phone number of your facility e For out of warranty repairs or spare parts orders a purchase order or credit card number e For parts order the required spare or replacement part number s Repairs If your product requires warranty extended warranty or non warranty repair service please call first the nearest Welch Allyn Technical Support Center A representative will assist you troubleshooting the problem and will make every effort to solve it over the phone avoiding potential unnecessary return In case the return cannot be avoided the representative will record all necessary information and will provide a Return Material Authorization RMA number as well as the appropriate return address A Return Material Authorization RMA number must be obtained prior to any return Note Welch Allyn does not accept returned products without an RMA Packing Instructions If you have to return goods for service follow these recommended packing instructions e Remove all hoses cables sensors power cords and ancillary products as appropriate before packing unless you suspect they are associated with the problem e Wherever possible use the original shipping carton and packing materials e Include a packing list and the Welch Allyn Return Material Authorizat
31. possibility of hazardous currents passing from the cardiograph through the patient s heart to ground To ensure the patient s safety and your own please observe the following Any system components e g treadmill personal computer ergo meter that require to be connected to an outlet socket shall use only grounded power cords three wire power cords with grounded plugs Also make sure the outlet accepts the plug and is grounded Never adapt a grounded plug to fit an ungrounded outlet by removing the ground prong or ground clip Multiple portable outlet sockets shall not be placed on the floor Multiple portable outlet sockets or extension cord shall not be connected to the system Do not connect items which are not part of the system The use of multiple non medical electrical equipment connected to the same patient may pose a safety hazard due to the summation of leakage currents from each instrument Any combination of non medical electrical equipment should be evaluated by local safety personnel before put into service Multiple portable outlet sockets use without an isolation transformer is disapproved unless casual access for additional equipment is impeded or prevented Patient cable and Interface cable The patient cable supplied with the CardioPerfect cardiograph is an integral part of the cardiograph s safety features Using any Caution other patient cable may compromise defibrillation protection as well as cardiograph performance
32. print protocols can be added using the Protocol editor see page 60 Protocol Here you can select if a report should be printed at the end of each stage manually triggered or according to a user defined protocol Print format From this list you can select the printing protocol that is used for printing during recording Grid From this list you can select the grid style used for the printouts during the test The grid style used for printouts after recording is set separately see the Default report formats section below DIR 80012335 Ver F 51 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Default report formats printing after recording Selected From this list of formats you can select the formats that are printed when automatic printing is enabled These formats are also printed when you click Print selected formats in the ECG window Full disclosure lead From this list you can select the default lead that appears in the Full disclosure view and print Grid From this list you can select the grid style used for the printouts after recording is completed The grid styles for printing during test and printing after recording are independent and must be selected separately Print after recording If this option checkbox is selected the ECG is automatically printed when the recording has finished Welch Allyn CardioPerfect Exercise ECG prints the formats that you selected in the Default report for
33. timed made this phase uses the stages as defined above Dia action 10 seconds after stage change f Follow exercise protocol made In follow exercise protocol mode action is triggered on every stage change of the active exercise device protocol 1 Select Timed mode to create a protocol which will run independent of the ergometer or treadmill stages An independent protocol consists of stages each of which has its own duration Regardless of whether you hold or accelerate an exercise device stage the independent BP or print protocol will continue to run using the stage intervals defined for that protocol 2 If you select Follow Exercise protocol mode the Blood pressure action prompt or automatic BP start or printout will occur at a fixed time after the start of each stage All stage related fields and menus will then be disabled Any information in the pane above the mode selector will be disregarded 3 You can select a different mode independent or Follow Exercise protocol for each phase 8 4 Protocol editor window Use the Protocol editor window to create and edit protocols and their stages T Protocotegitor loxi File Help Protocols Treadmill Pretest Exercise Recovery Posttest Name Duration Bruce 1 180 Repeat Speed km h Elevation 27 10 Naughton New protocol Ellestad Modified Bruce Balke Ergometer 20 Watt min 50 watt 3 min Asperen New
34. value for BP Response to Exercise BP Response to Exercise Functional Capacity HR Response to Exercise C Blunted Reasons for Termination O Hypertensive ST Changes L1 Hypotensive Symptoms During Stress E Normal Pharmacological Indications O 1st Degree AV Block Pharmacological Stress Age O Atrial Fib Reasons For Stress Test L1 Atrial Flutter Stress Test Type O Bifascicular Block O Left Anterior Fascicular Block O NSR Normal O Non Specific ST Changes CO Normal ST Segment O RBBB O ST Changes Suggestive of Digitalis effect O 5T Changes Suggestive of Ischemia O Sinus Bradycardia O Sinus Tachycardia O Other Other Cancel Help Cancel Help Click on the Test information tab to add Click on the Test observation tab to general information about the test add information including for example the reasons for the recording and risk factors Select a keyword from the left pane then select a value from the picklist in the right pane If other is selected free text can be entered in the entry box below the picklist 5 Inthe Interpretation tab you can enter comments by using either the predefined statements in the left hand pane or by simply typing in the right hand pane Click on the save button to save these entries with the test New exercise ECG l x CCNV 001 Stella Jongmans General Test Information Test Observations Interpretation INDICATIO
35. while recording an exercise ECG e 2x6 simultaneous or sequential e 4x3 simultaneous or sequential e rhythm To print during recording In the Real time monitor click the Print button It may take some time for the copy to be printed especially with slow printers The Print format that is selected in the settings will be printed Tip for printing during recording If you frequently print during recording you might want to consider Automatic printing With Automatic printing you can configure Welch Allyn CardioPerfect Exercise ECG to print at set times during the recording 2 3 12 Target heart rate The Real time monitor displays the current Heart rate and the target Heart rate during recording in the overview area HH r5 37 of 203 The target Heart rate can be adjusted at the start of a new exercise ECG You can either set the target Heart rate directly or set it as a percentage of the predicted maximum Heart rate By default the target Heart rate value is set as 85 of the predicted maximum HR The predicted maximum Heart rate is calculated with the following formula Predicted Maxium Heart Rate 220 patient s age in years Welch Allyn CardioPerfect displays the Predicted Maximum Heart Rate next to the Target Heart rate field when the new exercise dialog window is opened Fred ax HA Target heartrate 185 bpm 85 z 157 To set the target Heart rate Enter a value in the Target Heart rate field To set t
36. 2 0 94 106 33 33 D 33 8 05 454 2 4 0 km h 12 0 33 103 33 25 8 25 25 06 00 2 4 0 km h 12 0 36 96 25 0 25 8 17 06 15 3 5 4 km h 14 0 104 96 25 8 17 17 1 06 30 3 5 4 km h 14 0 114 103 33 0 25 17 25 06 451 3 5 4 km h 14 0 115 103 33 8 25 17 33 O7 00 3 5 4 km h 14 0 116 100 25 17 0 17 17 07 154 3 5 4 km h 14 0 116 107 33 42 83 8 58 n7 2n 2 E A Lm 14 n7 12N q 17 n 17 2 17 Pin 4 b Note To make the display easier to read select colored bands from the right click menu The ST table view shows points in the recording together with the stage workload or speed elevation blood pressure heart rate rate pressure product the PQ and the QRS duration and the ST values for various leads To select the points in time for which this information is displayed e Inthe Selection list click on a selection 3 8 1 Rate pressure product The rate pressure product gives information about the strain on the myocardial muscle It is calculated as follows RPP Systolic blood pressure heart rate The RPP is listed in the Trends view in units of 100 bpm mmHg DIR 80012335 Ver F 38 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 3 8 2 Copy ST measurements into other applications The ST table can be copied fully or partly into other MS windows applications Select a single measurement row with a left mouse click or select multiple rows with Ctrl left mouse
37. 32 47 2i 47 IN n EEEE anew a eed M MIS M UNE 47 Baseline filter 13 24 36 BUOY NR eE 71 DIGS 22 Blood pressure 12 14 21 32 50 57 Be 52 C 37 Protocol 16 17 21 52 58 60 Geli iE 45 48 Chart speed 11 21 29 Comment f ofa MEER TREES 14 18 22 23 35 EON PERCEPTIS 12 Window enn 51 Compare Averages 33 Heart rate graphs 39 Computer crash eeeeeesss 62 eode s 48 Automatic printing 27 50 Exercise device eeeeeeene 52 Recording settings 51 SY 10 1 10 0 49 SOITWalOs desccsacritetak dtu ke ERR MER aw iara 65 Connect Blood pressure Device 52 EleclrOdGS an ee nee a dO 16 Exercise Device ccc oot ete iiape ceret dete 52 Belege T E TET 65 Create New Exercise ECG 15 16 New patient See Workstation manual NOW stage suceder coavbadon Redi csqul auia uncu9 61 FOL C Ol MEME 57 Search Pattern cccsssseseecceeeeesseeeees 9 Selections aaien aneia 48 Customize General tab eeeeeeeeeeeene 47 FF OLOC Ol era E aA 57 Selections eseeeeennnne 48 Summary report seeseeeeeeeeee 54 Welch
38. 4 1 Edit save and confirm interpretation ccccceeccccceseceeeeeeeeeceeeeeeseeeeeesseeseesseaeeeeeas 41 4 2 View interpretation DISlOT Vis usecasees eucaiasvO nde uci Eva Vi UR SUN oap eu x CU da a OV ED vv 42 AS Clean upTUlkdisSecloSLEe csveeniaevncinfdisihus dva dodi hUREVi a ER SVa S Qu FON I UR ea REV Ud o opaca DIETER 42 5 PRINTING AN EXERCISE ECG 1 eere eeeee leere nennen nnns 44 5 1 Pintan exerc e EOC MER a AR An A e ER Ea aaa 44 5 2 Automatically print an exercise ECG cccececcccccssseeeeeeeseeeeeeeeeeeeeeeeeesaaaeeeeeesaaaeeeees 45 6 MAINTAINING THE RECORDER cccccssseesseseeeeesenseeeeeseneees 46 6 1 Cleaning the Patient cables and PC interface cables esesssesseuusss 46 7 CUSTOMIZING THE EXERCISE ECG MODULE 48 7 1 Exercise ECG settings General tab ccccccccccccsssseeeeeeeeeeeeeeesseeeeeeessaaeeeeeseaaaeeeess 48 7 2 Exercise ECG settings Viewing tab eeeeeesssessesseseeeeennnrennnnn mens 49 7 3 Exercise ECG settings Printing tab cccccccccccccssssececceeesseeecseeaseeeesseaaseeeesseaseeess 51 7 4 Exercise ECG settings Monitor tab cccccccccccssseececeeesseeesseeeseeeesssaseeeesseaeeees 52 7 5 Exercise ECG settings Devices tab cccccecccccccssseeeeeeseeeeeeeeseeeeseeeessaaseeeesssaaeeees 53 7 6 Exercise ECG settings Recorder tab
39. 6 PCC OF GO NEMUS E 14 SITBIGIEIE B mractctecusteeccnamemautatoroneiancaunes 10 NOW PERMET 29 Exercise ECG settings 49 Favorites button eese 32 Full disclosure ees 34 Clean up eeeerreeeenn 43 WCW 39 Heart rate usos reine eei esr tURU 17 27 31 COMP ONG ERR 39 mT 37 EIN S E S PEE 32 VIEW MMM 39 Highest S T MNT RR 14 47 E E E E E E E 42 o 13 79 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Import POLO C OW MM 60 Interpretation esee 41 LO POTERE UN 42 Statements cseseeenn 31 iom 14 Lead Preterernee iiicetest ees nnii nakai 47 Sequence seeeseseseseeeeennnnnnnns 48 Maintaining Ret 46 Manually print sssssesussss 44 PAESI o ESTNE 11 Sigel 34 Display 33 Measure blood pressure 21 Measurements eeeeee 39 Monitor geen 11 20 o f 51 Muscle noise FUNG TREES 24 Muscle noise filter 13 New exercise ECG COANE E 15 New protocol 7 60 New stage 817 61 pacemaker signal indicators
40. IVE LIL VIVE BLRERB REB RE EAM ELLE Ld LANCEA AME AJ Lie Unt unde qm Legs m OE QRS dur 110 msec uM m Er End HESS ecu 00 3 vs E E 941 For each point the averaged complexes of six leads are displayed together with the patient s heart rate the QRS duration the workload in case of an ergometer test or speed and elevation in case of a treadmill test the phase and the blood pressure The ST levels and slopes are displayed above the complexes To select which six leads you want to view Click the l aVF button to display the averages of leads to aVF Click the V1 V6 button to display the averages of leads V1 to V6 Click the I III V1 V6 button to display the averages of leads to V6 Click the Favorites button to display the lead preference that was set in the exercise ECG settings p 9 Iw a To display multiple rows with averaged complexes 1 Click the right mouse button on the view to display the contextual menu 2 Click Number of Rows The Rows dialog box is displayed 3 Enter the number of rows you want to see DIR 80012335 Ver F 32 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 3 4 2 Display markers Markers indicate where in the QRS complex the measurement reference points have been set These reference points are automatically calculated but they can be modified You can use a marker as a starting point for your observations or measurement
41. NS FOR STRESS 4 INDICATIONS FOR EXE Chest Pain Dyspnea on Exercise Palpitation Fatigue Orthopnea ASHD PVC PSY W Tach CHF amp Fib A Flutter Abnormal EKG LBBB RBBB Dld MI HTN Dther CAD RISK FACTORS BASELINE EKG HEARTRATE RESPONSE T BP RESPONSE TO EXERCI x 4 b Cancel Help Note Unconfirmed interpretations can continue to be edited during and after the test Once the interpretation has been confirmed by a physician with the save and confirm button the test can only be edited by a user with confirm interpretation rights For more information see the Administrator Tool 6 Click OK DIR 80012335 Ver F 18 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 2 4 Add Physicians to the test With Welch Allyn CardioPerfect workstation you can link the names of three types of physicians to an exercise test e Referring physician e Ordering physician the physician that ordered the test e Attending physician the physician that is supervising the test You can add the names of the physicians in the New exercise ECG dialog Click on the bd button to select a name from a list of most recently selected physicians Click on the button and a more extended list of physicians will appear Select physician Specialty pu Rd Add Physician Huub Lupsch Joe Joh
42. RE ER eee a EP ES ERI re ee ER EET EIER ER TEETH EE ERE PHE ES SEES ES ae E 4 Po Pe Pit fete EV eee EI BARON Bg UND RS 6 SHEETS ES ESSE ESTE EET EHE SHE SEES H eso a ee ee ee nen eee DIESES ee et ee ER HEISE EE ERE EIE EE ERE ptt ERE ee EE EL Ed f Ed wd lb n Hd HE d E CBE z ES ES E Am ETC EE ESSE EET EIS PE EE EBEEE ED EE ER ER ER n E EE EE SEE e E ESSERE SISEEE E SSEDEESSEL EE SE Ed Eg T2 31 401341 IB FEE EE EE FEE EC EE EE FEE EE ERE D E EH EE EE E En EE ER DE em vetere E EE on d ee ee ee ee epee ee pep AEREE ARR RS N51 E pns teres poppe ssp Ep pps ppp S ES ESSE FEE ES EE EE ES E EB ERE E em e E EE EE e E EE ER EE ES EE EE ER DER E Ed Expo SEES ETTRES SE some ST feos GE EE ERE REB EE ER EE ERES E 3 REI ERE ER EEG ee ER EEG EE EEG EE ER EEG E Ld saa TED D FREI EEB ES ER ER EE ED E FE REB ER ol ER ER e Ed E E id E Ed Ed RH g l E E ES ER ed E E E E A E E E E E i E E Es Ed E FEIER EH EE EE EP GER RE ERE EE E EE GG EEG EB oc EE EE REB ERE 48 ER ER GE o 8 mu pr ENEEEBEBEBIET NEST E FERES EER EE EB EE ERU ER EE ED EE nu E EE EEG E Pe ER ERE EE EE Ps E ERE EE RR PEERS Fs EE s pep SETS ES ES ES ee S p ES ES ES eo o PaF nha x prox frie anae lel ot lt E E E E EE ELE BERE EN EH EB ERE ED EB ES ERR ER R LEER ER EB E EB ER EB ELE IR E EE ER ERE m EH ut EE EN Rupe EX ET BEEN E Pull uM ig EHE CER I S 3 ES dE 0M v 35 H BE HE
43. Select the preferred template with the Browse button The information available in the template is shown below Add new template With this option you can customize the contents of the summary report Clicking on the Add new template button will open the XECG Summary template wizard The selected template contains the following information Displays the sections that are selected and will display in the summary report DIR 80012335 Ver F 55 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To customize a new summary report template 1 Click on the Add new template button in the Exercise ECG settings Summary tab 2 Select which fields should be included in the Summary report The options button will change with the option selected above the button if no options are available for the selected item the button is disabled For example If Insert custom logo is selected the button changes to Insert custom logo click on the button and you can browse for your own custom logo If Maximum heart rate is selected you can select the settings for the Maximum heart rate with the options button E nmn ae Exercise ECG General Viewing Printing Monitor Devices Recorder Summary General Select the template to use for the XECG Summary page xecg_summary htm Browse PITE ECG i Add new template XECG Summary template Wizard Step 1 3 x v dius pain ae conta
44. al 3 3 Work with the Summary view Summary view The summary view displays a report with the most important information measurements and results The default summary view can be adjusted to your own preferences from the settings menu See page 55 for more information Summary Averages Full Discloowe 2x6 4x3 Trends ST table Heserate ST HR Exercise ECG Summary Patient Information Current user admin Welch Allyn CardioP erfect Workstation CCNV 001 Jongmans Stella 5 17 1971 Female Treadmill Protocol Pharmacological Stress Agents Cardiac Risk Factors Stress Test Type Baseline or Resting ECG Pharmacological Indications Reasons For Stress Test Test Results Recorded 8 24 1998 10 15 49 AM Target heart rate 193 bpm Maximum heart rate 122 bpm 07 36x 66 Maximum workload 3 4 mph 14 096 10 1 METS 06 00x Maximum blood pressure Highest ST Test Duration 14 93 Exercise duration 0901 Recovery duration 03 01 Duration of the last stage in 00 01 Exercise Number of Stages in Exercise 4 Duke score 0 Medium risk Technician vw Doforninn nhwcician The default summary view consists of Patient information The name number birth date gender height and weight of the patient Test information Information about the reasons for the test test type medications and cardiac risk factors Test results Information about the test date duration device the used protocol the length
45. ame of the Next phase or stage ul 30 to Bruce 2 When you have reached the end of the test click the Stop test button to stop the test Welch Allyn CardioPerfect Exercise ECG will ask you to switch off the recorder Welch Allyn CardioPerfect Exercise ECG automatically saves the ECG Stop test In case of an emergency you can also use the Emergency stop button or F12 to stop the test Welch Allyn CardioPerfect will immediately stop the exercise device The monitoring of the patient will continue and printouts can be made During the test you can Measure the blood pressure Capture an event Add a comment Turn pacemaker mode on or off Apply a baseline filter to filter out baseline wander Change the load Pause the protocol Print a report 2 3 1 Select how you want to view leads Once you have created a new exercise ECG the Real time monitor displays the ECG traces Before you start the actual recording you can select how you want to view the traces Welch Allyn CardioPerfect Exercise ECG offers different views different chart soeeds and different sensitivities To select a different view e Inthe View menu point to Monitor style and click a value You can choose between 3 6 or 12 simultaneous leads The new view is immediately displayed To arrange the leads in 3 lead and 6 lead views e Click on the tabs under the traces to display different lead groups J Ett pi ji Favorites II IIl aVR avL avF
46. an Welch Allyn or their authorized service personnel Accessories The Welch Allyn warranty can only be honored if you use Welch Allyn approved accessories and replacement parts Use of accessories other than those recommended by Welch Allyn Caution ay compromise product performance DIR 80012335 Ver F 2 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Warranty Service and Spare Parts Warranty All repairs on products under warranty must be performed or approved by Welch Allyn Unauthorized repairs will void the warranty In addition whether or not covered under warranty any product repair shall exclusively be performed by Welch Allyn certified service personnel Assistance and Parts If the product fails to function properly or if assistance service or spare parts are required contact the nearest Welch Allyn Technical Support Center USA 1 800 535 6663 Canada 1 800 561 8797 Latin America 1 305 669 9003 South Africa 27 11 777 7555 European Call Center 353 46 90 67790 Australia 461 2 9638 3000 United Kingdom 44 207 365 6780 Singapore 65 6419 8100 France 33 1 55 69 58 49 Japan 81 42 703 6084 Germany 49 695 098 5132 China 86 21 6327 9631 Netherlands 31 202 061 360 Sweden 46 85 853 65 51 Before contacting Welch Allyn it is helpful to attempt to duplicate the problem and to check all accessories to ensure that they are not the cause of the problem When calling
47. anual Hardware The PRO Recorder uses a Prolink USB cable to communicate with the computer DIR 80012335 Ver F 65 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 11 Installing the Exercise ECG Module Before you can start recording ECGs you need to e Install the hardware e Install the correct drivers e Configure the software 11 1 Connecting the ProLink USB Interface Please run the software installation prior to inserting the USB Interface into a USB socket of your computer To set up your computer for use of the USB Interface 1 Connect the USB Interface to the USB port of the computer 2 Connect the other end of the interface directly to the PRO Recorder To configure Welch Allyn CardioPerfect Workstation 1 Start Welch Allyn CardioPerfect Workstation and log in as Administrator 2 Inthe File menu click Settings click Exercise ECG and click on the Recorder tab 3 From the Port list select Unilink USB This is the default setting after a new installation 11 2 R wave triggering Interface capabilities The Welch Allyn PRO Link interface cable provides both a TTL and an Analog representation of the QRS complex e he analog output rendered on port 1 is an approximate representation of the signal on lead Il The analog signal output is dependent on the input stimulus and uses a 1 V mV conversion Stimulus ranges from O volts to 5 volts peak to peak e he TTL output rendered on po
48. can use the statement tree to select and enter common interpretation statements Until confirmed the test will be labeled as Unconfirmed Interpretation Once the interpretation has been confirmed by a physician only a user with confirm interpretation rights can further edit the interpretation For more information on user rights see the Administrator tool To enter text in the Interpretation editor 1 Inthe Tools menu click Interpretation The Interpretation editor is displayed Interpretation editor x ey Save E Confirm x Cancel Clear x Undo D ate time INDICATIONS F R STRES CAD RISK FACTORS BASELINE EKG HESRTRATE RESPONSE TE BF RESPONSE TU EXERCIS FUNCTIONAL CAPACITY REASONS TO TERMINATE T SYMPTOMS DURING STRES k Once the interpretation is confirmed the save button will be grayed out 2 Inthe right hand pane at the pointer start typing E Ez E E E E E E 4 To enter a statement from the statement tree 1 From the statement tree click on one of the categories to display all possible statements for that category 2 From a category click on the statement that you want to include in the interpretation The statement is added 3 To delete a statement from the interpretation select the statement text and press BACKSPACE to delete it 4 Click the Save or Confirm if available button to save your comments and to return to the ECG Tips for editing and confirming an interpretation
49. cise laboratory should be trained in cardiopulmonary resuscitation A physician should also be present at all exercise tests in patients with suspected or known heart disease A defibrillator and drugs should be immediately available DIR 80012335 Ver F 8 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 1 Getting started 1 1 The Welch Allyn CardioPerfect Exercise ECG window This section will guide you around the various parts of Welch Allyn CardioPerfect Exercise ECG Welch Allyn CardioPerfect Send 6 Type Date amp time Xe 3 4 1990 104521 AM 4 3 4 1998 10 34 06 AM 9 4 1998 10 3345 AM 9 4 1998 10 3305 AM 8 24 1998 10 15 49 AM Title bar Menu bar Tool bar Search area Workspace DIR 80012335 Ver F Search Toolbar Menu bar IC Paer ZECG AvEvercse ECG E Recolea 3 Spiomesy T ABP Prin A Print Preview ig Send Recewe 1 C Zomin Q Zomot fSjinterpretaiion IS Edi test CCNV 001 Stella Jongmans F 5 17 1971 Summa Averages Fu Disclosure 26 4x3 Trends ST table Heatvate ST HR Selection Reference complex None Iretal Favorites lavF VIVE MHIL VITAES Title bar 2 ini xi 40 j Test date 9 4 1998 10 45 21 AM Workspace FI Y Goto Full Disclosure 20 manim ey eee Number of rows t Tt ER 1
50. ct is Copyright 2015 Welch Allyn All rights are reserved The software is protected by United States of America copyright laws and international treaty provisions applicable worldwide Under such laws the licensee is entitled to use the copy of the software provided on the original distribution medium The software may not be copied decompiled reverse engineered disassembled or otherwise reduced to human perceivable form This is not a sale of the software or any copy of the software all right title and ownership of the software remains with Welch Allyn The information contained in this manual is subject to change without notice All changes will be in compliance with regulations governing manufacture of medical equipment User responsibility This product is designed to perform in conformity with the description thereof contained in this manual and accompanying labels and inserts when assembled operated maintained and repaired in accordance with the instructions provided A defective product should not be used Parts that are broken plainly worn missing or incomplete distorted or contaminated should be replaced immediately Should any repair or replacement become necessary we recommend that service be performed at the nearest approved service center The user of the product shall have the sole responsibility for any malfunction which results from improper use faulty maintenance improper repair damage or alteration by anyone other th
51. d pressure during the test Select Manually controlled if the blood pressure protocol will not be used or if the protocol is selected at the start of a test DIR 80012335 Ver F 53 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 7 6 Exercise ECG settings Recorder tab The Recorder tab is only accessible if you have Windows administrator rights Use the Recorder tab to adjust settings for the Welch Allyn CardioPerfect recorder The Recorder tab contains the following options Recorder model Model Use the MDXN1 PRO Recorder Sample Frequency The sampling frequency of the Recorder 300 600 or 1200 Hz AC mains frequency The frequency that is filtered by the AC mains filter You can choose between 50 and 60 Hz Recorder connection Port type The communication port of the PC to which the recorder is connected This is typically the USB port Analog output If you use USB with an analog port select the function of the analog output here You can use the output to control an ergometer or to transmit the ECG signal Channel If you set the function of the analog output to transmitting the ECG signal select the channel from which the ECG signal is taken here Recorder options Display switch off message This option disables the display of the message Switch recorder off after a test has been completed If a Welch Allyn CardioPerfect PRO Recorder with USB connection is used this option should be of
52. daily e Check for cracks or breaks in the PC USB interface cable the patient cable the patient electrodes and the PRO ECG Recorder e Check for bent or missing pins on all cables e Check all cable and cord connections reseat if any connectors are loose 6 3 Accessories For information about the ECG hardware and accessories please refer to the Pro Manual DIR 80012335 Ver F 47 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 7 Customizing the Exercise ECG module You can customize Welch Allyn CardioPerfect to your own preferences To open the settings click Settings in the File menu The features that you can customize are located in the Exercise ECG settings In the navigation bar click Exercise ECG ay 7 1 Exercise ECG settings General tab Use the General tab to customize general functions of Welch Allyn CardioPerfect Exercise ECG The General tab contains the following options Lead Preference In this section you can specify your own favorite lead sequence Use the arrows to move a lead up or down The favorite lead sequence is available in the Averages view and the Real time monitor When displaying views with fewer than 12 leads the leads that are shown are selected from the top down from this list thus a 3 lead view shows the top 3 leads ST options Reference Point With this setting you can determine the default point that is taken for ST measurement Possible choices are J 0 J
53. e RF emissions The Welch Allyn CardioPerfect PRO Cardiograph uses RF energy only for its internal function Therefore its RF emissions CISPR 11 are very low and are not likely to cause any interference in nearby electronic equipment TT eMlesions a The Welch Allyn CardioPerfect PRO Cardiograph is suitable for CISPR 11 use in all establishments other than domestic and may be used in domestic establishments and those directly connected to the Harmonic emissions Class A public low voltage power supply network that supplies buildings used for domestic purposes provided the following warning is heeded ee CU WARNING This equipment system is intended for use by healthcare professionals only This equipment system may cause radio interference or may disrupt the operation of nearby Voltage fluctuations Complies equipment It may be necessary to take mitigation measures flicker emissions such as re orienting or relocating the Welch Allyn CardioPerfect IEC 61000 3 3 PRO Cardiograph or shielding the location DIR 80012335 Ver F 71 80 WelchAllyn Electrostatic discharge ESD IEC 61000 4 2 Electrical fast transient burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and voltage variations on power supply input lines IEC 61000 4 11 Power frequency 50 60 Hz magnetic field IEC 61000 4 8 NOTE DIR 80012335 Ver F CardioPerfect Workstation Exercise ECG Module User Manual E
54. e User Manual 3 10 Work with the ST HR view 3 10 1 ST HR view v5 Y MV Exercise V 4 amp Recovery j p ec T 0 ST mV 5 50 55 60 65 70 75 80 85 90 95 100 105110 115 120 125 130 135 140 145 150 The ST HR view plots the ST segment depression against the heart rate You can display this graph for each lead In the left hand pane the ST HR index is shown More information can be found in Okin PM Kligfield P 1989 Computer based implementation of the ST segment heart rate slope American Journal of Cardiology You can select to show the exercise phase the recovery phase or both by checking the option from the checkbox above the graph To display the ST HR graph for a different lead e Click on a lead in the left hand pane or select the lead from the drop down box To invert the ST HR curve e Click on the graph with your right mouse button and select Invert from the shortcut menu Click once more to flip the graph back to its original position DIR 80012335 Ver F 40 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 4 Interpreting an exercise ECG Once you have viewed measured and compared the information in the exercise ECG you can add edit and confirm the interpretation 4 1 Edit save and confirm interpretation After test anyone with edit rights can edit an unconfirmed interpretation in the Interpretation editor In this editor you can enter your own texts Alternatively you
55. e treadmill or bicycle A record of patient perception for several parameters can be added to the test with the Perception button With the Blood pressure button you can enter a blood pressure measurement at any time Blood pressure can be measured manually or automatically This depends on the blood pressure device With the Comment button you can add information to the exercise ECG like a description of an arrhythmia that has occurred With the Event button you can indicate an event like arrhythmia When you click the button Welch Allyn CardioPerfect Exercise ECG inserts a mark in the full disclosure view and adds the event to the event list The Event button functions similar to the Comment button but additional information cannot be added With the Print button you can print a report See 7 3 1 on how to select the report format With the Emergency stop button you can stop the exercise device The monitoring of the patient will continue See page 16 for important information regarding the Emergency stop function 12 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Overview area Overview area In the Overview area you can find the following information about the exercise ECG e Phase of the exercise ECG monitoring exercise recovery and the duration of the phase e Number and name of the Stage that is currently being recorded e The current heart rate of the patient and the curren
56. e curves e Workload against time e Heart rate against time The VES ventricular extra systole count can be displayed in the Heart rate graph from the shortcut menu e Blood pressure against time The RPP Rate Pressure Product can be displayed in the Blood pressure graph from the shortcut menu History tab The History tab shows the history of all twelve leads Here you can move back in time or print a view while the exercise ECG recording continues Clicking the double arrow buttons moves forward and backward from event to event DIR 80012335 Ver F 13 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Tabs below the ECG traces ST Slope tab This ST slope tab shows the comparison between the actual and referral ST measurement The arrows below give the direction of the slope Test Information General information about the test including for example the reasons for the recording the type of test and cardiac risk factors can be added in the test information tab Test observations Observations made during and prior to the recording including for example the symptoms during stress baseline ECG results and reasons for test termination can be added in the test observations tab Interpretation tab In the Interpretation tab you can add an interpretation and comments like reasons for stopping the test You can start adding comments while the test is still in progress Tabs to the right of the ECG trac
57. e highest blood pressure or the highest workload were measured The view can be simultaneous or sequential selectable from the shortcut menu 4x3 view The 4x3 view displays a 12 lead ECG strip The leads are shown in a 4x3 configuration with a rhythm strip at the bottom of the view The view can be simultaneous or sequential The rhythm lead can be set in the general XECG settings Rhythm view The Rhythm view displays leads in different groupings so that you can easily switch between the most common groups 3 6 1 Use filters When viewing the 2x6 or 4x3 view you can use two filters e Baseline filter e Muscle filter Both filter options can be found in the Action menu Select the appropriate filter to enable it The filter option will be marked with a check To disable the filter simply select it again Note When you enable a filter from the Action menu it will also affect the full disclosure and 4x3 or 2x6 view Note You can tell which filters are enabled in the portion of the full disclosure 2x6 and 4x3 views by looking at the frequency response displayed If the baseline filter is enabled the lower frequency will be 0 5Hz If the muscle filter is enabled the upper frequency will be either 25 or 35 Hz depending on the settings If accurate ST segment contours are required for ECGs do not use the 0 5 Hz baseline wander filter This filter suppresses baseline wander to the extent that it may alter the ST segment Instead co
58. e is not calculated if the Test type is not Exercise 2 3 6 Add a comment During recording you can make notes about for example the state of the patient You can choose from predefined comments or type in your own comment To add a comment during recording 1 Click the Comment button in the Real time monitor 2 In the Comment dialog box either use the arrow to select a comment from the list or type in your own comment DIR 80012335 Ver F 23 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 3 7 Apply filters Baseline filter ECG traces can contain baseline wander that disturbs the signal You can use the baseline filter to filter out this disturbance When you use the baseline filter the recorded signal is not changed You only change the way the signal is displayed and printed To filter out baseline wander during recording In the Real time monitor check the Baseline option in the Overview area or press F3 The filter is immediately applied Clicking the button once more switches the filter off e Alternatively in the Action menu click Baseline to switch on the Baseline filter Clicking the option once more switches the filter off The baseline wander filter introduces a delay of 3 seconds before data are shown on the real time display To filter out baseline wander during viewing e Inthe Action menu click Baseline to switch on the Baseline filter Clicking the option once more sw
59. e of protocol that you want to create treadmill ergometer blood pressure or printer Then right click on the selected protocol type 3 Inthe shortcut menu click New A new protocol is added to the protocol list 4 Select the measurement units mph or km hr for the new protocol if a treadmill protocol was selected 5 Enter a name for the new protocol 8 5 2 Import a protocol With the import function you can import protocols that were created with previous versions of Welch Allyn CardioPerfect Exercise ECG To import a protocol 1 In the Protocol menu click Import 2 Inthe Open dialog box select the protocol that you want to import and click Open 8 5 3 Delete a protocol When you no longer use a protocol you can delete it To delete a protocol 1 Select the protocol that you want to delete 2 Right click on the protocol 3 Inthe shortcut menu click Delete DIR 80012335 Ver F 61 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 8 6 Working with stages 8 6 1 Create a new stage Once you have created a new protocol you can define the different stages for that protocol Each phase in the protocol can have a number of stages When you design these stages take into account that not every test may use all phases and that the protocol needs to be specified accordingly Most Treadmill and Ergometer protocols only have stages in the Exercise and Recovery phase To create a new
60. e test To select the parts of the test that you want to view e Inthe Selection list that is present on the Averages Full disclosure 2x6 4x3 and ST table views click on a selection To view a part of the selection e Point to the binoculars icon A list with times and events is displayed If you click on one of the events you are automatically taken to that point in the recording Tips for making selections e You can configure the items in the Selection list in the exercise ECG settings please refer to page 51 to read how to do this 3 2 4 Copy into other applications A bitmap of the Averages view the Full Disclosure view the 2x6 and 4x3 view and the text of the ST table can be copied into other MS windows applications Select the view you want to use and right click on the view and select copy You can now paste the bitmap for the graphs or the text for the ST table into other MS windows applications 3 2 5 Post test editing of tests The information added in the New Exercise ECG dialog is editable as long as the interpretation is not yet confirmed To edit an unconfirmed test e Select Edit test from the Action menu or click on the A Edit test button in the Toolbar Select the Test Information Test Observation or Physicians tab to edit the test information Click save to save the information with the test DIR 80012335 Ver F 30 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manu
61. ead monitor Show next lead group in 3 or 6 lead monitor Set the ST reference point to J 0 et the ST reference point to J 20 et the ST reference point to J 40 et the ST reference point to J 60 Set the ST reference point to J 80 Set the ST reference point to Dynamic nserts a user event in the recording Esc Exitthe Real time monitor cannot exit when recording is active DIR 80012335 Ver F 75 80 WelchAllyn CardioPerfect Workstation Viewing Key CTRL DOWN CTRL UP CTRL Z CTRL I CTRL H CT RL R ALT 0 ALT 2 ALT 4 ALT 6 ALT 8 Exercise ECG Module User Manual Zooms out Zooms in Reset zooming Opens the Interpretation window Opens the Interpretation History Activates the refresh functionality which clears all user made measurements Set the ST reference point to J 0 Set the ST reference point to J 20 Set the ST reference point to J 40 Set the ST reference point to J 60 Set the ST reference point to J 80 ALT D set the ST reference point to Dynamic DIR 80012335 Ver F 76 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 15 Additional information 15 1 Duke Treadmill score The Duke Treadmill Score DTS was introduced by DB Mark cs According to the ACC AHA Practice Guidelines the Duke Treadmill Score adds significant prognostic information to the standard clinical data Besides improving diagnostic and prognostic accurac
62. ecord an exercise ECG cc cecccccccssssecececeeesecceeceaaseceeessauseceeesseaeeeeesssaeeeeessuaeeeeess 14 2 3 Real time MONIMON eee cccceesceeceeseeeceeueeecceasececseeeecsauseeessaseeeesaseessausenessaseeessaeees 20 3 VIEWING AN EXERCISE EQCO2Q 1 eere Leere rennen nena nnn 29 3 1 X About viewing exercise ECQs cccccccccssssescceeeeeeeseeseeceeeeessaeeeeeeeeeeeesseeeaeeeeeeeesaaas 29 3 2 View an exercise ECG 20 eeccccceccccccseeccecceeceeceeeceesaeeeceeseuseeeseueeeesausecessaeeeeseaseeesaaeees 29 3 3 Work with the Summary view lsssssessseeseseeen nennen nnnm nennen nnn nnns 31 3 4 Work with the Averages view esssssssssseeeene eene nnn nnn nnns 32 3 5 Work with the Full disclosure view sseeeeeseeeeeeneeeernnnennm 34 3 6 Work with the 2x6 4x3 and Rhythm views ccccccseececeeeeeceeeeeeeeeesseeeesseeeesaneeees 36 3 Work with the Trends ViQW ccccccccccsseceeceeeceeceeeeceseaeeceeceeeeeeseueeesseaeeeeseaeeeesaaaeees 37 3 8 Work with the ST table view esseeesseeeeeeeennnnennnne nennen 38 3 9 Work with the Heart rate view cccccccseecceceeceecseeeeeeseeeeesseeeeeeaeaeeeeeeeeeessneeessaeees 39 3 10 Work with the ST HR ViQW cccccscccssececesececeneeeeeseeteeeeeteneeeteneeeeeneetsegeetseeeteneeens 40 4 INTERPRETING AN EXERCISE ECG enrenenen nennen 41
63. er to make changes in this section you must have Windows Administration privileges These privileges are set outside of CardioPerfect application and are specific to each computer If a section is grayed out you do not have the necessary privileges and should consult your IT administrator The Devices tab contains the following options Exercise device Type The type of exercise device that is used during the exercise ECG Device Select your exercise device from the pull down list if your exercise device is not in the list or if you do not want your device to be controlled by the CardioPerfect workstation then select manual Connected to From this list you can select the COM port to which the exercise device is connected This is only possible when the selected device has a serial or RS232 interface Default protocol The default workload protocol that is used for the exercise ECG Instant manual load When this option is enabled the treadmill speed and elevation or the changes ergometer workload will be instantly adjustable in the Real time monitor Blood pressure device Device With this option you can specify which blood pressure device is used for measuring the patient s blood pressure during the exercise test Connected to From this list you can select the COM port to which the blood pressure device is connected Default protocol With this option you can specify which protocol is used by default for measuring the bloo
64. ermined to be defective because of defective materials components or workmanship and the warranty claim is made within the warranty period described above Welch Allyn will at its discretion repair or replace the defective Product or accessory free of charge You must obtain a return authorization from Welch Allyn to return your Product before you send it to Welch Allyn s designated service center for repair THIS WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE WELCH ALLYN S OBLIGATION UNDER THIS WARRANTY IS LIMITED TO REPAIR OR REPLACEMENT OF PRODUCTS CONTAINING A DEFECT WELCH ALLYN IS NOT RESPONSIBLE FOR ANY INDIRECT OR CONSEQUENTIAL DAMAGES RESULTING FROM A PRODUCT DEFECT COVERED BY THEWARRANTY Power strips multiple portable socket outlets are not allowed for N use in connecting the medical electrical equipment or any WARNING accessories to ground unless used in concert with a medical approved isolation transformer During defibrillation the ECG signals displayed may show waveform artifacts and cannot be relied on as a true indication of the patient s physical condition Accessible metal parts such as electrode terminations should not come in contact with other electrically conductive parts including earth ground Welch Allyn provides a number of high quality patient leads in varying termination styl
65. es ST tab The ST tab displays trends for the measured ST and ST slope against time You can display three leads at a time and select which leads you want to see Table tab The Table tab displays an overview of the last measured ST values the value for the reference ST and the resulting ST deviation for each lead The highest deviation values are displayed in bold red text Below the ST values the lead with the highest ST elevation or depression is displayed Complex tab The Complex tab displays the average complex of a lead You can select which lead should be displayed Shortcut menu The shortcut menu provides a variety of controls depending on the tab which is active including setting the ST point and the display of the Slope values 2 2 Record an exercise ECG Welch Allyn CardioPerfect Exercise ECG records exercise ECGs easily and reliably The only thing you have to do is make sure the electrodes are placed correctly and switch on the recorder Welch Allyn CardioPerfect Exercise ECG takes care of recording adjusting the ergometer or treadmill making a number of measurements and calculations taking blood pressure readings and saving the recording To record an exercise ECG you need to follow these global steps Each step is explained in more detail on the following pages To record an exercise ECG 1 Place electrodes on the patient Important Because Welch Allyn CardioPerfect Exercise ECG is a 12 lead electrocardiograp
66. es Use of these approved patient leads is required for electrical protection of the patient during cardiac defibrillation CardioPerfect devices are not intended for direct cardiac application DIR 80012335 Ver F 4 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual An inoperable or damaged electrocardiograph can be identified by abnormal signals on the ECG waveforms Abnormal signals are characterized by flat lines excess noise square waves or other non typical anomalies that appear on the ECG waveform The electrocardiograph can be periodically tested by connecting the CardioPerfect to an ECG simulator Follow manufacturer s instructions If there is a requirement for equipment to be connected to a personal computer or other non medical rated equipment it is the responsibility of the user to ensure that the electric power circuit to which the CardioPerfect system is connected includes an additional protective earth ground or an isolation transformer in order to satisfy the IEC 60601 1 safety standard Other medical equipment including but not limited to defibrillators ultrasound machines pacemakers and other stimulators may be used simultaneously with the electrocardiograph However such devices may disturb the electrocardiograph signal The electrocardiograph has not been designed for use with high frequency HF surgical equipment and does not protect against hazards to the patient Fire and
67. f unchecked DIR 80012335 Ver F 54 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual 7 7 Exercise ECG settings Summary tab In the summary tab of the Exercise ECG settings the contents of the Summary report can be adjusted see Viewing an exercise ECG page 29 The summary tab of the Exercise ECG settings shows which information is currently displayed in the Summary report view To change the Summary report you can select a previously created template or add a new template Ini x ae Exercise ECG General Viewing Printing Monitor Devices Recorder Summary General Select the template to use for the XECG Summary page g Browse ECG Add new template The selected template contains the following information Test information Observations C Pharmacological Stress Agents O 5T Changes Q Cardiac Risk Factors D Functional Capacity T O Stress Test Type C Symptoms During Stress O Baseline or Resting ECG CO HR Response to Exercise C Pharmacological Indications O BF Response to Exercise af J Reasons For Stress Test D Reasons for Termination Exercise ECG Spirometry Ambulatory blood Test results eee Insert custom logo O Include html file Poy O Current user HRS O Registered owner O Registered company O Title O pplication Recorded r5 Cancel Apply Help Select the template to use for the XECG Summary page
68. following sections give an overview of the exercise device protocols There are special variables that you can use to make the exercise device protocol quite sophisticated and flexible These variables are also defined in the following sections 8 2 1 Ergometer protocols An ergometer protocol is a collection of stages that together define the ergometer test For each stage in an ergometer protocol you need to specify the name duration repetition load and maximum load The Protocol editor automatically generates a stage name this name can be changed DIR 80012335 Ver F 58 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Expression Variables You can use an expression to create a stage that is dependent on weight height age etc To create such an expression you can use the following variables p value Watts km h or 96 KG J Weightofthe patient in kilograms ge of the patient in years Height of the patient in centimeters HR Current heart rate Expression Operators You can combine variables into an expression with the following operators Examples Here are some examples of expressions To JUsethis expression Increase ergometer load by 40 W C 40 Increase ergometer load by half the weight C 0 5 KG 8 2 2 Treadmill protocols A treadmill protocol is a collection of stages that together define the treadmill
69. h all electrodes must be connected Proper skin preparation abrasion if necessary and proper electrodes are essential for a good signal quality DIR 80012335 Ver F 14 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 In the Workstation select or create a patient 3 Create a new exercise ECG The Real time monitor is displayed Depending on the ECG recorder used Welch Allyn CardioPerfect may ask you to switch on the recorder 4 Switch on the Recorder If a PRO Recorder with USB cable is used no message will appear the Recorder will be switched on automatically The Real time monitor displays the ECG traces 5 Adgjust the real time display to your requirements 6 Inthe Real time monitor wait until the signal is stabilized and click the Start button to start recording Welch Allyn CardioPerfect Exercise ECG automatically starts the first phase and stage of the test protocol 7 During the test you can Measure the blood pressure Add patient perception parameters Capture an event Add a comment Turn pacemaker mode on or off Apply a baseline filter to filter out baseline wander Apply a muscle filter Change or hold the current load Print a variety of reports 8 To move to the next phase of the test click the button that displays the name of the next phase 9 When you have reached the end of the test click the Stop button to stop the test Welch Allyn CardioPerfect Exercise ECG may ask
70. he target Heart rate as a percentage of the maximum Heart rate Enter a percentage in the corresponding field DIR 80012335 Ver F 27 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 3 13 Target Workload If an Ergometer was selected as exercise device the Real time monitor displays the current Workload and the current Workload as a percentage of the Target Workload during recording in the overview area Workload 80 Watt 39 of 203 The Target Workload can be adjusted at the start of a new exercise ECG in the New Exercise ECG window Target workload 203 b watt The Standard Target Workload shown is calculated with the following formula Target Workload 2 Height 2 37 Age 73 1 01 16 6 In case of a female patient multiply the above by 0 8 Units The height is specified in centimeters The Age is specified in years To set the Target Workload Enter a value in the Target Workload field DIR 80012335 Ver F 28 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 3 Viewing an exercise ECG 3 1 About viewing exercise ECGs Welch Allyn CardioPerfect Exercise ECG offers various views on an exercise ECG Each view highlights a different aspect of the ECG You can have a look at all twelve leads in full disclosure 2x6 and 4x3 format but you can also view the test results in a summary report Additionally you can view the average complexes
71. his a mark is inserted at the place where the event occurred and the event is added to the event list After recording you can edit or expand the description of the event To capture an event 1 Start a recording 2 When an event occurs click the Event button Event To edit events after recording 1 Inthe Action menu click Edit events The Event list is displayed R Modify X Delete 116 71 mmHg 5 4 03 43 Blood pressure 149 67 mmHg 8 4 06 34x Blood pressure 165 87 mmHg 8 02 35r Blood pressure 158 75 mmHg Fr 04 35r Blood pressure 132 74 mmHg Cancel Help 2 Inthe Event list select the event that you want to edit and click Modify 3 Select a description from the list or type a new comment 4 Click OK The description is added to the event 2 3 4 Patient Perception Parameters During recording you can add comments about the perceived exertion dyspnea and chest pain using Borg scales These scales developed by Gunnar Borg are general scales to quantify perceptions and experiences To add a perception parameter 1 Click the perception button F in the Real time monitor 2 Inthe add event dialog select one of the following parameters a Dyspnea b Chest pain c Perceived exertion 3 Directly enter the value or use the slider to set the value Click the OK button to add the information to the test DIR 80012335 Ver F 22 80 WelchAllyn CardioPerfect Workstation E
72. ins the followir This wizard will quide you though the creation of a summary page template est information Exercise ECG C Pharmacological Stress Agents O Cardiac Risk Factors Step 1 T 1 Stress Test Type Select which items you would like to have included in the template O Baseline or Resting ECG Spirometry e O Pharmacological Indications Technician Target heart rate O Post tes 3 O Reasons For Stress Test Referring physician O Target workload O Exercise D Attending physician Maximum heart rate O Recove ITI T Test results O Ordering physician Maximum workload O Duratior pressure i O Location Maximum blood pressure O Duratior o eae iad Interpretation Highest ST O Duratior o z a mcs Device Test Duration O Duratior pea o Sedi in Protocol L Pre test duration O Stage te Recollect egistered owner O Registered company eT CO Application Options T Recorded C Pharmacological Stress Agents O ET Chana Options Maximum heart rate ini x DILE O Cardiac Risk Factors C Functional O Stress Test Type C Symptoms e eae M O Baseline or Resting ECG C HR Respo P 9 C Pharmacological Indications O EF Respor C Reasons For Stress Test O Reasons k Next B Cancel Note Which fields are displayed is optional the location of the fields is fixed 3 Click Next 4 Enter a file name for the new Summary report template Click Next If the file name already exists a warning will appear You can ove
73. ion For all general information about the workstation software please refer to the Workstation manual this describes Creating and editing Patient cards General information about printing For information about the ECG hardware and accessories please refer to the Pro Manual For further information on installation and configuration please refer to the Installation manual Detailed information on servicing is described in the Service and Advanced Installation manual Intended use Using the optional ECG module and associated accessories the user can acquire view store and print ECG waveforms Indications Indications for electrocardiography range from routine screening of cardiac health in the physician office environment to directed diagnostic differentiation in a hospital cardiology department Contraindications and precautions The following contraindications are known for the recording of an exercise ECG e Recent onset of chest pain or a change in the pattern of pain to suggest unstable angina e Acute myocardial infarction within a week after its onset e The presence of congestive heart failure excessive hypertension or severe aortic stenosis in adults e Uncontrolled ventricular arrhythmias e Known critical stenosis of left main or proximal coronary artery Ellestad MH Blohmqvist CG Naughton JP Standards for adult exercise testing laboratories AHJ A 421A 30A Since the risk is not negligible the staff of the exer
74. ion RMA number It is recommended that all returned goods be insured Claims for loss or damage to the product must be initiated by the sender DIR 80012335 Ver F 3 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Limited Warranty Statement Welch Allyn Inc warrants that the Welch Allyn CardioPerfect Workstation computer based product you have purchased meets the labeled specifications of the Product and will be free from defects in materials and workmanship that occur within 1 year after the date of purchase Accessories used with the Product are warranted for 90 days after the date of purchase The date of purchase is 1 the date specified in our records if you purchased the Product directly from us 2 the date specified in the warranty registration card that we ask you to send to us or 3 if you don t return the warranty registration card 120 days after the date on which the Product was sold to the dealer from whom you bought the Product as documented in our records This warranty does not cover damage caused by 1 handling during shipping 2 use or maintenance contrary to labeled instructions 3 alteration or repair by anyone not authorized by Welch Allyn and 4 accidents You assume all responsibility for use of the Product with any hardware or software that does not meet the system requirements described in the Product documentation If a Product or accessory covered by this warranty is det
75. itches the filter off Note f accurate ST segment contours are required for ECGs do not use the 0 5 Hz baseline wander filter This filter suppresses baseline wander to the extent that it may alter the ST segment Instead configure your cardiograph to operate without the baseline wander filter Regardless of the filtrer used the rhythm characteristics of the ECG are accurately recorded Muscle noise filter Muscle noise in an ECG signal hides low amplitude signals that may be important for the interpretation of an ECG You can remove this noise with a muscle noise filter To apply a muscle noise filter e Atthe top of the Real time monitor click Muscle filter Click again to switch the filter off 2 3 8 Manual load change During recording it is possible to change the load by clicking the Change load button Clicking this button will open the change load dialog window which is always on top If a treadmill is used the speed and elevation can be changed if an ergometer is used the workload can be changed When the pause the protocol after change option is enabled the protocol will hold at the current load The pause protocol checkbox is linked to the pause button on the monitor form Clicking either one of them will automatically change the state of the other one New values can be entered directly or via the up down buttons It is also possible to increment decrement the value by using dedicated keyboard keys see tab
76. le DIR 80012335 Ver F 24 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Load change Change Keyboard Treadmill Increment Ergometer Increment keys decrement decrement CTRL 7 Elevation 1 5 Watt CTRL Elevation 1 5 Watt CTRL Speed 0 1 km h N A CTRL Speed 0 1 km h N A When a key combination is pressed e g C TRL T when the load change window is not visible the load change window will pop up and the corresponding load will change e When the Instant manual load changes option is enabled Exercise ECG settings Devices tab changes of the load are instant and confirmed The change workload window will have the following appearance Ergometer Treadmill Welch Allyn CardioPerfect l Welch Allyn CardioPerfect Change current workload to Change current load of the treadmill a E 4o is Pause protocol after change 00 4 x Pause protocol after change Close Upon changing the values will immediately be sent to the exercise device e When the Instant manual load changes option is NOT set the form has the following characteristics Ergometer Treadmill Welch Allyn CardioPerfect Change current load of the treadmill EE a km h 10 4 amp Pause protocol after change Welch Allyn CardioPerfect 1 Change current workload to E Walt Pause protocol after change Cancel Cancel
77. lectromagnetic Immunity The Welch Allyn CardioPerfect PRO Cardiograph is intended for use in the electromagnetic environment specified below The customer or the user of the Welch Allyn CardioPerfect PRO Cardiograph should assure that it is used in such an environment Immunity test IEC 60601 Compliance level Electromagnetic environment test level guidance 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV common mode lt 5 Ur gt 95 dip in UF for 0 5 cycle 40 Ut 60 dip in Ur for 5 cycles 70 Ur 30 96 dip in Ur for 25 cycles lt 5 U gt 95 dip in Ur for 5 sec 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV common mode lt 5 U gt 95 dip in UF for 0 5 cycle 40 Ut 60 dip in Ur for 5 cycles 70 96 Ur 30 96 dip in Ur for 25 cycles lt 5 U gt 95 dip in UF for 5 sec Ur is the AC mains voltage prior to application of the test level Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 96 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hos
78. llary line on the same horizontal level as V5 V4 C At the left midaxillary line on the same horizontal level as V4 V6 C and V5 RA On the right below the clavicle or above the crista scapulae R Right just above the spina iliaca superior posterior or the crista iliaca L l LL Left just above the spina iliaca superior posterior or the crista iliaca N F On the left below the clavicle or above the crista scapulae 2 2 2 Select or create a new patient See the Welch Allyn CardioPerfect Workstation user manual for detailed information on selecting or creating a new patient 2 2 3 Create a new exercise ECG Before you can record an exercise ECG you first need to create a new ECG in Welch Allyn CardioPerfect When you do this you will be able to set the target heart rate and the exercise blood pressure and print protocols You can also identify the physicians associated with the test and enter a variety of test data and information DIR 80012335 Ver F 16 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual To create a new ECG 1 Inthe File menu point to New and click Exercise ECG The New exercise ECG dialog box is displayed Click on the General tab xi lt CCNV 001 Stella Jongmans General Test Information Test Observations Interpretation Test Age Pred Max HR Target heartrate Target workload 35 years 185 bpm 35 z 157 Referring physician
79. lood pressure devices can be controlled by the Welch Allyn CardioPerfect Workstation If a device is being used that is not controlled by the Workstation 1 Measure the blood pressure Jn 2 Click the Blood pressure button P 4 esvs The Blood pressure dialog box is displayed Enter a new blood pressure E p m DK Cancel 3 Ifa blood pressure protocol is used the dialog box appears automatically so that you know a measurement should be performed Enter the blood pressure values If a device is being used that is controlled by the workstation 1 Ameasurement is started automatically according to the protocol if selected or by pressing the blood pressure button 2 he values are automatically stored with the test 2 3 89 Capture an event Welch Allyn CardioPerfect Exercise ECG can automatically recognize a number of arrhythmias The arrhythmias that can be detected are e Ventricular fibrillation e Ventricular tachycardia DIR 80012335 Ver F 21 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Bigemini Triplet PVC run Couplet Arrest When Welch Allyn CardioPerfect Exercise ECG detects an arrhythmia an event is created that displays the time of occurrence and a description of the arrhythmia The event is displayed in the event list see 7 2 for more information on configuring which events will be displayed or printed You can also capture events yourself When you do t
80. losure you cannot use the 2x6 or 4x3 view or the 2x6 or 4x3 report formats any longer DIR 80012335 Ver F 42 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual To delete some or all leads from the full disclosure 1 Inthe Tools menu click Full disclosure clean up Full Disclosure Cleanup x amp Remove leads from the full disclosure Remove C Delete all leads Delete specific leads Keep Delete l avF DK Cancel Help 2 Inthe Full disclosure cleanup window select whether you want to delete all leads or specific leads 3 If you selected specific leads click on the lead that you want to delete and use the arrow button to move that lead to the right hand column 4 Click OK DIR 80012335 Ver F 43 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 5 Printing an exercise ECG This section holds a brief outline on printing an exercise ECG for a more elaborate description on printing with the Welch Allyn CardioPerfect software please refer to the Workstation manual 5 1 Print an exercise ECG You can make a printout of each view in the exercise ECG Making a printout Print Ctrl P Print Preview Print selected Formats CEri AlE P Click on the Print button in the toolbar or select Print from the File menu Copie Number of copies m W Collate m Page rang All pages Curent page
81. mats area 7 3 1 Set selected formats This selection defines which report formats will be printed after recording or when you click the Print selected formats button To print a view of an ECG you need to select its corresponding format in the ECG settings To set the printing options 1 Inthe File menu click Settings The Settings dialog box is displayed 2 Click Exercise ECG and click on the Printing tab 3 Inthe Printing tab a To enable automatic printing click Print after recording b To select formats in which the ECG should be printed select one or more default report templates 4 Click OK to save your changes 7 4 Exercise ECG settings Monitor tab Use the Monitor tab to configure recording settings The Monitor tab contains the following options Predefined comments Here you can define pre entered comments that can be used during the recording of the ECG They become available in the Comment window Use event dispatcher for external applications Use this option to start the event dispatcher during monitoring The event dispatcher can be used to interface to an external application such as a gas exchange system This can only be done if that application uses a compatible interface DIR 80012335 Ver F 52 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 7 5 Exercise ECG settings Devices tab Use the Devices tab to select and configure the exercise devices Important In ord
82. medical devices cellular products information technology equipment and radio television transmission To reduce EMC interference the cardiograph shall be separated from the emitting source as much as possible If assistance is needed call your local Welch Allyn service representative Artifact on the ECG caused by electromagnetic interference should be evaluated by a physician or physician authorized personnel to determine if it will negatively impact patient diagnosis or treatment Like all electronic devices this cardiograph is susceptible to electrostatic discharge ESD Electrostatic discharge typically occurs when electrostatic energy is transferred to the patient the electrodes or the cardiograph ESD may result in ECG artifact that may appear as narrow spikes on the cardiograph display or on the printed report When ESD occurs the cardiograph s ECG interpretation may be inconsistent with the physician s interpretation Welch Allyn assumes no liability for failures resulting from RF interference between Welch Allyn medical electronics and any radio frequency generating equipment when these levels exceed those established by applicable standards DIR 80012335 Ver F 69 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Patient and Operational Safety The cardiograph isolates all connections to the patient from electrical ground and all other conductive circuits in the cardiograph This reduces the
83. n the first display of the event and the next display of the event in seconds In the Interval start area enter the start time of the interval display DIR 80012335 Ver F 50 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Examples If you select In phase You see Blood pressure Exercise All blood pressure measurements that were entered during the Exercise phase but no blood pressure measurements that were recorded during the Pretest Recovery or Posttest phases Interval Recovery An event at 3 minutes 2180 seconds 5 minutes Start time Interval 120 with interval time added 180 seconds 120 seconds 7 Start at 180 minutes previous 120 seconds etc after the start of the Recovery phase Interval checkbox Display of selections For each event identified by a selection Welch Allyn CardioPerfect Exercise ECG creates the following displays e Inthe 2x6 or 4x3 view there will be a waveform display representing the time when the event occurred e Inthe ST table view the will be a line of ST measurement data associated with the event e Inthe Averages view there will be a set of averages associated with the event 7 3 Exercise ECG settings Printing tab Use the Printing tab to configure the automatic printing settings The Printing tab contains the following options Printing during test These settings can still be changed when you create a new exercise ECG New
84. nded separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following te symbol NOTE 1 At 80 MHz and 800 MHz the higher frequency range applies NOTE2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the Welch Allyn CardioPerfect PRO Cardiograph is used exceeds the applicable RF compliance level above the Welch Allyn CardioPerfect PRO Cardiograph should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the Welch Allyn CardioPerfect PRO Cardiograph Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m DIR 80012335 Ver F 73 80 WelchAllyn CardioPerfect Workstation Exercise
85. ne number fax number and e mail address Product serial number Exact product name and version number Type of operating system Type of installation network or standalone A copy of the CCW Technical Support Form Complete description of the problem and the steps to reproduce it If applicable we would also like to have the exact error message To print the Technical support form 1 Inthe Help menu click Information 2 Click on the Registration tab 3 Click on the Support button The Welch Allyn CardioPerfect support form is now printed and saved as file MDW txt in the MDW installation directory You can fax the printout or e mail the file DIR 80012335 Ver F 64 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 10 Before installing the Exercise ECG software In this chapter you will find information about the structure of the Welch Allyn CardioPerfect Exercise ECG software 10 1 Structure The workstation consists of two elements e Hardware the recorder and the interface to the computer e Software the Exercise ECG module that runs in the Welch Allyn CardioPerfect Workstation The recorder must be connected to the computer that runs the module Software The Exercise ECG module is automatically installed with Welch Allyn CardioPerfect Workstation For instructions on how to install and configure Welch Allyn CardioPerfect Workstation please refer to the Installation and Configuration m
86. nfigure your cardiograph to operate without the baseline wander filter Regardless of the filter used the rhythm characteristics of the ECG are accurately recorded and do not affect the interpretation algorithm DIR 80012335 Ver F 36 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 3 Work with the Trends view Trends view V1 v4 Workload 4 4 500 2 2 400 chose e 300 2 2 go 1 E 4 1 4 1 1 0 A E E 02 4 6 8 101214 002 4555851051 2 14 02 4 6 8101214 02 4 6 8 101214 02 4 6 8101214 li avL v2 V5 HR VES 10 i 4 4 4 2 2 2 0 i Ur REEEE CE mS ERE 2 2 2 4 4 4 EVONA Uu i 4 0 i mee 0 2 4 6 6101214 02 4 6 6 101214 02 4 6 8101214 O02 4 6 6101214 02 46 8101214 il aVF v3 V6 BP RPP 5 5 5 5 300 Les 2 200 0 fee ee 0 fee ee 0 i 0 ae i i i i m tli Uu Uu i 0 02 4 6 8101214 02 4 6 8101214 0 2 4 6 8101214 0 2 4 6 8101214 02 46 8101214 ST 100 pv Slope x100 ps The trends view displays various trend graphs ST trends For each of the twelve leads the Trends view displays the ST trends as measured from the ST reference point together with the ST slopes You can change the ST reference point Workload graph The Workload graph shows the workload against time The workload is expressed in Watts for an ergometer test and in METS for treadmill tests Heart rate graph The Heart rate graph shows the patient s heart ra
87. ngs menu from the Default report formats list These will be the same formats that the Print Selected Formats button will print DIR 80012335 Ver F 45 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 6 Maintaining the Recorder To keep your Welch Allyn CardioPerfect Recorder in good working condition do not expose the recorder to temperatures lower than 20 C or higher than 50 C at a maximum non condensing humidity of 9096 N I Keep the PRO ECG Recorder reusable electrodes and the patient Warning cable clean Patient contact with contaminated equipment can spread infection The patient cables should be cleaned after each use and disinfected as needed N Never immerse the PRO ECG Recorder or the patient cable in Caution liquid Never autoclave or steam clean the PRO ECG Recorder or the patient cable Never pour alcohol directly on the PRO ECG Recorder or the patient cable and never soak any components in alcohol If any liquid enters the PRO ECG Recorder remove the PRO ECG Recorder from service and have it inspected by a qualified service person before using it again 6 1 Clean the PRO ECG Recorder Unless the PRO ECG Recorder the device itself rather than the cables and electrodes comes in direct contact with a patient it is acceptable to clean the device on a routine basis according to your facility s protocols and standards or local regulations Patient contact with the device might
88. nson Sarah Sassoon Cancel Help In this window you can select a specialty and then select a physician from the list You can also add a new physician To add a new physician 1 Click on the E button next to the physician in the New Exercise ECG window 2 Click on the Add button in the Select physician window 3 Select a specialty and enter the last name Specialty Cardiology Title First name Middle name Justin Last name Cave Phone number 1 Phone number 2 Fas number E Mail address Cancel Help 4 Click on the OK button 5 Click on the OK button to return to the New Exercise ECG window Note You can still add or edit the names of the physicians in review mode if the test is not confirmed yet Select Edit test from the action menu A specialty can only be added with the Admin tool DIR 80012335 Ver F 19 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 3 Real time monitor You are now ready to record the test In the Real time monitor click the Start button to start recording After the Start button is pressed it will change to a Stop test button Start i ie H4 Welch Allyn CardioPerfect Exercise ECG automatically starts the first phase and stage of the test protocol and moves automatically to the next stage ho to Recovery according to the test protocol To move to the next phase or stage manually click the button that displays the n
89. oPerfect Workstation Exercise ECG Module User Manual 2 Recording an exercise ECG 2 1 The Real time monitor The Real time monitor is displayed when you start a new exercise ECG During the test this window allows you to control and monitor all aspects of the test and review any recorded results 25mm sec Monitor Exercise oj xj Protocol Wew Action e n X W a 8 8 1 Button bar Stop test Go to Recovery Goto Hold stage Change load Perception comment Pret Evert E y stop Phase Stage HR BP 03 00 00 00 75 130 80 Exercise 4 37 of 203 120 80 10 mmm v Muscle bha v Baseline liter t Blood pressure C metgenc 80 Watt 20 Watt min 1 eno bbs d Overview area ji i O i NE NN B a moa T ST Table Co EL HIS Hr HEH EGT m Tabs IEEE ER H BS iS i Eg i AI ECG traces Tabs EE uM Trends History ST SlopeeTest Information Test observations Interpretatic 112 Loenen ST 3440 03 00 20 Watt min Out of sync 1 ECG traces The leads of the ECG You can select different lead configurations 1x12 2x6 4x3 from the shortcut menu With the shortcut menu you can also adjust the chart speed and the sensitivity Dividers The dividers in the ECG traces area can be switched on or off from the shortcut menu
90. oints in a test for example all blood pressure measurements that were made during the Exercise phase A selection of points at specific times during the test To create a selection of events for printing or viewing 1 2 f In the Exercise ECG settings click on the Viewing tab In the Selection area click the Configure button The Configure selections dialog box is displayed In the Configure selections dialog box click the Add button The Edit selection dialog is displayed Enter a name for the selection IIT Few 54 aem had Pie onm agree oT T Masa o d Pw mn i e Lecce Portes re wa Cae ee Pd In the Global events area select the events that you want to include in your selection In the Events per phase type area select the events from the phase that you want to include in your selection You can use both events from the Global events area and the Events per phase type area in one selection Click OK To create a selection that shows information at fixed points of time in the recording 1 3 In the Events per phase type area select intervals for the phases that you want to include in your selection For example if you want to show information from the Exercise and Recovery phase click the Interval check box in the Exercise and Recovery column In the Interval seconds area enter the values for the intervals that you selected in the previous step the time betwee
91. pital environment If the user of the Welch Allyn CardioPerfect PRO Cardiograph requires continued operation during power mains interruptions it is recommended that the Welch Allyn CardioPerfect PRO Cardiograph be powered from an uninterruptible power supply or a battery Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment 72 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Electromagnetic Immunity The Welch Allyn CardioPerfect PRO Cardiograph is intended for use in the electromagnetic environment specified below The customer or the user of the Welch Allyn CardioPerfect PRO Cardiograph should assure that it is used in such an environment Immunity test IEC 60601 Compliance level Electromagnetic environment test level guidance Conducted RF 3 Vrms Portable and mobile RF communications IEC 61000 4 6 150 kHz to 80 MHz equipment should be used no closer to any part of the Welch Allyn CardioPerfect PRO Cardiograph including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance dal f a JVP V1 Radiated RF 3 V m IEC 61000 4 3 80 MHz to 1 GHz 80 to 800 MHz a P E1 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W and d is the recomme
92. protocol 10 watt min 25 Watts min Asperen C Constant pulse rati Blood pressure New BP protocol Printer New protocol 1 Bruce 2 180 1 Bruce 3 180 1 Bruce 4 180 1 1 1 1 Bruce 5 180 Bruce 6 180 Bruce 7 Forever T CD C WM Maximum speed Maximum elevation 25 Protocol list The left hand pane of the Protocol editor window contains a list with all existing protocols These protocols are divided into treadmill protocols ergometer protocols blood pressure protocols and printer protocols Protocol workspace The right hand pane of the Protocol editor window is where you add edit and delete stages The workspace is divided into four tabs that represent the four phases in a protocol pre test exercise recovery and post test For each phase you can create a number of stages Menu bar Here you find functionality to import and export protocols and to consult the help file DIR 80012335 Ver F 60 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 8 5 Working with protocols 8 5 1 Create a new protocol The procedure for creating a new protocol is the same for treadmill ergometer blood pressure and printer protocols After you create a new protocol continue with defining the stages for that protocol To create a new protocol 1 Select the Protocol editor from the Tools menu 2 Inthe left pane of the protocol editor first left click on the typ
93. r then no DTS calculation DIR 80012335 Ver F 77 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 1 Mark DB Hlatky MA Harrell FE Jr Lee KL Califf RM Pryor DB Exercise treadmill score for predicting prognosis in coronary artery disease Ann Intern Med 1987 106 793 800 2 Mark DB Shaw L Harrell FE Jr et al Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease N Engl J Med 1991 325 849 53 3 Gibbons Pu et al ACC AHA 2002 Guideline Update for Exercise Testing American College of Cardiology Foundation and the American Heart Association 2002 15 2 Mets Value The METS value is interpolated It gradually changes and attains the value predicted by the load to METS formula after the load change occurs on your stress device 2 minutes on a treadmill 40 seconds on an ergometer DIR 80012335 Ver F 78 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Index Zo RR E REDE 11 29 30 36 48 mill RECENTES 2 45 AS NOCTEM 29 30 36 47 mii MR ROREM 2 45 Action menu 19 22 24 30 33 35 Add comment eee 22 Arrhythmia 8 12 34 35 48 Automatic Blood pressure 5 58 59 Printing 45 50 51 57 58 Average complex 11 14 29 34 45 View een 32 33 37 47 50 za RR TRmu
94. re you can use two filters e Baseline filter e Muscle filter Both filter options can be found in the Action menu Select the appropriate filter to enable it The filter option will be marked with a check To disable the filter simply select it again Note When you enable a filter from the Action menu it will also affect the 2x6 and 4x3 view Note You can tell which filters are enabled in the portion of the full disclosure 2x6 and 4x3 views by looking at the frequency response displayed If the baseline filter is enabled the lower frequency will be 0 5Hz If the muscle filter is enabled the upper frequency will be either 25 or 35 Hz depending on the settings If accurate ST segment contours are required for ECGs do not use the 0 5 Hz baseline wander filter This filter suppresses baseline wander to the extent that it may alter the ST segment Instead configure your cardiograph to operate without the baseline wander filter DIR 80012335 Ver F 35 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Regardless of the filter used the rhythm characteristics of the ECG are accurately recorded and do not affect the interpretation algorithm 3 6 Work with the 2x6 4x3 and Rhythm views 2x6 view The 2x6 view displays the 12 leads in two columns and six rows This is a convenient format for comparing leads at specific points in the test such as the end of stages the point where the maximum ST level th
95. require immediate cleaning The following agents are compatible with the PRO ECG Recorder e 70 percent isopropyl alcohol e 10 percent chlorine bleach solution N i When cleaning the device avoid using cloths or solutions that Caution include quaternary ammonium compounds ammonium chlorides or glutaraldehyde based disinfectants 6 2 Cleaning the Patient cables and PC interface cables When you use electrodes that need electrode gel make sure that the cables and the non disposable electrodes are cleaned regularly Otherwise the gel may build up on the wires Clean the cables 1 Slightly dampen a soft clean cloth with lukewarm soapy water or a neutral cleaner and clean the patient cable PC USB interface cable plugs and power cord 2 Dry all cables with a clean soft cloth or paper towel 3 Wait at least 10 minutes before powering on the PRO ECG Recorder again DIR 80012335 Ver F 46 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Disinfect the cables When disinfection is required use chemical disinfectants containing ethanol 70 80 propanol 70 80 or aldehydes 296 496 Disinfect according to your facility s protocols and standards or local regulations N Do not use these agents for routine cleaning of the cables Alcohol Caution can cause the plastic to become brittle and may cause the cable to fail prematurely Inspecting the equipment Perform the following inspections
96. rt 2 is a digital signal 5V amplitude with a duration of 120ms It is triggered by the rising edge of the R wave This can by used to interface to devices for R wave triggering The delay between R wave peak and TTL output pulse is typically between 30 and 50 ms It is the responsibility of the user to ensure the compatibility of the output with their device and its intended use This output is not suitable for cardioversion synchronization N wannina P y DIR 80012335 Ver F 66 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Note Cables which connect to the Pro Link must be terminated in a mini phone 3 5 mm stereo plug The interfacing cables must follow the connection convention summarized by the following pin assignment diagram bL No Connection Reference Signal Connector pin assignment N C The TTL and Analog connections are not intended to be used with aution audio IT equipment DIR 80012335 Ver F 67 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 12 Safety and precautions 12 1 Conventions WARNING Warning statements describe conditions or actions that can result in personal injury or loss of life CAUTION Caution statements describe conditions or actions that can result in damage to the equipment or software NOTE Notes contain additional information on cardiograph usage Attention Caution Warning Danger Importan
97. rwrite the old file or select cancel and add a new name 5 Select Yes to change your default summary report to the generated template Select No to leave the settings as previous The generated template will be available for subsequent use 6 Click the Finish button DIR 80012335 Ver F 56 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual The window will close and the now available information in the summary report will be shown in the checkboxes Editing existing templates It is possible to edit an existing template a htm file by hand by using Notepad or a html editor For more information see the section on customizing txt files in the Workstation manual Note Do not overwrite the built in default summary file xecg summary std htm as this file may be overwritten when updating the software DIR 80012335 Ver F 57 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 8 Customize exercise protocols 8 1 Protocols phases and stages A protocol is a set of predefined rules and conventions of how a test is structured With the Protocol editor you can create protocols for e The structure of a treadmill test e The structure of an ergometer test e The points in time at which the blood pressure is automatically measured or the points in time when a Blood Pressure prompt will appear e he points in time at which a copy of the test is automatically printed The pro
98. s Markers can only be displayed in the Averages tab Welch Allyn CardioPerfect Exercise ECG shows markers at the following points e Q QRS onset e J QRS end e J X ST measurement point To display markers e Inthe Averages view click with your right mouse button and select Markers Click once more to hide the markers again Tips for displaying markers e You can change the color of the markers in the exercise ECG settings 3 4 3 Make measurements In each view that displays leads or complexes you can make measurements between two points To make a measurement between two points 1 Move the crosshair pointer to the starting point of your measurement 2 Double click on the starting point Welch Allyn CardioPerfect Exercise ECG inserts a mark 3 Move the crosshair pointer to the end point of your measurement 4 Double click on the end point Welch Allyn CardioPerfect Exercise ECG draws a line between the two points and displays the measured values You can remove these measurements by selecting Refresh from the Action menu or pressing Ctrl R 3 4 4 Set reference complex In the Averages view you can set a reference complex that can be used for comparison To select a reference complex e Select a phase from the Reference complex list If you do not want to see a reference complex select None The reference complex is displayed in the Averages view as a red curve 3 4 5 Compare averages with full disclosure data
99. stage 1 Select the protocol and phase to which you want to add the stage 2 Right click in the right pane of the Protocol editor 3 Inthe shortcut menu click New The Edit stage dialog box is displayed 4 Enter a name for the stage 5 Enter the duration of the stage in seconds If you select Never expires the stage will continue for an indefinite number of seconds 6 Enter the number of times the stage should be repeated If you select Loop forever the stage will be repeated for an indefinite number of times Note Itis not possible to add a new stage after a forever looping stage 7 Forthe Treadmill and Ergometer stage you can now enter either a value or an expression for Stage for Adjustable items Treadmill Speed Km h or mph Elevation Workload Watt 8 6 2 Edit a stage When you want to change an existing stage you can use the edit function to make those changes To edit a stage 1 Right click on the stage and click Edit in the shortcut menu The Edit stage dialog box is displayed 2 Editthe information 8 6 3 Delete a stage When you no longer use a stage you can delete it To delete a stage e Right click on the stage and click Delete in the shortcut menu DIR 80012335 Ver F 62 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 9 Troubleshooting 9 1 Test recovery Recover a test after a computer crash When a recording is not finished properly for
100. t Note Refer to Accompanying Documentation Ingress Protection Not protected against the ingress of water Serial Number Product Identifier Defibrillation Proof Type CF applied part Manufacture Date YYYY MM DD CE Mark for Class Is Im lla Ilb amp IIl Temperature Range DIR 80012335 Ver F 68 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual Do not dispose of in trash for devices Consult operating instructions directions for use DFU A copy of the DFU is available on this website A printed copy of the DFU can be ordered from Welch Allyn for delivery within 7 calendar days Global Trade Item Number Electromagnetic Compatibility When using the CardioPerfect PRO cardiograph electromagnetic compatibility with surrounding devices should be considered and evaluated The CardioPerfect PRO cardiograph complies with IEC 60601 1 2 limits for EMC 12 2 General Safety and Precautions tips Radio Frequency RF interference between the cardiograph and any existing RF transmitting or receiving equipment at the Caution installation site including electrosurgical equipment in close proximity to the cardiograph should be evaluated before the equipment is operated as they may seriously degrade performance The CardioPerfect Cardiograph is susceptible to interference from RF energy sources lowered RF immunity which exceed the IEC 60601 1 2 limits such as power line bursts other
101. t heart rate as a percentage of the maximum predicted heart rate e VES the number of VES beats Ventricular Extra systole per minute e The current blood pressure and previous blood pressure are displayed e The current workload and the current workload as a percentage of the maximum workload The maximum workload is calculated based on the last valid stage By default the minimum stage duration is 30 seconds e he RPM is displayed when an ergometer is used e The protocol that you selected at the start of the test The following variables can be set e Speed mm sec and sensitivity mm mV e Pacemaker on off ECG traces can contain artificial pacemaker signal indicators You can remove this artificial pacer indicator by disabling the Show Pacer selection To learn how see Exercise ECG settings General tab on page 48 e Baseline filter on off ECG traces can contain some baseline wander caused by movement You can reduce this wander of the baseline by applying a baseline filter e Muscle filter on off Muscle noise in an ECG signal hides low amplitude signals that may be important for the interpretation of an ECG You can remove this noise with a muscle noise filter After switching to the recovery phase the total exercise time the maximum heart rate the maximum workload the protocol name and the current METS values are displayed Tabs below the ECG traces Trends tab The Trends tab contains the event list and thre
102. te against time From the shortcut menu you can also select to display the VES trend in the Heart rate graph Blood pressure The blood pressure graph shows the patient s blood pressure graph against time From the shortcut menu you can also select to display the RPP in the Blood pressure graph 3 1 Seta different ST reference point You can change the reference point for the ST calculation both during recording and viewing The values for the ST reference point can be e J 0 J 20 J 40 J 60 J 80 J Dynamic J 1 16 R R To set a different ST reference point e Inthe View menu point to ST Reference Point and select a value e You can also change the QRS end J marker yourself in the Average complex view See page 34 DIR 80012335 Ver F 37 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 3 7 2 Display ST slopes Welch Allyn CardioPerfect Exercise ECG not only measures ST levels but can also calculate the value of ST slopes The ST slope value gives additional qualitative information about your ST level measurements The ST slope is calculated as follows ST at J 60 ST at J 40 20 msec To display slopes e Click with your right mouse button on the view to display the shortcut menu Click Slopes to display the slopes Click once more to hide the slopes 3 8 Work with the ST table view ST table view Selection None m Time Stage Workload HR BP RPP PQ QRS Il TUN a
103. test For each stage in a treadmill protocol you need to specify the name duration repetition soeed and elevation The Protocol editor automatically generates a stage number Expression Variables amp Operators Please refer to the similar paragraphs in the previous description on Ergometer protocols Note The speed is always in km h To convert from mph to km h multiply the value in mph with the M factor 8 3 Blood pressure and Printer protocols Blood pressure protocols A blood pressure protocol can be used to automatically take blood pressure measurements during the exercise test For each stage in a blood pressure protocol you need to specify the name duration and repetition The Protocol editor automatically generates a stage number Printer protocols A printer protocol can be used to automatically print copies during the test For each stage in a printer protocol you need to specify the name duration and repetition The Protocol editor automatically generates a stage number 8 3 1 Blood pressure of printer protocol modes Both Blood pressure protocol and Printer protocol can optionally be set to follow the exercise protocol in the protocol editor window To set a Blood pressure or Printer protocol e Select a protocol or enter a new protocol see section 8 3 DIR 80012335 Ver F 59 80 Welch Allyn CardioPerfect Workstation Exercise ECG Module User Manual e Select a mode see picture Timed mode In
104. the QRS end marker according to the set value for the reference point value in the Exercise ECG settings To change the QRS onset and QRS end markers 1 In the Averages view right click on the view and select Edit from the shortcut menu The Edit average complex dialog box is displayed 2 From the list in the left hand corner select the lead you want to be displayed during editing 3 Move your mouse over the markers until the cross hair pointer changes shape 4 Click your left mouse button and keep it pressed and drag the marker to adjust Note You can select an aimer from the right click menu as a positioning aid 3 5 Work with the Full disclosure view 3 5 1 Full disclosure view The Full disclosure view displays the complete 12 lead recording This view is very convenient for reviewing any arrhythmias that may have occurred during the recording Summary Averages Full Disclosure 2x6 4x3 Trends ST table Heartrate ST HR Selection None d 1 jm an w aw ww v2 va y vs ve dE EE GER EE EE E EE EHE ED EE EE EE EE ED EE EE ED EE RED EDGE ET EE EE RED EE ED EE ED EE ED EE ER EE CER ED EE ER ERE ER ERE CERES CHEERS HERES ER EE ER EDGE ER EE ERE E E VU y QUI UU v Ed Fete RHERHERHER D C NU BH ER SF Cid Te Ge ecg FS HR E FF Og j Fu d HA tat te m E Ed SER pH gpl c m n o 1 es ER EE ER ERES E ep Uer EE ES ES Bali HU UII Ep d eeoee bee eae ES ee eee EE ERE EET ERE ER UE EE ERE ERE HE
105. tocol editor is available from the Tools menu when an Exercise ECG is displayed or when Exercise ECG is opened from the File Open menu Phases Each protocol contains four phases e Pre test this phase is normally used to allow the patient to get accustomed to the exercise device and to record reference resting ECGs e Exercise during this phase the exercise portion test takes place e Recovery during this phase the patient is allowed to recover from the test monitoring of the patient continues e Post test the phase in which any post test activity measurements take place Monitoring of the patient continues A protocol does not necessarily need to use all four phases Many protocols use only the Exercise and the Recovery phases Regardless of the phases selected every patient heartbeat is recorded from the beginning of the test until the end Stages Each phase in a protocol consists of a number of stages There is no limit as to the number of stages that make up a phase 8 2 Exercise Protocols overview All commands which allow editing or creating a protocol are available through right mouse button menus There are four kinds of protocols e Ergometer protocols e Treadmill protocols e Blood pressure protocols e Printer protocols Normally you will create the exercise device ergometer or treadmill protocol first and then ensure that the blood pressure and printer protocols are consistent with the exercise device protocol The
106. vR avL g DO 15pre 2 0 km h 0 0 62 113 42 75 25 58 8 O0 30pre 2 0 km h 0 0 63 120 75 83 8 75 25 00 45pre 2 0 km h 0 0 73 123 58 83 1 67 25 01 00pre 2 0 km h 0 0 67 113 67 75 17 b 25 01 15pre 2 0 km h 0 0 70 130 67 92 25 75 17 01 30pre 2 0 km h 0 0 61 103 42 50 D 50 17 01 45pre 2 0 km h 0 0 58 150 58 83 17 67 25 02 00pre 2 0 km h 0 0 60 103 42 50 8 50 17 00 154 1 2 7 km h 10 0 62 103 25 58 33 50 8 00 30 1 2 7 km h 10 0 74 137 67 83 17 75 25 00 454 1 2 7 km h 10 0 79 106 33 42 0 42 17 01 00 1 2 7 km h 10 0 79 116 42 50 D 50 17 01 315 1 2 7 km h 10 0 80 s CINE 42 58 8 50 17 01 304 1 2 km h 10 0 81 127 42 42 8 42 25 01 454 1 2 km h 10 0 84 116 42 58 8 50 Le 02 00 1 2 7 km h 10 0 86 113 42 58 17 50 1 02 154 1 2 km h 10 0 82 110 67 50 17 50 42 02 30 1 2 km h 10 0 8n 120 50 83 33 67 8 02 454 1 2 km h 10 0 ti 106 42 58 1 58 1 03 00 1 2 km h 10 0 8n 116 42 42 D 42 25 03154 2 4 0 km h 12 0 84 Na 25 33 D 33 1 03 30 2 4 0 km h 12 0 92 116 50 25 25 33 33 03454 2 4 0 km h 12 0 33 123 58 42 8 50 33 04 00 2 4 0 km h 12 0 35 120 42 33 8 42 25 04154 2 4 0 km h 12 0 95 114 42 25 8 33 17 04 30 2 4 0 km h 12 0 95 117 42 42 D 42 8 0445 2 4 0 km h 12 0 97 113 33 42 8 42 1 05 00x 2 4 0 km h 12 0 95 117 50 42 D 42 25 O5 15 2 4 0 km h 12 0 94 110 33 42 8 42 17 05 30 2 4 0 km h 1
107. workspace is the place where you record view compare and measure exercise ECGs 9 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual Shortcut In the workspace you can use shortcut menus to access the most common menu tasks You can access these tasks by clicking on the workspace with your right mouse button Shortcut menus only contain those tasks that can be performed in one specific test or part of that test As a result shortcut menus look different in different views Status bar The status bar shows important information about the patient and test that are currently selected Additionally the status bar displays the name of the user that is currently logged on to Welch Allyn CardioPerfect 1 2 Structure of an exercise ECG An exercise ECG consists of the following elements e Phases the distinct parts of an exercise ECG In CardioPerfect they are pretest exercise recovery and posttest e Stages the distinct parts of a phase For instance an exercise phase can have different stages with different workloads e Exercise protocol a specific set of rules and conventions that determine how the exercise ECG is performed A protocol consists of a number of phases Each phase consists of a number of stages Welch Allyn CardioPerfect Exercise ECG offers a number of well known protocols that you can use Additionally you can create your own exercise protocols DIR 80012335 Ver F 10 80 WelchAllyn Cardi
108. xercise ECG Module User Manual Depending on the type of event the following dialog will appear Dyspnea and Chest pain Perceived exertion Perception x x Event type Event type Dyspnea Perceived exertion Enter a value for this event Enter a value for this event D nothing 6 no exertion E 10 almost maximum fi 3 7 20 maximum exertion maximum ee I LI LI LI LI LI I 1 LI 1 6 8 39 10 11 12 13 14 15 16 17 18 31939 20 Cancel LUE iby UES a S02052503 7 3 fy GE th Cancel The Borg CR10 scale is used to add The Borg RPE scale is used to add Patient dyspnea and chest pain parameters to the Perceived Exertion to the test test 0 Nothing at all 6 No exertion at all 0 3 f Extremely light 0 5 Extremely weak 8 0 7 9 Very light 1 Very weak 10 15 11 Light 2 Weak 12 25 13 Somewhat hard 3 Moderate 14 4 15 Hard heavy 5 Strong 16 6 17 Very hard 7 Very strong 18 8 19 Extremely hard 9 20 Maximum exertion 10 Extremely strong Absolute maximum 2 3 5 Duke Treadmill Score The Duke Treadmill Score DTS is shown in the Summary tab if selected See page 55 for more information on selecting the DTS and section 15 for more information on the DTS calculation Note The Duke Score is not applicable for pharmacological stress testing it is only applicable if the selected exercise device is physically used The Duke Scor
109. y scores eliminate physician bias and lessen the variability of decision making The Duke Treadmill Score is calculated as follows DTS Exercise timeji 5 ST segment deviationnm 4 Exercise angina index Angina index has a value of 0 for no exercise angina 1 for non limiting angina 2 for exercise limiting angina The Exercise time is originally measured in minutes of the Bruce protocol which can be derived from attained metabolic equivalent The resulting more universal version of this score translates the exercise duration which assumes the Bruce protocol from maximum attained METs making it applicable for any exercise protocol or device type for which METs can be calculated or measured Risk stratification based on the Duke score is estimated as Score Risk gt 5 Low risk 10 lt Score lt 5 Medium risk lt 10 High risk The Duke Treadmill Score DTS is shown in the Summary tab if selected in the Summary template under Test results See page 55 for more information Note The Duke Score is not applicable for pharmacological stress testing it is only applicable if the selected exercise device is physically used The Duke Score is not calculated if the Test type is not Exercise Input variables Symptoms during test used in determining Angina Index Reason for terminating test used in determining Angina Index Stess Test type if not a standard Exercise test i e Pharmacological or othe
110. you to switch off the recorder If a PRO Recorder with USB connection is used the recorder will be switched off automatically no message appears Welch Allyn CardioPerfect Exercise ECG automatically saves the exercise ECG and displays it on your monitor 10 Disconnect the patient Important n case of an emergency the test can be stopped with the Emergency Stop button Welch Allyn CardioPerfect will then continue monitoring the patient but all connected exercise devices will be stopped immediately Printouts can still be made and the operator can still enter comment and user events when the Emergency Stop is engaged All other functions are disabled Click the Stop button to stop monitoring the patient Welch Allyn CardioPerfect Exercise ECG automatically saves the exercise ECG and displays it on your monitor DIR 80012335 Ver F 15 80 WelchAllyn CardioPerfect Workstation Exercise ECG Module User Manual 2 2 1 Place electrodes on the patient When you connect the electrodes to the patient make sure that the electrodes and their connectors also the RL N electrode do not contact other conducting parts including earth Connect the electrodes in the following positions Fourth intercostal space at the right border of the sternum Fourth intercostal space at the left border of the sternum Midway between locations V2 and V4 At the left mid clavicular line in the fifth intercostal space C4 5 6 4 At the left anterior axi

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