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Norav Users Guide

1. Export to Rest File gt Export to Rest A 10 sec segment containing original leads LILV1 V6 and calculated leads HI aVR aVL aVF is transferred into Rest format up to 12 leads 10 sec Calculated leads are performed only if I and II are acquired Export to File gt Export A 10 sec segment containing acquired leads is MATLAB to MATLAB transferred into MATLAB format Import from File gt Import Long term high resolution ECG recorded on ISHNE from ISHNE Holter can be transferred into a monitoring study Plot in real Sj Real time printing on a thermal printer Can print time continuously while monitoring up to 8 leads Set change View gt Patient he patient data til dara Displays patient demographic information Allows the user to enter free text during or after gt Alla VIEN the ECG recording This is printed and saved g p remarks Remarks lt together with ECG traces Set preferences Pe Allows the user to tailor operation preferences Software version number Quote this for any software inquiry Also shows memory size and 19 d phy 2 Help gt free disk space The HASP ID number is the ID information About of existing software keys This ID number is used for adding software options Norav Medical Monitoring 97 Or use 3 Click this Or select this ware To do this this Description i short cut menu icon
2. 1 Click the Print ECG button on the toolbar or select Print ECG from the file menu 3 Select the beats and leads to print from the dialog box and click OK 4 Select the printer from the print dialog box 5 Click OK to close the dialog and print the ECG HRV Setup 1 Click the HRV icon The HRV window is displayed 1 Click the Setup icon hammer The following folders are displayed Tab Option Description Sample E f Be Leads Choose leads and sampling rate Select up to four neighboring leads for a calculations Selection aoe a Filters Set filters as active Recording Define the test duration either by target number of beats or by the ECG Test Duration recording time Select the preferred parameter and define the value for the test duration Set the Preferred saving options To save test automatically at the end of the test check the Auto Save option When this option is cleared the test is saved only on demand Save Options Define the saving format either as No ECG Data or Full Disclosure Define the file naming convention of the saved files either by Patient Last Name or ID Use ECG Select this option to connect to the default ECG database When this option Database is checked the ECG tests are saved in the database Define a directory for saved ECG recordings if ECG database is not used Data Directory Use a secondary hard disk if one is available When cleared default
3. El Ctrl S File gt Save Saves recording to disk default file name REST recording Send data via tal File gt Send Sends recording data via email if present on the email computer Print results 5 F6 File gt Print Prints the active study File gt GDT BDT This file always contains the last patient data Import Format demographic For details data from HIS see Import to PC ECG from GDT BDT page 125 File gt GDT BDT Format Export the CO TBT rn This file always contains the last patient data from PC ECG er ee SEP to HIS Test in GDT BDT page 125 Adds this data to the recording It is printed together Sen change View gt with the ECG traces If the recording is saved then the patient data Patient Data PATIENT DATA is saved together with the ECG traces Use the Previous option if the same patient undergoes a second study Norav Medical Late Potential Signal Averaging 87 Move the On and Off Allows the user to move the ON OFF markets Gik this Or select BE To do this this E Description short cut this menu icon key Aer Me Remarks ng It is printed and saved together w e RT i z Ser preferences gt Cirl T View Display s the setup dialog box and allows the user to Setup tailor operation preferences To del Help gt Displays software version number which should be 5 2 quoted on any inquiry regarding the softwa
4. To do this this chie Or calec iie Description shott menu icon cut key File gt Save Save theses as BOG pa Saves ECG test as a JPG image an image Picture Format E Je gt Pri Pri en Mile Br 5 Prints results as a mini card that can be carried in the printout of Average Mini pocket or wallet results Card Printres its amp E6 File gt Print Prints the recordings currently shown on the scteen Note that the 1 mV signal is always printed File gt PDF HUS Nasa ed aa Report for 10 Create PDF file of 10 sec ECG 10 sec ECG sec ECG ile gt PDF Report of ee a Create PDF file of the entire ECG up to 60 sec If the Entire ECG entire ECG ECG is longer than 10 sec Allows the user to set preferences for Leads ECG Recording Diagnosis View Installation Environment Set preferences PR View gt Setup Picture Format GDT BDT Format and Text File For details see Table 5 page 48 Change a an Opens a dialog with list of supervising physicians which Supervising super ie enables to select a different supervising Physician from Physician Physician the list Display Displays software version number which should be program quoted on any software inquiry software key and Hardware and R Help gt About permissions Norav contact information memory size and free disk space HASP ID number ID of existing contact software keys This ID number is used for adding information software options Print patient d
5. medical ce 0473 11 Norav Users Guide Norav Users Guide For Models S M HR W and Blue ECG software versions 5 34 Copyright O Norav November 10 All rights reserved Document Number NV 54 PCECG1200 No part of this publication may be reproduced in any material form including photocopying or storing it in any medium by electronic means whether or not transiently or incidentally to some other use of this publication without the prior written permission of the copyright owner or under the terms of a license issued by the copyright owner The information contained in this document is subject to change without notice Norav is neither responsible for nor liable to anyone in connection with this document Contact Information Norav Medical Kreuzberger Ring 23 65205 Wiesbaden Germany Tel 49 611 7788345 Fax 49 611 7788330 Email support norav com Standards Compliance The interference generated by the device was tested according to the EMC 89 336 EEC and found compliant with the standard The software complies with Standards for Analysis of Ventricular Late Potentials Using High Resolution or Signal Averaged Electrocardiography published in 1991 by the Task Force Committee of the European Society of Cardiology the American Heart Association and the American College of Cardiology The PC ECG conforms to MDD 93 42 EEC Annex V EC11 and EN 60601 2 MDD authorized representative in Europe is
6. ECG recording is performed from the PC ECG unit Simulator ECG When checked the ECG recording is performed from the demo file included in the software package In this case the recording unit is not needed View Change default colors for ECG and for graphs NV 54 PCECG1200 102 Norav Users Guide Tab Option Desctiption Restore BE Defaults Restores factory default color definitions for ECG display and graphs Installation Saves hospital and physician data This data is included in print out and mail Measurement Define whether measurements will be calculated according to the metric or Standard USA standard The default is metric Magnetic Card Select this option to use a magnetic card with bar code to insert patient Reader details Select the magnetic card type Select the option button COM port USB to choose the port for device connection 2 If the COM port option is selected select the serial input for the PC ECG Environment Connection unit from the COM port list The option is disabled if the USB connection is selected Default at installation is USB Choose between 14 15 inch screen default and 17 inch screen This setting Display Size N vg is required to display the ECG and grid in correct scale When set to On prints 1mm and 5 mm squares on printouts ar Papet Regular Grid works with any printer Print options d Improved Grid shows a fine grid b
7. Fatigue Conclusions Normal blood pressure Norav Medical Interfacing with Information Systems 125 GDT BDT Type Communication PC ECG and HIS Hospital Information System Maintain Bi Directional GDT BDT Type Communication ds Import demographic data from HIS to PC ECG a b C d In setup select GDT BDT Check Import from GDT BDT Define the GDT BDT directory in which the HIS file will be ready Define the first four characters of the Token for PC ECG file This file always contains the last patient data Export the GDT BDT file from PC ECG to HIS a b C d In setup select GDT BDT Check Save Test in GDT BDT Define the GDT BDT directory in which PC ECG file will be ready It can be the same as in 1 Define the first four characters of the Token for Practice EDP file This file always contains the last patient data NV 54 PCECG1200 126 Norav Users Guide DICOM Communication The Norav PC ECG 1200 is enabled for following DICOM operations a Receive ECG orders using DICOM Modality Work list MWL b Store study reports as Encapsulated PDF files c Store Resting ECG study as 12 Lead ECG Waveform Interaction with DICOM occurs through mediation of NoravScheduler executable that exists in main PCECG folder Receive ECG orders from DICOM MWL To enable the MWL functionality a Start NoravScheduler application b On Patient List section o
8. Favironinient isa If the COM port option is selected select the serial input for the PC ECG unit from the COM port selection list If the USB Bluetooth connection is selected the COM PC ECG selection list is disabled Default at installation is USB Choose between 14 15 inch 17 inch default 19 inch W22 inch screen Display Size or custom screen X Y settings This setting is required in order to display the ECG and grid in the correct scale If set to On prints 1mm and 5 mm squares on printouts Graph paper Regular Grid is guaranteed to fit any printer Improved Grid shows a fine grid but may not work on some printers Paper Size Sets paper size either conventional printer or 4 inch thermal printer Picture Format Large Remarks Font Color Printout Shadow Frame For Area of Interest AutoSave ECG in Picture Format Set File Name By Picture Format Picture File Type Enables large font for user entered free text Select this option for colored printouts Allows the user to choose between shadow and frame to highlight the interest area Select this option to save the test automatically as a JPG image Set the file names to include Patient Last Name or Patient ID Check date and or hour to include them in the file name Select the resolution of the picture normal or high resolution Select picture JPG TIF Both as file type for picture Norav Medical Resting ECG 47
9. Numerical results NV 54 PCECG1200 82 Norav Users Guide Quick Start To Start a New Test 1 Click F1 or the New button on the tool bar 1 Insert patient details in the dialog box 2 Click OK 3 Click F3 or F4 to start the LP averaging test 4 Enter the interval name and or remarks as appropriate in the dialog box and click OK 5 Click F3 or F4 or Start Stop Averaging button to stop the LP averaging test or wait until it terminates To Print 1 Click F6 or select Print item from the File menu 1 Select the printer from the Print dialog box 2 Click OK to close the dialog box and print the display the LP averaging report or the ECG test Norav Medical Late Potential Signal Averaging 83 Operation with Function Keys F1 New recording F3 F4 Start stop F6 Print F11 Open saved study Table 16 LP Signal Averaging Function Keys For an example of a printed report see Appendix C page 132 Leads Recording is performed for leads X Y and Z orthogonal using the regular 12 lead cable Arrange the leads as follows 12 Lead Orthogonal Lead position V2 X left side of the chest v1 X right side of the chest V4 Y lower side of the chest V3 Y upper side of the chest V6 Z middle of the chest V5 Z middle of the back RA LA LL RL Same position as in 12 leads Table 17 LP Signal Averaging Leads Placement NV 5
10. Tab GDT BDT Format Text File FDA XML SCP Mckesson DICOM Option Picture Directory Automatic Save test in GDT BDT Import from GDT BDT File Format Import Codepage 437 Export Codepage 437 Edit Labels GDT BDT Data Directory Token for PCECG Token for Practice EDP Auto Save Test Data in Text file Set Text file Name by Text File Data Directory FDA XML format Auto Save in FDA XML format Annotations for leads File Data directory Parameters SCP format Description Set the directory for saved pictures The default is C Program Files PCECG Data Setup automatic GDT BDT format If checked save test automatically to GDT BDT format If checked imports tests automatically as GDT BDT format Select the file format GDT or BDT Check this option to import Code page 437 Check this option to export Code page 437 Click this button to open a dialog box with an editable list of the field labels used in the GDT and BDT files Define the directory path where the GDT BDT files should be maintained Default is PEKG Default is EDV1 Select this option to save the test data in a text file automatically at the end of the rest test Set the text file name according to Test File Name or according to the fields Patient ID and or Patient Last Name Set the directory path to maintain the text files with
11. e To use one formula for speed up to 3 7 m h and a second formula above that speed set the option Two formulas Up to and from 3 7 m h METS VO2 Updating Select the method for updating the METS VO2 values Method The values can e remain constant through the entire stage e switch to the current METS value 1 or 2 minutes after the stage begun e have values vary during the stage at every quarter of the stage time ST VPB Options ST Measurements After J Choose the number of milliseconds after the J point at which the ST is measured The factory set up is 60 Ms Detect ST Event Define the mm level for elevation and depression This option also allows the user to save only deteriorated ST episodes Worst case ST Report Select ST Elevation ST Depression or both to be reported as Worst case ST Arrhythmia Detection Select VPB or SVPB event to be detected and stored Check Store one event per stage only option or clear this option if you wish all selected event type to be stored Real Time Printing Set the events to print including ST VPB SVPB Any checked event will be printed Cleared events will not be printed 9 events Show Dialog Check events to display a dialog box at the beginning Clear events to prevent display of dialog box Print Page Format Check the required option for printout format Print Scale Format Select the scale for printout format ST Slo
12. key Display Hide re a EJ View gt Grid Optional display of 5mm raster Start ECG ECG gt 5 Recording F2 Start Stop Starts ECG recording Stop ECG ECG gt Recording F2 Start Stop Stops ECG recording Display 3X4 View gt Leads Classical format Displays 12 lead ECG of 2 5sec bee Ctrl 1 format gt Leads ene ECG 10sec trace Windows View gt Leads Display 12X1 en Ctrl 2 format gt All Displays 12 lead ECG of 10sec ECG Nr leads View gt Leads eee Ctrl 3 format gt Lead Displays 3 lead ECG of 10sec ECG Leads granp View gt Leads Display the g Allows the user to scroll through all leads in the next leads L er ng NES 3X1 display Set 50 60 Hz GER ECG gt Filters ON OFF for line interference filter Set filter gt 50 60 Hz OPTIONS for 50 or 60 Hz prior to operation Set EMG filter EMG ON OFF for muscle noise filter Set base me EL Ne Piles ON OFF for baseline filter on ECG data filter gt BaseLine Table 22 Monitoring Toolbar and Menus ECG data can be set up as limited amplitude or unlimited amplitude which can cause one lead data to overlap a neighboring lead NV 54 PCECG1200 Heart Rate Variability HRV 99 CHAPTER 4 HEART RATE VARIABILITY HRV This option is available with the H1 license Time and frequency domain analysis is designed for short studies in which one or more time segments are measured as in a Tilt study Measured reporte
13. liquid Maintain in a dry place Caution Use alcohol pads to clean the device of moisture and hairs Calibration No calibration is required Norav Medical Hardware Installation 27 Installing Model 1200W The PC ECG 1200W kit contains the following items gt gt gt gt Acquisition box see Figure 6 below Patient leads USB cable see Figure 7 page 28 Antenna 1200 WR receiver see Figure 8 page 30 Software CD of PC ECG 1200 installation package Software key if optional software is included NV 54 PCECG1200 Norav Users Guide Norav Medical Hardware Installation 29 To Connect Via USB Make sure the device is switched off Cautions refer to practices necessary to protect against potential damage or loss to equipment Caution 1 Connect Antenna Figure 8 Page 30 detail 4 to the connector on 1200WR Receiver Figure 8 Page 30 detail 2 2 Connect the A type connector of the USB cable Figure 7 Page 28 detail 1 to the PC 3 Connect the B type connector of the USB cable Figure 7 Page 28 detail 2 to the input of the 1200WR Receiver Figure 8 Page 30 detail 1 4 A wizard for installing new hardware driver appears Follow the instructions If working under Windows XP press Continue anyway on message regarding the digital signature each time it appears After the driver is installed make sure the green l
14. 2 Vendor MS LP LASER INK 2 Vendor MS HRV LASER INK 2 Vendor MS Database LASER INK 2 Vendor MS Stress Fast LASER 8 MS Table 2 Printers Installation Requirements Installing the Thermal Printer Use a 4 inch or 8 inch thermal printer The thermal printer driver is installed separately from the PC ECG 1200 program A thermal printer can be supplied by Norav MP200 8 inch This printer requires the purchase of a dongle with P1 license permission The MP200 driver is available on the PC ECG 1200 CD at the following path lt CD gt MP200 OEMPRINT inf Installing or Updating The PC Software mm 0 A Install the software before installing the hardware If the device is connected to the PC disconnect the device before installing the software Note The software package works under Windows XP VISTA Windows 7 OS Norav Medical Software Installation 11 To Install PC ECG 1200 1 Insert the CD in the drive The installation program starts automatically Follow the instructions on screen 0 After you have completed installation a group icon called PC ECG 1200 is added to the desktop Double click the group icon to display the following program icons mn gp Icons are displayed only for those programs for which you have purchased the license Note Icon Explanation P f 5 ich Heart Rate Variability Late Potential Signal Averaging Monitori
15. File gt Save Saves the active study recording File gt Print Print results 5 Ctrl P Report or Print Prints the active study ECG y Enables saving and viewing data if the Stress File gt er Na Recover file to application crashes Select this option in the main VE Recovery File Monitoring to Monitorin frame In the dialog box provide a name and path for format a S the file TMP To view the ECG open this file with er the Monitoring application main frame menu File gt GDT BDT Import Format demographic This file always contains the last patient data For details see data from HIS Importfrom to PC ECG GDT BDT page 125 File gt GDT BDT Export the Format GDT BDT file For details see from PC ECG Save Test in This file always contains the last patient data to HIS GDT BDT page 125 Create a text File gt Create file Text File Saves ECG data in text format View gt Set Restore default Restores the default window size of the sections in i Default i window size the window Available in realtime Window Size Set change gt patient data View gt Patient Sets or changes patient data Add view View gt Allows you type free text during or after the ECG 07 Ctrl R recording It is printed and saved together with the remarks Remarks s ECG traces i gt Change Ei had Mong Opens a dialog with a list of defined physicians to Supervising Suprvising enable to chan e the su
16. Interval Measurement A QRS detector measures the interval between any two valid beats It calculates a sliding N N average and compares each interval to it When a significant change occurs the current beat is either a premature beat as in PVC or a prolonged one which may indicate either a compensatory pause following a PVC or a missing beat A premature interval and a following prolonged interval compensatory pause timed in the range of twice the current N N interval are averaged This methodology maintains a consistent time axis in the presence of PVCs If a prolonged interval follows a normal interval but at twice the current N N interval it indicates the presence of a missing beat Accordingly the missing beat is computed as present This last event is very rare because the recording is made in rest condition and the software detects the QRS efficiently under such conditions Norav Medical Measurements Interpretation MEANS 105 CHAPTER 5 MEASUREMENTS INTERPRETATION MEANS This option is available with the 11 I2 or I3 license Measurements is not an autonomous application The Measurements application is used for calculations of QRSs and interpretation of the ECG signal The user can manually change the QRS identification parameters 10 seconds of data are calculated Add Remove Marker type eet Measurements 6798 Yonialer Yolanda 27 07 2004 17 55 58 jeje ala o IE sb mj sju ej l gt
17. Rate Var Figure 46 Norav Users Guide 136 09 PAR PIT pepa ABION 2yuajo y aye og wdq YH N bien N y LL6T TO SO sur BOJANA 7007 90 Arenuve SAWU OST ag 2180 pg EN JIS WEN 1587 gr ISW OE gt gt AU DOS AUS Late Potential Report 47 Figure Norav Medical Troubleshooting 137 APPENDIX D TROUBLESHOOTING USB Driver is not Installed Properly on Windows XP During PC ECG Installation Problem If you connect the device to the PC via the USB before installing PC ECG 1200 including the USB driver the USB driver is not installed The Windows operating system identifies new hardware and starts the hardware installation wizard If you complete the wizard the driver is not found and the hardware is defined in the Device Manager as USB device with an icon indicating that the driver is not correctly installed If the USB cable is left connected while trying to install the driver from the PC ECG1200 installation CD a message regarding Win XP signature does not appear and the driver is not installed Solution 1 Disconnect the USB cable 3 Install the PCECG software from the CD ROM During installation a message should appear about the Windows XP signature If the message does not appear during the installation of PC ECG then the driver is not installed If working under Windows XP press Continue anyway on message regarding the
18. Reset application This option will eliminate all the Measurements Te Measutements modification performed manually in the measurements To Open View gt View Measurements EEE Format gt in Table Measurements Displays the measurements in a table format Format table To Display View gt View QRS Averages Ja Displays the QRS averages on screen To Display View gt View QRSs in All the IR Format gt Displays the QRSs in all the channels on screen Channels z QRS m View gt View Display Caliper NE Format gt Displays the Caliper Caliper View gt View Display the Lets you scroll through all leads in the 3X1 Next Leads Sr u on display Display Hide the Grid Hi View gt Grid Optional display of 5mm raster Norav Medical Measurements Interpretation MEANS 113 Or use Elk this Or select this o To do this this Description short cut menu icon key Displays software version number Quote this for any software inquiry Also shows memory size 19 Display R Hap and free disk space The HASP ID number is the Information About ID of existing software keys This ID number is used for adding software options Previous QRS View gt View Format gt Previous QRS Moves to previous QRS on the same channel View gt View Next QRS Format gt Moves to next QRS on the same channel Next QRS gt Set 50 60 Hz FR u gt ON OFF for line inter
19. Right Bottom arrows on the toolbar or drag amp drop the marker to the required position The calculations are modified accordingly Features View all calculated parameters on every QRS on every channel and average calculations in tabular format The upper table displays measurements for a channel The lower table displays measurements values for a QRS To View the Measurements on a QRS Select a QRS from the upper table and view the results on the lower table To View the Measurements on a Channel Select a channel from the lower table and view the values on the upper table To View the Measurements on All Channels for QT Click gt between the two tables to view measurements for All Leads for QT on the lower table Tabular Screen The Tabular screen see page 105 displays calculations of the QRS parameters in all the leads in a tabular format Original calculations or changes performed in the other screens Averages QRS or Caliper are displayed in a tabular format and can be printed out NV 54 PCECG1200 108 Norav Users Guide Averages Display 38 Measurements 6798 Yonialer Yolanda 27 07 2004 17 55 58 fy File View Help aio el mf ale ER wow 1 Se gt fammsec Jfiomav Figure 34 Measurements Averages Display The Averages screen displays the average QRS in each of the leads and the average ECG of the Strip lead Each QRS identified is
20. Stress 7 Stg Speed 1 7 6 0mph Grade 10 22 Time 21 00 Recovery 3 Stg Speed 1 5 1 5mph Grade O 0 Time 5 00 Figure 25 Change Test Protocol 3 Click the white page icon The Stress working screen and patient data entry screen are displayed Patient Data Personal ID PM er Last Name Previous First Name Birth Date Sex CF GM Weight kg 0 Tech Name Extemal Figure 26 Patient Data Entry Norav Medical Stress ECG 71 Enter patient data and click OK Monitoring of 12 leads begins After about 15 sec the average QRS is displayed Inspect the protocol label in the lower right hand corner To choose another protocol click the Change Protocol icon or select View gt Change Protocol select the requested protocol and click Change 5 Enter blood pressure for rest You can print a Rest printout using the EVENT icon _ without starting the Stress program This enables multiple Rest printouts To start the stress session click the Stress icon running man The stress time is displayed in the lower left hand corner The following options are available Define events Go to Manual Freeze Stage Advance Stage gt gt o o gt Go to Recovery phase Play Back display During a Stress test at real time a period of any 10 second period of the recorded ECG can be viewed in a separate window This option is enabled 10 seconds after beginning of the stress tes
21. a tabular format Graph Paper When set to On prints 1mm and 5 mm squares on printouts Regular Grid works with any printer Improved Grid shows a fine grid but may not work on some printers Color printout Select this option for colored printouts Blending out ST values Select this option to print results without ST values Rest Event Select Interpretation and or Measurements to display Interpretation and or Measurements on Rest stage printout GDT BDT Automatic Options Setup automatic options for saving and or importing files in Format GDT BDT format File Format Select the file format GDT or BDT Import Codepage 437 Check this option to import Code page 437 Export Codepage 437 Check this option to export Code page 437 Edit Label Click this button to open a dialog box with an editable list of the Bt tye field labels used in the GDT and BDT files GDT BDT Data Directory Define the directory path where the GDT BDT files should be maintained Token for PCECG The default is PEKG Token for Practice EDP The default is EDV1 Text File Auto Save Test Data in Text Check this option to save the test data automatically to a text file File at the end of the test according to the naming and directoty defined in this tab Set Text File Name by Define the naming convention of the text file created automatically or on demand Text File Data Directory Define the directo
22. an ECG test via the USB connection e Defibrillation protection is built in for Models W M HR S and Blue ECG e Operate the unit only at clinics and hospitals Do not use at home e Operation only by trained medical staff This device complies with Part 15 of the FCC Rules Operation is subject to the following two conditions 1 This device may not cause harmful interference and 2 This device must accept any interference received including interference that may cause undesired operation mm ya The manufacturer is not responsible for any Radio or TV interference caused by unauthorized modifications to this equipment Such modifications could void the user s authority to operate the equipment ote y ae Install hardware only after software installation Note Norav Medical Hardware Installation 19 CLASSIFICATION OF THE EQUIPMENT O According to the type of protection against electric shock INTERNALLY POWERED EQUIPMENT According to the degree of protection against electric shock TYPE CF APPLIED PART According to the degree of protection against ingress of water ORDINARY EQUIPMENT According to the degree of safety of application in the presence of a flammable anaesthetic mixture with air or with oxygen or nitrous oxide EQUIPMENT NOT SUITABLE FOR USE IN THE PRESENCE OF A FLAMMABLE ANAESTHETIC MIXTURE WITH AIR OR WITH OXYGEN OR NITROUS OXIDE According to
23. captured during the study HR Average in beat min High Frequency QRS Duration in Milliseconds from ONSET to OFFSET Displays the width of the filtered QRS containing only high frequencies A higher number indicates higher patient risk RMS LASTS 40 milli Displays the total activity for the last 40ms portion of the QRS A lower seconds in Microvolts number indicates higher patient risk DURATION UNDER 40 Shows the period in ms from offset of the QRS till the first point of 40uV Microvolts in Milliseconds activity A higher number indicates higher patient risk Quality assurance A lower number corresponds to higher result accuracy H F Noise in Mi It a as The maximum number should not exceed 1 uV Table 20 LP Signal Averaging Numerical Results The results are calculated automatically You can overrule the automatic positioning of the ONSET OFFSET markets with the direction keys NV 54 PCECG1200 Monitoring 91 CHAPTER 3 MONITORING This option is available with the M1 license This option enables long term recording and storage to disk The user decides which leads and at which sample rate to monitor on screen and save to disk During the study you can print in real time on a thermal printer Horizontal scale Vertical scale mm sec mm mV AS I ER cur Tine 09 00 00 Test Time 00 01 00 yuu it m ar t JIVI t JUAS rut ut Dd Manet Word mE Jem
24. customer Except for the express warranties stated above Norav disclaims all warranties including implied warranties of merchantability and fitness The stated express warranties are in lieu of all obligations or liabilities on the part of Norav for damages including but not limited to special indirect or consequential arising out of or in connection with the use or performance of Norav products Any action for breach of warranty shall be commenced within one 1 year of said breach or be forever barred Any repairs made to the product that are not covered by the warranty shall be billed to the customer For service or technical support contact your local supplier or Norav Medical Document History Version Date Updates Changed by 060408 06 04 2008 David 060708 06 07 08 Norav Logo David Document history RS232 controlled treadmill types 100708 10 07 2008 Stress Add Dynamic ST function David 181110 18 11 2010 Updates David 241110 24 11 2010 Updates David vi Norav Users Guide Table of Contents CHAPTER 1 INTRODUCTION 1 MANUAL ORGANIZATION ri beige im 1 DOCUMENT CONVENTIONS raskeste 1 NN O AN AN 1 FAK INT RR NE A 2 EU Seen 2 CHAPTER2 OVERVIEW ses 3 PACKAGE CONTENTS ske A Tiss do AE 3 PROGRAMS naaa 4 P EEE EGG MOD EES ai Ai it DUR 4 INDICATIONS FOR USE OF THE PC ECG 1200 erronrrnrrnvvenronrrnvrnneenrnnrrnvenneenrnnessvsenennrsnvssnsnnsnnn 5 ECG Inten
25. data in the temporary file You can convert this data into Monitoring ECG application file format as follows 1 Start the Stress ECG application 10 Click Recovery File to Monitoring Format in the File main menu The Choose files for conversion dialog box is displayed 11 Select the Windows Temp folder 12 Select strXX tmp last created temporary file and click Open 13 Select the Monitoring ECG files folder 14 Insert monitoring ECG file name according to patient ID or last name and click Save 15 Close the Stress ECG application 16 Open the Monitoting ECG files folder and double click on the last stored file The monitoring ECG application opens 17 Click the Patient main menu button and insett patient data 18 Save the updated Monitoring ECG file You can now inspect and print ECG sttip from the Monitoring ECG application Working in AutoSave Mode Without Saving Modifications If you perform modifications adds edit remarks measurements recalculations etc while in AutoSave mode but do not wish to save the modifications do the following 1 Click Setup 19 Uncheck the Auto Save option and click OK 20 Close the application or the file with the X button A dialog box is displayed requesting acknowledgement for the save 21 Click No 22 Reopen the application and the file 23 Check that the modifications were not saved 24 It is now safe to re enable the Auto Save mode if required N
26. feature automatically displays the lead with the current worst ST in the Average QRS display on the upper right hand side of the screen To enable this function 1 In Setup choose View and at the bottom in Real time Average QRS select the Dynamic Worst Case ST Go to ST VPB Options and select from amongst the 3 options in the Worst Case ST Report Press Apply and OK and you are ready to enjoy this great new tool y The Dynamic ST function is available exclusively with the S2 Advanced Stress software Note NV 54 PCECG1200 78 Norav Users Guide RS232 Controlled Treadmill Types Vendor Model Vendor s Fax Email RS232 Connector RS232 Wiring on the TM Type Norav Trackmaster TM425 1 316 283 3350 D 9 female Straight Norav Trackmaster TMX425 1 316 283 3350 D 9 female Straight GE Marquette 2000 series D 9 female RS422 M422 DIN 5 pin female Tx 5 Rx 4 GND 2 Cardiac Science TM 55 imernationalsercieu tcn D 9 female Straight QUINTON tdiacscience com Cardiac Science ST 55 en D 9 female RS422 Q422 QUINTON ralacscience com HP COSMOS All models 49 8669 864249 D 9 female Crossed Schiller Lode Lode Valiant DB9 female Crossed 110082 Woodway PPS55 MED D 9 male Crossed Technogym Treadmill C Safe protocol RAM 770 39 049 8703388 D 9 female Straight SBI Powerjog GM J 44 121 4333035 S
27. for automatic printing of the test at the end of the Rest test If more than one printer is defined in the network select the appropriate one from the list If cleared default ECG recording is done from the PC ECG unit If checked the ECG recording is done from the demo file included in the software package In this case the recording unit is not needed Enables to set a long rest test up to 60 seconds User can select to view and report 30 sec back and 30 sec ahead or 60 sec ahead Set minimum test time for any test in seconds Allows the user to define a directory for saved ECG recordings if ECG database is not used Use a secondary hard disk if one is available Norav Medical Resting ECG 45 Tab Diagnosis View Option Use ECG Database BACKUP Data directory for AutoSave mode ST after J Default Confirm Diagnosis status Print Options Draw over lead borders View calibration pulse 1 mV Leads Base line shift Separate Leads Draw Grid Open in Tile mode Horizontal Scale Vertical Scale Rest ECG color selection Restore Defaults Description Select this option to connect to the default ECG database When this option is selected checked the ECG tests are saved in the database When Auto Save option is selected this allows the user to define a local path for a backup directory The backup director
28. from File menu Select Current Stage Entire Study from the Print ECG submenu Select the printer from the print dialog box Click OK to close the dialog box and start printing To Print a Report 1 Click Print on the toolbar Select the report s to print Click OK to start printing to the default printer Or 1 Select Print Reports item from the File menu Select the repott Define the printer in the Print dialog box Click OK to start printing the repott For an example of a printed report see Appendix C page 132 Norav Medical Stress ECG 57 Leads Placement You can place the leads on the patient in various ways The usual method is to place the leads in the standard positions on the chest V1 V6 To identify the placement of the leads the channels are renamed One option for standard lead placement is V7 V9 Another is the Right chest Lead system To Define the Lead System Click Setup gt Lead Select the lead system to use the default is Standard Operation with Function Keys F1 New recording F2 Run stop pre test monitoring F3 Begin stress test F4 Stop test F5 Begin Recovery phase F6 Set Event F7 Freeze stage F8 Next stage F9 Manual control F10 Previous stage F11 Open saved study F12 Stop treadmill or ergometer in emergency Table 7 Stress Function Keys 0 gt Before using the stress test package define preferred parameters in Set
29. if unavailable TTT Diastolic BP in mmHg 999 if unavailable KKKK ST Level for most significant ECG lead in 0 01 mV 999 if unavailable LLLL ST Slope for most significant ECG lead in 0 01 mV s 999 if unavailable MMMM ST Integral for most significant ECG lead not used alvays 999 NN rightmost 2 ASCII characters of checksum expressed hexadecimal in UPPER CASE PP fixed string CR for Carriage return NV 54 PCECG1200 76 Norav Users Guide Example connect the Norav Stress ECG to CareFusion LAB 5 CPET system 1 In Norav Stress ECG setup a Advanced panel of Environment tab Insert C LAB5 DB ERGOSPIR DAT for export file name b GDT BDT tab enable the Import from GDT BDT check box insert the C LAB5 DB path for GDT BDT Data Directory insert Hell text to Token for PC ECG field 2 In CareFusion LABS CPET system setup a select Extern ECG for Oxycon Configuration Tool b perform Service Login open Settings and select Norav from the ECG Type list a in Path and program name field select the Stress EXE application executable name with full path e insert Stress in Title Use the text in ECG application field f insert C LAB5 DB in Path When ECG is not located field Oxycon Configuration Tool SEO Oxycon Mobile Simulation Gas calibration ECG Report Cardiac Output Delta Bicycle Ergo data AT AE Markers Via Sprint Filter data Heart
30. nass 11 TABLE 4 OPERATION WITH FUNCTION KEYS cccecsesscecesececeesessececeseceeseeessessseeeseeeens 42 TABLE 5 RESTING ECG SETUP OPTIONS cccccccccscsssssssecesececeeeesssseceeececeseseeessaeeeseeseeeees 48 TABLE 6 RECORDING RESTING ECG cccccccccccccsceesssssnecesececeseessnseceeesccsesessnseseeeseeseseees 52 TABLE 7 STRESS FUNCTION KEYS 1 nad odds besebeduadesndeabesaaadeue 57 TABLE 8 STRESS ECG SETUP OPTIONS c scccccsccscessessssecesececeesesssseceeecceseeessnseseeeseeseseees 66 TABLE 9 MAIN STRESS TOOLBAR AND MENUS ssssessscesececessessssecececceseeessnseseeeseeseneees 67 TABLE 10 STRESS TEST COMMANDS eshitsa na a a NR a 68 TABLE 11 AVERAGE VIEWER TOOLBAR o0oooooconcncnconononnanononcnconononnnnonononccnononnanononannncononanos 69 TABLE 12 POST PROCESSING TOOLBAR AND MENUS oocococonononononononononononononononononononononona 70 TABLE 13 TRANSFER FILE FORMAT ccccessssscesccscessessssecececccsesesssceeeecceseseesnssaeeeseeseneees 74 TABLE 14 CONTROLLED TREADMILLS ccccccccccccscessessssecesececesessssseeeeeeseccesensnsaeeeseeseneees 78 TABLE 15 CONTROLLED ERGOMETERS scsscccccsccscsssesssseceseccesesesssseceeescesesensnseseeeseeseeeees 79 TABLE 16 LP SIGNAL AVERAGING FUNCTION KEYS sssssossssrsrsrsrsrsesesrsrsrsrsrsrsrsrsrsrsrs rr rr rn rn 83 TABLE 17 LP SIGNAL AVERAGING LEADS PLACEMENT ssssssossrsrsrsrsesrsrsrsrsrsrersrsrsrsrsrs rr rn rn 83 TABLE 18 LP SIGNAL AVERAGING SETUP oervrorerree
31. operation Start stop E ECG gt Filters i EMG EMG filter gt EMG ON OFF for muscle noise filter Start stop ECG gt Filters L Pr B gt Baseline ON OFF for baseline filter Select Lead 7 HN Select the Lead system to display and report according to System the lead placement on the patient ECG Status 60 ECG gt ECG ON OFF long ECG test 60 sec or 30 30 sec according Status to the set up status Select two or more Rest tests from the Database interface and click Compare This option is only View gt available when you check Setup gt ECG Recording gt Compare Compare Use ECG Database ER Tests Click Compare again to end Compare mode and display the Rest test ECG data can be set up as limited amplitude or unlimited amplitude which can cause one lead data to overlap a neighboring lead Table 6 Recording Resting ECG Norav Medical Resting ECG 53 Using the Matlab Feature within PC ECG 1200 Record a rest study and apply the MATLAB function under the File menu A file with extension LIB is created in the default data folder The file has the following structure 10 000 bytes X 12 Leads I II HI AVR AVL AVF V1 V2 V3 V4 V5 V6 1sec 1000 bytes 500 samples Start Matlab not included in PC ECG software and perform the required operation Example of ECG Display with MATLAB 1 Open a file handle fopen c default_ patient name lib r Choose from which lead and which
32. supply It is also sensitive to electrical interference WARNING The PC ECG 1200 controls exercise machines To prevent possible injury read this page carefully prior to installing the device e A patient undergoing a test must be at a distance of at least a 1 5 meters from the computer printer and other peripherals and a 2 5 meters from the ceiling e If such conditions cannot be fulfilled the entire system needs to be connected to the A C power supply through an Isolation transformer meeting the EN60601 1 standard e Use only the original data cable power adaptor assembly e Use only the recommended battery type as instructed in the technical specifications to operate the PCECG1200W 4 AA alkaline or NIMH rechargeable or for Blue ECG 2 batteries e Do not use batteries with expired dates e Remove batteries form the unit PCECG1200W Blue ECG when it is not in use e Any treadmill used with the PC ECG 1200 must contain a manual control in order to allow the user to stop the operation of the treadmill in case of emergency e Inthe event of apparent changes in the performance of the device discontinue use immediately Do not resume use until the device is approved by the manufacturer or by a representative of the manufacturer NV 54 PCECG1200 18 Norav Users Guide e If audio is playing on the PC the ECG shows interference Do not run an audio CD on the PC while running
33. up and running quickly The software must be installed before the hardware See Software Installation page 9 and Hardware Installation page 77 Document Conventions Notes and Cautions Pay particular attention at specific points in a procedure when one of the following messages appeats Warnings call attention to possible hazards involving potential damage or injury to persons WARNING Cautions refer to practices necessary to protect against potential damage or loss to equipment Pay careful attention to instructions Caution va p Notes provide pertinent information to help obtain optimum performance from the software or signify an important step or procedure that requires special attention Note NV 54 PCECG1200 Norav Users Guide Abbreviations and Acronyms Abbreviation Meaning BP Blood pressure ECG Electrocardiogram Database Database application HRV Heart Rate Variability ID Identification LP Late Potential Long QT Syndrome Metabolic Stress Estimation Serial Number Universal Serial Bus Equipment Symbols Type BF equipment Type CF equipment Class II equipment Complies with the Medical Device Directive of the European Union Non ionizing radiation Norav Medical Overview CHAPTER 2 OVERVIEW Package Contents The PC ECG 1200 package c
34. 0 S Record ECG test during stress condition stationed on table 1200 M Record ECG test at rest condition 1200 HR Portable device to record ECG during stress condition attached to patients body Wireless RF ECG Recording test during stress and rest condition attached to 1200 W Bee patient s body Blue ECG Wireless Bluetooth ECG Recording test during rest condition attached to patient s body Norav Medical Overview 5 Indications for Use of the PC ECG 1200 ECG Intended Use ECG is intended to disclose either normal condition or patterns of arrhythmia myocardial ischemia rate abnormalities or features of prognostic value in the following cases 0 Patients with suspected cardiac abnormalities 0 Populations of patients at an age or period in which a routine baseline evaluation of ECG characteristics is desired QT Analysis is useful in the assessment of long QT syndrome LQTS In some instances LQTS can be corrected by pharmacological therapy QT analysis is also used to measure QT dispersion the difference between maximal and minimal QT values QT dispersion is a measure of the in homogeneity of ventricular repolarization The PC ECG 1200 has been tested to measure Heart Rate Variability to within 1 millisecond tolerance The clinical significance of Heart Rate Variability measures should be determined by a physician The PC ECG 1200 has been tested to measure Late Potential to a tolerance of within 1 millis
35. 10 2004 1 123213 yoel oe ke a EF monitoring f 26 10 2004 1 123213 yoel 1234 dav von lustig 1234 dear sir 1234 dsds rwerew 12345 Yahalomi Moshe 123456 larry hugiey 1313 rew gd 1313 rew123 gd 56787 longer Hugin 58800321006113 Doactviewinsertdelete test 5883216300011 Sugarelephantapplelion Doactviewinsertdenay Yonialer Yolanda 7776 yoavi Dartmore 877 lyn uti 88765 Yahalomi Aaroni 887655 Yahalomimi Aaroni 8876554 Yahalomimit Aaronimi 901 danieli Yehosua 90112 Don Yehosua ABCDEFGHIJKLMNOPO davOKLASSOREEEds von lustigasD hjjhajhaj of dF hi Ready Tests 6 NUM Figure 39 NEMS Main Screen List of patients in database or in selected group NV 54 PCECG1200 116 Norav Users Guide First Time Use When you first start NEMS application you are prompted to confirm the location of the database e Choose New if no database exists e Choose Open to work with an existing database ECGDBase1 Edb ECG DataBase Application oN Wizard Import Setup About amp E amp a s x Open New Delete Test Comp Copy Move Delete Date Time Patient 27 10 2004 0 123213 yoel Last Name 27 10 2004 0 123213 yoel itori 26 10 2004 1 123213 yoel yaron Ez 26 10 2004 1 123213 yoel REDBULL Alexis a sfdds sf haem von lustig sir rwerew ID Yahalomi Moshe larry hugiey Last Name TEN First Name rew123 lo
36. 1200 Norav Users Guide The significance of the ST segment changes must be determined by a physician Norav Medical Overview Contraindications for Use and Adverse Effects The device has no contraindications or adverse events NV 54 PCECG1200 Software Installation 9 CHAPTER 3 SOFTWARE INSTALLATION System Requirements and Prerequisites Hardware mm 0 y Stress application with real time printout is resource intensive To optimize performance we recommend that you disable Start Up programs to free system resources For instructions see Windows help Note we The PC should not be set up to work under saving power conditions Do not enable PC sleep mode standby hibernate or turning off the hard disk while running an ECG test Note PC Minimum Configuration Application CPU Speed RAM Memory Disk Space GB Number MHz MB of Free RS232 or USB Ports Rest 100 32 2 1 Monitoring Application 201 4 7 LP 450 128 2 1 HRV 450 128 2 1 Database 200 64 8 1 Stress 1000 128 20 2 en 1300 128 20 2 trigger Stress Blood pressure 1500 128 20 3 monitor Table 1 Minimum Computer Configuration NV 54 PCECG1200 10 Norav Users Guide Installing Printers Application Technology RAM Memory Driver MB Rest LASER INK 2 Vendor MS Monitoring Application LASER INK
37. 200 Blue ECG kit contains the following items Acquisition box Patient cable Two AA size alkaline batteries optional Bluetooth USB adaptor USB extension cable Software CD of PC ECG 1200 installation package gt gt gt Software key if optional software is included Figure 9 PC ECG 1200 Blue ECG NV 54 PCECG1200 32 Norav Users Guide To install the Blue ECG device 1 E PC doesn t have built in Bluetooth device connect the Bluetooth adapter to computer s USB port and check that it installed correctly e Note mm The Blue ECG is only compatible with Microsoft Bluetooth Stack communication software Toshiba laptops and other computers having Toshiba Bluetooth Stack software are not compatible Check that Bluetooth icon appears in system tray EN cal 919 AM Figure 10 Bluetooth Icon on system tray 2 Add the Blue ECG to Bluetooth devices list a Switch ON the Blue ECG device b Double click on the Bluetooth icon in the system tray c On the Bluetooth Devices tab click on the Add button d Check the My device is setup and ready to be found option and click on the Next button e When Windows will detect the Blue ECG device select it in a list then click on the Next button f On next panel select Use the passkey found in the documentation Enter 12345 as the passkey and click on the Next button g Click Finish button to final
38. 24 1 1955 M 80 ke 2 Hospital and Physician Information Hospital Name Hospital Address Physician Name General Hospital Megapolis Dr Stern 3 Test Date and Time Test Date Test Time 4 Test Results Protocol Target HR Max HR Max SBP Max DBP Max METS Max VO2 18 09 1999 12 41 51 Bruce 183 175 95 200 100 8 8 30 9 J 60 NV 54 PCECG1200 124 Norav Users Guide 5 Results of Blood Pressure HR Double Product HRXBP sys ST level mm and ST Slope mV sec for the Most Important Stages of Stress Test Rest BP 150 100 HR 79 Product 11850 ST Level mm Slope mV sec 1 2 0 7 0 2 1 8 1 9 0 5 2 0 0 4 2 9 3 3 1 1 2 6 1 4 2 2 1 6 1 8 1 3 6 1 1 8 2 5 1 7 1 5 Max HR Time 7 05 BP 200 100 HR 175 Product 35000 ST Level mm Slope mV sec 1 2 0 7 0 2 1 5 1 9 0 5 2 0 01 2 9 3 3 2 1 2 6 1 4 2 2 1 4 1 8 1 7 6 1 1 2 2 4 1 7 1 5 Worst ST Lead aVF 1 2 mm Time 4 15 BP 200 100 HR 137 Product 27400 ST Level mm Slope mV sec 1 3 0 4 0 2 1 5 1 2 0 5 2 0 01 2 5 3 3 JA PENTA NAAR A B D 1 4294 1715 Recovery Time 10 59 BP 170 80 HR 127 Product 21590 ST Level mm Slope mV sec 1 3 0 4 0 6 1 5 1 3 0 5 2 0 01 1 5 3 3 2 1 2 6 1 5 2 2 1 4 1 9 1 3 2 1 1 2 2 3 1 7 1 5 6 Physician Remarks and Conclusions Reason for Test Chest pressure Reason for Ending Test
39. 4 PCECG1200 84 Norav Users Guide LP Signal Averaging Setup Click Setup on the Toolbar to access the following parameters Tab Option Description ECG Auto Save Save Options When Auto Save is ON the file is stored by Last name or Recording by ID When Auto Save is OFF the program requests a filename Set File Name by Save Set the naming convention for saving files by Patient Last Options Name or ID Simulator ECG When cleared default ECG recording is performed from the PC ECG unit If checked the ECG recording is performed from the demo file included in the software package The recording unit is not required Stop to confirm QRS When ON the user can choose the Normal QRS When OFF the program chooses the Normal QRS automatically Template Correlation Defines the QRS percentage match during signal averaging A higher number corresponds to a better match Target Number of Beats Number of typical heartbeats that will be counted during the averaging stage Use ECG Database Check this option to connect to the default ECG database ECG tests are saved in the database Data Directory Defines the directory for saved ECG recordings View ECG s Colors To modify the ECG colors click the appropriate button and select the color from the color palette Averages Color To modify the colors in the Averages window click the appropriate button and select the color from the color pale
40. 53 Example of ECG Display wrt MA LIGA sauna een 53 CHAPTER STRESS GCG nicas eos sano aa dad aaa asii ie 55 EDC MOTI IN io dali 55 To Lock Screen Window Pee Saba rasens 55 QUICK START un HE EE 56 To Perform a New Tre a a a she 56 To Printan BOG nee 56 TOVAR EN NN EE 56 LEADSIPEACENEND SERIEN RER Ane Sk To D mne the Lead SYM avsides sons Sera A Ern i RAN USSR ken TASSAR Ren 57 OPERATION WITH FUNCTION KEYS c cccccccsssscsssscsssecsssscsssccssssscessscsssecsssssesssscesseceeseceesssessssess 57 Vill Norav Users Guide TOOLBAR OVERVIEW henseende ide 58 Var Toolbar Easy Toolbars Mode SE use 58 Stress Test Conmand Snin a a a a a a A aar Eanna Esse 58 Views and Filters Toolbar ssessersvvsnvsnvrsvrsnrsnesnvrsvrsvesnesnvrsvesvesnrsnvesvesnesnrenvesvesvasnvesvesvesvessvesvesvesnee 59 Average Viewer LORA sinne ee EEE oE 59 P st Processing A ei ao 60 STRESS EC Ge SETUP EEA E A A E E A EETA 61 TOOLBAR AND MENUS MAIN nariai man nn aia a ai ia iia 66 TOOLBAR AND MENUS STRESS TEST COMMANDS ccccssssssssessceseeseeseeeeeeseesecseceeeesseseeseensens 68 TOOLBAR AND MENUS AVERAGE VIEWER csccscsssssesssscssesscssescescssessescescsscsecssescescsecsseaeeeeess 69 TOOLBAR AND MENUS POST PROCESSING s ccssssssssesseeseessesseceescesecsececcesseseeseeeeeessessesseensens 69 To Start the Stress Recording Program ci AAA AAA AA AA 70 VAY A NO Titus SS teak ananas A ii 70 Play Back da Payne 71 Role Phasen a don ET n sa i rr is Te gine
41. 54 PCECG1200 38 Norav Users Guide A Verification of Pressure Calibration Equipment Required 1 Calibrated electronic manometer or equivalent 2 500mL volume or the Orbit K Adult Plus cuff wrapped around something that will not break or crush no glass 3 Hand Inflation Bulb with bleed valve 4 Tubing Tee pieces and miscellaneous connectors or you can order the T Tube Kit SunTech Part 98 0030 00 Procedure 1 When the operating screen is displayed press the SELECT button 2 times This will bring up the MAIN MENU screen 2 Using the UP or DOWN arrows highlight MONITOR SET UP and press the SELECT button 3 Using the UP or DOWN arrows highlight VERIFY CALIBRATION and press the SELECT button The monitor will close its bleed valves and will display on its screen the pressure applied to the patient hose connector 4 Verify the Tango calibration by manually inflating and checking the manometer against the pressure reading on the Tango display 5 Once the calibration has been completed use the UP or DOWN arrows to select EXIT twice and return to the operating screen Norav Medical Patient preparation 39 CHAPTER 6 PATIENT PREPARATION The ECG traces quality depends very much on the stability and conductivity of the electrodes during the test especially during high stages when the patient movements can cause artifacts Here are some basic rules to ensure good electrical contact 0 0 0 0 Sh
42. 601 2 27 and EC11 NV 54 PCECG1200 Norav Users Guide REPORT SAMPLES 132 APPENDIX C PENE LTOT FOOT 90 renner ZH OST 0 0 BO TE O ZH OS SOMA AUT os SZ Dr ET ET TT KST TT TETT EERO N ETT OO RL Ev uber iT aby LLOT TO SO eq wig SUBH Sweya Sq AA 208NISET 98 AH cl ar 071 08 dd Figure 43 Rest Report Norav Medical 133 Report Samples FA ATONA es NAR ETTOR SG Way vargad AM dad STK aysi Wak NTN R a SOA TR YH YER z 962 HETET SANTE SLIK CK IH WITZ Mp yee DIE EY y uz L LELLEL CML Gr IREN CZ Report ive Comprehens Stress Applications Figure 44 NV 54 PCECG1200 Norav Users Guide 134 09 PAR PIT pepa ABION EEL FOOT SO renner 2H 05 1 00 BO TH HO ZH OS SOMA AWUMEQT SOSU SZ 98 UH 00 00 0 0 sun pasdeg L 6x ben by LLGT N 710750 sur BOQQANDA Tl RET yug RUBEN Ji JIWAN 1987 gr ing Report itor ECG Mon Figure 45 Norav Medical 135 Report Samples sor SOOT FOOT ZO PIU ZH OST 0 0 BO TA HO ZH 08 SO AUF OT IOSA S7 7 Tos 7 sh ldh HSO 00 82 By rana IN xes by TY6L EO TO REQ yg mor RUN JENS fua ban ymus WEN ISBT 58 AH TT 70 0 10 00 0 SWIL TTL a Report ity il NV 54 PCECG1200 iab Heart
43. AUTOSAVE MODE WITHOUT SAVING MODIFICATIONS ooooooonconcnonnnncnncnnos 138 THICK STRAIGHT LINE IS DISPLAYED FOR ALL LEADS cccccsscssescesessessesceecsecseseeeeeees 139 EE A A E EER RT 139 Smet 139 NOISYECG SIGNAL ON LEADS i aaa aan iii 139 Problem 139 Some 139 MISSING DATA ARTERA THICGK LINE sansene a a 140 Problems 140 SOUULIOM married ee eee erd 140 xi List of Figures FIGURE 1 SAVING STRESS SETUP unina at a a a a a a a a a a 14 FIGURE 2 PC ECG 1200S PCECG 1200M aan FA 20 FIGURE 3 PATIENT CABLE cccsesssscceseccceseessnsececeseccceesensaeceeesecsesesssssaeeeseceesessnsaeaeeesees 21 FIGURE 4 gt USB CABLE cuida tad its 22 FIGURE 5 PC ECG 1200HR WITH BUILT IN USB CABLE ooccccoocccconcncnoncnonancncnnnccnnnnnnnn 25 FIGURE 6 PC ECG 1200W irnik raa nnd ai aa raas iaid iai 27 FIGURE 7 USB CABLE u a sa aa Richie Haan NR EN 28 FIGURE 8 1200 WR RECEIVER c cccccccccscsssessececesececessessnseceeeeseseseseseaeeeseceesenensaeaeeesees 30 FIGURE 9 PC ECG 1200 BLUE ECG gt drata aaia Aa TER 31 FIGURE 10 ELECTRODE PLACEMENT soinn n e a E E E R i 39 FIGURE 11 RESTING ECG MAIN SCREEN ccccccsccsccecessessnseceeecccsesessssececeseeeecsesesaeeeeeeees 41 FIGURE 12 RESTING ECG TOOLBAR wes ssd stav i dssvesbesdsrssssderbensesdessadedesors sd undar ania 43 FIGURE 13 STRESS ECG RESULTS SCREEN rerrrrrerrerrennnnrnrrenrsrrsensnnnnrrensnnsersensnnrnrsenssrseer 55 FIGURE 14 MAIN STRESS TOOLBAR cccecsesseseces
44. Akne 72 VIEWING RESULT Sunesen 72 LEVAS Take eanet 72 To Display the Review Screen LARIOS 72 To Display the Review Screen Manually saadan 72 To Save STAY FAST RMR RR an 73 METABOLIC STRESS ESTIMATION METS A EEE REDE Ad 74 TRANSFER EIER LRNSE TR T n a E nn TEST TNS 74 T v 74 EXPORT THE EXERCISE PROTOCOL REAL TIME VALUES sccssscsssscssesessesescssesesseseseessseseseneees 74 To enable the exercise protocol export TUS ssd 75 ADDITIONAL FEATURES taa dada td 77 ASSER EEE 77 LOD ene Wort ST na RR RR Rn 77 A Dynamic STEGET 77 RS232 CONTROLLED TREADMILL TYPES n a T O A T rerna 78 RS232 CONTROLLED BICYCLE ERGOMETERS ccsscssssscessessessesscescesecseceecessesseseseceeseeseeneeeseeaes 79 CHAPTER 2 LATE POTENTIAL SIGNAL AVERAGING cscccccesesseees 81 QUICKSTART svak ESN 82 TOS LOVE GIN CWE Tekstene eneeier 82 VOD aisha esi a Se en 82 OPERATION WITH FUNCTION KEYS cccsscsscsscsscsssesecssceccesseseeecescesscsecseceseesscseceeessesseseeeseeaees 83 VE DS Re ae aetna 83 LP SIGNAL AVERAGING SETUP csccsssssssssssscescssescescesesscsseseescsscsseseeseseesscssescesesscsseseeeesscasesseneeees 84 TOGEBARAND MENUS ude 86 INTERPRETING RESULTS nn u anna Rene 88 Neral REU Fess sacs Bee nn TEE ET 89 CHAPTER 3 MONITORING lin 91 QUICKESTAR Eros 92 LOS tarta Neri llista lied dis 92 To Prater 92 Print Study print a selected time range and leads si tios 92 MONITORING E OES A HD AA E E aire 92 TOOLBAR AND MEN S nenne
45. C side connects to pin 5 on the exercise device side Crossed type means that pin 2 on the PC side connects to pin 3 on the exercise device side pin 3 on the PC side connects to pin 2 on the exercise device side and pin 5 on the PC side connects to pin 5 on the exercise device side To Determine Treadmill Cabling Check which pins are assigned for TD and RD on the exercise device connector e If pin 2 is RD and pin 3 is TD then the exercise device requires a crossed cable e If pin 2 is TD and pin 3 is RD then the exercise device requires a straight cable NV 54 PCECG1200 34 Norav Users Guide Norav Medical Accessories Installation 35 CHAPTER 5 ACCESSORIES INSTALLATION Installation of the TANGO Automatic BP Unit Norav Stress ECG Tango Interface Notes To setup Tango with the Norav Stress ECG system simply follow the directions below 1 Verify Correct RS 232 and ECG Trigger Cables e RS 232 Cable used to communicate with the stress system This cable enables the stress system to prompt Tango when it needs a BP measurement and allows the Tango BP reading to be transferred to the stress system s display and reports o SunTech Part Number 91 0013 00 o Connection Ends Norav Stress ECG Connection Tango Connection 9 pin female 9 pin female Figure 11 Stress ECG Connection Figure 12 Tango connection e ECG Trigger Cable provides the ECG signal from the stress system to the Tan
46. Click Browse and find the location in which the file is saved Select the file with the name you gave it and the suffix STF and click OK To Save Stress Protocols 1 Create a new directory in CA My Documents with a name like PcBackup Copy file StWorked mdb from the directory where PC ECG is installed normally C Program Files PC ECG Paste it into a backup directory e g C My Documents PcBackup Norav Medical Software Installation 15 To Load Stress Protocols 1 Copy the file StWorked mdb from the directory where you saved it e g CA My Documents PcBackup Paste it into the directory where PC ECG is installed normally C Program Files PC ECG A window is displayed asking you if you would like to replace the existing file Click Yes To Set Preferences 1 After installing the PC ECG 1200 package and prior to operation click Setup to tailor your preferences Begin with Environment which configures the hardware Continue with the other tabs in any order NV 54 PCECG1200 Hardware Installation 17 CHAPTER 4 HARDWARE INSTALLATION Safety The PC ECG 1200 uses mains power supply unless connected via the USB port It is also sensitive to electrical interference The wireless PC ECG 1200W transmitter uses battery power supply PCECG1200WR receiver uses Power supply via USB port It is also sensitive to electrical interference The wireless Blue ECG uses battery power
47. ERAGES QRS DISPLAYS ai 110 CALIPER DISPLAY meine 111 Toolbar of Caliper DNG 111 TOOEBARAND MEN US uranet ken E E a 112 CHAPTER 6 NEMS APPLICATION sosoosssecseessererererererrrerrerssrersrrrrrrrrr sees srrsrrrrrrr 115 First Tamne A cae a iia a DN a 116 COMPARING REST TESTS mRNA 117 To Compare Ras Pose Sein 117 NEMS SETUP visast based 118 TOOLBAR AND MENUS inaen naa naa an naan aeaa ean aeaaea anan ae eonan teaa ierse eristi 118 Norav Users Guide APPENDIX A INTERFACING WITH INFORMATION SYSTEM G 121 DEMOGRAPHICIDATA dida iia 121 HET RORMAT PIE AA a sne SR SIMA LER 123 GDT BDT TYPE COMMUNICATION a orbe 125 DICOM COMMUNICATION eis eat use escitas i 126 SAVING THE STRESS TEST AS A RAW DATA NATIVE BINARY FORMAT FILE 128 SAVING THE MONITOR TEST AS A RAW DATA NATIVE BINARY FORMAT FILE 129 APPENDIX B TECHNICAL SPECIFICATIONS eeeronorrnnevrnnnvennnsvrnnneennnsennnser 130 APPENDIX C REPORT SAMPLE cccsscccssscccsseccnsscccsscccssccesscccssceeeee 132 APPENDIX D TROUBLESHOOTING ccscccesseccnsscccsscccessccesscccsssceeesee 137 USB DRIVER IS NOT INSTALLED PROPERLY ON WINDOWS XP DURING PC ECG INSTALLATION Ga ise nn ne eat 137 POD Su RAN SRS re A AA meme 137 ISOLATION xt eat ee a ee Malta inane a ehe RER 137 RECOVERING ECG DATA AFTER UNEXPECTED SHUTDOWN OF THE STRESS APPLICATION da ae a site BROS 138 PIO HB aes aa E A GA Aad Re vt 138 SOU daa 138 WORKING IN
48. I IAS 24 CADA dados 24 INSTALLING MODELAZ200H Rina iR keletelsnnei hauen 25 To Conn Via USD lidad idas tallada 25 COMPRE COMEN dada a pica 26 To Connect to the Patient and the ORO o oe 26 RE ET REE ERE EN NET 26 UR A A o a a a aa 26 Calibration i eee O te i Ds tr BS eE E E e Eo E ie ei 26 INST LLING MOD EL 1200W aA 27 To Conned Via US Bien are 29 To ER aai 30 IN A O ai aa aa 30 GLE A O an 30 INSTALEN MODELBEUE LES aan EEE 31 VO Detail th Bine ECG MOVIE san rats eae athe ae Saar 32 CONNECTING AN EXERCISE DEVICE naar 33 To Connect an RS232 Controlled Treadmill Ergometer amssssrrsssrrrssrrrssrrrnnrrrnnrrrnnrrnnnnrrnrrnn nana 33 To Connect an Analog Controlled Treadmill Ergometer smmsssessrrrssrrnssrrrnsrrrnsnrrrnnnrrnnrnnnnnrn nr nn nana 33 ADMINS EEEE EE wt ate 33 Fo Dee Treadmill Cali tect os ois vss Sia oso ls eA pan Bas ped Raised Ne bass Aa basen eas 33 CHAPTER 5 ACCESSORIES INSTALLATION ccccoocccncooonnnnnonoonnannnnnanncnnononans 35 INSTALLATION OF THE TANGO AUTOMATIC BP UNIT usa 35 CHAPTER 6 PATIENT PREPARATION 02 000 39 CHAPTER 7 RES FUNG BCG na ant han 41 QUICK START san Aia 42 To Perform a New ks sakens see nis aE 42 Operation with FEunition Keys ASAS SSA 42 RESTING 12 LEAD BCG a ERINNERN 42 LEADS PLACEMENT nn IN En 42 To Dame thel zad System 43 TOOLBAR OVERVIEW nenne 43 The Toolbar Easy Toolbars Mon naar 43 RESTING ECG SETUP aeh Se ERROR 44 TOOLBAR AND MN See 48 USING THE MATLAB FEATURE WITHIN PC ECG 1200 ae
49. Lb I 2 Hb 3 Lb II 4 Hb 1 21 Lb V5 22 Hb 23 Lb V6 24 Hb 1 25 Lb I 26 Hb 27 Lb II 28 Hb 2 45 Lb V5 46 Hb 47 Lb V6 48 Hb 1 n 1 24 Lb I 2 n 1 24 Hb 3 n 1 24 Lb 1 4 n 1 24 Hb n n 500 21 n 1 24 Lb V5 22 n 1 24 Hb 23 n 1 24 Lb V6 n 24 Hb Table 27 Stress Raw Data File Format Norav Medical Interfacing with Information Systems 129 Saving the Monitor Test as a Raw Data Native Binary Format File 1 Record a Monitor study 2 Under File menu create a RAW Data File A file with extension RDT is created with the following structure Number Leads low byte high byte Sample Rate low byte high byte low byte high byte x Number Leads x n samples 1sec sample rate Sample Second Byte Number Byte Type Lead Number Number Number 1 Lb 1 2 Hb 3 Lb 2 4 Hb 1 2N 1 Lb N 2N Hb 1 2N 1 Lb 1 2N 2 Hb 2N 3 Lb 2 2N 4 Hb 2 2N 2 1 Lb N 2N 2 Hb 1 n 1 2N Lb 1 2 n 1 2N Hb 3 n 1 2N Lb 2 n 1 4 n 1 2N Hb n sample rate 2N n 1 Lb N 2N n Hb Table 28 Monitor Raw Data file format NV 54 PCECG1200 130 Norav Users Guide APPENDIX B TECHNICAL SPECIFICATIONS Model 12008 1200M 1200HR 1200W Blue ECG Lead cable Standard 12 leads Standard 12 leads Standard 12 leads Patient leads Detachable 10 wires conform to AAMI Lead OFF detection De
50. Mean HR 75 Measurements done on STEEN Le le 94 cee Figure 33 Measurements Tabular Screen NV 54 PCECG1200 106 Norav Users Guide Quick Start To Start Measurements Click the ruler icon in the Rest Stress and Monitoring applications ot click View gt Measurements The application has four view formats e Measurements Table default display e ECG Averages e QRS Signal e Caliper To Print Reports 1 Click the printer icon or select File gt Print Reports 2 Select the reports to print and click OK Performing Changes in Calculations To Move the QRS Marker Averages and QRS views only 1 Click and drag the marker to the required position between the previous and next markers 2 The calculations are modified accordingly To Add or Remove a Wave Marker 1 Click the Add Remove ECG Wave Markets icon on the toolbar or select File gt Add Remove ECG Wave Markers 2 Check or clear wave markers in the dialog box displayed 3 Click OK to save the selection close the dialog box and display the change Norav Medical Measurements Interpretation MEANS 107 To Move the Wave Marker Caliper view only 1 Select a wave from the wave list on the left hand side of the viewer or from the Wave Type combo box 2 Select the marker from the Marker Name combo box in the toolbar or by clicking the marker 3 Use the Left Top
51. Norav Medical GmbH Krenzberger Ring 23 65205 Wiesbaden Germany Tel 49 611 7788345 Fax 49 611 7788330 Email sales norav com Caution US Federal Law restricts this device to sale by or on the order of a physician ill The PC ECG 1200 is tested and certified for the following standards EN60601 1 International ENG60601 2 25 International ENG60601 2 27 International Protection type and class Model M II BF Model S II CF Defibrillation protection Built in for Models 1200M 1200HR 1200W Blue ECG and 12008 Disclaimer This system is intended as a decision support system for persons who have received appropriate medical training and should not be used as a sole basis for making clinical decisions pertaining to patient diagnosis care or management Any application of medical information from the program other than the original design or intended use thereof is not advised and considered a misuse of the software product Norav Limited Warranty Norav products are warranted to be free from manufacturing and material defects for a period of one 1 year from the date of shipment from Norav or the dealer to the original purchaser Excluded from this warranty are expendable supply items including but not limited to electrodes lead wires patient cables and batteries This warranty does not apply to any product that Norav determines that it has been modified or damaged by the
52. aa Us A AAA A OES cae See 5 Stress Testno Intended ann Waal Nee Wan ar Re ae aa 5 CONTRAINDICATIONS FOR USE AND ADVERSE EFFECTS ssssorsrsssrsssrsrserersesersesesenrsrrrerererenenenrn en 7 CHAPTER 3 SOFTWARE INSTALLATION 0 ccccccssscessscccevsccsescecessceees 9 SYSTEM REQUIREMENTS AND PREREQUISITES ssscsscsscessessessceccessesecseceecessesecseseeceseeseeeceneeass 9 FT AP AM AVC sic lis iether eee Os URNA ENN SAS eso 9 INSTALLING OR UPDATING THE PC SOFTWARE cscccsccsssssssseescescessessesscessesscseceecessesseseeseeaes 10 To Install PGE GG 1200 22 as en ee 11 To Uninstall PGE CGA 200 iia iii ds 12 To Free Disk Space and Ensure Smooth Operation siehe 13 BACKING UP AND RESTORING SETUPS AND PROTOCOLS sssssssrssssrsrsnesrssrersesrnersrsrernrsrsrersrsnenrrnen 13 To Save TETAS PU isa 14 OSTIAS Tt GSES CII ao 14 To Save Stress Protocol s ccccccccccccccscsscsccsesscsssssscescsscsssesesscsscssscseesesssessessesssesssssceessesssessensessessses 14 To Load Stress Protocols ceccccccccccccsccscscescsssssscscssesscsssesscsscsssssscsscesesssssscsscsscessesscescssesssessensessessees 15 FOS ELA tata 15 CHAPTER 4 HARDWARE INSTALLATION s sssossecssecseeesereeserererrsrrrsrrrsrsrsrrrrrs 17 SAFE A eier 17 CLASSIFICATION OF THE EQUIPMENT asia 19 INSTALLING MODEL 1200S AND MODEL 1200M ossssorsrssrssresrsresrsrenrsrsrnesrsrnesrsrersrsrerrsrsresrsn enn n en 20 To Conner Vid USD 23 To VOR as ATA ae 23 To Perform Maintenance AS iii ii AI E AI A
53. ata View gt Patient Data Can be added to the recording It will be printed together with ECG traces If the recording is saved then the PATIENT DATA will be saved together with the ECG traces Use the Previous option if the same patient undergoes a second study Add remarks View gt Remarks Interpretation Allows the user to enter free text during or after the ECG recording This is printed and saved together with ECG traces If the Interpretation option is installed then Interpretation Statements is also displayed Norav Medical Resting ECG 51 Or use Click y 5 To do this this ee r Or select this Description icon Short menu cut key An optional feature that requires a software key 11 or 12 license Displays a comprehensive table of measured values You can alter the values either by editing them in the table or Micwiand View gt by using Caliper to change the horizontal and vertical modify QRS E Eu Measurements markers When Caliper is activated a large QRS is shown 1 y with the standard markers Open the Standard Markers oe window upper right side and select the QRS interval of interest for modification The area changes to blue Use the mouse to move the markers For details see Measurements Interpretation page 105 Display hide Displays or hides the 5mm raster grid Print outs are gt the grid Hi ee always with 1mm raster Display information from d
54. ations are recorded and displayed e 3 Bipolar derivations I II III e 3 Augmented derivations aVR aVL aVF e 6 Unipolar derivations V1 V6 e You can use a simpler cable with four contacts only limbs It produces six derivations only three Bipolar and three Augmented Leads Placement You can place the leads on the patient in various ways The usual method is to place the leads in the standard positions on the chest V1 V6 To identify the placement of the leads the channels are renamed Additional options for lead placement are Posterior V7 V9 Right side chest Lead system V3R V6R and Pediatric Lead system V7 V3R V4R Norav Medical Resting ECG 43 To Define the Lead System Click Setup gt Lead Select the lead system to use Default Standard Toolbar Overview The Toolbar Easy Toolbars Mode View modify 60 sec Set Show patient Select Bey En preferences details TT Start Filters PE D se 8 m 72 HW m w mm BL st FL Fil F6 PDF R Setup Patient Remar Measu View F2 50Hz EMG Baseli LeadS ECG St Open PDF Supervising Add Select leads Record 10 Standard report Physician remarks to display seconds Lead system Figure 18 Resting ECG Toolbar mn 0 d The icons shown on page 48 are from the full toolbar You can use the view menu to show an abbreviated display with or without captions Note NV 54 PCECG1200 44 Norav Users Gui
55. ave hair at the electrode contact points Use a special shirt that attaches the electrodes and lead wires to the body Use high quality liquid gel electrodes Make sure that the lead wires do not swing Attach the leads as shown in Figure 16 below RA right arm LA left arm RL right leg LL left leg Figure 16 Electrode Placement NV 54 PCECG1200 Resting ECG 41 CHAPTER 7 RESTING ECG Toolbar Blood pressure Heart rate systole diastole beats min user input 27 Res ing ECG Deme 1 24 05 2004 17 58 37 PENE Eie View ECG Wfidow Help a AN Selected strip Multiple lead Horizontal recording display strip display mm sec and lead vertical mm mV scale Figure 17 Resting ECG Main Screen NV 54 PCECG1200 42 Norav Users Guide Quick Start To Perform a New Test Click F1 or the New button on the tool bar Insert patient details in the dialog box Click OK Enter blood pressure Click F2 to stop data collection or F3 to start data collection 10 seconds Operation with Function Keys F1 New Recording F2 Start Stop F3 10 sec recording F6 Print F11 Open Saved Study Table 4 Operation with Function Keys For an example of a printed report see Appendix C page 132 Resting 12 Lead ECG This application uses the standard 10 contact cables It contains four limbs RA LA LL and RL and six chest V1 V6 contacts 12 deriv
56. d grid in correct scale GDT BDT Automatic Options Define automatic options for saving and or importing files Format in GDT BDT format File Format Select the file format GDT or BDT Import Codepage 437 Check this option to import Code page 437 Export Codepage 437 Check this option to export Code page 437 Edit Labels Click this button to open a dialog box with an editable list of the field labels used in the GDT and BDT files GDT BDT Data directory Define the directory path where the GDT BDT files will b be maintained Token for PCECG Default is PEKG Token for Practice EDP Default is EDV1 Loer ie Das Ne Define the path for the flash card program directory Path Program x Download Directory Define the directory to maintain the downloaded Holter files Table 18 LP Signal Averaging Setup NV 54 PCECG1200 86 Norav Users Guide Toolbar and Menus alae LE E this Or select LA To do this this Description A short cut this menu icon key Starts a new XYZ recording The patient s demographic data can be entered prior to ECG recording optional Start a new T F1 File gt New The three channels are displayed on the screen for quality study assurance If the results are unsatisfactory check skin preparation and disposable electrode contacts Then click Start Stop Averaging Open an RR existing study gt F11 File gt Open Opens an existing study Save a
57. d parameters are according to NASPE ESC Guidelines er e havet DANZA NV 54 PCECG1200 100 Norav Users Guide Key Histogram The histogram relates to the active part yellow of the tachogram P S D The power spectrum distribution The tachogram trend shows all intervals Bach beginning of an interval is SR checked with a red line followed by the interval s name To activate an a interval click it To activate several neighboring segments press SHIFT and move the slider Use the slider at the bottom to e Define new intervals Slider e Change interval duration and e Activate several intervals HRV results The HRV results pane displays the results in numerical format Table 23 HRV Screen Quick Start To Start a New Test Click F1 or the New button on the tool bar 1 1 2 3 4 Insert patient details in the dialog box Click OK Click F3 or F4 to start the HRV test Enter the interval name and or remarks as appropriate in the dialog box and click OK Click F3 or F4 or the Start Stop HRV button to stop the HRV test or wait until it ends To Print an HRV Report 1 1 Click Print on the toolbar or select Print from the file menu Select the printer from the print dialog box 2 Click OK and the report is printed For an example of a printed report see Appendix C page 132 Norav Medical Heart Rate Variability HRV 101 To Print an ECG
58. d with no grid lines Default is checked Select Tile mode to set the mode horizontal or vertical which 2 or more opened tests will be viewed Sets the default value for the horizontal scale window on the screen mm sec Sets the default value for the vertical scale window on the screen mm mV Allows the user to choose colors for the Rest ECG application for background traces grid and text When activated restores the factory default colors black for background yellow for traces green for grid turquoise for text NV 54 PCECG1200 46 Norav Users Guide Tab Option Desctiption Easy Toolbar If checked allows the user to use the regular Icons Mode If cleared allows the user to use the optional Icons Adds text to the Icons Text Label Enables use by keyboard Tiger Saves users data hospital physician and modality name This data is printed on any print out and sent as email Supervising Add Remove Physician name to list Add Remove button Select from Physician list and set as default Supervising Physician Measurement Define whether measurements will be calculated according to the metric Standard or the USA standard Default is metric Magnetic Card Select this option to use a magnetic card with bar code to insert patient Reader details Select the magnetic card type Select the option button COM port USB Bluetooth to choose the port the device should be connected through
59. dality name and supervising physician This data is recorded on any print out and sent as email Measurement Standard Define whether measurements are calculated according to the metric or the USA standard The default is metric Magnetic Card Reader Select this option to use a magnetic card with bar code to insert patient details Select the magnetic card type Environment Connection If an automatic blood pressure monitor Tango is to be connected to the system checks for the appropriate COM port Norav Medical Stress ECG 63 Tab amp Secondary Tab Option Description Display Size Choose between 14 15 inch 17 inch default 19 inch W22 inch screen or custom screen X Y settings This setting is required in order to display the ECG and grid in the correct scale Measure BP by Automatic Device If a blood pressure monitor is used define whether automatic measurements should be performed in addition to manual measurements Automatic BP COM Port Set the COM Port that the BP device optional is connected to Exercise Device COM Port Select the COM port that the exercise device is connected to from the list Advance Cards R wave trigger requires D1 t board should be ticked if a blood pressure monitor is used or if external synchronization is needed If analog out requires D A board for metabolic or exercise device control is needed selec
60. de Resting ECG Setup Click Setup on the Toolbar to access the following parameters Tab Option Desctiption Define the lead system to be used and displayed according to the Lead Lead Svst electrode placement on the patient Choose between Standard Cabrera ac er Posterior V7 V9 Right side V3R V5R and Pediatric V7 V3R V4R lead systems default standard system Default 3 leads Define the 3 leads that will be displayed as default when using 3x1 view format Default 6 leads Define the 6 leads that will be displayed as default when using 6x1 or 3x2 view format Strip Lead 10 sec lead to appear in 4x3 and 6x2 formats Default is cleared ECG Recording Filter 50 60Hz When checked the default status of 50 60Hz filter is ON according to the checked frequency 50 or 60 Default is cleared EMG Filter Baseline Filter Save options Auto stop after 10 sec Auto Print Simulator ECG ECG Status Minimum Test Time Data Directory When checked the default status of the EMG filter is ON Default is cleared When checked the default status of the Baseline filter is ON If Auto Save is ON the file is stored by last name or by ID If Auto Save is OFF a dialog box is displayed asking the user to enter a file name If cleared default recording runs till stopped by the user If checked stops recording automatically after 10 sec Use this option
61. digital signature 4 Check if the driver is now installed correctly there is no question mark icon next to the USB driver in the device manager and the LED on the USB adaptor is on If the device is still not correctly installed then complete the following steps 5 uninstall the unidentified USB driver as follows a While still connected to the USB right click My Computer b Select Properties from the pop up menu c Click Device Manager on the Hardwate tab d Double click the USB Device with the icon in the list of devices e Select Driver tab f Click Uninstall and then OK 6 After the driver is deleted disconnect the USB cable from the PC 7 Install the PC ECG software and continue to the next step 8 Reconnect the USB cable to the computer connector Windows XP identifies the new hardware automatically and the new hardware wizard opens 9 Follow the instructions on screen If working under Windows XP press Continue anyway on message regarding the digital signature After the driver is installed make sure the green light is illuminated on the 1200 USB adaptor NV 54 PCECG1200 138 Norav Users Guide Recovering ECG Data after Unexpected Shutdown of the Stress Application Problem If the application terminates unexpectedly before the ECG test is completed and saved it may be possible to recover the ECG data of the exhausted patient Solution Stress ECG application stores native ECG
62. do the following 1 right click on the desktop 2 select PROPERTIES form the pop up menu 3 Select SCREENSAVER tab 4 Press on POWER button in the Monitor Power frame 5 Select Power Schemes as either PRESENTATION or HOME OFFICE DESK 6 Set NEVER to Turn off Hard Disk System Standby and System Hibernates 7 Press OK to apply this configuration Norav Medical
63. e Al F9 Fe Manual Manually controls the exercise device management manually Stop the treadmill or Test gt Stop erpameter in an F12 ee Emergency stop for treadmill or ergometer emergency Display gt enlarged heart g Ctrl H Enlarges display of heart rate window rate P Display Pl ee Space bar Test gt Play Opens window to Play Back any previous 10 second Back during p i E key back selected section during real time Real Time Display study gt 4 T ae Test gt Review Displays study results Table 10 Stress Test Commands Norav Medical Stress ECG 69 Toolbar and Menus Average Viewer To do this Click this icon Description Display 3 lead average is Averages of 3 leads and ST trends Display 12 lead average 12 leads averages Display single QRS de Single QRS Scroll between lead displays ej l Double function a scroll for all leads in the 3X1 display b point to the requested lead Display QRS Je Base line QRS in white and current QRS in yellow Table 11 Average Viewer Toolbar Toolbar and Menus Post Processing Right hand side of tool bar Click SR To do this this Or select this menu short cut icon key View 12 leads ST trends View gt 12 Leads ST results View 3 leads ST trends View gt 3 Leads ST results View man ST wanie Q View gt Next ST L
64. e markers to be displayed and calculated File gt Print Lets you choose the report to be printed from the Print Reports en sub menu Single QRS QT Report Multiple QRS Report or All Reports Table 24 Measurements Toolbar and Menus Norav Medical NEMS APPLICATION 115 CHAPTER 6 NEMS APPLICATION This option is available with the D1 D3 license Norav ECG Management System NEMS application is an optional package requiring a D1 NEMS A or D3 NEMS Q permission license Install NEMS Database from the PC ECG1200 package Keep and manage ECG studies in a catalog organized according to patient name or ID In a network users can share the database save it in the server Data acquisition for all applications can be initiated either in the application itself or from the NEMS main screen Select group field values for query List of tests referring to selected of displayed list of patients patient selected test highlighted tel ECGDBase1 Edt File view Patient Test Help ECG DataBase Application ow 7 gt Wizard Import fetup About z amp amp G ih ab Q De X Groups Find Open New Delete Test Open Comp Copy Move Delete ESTE Type Dee Time Patient Pury zf 10 2004 0 123213 yoel ID Number Last Name First Name 123213 yoel 123213 yoel 1112 yaron vont ESTE 1115 REDBULL Alexis 26
65. eads Triplet View numerical results S Ctrl V View gt Properties Undo the last action Ctrl z View ECG 10 sec data al Enter View gt Open ECG Data requires I1 or I2 license Move marker to previous Ctr 6 View gt Event gt Previous Event event Move marker left 10 sec lt View gt Event gt Left Play back results gt View gt Play ECG Data Move marker right 10 sec gt gt View gt Event gt Right Move mamisa 0 mex Ctrl gt View gt Event gt Next Event event Add create a new event a View gt Add New Event Delete the current event View gt Delete Current Event Set preferences Pe Ctrl T View gt Setup NV 54 PCECG1200 70 Norav Users Guide Click en To do this this Or select this menu o short cut icon key Print the study E a This enables you to print the entire study or a single stage Position ie ST maika View Rec This enables you to position the ST marker for the entire alculate ST study Table 12 Post Processing Toolbar and Menus To Start the Stress Recording Program Double click the stress icon The initial screen is displayed To Start a New Test 1 Define the exercise machine Treadmill Ergometer See page 63 a 2 If necessary click the Change Protocol icon to select a test protocol Change Current Protocol Current Protocol Bruce Balke Ware Bruce Modified Ellestad Kattus MacHenry 2min Stg
66. ececessessceceeecceseeessrseaeeeseceesenensseaeeeeees 58 FIGURE 15 STRESS TEST COMMANDS TOOLBAR cccccccoonnononononcnnononannnnonononconononnnnonanoncnnos 58 FIGURE 16 STRESS ECG VIEWS AND FILTERS TOOLBAR o ococccccccocononanoncncncononanannononononnos 59 FIGURE 17 STRESS ECG POST PROCESSING DISPLAY TOOLBAR ccccccccceesessrseeeesees 59 FIGURE 18 STRESS ECG PLAYBACK TOOLBAR coccccccconnnonononnnconononannnnononnnconononananononanonos 60 FIGURE 19 CHANGE TEST PROTOCOL ccsessesscesececessessssecececcesesesensesseeeeesecsesessnsaseeeees 70 FIGURE 20 PATIENT DATA ENTRY susanne sta asien 70 FIGURE 21 PLAY BACK WINDOW ccccccessssscecesececessesssecesecccseeessssseeeeseceesenenssseeeesees 71 FIGURE 22 CAREFUSION LAB5 CPET SETTINGS sssossseserrrrerersrserrrrereresserrrrrrererrrrrrr rr rr rn rn 76 FIGURE 23 LATE POTENTIAL SIGNAL AVERAGING SCREEN ccccccccceseeeeeceeeeeeeeeeeeeeeees 81 FIGURE 24 LP SIGNAL AVERAGING REVIEW SCREEN cccscccscscceeeessssceceseceesesenssseeeeeeees 88 FIGURE 25 MONITORING SCREEN cccccccesssssssscecesececessessnececeeccscesesesseceseceesenensneaeeeeees 91 FIGURE 26 HRV RESULTS Hentai eee PS ste ata ASS 104 FIGURE 27 MEASUREMENTS TABULAR SCREEN ssssessecseesceseeesesssseceseccesesessnseeeeeeees 105 FIGURE 28 MEASUREMENTS AVERAGES DISPLAY ccssccsccsccsceesesssssceeececsesessnseeeeeeees 108 FIGURE 29 MEASUREMENTS QRS DISPLAY c sccccssssssecessescecessesseeecss
67. econd and 1 microvolt The clinical significance of Late Potential measures should be determined by a physician Stress Testing Intended Use Angina pectoris chest pain is a clinical syndrome resulting from myocardial ischemia indicative of reduced blood supply to the cardiac muscle The electrocardiogram may establish the diagnosis of ischemic heart disease if characteristic changes are present Stress testing is the most widely used method to decide whether this chest pain is related to myocardial ischemia and thus to coronary artery disease In stress testing the contractile capability of the heart muscle is monitored via ECG during patient exercise Patients exercise by bicycle treadmill or other means while the ECG is monitored continuously Exercise loads are determined by predefined protocols The ECG signals are recorded for the resting exercise and recovery phase portions of the exercise protocol The changes in ECG waveforms are compared to the resting ECG records Most of the commercial stress test systems control the bicycle or treadmill automatically according to the requirements of the chosen protocol although this is not essential ST segment monitoring is intended as an aid in the evaluation of myocardial ischemia in patients with known or suspected coronary artery disease The ST segment algorithm has been tested for accuracy of the ST segment data and a database is used as a tool for performance testing NV 54 PCECG
68. ference filter Set Filter 50 60 Hz OPTIONS for 50 or 60 Hz prior to operation ECG gt Set EMG Filter EMG Filters gt ON OFF for muscle noise filter EMG Set Base Line ane are BL Filters gt ON OFF for baseline filter on ECG data Filter BaseLine Move Marker to gt Enabled in Caliper screen when a wave type and marker name are selected Click to move the marker right or down according to the marker selected Right Bottom I Disabled when no wave marker is selected or the Caliper screen is not displayed Averages and QRS screens Horizontal 1 Lets you choose between horizontal displays of Resolution Fs 12 5 25 50 and 100 mm sec Default 25 mm sec In Caliper lets you select the QRS wave type Er wa se from the list to view its markers After selecting eb the wave type select a marker name to move it Averages and QRS screens Vertical ee Lets you choose between vertical displays of 5 Resolution 10 20 and 40 mm mV Default 10 mm mV NV 54 PCECG1200 114 Norav Users Guide Or use a a this Or select this a To do this this Description 5 short cut menu icon key Select Name of In Caliper lets you select the name of a marker to QRS Marker EE mm edit it move it up down left right Add Remove File gt Caliper screen only Add Remove ECG Wave af ECG Wave Opens a dialog box and lets you check clear the Marker Marker wav
69. file feature 1 Click Setup gt Environment 2 Click the Advance tab 3 Check Use real time protocol export file 4 Insert the export file full file name including directory path An export file is created in the specified directory The export file receives real time data from the Stress application such as stage Name exercise device type Treadmill ot Ergometer Speed or Workload Grade or RPM Heart Rate Blood Pressure ST value and slope It is a text file updated every 1 second Export file format AAAA BBBB C DDDD E FFFF GGGG HHHH IIlI JJJJ KKKK LLLL MMMM NNPP where a space is shown as AAAA combined Phase and Stage name Chek initialization Base base phase Resting stage Warm warming phase pre test manual warming stage Exer exercise phase stress stages Reco recovery phase all recovery stages Stop finish of test post processing no ECG running BBBB value for Load Parameter 1 C designator for Load Parameter 1 M treadmill Speed in 0 1 mph K treadmill Speed in km h W ergometer Load Watt DDDD value for Load Parameter 2 E designator for Load Parameter 2 treadmill Grade in 0 1 percent U ergometer revolutions in min RPM FFFF Heart Rate in bpm GGGG Ventricular Ectopic beats per minute not used always 0 HHHH BP measurement NBR not used always 999 TITT Systolic BP in mmHg 999
70. go o SunTech Part Number 91 0011 00 o Connection Ends Norav Stress ECG Connection Tango Connection BNC male BNC male Figure 13 BNC Connection to Stress Figure 14 BNC Connection to Tango NV 54 PCECG1200 36 Norav Users Guide RS 232 Connection Part 91 0013 00 ECG Trigger Connection Part 91 0011 00 Figure 15 Tango monitor back side 2 Connect the RS 232 Cable From the RS 232 connection on the rear panel of the Tango To a COM port on the back of the stress system PC 3 Connect the ECG Trigger Cable From the BNC External ECG connection on the rear panel of the Tango To the BNC connection on the 1200 USB A adapter part of the Norav Stress ECG 4 Tango Monitor Setup a b When the operating screen is displayed press the SELECT button 2 times This will bring up the MAIN MENU screen Using the UP or DOWN arrows highlight MONITOR SET UP and press the SELECT button Using the UP or DOWN arrows highlight STRESS SYSTEM and press the SELECT button Using the UP or DOWN arrows scroll through the list until CUSTOM is highlighted and press the SELECT button to confirm the choice With PROTOCOL highlighted press the SELECT button Using the UP or DOWN arrows scroll through the list until SUNTECH is highlighted and press the SELECT button to confirm the choice Press the DOWN arrow to highlight ECG Trigger and press the SELECT button Using the UP or DOWN arrows
71. he Scale screen Vertical Scale Slider step size Colors Restore Defaults Sets the default value for the Vertical scale window on the screen Off line function Sets the default value for slider steps when moved by mouse or arrow keys Allows the user to choose colors Restores factory defaults NV 54 PCECG1200 94 Norav Users Guide Tab Option Description Installation Saves hospital and physician data This data is included in print out mail Measurement Define whether measurements will be calculated according to Standard the metric or the USA standard The default is metric Magnetic Card Select this option to use a magnetic card with bar code to insert Reader patient details Select the magnetic card type Select the option button COM port USB to choose the port for device connection Envi R Connection If the COM port option is selected select the serial input for the PEER PC ECG unit from the COM port list Disabled if the USB connection is selected Default at installation USB Choose between 14 15 inch screen default and 17 inch screen Display Size This setting is required to display the ECG and grid in correct scale If set to On it prints 1mm and 5 mm squares on printouts Giaph paper Regular Grid is guaranteed to fit any printer Improved Grid shows a fine grid but may not work on some printers Large Remarks Enlarges printed text font Color Printout Forces B W printing on col
72. he other leads to be displayed and monitored on X Y Z a y screen With this option monitoring other leads is not possible default is cleared 12 Leads View Default 3 leads This function is available only if 12 lead monitoring is selected 3 leads appear if 3X1 format is used Strip Lead 10 sec lead appears in 4X3 and 6X2 formats When checked the default status of 50 60Hz filter is ON ECG recording Filter 50 60Hz according to the checked frequency 50 or 60 Default is cleared EMG Filter When checked the default status of the EMG filter is ON Default is cleared r When checked the default status of the Baseline filter is ON Baseline filter i Default is cleared If Auto Save is ON the file is stored by last name or by ID Save options If Auto Save is OFF the program requests a filename If cleared default ECG recording is performed from PC ECG unit Simulator ECG Jf checked ECG recording is performed from the demo file included in the software package The recording unit is not needed ECG Recording time Determines study duration in minutes h m Data Directorv Defines the directory for saved ECG recordings Use secondary ata HEY hard disk if available If checked default does not limit the extreme high amplitude Vs Draw Over ECG pulses from exceeding the borders Lead Borders If cleared chops the pulses at the borders Horizontal Sets the default value for the Horizontal scale window on t
73. her fitness level Transfer File Trnsf txt Use this option when the PC ECG 1200 shares the same PC with another application in real time To Transfer a File 4 Click Setup gt Environment 5 Click the Advance tab 6 Check Use transfer file TRNST TXT A transfer file is created in the directory containing the Stress application file The default is C Program Files Pc ecg The transfer file receives real time data from the Stress application such as current Heart Rate Workload Speed and Grade of external device It is a text file updated every 5 seconds The format is as follows Each text line starts with a descriptive header and a parameter that always starts at character number 13 The value of each parameter may change during the study Parameter Current Range not included in text Value file HR 86 0 200 Speed mph 3 3 0 25 Grade 3 1 0 0 30 Workload 10 1 0 1000 Table 13 Transfer File Format A Sharing Violation error may occur if the file is read while the Stress Application is updating it Wait until updating is completed a second or two Note Export the exercise protocol real time values Use this option when the PC ECG 1200 shares the exercise protocol measurements with another application in real time The protocol data stored to single line text file Norav Medical Stress ECG 75 To enable the exercise protocol export
74. id 96 CHAPTER 4 HEART RATE VARIABILITY HRV ooooocccnnncccnnnnonnnnnnncnnnnnnnnoonos 99 QUICKSTART in iii ee kat a a aai eter 100 TR NASA NET 100 To Print an EN A Saka N 100 To Print am EEG an A Ne 101 HRV SETU Pinin it aid tinas 101 STARTING ASTUD Finse RENT TT TETTES 103 To Add OF Subtratkan IMHVAk ska Aa GA ee 103 TG EGAN GILES AASS 103 Lo Imborter Save GDT BDT Fi ee 103 RESULTS DISPLAY nn a sek eien 104 HRV INTERVAL MEASUREMENT 0tanlaleutnhbitehsteignbhseinienitleisnkinhitteltne 104 CHAPTER 5 MEASUREMENTS INTERPRETATION MEANS 105 QUICK START uni erhielten vene 106 To Start Measurements cecccccccccccsccccsccsceccsssssssesesscsssssscsscescsssssseesesscsssesscssessessscssesessscsscesessessseas 706 LGA and 106 PERFORMING CHANGES IN CALCULATIONS ovosssssrsrsrrsrsrsesrsrersrsrnersrsrnernrsrernesrsrersrsrerrsrsrrsren enn sn rna 106 Lo Move the ORS Marka o re 106 To Add or Remove a Wave Marker sessessrsonsonsnvsnvsnvnsneenesnvsnvnsvesnesnsnnvnsvesnesnvnsvesvennesnvnsvesvesnee 106 To Move ihe Wade Market en en in de lid 107 FEATURES IA ease DENS TARA R ALA A AAA KO NANA ANS na A 107 ToView the Min qa DN A a e a a 107 To View the Measurements on a Channel ssessersvvsnvrnvnsvrsnesnrsnvrnvrsvesnesnvenvesvesnernvesvesnesveevvesvesnesnne 107 To View the Measurements on All Channels for OT sjangsen nina 107 TABULAR SCREEN ie ae ENE 107 AVERAGES DISPEAY 22 2220er antenne rinnen tens 108 ORSDISPEAV nn ein SA 109 TOOLBAR OF AV
75. iew format Strip Lead 10 sec lead to appear in 4x3 and 6x2 formats View Count Recovery Time Separately from Stress Check this option to have separate times for the Stress phases and the Recovery phases Clear this option to have the time displayed on screen in Real time and in Review Screen as the overall test time including the Stress and the Recovery phases NV 54 PCECG1200 62 Norav Users Guide Tab amp Secondary Tab Option Description Default Colors To define the default colors for background traces grid light grid text and base average click the appropriate button and select the color from the color palette To restore the default colors click Restore Default in the frame Default ECG View Select the default on screen lead display from the list in the combo box When 6 Leads is defined in the ECG Recording tab the maximum view is 6 leads Easy Toolbar mode Check this option to display fewer icons Text Labels heck this option to add text labels to the toolbar buttons Separate Leads heck this option to have the leads separated by borders eat this option to have the leads not separated by borders Draw over Leads Border ODO 10 heck this option to have high signals exceeding the channel display drawn beyond the lead border Clear this option to have high signals cut off Draw Grid Check to disp
76. ifferent leads 5 options View gt Leads Classical format 12 lead ECG of 2 5sec ECG 10sec Display 3x4 cnn Format gt 3x4 Windows u View gt Leads Display 6x2 AR Format gt 6x2 12 lead ECG of 5sec ECG 10sec trace Windows View gt Leads Display 12x1 Format gt 12 12 lead ECG of 10sec ECG Leads E View gt Leads Display 6x1 Format gt 6 6 lead ECG of 10sec ECG Leads View gt Leads Display 3x1 Format gt 3 3 lead ECG of 10sec ECG Leads Produces a typical QRS for every lead from the raw ECG 3 data The averages can be printed either full size or View print de minimized in a credit card size averages To perform a miniature print enter FILE and then PRINT MINIATURE Scroll between displays from different leads View gt Leads Format gt Next leads Double function Scrolls for all leads in the 3X1 display Points to the requested lead NV 54 PCECG1200 52 Norav Users Guide Or use Click To do this this this Or select this Description short menu icon cut key Start stop ECG F2 MG Controls start and stop of ECG recording D Start Stop Record a 10 second F3 ECG gt 10 Sec Start 10 sec timer for recording ECG data segment Start stop PA o ECG gt Filters ON OFF for line interference filter Set Options for 50 50 60 Hz filter gt 50 60 Hz or 60 Hz prior to
77. ight is illuminated Figure 2 detail 3 Connect the patient cable Figure 3 Page 21 detail 8 to the 15 pin plug of the PC ECG 12005 Figure 2 page 20 detail 1 If the optional software key is included connect it to the parallel port of the computer or USB if of such type If a printer is connected plug the printer cable into the key To Verify the Connections 1 Run REST application 2 Press F1 for a new test 3 Insert patient details in the dialog and then press OK 4 Verify that traces are acquired and displayed on the screen NV 54 PCECG1200 24 Norav Users Guide To Perform Maintenance The device is not waterproof Do not expose the device to water or any kind of liquid Maintain in a dry place Caution Use alcohol pads to clean the device of moisture and hairs Calibration The device does not need any calibration Norav Medical Hardware Installation 25 Installing Model 1200HR The PC ECG 1200HR kit contains the following items Acquisition box see Figure 5 below Patient leads Built in USB cable see Figure 5 below Software CD of PC ECG 1200 installation package gt gt gt o Software key if optional software is included Figure 5 PC ECG 1200HR with built in USB cable To Connect Via USB Make sure the device is switched off Cautions refer to practices necessary to protect against potential damage or loss to equipment Ca
78. ight is illuminated on the 1200 WR Receiver Figure 8 Page 30 detail 3 5 Insert 4 AA alkaline or NIMH rechargeable batteries into the battery compartment of the PCECG1200W unit 6 Switch on the PC ECG 1200W Figure 6 Page 27 detail 2 and verify that the ON light is illuminated Figure 6 Page 27 detail 3 7 Connect the 10 patient leads according to the lables to the 10 connectors of the PC ECG 1200W Figure 6 Page 27 detail 1 8 If the optional software key is included connect it to the parallel port of the computer 9 Ifa printer is connected via the parallel port plug the printer cable into the key The optional BNC output Figure 8 Page 30 detail 5 is a trigger control for connecting to an external device such as an ergometer or the Tango unit NV 54 PCECG1200 30 Norav Users Guide Figure 8 1200 WR Receiver To Verify the Connections 10 Connect the PC ECG 1200W to the patient 11 Connect the electrode leads to the electrodes starting with RL 12 Verify that an ECG is acquired and displayed on the screen To Perform Maintenance The device is not waterproof Do not expose the device to water or any kind of liquid Maintain in a dry place Caution 1 Use alcohol pads to clean the device of moisture and hairs Calibration The device does not need any calibration Norav Medical Hardware Installation 31 Installing Model Blue ECG The PC ECG 1
79. il final stop Metabolic Card Control Metabolic Card Control Check this option to control an external metabolic testing device for blood gas content If this option is cleared default no communication is made with the metabolic testing device Metabolic Card Manufacturer Select the metabolic card manufacturer from the list Auto Print Print Report Check this option to print the metabolic test report automatically at the end of the test Printouts Auto Print Default Reports on End Test Check this option to automatically print the default reports at the end of each test Default Reports Define the default reports NV 54 PCECG1200 64 Norav Users Guide Tab amp Secondary Tab Option Description Paper Size for ECG Printing Set paper size either conventional printer or 4 inch thermal printer Use Large fonts for Remarks Enables large font for user entered free text Shadow Frame for Area of Interest Allows the user to choose between shadow and frame to highlight the area of interest Load Printer Drivers Ahead Check this option to save time by reading the driver before sending the print action ECG Line Define the line width in the printouts either Normal or Bold Event Format Set Event format for printout to either 3 lead or 12 leads format Tabular Results Format Check this option to print out results in
80. ize registration 3 Run the Resting ECG program select Bluetooth option in setup ENVIRONMENT panel 4 Close the Resting ECG program 5 Connect the patient cable 6 If the optional software key is included connect it to USB port of the computer Norav Medical Hardware Installation 33 Connecting an Exercise Device You can connect a treadmill or ergometer to the computer independently of the PC ECG 1200S M HR W Blue ECG You can also operate the exercise device without using an ECG recorder by using the software with Simulator option selected To Connect an RS232 Controlled Treadmill Ergometer Connect the RS232 cable as specified by the vendor to COM 2 if COM 2 is in use then wait until the software has been installed and use the assigned COM port To Connect an Analog Controlled Treadmill Ergometer A digital analog converter D A board converts the digital signal from the computer into an analog signal that the treadmill or ergometer can read 1 Insert the D A board into the PC Connect the cable from the D A board as specified in the D A board table Cabling The connection cables may be purchased from Norav Medical distributors The RS232 cable should contain at least 3 wires TD RD using pin 2 and 3 and GROUND using pin 5 Straight type means that pin 2 on the PC side connects to pin 2 on the exercise device side pin 3 on the PC side connects to pin 3 on the exercise device side and pin 5 on the P
81. large icons are used the operation must be performed through the FILE menu Prerequisites e mail software package modem and internet provider not included in the PC ECG 1200 package Send results via Once an ECG study is displayed on the screen of the email tal File gt Send transmitting side click this icon to attach the ECG file and send an e mail to a specified address The receiver must have the PC ECG 1200 software installed A regular email is sent with the ECG as an attached file The receiver can either double click the file to display the ECG on the screen or save it in the PC ECG 1200 studies default directory File gt Export Saves ECG results in MATLAB format Export to MATLAB format Ctrl E to Matlab For details see Using the Matlab Feature within PC Format ECG 1200 page 53 File gt Export ea 0 FIDA to FDA Saves ECG results in FDA XML format XML format Format Export to SCP format File gt Export to SCP Format Saves ECG results in SCP format Export to Mckessen format File gt Export to Mckessen Format Saves ECG results in Mckessen format Export to DICOM format File gt Export to DICOM Format Saves ECG results in DICOM format For details see DICOM Communication page 126 Create a text file File gt Create Text File Saves ECG data in text format NV 54 PCECG1200 50 Norav Users Guide Or use Click
82. lay grid lines Uncheck to hide gridlines Cabrera Display Check this option when using a Cabrera lead system When using the standard LEDs system clear this option Lock Splitter When this option is checked the window splitters cannot be moved and the sections in the viewer cannot be resized To resize the different sections in the viewer clear this option Clock count up Check this option to set the time from beginning of the current stage count up If not checked the time displayed is the time left until the end of the current stage count down The default not checked Horizontal scale Sets the default value for the horizontal scale window on screen mm sec Vertical scale Sets the default value for the vertical scale window on screen mm mV Ergometer METS Watt Applies to an Ergometer test The selected units METS or WATT are displayed for the Workload on the Review Screen post processing Real Time Average QRS Select Static or Dynamic worst case ST to display Average QRS If Static option is selected the Average QRS displayed is of the default strip channel selected in the setup If Dynamic option is selected the channel of the displayed Average QRS dynamically changed according to the channel with the worst case ST Smooth ECG Trace Check this option to display a smooth ECG trace on the screen Default Not checked Installation Saves user data hospitaldetails Mo
83. lect the path and file name of the ABPM application This field Blood i 3 can be filled in only through browsing It is not possible to insert directly in the Pressure 7 ae text box Application Table 25 NEMS Setup Options Toolbar and Menus E i Or use a To do this a ae this short DE Description icon menu cut key Main Toolbar Connect to Ctrl W File gt Creates a new database or retrieve Database EY Database path for an existing one Wizard Connection Wizard Import tests to Ctrl I File gt Import Adds studies recorded and saved database amp ECG Data File outside the database 1 t To select all patient data files within ranet a directory press CTRL A and verify that all files are checked Norav Medical NEMS APPLICATION 119 ea aes Or select this To do this a this short Description icon menu cut key Define Ctrl T View gt Setup Defines the location of default Workspace workspace patient identification Preferences and a special file called External Pe File This file Windows INI format allows the user to prepare a Setup list of patients that can be read by PC ECG 1200 applications Note This feature does not require the D3 software key Edit Groups 3 File gt Groups Defines different patient groups Groups such as Private HMO Military etc View Help gt About Displays version number Application communication and web I
84. leted or if terminated by clicking the R R icon the HRV screen is displayed To Add or Subtract an Interval 1 1 Select the interval with the slider Click or at the top of the HRV results pane To Edit Interval Names Use the pencil icon To Import or Save GDT BDT Format See Import from GDT BDT and Save Test in GDT BDT page 125 NV 54 PCECG1200 104 Norav Users Guide Results Display The AVERAGE HEART RATE is displayed in the lower left side All results are for the chosen segment check the yellow selection or the From To bits number Other results are shown in the right hand side as follows RR no Number of beats in the active interval max RR Longest R R period min RR Shorter R R period Average RR Average of interval in active interval Time SDNN Standard deviation of all R R periods in interval Moman SDANN Standard deviation of the averages of R R periods in all 5 min segments of the active interval RMSSD The square root of the mean of the sum of the squares of differences between adjacent NN intervals HRV triangular Total number of all R R intervals divided by the height of the Index histogram of all R R intervals measured on a discrete scale ULF Power of the ultra low frequency range Frequency VLF Power of the very low frequency range Domain LF Power of the low frequency range HF Power of the high frequency range Figure 32 HRV Results HRV
85. located on the SunTech Medical website under Products gt Tango for correct microphone placement Follow steps 1 and 2 in Conducting the Stress Test in the User s Guide to provide the best conditions to obtain a measurement Q Can I use a heart rate or blood pressure simulator to test whether the Tango is working correctly with my stress system A You cannot use a heart rate or blood pressure simulator to test whether the Tango is working with your stress system The Tango monitor requires that the ECG signal and the Korotkoff sounds collected by the microphone in the cuff originate from the same source meaning the patient Q I cannot clearly see the Tango display How do I fix this A If you cannot clearly read Tango you can adjust the contrast of the display by following these steps 1 When the operating screen is displayed press the SELECT button 2 times This will bring up the MAIN MENU screen 2 Using the UP or DOWN arrows highlight MONITOR SET UP and press the SELECT button 3 Using the UP or DOWN arrows highlight CONTRAST and press the SELECT button 4 Using the UP or DOWN arrows modify the contrast of the screen When you are finished and press the SELECT button to confirm the choice 5 Using the UP or DOWN arrows select EXIT twice to return to the operating screen Q My Tango displays a message Please VERIFY CALIBRATION or Equipment Maintenance and Calibration Required What do I do NV
86. marked with a red marker in the strip lead The marker actually marks the R wave of every QRS The QRS markers can be moved to the left and right between the previous and the next marker Changes in marker positions are recalculated and displayed in the tabular screen and the QRS screen Norav Medical Measurements Interpretation MEANS 109 QRS Display S Measurements 6798 Yonialer Yolanda 27 07 2004 17 55 58 BAE Im Eile View Help Isola HA le fe gt sj en l el nn fom Figure 35 Measurements QRS display The QRS screen displays the QRS in each of the leads and a strip lead of a default lead defined in the setup of the application from which Measurements was accessed The QRS displayed in each of the leads is marked by a red rectangle in the strip lead To view a different QRS in all the leads drag and drop the square by to a different QRS The QRS markers can be moved to the left and right between the previous and the next marker Changes in marker positions are recalculated and displayed in the tabular screen and the Averages screen NV 54 PCECG1200 110 Norav Users Guide Toolbar of Averages QRS Displays Vertical Scale Measurements 769679 6796 09808 19 01 2003 09 02 13 User Administrator 0 File View Help E alalt Al 2 eal A alu 64 ES gt de p 25 mm sec v iO mm mv y A Horizontal Scale Figure 36 Toolbar of Average
87. matically to the Review Screen and the post processing information is displayed To Display the Review Screen Manually If Switch to Review Automatically is not enabled 1 Click F4 The test exercise device stops but the ECG signal continues to run 2 Click F2 The ECG signal stops and a Review button is displayed on the tool bar The Review button is not displayed if Switch to Review Automatically is enabled 3 To review the post processing information click Review The Review Screen is displayed with the post processing data It provides the following options 0 Print reports automatically 0 Save and display ORIGINAL Data with real time filters with removal option 0 Print All Events in REVIEW 0 Print on an additional page if necessary Print ST Measurements optionally Norav Medical Stress ECG 73 To Save Study Results 1 Click Setup gt ECG Recording 2 Select options for saving the study and click OK 3 Click File gt Save define the file name and path and click OK NV 54 PCECG1200 74 Norav Users Guide Metabolic Stress Estimation METS A very important feature of the software is the estimation of Metabolic Equivalency METS This estimates how many ml of oxygen the body produces for every kg of weight per minute The results are shown in units of METS or VO2 Max One unit of VO2 is 3 5 units of METS 1 METS corresponds to a person at rest A higher METS indicates a hig
88. name b In NoravScheduler tool OPTIONS On Reports panel mark Store PDF reports and send to DICOM SCP mm The FROM directory path for PDF files must be same as PDF File Data Directory parameter in Resting ECG Stress ECG application setup Note On DICOM panel fill the DICOM SCP Server connection parameters Store 12 lead ECG Waveforms to DICOM SCP Supported in Resting ECG application To enable the 12 lead ECG Waveform functionality a In Resting ECG software setup Enable Auto Save parameter for DICOM ECG format files b In NoravScheduler tool OPTIONS On Reports panel mark Send DICOM ECG and send to DICOM SCP mm 0 we The FROM directory path for DICOM ECG files must be same as DICOM ECG File Data Directory parameter in Resting ECG application setup Note On DICOM panel fill the DICOM SCP Server connection parameters NV 54 PCECG1200 128 Norav Users Guide Saving the Stress Test as a RAW Data native binary Format File 1 Record a stress study 2 Under File menu create a RAW Data File A file with extension RDT is created with the following structure low byte high byte x 12 Leads x n samples 1sec 500 samples Leads sentence I II III AVR AVL AVE V1 V2 V3 V4 V5 V6 Sample Second Byte Number Byte Type Lead Number Number Number 1
89. nformation 2 information and disk and RAM memory size The HASP ID number is used for identification of the software key for adding software options Patient Toolbar Find a Patient Patient gt Find Allows the user to find a patient by entering a string in any or all of ID Find Last Name and First Name fields Open Patient P Patient gt Allows the user to check for patient Detail a Open Patient information before performing a study on a patient Add New Patient to Database Patient gt New Patient Inserts a new patient You are prompted to enter partial or complete patient details Enter ID Last and First Name at least If patient details match an existing New 5 one you cannot add this patient to the list The existing patient matching the details will be checked to allow the user to add a study Delete a Patient x Patient gt Deletes an entry If the entry is not MER N Delete Patient empty of studies you will be asked Delete to confirm deletion Se a New Mm no gt New Starts the application and starts ce Test est recording NV 54 PCECG1200 120 Norav Users Guide 7 Or use E To do this ae ie this short Ore Description icon menu cut key Test Toolbar Open a Test en Test gt Open Allows the user to view a study Open Test You must first select a study to p activate OPEN Compare Rest Tes
90. ng Resting ECG Stress Test Y ua pusse USSBES NN i Database application Table 3 Program Icons Resting ECG is the basic software package It does not require a software key The following are optional and require software keys 0 Measurement and interpretation functions for Resting ECG NV 54 PCECG1200 12 Norav Users Guide ECG Database Heart Rate Variability Late Potential Monitoring ee gt gt gt gt Stress Test You can activate optional packages that have no key by selecting Simulator in Setup see Simulator ECG Page 44 If you have purchased the S2 remote viewing install the Remote View program from the Remote View directory on the CD This program enables a remote viewer for an ECG study The image is displayed in JPEG format mn Only one HASP key dongle per computer is possible If you already have a HASP key dongle 0 ya with a Norav option and would like to add an additional option s it will need to be added to your present key When requesting an additional software option kindly inform your local supplier that you already have a HASP key donele its serial number and the option codes To Note find this information go to Help About and copy HASP ID Number and Permissions To Uninstall PC ECG 1200 New Version Replacing Old Version There is no need to remove the previous installation The existing setup will remain fot the new vetsi
91. nger i Birth Date Fi27 09 1953 2 Age 51 58800321006113 Doactviewinsertdelete 5883216300011 Sugarelephantapplelion jewing Ser CE CM Yonialer Yolanda 7 4 en DR Weight kg 87 Height om 0 lyn uri Yahalomi Aaroni Yahalomimi Aaroni Patient Group lt None gt y Yahalomimit Aaronimi danieli Yehosua Don Yehosua ABCDEFGHIJKLMNOPQ davOKLASSOREEEds von lustigA s hjihgihgi ofdF hjt Ready Patients 25 Num Figure 40 Database Patient Query Norav Medical NEMS APPLICATION 117 ECGDBase1 Edb ECG DataBase Application Fil atient X Wizard Import Setup 2 About A amp m amp Ss x Groups Find Open New Delete Test Open Comp Copy Move Delete 3 Typ Date Ti Patient ar patients gt xj Ste Time Sen WHr 27 10 2004 0 123213 yoel ID Number Last Name First Name Wir 27110 2004 0 123213 yoel E Monitoring 26 10 2004 1 123213 yoel 1112 yaron yonat Rest 26 10 2004 1 123213 yoel 1115 REDBULL Alexis y e 6 10 2004 gel 12222 sfdds sf f 123213 yoel haem Study Properties EAI 1234 dav von lustig 1234 dear sir 1234 dsds rwerew 12345 Yahalomi Moshe October 26 200 ar er fe October 26 2004 1313 rew gd 1313 rew123 ad Description Technician fdgdf32 56787 longer Hugin 58800321006113 Doactviewinsertdelete test 5883216300011 Sugarelephantapplelion Doactviewins 6798 Yoniale
92. nnnnnnrrvnnnrsernensnnrnrrenssessensnnnnrsensnrseenennnnr 85 TABLE 19 LP SIGNAL AVERAGING TOOLBAR AND MENUS sosssossssesesesesesesrsrsrsrsrsrsrsrsrsrnrn 87 TABLE 20 LP SIGNAL AVERAGING NUMERICAL RESULTS sssssssssrsssrsrsrsrsrsrsrsrsrsrsrsrs rr rr rn 89 TABLE 21 MONITORING SETUP OPTIONS cccccccccsssessssecesecececsesssseceeecccsesessntsaeeeseeseneees 95 TABLE 22 MONITORING TOOLBAR AND MENUS ccoococonononononononononononononononononononononononononona 97 TABLE 23 HRV SCREEN annat ene 100 TABLE 24 MEASUREMENTS TOOLBAR AND MENUS sassossrseersrsrsrsrsrsrsrsrsrsrsrsrsrsrsrsrrrs rr rn rn 114 TABLE 25 DATABASE SETUP OPTIONS sssoososrerereresseserrrrerersrrerrrrerererrerrrrrr enes rr rerr rr rr rr rr rna 118 TABLE 26 DATABASE TOOLBAR AND MENUS ssssosossesesesesesrsrsrsrsrsrsrsrsrsrsrsrsrsrsrrrsr sr rr rr sen 0n 120 TABLE 27 STRESS RAW DATA FILE FORMAT cccccccncnonnonononcnnonononnnnonononconononannn ono rr rr rr rr nn 128 TABLE 28 MONITOR RAW DATA FILE FORMAT ssssossesesrsesrsrsrsrsrsrsrsrsrsrsrsrsrsrsrs rr rr rr rr rr rr rn en 129 Introduction 1 CHAPTER 1 INTRODUCTION Manual Organization This manual explains in detail how to install and use the PC ECG 1200 At the beginning of each application chapter there is a Quick Start section which is a brief explanation of how to carry out a study including the keyboard short cuts for the main functions If you are familiar with ECG procedures you can use this Quick Start section to get
93. o ULN 40904 11 Heart rate Slider time Total study time beats min Figure 31 Monitoring Screen NV 54 PCECG1200 Norav Users Guide Quick Start To Start a New Test 1 Click Fl or the New button on the tool bar 1 Insert patient details in the dialog box 2 Click OK 3 Click F2 or Start Stop button to stop data collection or wait until end time To Print 1 Click F6 or select Print item from the File menu 1 Select the printer from the Print dialog box 2 Click OK to close the dialog box and print the display Print Study print a selected time range and leads 1 Click Print Study on the toolbar or select Print Study Item from the File menu Define the time range and select the leads to print from the dialog box Click OK to acknowledge selection and close the dialog box Select the printer in the Print dialog box A GER Click OK to start printing Monitoring ECG Setup Click Setup on the Toolbar to access the following parameters Tab Option Description er d Lead Allows the user to select leads To select all leads click Select Be Ar All To deselect all leads click Unselect Selection Sample rate Allows the user to choose requested samples per second per channel Norav Medical Monitoring 93 Tab Option Description Check this option to monitor X Y and Z axis Clear the option 5 to select t
94. on If the new software version does not operate properly remove the old installation see Old Version Replacing New Version below and then remove the old existing setup as follows Start gt Run Type regedit OK Choose HKEY CURRENT USER gt Software NORAV MEDICAL gt Edit gt Delete Old Version Replacing New Version Uninstall the existing version as follows My Computer gt Control Panel gt Add Remove Programs gt PC ECG 1200 gt Add Remove gt OK Norav Medical Software Installation 13 To Free Disk Space and Ensure Smooth Operation Windows provides utilities to delete superfluous files and to defragment the disk Refer to Windows help for instructions on using Disk Cleanup and Defragment Backing up and Restoring Setups and Protocols When you reinstall or upgrade PC ECG 1200 the program overwrites your existing configurations and protocols To save the configuration data for stress application follow these procedures NV 54 PCECG1200 14 Norav Users Guide To Save Stress Test Setup Start Stress ECG Click View Save Setup see Figure 1 amp Stress PC ECG Application File View Help lv Status Bar Fi Easy Toolbars Mode Y Text Labels 3 Change Protocol Pe Setup Figure 1 Saving Stress Setup Name the file Provide a location in which to save the file and Click OK To Load Stress Test Setup 1 Start Stress ECG Click View Load Setup
95. ontains the following elements e Acquisition box e Patient cable e Data cable combined with power supply or USB cable e Software CD with the PC ECG 1200 installation package including Rest Measurements and Interpretation MEANS Stress Monitor HRV LP e gt gt o gt gt gt Database e Software key if optional software is included e One of the following devices PC ECG 12008 page 20 PC ECG 1200M page Error Bookmark not defined PC ECG 1200HR page 25 PC ECG 1200W page 27 Blue ECG page 31 ooo gt gt gt NV 54 PCECG1200 Norav Users Guide Programs Each program has a specific purpose The following is a brief description of when to use each one Rest Records and measures short ECG tests on patients in resting position up to 10 seconds Records and measures ECG tests on patients under stress conditions using a pre defined test protocol The stress test includes 3 basic stages e Rest Stress e Stress e Recovery Each stage may be divided into more than one phase according to the testing protocol used Monitor Works with an ECG device to record monitor and save a prolonged ECG test in rest condition HRV Tests according to time how patient pulse and heart rate varies with load medication etc LP Predicts tendency to ventricular tachycardia Database ECG Database Management System Manages patients and ECG tests details PC ECG Models 120
96. or printer Thermal Plotter Sets LPT port for optional thermal paper GDT BDT Automatic Setup automatic options for saving and or importing files in Format options GDT BDT format File Format Select the file format GDT or BDT Import 437 Codepage 437 Check this option to import Code page 437 Export 3 Codepapeda1 Check this option to export Code page 437 Edit Labels Click this button to open a dialog box with an editable list of the field labels used in the GDT and BDT files GDT BDT Define the directory path where the GDT BDT files will be Data directory maintained Token for PCECG Default is PEKG Token for Practice EDP Default is EDV1 Norav Medical Monitoring 95 Table 21 Monitoring Setup Options NV 54 PCECG1200 96 Norav Users Guide Toolbar and Menus era 3 y this Or select this SR To do this this Description short cut menu icon key Starts a new monitoring session Patient data can be entered prior to ECG recording optional ee ey O F1 ag New The recording time is set in SETUP for ECG os RECORDING The user can stop recording by clicking the GO STOP icon Ben dy F11 File gt Open Shows recordings saved on disk er E Ctrl S File gt Save Saves recording to disk Off line printing Determine the time range to be Pine 5 E6 File gt Print printed The acquired ECG is printed in miniature format horizontal 6 25mm sec and vertical 2 5 mm mV
97. orav Medical Troubleshooting 139 A Thick Straight Line is Displayed For All Leads Problem A thick straight line appears on screen for all leads when the connection to the acquisition box fails Solution When using USB connection check that the led on the 1200USB adapter is illuminated If the led on USB adapter is not illuminated check connections to the USB port and to the adapter If the led on the USB adapter is illuminated or if connected through RS232 check the connection to the acquisition box and make sure the box is switched on Noisy ECG Signal on Leads Problem A noisy ECG signal on one or more of the leads may be caused due to poor connection of the appropriate electrodes or leads on the patient Solution Check the connection of the appropriate leads on the patient Make sure the electrodes are applied OK on the patient NV 54 PCECG1200 140 Norav Users Guide Missing data after a thick line Problem On the screen and in printouts of the ECG appears for a few seconds a thick strait line and after that there is missing data for a period of time The ECG traces resume after this random period of time This problem may be caused due sleep mode or hibernation mode the PC entered while the ECG test was running Solution Any settings related to the power management should be disabled no standby no stop HD no hibernation etc on the laptop during the Stress test To set the power management
98. pe Printing Select this option to print the ST and ST slope values Clear to prevent printing Use last saved BP value during the stage Select this option to continue to use the same BP value that was last saved When not selected the last BP value will not be used Switch to Review Automatically Check this option to switch automatically to the Review screen at the end of the test When cleared the real time screen remains Print User Event Select 5 sec Prior and 5 sec Post Request or 10 sec Prior to set the time of ECG printed in reference to the time the Print button is pressed NV 54 PCECG1200 66 Norav Users Guide Tab amp Secondary Tab Option Description Remarks processing Defines statements that can be entered during the test It is divided into five sets of statements used during real time and post Remote View Valid for option S2 Enables viewing a study that takes place in any of the network stations across the whole network Enables a physician to view a study remotely Table 8 Stress ECG Setup Options Toolbar and Menus Main Click py An To do this this a a EMIS Description short cut menu icon key Start a new O F1 File gt New Creates a new study study Open an zu bis existing study gt F11 File gt Open Opens an existing study Save p A Ctrl S
99. pen OPTIONS panel Mark Update Worklist checkbox Insert correct File name for Patient List file Insert correct path for store the Patient List file Setup chapter Note mm p The Patient List settings must be same as selected in Database application setup see External Patient Data file under Database c Workflow a that is taken from MWL b Personal ID Last Name Clear Previous First Name Birth Date Sex Weight ka Refer Phys Select import from DICOM MWL option On DICOM section fill the DICOM MWL Server connection parameters NoravScheduler utility fills the PatientFile ini with list of orders for current date On begin of a new test select the patient name from list using the EXTERNAL button on a patient dialog box External Patient List Type ID Number or select it from list Tech Name Figure 42 External Patient List First Name John Jim John111 Last Name Demo Demol Demo111 ID Number 123 1234 12345 Norav Medical Interfacing with Information Systems 127 Store Encapsulated PDF reports to DICOM SCP Supported in Resting ECG and Stress ECG applications To enable the Encapsulated PDF report functionality a In Resting ECG Stress ECG software setup Enable Auto Save parameter for PDF files Select all checkboxes under the Checked Fields option for PDF file
100. pervising physician Physician Physician 8 P 8 Poy i Norav Medical Stress ECG 67 Select a View gt different al Change current Changes the protocol protocol protocol Set preferences Pe Ctrl T View gt Setup Displays the setup dialog box To display information Help gt About Stress Displays program information version number and copytight Table 9 Main Stress Toolbar and Menus NV 54 PCECG 1200 68 Norav Users Guide Toolbar and Menus Stress Test Commands Ei a this Or select this Be To do this this Description short cut menu icon key Start st Le BE F2 Run stop Runs stops monitoring monitoring gt Start stress test IR F3 Te Ss Starts stress test test begin Start recovery Test gt phase F5 Racovee beuia Starts recovery phase Stop gt test recovery S F4 Steg Stops stress test or recovery phase phase gt Set an event gt F6 pe Sets events and prints according to options gt ae pod K ee BP Activates the blood pressure monitor gt Breeze tie il F7 run Freezes the current protocol stage current stage stage R eturn to the Tess previous F10 Returns to the next protocol stage Previous stage protocol stage Advance to the Test gt Next next protocol F8 Advances to the next protocol stage stage stage Control the gt exercise devic
101. r Yolanda 7776 yoavi Dartmore File Name C Program Files PCECG ECGDBasel Rest yoel rst 877 lyn uri F SOIREE A 88765 Yahalomi Aaron File Date October 26 2004 16 49 Filesize 80120 887655 Yahalomimi Aaroni Backup j 8876554 Yahalomimit Aaronimi 901 danieli Yehosua 90112 on Yehosua ABCDEFGHIIKLMNOPQ davOKLASSOREEEds von lustig SD hjihgihgi ofdF hjt Ready Tests 6 Nm Figure 41 Database Properties of Selected test Comparing Rest Tests NEMS application allows the user to compare rest tests on 1 or 12 channels To Compare Rest Tests 1 Select two or more Rest tests from the NEMS interface 1 Click Compare NV 54 PCECG1200 118 Norav Users Guide NEMS Setup Click Setup on the Toolbar to access the following parameters Tab Description Default Workspace Select the default workspace Choose Data Directory Input data directory with browsing option ns ee Input the location of the external patient data file with browsing option for Patient Data 5 PatientFile INI file file Delete with gt Check this option to require a password for DELETE default unchecked Password Check this option if NET key is installed on another computer server on the Check NET network Uncheck this option if the dongle is installed on the local working PC key if NET key is not installed elsewhere it is recommended to clear this option to save the software searching time SE Browse to se
102. rate ker Ergospirometry Extern ECG Aux Channels Parameter Selection High FiO2 lobile e MsCPx ECG Type Norav Set Style F1 activated in recovery Close ECG at end of measurement Ergometer e Bicycle Treadmill ECG None Jaeger e Extern ECG Path and program name CASE Network 3 C Programme PCECGistress exe Browse Title Use the text in ECG application Stress Path When ECG is not located on the same harddisk as the Jaeger software C LABS DB Skip device _ e None Blood pressure Bicycle Treadmill All 10 Time out in seconds to find connection with extern ECG program gt Apply gt Reload Ergometer selection meet cotos Hardware confouration ERE senn Figure 28 CareFusion LAB5 CPET Settings Norav Medical Stress ECG 77 Additional Features To Define Max HR dl 2 Open a test in a Review Screen post processing Click Properties on the toolbar The Properties dialog box is displayed Select the cell with the highest HR value Click Define Max HR The cell is highlighted and the background color of the cell is changed To Define Worst ST Open a test in a Review Screen post processing Click Properties on the toolbar The Properties dialog box is displayed Select a cell in one of the channels with the worst ST Click Define Worst ST The cells in the 12 channels of the same event are highlighted and the background color is changed A Dynamic ST function This
103. re Also information About i displays memory size and disk free space Allows the user to start the averaging period The ECG gt Start Stop F3 F4 Start Sto averaging period default is 200 beats It can be changed Averaging A top in OPTIONS ECG RECORDING and TARGET verging NUMBER Display Hide f Optional display of 5mm raster Print outs are always the grid El BEE with 1mm raster Start BEG AE F2 Start Sto Starts monitoring monitoring Monitoring 8 Stop Rn TER F2 Start Sto Stops monitoring monitoring D P 8 Activate Onset Cul amp ECG Onset Allows the user to move the Onset Marker using the Marker r marker direction arrow icons Activate Offset Cul gt ECG Offset Allows the user to move the Offset Marker using the Marker bs marker direction arrow icons el H markers Table 19 LP Signal Averaging Toolbar and Menus NV 54 PCECG1200 88 Norav Users Guide Interpreting Results When the signal averaging phase is complete the result screen is displayed ir Wie h Bislet aj a ale al pl um m pL et Mtas JHEMER 15 Syeisced Jest n Im Jr ES Irder an 1108 TI start kane vort rE r borr Paita resa GH em votersal Numerical results Figure 30 LP Signal Averaging Review Screen Norav Medical Late Potential Signal Averaging 89 Numerical Results Averaged Beats Displays the number of averaged normal beats
104. ry where the text files will be maintained PDF File Auto Save Test Data in Check this option to save the test data automatically to a PDF file PDF File format at the end of the test according to the naming and directory defined in this tab Set PDF File Name by Define the naming convention of the PDF file created automatically or on demand PDF File Data Directory Define the directory where the PDF files will be maintained Target Target HR Set the maximum male and female HR for to be allowed for use HR METS in the Target HR equation The target HR is affected by the age of the patient Norav Medical Stress ECG 65 Tab amp Secondary Tab Option Description Target HR warning zone Set the percentage of target HR for warning Above this level the HR trend is displayed in a different color If the percentage value is reached during the test and Switch to Recovery when reaches HR Warning zone option is checked the stress test stops automatically and recovery phase begins Stop Stress and start Check this option to stop stress test when HR reaches the target Recovery HR or warning zone and start the recovery phase When Switch to Recovery when reaches HR Warning Zone is cleared the Stress test continues according to the test protocol METS VO2 Formula Set the formula to calculate the METS VO2 values selection e To use a single formula check single formula for any speed
105. s QRS Norav Medical Measurements Interpretation MEANS 111 Caliper Display ES nents 6798 Yonialer Yolandi 1 Eile View Help SOA BKK e gt gt mjesje 2 4 Standard gt 40 mm mY NUM ED ao Figure 37 Measurements Caliper Toolbar of Caliper Display Previous QRS Right down market Marker time Figure 38 Toolbar of Caliper NV 54 PCECG1200 112 Norav Users Guide The Caliper screen above is opened via the menu the toolbar or by double clicking a lead in the QRS or Averages screens It displays one QRS with its values The user can edit locations of wave markers display different QRS in the same lead or navigate through leads and display QRS in different leads Changes in wave marker positions are recalculated and displayed in the tabular screen Toolbar and Menus Glick oe E a 6 this Or select this our To do this this Description short cut menu icon key vale E Ctrl S File gt Save Saves measurements to test file on disk Measurements Off line printing The ECG is printed in Print ECG 5 F6 ao Prot miniature format Horizontal 6 25 mm sec vertical 2 5 mm mV Add View Views Lets you enter free text during or after the ECG 07 Alt V R recording This is printed and saved together with Remarks Remarks ECG traces Reset measurements to those calculated by the Reset vi File gt
106. s ee Or select this To do this this en ee Description icon 3 cut key Starts a new 12 lead recording The patient data can be Start ae File gt New entered prior to ECG recording but this is not d k F1 Rest Test mandatory The recording time is according to the setup oe ven for ECG Recording either continuous or limited to 10 sec To stop recording click GO STOP an ee F11 File gt Open Shows recordings that are saved on disk existing study Import Data from SCP Format File gt Import from SCP Format Select the required file s and path SCP format is a European format for ECG files The Rest application can identify these files import them and save them as Rest files either to the database or to the from the defined folder for the Rest files dialog box and click OK File gt GDT BDT This file always contains the last patient data Import Format demographic data from HIS to For details see PC ECG Import from GDT BDT page 125 Norav Medical Resting ECG 49 Or use Click y To do this this cis Or SELLS Description E short menu icon cut key File gt GDT BDT Export the Format GDT BDT file For details see from PC ECG to Save Test in This file always contains the last patient data HIS GDT BDT page 125 Save a i E Ctrl S File gt Save Saves recording on disk default file name REST recording Sends recording data via email If the
107. scroll through the list until DIGITAL is highlighted and press the SELECT button to confirm the choice N Norav Medical Accessories Installation 37 i Using the UP or DOWN arrows select EXIT twice to return to the operating screen 5 Norav Stress ECG System Setup a In the Stress ECG software go to Setup gt Environment b Open the Automatic BP COM Port scroll box and choose the communications port to which you connected the RS 232 cable in Step 2 Check Measure BP by automatic device option Click Advance header select R wave Trigger Rising option on USB frame Click OK to close the Setup dialog To check functionality start a new stress test and when you click the Measure BP option under the Test main menu the Tango will take a measurement mo ao FAQs for Tango Q The Tango displays a status message What does it mean and what do I do A See the Quick Set Up guide that is attached to your Tango or the Troubleshooting section in your User s Guide for details on the Status Message and solution Q The Tango monitor returns results of 0 0 after blood pressure measurements What do I need to do to get a BP reading A There are certain noisy conditions where the Tango cannot accurately measure BP When the Tango encounters these situations it returns a reading of 0 0 Placement of the microphone attached to the cuff is critical for reliable operation of the Tango Follow the instructions in the Cuff Tutorial
108. second to display the ECG fseek handle Lead 1 10000 Sec 1 500 1 where Lead 1 2 3 12 and Sec 1 2 3 10 For example if lead AVR number 4 from the second 3 is requested fseek handle 3 10000 2 500 1 t fread handle sec 500 1 int16 where sec 1 2 3 4 10 Type plot t The graph is displayed NV 54 PCECG1200 Stress ECG 55 CHAPTER 1 STRESS ECG This option is available with S1 and S2 licenses Multiple lead display Selected display ST trends 12 averages Single QRS current Separating bars Figure 19 Stress ECG Results Screen To Customize the Display Click and drag the separating bar between two sections with the mouse cursor To Lock Screen Window Borders If you want to keep the display in its present format Click Setup gt View tab Check Lock Splitter NV 54 PCECG1200 56 Norav Users Guide Quick Start To Perform a New Test 1 Click F1 or the New button on the toolbar Insert patient details in the dialog box Click OK The preliminary Rest phase begins Click F3 or Stress button to start the Stress phase Insert blood pressure and or remarks if relevant in the dialog box and click OK Click F5 or Recovery button to begin the Recovery phase Enter blood pressure and or remarks if relevant in the dialog box and click OK Click F4 or Stop button to stop the test To Print an ECG 1 Select Print ECG
109. splay QRS ho Ge View Leads Aver Select next leads Figure 23 Stress ECG Post Processing Display Toolbar NV 54 PCECG1200 60 Norav Users Guide Post Processing Options Toolbar When the test is complete you can review it using the Post Processing Options Toolbar Show Display Skip to Open sav Cd Print results patient stages events previous Skip to next i details Setup as table event event Ss U amp DOD gt Q gt Fil Save Print PDFR Patient Rem Setup STLea Property Open Play Net ee Re Add Display next Display ECG Play current 5 remarks leads test in new event window Figure 24 Stress ECG Playback Toolbar Norav Medical Stress ECG 61 Stress ECG Setup Printer Definition Printer definition is very important because of the high data rate during real time printing If the printer has about 8 10 MB RAM set the graphic resolution at 600 dpi If the printer has about 2 MB RAM reduce the resolution to 300 dpi Click Setup on the Toolbar to access the following parameters Tab amp Secondary Tab Option Description ECG Recording Default filters Defines the filter s initial status in ECG recording Save format Defines the amount of data to be saved on the disk Save Options Auto Save Select this option to save the ECG test automatically at the end of the test The test will be saved into
110. sseeecsessseeeeeeeaes 109 FIGURE 30 TOOLBAR OF AVERAGES QRS ccssscesssecssseecesseecesseeceseeeceseeeesseeeesseeeeaees 110 FIGURE 31 MEASUREMENTS CALIPER ccsccscccsecccessesssseceeescesesesesseseceseceesenensasaeeeeees 111 FIGURE 32 TOOLBAR OF CALIPER cccccesesssssccecececeseesssseceeececsesesensaaeeesecccsesensaasaeeeeees 111 FIGURE 33 DATABASE MAIN SCREEN sssssesssceseccesceesesseceeeccesesesesseaeeeeeccesesensaeaeeesees 115 FIGURE 34 DATABASE PATIENT QUERY Essen aa GEN 116 FIGURE 35 DATABASE PROPERTIES OF SELECTED TEST ccccccccceeseeceeeeeeesseeeseseseeeeeees 117 FIGURE 36 EXTERNAL PATIENT LIST ccsccsccscecccessssssseceeesccsesessssauececescesesssssseaeeeses 126 FIGURE 37 RESTREPO Toi ask sahne 132 FIGURE 38 STRESS APPLICATIONS COMPREHENSIVE REPORT s sccsscceceesessrseceeeeees 133 FIGURE 39 ECG MONITORING REPORT sccsccsseccceseesssseceeescesecensnssaeeesececsesensseaeeeeees 134 FIGURE 40 HEART RATE VARIABILITY REPORT cccsessccscesececeesesscseeesececsseessnseeeeesees 135 FIGURE 41 LATE POTENTIAL REPORT cccccssssesceccccceccssessssscecccscceusuensscesceceeesuaenenss 136 xii Norav Users Guide List of Tables TABLE 1 MINIMUM COMPUTER CONFIGURATION ccooococonononononononononononononononononononononononononana 9 TABLE 2 PRINTERS INSTALLATION REQUIREMENTS sassosossrsrsrsrsrsrsesrsrsrsrsrsrsrsrsrsrsrs rs rr rr rn rn 10 TABLE 3 PROGRAM TIEONS aa lange anna
111. t available only for S2 software key option To start play back 1 Presson or on space bar key or select Test gt Play Back menu to open the Play Back window See Figure 27 71 PC ECG Application ssdidss ECG Period RO 2 5 mon fl E eon 2 10327 2 01 33 Horizontal scale Play Play Back Back Figure 27 Play Back Window NV 54 PCECG1200 72 Norav Users Guide 2 Navigate with the scroll bar to the requested time 3 Presson P or on space bar key or select Test gt Play Back menu to close the Play Back window Recovery Phase When you switch to recovery phase the recovery phase elapsed time is counted as well as the total elapsed time Wait for recovery phase to finish according to protocol or stop it using the stop icon Both TEST time and RECOVERY time are fixed Patient monitoring continues Click and disable Go to stop it Viewing Results There are two options for completing a stress test e Display the post processing data screen Review Screen automatically e Remain in ECG display To View Study Results Click the Post Processing icon This enables display and printout of the entire study Note that before saving the study to disk the entire ECG is kept for review To Display the Review Screen Automatically In Setup click the Real Time tab and check Switch to Review Automatically At the end of the test protocol or after clicking F4 the display switches auto
112. t gt Select two or more Rest tests from tests Compare the Database interface and click Compare This option is only available when you check Setup gt Ex ECG Recording gt Use ECG Comp Database Click Compare again to end Compare mode and display the Rest test Copy a Test gt Test gt Copy Copy Test Copies a study Move a Test Test gt Move Moves a study and deletes it from Test the database The default option is to leave the study s properties in the gt database upon completion of the Move operation The study remains in the list with an X sign You can choose to remove the entire study instead Delete a Test Test gt Delete Deletes a study from the database Test The default option is to leave the study s property in the database x upon completion of the operation Delete the study remains in the list with an X sign You can choose to delete the entire study instead Update File gt Update Updates the database Database Database Print Setup File gt Print Opens the Print Setup dialog box Setup to set printing preferences aa ss Te TES Displays study properties Properties Properties ni Table 26 NEMS Toolbar and Menus Norav Medical Interfacing with Information Systems 121 APPENDIX A INTERFACING WITH INFORMATION SYSTEMS There are several ways to exchange information between PC ECG 1200 and Hospital Information System HIS These are described below Demographic Data Information S
113. t the appropriate options The software is compatible with a metabolic chart manufactured by Ganshorn Germany USB Check R wave trigger option when using USB connection with BNC output if a blood pressure monitor is used or if external synchronization is needed Select the required R wave trigger width from the option list Check ECG option for analog ECG signal Use Transfer file Trnsf txt Check this option to use Trnsf txt file see page 74 Use real time protocol export file Check this option to use external CareFusion LAB 5 CPET system to export ECG exercise real time data When checked the path and file name can be defined Default C LAB5 DB ERGOSPIR DAT Exercise device Type Set up for PC ECG connection the external device treadmill or ergometer connection and type The factory default setup for the external device type is None In this mode the software does not control an external device Define the type of ergometer or treadmill that is being used Exercise Device Default protocol Valid for S1 S2 options Choose one of the available protocols or define your own protocol Exercise Device Speed unit Set up for MPH or KPH This option refers to treadmills only Exercise Device Emergency STOP Select the procedure for Emergency STOP Select Immediately for abrupt stop of the treadmill or Slow Down for gradually slowing down the treadmill unt
114. tached Lead or Offset gt 0 5 V Pacemaker Pulse From 0 1 to 2 ms at 2 to detection 700 mV Sensitivity mm mV 5 10 20 40 5 10 20 40 5 10 20 40 Standard 10 leads AHA IEC Detached Lead or Offset gt 0 5 V From 0 1 to 2 ms at 2 to 700 mV 5 10 20 40 Horizontal scale 5 12 5 25 50 100 Stress 12008 12 5 25 50 100 12 5 25 50 100 12 5 25 50 100 mm sec 8 channels 250 500 XYZ channels 250 12 5 25 50 100 Rest 1200M 500 1000 4 2 channels 250 ECG Max sample rate 16 000 samples sec gt 00 1000 Resolution A D bits 12 2 44 uV LSB 16 bits 0 3 V LSB 16 bits 0 3 12 bits 2 44 V LSB yu V LSB Defibrillation protection Yes Protected against 360 J Protected against Yes discharge 360 J discharge Simultaneously 12L Yes with sample hold Yes circuitry to assure zero delay between leads Low pass filter 20 35 40 Hz 20 35 40 Hz 20 35 40 Hz 20 35 40 Hz software Base line software Yes Yes Yes Line noise filter 50 60Hz 50 60Hz 50 60Hz 50 60Hz software Norav Medical Technical Specifications 131 Communication USB Digital RF Bluetooth interface 2 0 EDR Class1 up to 100m open Radio frequency range 2400 2483 5 MHz RF output power 0 4mW conform to FCC Battery 4 AA alkaline or 2 AA Alkaline or NiMH NIMH rechargeable Operation Time Up to 40 hours Up to 12 hours with alkaline batteries IEC 60601 1 EN 60601 2 IEC 60601 2 25 IEC 60
115. the ECG data Default is C Program Files PCECG Data Set FDA XML saving options ID Root and directory Select this option to save the test data in a FDA XML file automatically at the end of the rest test Check this option to set annotations for leads Select the leads that should be annotated If not checked the leads are disabled and no annotations will be saved in the FDA XML file Set the directory path to maintain the FDA XML files with the ECG data Default is C Program Files PCECG Data Insert ID Root for the FDA XML file Set Autosave option for SCP format and the SCP files directory Default is C Program Files PCECG Data NV 54 PCECG1200 48 Norav Users Guide Tab Option Desctiption een torma Set Autosave option for Mckesson format and the Mckesson files directory Default is C Program Files PCECG Data DICOM format Set Autosave option for DICOM ECG format and the DICOM ECG files directory Default is C Program Files PCECG Data A Autosave in PDF Select this option to save the test data as a PDF file automatically at the PDF File 7 format end of the rest test Set PDF file name PDF file data directory Set the PDF file name according to Test File Name or according to the selected field Set the directory path to maintain the PDF files with the ECG data Default is C Program Files PCECG PDF Table 5 Resting ECG Setup Options Toolbar and Menus Ale
116. the defined directory or to the database if used Set File Name by To add the Patient ID or Patient Last Name to the file name select the required option Simulator ECG When cleared default ECG recording is performed from the PC ECG unit When checked the ECG recording is performed from the demo file included in the software package In this case the recording unit is not needed On leads display and on reports the word Simulator will appear Alert Signal OFF There is an alert beep when reach the target warning zone of HR If this option is marked there is no alert Beep on QRS When marked beep is heard every time QRS is detected ECG Leads When using the standard 12 lead patient cable select the 12 Leads option to read and display up to 12 leads default When using a 6 lead cable select the 6 Leads option to read and view up to 6 leads Use ECG Database Select this option to connect to the default ECG database If this option is selected checked the ECG tests are saved in the database Data Directory Allows the user to define a directory for saved ECG recordings if ECG database is not used Use a secondary hard disk if one is available Lead Systems Default 3 leads Define the 3 leads that are displayed as default when using 3x1 view format Default 6 leads Define the 6 leads that are displayed as default when using 6x1 or 3x2 v
117. the mode of operation CONTINUOUS OPERATION NV 54 PCECG1200 20 Norav Users Guide Installing Model 1200S and Model 1200M The PC ECG 12008 or PCECG 1200M kit contains the following items Acquisition box see Figure 2 below Patient cable see Figure 3 page 21 USB cable see Figure 4 Page 22 Software CD of PC ECG 1200 installation package SS gt gt gt o Software key if optional software is included Figure 2 PC ECG 1200S PCECG 1200M Norav Medical Hardware Installation 21 Clip connections Banana type connections Press stud type connections Figure 3 Patient Cable NV 54 PCECG1200 Norav Users Guide Norav Medical Hardware Installation 23 To Connect Via USB Make sure the device is switched off Cautions refer to practices necessary to ll protect against potential damage or loss to equipment Caution 1 Connect the A type connector of the USB cable Figure 4 Page 22 detail 1 to the PC 2 Connect the B type connector of the USB cable Figure 4 Page 22 detail 2 to the input of the 1200 S unit Figure 2 Page 20 detail 1 A wizard for installing new hardware driver appears Follow the instructions If working under Windows XP press Continue anyway on message regarding the digital signature After the driver is installed make sure the green light is illuminated on the 1200 S unit Figure 2 detail 3 Verify that the ON l
118. tte HR Trend s Color To modify the colors in the HR Trend s window click the appropriate button and select the color from the color palette Restore Defaults Click to restore the default factory colors Installation Saves hospital and physician data This data is included in print out and email Measurement Standard Define whether measurements will be calculated according to the metric or the USA standard The default is metric Norav Medical Late Potential Signal Averaging 85 Tab Option Desctiption Vane Gard Redal Select this option to use a magnetic card with bar code to insert patient details Select the magnetic card type Environment Connection Use the option button COM port USB to select the port for device connection If COM port is selected select the serial input for the PC ECG unit from the COM port list If the USB connection is selected the COM PC ECG selection list is disabled Default at installation is USB Graph paper If ON prints 1mm and 5 mm squares on printouts Regular grid prints from all printers Improved grid shows a fine grid but may not work on some printers Use Large Fonts for Remarks Enlarges font for free typed text Color printouts Clear this option to force B W printing on color printer Display Size Choose between 14 15 inch screen default and 17 inch screen This setting is required in order to display the ECG an
119. up Otherwise the program will operate according to the factory setup Note NV 54 PCECG1200 58 Norav Users Guide Toolbar Overview Main Toolbar Easy Toolbars Mode This toolbar is displayed at startup Use it to open an existing test or to begin a new one New Change Setup protocol D a Ff 2 q FL Fil Chang Super Setup About Open saved Supervising About study Physician Figure 20 Main Stress Toolbar Stress Test Commands This toolbar is displayed at the start of a new test Run stop pre test Manual monitoring Set event control Begin Previous Zoom heart Add Setup recovery stage rate remarks b P I A a Rem Setup F5 F4 F6 F7 F8 F9 HR Change Begin Stop test Freeze Next stage Emergency Supervising stress test stage stop treadmill Physician Figure 21 Stress Test Commands Toolbar Norav Medical Stress ECG 59 Views and Filters Toolbar The toolbar controlling views filters appears beneath the main toolbar Select Select leads Display horizontal vertical to display Select filters Play Back scale sey dk EMG BL 25 mm sec vi 10 mm vi View 50 Hz EMG BL ECG Play Display next Display leads ECG only Figure 22 Stress ECG Views and Filters Toolbar Average Viewer Toolbar The toolbar displaying various post processing views appeats to the right of the Views and Filters toolbar Select leads Display to di
120. ut may not work on some printers Large Remarks Enlarges font for free typed text Font Color Printout Clear the check box to force B W printing on color printer GDT BDT Automatic Define automatic options for saving and or importing files in GDT BDT Format Options format File Format Select the file format GDT or BDT Import T ET Check this option to import Code page 437 Export i Codepapeday Check this option to export Code page 437 Click to open a dialog box with an editable list of the field labels used in the Ba GDT and BDT files SD DT Define the directory path where the GDT BDT files will be maintained Data directory Token for 3 PCECG Default is PEKG Token for Default is EDV1 Practice EDP Norav Medical Heart Rate Variability HRV 103 Starting a Study 1 T Click New Enter patient data in the Patient Data field The ECG leads are monitored on the screen for quality check If you are satisfied with the quality check click the R R icon The display comprises three sections The ECG leads are displayed on the upper part of the screen 0 The tachogram trend display is built up in the middle strip 0 A slider shows the study status and time at the bottom During the study define a new time segment interval by clicking the flag icon interval Name each interval during the study to retain it as a valid interval When all predefined beats are comp
121. ution 1 Connect the USB A type connector of the USB cable Figure 5 Page 25 detail 3 to the PC 2 A wizard for installing new hardware driver appears Follow the instructions If working under Windows XP press Continue anyway on message regarding the digital signature each time it appears After the driver is installed make sure the green light is illuminated on the 1200 HR Figure 5 Page 25 detail 4 NV 54 PCECG1200 26 Norav Users Guide 3 Connect the patient cable Figure 3 page 21 detail 8 to the 15 pin plug of the PC ECG 1200HR Figure 5 Page 25 detail 2 To Verify the Connections 1 Run REST application 2 Press F1 for a new test 3 Insert patient details in the dialog and then press OK 4 Verify that traces are acquired and displayed on the screen To Connect to the Patient and the Computer 1 Verify that the indication LED is on 2 Connect the electrode leads to the electrodes starting with RL 3 If the optional software key is included connect it to the parallel port of the computer 4 Ifa printer is connected plug the printer cable into the key To Verify the Connections 1 Connect the PC ECG 1200 to the patient 2 Connect the electrode leads to the electrodes starting with RL 3 Verify that an ECG is acquired and displayed on the screen To Perform Maintenance The device is not waterproof Do not expose the device to water or any kind of
122. y is useful when the data directory or database is not on the same computer In such a case ECG file save can fail due to failure in connection Optional Active only if the measurement option 11 13 is installed Defines the ST spot relative to the J point Relates to the checkbox status of the Confirm Diagnosis on the Remarks dialog of the Interpretations If checked the default value of the checkbox on the Remarks dialog will be checked If not checked the checkbox on the dialog will be unchecked Allows the user to determine if and when to have automatic results printed Define if measurements and or interpretations should be added to printouts Options are Never After Confirmation or Always If checked default does not limit the extreme high amplitude ECG pulses from exceeding the borders If cleared chops the pulses at the borders If cleared default the 1 mV pulse will appear only in printing If checked the 1 mV pulse will also appear on the screen If cleared default the base line of each lead is exactly in the middle of the lead s area If checked a special shift is added to each lead to view its maximum For example lead V6 being positive pulsed gets negative shift If checked leads are displayed framed and separated from each other If cleared leads are not separated Default is checked If checked displays grid lines when the application is opened If cleared the application is opene
123. ystem Biomedical 91 22 4963147 KIP Machines KIP Series 5411 4327 2963 DB9 Male Lines RX TX GND standard 54341 464 7302 place in DB9 54341 463 7919 Male connector BONTE Bonte 31 038 4554030 DB9 crossed Treadmill SUB MACHINEFABRIEK D 25 lt gt PC B V SUB D 25 2 3 3 2 Vo 7 BONTE Bonte2 MACHINEFABRIEK B V Parker PM 1 334 8213221 D 9 female Straight Parker Parker 1200 Micromed Micromed Requires a special adaptor supplied by Norav Medical Table 14 Controlled Treadmills Norav Medical Stress ECG 79 RS232 Controlled Bicycle Ergometers Vendor Model Vendor s Fax RS232 RS232 Wiring Connector on Type the Ergometer LODE BV Corival LODE EXCALIBUR Ergoline ER900 49 7431 989427 DIN 5 pin SECA CT100 49 40 20000050 D 9 male Crossed ERGOSANA 41 41 7618022 D 9 female Straight Daum ERGOFIT Tunturi T PROTOCOL Monark Monark Monark 339E Technogym Bike C Safe protocol Dimeq 770 49 30 72376240 ELMED Table 15 Controlled Ergometers NV 54 PCECG1200 Late Potential Signal Averaging CHAPTER 2 LATE POTENTIAL SIGNAL AVERAGING This option is available with the L1 license Signal Filtered Vector averages averages magnitude Di Dv phos ial AG Vener P a 1 se y Y HESELFETEIS ins VI se Heart trends Figure 29 Late Potential Signal Averaging Screen
124. ystem Prepares Patient Demographic Data for PC ECG 1200 This uses a text file called PatientFile ini The location is defined in Database setup File Name PatientFile ini File Format PATIENTDATAXXX ID LastName FirstName BirthDay BirthMonth BirthYear Sex Weight Height Address Phone1 Phone2 Fax E Mail Medications Other PatientDataXXX Section name XX X number from 000 to 200 At least one of the keys ID LastName or FirstName must be completed If all these keys are empty section of this patient will be ignored The keys Height Address Phonel Phone2 Fax Email Medications and Other appear only with Database NV 54 PCECG1200 122 Norav Users Guide Example PatientData001 ID 1234567890 LastName Smith FirstName Worker BirthDay 11 BirthMonth 6 BirthYear 1959 Sex 1 Weight 59 Height 170 Address 523 Main st Tacoma Mexico Phone1 702 8765643 Phone2 702 8743031 Fax 702 8743032 E Mail nkir sympo ca Medications none Other none PatientData003 ID 123456789 LastName Smith FirstName Worker3 Norav Medical Interfacing with Information Systems 123 HL7 Format File PC ECG Prepares HL7 Format File with Stress Test Results This file is created upon demand in the study review screen The file of Stress test in Format HL7 includes 1 Patient Information Name Last Name Id Number Birth Date Sex Weight John Smith 12345678

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