PBI QRS-Card Cardiology Suite 4.

0X Rev 2 1

USER GUIDE

Cardiology Suite 4.0x

Resting, Stress, Holter, ABPM* and Spiromety*

*
USA Customers supplied with
software from device manufacturer
and not Cardiology Suite4.0x Software

Pulse Biomedical Inc.

1305 Catfish Lane
Norristown, PA 19403
USA
610-666-5510 Tel
610-666-5630 Fax

[Link]

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 2

System Setup
QRS-Card Cardiology Suite 4.0 Overview
The QRS-Card Cardiology Suite is a state-of-the-art ECG device(s) which when interfaced to an IBM ®
compatible personal computer converts the computer into a highly sophisticated Cardiology Suite (Resting ECG,
Stress ECG system, Holter ECG, Ambulatory Blood Pressure Measurement and Spirometry System). Physicians can
run Resting, Stress, Holter, Blood Pressure and PFT tests on patients using a standard Desktop or a notebook computer.
Results of the tests can be viewed on the computer color screen and can be printed automatically (or on demand) at any
time during a test. The results of the tests can be saved on the computer hard disk for future referral or report
generation purposes.
The QRS-Card Cardiology Suite is programmable for treadmill and Ergometers controls. Input of blood pressure
can be performed automatically (screen prompts or direct interface to BP device) at predefined intervals.

QRS-Card Cardiology Suite Components and Assembly:

Depending on the total number of Cardiology Suite Modules you have purchased includes the following hardware and
software components:

Resting and Stress ECG System

1. QRS-Card ECG device
2. ECG Patient Lead Wires
3. QRS-Card data cable (USB or Serial)
4. QRS-Card Cardiology Suite Software CD
5. User s Guide
6. Quick Reference Card
7. USB Security Key with Product ID Number (PID)
* For Hardware Installation and Setup see Appendix X

Holter ECG System

1. Holter Recorder
2. Holter ECG leadwires
3. Holter Recorder Pouch
4. Holter recorder data cable (or flash memory card reader)
5. QRS-Card Cardiology Suite Software
6. User Guide
7. Quick Reference Card
8. USB Security Key with Product ID Number (PID)
* For Hardware Installation and Setup see Appendix X

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 3

Ambulatory Blood Pressure

WARNINGS
US Customers will be supplied with ONLY software supplied by the device manufacture
(and not the Cardiology Suite ABMP software module).
1. Ambulatory Blood Pressure Recorder
2. Blood Pressure cuff
3. Recorder Carrying pouch
4. Data cable (serial or USB)
5. QRS-Card Cardiology Suite Software
6. User Guide (Supplied on Software CD)
7. Quick Reference Card
8. USB Security Key with Product ID Number (PID)
* For Hardware Installation and Setup see Appendix X

Spirometry

WARNINGS
US Customers will be supplied with ONLY software supplied by the device manufacture (and
not the Cardiology Suite Spiromtery software module).
1. Spirometer
2. Disposable Mouth Piece
3. Data cable (Serial or USB)
4. QRS-Card Cardiology Suite Software
5. User Guide (supplied on software CD)
6. Quick Reference Card
7. USB Security Key with Product ID Number (PID)
* For Hardware Installation and Setup see Appendix X

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 4

QRS-Card Cardiology Suite 4.0 Software Installation

The first time you use the system, you need to install the QRS-Card Cardiology Suite software by using the Setup
file on the QRS-Card Cardiology Suite software CD. Once the software is installed, you will be able to use the
QRS-Card Cardiology Suite for Resting, Stress, Holter, Ambulatory BP and Spirometry. It will take
approximately 3 to 5 minutes for all of the directories to be created and for all of the files to be copied to your computer
hard disk.
In order to install the QRS-Card Cardiology Suite software, the following steps are required:

1. Switch on and boot up your computer with Windows XP, Window 2000 or Windows Vista
2. Insert the QRS-Card Cardiology Suite software CD into the CD drive.
3. Follow the instructions on the screen
4. Once the installation is complete, you are ready to start using your computer for Resting ECG, Stress ECG,
Holter ECG, 24 hour BP and Spirometry .

NOTE: 1. Write down the Product ID (PID) of your QRS-Card ECG device written on the USB Security
Key and also on the back of your QRS-Card (or provided by dealer or distributor). For Demo software Tutorial the
PID is 0001-0001-2000-DEMOU .

2. For Hardware hookup and setup please see appendix XX

Product License and Registration Screen

License - Registered
Company Serial Number (SN) Register
Name PID (Product ID) Modules Activated
(Bought/Acquired)

Press "CTRL F1" or Select from pulldown menu "HELP" then "About"

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 5

Quick Start ---------------- -------------------- RESTING ECG

1. Connect QRS-Card ECG machine to your computer USB port (or serial port).
(See Appendix X for more help)
2. Start QRS-Card Cardiology Suite Software on your computer
3. Perform one time Setup for your Resting ECG
( File/Resting/Setup or Press CTRL F2 . See Appendix X for more details)
4. Press Resting ECG button (or Hot key F2 ) on the Main Software Screen
5. Type in Patient demographic data
(if Setup screen is displayed then press OK to go to patient demographic data input)
6. Press OK button to start acquire Resting ECG
7. ECG report will be printed manually or automatically
(Auto or Manual print depends upon printing preference under Resting Setup)

Print ECG ECG Heart Blood

Save Strip If not Auto Print Finish Test Measurements Rate
If not Auto Save Pressure
If not Auto Save

Resting ECG Acquisition

Resting ECG Acquisition

Patient ECG Tabular Reports Heart

Blood Pressure
Data Data Data Help Rate
Resting DataView

Resting DataView

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 6

Resting ECG Flow Diagram

Easy Steps To Perform Resting ECG

A. Press Resting Button to Start a Test

B. Enter Patient Demographic data

C. Auto or Manual Print Test Report

A
SETUP FOR AUTO PRINT:
For Auto Report Print to work: Start Resting Test
a. Printer MUST be attached to the computer
b. Under Resting/Restup (CTL+F2)
i) Print ECG Report Must be checked off
ii) Type of Report
(e.g 12 Lead Standard) must be selected

B
Enter Patient Data
C AUTO PRINT
Must be defined
in Resting Setup

MANUAL PRINT

View Saved Test

MANUAL PRINT of reports can be done:

a. From Main Menu
- Select a desired Patient/Test
- Press Print Button
- Select Type of Report (s) to Print List of Saved Tests
b. View / Edit / Typing of Notes/comments
- From Main menu Select a desired Patietn/Test
- Press Open/View Test Button
- View Test / Type Notes
- Press Print Button
- Select Type of Report to Print

Print Report (s)

Multiple Style Reports
View / Type Notes

Task performed during a Resting ECG

Save Strip Print ECG Finish Test

Save Strip Print ECG

Finish
Only When No Auto Save on Demand
Test
Single Style Report If No Auto Save

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Quick Start --------------------- ------------------- STRESS ECG

1. Connect QRS-Card ECG machine to your computer USB port (or serial port).
(See Appendix X for more help)
2. Start your QRS-Card Cardiology Suite Software on your computer
3. Perform one time Setup for your Stress ECG
( File/Stress/Setup or Press CTRL F3 )
See Appendix X for more details
4. Press Stress ECG button (or Hot key F3 ) from the Main Software Screen
5. Type in Patient demographic data
(if Setup screen show then press OK to go to patient demographic data)
6. Press OK button to start acquiring Stress ECG
7. ECG report will be printed after the completion of the Stress Test
Save Demand Finish
Advance Begin Enter Pause
Annotate Print Test
Stage Recovery BP Protocol
Strip
Stress ECG - Acquisition

12 LEAD RHYTHM AVERAGE

COMPLEX

TREND
HR, BP, ST
SPEED/ELEV

ARRHYTHMIA / RHYTHM

Protocol
Phase Stage
Stress ECG - Acquisition BP
Speed
(Pre, Exercise, METS Stage Time
or Recovery) Elevation Phase Time Heart Rate Target HR
Reference,85%,100%
Page View Full Page /
Complex Strips Trend
Rhythm
FULL DISCLOSURE / RHYTHM / TREND

PAGE / FULL DISCLOSURE

Demand Print User Select

User Select Strip Strip
HR or RR

RHYTHM TREND

Stress DataView - Page/Rhythm/Trend

Stress ECG Flow Diagram

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 8

Start
Stress Test
A

Easy Steps To Perform Enter

B
A Stress Test Patient Data

A. Press Stress button to Start Test

SUPINE
B. Input Patient Demographic Data

Pre Test
Phase
C. Acquire Pre Test Phase ECG Perform HYPER Advance
Pre Test C VENT Stage

D. Acquire Exercise Phase ECG Phase ECG

1
WARMUP Advance
E. Acquire Recovery Phase ECG Stage

F. Complete Stress Test

Advance
STAGE E1 Stage
G. Print Stress Summary Reports

Exercise
Perform

Phase
Exercise D STAGE E2
Phase ECG

2
STAGE E3

Blood Pressure Input is automatically prompted

on the computer screen as per protocol in use

Recovery
STAGE "X"

Phase
Perform
Recovery E
Phase ECG RECOVERY Advance
Phase
3

Complete
Note: Complete ECG for the COMPLETE Stress Test is SAVED Stress F
to computer hard disk which then can EDITED/VIEWED/ Test
PRINTED Manually or Automatically.

Print Stress
Sumary Reports G
Multiple Style Reports

Task Performed During a Stress Test

Advance Stage Begin Recovery Blood Pressure Save Strip Print ECG Pause Protocol Finish Test

Blood Pressure Print ECG Pause or

Advance Begin Save Strip Finish
Auto or Manual on Demand Manual Protocol Test
Stage Revovery & Annotate
Single Style Report

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Quick Start ---------------------- ------------------- HIRES ECG

WARNINGS
Supplied for use only to outside US Customers

1. Connect QRS-Card ECG machine to your computer USB port (or serial port).
(See Appendix X for more help)
2. Start your QRS-Card Cardiology Suite Software on your computer
3. Perform one time Setup for your HiRes ECG
( File/HiRes/Setup or Press CTRL F4 )
See Appendix X for more details
4. Press HiRes ECG button (or Hot key F4 ) from Main Software Screen
5. Type in Patient demographic data
(if Setup screen show then press OK to go to patient demographic data)
6. Press OK button to start acquiring HiRes ECG
7. ECG report will be printed after the completion of the Stress Test

Note: In addition to placing limb leads at normal place on patient body, V1-V6 leads are places differently
then in Resting or Stress ECG.
V1 - +X
V2 - -X
V3 - +Y
V4 - -Y
V5 - +Z
V6 - -Z
HiRes Acquisition Screen

HiRes DataView Screen

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 10

Quick Start -------------------- ---------------------- HOLTER ECG

1. Record 24 or 48 hours patient s Holter ECG data

(For using/setup the recorder see recorder Operator guide)
2. Connect Holter recorder (or flash card) to the computer
(See Appendix for hardware setup)
3. Start QRS-Card Cardiology Suite Software
4. Perform one time Holter Setup
(File/Holter/Setup or Press CTRL F5)
See Appendix XX for more details
5. Press HiRes Button or Hot Key F5 from Main Software Screen to start Holter ECG procedure
6. Press OK button to start downloading and Analysis of the Holter ECG
7. Enter Patient demographic data while Holter data is being downloaded
8. Highlight patient from database listing then double click to View, Edit and Print reports
9. Edit any Bins, Episodes and Strips (if necessary)
10. Print Reports

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Quick Start ---------------------- ----------------------- ABPM

WARNINGS
US Customers will be supplied with ONLY software supplied by the device manufacture (and not the
Cardiology Suite ABMP software module).

1. Record 24 hours patient s Ambulatory Blood Pressure (ABPM) data

(For Using/Setup the ABPM Recorder see Recorder Operator Guide)
2. Connect Blood Pressure recorder to the computer via serial or USB Port
(See Appendix for hardware setup)
3. Start QRS-Card Cardiology Suite Software
4. Perform one time Ambulatory BP Setup
(File/Ambulatory BP /Setup or Press CTRL F6)
See Appendix XX for more details
5. Press ABPM Button or Hot Key F6 to start Ambulatory BP data download
6. Press OK button to start downloading Ambulatory BP data
7. Type in the Patient demographic data
8. Highlight the patient test from database listing then double click to view ABPM data
9. Print Summary Report

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 12

MAIN SOFTWARE SCREEN

Resting Stress Ambulatory

Hi-Res Holter Spirometry
ECG ECG Blood Pressure Help
ECG ECG

Rest ECG Stress ECG Hi-Res ECG Holter ECG ABP Spirometry Help

Name ID Date Open Print Mail Add Delete

Search by Delete
Name, ID Open Patient Print Add Patient
or Date Report New Patient

Test Report
Patient Preview
Database

MAIN SOFTWARE SCREEN

QRS-Card Cardiology Suit Software Master screen is divided into following sections:

1. Pull Down Menu Selection for various items (File, Utility, Logs and Help)
2. Buttons to QUICKLY access Test or to obtain Help (Resting, Stress, HiRes, Holter,
AMPB, Spriometry & Help)
3. Folders for Patient Names and Test Database
4. Patient Database tools (Search, Open, Print, Email, Add New Patient, Delete Patient)
5. Test Report Preview

Database Tools:
Sort Test
The ECG Tests can be sorted by name , patient ID or date acquired by clicking on the respective
buttons (Partial name or date sort can be typed in the empty space between the database listing and
the tool bar buttons)

To sort Tests by Name, from the toolbar press.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 13

To sort Tests by patient ID, from the toolbar press.

To sort Tests by Date, from the toolbar press.

Open Test
Use the Open Test command to retrieve a previously saved Test from the QRS database. After selecting
test, The Open Test command can be executed as follows:

From the toolbar press.

Print Test
Use the Print Test command to save and print the selected ECG Test to the QRS database and local printer.
The Print Test command can be executed as follows:

From the toolbar press.

Mail Test
The Mail Out option allows the user to E-mail ECG Test.

From the toolbar press.

ADD NEW PATIENT

To Add a Patient ahead of time and before patient test is started execute following command:

From tool bar press

Delete a Patient
Highlight the patient or the test to be deleted from the database the execute the following command:

From tool bar press

Note: To quickly search for a Name, ID or Date in a large patient database, type partial name, ID or data to jump
to the closet match.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 14

RESTING ECG

Topics
Modes of Operation
Starting a Resting ECG (Acquisition Mode)
Viewing a Resting ECG (Dataview Mode)
Resting ECG Setup

=====================================================
Modes of Operation
During normal operation of the QRS-Card ECG the system performs in either of three modes:

Standby Mode
Standby Mode is while QRS-Card Cardiology Suite Master screen is open and no selection of a test (new ore
review) has been made.
During this mode certain operation like patient search, adding a new patient or delete a patient can be
performed.

Acquisition Mode
The Acquisition Mode supplies the functionality to acquire Resting ECG data. The monitor mode displays

an icon, , in the left hand corner of the title bar.

During this mode patient is attached to the QRS-Card and the ECG data is seen in real-time on the computer
screen.
Dataview Mode
The Dataview mode supplies the functionality to view previously acquired ECG data. Open a patient record
to access the Dataview Screen. For more details see Open Test Record.

Print ECG ECG Heart Blood

Save Strip If not Auto Print Finish Test Measurements Rate ECG Tabular Heart
If not Auto Save If not Auto Save
Pressure Patient Reports Help Blood Pressure
Data Data Data Rate
Resting ECG Acquisition

Resting DataView

Resting ECG Acquisition Resting DataView

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 15

STARTING A RESTING ECG TEST

A Resting Test can be executed by the following methods:

- From the Acquisition Screen select File > Resting > Perform Test OR

- From the toolbar select the Resting ECG icon OR

Use the Hot Key F2

Executing the Resting Test by one of the above methods will cause the Resting Setup dialog box to be displayed (IF the
Show This Window box has been checked in the Resting Setup. See Resting Setup.) After the Resting Setup dialog
box the Resting ECG Patient Information property box will appear.
Fill in the appropriate Information in the Patient, Test Information and Medication.

Click OK to start the Resting ECG.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 16

Print ECG ECG Heart Blood

Save Strip If not Auto Print Finish Test Measurements Rate
If not Auto Save If not Auto Save
Pressure

Resting ECG Acquisition

Resting ECG Acquisition
Save Strip:
Pressing this button Saves a 10 second ECG Strip.
During normal Resting ECG Test, selection of this button is not necessary as 10 Seconds ECG
trace is automatically saved.

Save Strip option is only applicable when selection under Resting setup:
Exit when all task completed is unchecked.
Note: Multiple Resting ECG traces can be saved under this setup.

Print ECG:
During normal Resting ECG this options is not necessary as 10 Seconds ECG trace is
automatically saved and can be printed automatically (or manually)

This Print button is applicable when selection under Resting Setup:

Exit when all task completed is unchecked.

Note: Only one kind of report can be printed with this option and it requires a HP PCL5 printer
attached to computer for printing this report
Finish Test:
During normal Resting ECG this options is not necessary as after 10 Seconds ECG trace Resting
ECG acquisition is automatically terminated.

This Print button is only applicable when selection under Resting Setup:
Exit when all task completed is unchecked.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 17

VIEWING A RESTING ECG DATAVIEW SCREEN

To view (or edit) a Resting ECG test, highlight from Main Screen the ECG Test desired then click on the
button on the toolbar. OR
Double click on the Test to be reviewed.

When a Resting test record is opened, the Resting Dataview screen is displayed. Information about the
patient can be viewed and/or edited, data from the test viewed and reports printed. An outline of the
features and options displayed on the Resting Dataview screen is given below, along with any available
links to other relevant topics.

Patient ECG Tabular Reports Heart

Blood Pressure
Data Data Data Help Rate

Resting DataView

Resting DataView

Edit
Use the Edit option to view or edit information about the patient and trace recalled from the database. The Edit
option can be executed by the following methods:

Patient and Test Property Sheets

Information about the patient is present in these two property sheets. If necessary, the information can be
edited.
Medication

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 18

Information about Patient medication is contained is contained in this property sheet.

Signal
Parameters on how the ECG was obtained, such as the sampling rate and use of filters, are contained on this
property sheet.

View
Page Window

Clicking on the blue in the upper right hand corner or the window will cause the toolbar to be
displayed. Clicking on the crossed out will hide the toolbar.

Lead View - Select to change number of leads to be displayed.

Available options are: 1, 3, 6 or 12 Lds

Gain - Select to change gain for ECG data

Available options are: 5, 10, 20 and 50 mm/mV

Speed - Select to change the Speed of ECG Data display

Available Options are: 10, 25 and 40 mm/sec

View - If depressed the Rhythm data will be displayed on the bottom of

the screen along with Page View on the top of the screen. Pressing this button
second time will hide the Rhythm data window.

Rhythm Window

Gain Select to change gain for ECG data

Speed Select to change the Speed of ECG Data display

Measure Select to measure ECG Measurement

This option can be used to measure the distance in time between two points.
Click on measure. Click on the first point and drag to the second point. The
bottom number is time in sec. It can also measure the differential in height of
two points. The top right number is this differential in mV.

Print Select to print the segment displayed in the Rhythm window .

Grid If pressed, the grid will be displayed in the Rhythm window.

Pressing this button second time will remove the ECG Grid

HR If pressed, the HR will be displayed for annotations.

Pressing this button second time will show RR time in second.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 19

Summary
Pressing summary button provides summarized data for ECG measurements and automatic ECG
Interpretation.
Table
This table provides different amplitude measurements from all 12 ECG leaads
General
This selection provides ECG Complex measurements. Moving measurements marker
(using left mouse button) user can manually over ride the automatic ECG measurements
P Wave
This provides P wave measurement markers. Left mouse button can be used to move the
marker to over ride automatic P wave measurements.
QRS Wave
This provides QRS Complex measurement markers. Left mouse button can be used to
move the individual marker to over ride automatic QRS Complex measurements.
T Wave
This provides T wave measurement markers. Left mouse button can be used to move the
marker to over ride automatic T wave measurements.
Hypertrophy
Provides Hypertrophy scores for Sokolow Lyon, Cornell and Estes.
Interpretation
Provides Computer generated Automatic ECG Interpretation. Typing free text or
accepting Statements from the Statement Libarary can over ride this Automatic ECG
Interpretation box.
Note: For the Automatic Computer Interpretation to work in the Resting test this option
has to be selected in the Resting Setup.
The Interpretation property sheet shows the computer-generated interpretation. The user
can also enter their own interpretation.
Click on the arrow from the computer interpretation box to enter that into the Physician's
Interpretation box. Other interpretations are available in the Statement Library on the
right of the screen. Select the statement desired and click on the arrow to transfer it over
to the Physician's Interpretation box.
If the computer interpretation is not appropriate and no statements from the library can be
found to describe the test record, the physician can add his own interpretation by simply
clicking in the Physician Interpretation box and starting to type.
In a view-only box at the bottom of the screen, the date and time of the computer-
generated interpretation is displayed. If the computer interpretation is not used, the name
of the analyst who overread the interpretation and the physician that confirmed it, along
with the date and time, can be entered.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 20

Report
Checked Off reports can be printed (automatically or manually) to printer attached to the computer.

If selection is made for PDF File Viewer then report will print as PDF file to the computer screen.
Save option button from Adobe Acrobat reader will make the report saved in PDF format, which
can be printed or emailed, if required by the user.

Note: In order to print PDF File Viewer to computer screen, installation of Adobe Acrobat Reader
6.0 or higher on user computer is required (also make sure that correct version of Acrobat Reader
is selected under \Utility\Configuration\Option\PDF . To make sure select Detect )

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 21

RESTING ECG SETUP

Resting ECG Setup is used to select various options for ECG saving and printing purposes. Resting Setup can be
accessed two ways:
From the Acquisition Screen select File > Resting > Setup and the Resting dialog box will appear OR
Click on the Rest ECG icon. If the "Show This Window" in the Resting Setup has been previously checked, the
Resting Setup dialog box will automatically be displayed.
Executing Stress causes the system to display the Resting dialog box.

Show This Window

If checked, the Resting dialog box will appear when accessing the Resting Test (File > Resting > Perform
Test or clicking on the Resting ECG icon). If not checked, the Resting ECG Patient Information dialog box
will appear first when accessing the Resting Test.
Show Electrode Position Diagram
If checked, the electrode positioning diagram will be displayed after the Resting ECG Patient Information
dialog box and before the Resting Test starts.
Collect Blood Pressure Measurement
If checked, the Blood Pressure dialog box will be displayed after the Resting patient information has been
entered. Enter the patient's blood pressure and click OK to continue.
Start Test When Measurements Valid
If checked, the test will automatically started once it is determined that the measurements are valid. If
unchecked, the ECG will begin, but the test will not start until the Save Strip icon is clicked on the Resting
ECG toolbar.
Provide Automatic ECG Interpretation
If checked, automatic ECG interpretations will be supplied.
Print ECG Report
If checked, an ECG Test report will be printed automatically after collection of the Resting ECG and will be
saved to the computer hard drive.
If the print ECG report option is checked, check the type(s) of reports desired.
View Test Record
If checked, the ECG record will be displayed right after the data is collected.
Exit When All Tasks Complete
If checked, the program will return to the Standby mode when all the tasks selected for the Resting ECG test
are completed. (NOTE: This feature, unchecked, can be used to save multiple Resting ECGs of the same

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 22

patient.)
ECG Filter
Electrical Interference
Allows the user to apply a 50Hz or 60Hz filter to smooth out the signal. If desired, the filter can
also be turned off.
Artifact Rejection
If the Artifact Rejection option is chosen, artifacts, like those caused by muscle twitches, will not
be assigned as peaks.
Baseline Drift Reduction
Drift of the baseline will be minimized.
Default Reports:
Checked Off reports can be printed (automatically or manually) as default reports to printer
attached to the computer.
ECG Acquisition
Recorder
Defines if the signal is coming from a QRS Card, a simulated device (QRS demo) or a remote QRS Card.
Sample Rate
Defines the sampling rate, per second.
Length
Defines the length of the ECG trace, in seconds, that is saved.
Average Cycles
Defines the number of beats averaged to make a complex ECG.
Screens
Defines Default parameters for Screen display values e.g. Gain, Speed, Lead Display etc for
Acquisition and Dataview Screens. See Appendix X for more help and details.

Reset Button
Selecting the Reset button will reset all parameters to their default positions.

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STRESS ECG
Topics
Modes of Operation
Starting a Stress ECG (Acquisition)
Viewing a Stress ECG (Dataview)
Stress ECG Setup

===================================================================

Modes of Operation:
During normal operation of the QRS-Card ECG the system performs in either of three modes:

Standby Mode
Standby Mode is while QRS-Card Cardiology Suite Master screen is open and no selection of a
test (new ore review) has been made.
During this mode certain operation like patient search, adding a new patient or delete a patient can
be performed.

Acquisition Mode
The Acquisition Mode supply functionality to acquire Stress ECG data (in real-

time). The monitor mode displays an icon, , in the left hand corner of the title bar.

During this mode patient is attached to the QRS-Card and the ECG data is seen in real-
time on the computer screen.
Dataview Mode
The Dataview mode supplies the functionality to view previously acquired Stress ECG data. Open
a patient record to access the Dataview Screen. For more details see Open Test Record.
Save Demand Finish
Advance Begin Enter Pause
Annotate Print Test
Stage Recovery BP Protocol Page View Full Page /
Strip Complex Strips Trend
Rhythm
FULL DISCLOSURE / RHYTHM / TREND
Stress ECG - Acquisition

PAGE / FULL DISCLOSURE

12 LEAD RHYTHM AVERAGE
COMPLEX

Demand Print User Select

User Select Strip Strip
TREND HR or RR
HR, BP, ST
SPEED/ELEV

ARRHYTHMIA / RHYTHM RHYTHM TREND

Protocol
Phase Stage
Stress ECG - Acquisition BP
Speed
(Pre, Exercise, METS Stage Time
Elevation Phase Time Target HR
or Recovery) Heart Rate Reference,85%,100% Stress DataView - Page/Rhythm/Trend

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 24

STARTING A STRESS ECG TEST

A Stress Test can be started by the following methods:

From the Acquisition Screen select File > Stress > Perform Test OR

From the toolbar select the Stress ECG icon OR

Use the Hot Key F3.

Starting a Stress Test by one of these methods will cause the Stress Setup dialog box to be displayed (IF
the Show This Window box has been checked in the Stress Setup. See Stress Setup). After the Stress
Setup dialog box the Stress ECG Patient Information property box will be displayed. Fill in the appropriate
information in the Patient, Encounter, and Medication property sheets. If the patient has been tested
previously the Browse option can be utilized.
Press Cancel to discontinue the Stress Test or OK to start the test . Successful commencement of the
Stress test can be verified by observing the appearance of the Acquire Stress ECG screen and the start of
the ECG trace.

Save Demand Finish

Advance Begin Enter Pause
Annotate Print Test
Stage Recovery BP Protocol
Strip
Stress ECG - Acquisition

12 LEAD RHYTHM AVERAGE

COMPLEX

TREND
HR, BP, ST
SPEED/ELEV

ARRHYTHMIA / RHYTHM

Protocol
Phase Stage
Stress ECG - Acquisition BP
Speed
(Pre, Exercise, METS Stage Time
or Recovery) Elevation Phase Time Heart Rate Target HR
Reference,85%,100%

Clicking on the blue in the upper right hand corner or the window will cause the toolbar to be
displayed. Clicking on the crossed out will hide the toolbar. (see page X under Resting ECG for more
details)

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 25

Tasks Performed During a Stress Test:

Advance Stage Begin Recovery Blood Pressure Save Strip Print ECG Pause Protocol Finish Test

Blood Pressure Print ECG Pause or

Advance Begin Save Strip Finish
Auto or Manual on Demand Manual Protocol Test
Stage Revovery & Annotate
Single Style Report

Stress ECG Test comprises of various Phases and Stages.

In general QRS-Card Stress ECG Test has three phases. These Phases are:

1. Pre-Test Phase
2. Exercise Phase
3. Recovery Phase

Note: User Intervention is required in moving during Stages while in Pre-Test mode. While Exercise and
Recovery stages are timed e.g Each Exercise Stage in Bruce protocol is 3 minutes each.

Each Phase can have multiple stages:

Pre-Test Phase (User intervention is needed to complete/forward Pre-Test Stages)

Supine
Hyperventilation
Warm-up
Exercise Phase
Stage E1
Stage E2
Stage Ex
Recovery Phase
Stage R1
Stage Rx

Note: The Advance Stage command can only be accessed when a Stress Test is running.
Use the Advance Stage command to advance the Stress Test to the next Stage. The Advance Stage
command can be accessed the following way:

Press the Advance Stage button on the Stress Status Bar.

Selecting the Advance Stage command causes the system to advance the Stress Test to the next Stage as
defined by the protocol.

This button can be used to acquire Pre-Test Stage ECG s. This button can also be used to advance Stages
while in Exercise Phase or in Recovery Phase.

Begin Recovery by Pressing button on the Stress Status Bar.

To manually enter Blood Pressure Press button on the Stress Status Bar.

To annotate or mark a Strip to print during final reports press button on the Stress Status Bar

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 26

To print a real-time ECG Report press button on the Stress Status Bar.

Note: 1. Number of pages (or continuous print) to print under Stress/Setup

2. HP PCL5 Printer is REQUIRED to perform real-time print

To pause (and manually control) the exercise stage and the protocol press button on the Stress Status
Bar.

Note: Pressing this Pause Protocol Button will display four additional buttons on the Stress Status bur. This
additional buttons are then used to manually control the Exercise Device (treadmill or Ergometer)

To complete the test (or Stop a test) press button on the Stress Status Bar.
This button is usually pressed while in RECOVERY phase. However this button can be pressed anytime during a test to
FINISH a test or to STOP a Test.

NOTE: In order to Stop a Test in an EMERGENCY SITUATION use TREADMILL EMERGENCY STOP
BUTTON.

REPORTS:
Checked Off reports can be printed (automatically or manually) to printer attached to the computer.
If selection is made for PDF File Viewer then report will print as PDF file to the computer screen (Installation of
Adobe Acrobat 6.0 or higher on computer is required). Save button from Adobe Acrobat reader will make the report
saved in PDF format, which can be printed or emailed, if required.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 27

Stress Test DataView

To view (or edit) a stress test highlight from Master Screen a Stress ECG Test desired from the patient test

list and click on the button on the toolbar

OR
Double click on the test to be viewed.

The test record will be displayed in the Dataview screen.

Information about the patient can be viewed and/or edited, data from the test viewed and reports printed. An
outline of the features and options displayed on the Resting Dataview screen is given below, along with any
available links to other relevant topics.

Edit Selection
This selection is used to review (and edit) any patient demographics information
and ECG device information. Information is subdivided into:

Patient
Test
Medication
Signal

Note: To see more about Editing and Viewing of Patient demographics information see
Appendix X page number Y

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 28

View Selection
This selection is used to review (and edit) acquired Stress Test ECG data in
various formats.

Page View Full Page /

Complex Strips Trend
Rhythm

FULL DISCLOSURE / RHYTHM / TREND

PAGE / FULL DISCLOSURE

Demand Print User Select

User Select Strip Strip
HR or RR

RHYTHM TREND

Stress DataView - Page/Rhythm/Trend

Page tab:

This selection shows full disclosure view of the complete stress test.

By Pressing or button under Page Rhythm data and

Trend Data can also be reviewed in conjunction with the page/full
disclosure ECG data.

Rhythm ECG data is synchronized by clicking left mouse button

anywhere on the Full Disclosure ECG Page or on Trend graph.

Complex tab:

This selection shows average complexes during different stages of the

Stress Test.

By Pressing or button under Complex Rhythm data

and Trend Data can also be reviewed in conjunction with the Average
ECG Complex data

Rhythm ECG data is synchronized by clicking left mouse button

anywhere on the Complex ECG Page or on Trend graph.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 29

Strips Tab:

This selection shows:

a. Auto Selected Arrhythmia Strips
b. Stress Event Strip (e.g every minute save for Bruce protocol)
c. Custom Save/Annotated Strips.

Strip shown with time stamp marked in YELLOW are the one, which
are ready to print. These strips can be marked and unmarked by using
the tool bar buttons for marking/unmarking.

Note: SPACE BAR keyboard key can also be used as a HOT

Key to quickly toggle Mark or Unmark a strip for printing.

Summary Selection

This selection is used to review Stress Test Summary Data. This data include Stress
Summary, tabular data for Stress Test and Summarized Stress Test Interpretation.

Summary Tab
This selection shows Summary of Stress test and the reason for the termination of the
Stress Test (user has the option to overwrite their comments for the Test termination).

Table Tab
This selection shows Stress Test Summary in a tabular format

Interpretation Tab
This selection shows summary of computerize Interpretation of the Stress Test. User has
the option to overwrite the final Stress Test Interpretation with their own interpretation.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 30

Report Selection
Checked Off reports can be printed (automatically or manually) to printer attached to the
computer.

If selection is made for PDF File Viewer then report will print as PDF file to the computer
screen. Save button from Adobe Acrobat reader will make the report saved in PDF
format, which can be printed or emailed, if required.

Note: In order to print PDF File Viewer to computer screen, installation of Adobe
Acrobat Reader 6.0 or higher on user computer is required (also make sure that
correct version of Acrobat Reader is selected under \ Utility \ Configuration \
Option \ PDF . To make sure select Detect )

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 31

STRESS ECG SETUP

The Setup command is used to define various parameters for running a Stress Test. The Setup command
can be accessed by the following method:

From the Acquisition Screen select File > Stress > Setup OR
Click on the Stress ECG icon. If the "Show This Window" in the Stress Setup has been previously
checked, the Stress Setup dialog box will automatically be displayed. See below.
Executing Setup causes the system to display the Stress dialog box.

Stress Property Sheet

Protocol:
Defines the Stress Test Protocol to be used in the Stress Test.
Controlled Device:
Defines the Stress Test Exercise device.
Test:
Tests the functionality and the connection between the computer and the Exercise device.
To test a device, first select it under the Device option described above.

Test Property Sheet:

In testing a Treadmill Device, clicking on the arrows under Speed should increase and
decrease the speed of the Treadmill. Using the arrows under Treadmill should increase
and decrease the elevation of the device.
In testing an Ergometer Device, using the arrows under Ergometer should increase or
decrease the load. The Blood Pressure can also be measured to verify the BP aspect of
the test is functioning properly.

Limits Property Sheet

Lists the limits of the driver.
Metric:
If checked, Exercise device measurements in will be given in Metric units.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 32

Blood Pressure
Defines whether or not a Blood Pressure reading will be used and if it is, whether it will by taken
automatically by the machine or whether the program will prompt the user to enter the BP
manually.
If NO BP is selected, the user will NOT be prompted for BP input unless the BP tool button is
manually executed.

Display Options
Show This Window
If checked, the Stress dialog box will appear when accessing the Stress Test (File > Stress >
Perform Test or clicking on the Stress ECG icon). If not checked, the Stress ECG Patient
Information dialog box will appear first when accessing the Stress Test.
Show Electrode Position Diagram
If checked, the electrode positioning diagram will be displayed after the Stress ECG Patient
Information dialog box and before the Stress Test starts.
Arrhythmia Screen
If checked, the Arrhythmia screen will be displayed during the Stress test.
Trend Screen
If checked, the Trend screen will be displayed during the Stress Test.
ST Segment Display
This option selects the display lead for the ST Trend Window. Selecting Normal provides the
display of ST for the user selected lead.
The Maximum ST Elevation or Depression Lead option automatically displays the ST values for the
lead that has either the maximum elevation or the maximum depression.
The Maximum ST Elevation Lead option automatically displays the ST values for the lead which
has the maximum ST elevation.
The Maximum ST Depression Lead option automatically displays the ST value for the lead which
has the maximum ST depression.
ECG Filter
Electrical Interference
Allows the user to apply a 50Hz or 60Hz filter to smooth out the signal. If desired, the filter
can also be turned off.
Artifact Rejection
If the Artifact Rejection option is chosen, artifacts, like those caused by muscle twitches,
will not be assigned as peaks.
Baseline Drift Reduction
Drift of the baseline will be minimized.
Reports
Demand
If desired, a printout of the ECG trace can be obtained while the test is running. Chose the number
of pages to be printed ( 1 to 6 pages or a continuous printout). Start the Stress test. Click on the
Print ECG icon and the printout will start from that point. If Continuous is chosen, the printout will
continue until the Print ECG icon is clicked again.
Protocol
If checked, an ECG trace will be printed for each time specified by the protocol.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 33

Final
Specifies the type(s) of final reports.
Target Heart Rate
Defines whether the Target Heart Rate is to be calculated from the patient s age or be manually
assigned.
ECG Acquisition
Recorder
Defines if the signal is coming from a QRS Card, a simulated device (QRS demo) or a remote QRS
Card.
Sample Rate
Defines the sampling rate, per second.
Length
Defines the length of the ECG trace, in seconds, that is saved.
Average Cycles
Defines the number of beats averaged to make a complex ECG.
Screens
Defines Default parameters for Screen display e.g. Gain, Speed, Lead Display etc for
Acquisition and Dataview Screens. See Appendix X for more help and details.
Protocol Editor
See Protocol Editor
Defining a New Protocol
Protocol Information
Updating a Protocol

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 34

HiRes ECG

WARNINGS
Usage of HiRes ECG Software is ONLY customer Outside of US
Topics
Modes of Operation
Starting a Resting ECG (Acquisition Mode)
Viewing a Resting ECG (Dataview Mode)
HiRes ECG Setup

======================================================
Start a Hi-Res Test by one of the following methods:

From the Acquisition Screen select File > Hi-Res > Perform Test. OR

From the toolbar select the Hi-Res ECG icon OR

Use the Hot Key F4.
Starting a Hi-Res Test by one of these methods will cause the Hi-Res Setup dialog box to be displayed. (IF
the Show This Window box has been checked in the Hi-Res Setup. See Hi-Res Setup.) After
confirming/editing the Setup information, click OK.
Next, the Hi-Res ECG Patient Information property box will be displayed. Fill in the appropriate patient
Information in the Patient, Test and Medication property sheets. If the patient has been tested previously
the Browse option can be utilized. When done with the patient information, click OK.
The XYZ Electrode Placement Diagram will be displayed next - IF the Show Electrode Position Diagram box
has been checking in the Hi-Res Setup.
Click OK to start the Hi-Res test.
i - Clicking on the blue i in the upper right hand corner or the window will cause the toolbar to be displayed.
Clicking on the crossed out i will hide the toolbar.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 35

HiRes ECG Dataview

To view (or edit) a HiRes ECG test, highlight from Main Screen the ECG Test desired then click on the button
on the toolbar. OR
Double click on the Test to be reviewed.

When a Resting test record is opened, the HiRes Dataview screen is displayed. Information about the patient can be
viewed and/or edited, data from the test viewed and reports printed. An outline of the features and options displayed on
the Resting Dataview screen is given below, along with any available links to other relevant topics.

Edit
Use the Edit option to view or edit information about the patient and trace recalled from the database. The Edit
option can be executed by the following methods:

Patient and Test Property Sheets

Information about the patient is present in these two property sheets. If necessary, the information can be
edited.
Medication
Information about Patient medication is contained is contained in this property sheet.
Signal
Parameters on how the ECG was obtained, such as the sampling rate and use of filters, are contained on this
property sheet.

View
Pressing View button provides ECG data in various formats. These views are:

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 36

Rhythm View
Complex View
Filtered Complex View
Vector Magnitude view

Summary
Pressing summary button provides summarized data for ECG measurements and automatic ECG
Interpretation.

Report
Checked Off reports can be printed (automatically or manually) to printer attached to the computer.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 37

HI-RES SETUP

The Setup command is used to define various parameters for running a Hi-Res Test. The Setup command
can be accessed by two methods:

From the Acquisition Screen select File > Hi-Res > Setup OR
Click on the Hi-Res ECG icon. If the "Show This Window" in the Hi-Res Setup has been previously
checked, the Hi-Res Setup dialog box will automatically be displayed.
Executing Setup causes the system to display the dialog box.

Show This Window

If checked, the Hi-Res dialog box will appear when accessing the Hi-Res Test (File > Hi-Res >
Perform Test or clicking on the Hi-Res ECG icon). If not checked, the Hi-Res ECG Patient
Information dialog box will appear first when accessing the Hi-Res Test.
Show Electrode Position Diagram
If checked, the electrode positioning diagram will be displayed after the Hi-Res ECG Patient
Information dialog box and before the Hi-Res Test starts.
Collect Blood Pressure Measurement
If checked, the Blood Pressure Entry dialog box will be displayed after the Hi-Res Patient
information has been entered. Enter the patient's blood pressure and click OK to continue.
Start Test When Measurements Valid-
If checked, the test will automatically started once it is determined that the measurements are valid.
If unchecked, the ECG will begin, but the test will not start until the Begin icon is clicked on the
Acquire Hi-Res ECG toolbar.
Print ECG Report
If checked, the report selected will be printed out at the end of the test.
Exit When All Tasks Complete
If checked, the program will return to the Standby mode when all the tasks selected for the Hi-Res
ECG test are completed.
ECG Acquisition
Recorder
Defines if the signal is coming from a QRS Card, a simulated device (QRS demo) or a remote QRS
Card.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 38

Sample Rate
Defines the sampling rate, per second.
Length
Defines the length of the ECG trace, in seconds, that is saved.
Average Cycles
Defines the number of beats averaged to make a complex ECG.
Reset
Selecting the Reset button will reset all parameters to their default positions.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 39

The first time you use the PBI Holter system, you need to install the QRS-Card Cardiology Suite
software by using the Setup file on the PBI software CD. Once the software is installed, you will be able to
use the QRS-Card Cardiology Suite software for Holter ECG analysis and report printing. It will take
approximately 1 to 3 minutes for all of the directories to be created and for all of the files to be copied to your
computer hard disk.
In order to install the QRS-Card Holter System software, the following steps are required:

1. Switch on and boot up your computer with Windows XP, 2000 or Vista
2. Insert the QRS-Card Cardiology Suite software CD into the CD drive.
3. Follow the installation instructions on the screen.
5. Once the installation is complete, you are ready to start using your computer to perform Holter ECG
analysis and report printing

NOTE: Write down the Product ID (PID) of your QRS-Card Cardiology Suite software as the
PID and security key provided are required to use the [Link] Demo software Tutorial
the PID is 0001-0001-2000-DEMOU .

Welcome to QRS-Card Cardiology Suite this software offers advanced Holter technology with many
standard features in one package making it forefront of the industry. The advanced analysis techniques
used provide accurate results that can be systematically reviewed with minimal technician involvement.
Standard features include:
Accurate arrhythmia analysis
Preset artifact detection
Simple user interface
Fast load and analysis
Color coded beats and trends
Full disclosure (24 or 48 hours)
3-channel ST analysis
Split-screen superimposition
Multiple report formats
Multiple format page mode
Network compatibility

Optional features include:

HRV (Heart Rate Variability) analysis
12-lead ECG analysis
Pacemaker function analysis
QT analysis

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 40

Click Download Holter Data button to start Holter download procedure

Download Holter Data

Use the Download Holter data command to start or finish a Holter Test. The Begin Test command can be
executed by the following methods:
From the File Menu select Holter > Download (F5).

From the toolbar press to download Holter ECG data.

Press Hot Key Ctrl+F5 to perform Holter ECG
Device:
Defines the recorder type to download from.
Record:
Defines the path for the Holter data file.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 41

Show This Window

If checked, the Holter dialog box will appear when accessing the Holter Test (File > Holter >
Perform Test or clicking on the Holter ECG icon). If not checked, the Holter ECG Download
dialog box will appear first when accessing the Holter Test.
Enter patient demographics
If checked the Holter ECG Patient Information dialog box will appear during Holter ECG
download.
After Download
Exit: If selected main software screen will be displayed after download.
Edit: If selected the Holter test will open for editing after download.
Print: If selected default reports will be printed after download.
Default Report
The reports that will print after Holter ECG data is analysed.
Upload Patient Data
Patiend data can be uploaded to the recorder. (Note: Only if recorder supports this option)
Beats
Opens the Configure Beat Detection dialog box.
Episodes
Opens the Configure Episode Detection dialog box.
Reset
Set all options to factory defaults.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 42

In Holter ECG data view mode click View button to view downloaded

Holter ECG data and access the following options:

Beats
Episodes
Page
Strips
The view Holter ECG module has been divided into the above parts to allow for easy navigation and
reclassification of the Holter ECG data.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 43

Tools option toolbar press

Use the Demographics option to view or

edit information about the patient and trace
recalled from the database.

Demographics
From the Dataview Screen select File > Demographics

When the Demographics option is executed; the Test Information dialog box will be displayed. This is used
to enter patient details.

Patient Property Sheets

Information about the patient is present in this property sheet. If necessary, the information can be edited.

Medication Property Sheet

Information about the prescribed medication can be entered in this dialog box.

Test Property Sheet

More detailed information about the patient can be entered on this property sheet.

Signal Property Sheet

Parameters on how the ECG was obtained, such as the sampling rate and use of filters, are contained on
this property sheet.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 44

Bins

Rhythm Edit Screen

·From the View option toolbar press

·From the Dataview Screen select View > Beats.

·Use the Hot Key F2.

All Beats are classified into Beats according to the software's algorithm.

The Beats that match a particular template can be viewed by selecting the desired tab displayed above the
template view window.

The Beats defined in the algorithm are as follows:

Normal
VE (Ventricular Extrasystole)
SVE (Superventricular Extrasystole)
Paced
Aberrant
Noise

The Beats Screen displays Bins, this allows the user to view all similar beats within a single template as a
group and the beats from the selected Bin are displayed in the Rhythm Edit Screen.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 45

R-R Interval

Episodes
List
Trend Screen

Rhythm Edit Screen

·From the View option toolbar press

·From the Dataview Screen select View > Episodes.

·Use the Hot Key F3.

The Episodes Screen enables the user to review ECG data through the R-R interval window and the trend
window. Data in both windows is synchronized with the Rhythm Edit Screen as the user highlights the data.

As the ECG data is analyzed the Episodes are evaluated against predefined criteria and are stored in the
following categories:
Fastest Rates
Slowest Rates
Bradycardia
Pause
Isolated VEB
VEB Pair
VEB Run
Bigemny
SVEB Pair
SVEB Run
Recorder Episode
STe Abnormalities

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 46

·From the View option toolbar press

The Strips screen allows the user to review and select which Episodes should be printed in the selected
report.

Strips are displayed in the following categories:

VPB
VPB Pairs
Bigeminy
SVPB
SVPB Pair
SVT
Pause/Asystole
Patient Episodes
Selected Strips
ST Episodes
Tachy/Brady
Fast rate
Slow rate

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 47

ST
List HR & ST Trend

Rhythm Edit Screen

·From the Tools option toolbar press

The ST Table screen displays data from the 3 ST channels individually as well as summarized data in the
form of the ST List. The user can synchronize this data with the Rhythm Edit Screen.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 48

·From the Tools option toolbar press

·From the Dataview Screen select View > Page.

·Use the Hot Key F1.

The Page view Screen displays the ECG data between the duration of 1 - 30 minutes. The Page view
Screen and Rhythm Edit Screen are synchronized according to user selection of ECG data in Page view
screen.

The Rhythm Edit Screen allows easy editing/reclassification of beats.

Page view can be toggle between Full Page View or combination of Page and Rhythm Edit Screen.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 49

·From the Tools option toolbar press

This screen allows the user to easily identify many kinds of ECG abnormalities such as changes in P-R
interval, Q-waves, QRS conduction, and ST elevation, by rapidly displaying QRS complexes on top of the
preceding complex against a scale. Therefore the user can use the Superimpose mode to quickly determine
if beats have been classified correctly as any major fluctuations can be identified easily with the help of the
scale.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 50

·From the Main toolbar press

·Use the Hot Key Shift+F2.

Summary Screen displays useful quantitative data about individual parameters.

The Summary Screen includes the following tables:

General
Supraventricular
Ventricular
Supraventricular Runs
Ventricular Runs
Bigeminy
Tachy/Brady
Interval Summary
Paced

Each table contains hourly results for each measurement and summary information for the entire record.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 51

·From the toolbar press

The HRV Screen gives the user graphical display of the ECG data through different parameters. This tool
assists the user to get an overview and analyze the ECG data at first glance.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 52

Reports Dialog Box

The reports dialog box is used to generate printed
Holter reports.

From the Dataview Screen select File > Print

reports

Use the Hot Key Shift+F4

When the Print command is executed, the Print

Report dialog box will be displayed. The type of
report desired can be selected here. The system
will then print the selected ECG Report. Report
format can also be customized. For details on
customized report formats please contact a
member of the PBI sales team.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 53

From the Dataview Screen select

Measure > Configure Beat Detection

This option allows the user to edit beat

template parameters. Switch between
tabs to set parameters for desired
beat type.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 54

From the Dataview Screen select

measure > Configure Episode Detection

This option allows the user to edit

episode detection parameters. Switch
between tabs to set parameters for
desired episode type.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 55

From the Dataview Screen select Measure > Blood Pressure

Use the Blood Pressure command to enter patient blood pressure values data.

The system displays the Blood Pressure Entry Dialog Box when the Blood Pressure command is executed.
Enter the patient blood pressure using this screen. Once entered, the system updates the blood pressure
values.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 56

The Rhythm Edit Screen allows the user to edit ECG data and reclassify beats. Beats classification
are indicated as follows:

N Changes the label to Normal.

V Changes the label to Ventricular.
P Changes the label to Paced.
A Changes the label to Artifact and the beat(s) are not included in the results.
S Changes the label to Supraventricular.
B Changes the label to aBerrant. (Supraventricular)
X Deletes the Beat and the beat(s) are not included in the results.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 57

To reclassify beats
1. Select the beat(s) from the Bins that you want to reclassify in the Rhythm Edit Screen.

To select a single beat click on the R-wave. To select multiple beats drag the R-waves that
you want to include.

2. Click the desired reclassify button that you want the beat to be reclassified to.

3 The Selected beat(s) will be reclassified (or deleted if you clicked on A or X)

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 58

The beats can be viewed in multiple view mode also.

To reclassify multiple beats

1. Select the template class (VE, Normal, SVE, etc.).
2. Select the desired bin.
3. Click view button to Toggle view single/multiple template beats in the Rhythm Edit Screen.
4. Select the template beats you want the edit by clicking on multiple beats or clicking Mark
Row, Mark Page, Mark All.
5. Click N, V, P, A, S, B, or X to reclassify the beats.
The selected beats will be reclassified and the Rhythm Edit Screen will be updated with the
remaining template beats in the selected Template pane.

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The Episodes Edit window allows the user to edit Episode data and reclassify Episodes.
Episodes classifications are indicated as follows:

N Changes the label to Normal.

V Changes the label to Ventricular.
P Changes the label to Paced.
A Changes the label to Artifact and the Episode(s) are not included in the results.
S Changes the label to Supraventricular.
B Changes the label to aBerrant. (Supraventricular)
X Deletes the Beat and the Episode(s) are not included in the results.

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PBI QRS-Card Cardiology Suite 4.0X Rev 2 60

To reclassify Episodes
1. Select the Episode(s) from the Episodes list that you want to reclassify in Rhythm Edit Screen

To select a single Episode click on the R-wave. To select multiple Episodes drag the R-
waves that you want to include.

2. Click the desired reclassify button that you want the Episode to be reclassified to.

The Episode(s) will be reclassified (or deleted if you clicked on A or X)

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To edit multiple Episodes using the Episode R-R Interval Histogram

1. In the Episode List box select the Episode type that you want to edit.
2. Drag the Episodes in the Episode R-R Interval Histogram to select the range of R-R intervals
to edit.
3. Click Toggle to view multiple Episodes in the Rhythm Edit Screen if it isn't already.
4. Select the Episodes you want the edit by clicking on multiple Episodes or click Mark Row,
Mark Page, or Mark All.
5. Click N, V, P, A, S, B, or X reclassify button to edit the Episodes

The selected Episodes will be reclassified and the ECG Edit window will be updated

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To edit multiple Episodes using the Event Trend

1. In the Episode List box select the Episode type that you want to edit.
2. Drag the episodes in the Episode Trend to select the time period that you want edit.
3. Click Toggle to view episodes in the Rhythm Edit Screen if it isn't already.
4. Select the template beats you want the edit by clicking on multiple episodes or click Mark
Row, Mark Page, or Mark All.
5. Click N, V, P, A, S, B, or X reclassify button to edit the episodes.

The selected episodes will be reclassified and the ECG Edit window will be updated

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To delete all Episodes of one Episode type

1. In the Episode List box select the Episode type that you want to delete.
2. Drag all of the Episodes in the Episodes R-R Interval Histogram or Episode Trend.
3. Click Toggle to view multiple Episodes in the Rhythm Edit Screen if it isn't already.
4. Click Mark All.
5. Click X to delete beats and the template

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The Strips window contains the following controls:

Strip category List Box

The Strips list box is located above the ECG Data View
window. The list box displays ECG strips from the following
categories:
VPB, VPB Pair, VTAC, SVPB, SVPB Pair, SVT,
Pause/Asystole, Patient event, Selected strips, STe
deviation, Tachy/Brady, Fast rate, Slow rate.

Display Strips
These control which ECG strips are displayed in the Strips mode.
· All - Use to display all strips for a category.
· Marked -Used to display all marked strips from a category.
· Unmarked - Used to display all unmarked strips from a category.

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Mark / Unmark Strips

These control which ECG strips are marked or unmarked. Marked strips are included the Holter
report. When a strip is selected (marked) it's start time is highlighted in yellow.
· Mark All - Used to mark all strips in a category.
· Unmark All - Used to unmark all strips in a category.
· Toggle - Used to Mark or Unmark the current highlighted strip. Click on a strip to highlight it.

Strip sorting criteria

These controls are located above the top-most ECG strip. These are used to control the order
that strips are displayed in the window.
· Time - Used to sort the strips in chronological order.
· Prematurity (%) - Used to sort the strips according to the degree of prematurity.
· Duration (seconds) - Used to sort the strips according to the strip duration.

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The Rhythm Edit Screen contains the following controls along the top of the window:

· Relabel buttons (N,V,P,A,S,B,X) - Used to reclassify beats.

· Gain - Used to select the ECG gain. Choices range from 1- 50mm/mV.
· Speed - Used to select the ECG time interval displayed in each pane. Choices range from 7.5 -
60 seconds.
· Measure - Used to activate on-screen calipers for interval and amplitude measurements.
· Print - Used to print one-page review screens.
· Insert - Enables you to insert new beats by clicking in the Edit pane.
· Select - Used to manually select ECG strips to be included in the Holter report.
· View - Switches the edit window between single and multiple Edit panes on the Beats and
Episodes tabs.

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The multi-edit pane mode also contains the following additional controls:

· View - Used to select the number of panes displayed when the window is toggled to the multi-
pane mode Choices include 2x2, 4x2, 8x2, and 12x3 panes.
· Mark Row, Mark Page, Mark All - In the Beats and Episodes mode you can use these buttons
to select multiple Edit panes during the editing process.

Tip:
· Double-click in the ECG Edit window to toggle between single and multiple Edit panes.

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You can reclassify individual beats displayed in the Page window using the procedure described
in Lessons: Reclassifying beats.

To edit multiple beats on Page screen

1. Drag the beats on the page window that you want to edit.
2. Click N, V, P, A, S, B, or X to reclassify the beats.

The selected beats will be reclassified and the Rhythm window will be updated.

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To toggle view/hide Rhythm Edit Screen

press

Scanning ECG data

· Click Scan to start scanning ECG data.

The current time in the record and heart rate are displayed in the top left corner of the
Superimpose window. The ST markers are displayed as vertical lines in the Normal Beats
pane. During scanning the position of the slider at the bottom of the display is continuously
updated to reflect the relative position in the ECG record.
· Click Scan to stop scanning.

Tips:
· Use the slider to jump to different times in the record.
· To quickly re-scan a section of ECG while scanning, move the slider back the desired amount.

Changing the superimpose settings

You can change the scan rate and enable or disable individual panes in the Superimpose mode.

To change the scan rate

· Move the Scan Rate slider up to increase the number of beats/second (bt/s) or down to
decrease the number of beats/second
The new rate is displayed above the slider. Note that with the scan rate set to 250 bt/s and an
average heart rate of 70 BPM it would take 6 minutes to scan an entire 24-hour record.

To hide individual superimpose panes

· Click the appropriate toggle button to hide/unhide individual panes

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To view a table
· Click the table tab you want to display.

To zero table values

1. Select the hour in the table that has values you want to zero.
2. Click Zero
3. Click the check boxes for the values you want to zero.
4. Click OK

To edit table values

1. Select the hour in the table that has values you want to edit.
2. Click Edit
3. Edit the values.
4. Click OK

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The HRV Screen functions give the user several options to view and analyze the ECG data with the help of
several graphical and statistical data views.

The lists of available options are:

Lorenz plots
3D plots
Circadian plots
Time domain plots
General Tables
RR Tables
Spectral Tables
24-hour plot

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Ambulatory Blood Pressure Measurement (ABPM)

WARNINGS
US Customers will be supplied with ONLY software supplied by the device manufacture (and not the
Cardiology Suite ABMP software module).

Topics
Downloading ABMP data
Viewing and Printing ABPM Data

===============================================

DOWNLOAD ABPM data:

Use the Configure Ambulatory Blood Pressure Download property sheet to transfer the ABPM data from the device to
the QRS-Card program. This dialog box can be accessed by the following methods:
From the Acquisition Screen select Procedures > Ambulatory BP > Download OR

From the toolbar, click on the ABPM icon OR

Use the hot key F6.
The Configure Ambulatory Blood Pressure Download dialog box primarily allows the user to specify the
device used and the data file location.

Device
Specify the ABPM device used.
Port
Defines which empty com port the device will be using or if a file is being downloaded.
Record
Specifies the location of the data file to be downloaded, including the drive.
Show this Window
If this box is checked the Setup dialog box will appear before each ABPM download. If the box is
unchecked the Setup dialog box will not appear before each download. The download will proceed
in the predesignated fashion.

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Enter Patient Demographics

Checking this box will allow for the entering of patient demographics while the ABPM data is
being downloaded. Click on the Finish button when data entry is completed.
After Download
Exit If the Exit option is selected, the program will wait in standby in the Acquisition Screen
after the ABPM file is downloaded.
Edit If Edit is selected, the ABPM file will be downloaded and then the Dataview screen will
appear to allow review and editing of the data.
Print The Print option will download the ABPM file and proceed with printing the report
selected.

Default Report
Allows for selection of a default report at the time of download. The type of report can be changed
after the download by opening the ABPM test and selecting File > Print Report in the ABPM
Dataview screen.

Upload Patient Data

The Upload Patient Data button allows the upload of ABPM data from the QRS system to the
ABPM Device.

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VIEWING A RESTING ECG Test DATAVIEW SCREEN

To view (or edit) a ABPM test, highlight from Main Screen the ECG Test desired then click on the
button on the toolbar. OR
Double click on the Test to be reviewed.

When a ABPM test record is opened, the ABPM Dataview screen is displayed. Information about the
patient can be viewed and/or edited, data from the test viewed and reports printed. An outline of the
features and options displayed on the ABPM Dataview screen is given below, along with any available
links to other relevant topics.

Edit
Use the Edit option to view or edit information about the patient and trace recalled from the database. The Edit
option can be executed by the following methods:

Patient and Test Property Sheets

Information about the patient is present in these two property sheets. If necessary, the information can be
edited.
Medication
Information about Patient medication is contained is contained in this property sheet.
Signal

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Parameters on how the ECG was obtained, such as the sampling rate and use of filters, are contained on this
property sheet.

VIEW
Use View option to see ABPM data in four different ways:
ALL views seen simultaneously
Trend data only
Pie data only
Bar data only

Summary
Pressing summary button provides summarized data for ABPM measurements (Summary, Hourly, Actual
Measurements) and location to type physician Interpretation.

Report
Checked Off reports can be printed (automatically or manually) to printer attached to the computer.

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UTILITY

Topics
Configuration
Physicians
Clinics
Technicians
Import Reports
Queue System
Rebuild

CONFIGURATOIN:
Configuration Section is used to setup various default parameters of using QRS-Card Cardiology Suite
Software. These options include:
Reporting
Database
Measurements
Options
GDT Interface
Real-Time Print
Email

REPORTING
Use the Reporting Configuration Property Sheet to set the default values for reporting ECG results.
Access the property sheet by the following method:
Select Utility > Configuration and click on the Reporting tab in the Configuration Setup property box.

Complex
Gain
Defines the Gain for ECG complexes to be printed on the Stress or Hi-Res ECG reports. Options
are 5, 10, 20 or 40 mm/mV.

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Speed
Defines the Speed for ECG complexes to be printed on the Stress or Hi-Res ECG reports. Options
are 25, 50 or 100 mm/sec.
Lead 1
Defines the 1st complex lead to be printed on the Stress or Hi-Res ECG reports.
Lead 2
Defines the 2nd complex lead to be printed on the Stress or Hi-Res ECG reports.
Lead 3
Defines the 3rd complex lead to be printed on the Stress or Hi-Res ECG reports.
Rhythm
Gain
Defines the Gain for the ECG to be printed on the ECG reports. Options are 5, 10 or 20 mm/mV.
Speed
Defines the Speed for the ECG to be printed on the ECG reports. Options are 5, 10, 25 or 50
mm/sec.
Lead 1
Defines the 1st ECG Lead for the three lead ECG reports.
Lead 2
Defines the 2nd ECG Lead for the three lead ECG reports.
Lead 3
Defines the 3rd ECG Lead for the three lead ECG reports.
Hi-Res Complex/Vector Magnitude
Gain
Defines the Gain to be printed on Hi-Res reports. Options are 50, 100, 500 or 1000 mm/mV.
Speed
Defines the Speed to be printed on Hi-Res reports. Options are 50, 100 or 200 mm/sec

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DATABASE
The Database property sheet allows the user to select the location of ECG data files and the
names of the individual files. This property sheet can be accessed by the following method:

Select Utility > Configuration and select the Database tab in the Configuration Setup property box.

Root:
Description: Defines the default root directory for all ECG data files.
Below the Root are all the default database file names.
Browse
The Browse button allows change of the root directory.
Reset
The Reset button sets all parameters back to their factory-set defaults.
Logging
Customer support may ask for this to be checked in order to pinpoint a problem.

Note: ECG database is in published SCP format. Each test is a separate file. These files are
stored in qrsdb4/files folder. It is important the user backup these individual SCP file for data
security purposes.

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MEASUREMENTS:
Select Utility > Configuration and select the Measurements tab in the Configuration Setup property box.
The options contained in the Measurements Configuration property sheet are advanced settings to adapt the
system to special needs.

Reset
The Reset button sets all parameters back to their factory-set defaults.

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OPTIONS:
Select Utility > Configuration and select the Option tab in the Configuration Setup property box
This option selects St Value s parameters, Multitask message display and PDF File Viewer Setup.

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GDT:
Select Utility > Configuration and select the GDT tab in the Configuration Setup property box

This option is Only for German Medical Office EMR software Interface.

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REALTIME PRINT
Select Utility > Configuration and select the Real Time Print tab in the Configuration Setup property box

This option is used to Enable or Disable Real Time Printer and to Setup Real Time Report Parameters.

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EMAIL
Select Utility > Configuration and select the EMAIL tab in the Configuration Setup property box

This option is used to Setup Server Parameter for Sending and Receiving ECG s via Email.

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PHYSICIAN
Select Utility > Physician then property box will appear

Names of attending and referring Physicians database are stored using this option.

Add:
Select to enter new Physician or Referring Physician name

Update:
Select to update on an existing entry in Physician database

Delete:
Select to delete an entry in Physician database

Export:
Select to Export a listing of an existing Physician database in text format

Import:
Select to Import an existing text format Physician list into Physician database

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Clinics
Select Utility > Clinics then property box will appear

This option is use to Enter Clinics Names for a multi-practice medical office.

Add:
Select to Add a new Clinic name in the Clinic database

Update:
Select to update an existing Clinic name and address

Delete:
Select to Delete an existing Clinic name in the database

Export:
Select to Export an existing Clinic database to text format

Import:
Select to Import a text format Clinics names into Clinics database

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Technician
Select Utility > Technician then property box will appear

This option is used to input Technician s name acquiring the ECG data

Add:
Select to Add a new Technician Name in the database

Update:
Select to Update an existing Technician name in the technician database

Delete:
Select to Delete an existing technician name from the database

Export:
Select to Export an existing technician database to text format

Import:
Select to Import a text format technician names into technician database

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Import Reports
Select Utility > Import Reports then property box will appear

The Import Report option is used to import any new ECG report formats supplied by Pulse Biomedical or to
import any changes made to already existing report formats. The Import Report command can be accessed
by the following method:
Executing the Import Report command will cause the system to display the Import QRS Report dialog box.
To import a report format, highlight the desired report and click on Open. The new report is now ready for
use. To make changes to the format of an existing report go to Windows Explorer. In the directory
containing the QrsCard software, click on the report to be modified with the right mouse button. Select
Open. The existing report format will open on the Notepad. Make the desired changes and save them.
Return to the QrsCard software and the Import Report option. Highlight the modified report and click on
Open. The modified report is now ready for use.

Open
Highlight one or all reports then select this option to import report(s) into report database

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Queue System
Select Utility > Queue System then property box will appear

The Queue System places the ECG traces from the patient Tests database in the queue system. At a later time, the user
can dump the queue to a printer, E-mail the traces, or export the traces to an external file (one not connected to the QRS
databases). Using the Queue system, the user can also receive ECG traces via E-mail or import a trace from an external
file.
After the test is complete, the Queue System command can be executed by the following method:

The system will display the QRS Queue System dialog box.

Dump Queue
Clicking on Dump Queue will dump the entire selected queue to the appropriate output device and
the Queue Dump dialog box appears. The Queue Dump dialog box shows the status of the queue
dump. Any errors that occurred will be listed.
Delete Queue
Clicking on Delete Queue will delete all items in the type of queue selected.
Reset Errors
Clicking on Reset Errors will reset any errors that occurred when dumping a queue.
Add
Clicking on Add will cause the system to display the appropriate Add dialog box for the
selected output device. See the Available Queues below for more information.
Update
Clicking on Update will bring up the Update QRS Queue Entry dialog box.

Details of the selected item can be edited in this dialog box. In particular, the type of
report selected for a particular queue item can be edited using this option.
Delete
Clicking on Delete in the bottom section of the dialog box allows the user to delete
individual items from a particular queue.

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Available Queue Options

Print Queue
To add to the Print Queue, double-click on Printer under Available Queues in the Queue Detail Dialog Box
or highlight Printer and click on the Add button. The Add Entries to QRS Print Queue Dialog Box will be
displayed.

Select the test and the type of report desired, add any comments necessary and click on Add. Click on the
Close button to exit this dialog box. The selected traces will be copied to the Print Queue. Select Dump and
the traces will be printed.
To aid in finding an encounter, the user may sort the database by name, ID or date/time the encounter was
obtained by clicking on the appropriate heading name.

Mail In
The Mail In option allows the user to receive ECG traces via E-mail.
Note: For best results, connect to the Internet before entering the Queue System.
As the Queue System is accessed, a message "Retrieving message X or X" will appear if E-mail has been
sent to you since you last logged onto the Internet. The Mail In option in the Available Queue box will show
the number of messages.
Highlight Mail In and click on Dump Queue. The messages will be dumped directly into your database.
Note: Be aware that the time on the encounter is when the test was taken not when it was e-mailed or
dumped into the database.
Mail Out
The Mail Out option allows the user to E-mail ECG traces.
Note: For best results, connect to the Internet before entering the Queue System.
To add to the Mail Out Queue, double-click on the Mail Out option under Available Queues or highlight Mail
Out and click on the Add button. The Add Entries to QRS Mail Out Box Queue Dialog Box will appear.
Highlight the encounter to be E-mailed and using the directory option, enter the recipient E-mail address.
Click on Add to the queue. Click on Close to exit the dialog box. Click on Dump Queue to start the E-mail
process.
Queue Import
Selecting the Import Queue option will allow the user to import ECG trances from an external file.
To add to the Import Queue, double-click on Import under Available Queues or highlight Import and click on
the Add button. The Add Entries to QRS Import Queue Dialog Box will be displayed.
Select the file to be imported and the format to be used and click Apply.
Queue Export
Selecting the Export Queue option will allow the user to export ECG traces to an external file.
To export a file(S) double click on Export under Available Queues or highlight Export and click on the Add
button. The Add Entries to QRS Export Queue Dialog Box will be displayed.
Select the file(S) to be exported and click on Add Encounter. Click on the Close button to exit this dialog
box. The files will be copied to the Export Queue. Select Dump. The selected files will be exported into the
Windows Temporary (TAMP) Directory.

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Rebuild
Select Utility > Rebuild then property box will appear

This selection is used to rebuild (Re-Index) a corrupted, bad database or merging of the database.

This selection can also be used if two or more database needs to be combined together into one
database (e.g copy both database *.SCP files into qrsdb4\files folder the select Rebuild
command)

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LOGS MENU

Log files are created each time the STWIN program is run. This file keep track of all operation performed by
the user. More importantly this files keep logs of any errors occur during the usage of the program.
Viewing of the file can very helpful in finding any user problems with the program.
Status
Use the Status command to display the status log. The Status command can be executed by the following
method:
From the Logs Menu select Status .
When the Status command is executed the system displays the Log View Dialog Box. This log file shows
the most recent events the system executed.

Error
Use the Error command to display the error log. The Error command can be executed by the following
method:
From the Logs Menu select Error.
Executing the Error command causes The system displays the Log View Dialog Box when the Error
command is executed. This log file shows the most recent errors that the system encountered.

Note: Error Log file is the MOST IMPORTANT file for trouble shooting the QRS-
Card Hardware and software. During technical support call to PBI the information contain in this
file will assist PBI the most information to solve or diagnose the problem over telephone.

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