Operation Manual

STRESS TEST SYSTEM

AST-3000

Manufacturer: Avecinna Company

Document code: TF06

Date of issue: 04/02/2014
Revision NO: 01
Date of revision: 06/06/2017

0476

Symbol for refere to given documents

Warning sign

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Head office Address: UNIT 1, NO.3, 58th St., YOUSEF ABAD St., TEHRAN, IRAN
Zip Code: 1436864843
Tel: +98 21 88054231
Fax: +98 2188051647
Website: www.avecinna.com
E-mail: sales@avecinna.com
E-mail: services@avecinna.com

Factory Address: No.TJ291, 13 th St., Professor Hesabi Blvd., Shams Abad Industrial
city, After Imam Khomeini International airport, 35 km Tehran – Qom (Persian Gulf)
Highway, Tehran, IRAN
Zip code: 183417890
Tel: +98 2156901242

Contents
Description and applications of Stress Test System ................................................................................. 4
Associated agreements for available safety issues in this user manual ................................................... 6
Revision report.......................................................................................................................................... 8
Stress test system overview (AST-3000)................................................................................................... 8
Leads attachment to patient’s body: ........................................................................................................ 9
ECG Baseline ........................................................................................................................................... 10
3- Stress test system (AST-3000) primarily setup ...................................................................................13

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3.1. Selection of related protocol ........................................................................................................... 15
3.2. Definition of a desired protocol ....................................................................................................... 16
3.3. Deleting a protocol from the list of protocols. ................................................................................18
4. Patient registration for test ................................................................................................................18
Treadmill control-4-1 ..............................................................................................................................22
2-4-how to enter blood pressure:........................................................................................................... 24
5-How to access the recorded data of patients (patient archive), and how to examine and analyze
it: .............................................................................................................................................................25
1-5-Review recorded signal of the patient: ............................................................................................32
2-5- how to PLAY the performed test again: ..........................................................................................37
3-5- a review of Average signal:.............................................................................................................. 38
4-5-reviewing the recorded events......................................................................................................... 41
5-5 Mets, Speed, Grade, BP, HR*BP diagram Trends ............................................................................. 43
6- How to enter the recorded archive of the patients: .......................................................................... 47
1-6-searching for the patients from the archive:....................................................................................47
2-6-how to make changes or corrections to the recorded patient details:............................................ 49
3-6-deleting patient data from archive: ................................................................................................. 50
4-6-data transfer from program to PC .................................................................................................... 51
5-6-data transfer from PC to the program..............................................................................................53
6-6-how to update patient data ............................................................................................................. 55
7- System setting..................................................................................................................................... 55
8- General warnings and cautions .......................................................................................................... 60
9-System maintenance instructions ....................................................................................................... 64
9-1Daily test: ........................................................................................................................................... 64
2-9-How to move and collect devices..................................................................................................... 65
10-environment conditions: ...................................................................................................................65
11-System clean-up:................................................................................................................................66
12-Periodic control: ................................................................................................................................67
13-Fault detection:.................................................................................................................................. 70

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Description and applications of Stress Test System

What is stress test?

Stress test is actually a screening method for investigating influence of exercise on heart. This
diagnostic proceeding obtains a general consideration about heart’s health.

Why to perform stress test?

The stress test is used to realize reason of pain in chest; capacity and ability of heart for
exercise, appropriate exercise level for people who has started a new exercising program and
diagnose cardiac rhythmic disorders during exercise. However, the stress test may also be
requested by doctor due to other reasons.

How is stress test performed?

A stationary bike or treadmill device may be used for the test. The individual starts to walk
on the treadmill or pedal the bike while electric activity of their heart is being recorded and

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blood pressure is being measured. In fact, the diagnostic proceeding reveals heart reaction to
increase in body’s need for oxygen.

Generally, the diagnostic procedure continues until heartbeat reaches an intended rate unless
some issues such as pain in chest or intense increase in blood pressure happen and such a
thing would lead to suspension of the test.

After the test, patient’s condition is controlled for 10 to 15 minutes or till the heartbeat go
back to the initial state.

What are the necessary preparations for stress test performance?

The individual is not allowed to smoke, eat and consume caffeine-containing or alcoholic
drinks for 3 hours before the test.

Medicine should be taken as usual unless another dosage is administrated.

Patient should wear convenient shoes and clothes for the test.

In case of using Sildenafil Citrate (Viagra) in the previous 24 hours, it is necessary that
doctor is informed; since, nitro-glycerin which is sometimes used during the stress test for
reduction of pain in chest can cause intensive low blood pressure if it used simultaneously
with Viagra.

How does the individual feel during the diagnostic proceeding?

Device electrodes are attached to the chest, hands and legs by means of electrically
conductive sticks. A mild irritation might be sensed during preparation of electrodes’
locations on the chest. Electrodes transmit electrical current of heart to the device in which,
heart activity is recorded. The blood pressure cuff is tied around the arm which is bloated
every few minutes and causes a slight press on the arm. Heartbeat rate and basic blood
pressure are measured prior to test. Then, walking or pedaling(on Stationary bike) starts so
that speed and slant of treadmill or resistance of bicycle’s pedal are gradually increased.

What are the danger factors of this test?

The stress test is usually known as a safe one. However, upon few cases some people may
feel pain in the chest, palpitation, dizziness and dyspnea or even faint during the test. Heart
attack or any dangerous abnormal rhythms is scarce during the test. Individuals who are
prone to such problems often have slow heartbeat rates are not usually prescribed this test.

What are the necessary attentions for performing this diagnostic proceeding?

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The stress test has less accuracy for young and middle-aged women who do not show usual
symptoms of heart diseases.

What are the normal results of this diagnostic proceeding?

Normally, heartbeat rate increases with increase in heart workload and reaches a certain
resistivity level based on patient’s age and condition.

What are the abnormal results of this diagnostic proceeding?

Abnormal results may indicate abnormal rhythms during exercise, pressure on the heart
during exercise and coronary arteries disorders (obstruction of vessels).

Safety information and labels

Avicenna Co. policy has been to produce devices which meet high performance standards
and bring trust. We insist on observance of quality control techniques in order to prevent any
imperfections and consequent risks. Our products must be used for the predicted purpose only
and any other applications may cause injury.

The following safety instructions are to make users acquainted with all of the safety methods;
so that, they would be able to observe related necessary safety issues.

Associated agreements for available safety issues in this user manual

This user manual applies three alert expressions to emphasize the potential risks for users or
the device itself. The following labels also may be applied as a guide to use the device
correctly.

Warning
An instruction which warns about injury or death

Caution It draws attention to risks of device break down or changing the correct
application mode

Provides more information such as detailed explanations, notifications and

Attention reminders

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 Symbol Description

Refer to the accompanying documents before using the device

Dangerous voltage symbol

Device production date

Producer address

Attention or warning sign

European representative address

Product serial number

Temperature limits

High voltage

AC power

Separate collection for EEE consists of the crossed-out wheeled bin

45 ⁰C Storage temperature
-10 ⁰C

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 Fragile

General warning on battery

Revision report

Substitution reason Date Revision No.

Stress test system overview (AST-3000)

Printer
Computer

USB

Receiver module

USB to
RS-232

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Transmitter module
Important tips before test

Attention

It is necessary to observe these tips before test

 Prior to attaching chestlead and electrodes on the body, clean the location with alcohol.
 Use high-grade and appropriate chest leads.
 Attach the cable to patient’s body and fix it.
 Fix the transmitter module on thepatientbody or on the treadmill.
 Inhibit sweating as far as possible.
 Tell the patient the correct form of positioning and walking on the treadmill and ask them to
walk quite calmly.
 The patient, operator, doctor and other
personnel are not allowed to use cell phone in
the place.
 If the patient is wearing clothes, the clothes
should be light, thin and without static
electricity.

Leads attachment to patient’s body:

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 Figure 3.3
Attention

in addition the pointed location, Lead (N) may also be attached to the right part
of body, opposite of Lead (F).

ECG Baseline

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On this purpose, it is necessary to observe following steps:

 ECG Baseline stabilization depends on resistance between electrodes and skin.

Huge resistance is created between skin and electrode direct contact. It has been
proved that resistance value may be between 1 M and 100 K ohms which conduct
a great deal of ECG flow and it is probable that ECG interferes with underground
magnetic field and alternative current.
 For ECG stabilization and clarification, please pay attention to electrodes
selection and apply this method.
3M electrode is suggested for tests.
If you follow the above instructions, you would have a stable and clear ECG in
using the electrodes.
 Cleaning and preparing the skin
 Choosing qualified and high-grade electrodes
 Locating electrodes place and attach them according to the selected method for
lead wires fastening
 Fixing the electrodes with medical sticks (in case of necessity)
 Attaching the lead wires to chest leads

Attention

This step (correctly preparing the skin and attachment area) plays a significant
role in successful accomplishment of the test. Observing the principles inhibits
any interference between my electric and Baseline deviation; besides, more
desirable projections and results would be achieved during and by the end of the
test.

 Shave the electrodes placement areas; it would lead to proper attachment between the
body and electrodes.
 Scrape the body in order that any undesirable material is removed from the skin.
Avoid pressing the scraper intensively on the body.
 Clean the skin with alcohol.
 Wipe the alcohol with cotton. In this case, the skin becomes light red.
 Prior to attaching, make sure that electrodes are qualified and high-grade enough and
check their expiration dates.
 Never use poorly-qualified electrodes made of incongruent materials. The electrodes
should be made of silver chloride.
 Use electrodes with IEC and CE.

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  In order to perform the test, attach the electrodes according to the selected method on
the skin which is cleaned and prepared in advance.
 Avoid excessively pressing during electrode placement; the central core of electrodes
is vulnerable toand excessive press would cause adverse effects on conduction.

Attention

The electrode placement method is of great significance after skin

preparations and selection of qualified and high-grade electrodes

 Prior to cable attachment to skin, the operator should always check cable lead wires
and other parts physically in case they have no significant deficiencies and should
ensure about its correct function. Otherwise, it is suggested that a spare cable be used
and the impaired cable be returned to the company for repair.
 It is strongly insisted on that new patient cables must be supplied by Avicenna Co.
Since, unqualified cables do not meet the required criteria.
 Polarization tolerance voltage is ±300 mV.
 Attach the electrodes to the body according to one of the above methods; then, join
lead wires of the patient’s body(patient cable) to proper locations considering the
defined colors.
 When attaching patient cable to patient’s body, Avoid pressing the central core of lead
wires intensively; this can cause damage to these parts.
 Do not pull the leads severely when detaching; this reduces cable’s lifetime.
 If it is possible that electrodes (chest leads) detach and fall; Medical sticks may be
used to fix the electrodes.
 Never use common sticks, this wears out the cable and reduces its lifetime.
 If above methods are followed, a clear and stable ECG is achieved using the
electrodes.

Charging the transmitter module

Plug the charger cable to the transmitter module at the end of everyday like the figure below:

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 Caution: Only use the specific charger of the device.

Before connecting the charger socket, Put the side button

on off mode or 0.

The complete charging of internal batteries lasts 180

minutes; each charge is sufficient for 10 hours of action.

Do not plug charger if the device is out of work for a

while.

Remove the battery when the device is not used.

3- Stress test system (AST-3000) primarily setup

At first, turn on the treadmill (by ON/OFF button)

In order to start the transmitter module, turn the on/off button to on.

At first, the blue light in top of the module turns on which shows the battery charge state (it should be
blue). According to the figure below: (blue=full charge, green=half charge, red= minimum charge,
15%)

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Next, a green light would automatically turn on as may be seen in the figure below. It indicates
readiness for PC connection.

Attention

If the green light did not turn on then reset the device.

Make sure that the receiver module is on by checking the LED light (blinking red) on it. According to
figure (3-C3):

Figure 3-C3

Attach the patient cable of transmitter module to the body according to figure 3.3. In order to start the
stress test program, double click on icon on PC’s desktop.

A window showed in figure 3.4 would be opened.

Figure 3.4
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This window contains the following items:

Quick open: quick access to patient’s recorded archive

Total archives: shows the capacity of fullness and emptiness of recorded patient archive

Start program: to start the test

Archive: to access to the archive of patient data

Protocols: to select a protocol or define a new one

Settings: system settings

Utility: calibration

Exit: to quit the program

3.1. Selection of related protocol

Click on Protocols option showed in figure 3.4 to select an intended protocol or define a
desirable one. A window illustrated in figure 3.5 would be opened.

Figure 3.5

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Click on Protocols Name option,

The list of available protocols would be opened.

Click on a certain protocol to choose it; then, click on

The selected protocol’s name would appear in Current Protocol part on top of the window.

The selected protocols’ steps may be seen at the bottom of this page.

- Each protocol contains 3 steps:

Pre-Exercise
Exercise
Recovery

By clicking on each option, constitutive steps of the protocol may be seen.

For example, assume that Bruce protocol is selected. By clicking on the above options, it is
seen that this protocol includes:

- Stage 1 in Pre-Exercise
- Stage 7 in Exercise
- Stage 4 in Recovery
-

3.2. Definition of a desired protocol

If you wish to use another protocol except the existing ones; you can define your favorite
protocol in the system.

Follow these steps to define your new and favorableprotocol:

1. In picture 3.5, click on

2. Click on

A list as shown in figure 3.6 would be opened.

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 Figure 3.6

Usage of treadmill and ergometer is possible in this system.

3. Choose the type of your desired device (treadmill or ergometer).

4. Enter the desired protocol name part.

5. Click on

6. Click on Pre-Exercise and determine the desired number of stages in Total Rest Stage

7. Click on Exercise and determine your desired number of stages in Total Rest Stage.

8. Click on Recovery option; choose your desired number of stages in Total Rest Stage
part.
9. In order to change time, speed, slope and created stages, choose the stage (it turns
blue) and then, click on Edit option. A table shown in figure 3.7 would be opened at
the bottom of the window in figure 3.6.
Apply the desired changes and click on OK to save them.

Figure 3.7

10. Then, click on save; the massage on figure 3.8 would be seen:

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 Figure 3.8

The new protocol’s name would then be added to the list of protocols.

In order to change the stages at all three previous steps, follow these instructions:

1. Click on Protocols Name option, icon. List of available protocols would be

opened.
2. Choose the desired protocol by clicking on it.
3. Click on

Then, the name of selected protocol would appear in Current Protocol zone on the top of
displayed page.

3.3. Deleting a protocol from the list of protocols.

If you wish to delete a protocol from the list; at first, choose that protocol from
on figure 3-4 and then, click on Delete option. To leave this window and
return to the main page, click on

Import: for sending out protocols from PC and archive them.

Export: for bringing in protocols to PC

These items would be discussed in detail at parts 6.4 and 6.5.

4. Patient registration for test

In order to register a new patient, click on in figure 3.4. A window as

shown in figure 4.1 would be opened.

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 Figure 4.1

Click on , a new window for entering the patient’s characteristics as

shown in figure 4.2 would be opened which contains these information:

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 Figure 4.2

ID: patient’s characteristics

Section: Number of sessions

Name: patient name and family name

Sex: sex of patient

Race: Race

DOB: date of birth

Target heart rate:

Height: stature

Weight

Address

Telephone

Smoking: if patient smokes cigarette, this place must be filled.

Diabetes: if the patient is diabetic, this place must be filled.

History of myocardial: check if patient has MI history.

Hypertension

Hyperlipidemia

Family diseases history

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Operator

Physician

Indication

Medication

Notes

Then, click on OK.

Figure 4.3

These items are at top of the page:

Patient: the patent’s name is showed in this zone.

Protocol: the using protocol’s name is showed in this zone

Target HR: maximum number of heart rate is showed here.

Exercise time: the duration of test is showed in this area. It starts from zero and lasts until the
end. It would start from zero again in beginning of a new test.

Speed and grade of treadmill: grade and speed conditions of the treadmill are showed in this
area.

Stage: name of stage is showed in this zone.

These items are in a column in the right part of this page:

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 Mets: in this part, Mets or the quantitative amount of metabolism is calculated

HR (heart rate) and HR percentage of target HR

ST level

QT gradients

Blood pressure

Attention

When target heart rate reaches 100 per cents (its maximum), its color
turns red.

Attention

When ST segment elevation or depression furthers 0.1 mV,

caution icon would appear.

Run and Recovery

Treadmill: you may either click on this icon or press F2 key to enter the
treadmill control page.

BP: a page for entering systolic and diastolic pressures would appear
by clicking on this option or pressing F3 key.

Event: a named event may be recorded at the moment that thisbutton is

clicked orF4 key is pressed.

Borg: by clicking on this button or pressing F5 key, a small page appears in which there
would be a list to estimate patient’s workload level .

Treadmill control-4-1

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Click on treadmill item or F2 in the right column of picture(4-3)where a page the same as the
(picture4-4)will appear.

_to turn off/on the treadmill by the use of program you can click on TURN ON&TURN OFF
and later click on OK (picture 4-5)

_to keep the treadmill in the current mode, click on Hold Stage and then click on OK, if so,
the treadmill will stay in the same mode and keep operating. Picture (4-6) and picture (4-7) in
this mode the Hold Stage key changes to Stop hold one.

_to exit Hold Stage mode and return to the rest of process click on Stop hold (picture 4-8)

_at every stage ,if you intend to pass a stage/stages, to move to next stage/stages you can
click on NEXT STAGE(picture 4-4)and then click on OK (picture4-9)

_if you intend to control the treadmill by hand, click on manual,(picture4-4) and picture(4-
10) at this stage you can give the intended speed and slope to the treadmill.

Enter speed in front of the SPEED and slope in front of the GRADE and then click on OK.

Figure 4-4 Figure 4-5 Figure 4-6

Figure 4-7

Figure 4-8 Figure 4-9 Figure 4-10

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2-4-how to enter blood pressure:

_in the right column of the (picture 4-3) click on BP or F3, a picture the same as item (4-11)
will appear. Now calculate the patient pressure and manually enter the systolic and diastolic
pressure and then click on OK (picture 4-11)

_event: by clicking on this item or f4 on the key board you can record a preferred moment as
an EVENT by (with) the related name. (4-12)

Figure 4-11 Figure 4-12

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Soft key: by clicking on this button or f6 key on the key board a page will appear where you
can change the rate of speed, amplitude and ECG signal filter according to picture (4-13)

Format: by clicking on this button or f7 on key board a page will appear to change the
number of leads which show ECG signal (for example two columns of 6 lead, twelve leads in
one page, six leads in one page, two columns of three leads in one page or three leads in one
page) and changing in the color of the signal background sheet(picture 4-14)

Leads: by clicking on this button or f8 on the key board, a page to determine base lead and a
lead to do ST calculations on the basis of that will appear. (Pic.4-15)

Compare: by clicking on this button or f9 on the keyboard, a page to compare recorded

EVENTs will appear (pic.4-16)

Figure 4-16 Figure 4-15 Figure 4-14 Figure 4-13

5-How to access the recorded data of patients (patient archive), and how to
examine and analyze it:

1. Click on ARCHIVE from main page (pic.3-4)

A page the same as (pic.5-1) willappear and you can see the recorded list of the patients.

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 Figure 5-1

2. Select the intended patient and double click on it. A page the same as (pic5-2) will appear.

Attention: quick access to patients archive is also possible through QUICK OPEN menu
at the top left of(pic.3-4)

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 Figure 5-2

3. At the top of the page (pic.5-2) click on Summary, max value and Arthythmia

. This item consists of the following three items.

Summary part consists of:

Protocol name: name of the protocol

Target HR: maximum beat

Exam time: test time

Max speed: highest speed

Max grade: highest slope

Lead over 0.1mV: shows ST segment elevation/depression more than 0.1 mv

Max values part consists of:

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*HR: heart beat

*target HR: goal HR

*METs: maximum quantitative amount of metabolism and the time it happened

*SYS: systolic pressure

*DIA: diastolic pressure

ARRHYTHMIA part consists of:

*total beat: number of all beats

*abnormal beats: number of all kinds of beats

At the top of the page (pic.5-2) click on ST and Statistics , and a page the
same as (pic.5-3) will appear

Figure 5-3

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ST segment part consists of the following items:

.ST segment elevation maximum

.ST segment depression maximum
.ST segment elevation change maximum
.ST segment depression change maximum
.ST segment up slope maximum
.ST segment down slope maximum
.ST/HR elevation maximum
.ST/HR depression maximum

4. At the top of the page (pic.5-2) click on

And a page the same as (pic.5-4) will appear

Figure 5-4

This part consists of the following items:

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.Angina Index
.Duke Score
.FAI%
.HR recovery
.HR reserve
.MET reserve
.Chronoscopic

Attention: HR reserve, HR recovery, FAI%, Angina Index, Arrhythmia data and MET
reserve and Chronoscopic as a Reference are only displayed on this page and there are not on
the print of summary report

The middle part of every three page of the pictures (5-2), (5-3) and (5-4) consists of:

Figure 5-5

Select Lead: consists of a list of selecting leads to make changes in the guiding lead to show
ST Segment

ST over0.1mV: shows ST elevation and ST depression

_Horizontal red dotted line in the table shows 0.1mV

_Vertical dotted line means start Stage

_Gray dotted line, Pre-exercise stage

_Blue dotted line, exercise stage

_Red dotted line, recovery stage

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 Attention: If ST segment occurs more than range of ±0.1mV, a red line will warn
about the recorded time.

Attention: Default display is 30 minutes, if test time takes longer, Page up/down item
will appear at the right corner below the Trending figure.

_ Click where you want, on the diagram, where a small box including: time of occurrence, ST
segment, and Heart rate appears which automatically disappears in 3 seconds

_at the bottom of every three page (pic.5-2) and (5-3) and (5-4) there are boxes to reports of
test results and symptoms and related explanations.

*reason for end: the reason to finish the test

*symptom: signs

*conclusion: result

*Reviewing physician: doctor review

After filling each part, click on save to record the data

Attention:all the information mentioned above is filled automatically according to

system analysis except:

Duke score, FAI%, reason of end, symptom, conclusion, report doctor

About above mentioned data, except Time item, others can be manually entered or corrected

In the right column (pic.5-4)

31
Patient data: by clicking on this item, patient data page appears, you can make changes or
correction here if you like and click OK to save the changes/corrections.

1-5-Review recorded signal of the patient:

Review: by clicking on this item you can review recorded ECG signal of the patient.

After clicking on this item a page the same as (pic.5-6) will appear.

Figure 5-6

At the page of (pic.5-6) there are following items:

32
To adjust speed and amplitude and determine lead

In this part at the top row, select the test part and at the bottom part select which state you
want to observe:

Max HR, Max ST elevation, Max ST depression

Click on measure option to measure preferred intervals.

Click on the beginning of the intended place and move the mouse up to the end of the
intended place. A window the same as (pic.5-7) will appear.

Figure 5-7

33
In this window, you can observe time interval according to mls, amplitude according to mv
and beat according to bmp.

And then click on OK.

: click on this item, a small blue box appears, that move on the page by
moving the mouse, click on the intended place and now right click on it.

At every right click you can adjust the changes about range(pic.5-8), changes about
speed(pic.5-9), changes about lead selection(pic.5-10), and changes about signal naming
(pic.5-11)

34
Figure 5-8

Figure 5-9

35
 Figure 5-10

Figure 5-11

N: Normal (Normal word is not displayed)

36
V:

S:

L:

O:

D:

: By clicking on this item before printing you can observe the Print
Preview, in advance.

: To print the page click on this icon.

: To return to previous page click on this item.

2-5- how to PLAY the performed test again:

: By clicking on this item you can observe the test stages again

37
 Figure 5-12

Further explanations on this part are available at pages 14, 15,16,17,18.

By clicking on Return item you can return to previous page.

3-5- a review of Average signal:

: By clicking on this item, you can see the signal combining

average along the test.

38
By clicking on this iconyou can see a page the same as (pic.5-13)

Figure 5-13

In the page of picture (5-13) you can see the following items:

: Foramplitude and speed adjustments

39
 : To select all or a column of recorded signals at this page

: Click on preview to see the print preview of the page before printing

: To print the page click on this item

: After making changes click on this item

: To cancel the page click on this item

Attention

_Through the process operator must be present next to the patient and check the patient signal
Permanently.

_The system is not able to display piece maker pals and doesn’t suit for patients which have
pace.

_The operator must be familiar with ECG signal related issues.

_To observe ECG signal on monitor, you must see the accuracy of signal in ST Measure

40
mode.

_Checking critical symptoms of life by monitoring system must be done by experienced

medical personnel and their presence all through the process is necessary.

_The physician must consider all known side effects while using the system.

Caution

_ Don’t use one monitor for more than one patient.

_ Don’t expose the monitor system to the local heat like direct sunlight.

4-5-reviewing the recorded events

: By clicking on this item you will see a page the same as (pic.5-14)

41
 Figure 5-14

At this page (pic.5-14) are the following items:

: Foramplitude and speed adjustments

To choose to show three selected leads at Events.

42
 : click on event and then on Review, to review recorded signal.

: To change the name of the recorded event, select the related Event,
click on the item, Modify and enter the related name to, on the opened column.

: To delete the recorded Events, select the related box and click on
delete

: To see the selected Event page before printing, click on this item,
now you can use the opened page for printing the related Event.

: To print this page click on this item.

: click on this item after making changes.

: To cancel the page uses this item.

5-5 Mets, Speed,Grade, BP, HR*BP diagram Trends

: By clicking this item you see a page as (pic.5-15)

43
 Figure 5-15

At the page of picture 5-15 there are following items:

: By selecting this item you will see diagrams according to ST level.

: By selecting this item you will see diagrams according to ST

changes.

: By selecting this item you will see diagrams according to ST Slope.

: By selecting this item you will see diagrams according to

ST/HR trend.

44
 : By selecting this item you will see diagrams according to J Trend.

: To see 3-dimensional graphs of these Trends click on the

following this item.

Figure 5-16

: By clicking on every lead, you can see the changes and traits of that lead.

:You can see the Print Preview of this page before printing.

: To print this pageclick on this item.

: To return to the previous page click on this item.

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 : To select the basic lead which analysesprocess happens according to
it.

: By clicking on this item ECG information is analyzed again.

: To calculate ST

If you click on Automatics you see a page as (pic.5-17) where in you can see HR range and
ST calculation method.

Figure 5-17

If you want to select some patient’s report simultaneously from the archive to observe or Edit
you can select names from the patient archive list and place mouse on them and click on

later, for example if you select three patients altogether at the top

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right of the page a picture like as appears, then by clicking on

you can observe related information about any number of selected

patient.

: To return to previous page click on this item.

6- How to enter the recorded archive of the patients:

1-6-searching for the patients from the archive:

At this page (pic.3-4) click on

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According to (pic.6-1) a page about recorded archive of the patients will appear.

Figure 6-1

You can observe the list ofrecorded patients at, on the left of this page

At the top of the page at QUICK SEARCH part you can search for intended patients, this
search can be according to the following items:

By exam time: search according to the time that test lasts.

By patient name: search according to the patient’s name.

By notes: search according to pre-speculated text

In 7 days: search for the late week patients

In 30 days: search for the last month patients

All: search for all patients

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Deleted Archives item: by activating this item, the name of the patients which were earlier
deleted from the archive will be displayed in red color.

2-6-how to make changes or corrections to the recorded patient details:

If you intend to make any changes in the recorded patient details, select the related patient
from the list and make the necessary changes in the page next to the archive (details) and then

click on

Advanced search:

_Choose this item to search for patients with complex conditions

_the search result will be recorded at patient list

_select the intended patient from the list of patients at, on the left of the page

_then you can carry out all performances of the right column on it.

:select the related patient ,to see the recorded patient data ,double
click on it or click on Open item.

: select the patient in mind from the list (6-1) (which changes to
blue)

By clicking on this item according to picture6-2you can see the patient history

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 Figure 6-2

Figure 6-3

By clicking on this item visual report file will open (if pictures have been recorded)

3-6-deleting patient data from archive:

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 : To delete a patient from the list of patient archive, select the
patient and click on delete.

A window as (6-4)will appear

Figure 6-4

If you click on Yes, the patient data will be deleted.

4-6-data transfer from program to PC

: If you want to transfer the patient data from program archive to a

drive in computer and keep it, click on this item as (pic.6-5)

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 Figure 6-5

Select your path in the opened page and click on OK.

A page same as picture (6-6) will be opened.

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 Figure 6-6

Which shows intended data transfer out of the program.

5-6-data transfer from PC to the program

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 : if you have transferred the patient data from program archive to a
drive in the computer and then delete the patient and now need that data, you can click on
Import ,a page as (6-7)appears

Figure 6-7

Select the previous path used to record the patient data and click on Import at the bottom of
the page.

Figure 6-8

Click yes if you want to enter the intended patient data to archive.

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6-6-how to update patient data

:click on this item to update the patient data

7- System setting

From the menu of picture (3-4) page click on a page as (pic.7-1) will
appear.

Figure 7-1

Click on System menu on top of the page (7-1)

Click on equipment part, and select Treadmill Med 2000 from the list which was opened.

Click on Connection part and select COM1 as the relating port.

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_you can enter hospital name or treatment center name at Hospital Information part.

_At Information part in front of the:

_Doctor name: the name of related doctor

_Section name: enter the name of the session

_Event Label: here you can add/delete Event Label

_ click on Testing & analysis at top page menu

A page as (pic.7-2) will appear

Figure 7-2

To calculate Target Heart Rate,

Filter adjustment;selecta lead as the basic lead,

Lead selection for ST adjustments

And automatic ST analysis adjustments (pic.7-3)

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Click on Display from top page menu (7-1)

A page as (pic.7-3) will appear

Figure 7-3

You may use this page for lead number adjustments at the page, amplitude and
speed,changing the background color of signal page.

Click on Print at top menu of page (7-1) a page as (pic.7-4) will appear.

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 Figure 7-4

For size adjustments and print format type you may use this page.

Click on Interface at the top page menu (7-1) a page as (pic.7-5) will appear.

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 Figure 7-5

Language change is done at this page.

From the top page menu (7-1) click on Miscellaneous,

A page as (pic.7-6) will appear.

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 Figure 7-6

For measurement norm adjustments and history classification method, you can use this page.

8- General warnings and cautions

*While locating the system, all stages of installation and launching is carried out by
AVECINNA company experts.

*If used properly, according to the above-mentioned conditions, the system is guaranteed 1
year warranty plus ten year post sale services since installation time.

*only contact AVECINNA company for any sort of service.

*To use the system, see Persian catalogue which is provided by AVECINNAcompany for the
operators.

*To turn on the system, first turn on other devices, and then turn on the computer.

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*To turn off the system, first turn off the computer, and then turn off other devices.

*After turning on the system, don’t move any devices or plug in/out any devices.

*Assemble all devices before turning on and you can move them after turning off the system.

*The time between every turning on and off, shouldn’t be less than 30 seconds, or it might
damage the system.

*Hardware parts are of high capacity and rarely encounter problems or lose any file. The
biggest of files are easily at hand. Keep the system free from dust and soil and pollution.
Never open up the system for changes or repairs or it might go out of normal operation.

*the device IPX is 0.

*All through the process the operator must be present next to the patient and check the patient
signal.

*The device cannot display piece maker and does not fit patients having it.

*The operator must be familiar with the ECG signal issues.

*Remove the battery if the device is not used.

*To see the ECG signal on the monitor you should see the signal accuracy in ST Measure
mode.

*Do not change/exchange the floppy disk.

*Back up your data.

*Do not use the device for other uses.

*While using devices such as MRI, Scan, do not use devices simultaneously

*Checking critical signs of the patient whenusingthe device must be done by experienced
medical personnel and they must be present all through the process.

*Before using the system read the manual booklet plus subsidiary equipment manual. By
opening the system there is a possibility of electric shock, every servicing and updating
services must be carried out by the certified and trained people from the company.

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*The operator must be assured of the system operation accuracy and subsidiary equipment.
To prevent EMC influences on the system, do not use the system in proximity of other
devices, if necessary the normal performance of the system should be certified.

*Alarm must be adjusted according to the condition of each patient, before working with the
system check the alarm system operation in advance (it’s better to have audio alarms in next
models)

*Using cell phone within the system atmosphere is forbidden, high electromagnetic waves of
the mobile phone can interrupt the monitoring system.

*Doctor must consider all known side effects of the system.

*Do not use one monitor to monitor more than one patient.

*Do not expose the system to direct sunlight.

*To avoid environment pollution, discard deficient accessories and used subsidiaries
according to the related rules.

*The software is planned to reduce risks of the software mistakes to the least.

*Do not touch the screen with cutting things.

When the alarm turns on

*Check the patient condition.

*Know the special alarms to special module.

*Know why the alarm happens.

*After fixing the cause of alarm, check if the alarm works properly or not.

*Alarm happens when stimulated by a parameter or something goes wrong with the system.
In this system it takes 1s to respond to any stimulating condition.

*Visual alarm is visible in a distance of 1.5 meter.

Conditions in which alarm activates parameters

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*when the measured amount extend the determined alarm limitation and alarm is in OK mode
, and also when the system is in ARITMI condition the alarm gets activated even if the alarm
is in the off mode.

* Only use the producer recommended accessories, other accessories might interfere with the
system.

*maximum time which the system reaches from 80 bpm to 120 bpm is 8 seconds.

* Maximum time which the system reaches from 80 bpm to 40 bpm is 8 seconds.

*In case of a heart attack it takes 8 seconds for the system to send an alarm.

Fluctuations caused by line isolation monitoring (LIM) may create wave forms similar to that
of real cardiac waves and stimulate the alarm system; these influences can be reduced to the
least by proper electrodes and cable attachments according to the things which was listed.

Attention

Alarms must be adjusted according to the condition of each patient; in the time which the
alarm is occurred (it’s recommended to use audio alarms in next models).

Electro coater

Interference caused by electro cardiograph or a system which is not connected to the earth
and is near the patient can cause loss of accuracy of ECG wave form.

*While connecting the electrodes and cables make sure there is no connection between metal
parts of the electrodes and protective land.

*Make sure all ECG electrodes are properly attached to the patient.

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*Use similar electrodes for one patient to prevent difference in electric resistance.

*Use of silver chloride electrodes is recommended.

*Use of different metals can produce big offset which affecting the form of ECG during
polarization.

Displayed faults

*If the ECG wave form was not definite and theirconnectionswereright, change the lead.

*The presence of devices not landed, or electro coater system near the patient can cause lack
of precision in the wave form.

*Don’t soak ECG leads in water and detergents, because the connecters are not water proof.

*It is strongly recommended to don’t sterile ECG cable with steam and ethylene oxide.

9-System maintenance instructions

9-1Daily test:

Check the following points before using the monitor.

*Check the equipment from mechanical point of view to have no fault.

*Check visible parts, cables and accessories.

*Pay attention to fluctuations and changes of voltage provision sources.

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*If any sign of damage or breaking down appears don’t apply it for monitoring the patients
and contact the AVECINNA Company. We provide you the best solution to earn your
satisfaction.

2-9-How to move and collect devices

*If you are not to use the devices for a long time, pack them properly and keep them
somewhere free from dust and destructive gases.

*Temperature:-40c~55c

*Humidity percentage 93%

*Atmosphere pressure: 50KPa~106KPa

*Do not damage them while transferring by hitting or pressing while transferring.

10-environment conditions:

1-It is recommended environment temperature 10-30 and humidity less than 70.

2-Keep computer room clean

3-Supply: voltage supply is constant and must not go out while monitoring.

4-Interference prevention: avoid magnetic fields and electric field caused by other devices
next to the computer. Don’t turn on/off other high voltage devices while the system is in
operation.

65
 Caution

Using mobile phones where the system is in operation is forbidden. high level of
electromagnetic waves can interfere in monitoring system.

5-Never use this device in poisonous area or places with flammable gases.

6-Recievers must be in a spacious place with air conditioning system.

7-Atmosphere pressure: 86KPa~106KPa

Attention

To avoid environment pollution, discard deficient accessories and used batteries

according to the related rules.

11-System clean-up:

*before cleaning, turn off the monitor and plug it out.

_IP=0

_Clean the system from dust

_Never use destructive detergents.

_For cleaning you might use light alcohol and dry it later.

_To prevent system break down in hospitals and to keep them for a long term, apply an
antiseptic program.

_Never use liquid detergents in parts such as connectors.

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 *Never use anti septic material.

*Don’t let liquid penetrate into the system.

*Don’t leave cleaning liquid on the surface of the instruments.

*Don’t splash cleaning liquid on the surface of the instruments.

caution

Hardware parts are of high capacity and rarely encounter problems or lose any file. The
biggest of files are easily at hand. Keep the system free from dust and soil and pollution.

12-Periodic control:

System checkup must be done annually, which is done according to hospital calibration.
After every repair, the system must be tested by someone from AVECINNA company in
terms of quality and others conditions.

caution

In case of a break down, system must be checked by an expert from the company,
producer takes no responsibility for unauthorized repairs of the device.

The user shouldn’t open the system for changes and repairs,because it might abnormal
function of the system.

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13- FAULT DETECTION:
faults Cause of occurrence
1 Straight line existence in all One of the lead wires are
signals separated N or F
There’s a problem in the
connection of lead wire and
recorder
There’s a problem in the
connection of lead wire and
recorder
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Solution
Please connect chest
leads and lead wires
again
Please check the input
connector pins, if they
are crooked,
disconnection occurs,
if they are ok ,connect
the connectors
properly
Please check the input
connector pins, if they
are crooked,
disconnection occurs,

2 ECG signal quality at recorded
ECG is poor and there’s
interference at signal Artifacts
3 Waves interference
Low ECG signal quality
Lead wire is not properly
fixed.
Chest leads are poor in
quality, therefore cannot be
well connected, and
consequently the signal is
irregular.
Skin surface is not well
prepared for connection or
the place of chest leads are
not correct
Too much movement of the
upper organs of the patient,
causes muscular electricity
and make a lot of flaws in
the system
The room temperature is
very low
Patient body muscle shake,
causes muscular electrical
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if they are ok ,connect
the connectors
properly
Please connect lead
wires
properly(according to
lead connections part
manual)
Please replace poor
quality chest leads
with high quality
chest leads
Please prepare the
body skin, attach
chest leads
again,(according to
important issues
before stress test),then
continue the test
Explain the correct
test performance to
the patient, according
to the instruction(the
important notes before
stress test)
The room temperature
must be above 16
centigrade
 interference

Chest leads are poor Prepare new high

quality, or their glue is dry quality chest leads
because of long term
keeping

4 ECG signal stops after a short There’s a disconnection in Please change the lead
time lead wire wire

5 Transmitter device LED doesn’t Batteries or one of them Replace old battery
turn on, program entrance give doesn’t have the required with new one
error message power, please test them
with multi meter

There is MRI or Scan Change the place of

device next to the device device

Batteries are misplaced Place them properly

6 Printer doesn’t work There’s no connection Check the connection,

between computer and if necessary change
printer or printer cable is the cable and check
faulty again

The hard ware is faulty Please change the

printer

The software is faulty Please install the

driver again

7 ECG signal or network Wrong adjustments of the Reset printer again,

background is not clear in the printer and close self-
print report regulation and ink
cost saving mode

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 The ink of cartridge is not Chargecartridge ink
sufficient

8 There are mistakes at report print Wrong Set up mode Do printer and print
adjustments and
repeat print

Printer driver is not match Uninstall wrong

with printer driver and install the
right one

AVECINNA COMPANY
Stress Test system
Model: AST-3000

UMDNS Code: 17723

ISIC Code: 3311413757
GTIN Code: 6265919900016
IRC Code: 6728583214267216
Model: AST-3000

Manufacturer: AVECINNA COMPANY

Head office Address: UNIT 1, NO.3, 58th St., YOUSEF ABAD St., TEHRAN, IRAN
Tel: +98 21 88054231
Fax: +98 2188051647
Email: export@avecinna.com

Factory Address: No.TJ291, 13 th St., Professor Hesabi Blvd., Shams Abad Industrial city,
After Imam Khomeini International airport, 35 km Tehran – Qom (Persian Gulf) Highway,
Tehran, IRAN
Tel: +98 2156901242

European Representative:
Tavakkolian-Vassbunnsvingen 1-1388-Borgen-Norway

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Partner for progress :
KIWA CERMET ITALIA S.P.A
Via Cadriano di Granarolo (BO)
Country: Italy
Phone: +39 051 4593111
Fax: +39 051 763382
Email: infobologna@kiwacermet.it
Website: www.kiwacermet.it
Notified Body number: 0476

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