44464842 ECG Project Report

8/18/2019 44464842 ECG Project Report

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Table Of Contents

1. Acknowledgements.

2. Certificate

3. Introduction to the project

. !asics of "C#

$. Circuit diagram

%. &orking of "C#

'. (atlab !asics


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ACKNOWLEDGEMENT

It is with pleasure that we find oursel)es penn* down

these line to e+press our sincere thanks to )arious people to

help me along the wa* in completing this work.

I am helpful to (r. !.,.!rar- (iss #urwinder aur / (r.

A.C. (ongra who ga)e me chance to go outside the college for

the training. Also thankful to (r. Abina)- who taught me

during the % week training.

I also thankful to m* parents / dearest who help me in

doing this report.


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Introduction

The electrocardiogram 0"C# or "# is a diagnostic tool that measures and

records the electrical acti)it* of the heart in e+uisite detail. Interpretation of these

details allows diagnosis of a wide range of heart conditions. These conditions can

)ar* from minor to life threatening.

The term electrocardiogram was introduced b* &illem "intho)en in 143 at a

meeting of the 5utch (edical ,ociet*. In 142- "intho)en recei)ed the 6obel

7ri8e for his life9s work in de)eloping the "C#.

The "C# has e)ol)ed o)er the *ears.

• The standard 12:lead "C# that is used throughout the world was introduced

in 142.

• It is called a 12:lead "C# because it e+amines the electrical acti)it* of the

heart from 12 points of )iew.

• This is necessar* because no single point 0or e)en 2 or 3 points of )iew

pro)ides a complete picture of what is going on.

• To full* understand how an "C# re)eals useful information about the

condition of *our heart reuires a basic understanding of the anatom* 0that

is- the structure and ph*siolog* 0that is- the function of the heart.

Basic Anatomy of the Heart

The heart is a :chambered muscle whose function is to pump blood throughout

the bod*.

• The heart is reall* 2 ;half hearts-; the right heart and the left heart- which

beat simultaneousl*.

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• "ach of these 2 sides has 2 chambers< a smaller upper chamber called the

atrium 0together- the 2 are called atria- and a larger lower chamber called

the )entricle.

•

Thus- the chambers of the heart are called the right atrium- right )entricle-left atrium- and left )entricle.

This seuence also represents the direction of blood flow through the heart.

• The right atrium recei)es blood that has completed a tour around the bod*

and is depleted of o+*gen and other nutrients. This blood returns )ia 2 large

)eins< the superior )ena ca)a returning blood from the head- neck - arms-

and upper portions of the chest- and the inferior )ena ca)a returning blood

from the remainder of the bod*.

• The right atrium pumps this blood into the right )entricle- which- a fraction

of a second later- pumps the blood into the blood )essels of the lungs.

• The lungs ser)e 2 functions< to o+*genate the blood b* e+posing it to the air

*ou breathe in 0which is 2=> o+*gen- and to eliminate the carbon dio+ide

that has accumulated in the blood as a result of the bod*9s man* metabolic

functions.

• ?a)ing passed through the lungs- the blood enters the left atrium- which

pumps it into the left )entricle.

• The left )entricle then pumps the blood back into the circulator* s*stem of

blood )essels 0arteries and )eins. The blood lea)es the left )entricle )ia the

aorta- the largest arter* in the bod*. !ecause the left )entricle has to e+ert

enough pressure to keep the blood mo)ing throughout all the blood )essels

of the bod*- it is a powerful pump. It is the pressure generated b* the left

)entricle that gets measured when *ou ha)e *our blood pressure checked.

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The heart- like all tissues in the bod*- reuires o+*gen to function. Indeed- it is the

onl* muscle in the bod* that ne)er rests. Thus- the heart has reser)ed for itself its

own blood suppl*.

• This blood flows to the heart muscle through a group of arteries that begins

less than one:half inch from where the aorta begins. These are known as the

coronar* arteries. These arteries deli)er o+*gen to both the heart muscle

and the ner)es of the heart.

• &hen something happens so that the flow of blood through a coronar*

arter* gets interrupted- then the part of the heart muscle supplied b* that

arter* begins to die. This is called coronar* heart disease- or coronar* arter*

disease. If this condition is not stopped- the heart itself starts to lose its

strength to pump blood- a condition known as heart failure.

• &hen the interruption of coronar* blood flow lasts onl* a few minutes- the

s*mptoms are called angina- and there is no permanent damage to the heart.

&hen the interruption lasts longer- that part of the heart muscle dies. This is

referred to as a heart attack 0m*ocardial infarction.

6er)es of the heart< The heart9s function is so important to the bod* that it has its

own electrical s*stem to keep it running independentl* of the rest of the bod*9s

ner)ous s*stem.

• ")en in cases of se)ere brain damage- the heart often beats normall*.

• An e+tensi)e network of ner)es runs throughout all chambers of the heart.

"lectrical impulses course through these ner)es to trigger the chambers to

contract with perfectl* s*nchroni8ed timing much like the distributor and

spark plugs of a car make sure that an engine9s pistons fire in the right

seuence.

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• The "C# records this electrical acti)it* and depicts it as a series of graph:

like tracings- or wa)es. The shapes and freuencies of these tracings re)eal

abnormalities in the heart9s anatom* or function.

Basics of ECG

ECG Electrodes

,kin 7reparation<

Clean with an alcohol wipe if necessar*. If the patients are )er* hair* @ sha)e theelectrode areas.

"C# standard leads

There are three of these leads- I- II and III.

ead I< is between the right arm and left arm electrodes- the left arm being positi)e.

ead II< is between the right arm and left leg electrodes- the left leg being positi)e.ead III< is between the left arm and left leg electrodes- the left leg

again being positi)e.

Chest "lectrode 7lacement

B1< ourth intercostal space to the right of the sternum.

B2< ourth intercostal space to the eft of the sternum.

B3< 5irectl* between leads B2 and B.

B< ifth intercostal space at midcla)icular line.

B$< e)el with B at left anterior a+illar* line.

B%< e)el with B$ at left mida+illar* line. 05irectl* under the

midpoint of the armpit

http://www.ambulancetechnicianstudy.co.uk/images/electrodes_position.gif


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Chest eads

B1 / B2

B3 / B

B$ / B%

Biew

Dight Bentricle

,eptumEateral eft Bentricle

AnteriorEateral eft Bentricle

The "C# records the electrical acti)it* that results when the heart muscle cells in the

atria and )entricles contract.

• Atrial contractions show up as the 7 wa)e.

• Bentricular contractions show as a series known as the FD, comple+.

• The third and last common wa)e in an "C# is the T wa)e. This is the electrical

acti)it* produced when the )entricles are recharging for the ne+t contraction

0repolari8ing.

• Interestingl*- the letters 7- F- D- ,- and T are not abbre)iations for an* actual

words but were chosen man* *ears ago for their position in the middle of the

alphabet.

• The electrical acti)it* results in 7- FD,- and T wa)es that are of different si8es

and shapes. &hen )iewed from different leads- these wa)es can show a wide

range of abnormalities of both the electrical conduction s*stem and the muscle

tissue of the hearts pumping chambers.

ECG Interpretation

The graph paper that the "C# records on is standardised to run at 2$mmEsecond-

and is marked at 1 second inter)als on the top and bottom. The hori8ontal a+is correlates

the length of each electrical e)ent with its duration in time. "ach small block 0defined b*


8/17

lighter lines on the hori8ontal a+is represents =.= seconds. i)e small blocks 0shown b*

hea)* lines is a large block- and represents =.2= seconds.

5uration of a wa)eform- segment- or inter)al is determined b* counting the blocks from

the beginning to the end of the wa)e- segment- or inter)al.

7:&a)e< represents atrial depolari8ation : the time necessar* for an electrical impulse

from the sinoatrial 0,A node to spread throughout the atrial musculature.

• ocation< 7recedes FD, comple+

Amplitude< ,hould not e+ceed 2 to 2.$ mm in height 5uration< =.=% to =.11

seconds

7:D Inter)al< represents the time it takes an impulse to tra)el from the atria through the

AB node- bundle of ?is- and bundle branches to the 7urkinje fibres.

• ocation< "+tends from the beginning of the 7 wa)e to the beginning of the FD,

comple+

5uration< =.12 to =.2= seconds.


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FD, Comple+< represents )entricular depolarisation. The FD, comple+ consists of 3

wa)es< the F wa)e- the D wa)e- and the , wa)e.

• The F wa)e is alwa*s located at the beginning of the FD, comple+.

It ma* or ma* not alwa*s be present.

The D wa)e is alwa*s the first positi)e deflection.

The , wa)e- the negati)e deflection- follows the D wa)e

• ocation< ollows the 7:D inter)al

Amplitude< 6ormal )alues )ar* with age and se+

5uration< 6o longer than =.1= seconds

F:T Inter)al< represents the time necessar* for )entricular depolari8ation and

repolari8ation.


10/17

• ocation< "+tends from the beginning of the FD, comple+ to the end of the T

wa)e

0includes the FD, comple+- ,:T segment- and the T wa)e

5uration< Baries according to age- se+- and heart rate

T &a)e< represents the repolari8ation of the )entricles. On rare occasions- a G wa)e can

be seen following the T wa)e. The G wa)e reflects the repolari8ation of the ?is:7urkinje

fibres.

• ocation< ollows the , wa)e and the ,:T segment

Amplitude< $mm or less in standard leads I- II- and IIIH 1=mm or less in precordial

leads B1:B%.

5uration< 6ot usuall* measured

,:T ,egment< represents the end of the )entricular depolari8ation and the beginning of

)entricular repolari8ation.

•

ocation< "+tends from the end of the , wa)e to the beginning of the T wa)e

5uration< 6ot usuall* measured


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The ECG and Myocardial Infarction

5uring an (I- the "C# goes through a series of abnormalities. The initial abnormalit* is

called a hyperacute T wave. This is a T wa)e that is taller and more pointed than the

normal T wa)e.

?*peracute T &a)e

The abnormalit* lasts for a )er* short time- and then ele)ation of the ,T segment occurs.

This is the hallmark abnormalit* of an acute (I. It occurs when the heart muscle is being

injured b* a lack of blood flow and o+*gen and is also called a current of injur*.

An "C# can not onl* tell *ou if an (I is present but can also show the appro+imate

location of the heart attack- and often which arter* is in)ol)ed. &hen the "C#


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abnormalities mentioned abo)e occur- then the (I can be locali8ed to a certain region of

the heart. or e+ample- see the table below<

ECG leads Location of MI Coronary Artery

II- III- aB Inferior (I Dight Coronar* Arter*

B1:B Anterior or Anteroseptal (I eft Anterior 5escending Arter*

B$:B%- I-aB ateral (I eft Circumfle+ Arter*

,T depression in B1- B2 7osterior (I eft Circumfle+ Arter* or Dight Coronar* Arter*

Circuit 5iagram

Design Considerations

TI9s new A5,124 pro)ides eight channels of 7#A plus separate 2:bit delta:sigma

A5Cs- a &ilson center terminal- the augmented #oldberger terminals and their

amplifiers- pro)ide for a full- standard 12:lead "C# integrated analog front end. The

A5,124 reduces component count and power consumption b* up to 4$ percent as

compared to discrete implementations- with a power efficienc* of 1 m&Echannel- while

allowing customers to achie)e the highest le)els of diagnostic accurac*

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ECG System unctionality and Evolution

!asic functions of an "C# machine include "C# wa)eform displa*- either through C5

screen or printed paper media- and heart rh*thm indication as well as simple user

interface through buttons. (ore features- such as patient record storage through

con)enient media- wirelessEwired transfer and 25E35 displa* on large C5 screen with

touch screen capabilities- are reuired in more and more "C# products. (ultiple le)els

of diagnostic capabilities are also assisting doctors and people without specific "C#

trainings to understand "C# patterns and their indication of a certain heart condition.

After the "C# signal is captured and digiti8ed- it will be sent for displa* and anal*sis-

which in)ol)es further signal processing.

Si!nal Ac"uisition challen!es#

• (easurement of the "C# signal gets challenging due to the presence of the large

5C offset and )arious interference signals. This potential can be up to 3==mB for

a t*pical electrode. The interference signals include the $=:E%=:?8 interference

from the power supplies- motion artifacts due to patient mo)ement- radiofreuenc* interference from electro:surger* euipments- defibrillation pulses-

pace maker pulses- other monitoring euipment- etc.

• 5epending on the end euipment- different accuracies will be needed in an "C#<

o ,tandard monitoring needs freuencies between =.=$:3= ?8

o 5iagnostic monitoring needs freuencies from =.=$:1=== ?8

• ,ome of the $=?8E%=?8 common mode interference can be cancelled with a high:

input:impedance instrumentation amplifier 0I6A- which remo)es the AC line

noise common to both inputs. To further reject line power noise- the signal is

in)erted and dri)en back into the patient through the right leg b* an amplifier.

Onl* a few micro amps or less are reuired to achie)e significant C(D

impro)ement and sta* within the G$ limit. In addition- $=E%=?8 digital notch

filters are used to reduce this interference further.


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Analo! front end options#

• Optimi8ing the power consumption and the 7C! area of the analog front end is

critical for portable "C#9s. 5ue to technological ad)ancements- there are now

se)eral front end options<

o Gsing a low resolution A5C 0needs all filters

o Gsing a high resolution A5C 0needs fewer filters

o Gsing a sigma:delta A5C 0needs no filters- no amplifier aside from I6A-

no 5C offset

o Gsing a seuential Bs simultaneous sampling approach.

• &hen a low resolution 01% bit A5C is used- the signal needs to be gained up

significantl* 0t*picall* 1==+ : 2==+ to achie)e the necessar* resolution. &hen a

high resolution 02bit sigma delta A5C is used- the signal needs a modest gain of

: $+. ?ence the second gain stage and the circuitr* needed to eliminate the 5C

offset can be remo)ed. This leads to an o)erall reduction in area and cost. Also the

delta sigma approach preser)es the entire freuenc* content of the signal and

gi)es abundant fle+ibilit* for digital post processing.

• &ith a seuential approach the indi)idual channels creating the leads of an "C#

are multiple+ed to one A5C. This wa* there is a definite skew between adjacent

channels. &ith the simultaneous sampling approach- a dedicated A5C is used for

each channel and hence there is no skew introduced between channels.


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$or%in! of ECG

The "C# works mostl* b* detecting and amplif*ing the tin* electrical changes on the

skin that are caused when the heart muscle ;depolarises; during each heart beat. At rest-

each heart muscle cell has a charge across its outer wall- or cell membrane. Deducing this

charge towards 8ero is called de:polarisation- which acti)ates the mechanisms in the cell

that cause it to contract. 5uring each heartbeat a health* heart will ha)e an orderl*

progression of a wa)e of depolarisation that is triggered b* the cells in the sinoatrial

node- spreads out through the atrium- passes through ;intrinsic conduction pathwa*s; and

then spreads all o)er the )entricles. This is detected as tin* rises and falls in the )oltage

between two electrodes placed either side of the heart which is displa*ed as a wa)* line

either on a screen or on paper. This displa* indicates the o)erall rh*thm of the heart and

weaknesses in different parts of the heart muscle.

Gsuall* more than 2 electrodes are used and the* can be combined into a number of pairs

0or e+ample< eft arm 0A- right arm 0DA and left leg 0 electrodes form the pairs<

ADA- A- DA. The output from each pair is known as a lead. "ach lead is

said to look at the heart from a different angle. 5ifferent t*pes of "C#s can be referred to b* the number of leads that are recorded- for e+ample 3:lead- $:lead or 12:lead "C#s

0sometimes simpl* ;a 12:lead;. A 12:lead "C# is one in which 12 different electrical

signals are recorded at appro+imatel* the same time and will often be used as a one:off

recording of an "C#- t*picall* printed out as a paper cop*. 3: and $:lead "C#s tend to be

monitored continuousl* and )iewed onl* on the screen of an appropriate monitoring

de)ice- for e+ample during an operation or whilst being transported in an ambulance.

There ma*- or ma* not be an* permanent record of a 3: or $:lead "C# depending on the

euipment used.

http://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Atrium_(heart)http://en.wikipedia.org/wiki/Ventricle_(heart)http://en.wikipedia.org/wiki/Voltagehttp://en.wikipedia.org/wiki/Electrocardiography#Leadshttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Atrium_(heart)http://en.wikipedia.org/wiki/Ventricle_(heart)http://en.wikipedia.org/wiki/Voltagehttp://en.wikipedia.org/wiki/Electrocardiography#Leads


16/17

It is the best wa* to measure and diagnose abnormal rh*thms of the heart- J2K particularl*

abnormal rh*thms caused b* damage to the conducti)e tissue that carries electrical

signals- or abnormal rh*thms caused b* electrol*te imbalances.J3K In a m*ocardial

infarction 0(I- the "C# can identif* if the heart muscle has been damaged in specific

areas- though not all areas of the heart are co)ered.JK The "C# cannot reliabl* measure

the pumping abilit* of the heart- for which ultrasound:based 0echocardiograph* or

nuclear medicine tests are used. It is possible to be in cardiac arrest with a normal "C#

signal 0a condition known as pulseless electrical acti)it*.

http://en.wikipedia.org/wiki/Electrocardiography#cite_note-1http://en.wikipedia.org/wiki/Electrocardiography#cite_note-ECG_Noncardiac-2http://en.wikipedia.org/wiki/Electrocardiography#cite_note-ECG_Noncardiac-2http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Electrocardiography#cite_note-ECC_2005_ACS-3http://en.wikipedia.org/wiki/Echocardiographyhttp://en.wikipedia.org/wiki/Nuclear_medicinehttp://en.wikipedia.org/wiki/Pulseless_electrical_activityhttp://en.wikipedia.org/wiki/Electrocardiography#cite_note-1http://en.wikipedia.org/wiki/Electrocardiography#cite_note-ECG_Noncardiac-2http://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Myocardial_infarctionhttp://en.wikipedia.org/wiki/Electrocardiography#cite_note-ECC_2005_ACS-3http://en.wikipedia.org/wiki/Echocardiographyhttp://en.wikipedia.org/wiki/Nuclear_medicinehttp://en.wikipedia.org/wiki/Pulseless_electrical_activity


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A&'A(TAGES

ow cost and high co)erage

,ecure transmission solution"fficient e+change of )ital signs

"as* to interfacing medical instrument to computer

Applications

(onitoring and control platforms

"lectronic medical record s*stems!io:medical applications

5atabase management s*stems

44464842 ECG Project Report

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