Cardea Biomedical Labs New Delhi

Table Of Contents

1. Acknowledgements.

2. Certificate

3. Introduction to the project

4. Basics of ECG

5. Circuit diagram

6. Working of ECG

7. Matlab Basics

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

ACKNOWLEDGEMENT

It is with pleasure that we find ourselves penny down

these line to express our sincere thanks to various people to

help me along the way in completing this work.

I am helpful to Mr. B.S.Brar, Miss Gurwinder Kaur &

Mr. A.C. Mongra who gave me chance to go outside the

college for the training. Also thankful to Mr. Abinav, who

taught me during the 6 week training.

I also thankful to my parents & dearest who help me in

doing this report.

Sunil Kumar

80405103010

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

Certificate
This is certified that the report file on ECG (electro cardio
graph) has been completed by

Sunil Kumar
80405103010

This file includes construction & working of ECG machine,

which he did in 6 week training.

Mr. A.C.MONGRA
H.O.D. (BME Deptt.)

ADESH INSTITUTE OF ENGG. & TECHNOLOGY, FARIDKOT

Sunil Kumar
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 Cardea Biomedical Labs New Delhi

Introduction
The electrocardiogram (ECG or EKG) is a diagnostic tool that measures and

records the electrical activity of the heart in exquisite detail. Interpretation of these

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

vary from minor to life threatening.

The term electrocardiogram was introduced by Willem Einthoven in 1893 at a

meeting of the Dutch Medical Society. In 1924, Einthoven received the Nobel

Prize for his life's work in developing the ECG.

The ECG has evolved over the years.

• The standard 12-lead ECG that is used throughout the world was

introduced in 1942.

• It is called a 12-lead ECG because it examines the electrical activity of the

heart from 12 points of view.

• This is necessary because no single point (or even 2 or 3 points of view)

provides a complete picture of what is going on.

• To fully understand how an ECG reveals useful information about the

condition of your heart requires a basic understanding of the anatomy (that

is, the structure) and physiology (that is, the function) of the heart.

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 Cardea Biomedical Labs New Delhi

Basic Anatomy of the Heart

The heart is a 4-chambered muscle whose function is to pump blood throughout

the body.

• The heart is really 2 "half hearts," the right heart and the left heart, which

beat simultaneously.

• Each of these 2 sides has 2 chambers: a smaller upper chamber called the

atrium (together, the 2 are called atria), and a larger lower chamber called

the ventricle.

• Thus, the 4 chambers of the heart are called the right atrium, right ventricle,

left atrium, and left ventricle.

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

• The right atrium receives blood that has completed a tour around the body

and is depleted of oxygen and other nutrients. This blood returns via 2 large

veins: the superior vena cava returning blood from the head, neck, arms,

and upper portions of the chest, and the inferior vena cava returning blood

from the remainder of the body.

• The right atrium pumps this blood into the right ventricle, which, a fraction

of a second later, pumps the blood into the blood vessels of the lungs.

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 Cardea Biomedical Labs New Delhi

• The lungs serve 2 functions: to oxygenate the blood by exposing it to the air

you breathe in (which is 20% oxygen), and to eliminate the carbon dioxide

that has accumulated in the blood as a result of the body's many metabolic

functions.

• Having passed through the lungs, the blood enters the left atrium, which

pumps it into the left ventricle.

• The left ventricle then pumps the blood back into the circulatory system of

blood vessels (arteries and veins). The blood leaves the left ventricle via the

aorta, the largest artery in the body. Because the left ventricle has to exert

enough pressure to keep the blood moving throughout all the blood vessels

of the body, it is a powerful pump. It is the pressure generated by the left

ventricle that gets measured when you have your blood pressure checked.

The heart, like all tissues in the body, requires oxygen to function. Indeed, it is the

only muscle in the body that never rests. Thus, the heart has reserved for itself its

own blood supply.

• 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

coronary arteries. These arteries deliver oxygen to both the heart muscle

and the nerves of the heart.

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 Cardea Biomedical Labs New Delhi

• When something happens so that the flow of blood through a coronary

artery gets interrupted, then the part of the heart muscle supplied by that

artery begins to die. This is called coronary heart disease, or coronary artery

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

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

• When the interruption of coronary blood flow lasts only a few minutes, the

symptoms are called angina, and there is no permanent damage to the heart.

When the interruption lasts longer, that part of the heart muscle dies. This is

referred to as a heart attack (myocardial infarction).

Nerves of the heart: The heart's function is so important to the body that it has its

own electrical system to keep it running independently of the rest of the body's

nervous system.

• Even in cases of severe brain damage, the heart often beats normally.

• An extensive network of nerves runs throughout all 4 chambers of the heart.

Electrical impulses course through these nerves to trigger the chambers to

contract with perfectly synchronized timing much like the distributor and

spark plugs of a car make sure that an engine's pistons fire in the right

sequence.

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 Cardea Biomedical Labs New Delhi

• The ECG records this electrical activity and depicts it as a series of graph-

like tracings, or waves. The shapes and frequencies of these tracings reveal

abnormalities in the heart's anatomy or function.

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 Cardea Biomedical Labs New Delhi

Basics of ECG

ECG Electrodes

Skin Preparation:

Clean with an alcohol wipe if necessary. If the patients are very hairy – shave the
electrode areas.

ECG standard leads

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

Lead I: is between the right arm and left arm electrodes, the left arm being positive.

Lead II: is between the right arm and left leg electrodes, the left leg being positive.

Lead III: is between the left arm and left leg electrodes, the left leg

again being positive.

Chest Electrode Placement

V1: Fourth intercostal space to the right of the sternum.

V2: Fourth intercostal space to the Left of the sternum.

V3: Directly between leads V2 and V4.

V4: Fifth intercostal space at midclavicular line.

V5: Level with V4 at left anterior axillary line.

V6: Level with V5 at left midaxillary line. (Directly under the midpoint of the armpit)

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 Cardea Biomedical Labs New Delhi

Chest Leads View

V1 & V2 Right Ventricle

V3 & V4 Septum/Lateral Left Ventricle

V5 & V6 Anterior/Lateral Left Ventricle

The ECG records the electrical activity that results when the heart muscle cells in the

atria and ventricles contract.

• Atrial contractions show up as the P wave.

• Ventricular contractions show as a series known as the QRS complex.

• The third and last common wave in an ECG is the T wave. This is the electrical

activity produced when the ventricles are recharging for the next contraction

(repolarizing).

• Interestingly, the letters P, Q, R, S, and T are not abbreviations for any actual

words but were chosen many years ago for their position in the middle of the

alphabet.

• The electrical activity results in P, QRS, and T waves that are of different sizes

and shapes. When viewed from different leads, these waves can show a wide

range of abnormalities of both the electrical conduction system and the muscle

tissue of the hearts 4 pumping chambers.

ECG Interpretation

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 Cardea Biomedical Labs New Delhi

The graph paper that the ECG records on is standardised to run at 25mm/second, and is

marked at 1 second intervals on the top and bottom. The horizontal axis correlates the

length of each electrical event with its duration in time. Each small block (defined by

lighter lines) on the horizontal axis represents 0.04 seconds. Five small blocks (shown by

heavy lines) is a large block, and represents 0.20 seconds.

Duration of a waveform, segment, or interval is determined by counting the blocks from

the beginning to the end of the wave, segment, or interval.

P-Wave: represents atrial depolarization - the time necessary for an electrical impulse

from the sinoatrial (SA) node to spread throughout the atrial musculature.

• Location: Precedes QRS complex

Amplitude: Should not exceed 2 to 2.5 mm in height Duration: 0.06 to 0.11

seconds

P-R Interval: represents the time it takes an impulse to travel from the atria through the

AV node, bundle of His, and bundle branches to the Purkinje fibres.

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 Cardea Biomedical Labs New Delhi

• Location: Extends from the beginning of the P wave to the beginning of the QRS

complex

Duration: 0.12 to 0.20 seconds.

QRS Complex: represents ventricular depolarisation. The QRS complex consists of 3

waves: the Q wave, the R wave, and the S wave.

• The Q wave is always located at the beginning of the QRS complex.

It may or may not always be present.

The R wave is always the first positive deflection.

The S wave, the negative deflection, follows the R wave

• Location: Follows the P-R interval

Amplitude: Normal values vary with age and sex

Duration: No longer than 0.10 seconds

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 Cardea Biomedical Labs New Delhi

Q-T Interval: represents the time necessary for ventricular depolarization and

repolarization.

• Location: Extends from the beginning of the QRS complex to the end of the T

wave

(includes the QRS complex, S-T segment, and the T wave)

Duration: Varies according to age, sex, and heart rate

T Wave: represents the repolarization of the ventricles. On rare occasions, a U wave can

be seen following the T wave. The U wave reflects the repolarization of the His-Purkinje

fibres.

• Location: Follows the S wave and the S-T segment

Amplitude: 5mm or less in standard leads I, II, and III; 10mm or less in precordial

leads V1-V6.

Duration: Not usually measured

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 Cardea Biomedical Labs New Delhi

S-T Segment: represents the end of the ventricular depolarization and the beginning of

ventricular repolarization.

• Location: Extends from the end of the S wave to the beginning of the T wave

Duration: Not usually measured

The ECG and Myocardial Infarction

During an MI, the ECG goes through a series of abnormalities. The initial abnormality is

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

normal T wave.

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 Cardea Biomedical Labs New Delhi

Hyperacute T Wave

The abnormality lasts for a very short time, and then elevation of the ST segment occurs.

This is the hallmark abnormality of an acute MI. It occurs when the heart muscle is being

injured by a lack of blood flow and oxygen and is also called a current of injury.

An ECG can not only tell you if an MI is present but can also show the approximate

location of the heart attack, and often which artery is involved. When the ECG

abnormalities mentioned above occur, then the MI can be localized to a certain region of

the heart. For example, see the table below:

ECG leads Location of MI Coronary Artery

II, III, aVF Inferior MI Right Coronary Artery
V1-V4 Anterior or Anteroseptal MI Left Anterior Descending Artery
V5-V6, I,aVL Lateral MI Left Circumflex Artery
ST depression in V1, V2 Posterior MI Left Circumflex Artery or Right Coronary Artery

Circuit Diagram

Sunil Kumar
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 Cardea Biomedical Labs New Delhi

Design Considerations

TI's new ADS1298 provides eight channels of PGA plus separate 24-bit delta-sigma

ADCs, a Wilson center terminal, the augmented Goldberger terminals and their

amplifiers, provide for a full, standard 12-lead ECG integrated analog front end. The

ADS1298 reduces component count and power consumption by up to 95 percent as

compared to discrete implementations, with a power efficiency of 1 mW/channel, while

allowing customers to achieve the highest levels of diagnostic accuracy

ECG System Functionality and Evolution

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

Basic functions of an ECG machine include ECG waveform display, either through LCD

screen or printed paper media, and heart rhythm indication as well as simple user

interface through buttons. More features, such as patient record storage through

convenient media, wireless/wired transfer and 2D/3D display on large LCD screen with

touch screen capabilities, are required in more and more ECG products. Multiple levels

of diagnostic capabilities are also assisting doctors and people without specific ECG

trainings to understand ECG patterns and their indication of a certain heart condition.

After the ECG signal is captured and digitized, it will be sent for display and analysis,

which involves further signal processing.

Signal Acquisition challenges:

• Measurement of the ECG signal gets challenging due to the presence of the large

DC offset and various interference signals. This potential can be up to 300mV for

a typical electrode. The interference signals include the 50-/60-Hz interference

from the power supplies, motion artifacts due to patient movement, radio

frequency interference from electro-surgery equipments, defibrillation pulses,

pace maker pulses, other monitoring equipment, etc.

• Depending on the end equipment, different accuracies will be needed in an ECG:

o Standard monitoring needs frequencies between 0.05-30 Hz

o Diagnostic monitoring needs frequencies from 0.05-1000 Hz

• Some of the 50Hz/60Hz common mode interference can be cancelled with a high-

input-impedance instrumentation amplifier (INA), which removes the AC line

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

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 Cardea Biomedical Labs New Delhi

inverted and driven back into the patient through the right leg by an amplifier.

Only a few micro amps or less are required to achieve significant CMR

improvement and stay within the UL544 limit. In addition, 50/60Hz digital notch

filters are used to reduce this interference further.

Analog front end options:

• Optimizing the power consumption and the PCB area of the analog front end is

critical for portable ECG's. Due to technological advancements, there are now

several front end options:

o Using a low resolution ADC (needs all filters)

o Using a high resolution ADC (needs fewer filters)

o Using a sigma-delta ADC (needs no filters, no amplifier aside from INA,

no DC offset)

o Using a sequential Vs simultaneous sampling approach.

• When a low resolution (16 bit) ADC is used, the signal needs to be gained up

significantly (typically 100x - 200x) to achieve the necessary resolution. When a

high resolution (24bit) sigma delta ADC is used, the signal needs a modest gain of

4 - 5x. Hence the second gain stage and the circuitry needed to eliminate the DC

offset can be removed. This leads to an overall reduction in area and cost. Also

the delta sigma approach preserves the entire frequency content of the signal and

gives abundant flexibility for digital post processing.

• With a sequential approach the individual channels creating the leads of an ECG

are multiplexed to one ADC. This way there is a definite skew between adjacent

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

channels. With the simultaneous sampling approach, a dedicated ADC is used for

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

Working of ECG

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

The ECG works mostly by detecting and amplifying the tiny 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. Reducing this

charge towards zero is called de-polarisation, which activates the mechanisms in the cell

that cause it to contract. During each heartbeat a healthy heart will have an orderly

progression of a wave of depolarisation that is triggered by the cells in the sinoatrial

node, spreads out through the atrium, passes through "intrinsic conduction pathways" and

then spreads all over the ventricles. This is detected as tiny rises and falls in the voltage

between two electrodes placed either side of the heart which is displayed as a wavy line

either on a screen or on paper. This display indicates the overall rhythm of the heart and

weaknesses in different parts of the heart muscle.

Usually more than 2 electrodes are used and they can be combined into a number of pairs

(For example: Left arm (LA), right arm (RA) and left leg (LL) electrodes form the pairs:

LA+RA, LA+LL, RA+LL). The output from each pair is known as a lead. Each lead is

said to look at the heart from a different angle. Different types of ECGs can be referred to

by the number of leads that are recorded, for example 3-lead, 5-lead or 12-lead ECGs

(sometimes simply "a 12-lead"). A 12-lead ECG is one in which 12 different electrical

signals are recorded at approximately the same time and will often be used as a one-off

recording of an ECG, typically printed out as a paper copy. 3- and 5-lead ECGs tend to

be monitored continuously and viewed only on the screen of an appropriate monitoring

device, for example during an operation or whilst being transported in an ambulance.

There may, or may not be any permanent record of a 3- or 5-lead ECG depending on the

equipment used.

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

It is the best way to measure and diagnose abnormal rhythms of the heart, [2] particularly

abnormal rhythms caused by damage to the conductive tissue that carries electrical

signals, or abnormal rhythms caused by electrolyte imbalances.[3] In a myocardial

infarction (MI), the ECG can identify if the heart muscle has been damaged in specific

areas, though not all areas of the heart are covered.[4] The ECG cannot reliably measure

the pumping ability of the heart, for which ultrasound-based (echocardiography) or

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

signal (a condition known as pulseless electrical activity).

Sunil Kumar
80405103010
 Cardea Biomedical Labs New Delhi

Sunil Kumar
80405103010