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BiomedicalEngineeringTheoryAndPractice/BiomedicalInstrumentation/ElectrocardiographyWikibooks,openbooksforanopenworld

BiomedicalEngineeringTheoryAndPractice/Biomedical
Instrumentation/Electrocardiography
ThischaptershouldcoverthebasicsofECGsystemsfromadesignpointofviewnotfromadiagnosispointofview.

Contents
1 PhysiologicalBackground
2 DesignofaBasicECGSignalAcquisitionModule
3 SignalArtifacts
4 BasicSignalConditioningfortheECG
5 AnalogImplementationsfortheSignalConditioning
6 DigitalHardwareImplementationsfortheSignalConditioning
7 SoftwareImplementationsfortheSignalConditioning
8 FurtherReading
9 References

PhysiologicalBackground
Thefunctionoftheheartistocontractrhythmicallyandpumpbloodtothelungsforoxygenationandthenpumpthis
oxygenatedbloodintothegeneralcirculation.Thisperfectrhythmiscontinuouslymaintainedandsignaledbythe
spreadofelectricalsignalsgeneratedbytheheartpacemaker,thesinoatrial(SA)node.[1]Detectingsuchelectrical
activityoftheheartcanhelpidentifymanyheartdisorders.ThisisthemainconceptbehindusinganECG
(Electrocardiogram),tracingtheelectricalactivityoftheheart.
Bymeasuringandtracingthepotentialdifferencebetweentwopointsontheoutersurfaceofthebodyweobtainthe
simplestECGchart.Twotypicalmeasuringpointsbetweentheleftarmandtherightarm.Bydefiningthetwo
pointsandsettinguptheconventionalpositivedirectionformeasuringthevoltage,wecreatewhatiscalleda
"Lead".
Thefirstphaseofthecardiacmuscleactivationisthestimulationoftherightandleftatriabyanelectricalsignal
generatedfromtheSAnode.ThisphaseappearsasthePwaveontheECGchart.Theelectricalsignal,originally
generatedbytheSAnode,thenspreadsthroughtheAtrioventricual(AV)Junction,thebundleofHis,andthe
Purkinjefiberstofinallyreachandstimulatetheventricles.Thespreadoftheelectricalsignalthroughtheventricles
causesventricularcontraction.ThephaseofventricularcontractionappearsasthecharacteristicQRScomplexon
theECGchart.Finally,withtherelaxationofthetwoventricles,adepolarizationsignalisgeneratedandappearsas
theTwaveontheECGchart.

TypicalECGsignal

DesignofaBasicECGSignalAcquisitionModule
TheacquisitionoftheECGsignalisaratherchallengingtask,asthecasewithmanybiologicalsignals.ECGvoltage
signalisverylowinmagnitude(fewmillivolts)andhasrelativelylowfrequencycontent.Theexpectedbandwidth
ofthesignaltypicallybeginsfrom0.01Hzandextendstonomorethan150Hz.
AnotherchallengeinacquiringtheECGsignalisthepowerlineinterferencethatisoftenorderofmagnitudes
greaterthantheoriginalECGsignal.Allthissuggestschallengingrequirementsforthedesignofthesignal
acquisitionmodule:Itshouldhaveminimumloadingeffect,itshouldcontainanamplificationstagetomakethe
signallevelappropriateforfurtheruse,anditshouldcontainafiltrationstagecustomizedtoremovetheexpected
noiseandpowerlineinterferencethatoftencorruptstheECG.
Inthissection,weareNOTgoingtoconsiderthefulldesignoftheECGsignalrather,weshallfocusonaminimal
ECGacquisitionmoduledesignthatwouldjustwork.
Asdiscussedinthephysiologicalbackgroundsection,anECGsignalisobtainedasthevoltagedifferencebetween
twopointsontheskin.Thissuggeststheneedforsomesubtractionmechanism.Thesubtractioncouldbedoneusing
anelectronicDifferenceAmplifier.Thisamplifierbasicallysubtractsandamplifiesthedifferencebetweentwo
electricalpoints.Forthesubtractiontoworkcorrectly,thevoltageofbothelectricalpointsshouldbemeasuredwith
respecttoacommonelectricalreference.Thiscommonreferenceistypicallychosentobetherightlegofthe
patient.
So,asimplifieddiagramofasimpleECGacquisitionmodulewouldbeasshowninthefigure.

Ananimationshowinghowtheelectricalactivityofthe
heartisreflectedontheECGsignal

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SignalArtifacts
ArtifactsthatcorrupttherawECGsignalhaveeitherphysiologicalornonphysiologicalorigin.Themost
dominantartifactisthepowerlineinterferencewhichappearsasansinusoidalwaveoffrequency50Hz(or60
HzinUSA).Otherartifactsinclude:[2]
MovementArtifactsduetopatientmovement,etc...
BaselineWanderwheretheECGwaveformbaselinestartstodriftupanddowninasinusoidalpattern
followingthepatientbreathing
EMGInterferencewheremusclecontractionsignalsinterferewiththeECG.
ElectrodeContactNoisewheretheelectrodesarenottightlycoupledtothepatientcausingsome
distortion
ElectrosurgicalUnit(ESU)interferencewherehighfrequencysignalsfromtheESUusedbysurgeons
duringoperationinterferewiththeECG

AVERYsimplifiedblockdiagramofanECGamplifier.
Thevoltageoftherightarm(w.r.trightleg)issubtracted
fromthevoltageoftheleftarm(w.r.trightleg)togetthe
ECGLeadIsignal).

BasicSignalConditioningfortheECG
Thissectionshoulddiscusstheoreticalsignalprocessingsolutionstotheaboveartifacts

AnalogImplementationsfortheSignalConditioning
DigitalHardwareImplementationsfortheSignalConditioning
SoftwareImplementationsfortheSignalConditioning
FurtherReading
ProgrammableChipEEG(http://opencircuits.com/Programmable_Chip_EEG)
theOpenEEGWiki(http://wiki.asiaquake.org/openeeg/published/)

Thethread"amplifyingbiomedicalsignals:150uAwith16bitresolution?"(http://forum.microchip.com/tm.aspx?m=114626)hasseveralopampsuggestions,and
mentionsthat"agood,lownoise,lowcost,isolatedEMG/EEGamplifierisoneofthemostdemandinganalogelectronicsdesigns."
HowtobuildyourownECGdevice(http://www.edsp.com/howtobuildyourownheartmonitoringdeviceasimpleecg/)
TIappnote"BiophysicalMonitoring:Electrocardiogram(ECG)FrontEnd"(http://focus.ti.com/docs/solution/folders/print/272.html)hasasimplecircuit:390KOhm
resistorsinlinewitheachleadoneendtouchespatient,theotherenddirectlyconnectedtotheinstrumentationampinput(ortherightlegdriveamplifieroutput,
whichhasnofurtherprotection).Theinst.amphas2protectiondiodesoneachinput,directlyto+powerandpower.Also,39pFcapacitorfromeachinputtoanalog
GND,and200pFbetweenthe2inputs.TheTIpublication"InformationforMedicalApplications"(2Q2004)reprintsthatcircuit,butleavesoutthecapsandthe
diodes.
Somepeopleuse420Hzsamplingrate,10bits/sample.(http://www.ieeta.pt/~escadas/ucecg/applications.htm)
"HighResolutionQRSDetectionAlgorithmforSparselySampledECGRecordings"(http://bsamig.uku.fi/pdf/QRSdet.pdf)byTimoBraggeetal.2004recommends:
"thesamplingfrequencyoftheECGshouldbeatleast500Hz"
"LowPower,LowVoltageICChoicesforECGSystemRequirements"(http://www.analog.com/library/analogDialogue/archives/293/low_power.html)byJonFirth
andPaulErricosays"Themultiplexedarchitecture,basedonanoldassumptionthattheconverterisbyfarthemostexpensivefrontendcomponent,isprevalentin
today'selectrophysiologicalmeasurementsystems.However,withtheproliferationofsigmadeltaconverterarchitectures,converterperchannelisnowapowerand
costcompetitivealternative".Italsogivesatypicalschematicforbotharchitecturesandsuggestssomeparts.
IsthereaMedicalElectronicsForum(http://www.electronicproducts.com/ShowPage1.asp?
SECTION=&PRIMID=&FileName=medtelconf3%2Ejul2004%2Ehtml&ReturnLink=%2FSearch1%2Easp%3FManufacturer%3D%26Keyword%3Dimplantables%26Slot%3D
Make:HomemadeElectrocardiograph(http://www.makezine.com/blog/archive/2006/01/homemade_electrocardiograph.html)([1]
(http://www.eng.utah.edu/~jnguyen/ecg/ecg_index.html)recommendsskinlotionorshampooasalowcostelectrodegel)

References
Pleaseciteallthereferencesyouhaveused.SeetheLocalManualofStyleforexamplesoncitations.
1. ClinicalElectrocardiography,aSimplifiedApproach.SeventhEditionAryL.Goldberger,MosbyElsevier,2006
2. TaklaG,PetreJH,DoyleDJ,HoribeM,GopakumaranB.Theproblemofartifactsinpatientmonitordataduringsurgery:aclinicalandmethodologicalreview.
AnesthAnalg.2006103(5):1196204
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