Escolar Documentos
Profissional Documentos
Cultura Documentos
Aims
By the end of this session you should be able to understand the following
what is measured in the ECG, the equipment needed, and how to use it
the factors mains hum (50Hz) and electromyogram (EMG) that can interfere with
ECG recording
the different components (P, QRS, T, etc.) of the ECG and how they relate to the
cardiac cycle
why the ECG differs when recorded between different pairs of limbs, and what
information this can give you
the origin of heart sounds and how they relate to (i) events of the cardiac cycle and
(ii) the ECG components.
Session content
NATURE OF THE ECG
The ECG is a voltage difference, recorded between two metal plates or electrodes
on the surface of the body, usually on two limbs. Different pairs of electrodes
are used to record signals described as "Lead I", "Lead II" and "Lead III". For
example, Lead I records the voltage at the Left Arm minus the voltage at the
Right Arm. The 3 patterns are shown on the diagram. There is a standard
colour code for connecting wires to the electrodes on each limb. The class
apparatus uses just one amplifier and a switch connects it in one of the 3
patterns.
Note that on each lead the trace will go up when the "+" electrode is more
positive than the "-" electrode. Signals the other way round will make the
trace go down.
Connect up the leads to your subject using electrode jelly (a strong salt
solution) to make a low-resistance electrical contact. Put the electodes on "fleshy" rather than "bony" parts
of the limbs to make the best contact. Otherwise, it doesn't matter where on a limb the electrodes go.
What do you think of the idea that ECG signals might be larger if you put the electrodes
on the upper arms and thighs (nearer the heart)?
They wouldn't be larger. Why not?
Connecting up the amplifier and computer
The electrodes connect to the switch unit and then to
r -
a high-gain amplifier and isolation unit. Set the COMPUTER
ISOLATION
BARRIER
g +
overall GAIN (amplification factor) to x2000 if it is y
adjustable, and the bandwidth to 50Hz (this reduces b
MAINS
A Good ECG ECG with mains hum 50Hz ECG with EMG noise
(Components are visible, but Irregular superimposed signal
thick trace: resolves to 50Hz fluctuations due to muscle
waves at higher time resolution. action potentials in arms, legs.
Try creating "bad" ECG records on the screen deliberately, using the converse of the tips set out above to
get rid of the problems. Print out a "good" ECG record.
Save recordings of the ECG from a single subject on leads 1,2, 3, on the computer screen panels on the right, using
the 'Notes' facility to label them clearly. Then print them out together, on one sheet. Sketch them below and label
P,R, T waves on each..
For safety reasons, the stethoscope works from batteries. Switch these off when not in use.
The equipment is fragile, so take care, for example. not to pull it off the bench by traction
Record the ECG on lead 2 (using channel '0') with a sweep duration of about 2s, and set the
program to record 'both channels'.
Switch on the microphone amplifier, and check it goes to computer Channel '1'.
Place the microphone directly on the chest wall in the third left intercostal space and strap it
there. It is hard to hold it in position by hand, without causing extra noise.
Adjust the gain (amplification) and offset (steady output voltage) to show clear displacements
due to heart sounds, not clipped at the top or bottom by the amplifier reaching max or min
output.
Look for signals that occur in every cardiac cycle: other signals are due to breathing, movement,
or noises. The subject should remain quiet and still.
Adjust the microphone position to give clear signals.
Print your records and identify the relation between sounds and the electrical events in the ECG. Expand
the sweep to inspect the time relations accurately. Discuss these with a demonstrator before the end of the
class.