1. Biomedical Instrumentation I
Chapter 8 in
Introduction to Biomedical Equipment Technology: Electrocardiography
By Joseph Carr and John Brown

2. Schematic Representation of Electro-Conduction System
SA Node
AV Node
Bundle of His
Bundle Branches
Purkinjie Fibers
From Berne and Levy Physiology 3rd Edition Figure 23-25

3. Pathway of Electro-Conduction System of the calf heart starting at AV Node
Bundle of His
Bundle Branches
Purkinjie Fibers
From Berne and Levy Physiology 3rd Edition Figure 23-28

4. Electrocardiograph (ECG)
Components:
P wave = Atrial Contraction
QRS Complex = Ventricular Systole
T Wave = Refractory Period
Typical measurement from right arm to left arm
Also see 1 mV Calibration pulse
Carr and Brown Figure 8-1

5. Different Segments of ECG
P wave: the sequential activation (depolarization) of the right and left atria  QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously)  ST-T wave: ventricular repolarization  U wave: origin for this wave is not clear - but probably represents "afterdepolarizations" in the ventricles  PR interval: time interval from onset of atrial depolarization (P wave) to onset of ventricular depolarization (QRS complex)  QRS duration: duration of ventricular muscle depolarization  QT interval: duration of ventricular depolarization and repolarization  RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate)  PP interval: duration of atrial cycle (an indicator or atrial rate

6. Typical Leads RA = right arm LA = Left arm LL = left leg RL = right leg C = Chest Different leads result in different waveform shapes and amplitudes due to different view and are called leads

7. Cardiac Axis by different Leads
Carr and Brown Figure 8-2

8. Types of Leads
Bipolar Limb Leads: are those designated by Lead I, II, III which form Einthoven Triangle:
Lead I = LA connection to noninverting amp. input
And RA connecting to inverting amp. Input
Lead II = LL connection to amp. Noninverting input RA connect to inverting input and LA shorted to RL
Lead III = LL connected to noninverting input LA connected to inverting input LL LL LL

9. Einthoven Triangle: Note potential difference for each lead of triangle
Carr and Brown Figure 8-3

10. Each lead gives a slightly different representation of electrical activity of heart

11. Types of Leads
Unipolar Limb Leads= augmented limb leads: leads that look at composite potential from 3 limbs simultaneously where signal from 2 limbs are summed in a resistor network and then applied to an inverting amplifier input and the remaining limb electrode is applied to the non-inverting input
Lead aVR = RA connected to non-inverting input while LA and LL are summed at inverting input
augmented (amplified) Voltage for Right arm (aVR)
Lead aVL = LA connected to non-inverting input while RA and LL are summed at inverting input
augmented (amplified) Voltage for Left arm (aVL)
Lead aVF = LL connected to non-inverting input while RA and LA are summed at inverting input
augmented (amplified) Voltage for Foot (aVF) LL LL LL

12. Types of Leads
Unipolar Chest Leads: measured with signals from certain specified locations on the chest applied to amplifiers non-inverting input while RA LA, and LL are summed in a resistor Wilson network at amplifier inverting inputs LL

13. Wilson’s Central Terminal
Configuration used with Unipolar Chest Leads where RA LA and LL are summed in resistor network and this is sent to the inverting input of an amplifier

14. Electrocardiograph Traces from different leads

15. Normal ECG with RA, LA, LL connected
Artrial Tachycardia with RA, LA, LL connected
Ventricular Tachycardia with RA, LA, LL connected

16. Variations in Chest Leads C with RA and LA connected

17. 1st Degree block RA LA LL connected
PR wave is prolonged >0.2 sec have a prolongation of delay
between atrial and ventricle depolarization
Normal

18. 2nd Degree Block
Intermittent failure of AV conduction, such that not every P wave
is followed by QRS complex
Normal

19. 3rd Degree Block
Complete failure of conduction between atria nd ventricles.
Common cause is AMI (Acute Myocardial Infarction
Normal

20. R Bundle Branch Block
Widened QRS complex abnormalities in R S as well as T wave Q is not
as affected because the left bundle branch initiates depolarization
Normal

21. Other ECG Signals
Interdigital ECG: Signal taken between 2 fingers usually for home monitoring
Esophageal ECG: electrode placed in esophagus close to heart typically used to record atrial activity where P and R wave are used to determine position
Toilet Seat ECG: used to detect cardiac arrhythmias that can occur during defecation

22. Block Diagram of ECG

23. ECG Pre-Amplifier High Impedance input of bioelectric amplifier
Lead selector switch
1mV calibration source
Means of protecting amplifier from high voltage discharge such as a defibrillator used on a patient
Amplifier will have instrumentation amplifier as well as isolation amplifier

24. Isolation Amplifier
Needed for safety! Want to isolate patient from high voltages and currents to prevent electric shock where there is specifically a barrier between passage of current from the power line to the patient.
Can be done using light (photo emitter and photo detector) or a transformer (set of inductors that are used in a step up / step down configuration)

25. Isolation of Signal of Patient from Power needed for safety

26. Typical Representation of an Isolation Amplifier

27. Common Mode Rejection
Until now we assumed Amplifiers were ideal such that the signal into each terminal would completely cancel lead to complete common mode rejection
However with practical Op Amp there is not perfect cancellation thus you are interested in what common mode rejection is.

28. Simplistic Example of ECG Circuit
Would like to analyze what type of common mode voltage (CMV) can be derived

29. Common Mode Voltage (CMV)
If 2 inputs are hooked together into a differential amplifier driven by a common source with respect to ground the common mode voltage should be the same and the ideal output should be zero however practically you will see a voltage.
CMV is composed of 2 parts:
DC electrode offset potential
60Hz AC induced interference caused by magnetic and electric fields from power lines and transformers
This noise is a current from in signal, common and ground wires
Capacitively coupled into circuit
(Other markets that work at V will experience 50Hz noise)

30. Analysis to reduce noise in ECG
Common Mode Rejection:
Instrumentation amplifier (EX. INA128) using a differential amplifier which will cancel much of the 60 Hz and common DC offset currents to each input
If each signal is carrying similar noise then the some of the noise will subtract out with a differential amplifier

31. Analysis to reduce noise in ECG
Right leg driver circuit is used in a feedback configuration to reduce 60 Hz noise and drive noise on patient to a lower level.

32. Use of Feedback to reduce Noise
Derivation: G1 G2 Σ Β
Vin Vo V1
V1G1
Vn = Noise V2
V2G2
B Vo +
Thus Vn is reduced by Gain G1
Note Book forgot V in equation 5-35

33. Analysis to reduce noise in ECG
Isolation Amplifier also will attenuate noise
Shielding of cables further reduce noise

34. Review of Five ways to reduce Noise in ECG
Common Mode Rejection (differential Amplifier)
Right Leg Drive (feedback loop to decrease noise)
Shielding of wires
Isolation amplifier
Notch filter to reduce 60 Hz noise

35. How to overcome offset voltage
Instrumentation Amplifier Gain (A1,A2,A3) =
Non-Inverting Amplifier A4

36. Problems of offset voltage and how to correct
If you had 300 mV of DC offset sent through two gains of 10 and then 50 you would have an offset of (300mV)(10)(50) = 150V thus you would saturate your amplifiers and not see any of your signal
3V offset after first set of noninverting amplifiers goes through differential amplifier A3 which reduces the offset voltage.

37. Other Corrections for Offset
Feedback circuit where output of A4 goes through HPF of A5 so only responses larger than cutoff frequency pass through thus the DC offset is attenuated
R and C should be switched
because this is really a LPF

38. Affect of High Pass Filter of A5
Feedback through HPF has a time constant of RC
3 Modes:
Diagnostic Mode (most time) where
RC = 1x10-6F*3.2x106Ώ = 3.2 sec
Cutoff Freq = 1/(2πRC) = 0.05Hz
Monitor Mode (medium time) where
RC = 1x10-6F*318x103Ώ = sec
Cutoff Freq = 1/(2πRC) = 0.5Hz
Quick Restore (least time) where
RC = 1x10-6F*80x103Ώ = 0.08 sec
Cutoff Freq = 1/(2πRC) = 2Hz
With Feedback the DC offset is eliminated and thus can have a gain of 50 on the 2nd Non-inverting Amplifier Stage without Saturating the Circuit
Drawn Incorrectly
R and C should be
switched

39. High Pass Active Filters
Attenuates High frequency where cutoff frequency is 1/(2)
=1/ 2RiCi Rf Ci Ri - A
Vinput +
Voutput Ci Ri Rf
Voutput
Vinput Ii
IRf
When frequencies (w) is large gain ~ -Rf/Ri
Gain (1MHz, Ci=1mF)
When frequencies (w) is small gain is reduced
Gain (1Hz, Ci =1mF)

40. Low Pass Active Filters = Integrator
Attenuates High frequency where cutoff frequency is 1/2=1/2RfCf Cf Rf Ri - A
Vinput +
Voutput Cf
ICf Ri Rf
Vinput
Voutput Ii
IRf
When frequencies (w) are high gain is reduced
Gain (1M Hz, C=1mF)
When frequencies (w) are low gain ~ -Rf/Ri
Gain (0 Hz, C=1mF)

41. Defribillator
A Defribillator = a high voltage electrical heart stimulator used to resuscitate heart attack victims
When a physician applies this high voltage the high voltages and currents can cause damage to medical equipment BUT physician still needs to view ECG of the patient
How do you protect your medical equipment from excessively voltages and currents?

42. Protection Devices in ECGs: Glow Lamps
Glow Lamps are pair of electrodes mounted in a glass envelope in a atmosphere of lower pressure neon gain or a mix of inert gases
Typically impedance across electrodes is high but if voltage across electrodes exceeds ionization potential of gas then impedance drops so you create a short to ground so vast majority of current goes safely to ground and avoids your amplifiers

43. Protection Devices in ECGs: Zener Diodes
Diode: device that conducts electricity in one direction only
Zener Diode: “Turns-On” when a minimum voltage is reached so in this configuration if a large voltage is applied (ie defibrillator) the zener diode will allow current to flow and shunts it to grounds thus current goes to ground and not to the amplifiers

44. Protection Devices in ECGs: Current-Limiting Diodes
Diode: device that conducts electricity in one direction only
Diode acts as a resistor as long as current level remains below limiting point. It current rises above the limit, the resistance will change and the current will become clamped
Can also use a varistor (variable resistor) which functions like a surge protector that clips spikes in voltages

45. Types of Defibrallitor Damage
Defibrillator is 6X greater than normal working voltage so damage will eventually occur
Two forms of Damage:
Both Amplifier inputs are blown thus readout is a flat line
One amplifier input is blown so the ECG appears distorted
Cause is from zener diodes becoming open or from glow lamps becoming defective from an air leak, or recombination or absorption of gases
Recommended that lamps are changed every 1-2 years or sooner if ECG is in Emergency Room

46. Effect of Voltage Transient on ECG
Sometime a high voltage transient is applied to the patient (defibrillator) which cause magnitudes much greater than biopotential signal (ECG) which saturates the amplifier
Once the voltage transient signal is removed the ECG signal takes time to recover

47. Example of bandwidth and magnitude of various biopotentials
ECG is approximately 1 mV and spans from DC to 500 Hz
Book assumes Diagnostic mode is 0.05 Hz to 100 Hz

48. Electro-Surgery Unit (ESU) Filtering
While a surgeon is conducting surgery he/she will want to see their patient’s ECG
ESU can introduce frequencies into the ECG of 100KHz to 100 MHz and with magnitudes up to kVolts which can distort the ECG
ESU introduces:
DC offsets
Obscures the signal
ESU needs to be of diagnostic quality thus you must eliminate higher frequencies which are noise

49. Correct for high frequency noise using LPF so ECG can function with ESU

50. RC Filters Vs FH
Frequency
Low Pass Filters will pass frequencies lower than cutoff frequency of FH =1/2RC Vs FL
High Pass Filters will pass frequencies greater than cutoff frequency of FL =1/2RC

51. Schematic of Multi-channel Physiological Monitoring System
Figure 8-11
Instrumentation Inputs:
Up to 12 leads to ECG
Lead 13 is for RL driver (feedback to patient and then machine needed to reduce common mode voltage
Blood pressure
Body Temperature
Blood gases
Buffers which are noninverting amplifiers to give high input impedance or large resistor
Wilson Network: series of resistors
Digitization of Signal
Serial data output to display

52. Instrumentation Amplifier using OPA621
Differential resistors are the same thus this stage of the circuit has a gain of 1

53. CMR OPA621
Vin = V1 = V2
Frequency has an effect on CMR!

54. Circuit Schematic of an example of ECG
Lead I (LA – RA) means LA is going to the noninverting input and RA is going to inverting input
Precordial are the chest leads

55. Block diagram of Entire ECG Circuit

56. Digitization of Signal
DC Offset severely affect the resolution of your signal and if DC offset is too high
You may not see your ECG Signal
More bits to A/D board (10, 12, 19, 22) the more resolution to your signal because you
Can represent you signal with better resolution

57. Homework
Read Chapter 9
Derive the gain equation for an instrumentation amplifier.
What resistor values could be used to produce a gain of 10 for an instrumentation amplifier?
Why do you use non-inverting Op Amps in the first stage of an instrumentation amplifier?
Prove that feedback used for the right leg driver can decrease the overall noise in your circuit.
Problem 1 Chapter 8

58. Schedule Home Ch8 due 4/4 Exam 2 on 4/11 ECG design labs due 5/2
Material on Exam 2 Chapters 7, 2, 8, 9, studio exercises, labs, homework, class notes
ECG design labs due 5/2
ECG team presentations 5/5 (Dr. Alvarez presenting at conference, Florence Chua and class will grade presentations)
Final Exam 5/13 from 2:30 to 5:00 in Colton 327 (same room that we meet)
Cumulative, anything discussed during the semester will be on the final, more emphasis on the material not covered on Exam 1 & 2

59. ECG Example