AN IMPROVED METHOD OF MEASUREMENT

OF ECG PARAMETERS FOR ONLINE

MEDICAL DIAGNOSIS
H.R SINGH, RAHUL SHARMA,
NITIN SAHGAL, POONAM SETHI,
AHUL KUSHWAH & PRANAV KACHHAWA
ABSTRACT
The ac c ur acy i n t he onl i ne measur ement of ECG Par amet er s has
a dec i si ve r ol e i n t he bet t er di agnosi s and ef f ec t i ve t r eat ment of t he
di seases.
The pr esent paper desc r i bes a Lab-VI EW based pr ogr ammi ng
usi ng Pan Tompk i ns met hod t o ex t r ac t out QRS c ompl ex w her eas QT
i nt er val measur ement s wer e c ar r i ed out usi ng Mat -l ab based Mat h-
Sc r i pt modul e.
Hi l ber t Tr ansf or m has been appl i ed on t he ECG si gnal t o c onver t i t
i nt o an anal yt i c al si gnal f or bet t er peak det ec t i on.
Peak det ec t i on and ot her par amet er s l i ke RR i nt er val , HR and
sever al t i me domai n measur es of Hear t Rat e Var i abi l i t y suc h as RR
mean and st andar d devi at i ons, HR mean and st andar d devi at i ons,
RMSSSD, NN50 c ount , pNN50 et c wer e c al c ul at ed f or sever al ot her
cl i ni c al appl i c at i ons apar t f r om onl i ne di sease di agnosi s.
ECG PARAMETERS AND THEI R I MPORTANCE
I N DI AGNOSI S.
P wave is produced by muscle contraction of atria.
The shape and duration of P wave indicate atrial
enlargement.
R wave marks the ending of the atrial contraction
and the beginning of ventricular contraction.
Magnitude normally varies from 0.1mV-1.5mV
Narrow and high R wave indicates a physically
strong heart.
T wave marks the ending of ventricular
contraction.
A normal T wave is slight round and symmetrical.
Pointed T wave is a cause of concern.
Tall T wave indicates a certain disease.
Ti me i t t akes t he i mpul se t o t r avel f r om
at r i a t o AV node (At r i o-vent r i c ul ar c onduc t i on
t i me).
The PR i nt er val
Measur ed f r om t he onset of t he P wave t o
onset of t he QRS c ompl ex
No mor e t han 5 smal l squar es i n dur at i on
(0.20 sec )
Pr ol onged PR i nt er val >0.20 sec s. i n 1st
degr ee hear t bl ock .
Pl ac ement of el ec t r odes
Repr esent s vent r i c ul ar c ont r ac t i on.
Bet ween 0.08 and 0.12 sec s i n dur at i on (3
smal l squar es).
Measur ed f r om t he onset of Q wave t o t he
end of S wave.
Si nc e t he vent r i cl es c ont ai n gr eat er
muscl e mass t han t he at r i a, t he QRS c ompl ex
i s l ar ger t han t he P wave.
The QRS c ompl ex
Fi r st negat i ve c omponent of t he QRS
c ompl ex
Shoul d be l ess t han 25% of t he assoc i at ed
R wave.
METHODOLOGY
QRS and QT det ec t i on wer e per f or med usi ng Pan Tompk i ns
w hi l e most of t he ot her par amet er s suc h as RR i nt er val , BPM,
peak s, RR measur ement s and sever al ot her st at i st i c al and
geomet r i c measur es wer e det ec t ed usi ng Hi l ber t Tr ansf or m.
I n or der t o i sol at e t he QRS ener gy pr edomi nant por t i on, t he
r aw si gnal af t er ac qui si t i on i s pr e- pr oc essed by pr oper si gnal
c ondi t i oni ng and r emovi ng base l i ne wander i ng.
These par amet er s af t er ex t r ac t i ng out f r om t he enhanc ed
ECG si gnal have been si gni f i c ant l y used i n di agnost i c
appl i c at i ons w i t h ac c ur ac y ac c ept abl e t o pr ovi de hi gher or der
of c ar e t o t he pat i ent .
PAN-TOMPKI NS ALGORI THM
I dent i f i es QRS c ompl ex based on t he anal ysi s of t he sl ope,
ampl i t ude and w i dt h of t he QRS.
Bandpass f i l t er f or med usi ng l ow pass and hi gh pass f i l t er s
r educ e noi se i n t he ECG si gnal .
I t al so r emoves basel i ne dr i f t .
The di f f er ent i at or di st i ngui shes QRS c ompl ex es f r om l ow
f r equenc y P and T waves.
Squar i ng emphasi zes t he hi gher val ues ex pec t ed due t o QRS
c ompl ex and suppr esses smal l er val ues r el at ed t o P and T
waves.
Movi ng w i ndow i nt egr at or i s r equi r ed due t o t he pr esenc e of
mul t i pl e peak s w i t hi n t he dur at i on of a si ngl e QRS, t hi s t akes an
aver age of N sampl es.
I t s out put c an be used t o det ec t QRS c ompl ex es, RR i nt er val
and det er mi ne t he dur at i on of t he QRS c ompl ex .
QRS DETECTI ON
A bl ock di agr am i mpl ement i ng t he above st at ed st ages i n Lab-VI EW
pr ogr am i s show n i n f i gur e f or QRS det ec t i on.
BLOCK DI AGRAM OF QRS DETECTI ON
I NPUT/OUTPUT WAVEFORMS OF
A NORMAL SI NUS RHYTHM
QT DETECTI ON
The gap i nt er val bet ween Q
onset
and T
of f set
val ues i s c al c ul at ed on
a si gnal as ac qui r ed and pr oc essed i n t he pr evi ous sec t i on of QRS
c ompl ex det er mi nat i on.
The bl oc k di agr am devel oped f or t he det ec t i on of QT i nt er val and
Q poi nt and T poi nt t i me measur ement s i s show n i n f i gur e.
BLOCK DI AGRAM FOR DETECTI ON OF QT I NTERVAL
The c or r espondi ng QT i nt er val measur ement di spl ayi ng
t he QT
of f
and QT
on
val ues separ at el y al ong w i t h t he si gnal
ac qui r ed i s show n bel ow :-
FRONT PANEL OF QT DETECTI ON
The der i vat i ve of t he si gnal ac qui r ed af t er f i l t er i ng and base l i ne wander i ng
el i mi nat i on usi ng medi an f i l t er i s t aken on w hi ch Hi l ber t Tr ansf or m i s
per f or med.
The r eason Hi l ber t Tr ansf or m i s used f or t hese measur ement s i s t o t ur n t he
ECG si gnal t o an anal yt i c si gnal , w hi ch gi ves a bet t er peak t o det ec t .
Thi s pr oc ess w i l l gi ve an enhanc ed ECG si gnal as c ompar ed t o r aw ECG
si gnal f i r st obt ai ned.
Peak det ec t i on.vi al gor i t hm i s devel oped t o f i nd al l t he peak s and t hei r
l oc at i ons by set t i ng appr opr i at e t hr eshol d par amet er s.
The RR i nt er val s ar e ex t r ac t ed by measur i ng t he t i me i nt er val bet ween t wo
c onsec ut i ve peak s.
The hear t r at e i s c al c ul at ed as f ol l ow s :
Sampl i ng r at e * 60/ RR i nt er val (ms)
HRV ANALYSI S METHODS
Ther e ar e di f f er ent met hods of HRV anal ysi s. one of t hi s met hod
i s Ti me Domai n Anal ysi s. Thi s met hod ex t r ac t s a f ew spec i al
measur es usi ng onl y t he t empor al RR i nt er val si gnal s.
For Ti me Ser i es Anal ysi s, Ti me Domai n measur es ar e c ommonl y
used. Many measur es c an be ex t r ac t ed f r om t he or i gi nal RR i nt er val
si gnal s t o show t he changes i n t he ans.
Var i abl es Uni t s Desc r i pt i on St at i st i c al Measur es
RR Mean & St d S Mean and st andar d devi at i on of al l RR i nt er val s
HR Mean & St d 1/mi n Mean and st andar d devi at i on of al l hear t r at es.
RMSSD MS Squar e r oot of t he mean of t he sum of squar es of
di f f er enc es bet ween adj ac ent RR i nt er val s.
NN50 c ount Number of pai r s of adj ac ent RR i nt er val s di f f er i ng
by mor e t han 50 ms i n al l measur ement s
pNN50 % NN50 c ount di vi ded by t he t ot al number of al l RR
i nt er val s
Geomet r i c al measur es
HRV t r i angul ar
i ndex
Tot al number of al l RR i nt er val s di vi ded by t he
hei ght of t he hi st ogr am of al l RR i nt er val s.
HEART RATE VARI ABI LI TY ANALYSI S
The Hear t Rat e Var i abi l i t y anal ysi s c an be per f or med i n many ways but t he
c ommonl y used met hod i s Ti me Domai n Anal ysi s w her e onl y t he t empor al RR
i nt er val si gnal s ar e used t o ex t r ac t out a f ew spec i al measur es such as mean
and st andar d devi at i on (RR mean) of al l RR i nt er val s and hear t r at e (HR),
RMSSD (squar e r oot of mean of sum of squar e of di f f er enc es bet ween
adj ac ent RR i nt er val s), NN50 c ount (Number of pai r s of adj ac ent RR i nt er val s
di f f er i ng by mor e t han 50 ms) and HRV t r i angul ar i ndex (Tot al no. of al l RR
i nt er val s di vi ded by hei ght of t he hi st ogr am of al l RR i nt er val s) et c .
PROCESS OF ACQUI RI NG SI GNALPARA METERS
The pr oc ess of ac qui r i ng var i ous si gnal par amet er s as st at ed above.
Basel i ne dr i f t
el i mi nat i on
Hi l ber t s
t r ansf or m
Peak Det ec t i on
Ti me domai n
HRV anal ysi s
Hear t r at e
Ex t r ac t R peak s &
RR i nt er val s
Ac qui r e r aw ECG
si gnal
BLOCK DI AGRAM OF TI ME DOMAI N HRV ANALYSI S
Data Acquisition
Signal Conditioning
Processing
Display raw ECG waveform, enhanced ECG waveform,
Heart Rate, time domain parameters of HRV
Transmission of data parameters and waveforms
Is Heart Rate out
of range?
Warning indicator at remote PC
Do you want to
save the data?
Do you want to
quit?
Press the save button
no
no
Start
Stop
Figure : ECG data of patient with normal heart rate on Local PC(top) and Remote PC(bottom).
Figure : ECG data of patient with abnormal heart rate on Local PC(top)and Remote PC(below).
CONCLUSI ON
VI s f or t he det er mi nat i on of QRS dur at i on usi ng Pan Tompk i ns
al gor i t hm i s devel oped and st epw i se exec ut i on of ever y st age i s
di spl ayed i n t he f r ont panel di agr am.
For QT i nt er val measur ement , Mat h-Sc r i pt t ool i n Mat -l ab i s used
and t he c or r espondi ng QT i nt er val s al ong w i t h t hei r Q poi nt and T
poi nt t i me measur ement s ar e di spl ayed i n t he r espec t i ve f r ont panel
di agr am.
A si ngl e w i ndow VI f or t he measur ement of al l t i me
domai n st at i st i c al and geomet r i c measur es suc h as RR
i nt er val , HR, HRV t i me var i ant anal ysi s, RR and HR mean and
st andar d devi at i ons, RMSSSD, NN50 c ount i s al so devel oped
and r esul t s ar e di spl ayed.
These r esul t s and t hei r i nt er dependenc i es on eac h ot her
ar e hi ghl y desi r abl e f or sever al cl i ni c al appl i c at i ons apar t f r om
t he onl i ne medi c al di agnosi s.