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Portable Real Time ECG Monitor and Disease Diagnostics

Conference Paper · November 2019

DOI: 10.1109/BECITHCON48839.2019.9063172

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 Portable Real Time ECG Monitor and Disease
Diagnostics
Mahmudul Hasan, Asiful Arefeen, Syed Taskeen Rahman, Tanvir Ahmed, Mohtasim Nakib,
Celia Shahnaz and Arik Subhana
Department of Electrical and Electronic Engineering,
Bangladesh University of Engineering and Technology, Dhaka 1205, Bangladesh.
*E-mail: asifularefeen1234@gmail.com
Abstract—Rapid diagnosis of heart disease has become a staple
of Cardiology. The electrocardiogram (ECG) is an effective
diagnostic tool which provides significant signals to detect heart
abnormalities. In this context, this paper presents a novel and
economical approach to the quick approximation of hearts overall
condition of a person. Using low cost ECG sensors, the real
time ECG signals have been generated via 3 leads, stored and
displayed on an android app developed by ourselves and some
techniques have been applied to diagnose common abnormalities.
The proposed system is convenient and consists of uncomplicated
circuitry compared to analogous recent electrocardiogram mon-
itoring technologies. It offers an affordable and easily accessible
way to diagnose heart disease and tackle preventable mishaps by
early diagnosis.
Index terms— ECG, Wearable, QRS, Periodogram, R-R
Interval, SVM, Detection
I. I NTRODUCTION
Cardiovascular diseases, which include diseases of the heart,
are the prime cause of death worldwide. As stated by World
Health Organization (WHO), 31% of all global deaths are
caused by such diseases and 85% of these deaths are due
to heart attack and stroke [1]. Therefore, heart diseases have
lately become a crucial issue in public healthcare services.
Health hazards related to heart diseases can be significantly
minimized if early detection is possible. An electrocardiogram
(ECG) based heart rate monitoring system serves as a useful
tool in diagnosing such deadly diseases. Heart diseases and
anomalies cause change in normal ECG signal and so, regular
monitoring of ECG signal leads to early detection of various
arrhythmia and heart diseases. However, conventional ECG
machines being bulky, unhandy and costly, it is not feasible
for general people to own a personal ECG machine for regular
checkup. Hence, a patient needs to visit a health care center
equipped with an ECG machine to monitor his/her heart
condition which is not easily manageable on a regular basis.
Moreover, an expert cardiologist is also needed to interpret
ECG signal accurately. But in a third world country like
Bangladesh, people have limited access to properly equipped
health care services and expert cardiologists; as a consequence,
many people die from heart diseases due to late detection. As
reported by WHO, at least three quarters of cardiovascular dis-
ease induced global deaths occur in low- and middle- income
countries [1]. The problem becomes even more prominent in
remote rural areas. In this context, a handy, user-friendly and
low cost ECG based heart rate monitoring system including
automated interpretation algorithm to detect heart diseases can
be highly auspicious.
This paper proposes a unique way to monitor the ECG
signal of a patient and process it to calculate the heart rate
and detect anomalies if present. A wearable vest is designed
where necessary signal acquiring electrodes and condition-
ing circuitry are preinstalled [2]. The process is integrated
in an android application (app) developed for continuous
monitoring of the users ECG and heart rate. The developed
algorithm can also diagnose five types of cardiac anomalies,
namely, arrhythmia, atrial fibrillation, malignant ventricular
arrhythmia, supravenous ventricular arrhythmia and Ventric-
ular fibrillation indicates [3], [4] the detected anomaly in the
app. The generated electrocardiogram signal is transmitted to
a dedicated server through an Arduino microcontroller for
the android app utilization. The server also provides storage
for the data to facilitate future uses; for instance, it can be
conveyed to a specialist for further interpretation if required.
The database used in this paper extensively is the MIT-
BIH database [5], which includes normal ECG signal along
with databases dedicated to patients with the aforementioned
abnormalities. The key is to sift through the complete signal
and determine the positions and spread of the ectopic beats
[6], which are, in a general sense, irregular heartbeats. To
date, various works have been done to detect the anomalies in
ECG signal such as using long short-term memory (LSTM)
networks, self-organizing maps (SOM), analyzing heart rate
variability (HRV), discrete wavelet transform (DWT) [7]. Most
of these use deep learning models which are not suitable
for implementation in smartphone applications. Here, two
transforms are used namely, Lomb-Scargle periodogram [8]
and the Hilbert transform [9] and the coefficients are used
as the features for model development. These transforms are
computationally efficient and therefore don’t have high system
requirements.
As the target is to look for a novel idea to apply our
knowledge of Biomedical Signal Processing, it has been
decided to do something that might benefit the healthcare
service [10] of low income countries since patients needing
to visit a health care center equipped with an ECG machine
to monitor his/her heart condition is not easily manageable.
Moreover, an expert cardiologist is also needed to interpret the
ECG signal accurately. But in a relatively low income country
like Bangladesh [11], people have limited access to properly
equipped health care services and expert cardiologists; as a
consequence, many people die from heart diseases due to
delay[12]. As reported by WHO, at least three quarters of
cardiovascular disease induced global deaths occur in low
and middle income countries. The problem becomes even
more prominent in remote areas. In this context, a handy and
low cost ECG based heart rate monitoring system including
automated interpretation algorithm to detect heart diseases
can be highly beneficial [13]. The entire system comprising
both the wearable unit and the android application is very
compact, user-friendly and low-cost; and hence, it is affordable
by masses and adaptable in any communities around the world.
II. M ETHODOLOGY
The discussion on this approach has been divided in two
parts, namely - the hardware and the algorithm.
A. Hardware
The prerequisite of this portion is that it must be portable,
Wearable Vest
easily wearable and low cost. It is considered that three leads
+ Conductive fabric
are enough and hence opt for ECG sensors with conductive Electrode
fabric that can be used a limited yet multiple number of Pocket for AD8232 & Wi-fi module
times. The placement of the three leads on the this fabric
also stabilizes the skin to sensor interface resistance. The
leads are connected to a differential amplifier (model AD8232)
[2] to convey the real time signal to the Arduino. The sole
task of the Arduino is to upload the data to Google Firebase Fig. 1. Schematic diagram of the complete setup
server. There is no processing involved here. This served two
purposes simultaneously. The first one is that the data can be
now transferred over to the hand-held devices for processing
and diagnostic outputs. The second one is that, both the data
and the further diagnosis are stored in the server, which can y(n) = x(n) − x(n − 10ms) (4)
be accessed later by specialists for further interpretation and
C. Feature Extraction
necessary treatment. Fig. 1 shows the schematic diagram of
the setup. 1) Lomb-Scargle Periodogram: For random processes, the
time domain signal is often not well defined. Estimating
B. Preprocessing properties such as its ensemble average, standard deviation etc.
Seemingly, an ECG signal suffers from multitudes of noise might require. In that case, Fourier transform is not applicable
and interference due to the nature of the electrode-body inter- as there is guarantee of convergence. So, Parseval’s theorem
face, human respiratory activity and surrounding environment. of Power Spectral Density (PSD) is also not applicable. The
One of the major effects of this is baseline wander [14]. In Schuester definition of PSD is
order to extract the actual signal from the noisy one. This way,
the baseline is adjusted without needing to address the QRS N N
X X
complex [4], [13]. Px (ω) = sin2 (2πf n − θ)Z 2 + cos2 (2πf n − θ)Z 2
n=1 n=1
y(n) = 2 ∗ y(n − 1) − y(n − 2) + x(n) (5)
(1)
− 2 ∗ x(n − 24ms) + x(n − 48ms) In that case, relying on an estimate of Power Spectral
y(n) = y(n − 1) − x(n) − x(n − 128ms) (2) Density, also known as periodogram is a solution. It is an
useful tool to analyze stationary random processes where the
z(n) = x(n − 64ms) − y(n) (3)
PSD is a biased estimate depending on what window and what
The above equations are low pass and high pass filters [15] length of the signal is chosen.
which remove both low and high frequency noise components In this approach, the Lomb-Scargle Periodogram [8] is
that typically appear in ECG signals. Next, the derivative of used. This falls under the class of Least Squares Spectral
the filtered signal is taken to better approximate the output. Analysis methods. Rather than just taking dot products of
the data with sine and cosine waveforms directly, first a time 3) Final Feature Matrix: The final feature matrix per
delay τ is found such that this pair of sinusoids would be ECG specimen is of length 40. 20 maximum values in the
mutually orthogonal at sample times ni and also adjusted for Lomb Scargle Periodogram and 20 maximum values from the
the potentially unequal powers of these two basis functions analytic function have been chosen and they are merged into
to obtain a better estimate of the power at a frequency. This a single vector.
is exactly what actually required as the necessity is to zero
in on the exact frequency spectrum where the significant III. C LASSIFICATION & R ESULTS
components of heart rate lie. The modified PSD is Using the databases of arrhythmia, atrial fibrillation, ven-
tricular fibrillation, the model has been developed using the
PN features extracted from the signals. All the signals are near-
1 (| j=1 Xj cos(ω)(nj − τ )|)2 noiseless and ground truth labelled. To verify the accuracy of
Px (ω) = PN the model, the SVM classifier has been used, employing a 5
2 j cos2 (ω)(nj − τ )
PN (6) fold cross validation to our database. Adjusting the kernels, it
2
1 (| j=1 Xj sin(ω)(nj − τ )|) has been found that the Gaussian SVM kernel produced the
+
2
PN 2 best accuracy out of all the cases. However, as we recall, the
j sin (ω)(nj − τ )
primary objective is the fast diagnosis of a heart condition. To
Here the time delay τ is defined as, achieve that, a smartphone is the best possible device. But, it is
PN clear, a smartphone has nowhere near the processing capability
j=1 sin(2ωτj )
tan(2ωτ ) = PN (7) of modern parallel computing. So this classification scheme
j=1 sin(2ωτj ) must be robust yet efficient. Therefore, the model developed
The reason why Lomb Scargle periodogram works well from the noiseless and ground truth labelled data has been
for ECG signals is that since the precise sampling rate or uploaded to the app and test any incoming data against this
sensitivity can not be determined in P, R or S waves, the delay pretrained model.
component ensures that unevenly sampled data or missing data Here, a detailed analysis of the obtained results is presented.
is accounted for. A. Sample Analysis
2) Hilbert Transform: The second feature taken is the
For an exemplary case, feature vector of a test signal is
Hilbert Transform coefficients. For an analytic function in
extracted using eclipse, an IDE console for Java. The code
the upper half plane, the Hilbert Transform [9] describes the
has been integrated in the app.
relationship between the real part and the imaginary part of
the boundary values.

Z +∞
1 u(τ )dτ
H(u)(t) = (8)
π −∞ t−τ
One of the key tools of the Hilbert transform is to convert
the signal into an analytic function. That is,

s(t) = sr (t) + jsim (t)

(9)
= A(t)exp(jφ(t))
The analytic signal is complex valued. Here, instantaneous Fig. 2. Original ECG
amplitude and instantaneous frequency can be easily obtained.
This is a significant piece of information while measuring The initial signal is noisy and affected by baseline wander.
properties of signals such as the ECG. To get a noiseless signal, combination of filters has been
The frequency domain representation of the Hilbert trans- applied as mentioned before.
form is fairly simple. It is equivalent to introducing 90◦ phase This signal is suitable for analysis.
shifts to spectral components. The Lomb-Scargle Periodogram displays a modified PSD of
the the signal, accounting for discrepancies in both sampling
rate and availability of data.
F (H(u))(ω) = (−isgn(ω)).F (u)(ω) (10) The Hilbert Transform of the signal presents us with an
According to Euler’s formula analytic expression from which the instantaneous amplitude
and phase can be extracted.

jπ
It can observed from the figures above, the significant
i = exp( 2 )
 ω>0 components of the heart rate center around an approximate
σH (ω) = 0 ω=0 (11) spectrum of 0.8-2 Hz, as verified by both Lomb Scargle
−jπ


−i = exp( 2 ) ω < 0 periodogram and Hilbert Transform analysis [16].
 TABLE I
ACCURACY OF D IAGNOSIS

Labeled Anomalies Accuracy

Arrhythmia 75.8%
Atrial Fibrillation 64.3%
Malignant Ventricular Arrhythmia 58.6%
Supravenous Ventricular 52.0%
Arrhythmia
Ventricular Fibrillation 61.6%

Researches in this field of study have yet to come up with a

Fig. 3. Filtered Signal
solution to the necessity for rapid diagnosis for heart disease.
This issue has been approached by incorporating real time
monitoring of ECG, a primary diagnosis and the option for
further confirmation. In Fig. 6, a sample of the beta version
of the app is represented. where, the x axis denotes time in
seconds and y axis refers to the amplitude of the ECG signal
in mili-volts. IHR and AHR are instantaneous heart beat and
average heart beat of the patient respectively. Set button is
pressed after adequate data (data of 2 minutes) for computing
the AHR are obtained. The P2P option is for viewing real
time ECG along with corresponding anomaly whereas the
Doctor Mode allows reviewing previous data from the server
and can be used for further necessities, for example, if expert
interpretation is needed.

Fig. 4. Original ECG

Fig. 6. Sample Interface of the app, x axis denotes time in seconds and y
axis refers to the amplitude of the ECG signal in mili-volts

IV. C ONCLUSION
This article focuses on implementing an ECG signal mon-
itoring system which symbolizes the necessity of signal pro-
cessing for humanitarian causes. The design is still in its
infancy, as this opens the door for possibilities involving
making the healthcare system bring closer to homes. However,
the challenges are quite elaborate. Medical Science is an
insurmountable collection of data where exceptions tend to
trump examples. There is still a lot more information from
Fig. 5. Hilbert Transform databases with different environments and setups to be gath-
ered. The difficulties of verification from multiple experts are
B. Accuracy and Comparative Analysis necessary yet daunting, as faulty analysis could lead to severe
consequences. We are looking forward to continuing our work
The performance analysis of this approach is discussed in in this field while looking for potential breakthroughs.
elaboration.
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