Universiti Tunku Abdul Rahman

Lee Kong Chian Faculty of Engineering and Science

Sungai Long Campus
Department of Mechatronics and Biomedical Engineering

UEMB2233 \ Biomedical Instrumentation

Laboratory Manual
Table of Contents
1.0 \ Introduction..................................................................................................................3
2.0 \ Theory ..........................................................................................................................3
3.0 \ Equipment ....................................................................................................................5
4.0 \ Procedures....................................................................................................................5
4.1 \ Standard 10-lead Resting ECG .................................................................................................. 5
4.2 \ Exercise ECG .............................................................................................................................. 7
4.2.3 \ Procedures............................................................................................................................. 10
5.0 \ Reporting Requirements ..................................................................................................11
6.0 \ Submission Details ......................................................................................................... 11

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1.0 \ Introduction

The purpose of this laboratory is to provide

• a basic introduction to the electrocardiogram (ECG)
• instrumentation used in ECG recording
• comparisons between resting and exercise ECG

2.0 \ Theory

The electrocardiogram records the electrical activity of the heart as measured on the body
surface. These surface potentials provide important information which may be used to
diagnose possible pathological cardiac conditions. A full clinical 12 lead clinical ECG consists
of the following leads:-

• Three (3) bipolar standard or limb leads - Leads I, II and III

• The three (3) unipolar augmented leads - aVR, aVL and aVF
• The six (6) unipolar precordial or chest leads (V1, V2, V3, V4, V5 and V6)

The six limb leads (3 standard limb leads and 3 augmented leads) record the electrical
activity of the heart in the frontal plane, providing six cardiac vectors spaced 30 degrees apart
from +30to -120 degrees. The six precordial leads record electrical activity in the transverse or
horizontal plane.

Not all twelve (12) leads are mathematically independent of each other and hence not all 12
leads need to be recorded simultaneously. Only two limb leads need to be recorded as the
remaining limb lead (III) and the augmented leads can then be directly derived using the
simple algebraic formulae;

III = II - I, aVR = -I - III/2, aVL = I - II/2, aVF = II - I/2

The 12 lead ECG has evolved historically to provide a balance between the number of frontal
and transverse views of cardiac activity and the convenience and accuracy of lead placement.
Different leads are more sensitive to changes in cardiac electrophysiology occurring at
different locations.

Thus, for an example, an inferior wall myocardial infarction (MI) is best observed in leads II, III
and aVF, an anterior wall MI is best observed in leads V1, V2, V3, and V4, and a lateral wall MI is
best observed in leads I, aVL, V5 and V6. Posterior wall infarcts in contrast are difficult to

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record directly as no leads are attached to the back surface of the patient, but reciprocal
changes may be observed in leads V1 and V2.

In this practical, one will record only a single ECG lead but by placing the electrodes on
various limbs you will be able to record leads I, II and III separately (not concurrently as is
needed for commercial (diagnostic) ECG machines.

Fig. 1 illustrates the main features of an ECG waveform. Many reference texts on cardiac
electrophysiology explain in detail the aetiology of the waveforms. The right leg lead of the
ECG is not used for recording but is used to reduce the common-mode voltage interference by
driving a current back onto the body surface to cancel the common-mode noise signal
(typically mains 50 Hz interference).

Medical instrumentation textbooks describe this technique in detail. Fig. 2 shows Einthoven's
method for deriving the mean cardiac vector. The cardiac vector typically points downwards
with a left axis deviation. However, heart enlargement (hypertrophy) can cause a right axis
deviation. Left ventricular hypertrophy often occurs in healthy hearts but is also very common
in patients with congestive heart failure.

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3.0 \ Equipment

• Schiller CS-200 Electrocardiogram System

• Ag/AgCl Disposable Electrodes – Round-Shaped

4.0 \ Procedures
4.1 \ Standard 10-lead Resting ECG
The colours used here are according to Code 1 (usually European) requirements. Figure 3
shows the placement of electrodes.

Figure 3 – Electrodes Placement for Resting ECG

4.1.1 Ensure that the test subject is warm and relaxed

4.1.2 Shave electrode area before cleaning

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4.1.3 Thoroughly clean the area with alcohol
4.1.4 When applying the electrodes, ensure that a layer of gel is between the
electrode and the skin
4.1.5 Place the C4 electrode first – in the 5th intercostals space (ICS) so that it
lines up approximately with the middle of the clavicle
4.1.6 Then place the following:-
4.1.6.1 C1 in the 4th ICS parasternal right
4.1.6.2 C2 in the 4th parasternal left
4.1.6.3 C3 between and equidistant to C4 and C2
4.1.6.4 C6 on the patient’s side and aligned with C4
4.1.6.5 C5 between and equidistant to C4 and C6
4.1.7 Place the
4.1.7.1 RA and LA (right arm and left arm), on the inside arm just above
the wrist
4.1.7.2 LL (Left Leg), on the left inside lower leg, just above the ankle
4.1.7.3 N (Neutral), on the right inside lower leg, just above the ankle
4.1.8 Check Skin/Electrode Resistance
4.1.8.1 Trigger the following menu

4.1.8.2 The following window will be displayed

4.1.8.3 Reference voltage readings from electrodes

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 4.1.8.3.1 With test subject connected with a good
connection, low resistance ± 100 mV. An offset of
up to ±300 mV will be acceptable
4.1.8.3.2 No cable connected -350 to -500 mV
4.1.9 Taking a Resting ECG recording
4.1.9.1 Auto Recording Procedure
4.1.9.1.1 Prepare the test subject and connect the electrodes
as per described in 4.1.1-4.1.7
4.1.9.1.2 Plug the cable into the cable socket on the back panel
marked EKG/ECG (if not already in). Check that the
cable is connected to the PC
4.1.9.1.3 In the patient screen, highlight current patient or click
on ‘New Patient’
4.1.9.1.4 Click on the resting ECG icon to enter the data
acquisition screen
4.1.9.1.5 Check and enter subject data
4.1.9.1.6 Check electrode offset. If the signal quality is not
satisfactory, reapply the electrodes
4.1.9.1.7 To take a recording
4.1.9.1.7.1 Press the Auto key
4.1.9.1.7.2 Click on the Auto icon in the tool bar
4.1.9.1.7.3 Press function key F5
4.1.9.1.7.4 Select Auto ECG in the function menu

4.2 \ Exercise ECG

4.2.1 \ Leads Placement

4.2.1.1 Leads placement for exercise ECG is shown in Figure 4.

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 Figure 4 – Leads placement for Exercise ECG

4.2.1.1.1 Place electrodes C1 to C6 as per described in 4.1.6

4.2.1.1.2 Place RA, LA, LL and N electrodes as the following:-
4.2.1.1.2.1 LL, on the left torso at the bottom of the rib cage
4.2.1.1.2.2 RL (N), on right torso at the bottom of the rib cage
4.2.1.1.2.3 LA and RR, place either on the back above the scapular or on the front just below
the clavicle

4.2.2 Data acquisition

4.2.2.1 Prepare the test subject, connect the electrodes, enter details
4.2.2.2 From the patient screen, click on the exercise icon

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4.2.3 \ Procedures

4.2.3.1 Inform the test subject that the test is to begin

4.3.3.2 Click on the control icon at the top right corner of the screen which displays START (or
press function key F7)
4.3.3.3 The control icon now display as Begin to indicate that the warm-up stage has
commenced
4.3.3.4 Click on the ST-Ref icon to define the QRS reference. The icon is only be available
below the control icon when Begin is displayed
4.3.3.5 The current average QRS complex displayed in the zoom average window is used as a
reference complex during the test. If the ST-Ref is not clicked, the reference QRS will be
taken as the average QRS
4.3.3.6 Click Begin (or press function key F7) to start the test
4.3.3.7 At the end the test, commence the recovery phase by clicking the control icon of
Recover
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5.0 \ Reporting Requirements
Each student is expected to submit an individual report. The content of the report must include
the following elements:-

1. A full laboratory report detailing the instrumentation used and procedures

performed for ECG recording.
2. Describe the key ECG characteristics. Refer to PR interval and QRS Interval.
3. Include all findings, data collected, and relevant information that describe both
resting-ECG and exercise-ECG. Compare and contrast both resting-ECG and
exercise-ECG.
4. Other discussions on outcomes are deemed necessary.

6.0 \ Submission Details

The duration for report preparation is one week. All submission should include each element
described in Section 5.0. All submission to be done electronically (uploaded to the
submission link in wble).

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