HeartToGo: A Personalized Medicine Technology for Cardiovascular
Disease Prevention and Detection
Zhanpeng Jin*¹, Joseph Oresko¹, Shimeng Huang¹, and Allen C. Cheng¹²³
Departments of Electrical and Computer Engineering¹, Neurological Surgery², and Computer Science³
University of Pittsburgh
Pittsburgh, PA 15261
{zhj6, jjo5, shh61, acc33}@pitt.edu
Abstract² To date, cardiovascular disease (CVD) is the first
leading cause of global death. The Electrocardiogram (ECG) is
the most widely adopted clinical tool that measures and records
the electrical activity of the heart from the body surface. The
mainstream resting ECG machines for CVD diagnosis and
supervision can be ineffective in detecting abnormal transient
heart activities, which may not occur during DQ LQGLYLGXDO¶V
hospital visit. Common Holter-based portable solutions offer
24-hour ECG recording, containing hundreds of thousands of
heart beats that not only are tedious and time-consuming to
analyze manually but also miss the capability to provide any
real-time feedback. In this study, we seek to establish a cell
phone-based personalized medicine technology for CVD, capable
of performing continuous monitoring and recording of ECG in
real time, generating individualized cardiac health summary
UHSRUWLQOD\PDQ¶VODQguage, automatically detecting abnormal
CVD conditions and classifying them at any place and anytime.
Specifically, we propose to develop an artificial neural network
(ANN)-based machine learning technique, combining both
individualized medical information and clinical ECG database
GDWD WR WUDLQ WKH FHOO SKRQH WR OHDUQ WR DGDSW WR LWV XVHU¶V
physiological conditions to achieve better ECG feature
extraction and more accurate CVD classification results.
I. INTRODUCTION
Cardiovascular disease (CVD), such as heart attack, stroke,
and hypertension, is caused by disorders of the heart and
blood vessels and is by far the leading cause of death in the
world for both women and men of all ethnic backgrounds.
According to a report released by the World Health
Organization (WHO), an estimated 17.5 million people died
from CVD alone in 2005, representing 30% of all global
deaths [10]. To date, CVD is the first factor contributing to the
global death and is projected to remain the leading cause of
death. If appropriate action is not taken, by 2015, an estimated
20 million people will die from CVD every year.
The Electrocardiogram (ECG) is the most widely adopted
clinical tool that measures and records the electrical activity of
the heart from the body surface. This electrical activity is
related to the impulse that travels through the heart, which
determines its rate and rhythm. Physicians use this
information to diagnose many CVD conditions such as cardiac
arrhythmias, myocardial infarctions, atrial enlargements,
* This research is currently supported by Microsoft Research Cell Phone
as a Platform for Healthcare Funding Award.
978-1-4244-4293-5/09/$25.00 
c 2009 IEEE
ventricular hypertrophies, and bundle branch blocks.
Currently, the commonly used ECG machine in most hospitals
for CVD diagnosis and supervision is stationary and
expensive. The goal of this research is to establish a cell
phone-based wearable platform, capable of performing
continuous monitoring and recording of ECG in real time,
generating individualized cardio health summary report in
OD\PDQ¶V ODQJXDJH DXWRPDWLFDOO\ GHWHFWLQJ DEQRUPDO &9'
conditions and classifying them at any place and anytime.
Given that ECG signals vary from individual to individual,
the specific waveform components, such as the P-wave, the
QRS-complex and the T-wave, will have different
characteristics for different individuals. Compared to
traditional approaches, personalized classification approaches
analyze the ECG waveform characteristics more precisely on
an individual-by-individual basis. However, real-time
applications often require faster training techniques or
methods that can be applied to the detector in advance. Thus,
we proposed a hybrid strategy that utilizes both personalized
medical information and an established ECG database, and is
more suitable for the target real-time and wearable
environment.
II. PRIOR WORK
In recent years, there is a trend of moving resting ECG
machines toward a mobile ECG solution. Prior mobile ECG
research activities mainly focus on developing 1) wearable
ECG sensors [7]; 2) device-sensor interface [8] that connects
the ECG sensor to a PDA or a cell phone; 3) wireless network
[4] that allows collected ECG data to be transmitted to a
remote server via a PDA or a cell phone; 4) PDA-based device
[5] that can display monitored ECG in real time. Most of the
prior mobile ECG research used either a PDA or a cell phone
only as a data display or a transmission device, which send the
collected ECG data to a remote PC for later review and
diagnosis by a physician. Unlike existing approaches, we want
to focus on developing a standalone cell phone-based mobile
ECG platform, which not only is able to collect, record,
display, and transmit ECG data in real time, but is also able to
analyze the acquired ECG data and automatically detect
cardiac abnormities and match them with possible CVD
conditions.
80
 Real-time Continuous ECG Display
HeartToGo Data Acquisition:
ECG & Health
History

Signal Processing
Microsoft Windows
Mobile Cell Phone
AliveTec Chestband ECG Summary
with ECG,
Tom Henderson ‡Normal sinus
Accelerometer and Feb/04/1950 (57yr)
Bluetooth Male/ Black/190Ib rhythm
Real-Time ECG HR: ‡Normal ECG
Vent. Rate: ‡Compared with
Feature Extraction PR interval: ECG of 05/01/2008:
and Monitoring QRS duration: No significant
QT/QTc: change

Cardio Health CVD

Real-Time Cardio CadioPro Report CadioPro Report
Health Assessment Regular heart Due to the
Bluetooth GPS and CVD Detection function detections of ST
06/01/2008, 10 am segment elevation,
absent R wave, T
Risk factors: wave inversion, and
‡High blood ST segment
cholesterol elevation, you may
‡Heavy Alcoholic have Anterolateral
Myocardial
911 Cardiologist Infarction

Fig. 2. HeartToGo Platform Prototype, including a Microsoft

Father had heart
attack once
Emergency
Contact
Windows Mobile cell phone with and a wearable 2-lead Alive Heart
Fig. 1. The Proposed HeartToGo Platform, including the prototype Activity Monitor with a built-in 3-axis accelerometer.
testbed (cell phone, ECG sensor, and GPS) running intelligent CVD
diagnostic algorithms in real-time.

III. HEARTTOGO DESIGN FRAMEWORK

The architecture of the proposed real-time ECG monitoring
and analysis system is illustrated in Figure 1. To acquire
real-time ECG signals, we employed Alive Technology¶V
state-of-the-art wireless ECG and heart monitor, which is a
light-weight (60g with battery), low-power (60 hours of
operation with continuous wireless transmission) wearable
2-lead ECG sensing device capable of recording 300 8-bit
samples per second. It is equipped with a class 1Bluetooth
transmitter, with a range of up to 100 meters, which can send
its data to cell phones or other wireless devices.
In addition to the constructed physical testbed, the complete
platform includes an efficient ECG processing module
capable of taking the collected ECG data and dynamically
extracting various ECG features, such as detecting P wave,
QRS complex, and T wave, and producing a ECG summary
report that may include, but are not limited to: the heart rate,
rhythm, axis, RR interval, QRS duration, ST segment,
P/Q/R/S/T wave morphologies. The produced ECG summary Fig. 3. The HeartToGo Cell Phone User Interface, including: (top) a
report will be similar to those generated by stationary ECG real-time ECG acquisition and display, plus an on-line CVD classifier;
and (bottom) a 3-axis accelerometer measurement indicating the XVHU¶V
machines used by cardiologists in many hospitals. corresponding physical movement intensity.
For all the commercially available ECG solutions that we
ventricular contraction (PVC). After being processed by the
have seen, the highest available functionality stops at
rule-based checker, the initial classification results will be fed
extracting ECG features and producing ECG summary report
into a Hybrid Fuzzy Network based neural classifier [6] to
that can be reviewed by the cardiologist. In this exploratory
determine the possible indications for any abnormal CVDs.
and transformative research, we are interested in taking a leap
To overcome the drawbacks of traditional ECG classification
by designing innovative algorithms that can take the identified
and analysis systems, which usually depend highly upon an
ECG features and search for potential matches for any CVD
existing ECG database, e.g., MIT-BIH arrhythmia database,
conditions. First, a rule-based method is implemented to
we explore a novel self-adaptive hybrid strategy to improve
perform a quick, first pass of CVD detection. This serves as a
the functionality and efficiency of ECG analysis and
light-weight checker for diagnosing CVDs on the cell phone
prediction. Although those ECG databases are fairly
platform in real time. Upon the acquisition of each heart beat,
representative and well studied, they are not sufficient to
this light-weight CVD checker will process and analyze each
represent every LQGLYLGXDO¶VGLIIHUHQW(&*GDWD>3]. Thus, a
heart beat and classify it by condition, be it normal or a
better way is to VXSSOHPHQWWKHGDWDEDVHZLWKRQH¶VRZQ ECG
condition indicating a CVD, for example premature
data for more personalized diagnosis. Thus, we propose a

2009 IEEE/NIH Life Science Systems and Applications Workshop (LiSSA 2009) 81
 hybrid strategy combining both individual-specific method
and conventional database method more suitable to deliver the
desired detection accuracy while still be able to satisfy the
more constringent mobile, real-time environment.

IV. EXPERIMENTAL PROTOTYPE AND

WORK-IN-PROGRESS RESULTS
$Q$OLYHΠBluetooth ECG and Heart Monitor, a Microsoft
Windows MobileΠbased cell phone, Microsoft Visual
6WXGLRŒ, MATLABŒDQG/DE9,(:Œ software packages
are utilized to implement our prototype as shown in Figure 2.
The Alive Heart Monitor is a wireless health monitoring
system for screening, diagnosis and management of chronic
diseases. The user interface of the proposed prototype, shown
in Figure 3, was written in Microsoft Visual C++ and features
an optional plug-in to calculate heart rate and perform
preliminary diagnosis. The plug-in is currently based the open
source EPLimited arrhythmia detection software package [2].
As shown, the heart rate is displayed in the upper-right hand
corner and is updated in real time. Also, each beat is classified
Fig. 4. The HeartToGo ECG Summary Report, providing statistical summary
and the corresponding letter for the beat is shown below it. In of extracted ECG features. Currently it includes summary of Heart Rate (BPM)
)LJXUH  HDFK EHDW KDV DQ ³1´ PDUNHU XQGHUQHDWK LW ZKLFK and abnormal PVC heart beat detection.
signifies a normal beat. The EPLimited-based plug-in
bundle branch block. Sinus bradycardia occurs when the sinus
implements a QRS detector and a classifier for normal and
rate is less than 40 beats per minute (bpm). Ventricular flutter
PVC beats, repreVHQWHGDVD³9´LQWKHXVHULQWHUIDFH. As part
is diagnosed by a heart rate of more than 200 bpm and the
of this work in progress, we have extended the diagnosis
tracing often resembles a sine wave, with little-to-no
capability to include additional features such as the R interval,
distinction between the QRS complex, the ST segment, and
the QRS width, the R peak, and the beat width.
the T wave. The left bundle branch block occurs when the
Based on the morphology information available, additional
QRS width is greater than 120 ms and the R peak time is
rules were added to the plug-in in order to detect the following
prolonged by more than 60 ms [9]. These arrhythmias have
conditions: sinus bradycardia, ventricular flutter, and left

Fig. 5. The ECG Signal Processing Workflow of the 6-Stage R-peak Detection

82 2009 IEEE/NIH Life Science Systems and Applications Workshop (LiSSA 2009)
relatively unique symptoms that can be classified by
rule-based detector. More of such conditions are being added
to further reduce the load on Fuzzy Network based neural
classifier, in order to make the most efficient use of CPU.
Furthermore, a preliminary ECG summary report was
added to the Alive Heart Monitor. As shown in Figure 4. Heart
rate and beat type statistics are captured and displayed in order
to provide simple diagnostic information. The average heart
rate, as well as the highest and lowest detected heart rates, is
displayed. Also, the total number of beats and the number of
beats for each condition that is detectable using the rule-based
method are displayed.
In order to diagnose additional conditions, more advanced
feature extraction information is necessary. For example, in
order to diagnose the myocardial infraction (heart attack), we
must be able to detect a new or presumably new Q wave, at
least 30 ms wide and 0.2 mV deep, in addition to a complete
left bundle branch block. Another example of the need for
additional features is the left ventricular hypertrophy, which is
patterned by an inverted T wave [1].
Thus, due to the limited number of features that are Fig. 6. The HeartToGo¶VAdvanced ECG Signal Processing User
extracted using the EPLimited plug-in, additional feature Interface developed using MATLAB and LabVIEW.
detection algorithms are being developed. The algorithms are report window was implemented to provide statistics such as
first evaluated and verified in MATLAB due to its powerful the average heart rate and number of detected beats for each
numerical computing ability and elaborate toolboxes, e.g., the condition. In order to be able to diagnose more conditions we
Fuzzy Logic Toolbox, Wavelet Toolbox, and Neural Network are working to extract additional features from the ECG
Toolbox used in this study. As one of the basic tasks of signal, such as the T wave and P wave locations and durations,
ECG-based clinical diagnosis, a 6-stage R-peak detection while DLPLQJ WR PHHW WKH ³FRPSXWDWLRQ EXGJHW´ RI
framework was illustrated in Figure 5, which could off-the-shelf cell phones.
successfully reduce the influence of those factors one can
encounter in processing ECG: irregular distance between ACKNOWLEDGEMENT
peaks, irregular peak form, and presence of low-frequency The authors would like to thank Sergey Chernenko for his
component in ECG due to individual¶V breathing. shared MATLAB demo of ECG processing.
In order to perform a rapid prototyping of the algorithms, a
LabVIEW-based platform has been developed. Using REFERENCES
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2009 IEEE/NIH Life Science Systems and Applications Workshop (LiSSA 2009) 83