Electrocardiogram

(ECG)
ECG Basics
• The electrocardiogram (ECG) is a time-varying signal reflecting the
ionic current flow which causes the cardiac fibers to contract and
subsequently relax.
• The surface ECG is obtained by recording the potential difference
between two electrodes placed on the surface of the skin.
• A single normal cycle of the ECG represents the successive atrial
depolarisation/repolarisation and ventricular
depolarisation/repolarisation which occurs with every heart beat.
• Simply put, the ECG (EKG) is a device that measures and records the
electrical activity of the heart from electrodes placed on the skin in
specific locations
Use of ECG
• Screening test for coronary artery disease, cardiomyopathies, left ventricular
hypertrophy
• Preoperatively to rule out coronary artery disease
• Can provide information in the precence of metabolic alterations such has
hyper/hypo calcemia/kalemia etc.
• With known heart disease, monitor progression of the disease
• Discovery of heart disease; infarction, coronal insufficiency as well as myocardial,
valvular and cognitial heart disease
• Evaluation of ryhthm disorders
• All in all, it is the basic cardiologic test and is widely applied in patients with
suspected or known heart disease
The Normal Conduction System
SA node -> atrial muscle -> AV node -> bundle of His -> Left and Right Bundle Branches -> Ventricular muscle
Typical ECG
• A typical ECG period consists of P,Q,R,S,T and U
waves
ECG Waves
• P wave: the sequential
activation (depolarization)
of the right and left atria
• QRS comples: right and
left ventricular
depolarization
• T wave: ventricular
repolarization
• U wave: origin not clear,
probably
”afterdepolarizations” in
the ventrices
Clinically Relevant Parameters
• QRS duration
Bundle brand block
depolarization

• ST segment
ischemia

• QT interval
ventricular
fibrillation

• PR interval
SA  ventricles
ECG Graph Paper
• Runs at a paper speed of 25 mm/sec
• Each small block of ECG paper is 1 mm2
• At a paper speed of 25 mm/s, one small block equals 0.04 s
• Five small blocks make up 1 large block which translates into 0.20 s
(200 msec)
• Hence, there are 5 large blocks per second
• Voltage: 1 mm = 0.1 mV between each individual block vertically
Electroencephalogram
(EEG)
 Origin of the signal

MEG
orientation
EEG of magnetic
recording
scalp B field
V surface

skull

CSF

tissue
current
flow

- noninvasive measurement
- direct measurement.
How small is the signal !! EYE (retina)
Steady activity
BRAIN (neurons)
Spontaneous activity
Evoked activity Evoked by sensory stimulation
-4
10
SPINAL COLUMN (neurons)
-5 Earth field LUNGS Evoked by sensory stimulation
10 Magnetic contaminants
HEART
Intensity of magnetic signal(T) 10
-6
LIVER Cardiogram (muscle)
Iron stores Timing signals (His Purkinje system)

-7
10 GI TRACK
FETUS Stimulus response
Cardiogram Magnetic contaminations
-8 Urban noise
10

10
-9 Contamination at lung LIMBS MUSCLE
Steady ionic current Under tension
-10
10
Heart QRS

10 -11
Fetal heart Biomagnetism
Muscle
10 -12 Spontaneous signal
(a-wave)
requires sensitive detectors
-13 Signal from retina
10 (low noise-high gain amplification)
Evoked signal
-14
10
Intrinsic noise of SQUID
-15
10
The surface potential established by intracranial neural activity
decresases with distance from the source.

For dipolar sources, the potential falls as a function of the

square of the distance. EEG measures the potential differences
between two recording sites.
 EEG Basics
• The electroencephalogram (EEG) measures the activity of large
numbers (populations) of neurons.
• EEG recordings are noninvasive, painless, do not interfere much with
a human subject’s ability to move or perceive stimuli, are relatively
low-cost.
• Electrodes measure voltage-differences at the scalp in the microvolt
(μV) range.
• Many neurons need to
sum their activity in order
to be detected by EEG
electrodes.
• The timing of their activity
is crucial.
• Synchronized neural
activity produces larger
signals.
Standard placements of
electrodes on the human scalp:
A  auricle
C  central
F  frontal;
Fp  frontal pole;
O  occipital;
P  parietal;
T  temporal.
Electrocorticography (ECoG), OR
intracranial electroencephalography (iEEG)
EEG Recording Example

Normal Adult
Male
10 /20 % system of EEG electrode placement
Different types of brain waves in normal EEG
Different types of brain waves in normal EEG

Rhythm Frequency Amplitude Recording

(Hz) (uV) & Location

Alpha(α) 8 – 13 50 – 100 Adults, rest, eyes closed.

Occipital region

Beta(β) 14 - 30 20 Adult, mental activity

Frontal region

Theta(θ) 5–7 Above 50 Children, drowsy adult,

emotional distress
Occipital
Delta(δ) 2–4 Above 50 Children in sleep
Magnetoencephalography
(MEG)
• MEG (MagnetoEncephaloGraphy) measures the
magnetic field around the head

• Compare EEG: Measures voltage changes on the

scalp

• MSI (Magnetic Source Imaging) is MEG coupled to

MRI
Intra-Cranial Sources

Dipole (source current)

• A dipole is a small current source
• Dipole generates a magnetic field
• Dendritic current from apical dendrites of pyramidal neurons
• At least 10,000 neighboring neurons firing “simultaneously” for
MEG to detect
How MEG works
• Records the magnetic flux or the magnetic fields that arise from the
source current

• A current is always associated with a magnetic field perpendicular to

its direction

• Magnetic flux lines are not distorted as they pass through the brain
tissue because biological tissues offer practically no resistance to them
(cf. EEG)
Recording of the Magnetic Flux
• Recorded by special sensors called magnetometers
• A magnetometer is a loop of wire placed parallel to the head
surface
• The strength (density) of the magnetic flux at a certain point
determines the strength of the current produced in the
magnetometer
• If a number of magnetometers are placed at regular intervals across
the head surface, the shape of the entire distribution by a brain
activity source can be determined (in theory)
Magnetic flux from source currents

Magnetic flux Magnetometer

Source current
Recording of Magnetic Signals
An MRI Machine
 EEG MEG
•Expensive
•Cheap
•Tiny Signal(10 fT)
•Large Signal (10 mV)
•Signal unaffected by skull/scalp
•Signal distorted by skull/scalp •Good temporal •Spatial localization ~1 mm
•Spatial localization ~1cm resolution (~1 ms) •Sensitive mostly to tangential
•Sensitive mostly to radial
•Problematic spatial dipoles
dipoles
resolution (forward •Subjects must remain still
•Allows subjects to move
& inverse problems) •Sensors in helmet
•Sensors attached to head
•Requires special laboratory with
•Can be done anywhere •No structural or magnetic shielding
anatomical
information

EEG vs. MEG

Phonocardiogram
(PCG)
Heart

36
Electrical System

37
Mechanical System

38
Heart Sounds

• S1 – onset of the ventricular contraction

• S2 – closure of the semilunar valves
• S3 – ventricular gallop
• S4 – atrial gallop
• Other – opening snap, ejection sound
• Murmurs
39
Heart Sounds in a Phonocardiogram Recording

2/21/2019 Phonocardiography 40
Sub-Components of S2

41
Electrooculogram
(EOG)
 Electrooculogram (EOG)
• Functions by modeling a natural dipole
found in the eye.
• Electric Potential of the eye created
between the Retina and the Cornea.
• Any movement of the eye causes a change
in electrical differences in potential.
• The EOG is an electrophisiological test of function of the outer retina and
retinal pigment epithelium in which the change in the electrical potential
between the cornea and the ocular fundus is recorded during successive
periods of dark and light adaptation.
• This positive potential behaves as if it were a single dipole
oriented from the retina to the cornea.
• Such corneoretinal potentials are well established and are in
the range of 0.4 - 1.0 mV .
• Eye movements thus produce a moving (rotating) dipole
source and, accordingly, signals that are a measure of the
movement may be obtained .
• The chief application of the EOG is in the measurement of
eye movement.
Measurement of EOG
Measurement of EOG
The calibration of the signal may be achieved by having the patient
look consecutively at two different fixation points located a known
angle apart and recording the concomitant EOGs.

By attaching skin electrodes on both sides of an eye the potential can

be measured by having the subject move his or her eyes horizontally a
set distance.

Typical signal magnitudes range from 5-20 µV/°.

Measuremant of the clinical EOG
Standard method
Galvanized Skin Response
(GSR)
GSR
• Known as a lie detector
• Costs anywhere from 5-10k
• Consists of 2 electrodes usually placed on fingers
• Measures electrical conductivity of skin
• Sweat = Na+ ions
• More sweat, more conductivity
• GSR is affected when the sympathetic nervous system is active, in
particular when a person is anxious.
Galvanic Skin response (GSR)
Electromyography
(EMG)
EMG
• Muscle contraction due to a change in the relative sliding of thread-
like molecules or filaments
• Filament sliding is triggered by electrical phenomenon (Action
Potential)
• The recording of muscle APs is called electromyography (EMG)
• The record is known as an electromyogram
• Typically, each motorneuron innervates several hundred muscle fibers
• Motor Unit Action Potential (MUAP) = summed electrical activity of
all muscle fibers activated within the motor unit
EMG Recording
• Electrical potential difference measured
between two points  bipolar electrode
configuration used
• Bipolar Electrode Types
• Fine Wire
• Needle
• Surface
• Most common, less invasive
• Silver-silver chloride electrodes
• Electrode Placement
• Overlying the muscle of interest in the
direction of predominant fiber direction
• Subject is GROUNDED by placing an electrode
in an inactive region of body

http://www.hhdev.psu.edu/atlab/EMG.jpg
EMG Electrodes

Fine wire

Needle
Surface electrode
Electrodes
Typical EMG recording

Amplitude (mv)

Time axis (msec) 

Blood Pressure
(BP)
 BP
 Blood Pressure is a measurement of the force against the walls
of the arteries as the heart pumps blood throughout the body

 Blood pressure is measured in mmHg (millimeters of mercury)

 1,000 Pa is about 7 mmHg!

February 21, 2019 Blood Pressure - Biomedical Signal Processing Page 9

  The blood pressure reading is taken in 2 numbers:
systolic and diastolic.
Measure of
pressure as the
heart is beating Systolic

Diastolic Measure of
pressure while
the heart is at rest
between beating

February 21, 2019 Blood Pressure - Biomedical Signal Processing Page 10

February 21, 2019 Blood Pressure - Biomedical Signal Processing Page 16
 Nowadays BP monitors

February 21, 2019 Blood Pressure - Biomedical Signal Processing Page 7

  Blood pressure changes all the time:
 It decreases when we sleep, or when we are at rest
 It increases when we are active, excited, practicing sports,
stressed and nervous

 Changing blood pressure is a vital part of a healthy cardiovascular

system

 Hypertension, or high blood pressure, happens when the blood

pressure stays too high over an extended period of time:

 Can cause the heart to have to work too hard and the force of
the blood flow can damage your arteries, heart, kidneys, brain
and eyes.

February 21, 2019 Blood Pressure - Biomedical Signal Processing Page 11

Pulse Oximetry
Pulse Oximetry
• A large proportion of the oxygen diffusing into the blood binds to
hemoglobin in the red blood cells, while a part of the oxygen dissolves in
the blood plasma.
• The amount of oxygen transported around the body is determined
mainly by the degree to which hemoglobin binds to oxygen (lung factor),
hemoglobin concentration (anemic factor), and cardiac output (cardiac
factor).
• Pulse oximetry measures the arterial oxygen saturation of haemoglobin.
• Pulse oximetry is simple to use, relatively cheap, noninvasive and
provides an immediate result.
• It is now used widely in all in-hospital settings and increasingly in both
primary care and the pre-hospital environment.
• Oxygen saturation, ‘the fifth vital sign’, now also forms a component of
many early warning systems to identify the deteriorating patient.
• Oxygen saturation is an indicator of oxygen transport in the body, and
indicates if sufficient oxygen is being supplied to the body, especially to the
lungs.
• The pulse oximeter can also measure pulse rate.
• The volume of blood being pumped by the heart per minute is called the
cardiac output.
• The frequency of pumping during one
minute is called the pulse rate.
• These cardiac function indicators can be
determined by the pulse oximeter.
The graph shows spectroscopic and absorptive properties (properties regarding
which color is absorbed) of oxygenated hemoglobin (HbO2) and deoxygenated
hemoglobin (Hb) Oxygenated hemoglobin absorb more infra red while
deoxygenated hemoglobin absorb more red