BIOENGINEERING LAB

BG2802

Anatomy and Physiology

Location: N1.3-B4-16

Name: _______________________________________

Matric Number: _______________________________________

Group: _______________________________________

Date of experiment: _______________________________________

Lab Unit SPIROMETRY

Pls start with reading the chapter on “Lung Volumes and Capacities” in the text-book
(Martini, Fundamentals of Anatomy and Physiology, 7th Ed., pp 837-9).
We’ll explain and demonstrate the procedure of the experiment first, and then one volunteer
has to perform the experiment (and gets a free lung diagnosis).
The total experiment has to be done within 15s!
The final printout for analysis is shown in the next figure. You have to calculate the following
volume parameters: TV = tidal volume
VC = vital capacity
ERV = expiratory reserve volume
IRV = inspiratory reserve volume
FEV1 = forced expiratory volume in one second
FEV1/VC must be >80%. If < 80%, then the patient suffers from an obstructive lung disease
(e.g., asthma, chronic bronchitis)
The experiment starts with normal breathing to get the tidal volume. Then continue with
exhaling maximally, followed by inhaling maximally, then hold your breath at maximal
inspiration for about 1s and then do the forced expiration. Forced expiration (see next figure)
means: exhale as fast and as powerful as you can. If your FEV1/VC is <80% then you have to
repeat the experiment.
Spirometry Experiment Procedure

Select a volunteer
Open Software: Vitalograph Spirotrac
Click: Add New Subject (Flie > New > Subject)
Enter all information as required

Place the disposable mouth piece onto the machine. Fit properly.
*Change new mouth piece for new user.

Disposable mouth piece

Click on FVC test

Start inhaling/exhaling into the mouthpiece (15seconds)

(Also refer to Figure: printout of the spirometry)

Test Quality Results: Good Test/ Good Test session

Click accept

Run atleast 3 test per group (Note: If you feel fatique, kindly rest.)

Throw away used mouth piece once test over

Capture results: Return > File > Report Preview > Test Report
Figure: printout of the spirometry experiment (pls note that the figure in the text-book is
upside down)

Lab Unit ECG

The electrocardiogram (ECG) is one of the most widely used and useful investigations in
contemporary medicine. It is essential for the identification of disorders of the cardiac
rhythm, extremely useful for the diagnosis of abnormalities of the heart (such as myocardial
infarction), and a helpful clue to the presence of generalised disorders that affect the rest of
the body too (such as electrolyte disturbances). [1]

This lab unit does not provide an ultimate crash course in ECG. Hence you are not able
to diagnose all ECG disorders after this lab session. Moreover, ECG diagnosis requires a
huge experience. Please read the following text first. Parts of the text written in GRAY
font-colour are not necessary for the experiment and serve for reference only.

What does the ECG actually record?

ECG macines record the electrical activity of the heart. [1]
History

The Nobel Prize in Physiology or Medicine 1924

"for his discovery of the mechanism of the electrocardiogram"

Willem Einthoven the

Netherlands Leiden University
Leiden, the Netherlands
b. 1860 (in Semarang, Java, then Dutch East Indies)
d. 1927
[http://nobelprize.org/medicine/laureates/1924/index.html]

An extensive description of ECG history can be found here:

[http://inventors.about.com/gi/dynamic/offsite.htm?site=http://www.ecglibrary.com/ecghist.html]

Equipment for this lab unit

Portable ECG unit

ECG “Leads”

A “lead” does not refer to the “wires” that connect the patient to the ECG macine – the wires
are called “electrodes” to avoid confusion.

“Leads” are different viewpoints of the heart’s electrical activity. [1]

A conventional ECG machine provides 12 leads, 6 limb leads and 6 chest leads, hence the
name 12-lead ECG.

Limb leads: I, II, III, aVR, aVL, aVF (a = augmented, V = voltage, R/L/F = Right [arm] / Left [arm] /
[left] Foot)

Chest leads: V1, V2, V3, V4, V5, V6

The limb leads are situated in the frontal (coronal) plane from different angles

The chest leads are located in the horizontal plane (however slightly tilted CW in front
view).

“Electrical current flowing towards a lead produces an upward (positive) deflection on the
ECG, whereas current flowing away causes downward (negative) deflection” [1].
Recording of ECG “Leads”

Colour Coding for Lead Systems

You should be aware that there are two different colour coding and labelling schemes in use
for identifying connections (AHA and IEC). The problem of choosing the wrong system can
be minimised if a department standardises on the one type of system. If this is not the case,
then always check both electrode inscriptions and colour to conform the system you are using
as this can sometimes lead to faulty electrode connections.
[http://www.gla.ac.uk/care/colourcoding.html]
AHA IEC

Location Inscription Colour Inscription Colour

Right arm RA white R red

Left arm LA black L yellow

Right leg RL green N black

Left leg LL red F green

Chest V1 brown/red C1 white/red

Chest V2 brown/yellow C2 white/yellow

Chest V3 brown/green C3 white/green

Chest V4 brown/blue C4 white/brown

Chest V5 brown/orange C5 white/black

Chest V6 brown/purple C6 white/violet

Right leg = ground electrode

Bipolar standard limb leads according to Einthoven

[2]

Lead I measures the potential difference between both arms.

Unipolar augmented limb leads according to Goldberger

 [2]modified
Limb leads combined
Leads II, III and aVF are called inferior leads because they view the inferior (diaphragmal)
portion of the heart.
Leads I and aVL are called left lateral leads because they most efficiently monitor the hearts
lateral side.
Minus (!) aVR can be conidered the transition from inferior to left lateral.

The heart / ECG co-ordinate system does not follow the conventional mathematical or
technical one; it rather is: x – towards the right, and y – downward. Hence a vector at +90°
points downward. The ECG co-ordinate system thus is a mirror image of the mathematical
one (about the x-axis).

[3]modified
Einthoven Triangle:
 [2]modified

The direction of the current is from – to +, i.e., towards the lead.

Hence the direction of the electrical vector in lead I is 0° Lead
II: 60°, lead III: 120°.

Einthoven Triangle including unipolar Goldberger leads:

[2]

The direction of the unipolar, augmented, leads is from the centre towards the corners of the
triangle: aVL  –30°, aVF  90°, aVR  –150° or 210°.

Unipolar chest leads according to Wilson

 [2]modified FIGURE:
Green line: plane of chest leads (tilted horizontal plane)

V1 is placed in the fourth intercostal space to the right of the sternum

V2 is placed in the fourth intercostal space to the left of the sternum
V3 is placed between V2 and V4
V4 is placed in the fifth intercostal space in the midclavicular line
V5 is placed between V4 and V6
V6 is placed in the fifth intercostal space in the midaxillary line Leads
V1 and V2 lie directly over the right ventricle
Leads V3 and V4 lie directly over the intraventricular septum
Leads V5 and V6 lie directly over the left ventricle

[F. K. Fuss]
FIGURE: Horizontal section through the thorax (spine, heart, lungs, aorta, esophagus). Blue:
anterior myocard (right ventricle), green: interventricular septum, red: lateral myocard (left
ventricle), pink: posterior myocard (left ventricle)
 [3]modified
FIGURE: Position of the chest leads. Blue: anterior myocard (right ventricle), green:
interventricular septum, red: lateral myocard (left ventricle), pink: posterior myocard (left
ventricle; V7 and V8 are optional chest leads)

ECG waves

By convention, the main waves on the ECG are given the names P, Q, R, S, T, and U. [1]

FIGURE: ECG waves [1]

Each wave represents depolarization (‘electrical discharging’) or repolarization (‘electrical

recharging’) of a certain region of the heart. [1]
ATTENTION: Q, and U waves are rare, and indicate a pathology in most cases (Q 
myocardial infarction; U  hypokalaemia / K+↓)

Conduction system of the heart

ATTENTION: the conduction system does not consist of nerve tissue! It rather is composed
of heart muscle proper, however modified such that it is specialises of conducting and
producing electrical impulses rather than producing a force.

The conduction system consists of the following parts:

1) SA node (sinoatrial node, Keith-Flack node; 1 in next figure): located subepicardially
(between epicard and myocard) at the transition of the superior vena cava to the right atrium,
in the “sinus” (cove) between superior vena cava and aorta.
2) three internodal tracts through the atria: Bachmann’s anterior internodal tract (6),
Wenckebach’s middle internodal tract (5), Thorel’s posterior internodal tract (4).
3) AV node (atrioventricular node, Aschoff-Tawara node, 2): located subendocardially
(between endocard and epicard) in the right atrium, at the atrio-ventricular septum (which is
between right atrium and left ventricle, B).
4) Bundle of His (3): beginning of ventricular bundles; located inside the atrio-
ventricular septum (B)
5a) Right bundle branch (10)  from interventricular septum (C) to right ventricle (as right
fascicle)
5b) Left bundle branch (7)  from interventricular septum (C) to left ventricle  divides into
2 fascicles: anterior (8) and posterior (9)
Consequently, there are 3 fascicles: right, left anterior, and left posterior! Purkinje
fibres (11): terminal branches of the 3 fascicles

[F. K. Fuss]
FIGURE: schematic figure of the heart chambers, the 3 septa (A, B, C), and the conduction
system. A = interatrial septum, B = atrio-ventricular septum (between right atrium and left
ventricle, C = interventricular septum; 1 = SA node, 2 = AV node, 3 = His bundle, 6 =
Bachmann’s anterior internodal tract , 5 = Wenckebach’s middle internodal tract, 4 = Thorel’s
posterior internodal tract, 10 = right bundle branch, 7 = left bundle branch, 8 = left anterior
fascicle, 9 = left posterior fascicle, 11 = Purkinje fibres
One of the major tasks of the ECG is to check whether the conduction system is intact.
A normal heart shows a sinus rhythm (coming from the sinus node).
Pathologies of the conduction system are:
1) Arrhythmias
2) Blocks of parts of the conduction system
3) re-entry tachycardias due to an accessory (abnormal) pathway between atria and ventricles
other than the AV node

Where do the waves come from?

In the normal heart, each beat begins with the depolarization of the SA node: start of P wave.
P wave: depolarization of the atria
PQ or PR segment (isoelectric): the electric impulse passes through the AV node
PQ or PR interval (P wave + PQ segment): time of depolarization wave to pass from the SA
node into the ventricular muscle; duration: 0.12 - 0.2 s
QRS complex: depolarization of the ventricles; duration: < 0.12 s
ST segment (isoelectric): transient period from de- to repolarization
T wave: repolarization of the ventricular myocardium
QT interval (QRS + ST + T): total activation time of the ventricles; duration: depends on HR,
eqn (1).
QT(s) = (0.66321 - 0.006781 HR + 0.000044566 * HR² - 0.0000001176 * HR³) ± 10% (1)
(Data for eqn 1 taken from ECG ruler scales, and polynomial fit applied)
The repolarization of the atria is not visible in the ECG, as this wave is “swallowed” by the
QRS complex.

Standard ECG for all 12 leads

On the graph paper, the x-axis (towards the right) corresponds to the time: 1 cm is 0.4 s, 1 mm
is 0.04 s (paper speed of 25 mm/s.
The y-axis (upward) corresponds to the voltage: 1 cm = 1 mV

Limb leads:

[1]modified
QRS of chest leads:

[3]modified
Electrical heart vector

The heart vector refers primarily to the RS (QRS) waves, although the propagating vector can
be drawn for any stage of the ECG, resulting into a vector loop.
 [2]
FIGURE: Vector loop of the cardiac cycle – frontal view

a [2] b [3]
FIGURE: 3D vector loop (a). Frontal view: limb leads (a); horizontal view: chest leads (a);
sagittal view (a): II, aVF, III (downwards, b), and V1, V2, V3 (upwards, b)
 [2] [2]
FIGURE: vector loop in frontal view FIGURE: vector loop in horizontal view

Calculation of the electrical heart vector (RS complex): cardiac axis

Basic rules:
Current flows towards a lead: overall positive deflection (positive RS complex)
Current flows away from a lead: overall negative deflection (negative RS complex) Current
flows at right angles to a lead: overall zero deflection (isoelectric RS complex; positive
wave + negative wave = 0)

[1]

Hence we get the following relationship:

θ = angle between electrical heart axis and any lead
V = voltage of any lead
C = constant
V = C cos θ (2)

Estimation of the heart axis:

According to eqn 2, the maximally positive RS complex coincides with the heart axis. The
maximally positive RS complex, however, is difficult to estimate (see example below).
Hence, we simply estimate the position of an isoelectric RS complex, and add 90° in positive
direction.
EXAMPLE

[1]modified

In the above figure there are 2 transitions from positive to negative: between aVR and aVL,
and between I and II. The angle between aVR and aVL is 120°, the one between I and II is
60°. Hence we take the latter for analysis.
I (0°) is more negative than II (60°) is positive. The isoelectric point thus is closer to II.
Furthermore, aVR is slightly positive, hence minus (!) aVR (30°) is slightly negative. The
isoelectric point must be between –aVR and II, i.e., between 30° and 60°. Hence we take 45°,
and add 90° in positive direction, which is towards aVF (which is positive, in contrast to I):
45° + 90° = 135°. The heart axis is at 135°, i.e., after III. The correct answer is:

[1]modified

Calculation of the heart axis:

Calculation of the electrical axis (EA in degrees) from leads I (0°) and aVF (90°) [sometimes
used in ECG recorders]:

EA = ATAN2 (aVF,I) (3)

In eqn (3) aVF and I is the overall polarity of the RS complex. In lead I of the above figure, R
is +2 mm, and S is –10 mm. The overall polarity thus is –0.8 mV. In aVF, R is +10mm, and
the overall polarity is +1 mV.
EA according to eqn (3) is: 128.66°. Our previous estimation hence is quite close.
Reconsidering the previous estimation, the polarity of –aVR is –1.5 and of II is +3. Hence the
isoelectric point is expected at 40° and EA is estimated at 130°.

If your calculator does not offer the ATAN2 function, then take ATAN (tan–1 ) instead, make
sure, however, that the axis lies within the region of positive polarity.
EA = tan–1 (aVF/I) (4)

Eqn (4) delivers –51.34°, yet aVL at –30° is negative. Hence take –51.34° + 90°.
Bipolar and unipolar leads, however, have different strengths: in unipolar leads the amplitudes
are increased (“augmented”, “a”VR, etc.) [5]. Eqn (3) hence has to be corrected by a factor of
2/√3 (=1.155) to account for different amplification [5].

EA = ATAN2 (2aVF,I√3) (5)

EA according to eqn (5) is: 124.7°.

EA is considered normal between +90° and –30° [1].

Left axis deviation: EA < –30° (typically in left anterior hemiblock; can also accompany
WPW syndrome, inferior myocrdial infarction)
Right axis deviation: EA > +90° (can be found in right ventricular hypertrophy, WPW
syndrome, anterolateral infarction, left posterior hemiblock)
Another classification of the EA distinguishes between several types [3,6]:
1) left over-rotation: EA < –30° (pathological!!!)
2) left type: –30° < EA < 0°
3) transverse type: 0° < EA < 30°
4) normal type: 30° < EA < 60°
5) steep type: 60° < EA < 90°
6) right type: 90° < EA < 120°
7) right over-rotation: EA > 120° (pathological!!!)
Left over-rotation indicates a left anterior hemiblock
Right type and right over-rotation can be a sign of left posterior hemiblock

EXPERIMENT
One volunteer has to serve as test-person for the experiment (and gets a free ECG diagnosis).
We record limb leads only!

On the print-out, calculate:

1) the heart rate (HR) in beats-per-minute (bpm); the recording velocity is 25mm/s
2) the heart vector (electrical axis, EA), according to eqns (3) and (5); indicate the vector on
the EA diagram (see figure below).

ECG Ruler

An ECG ruler is useful for analysis.

If you want, you can make a printout at the original size of this document and copy it to a
transparency. Check whether the scale on the ruler is exactly 20 cm. Usage of the ruler
will be demonstrated.
EA DIAGRAM

References used for this lab unit

[1] Houghton AR, Gray D (2003) Making sense of the ECG, a hands-on guide. 2nd ed.,
Arnold, London. [this is the best clinical ECG book available]
[2] Schmidt RF, Thews G (1989) Human Physiology. 2nd ed., Springer, NY.
[3] P Kühn (1982) EKG Fortbildung. Boehringer-Mannheim, Vienna.
[4] P Kühn (1982) Herzrhythmusstörungen. Boehringer-Mannheim, Vienna.
[5] Novosel D, Noll G, Lüscher TF (1999) Corrected formula for the calculation of the
electrical heart axis. CMJ online:40/1. Available:
http://www.cmj.hr/1999/4001/400113.htm.
[6] Silbernagel S, Despopoulos A (1991) Pocket Atlas of Physiology, 4th ed., Thieme, NY. [-]
other references indicated directly in the text

ASSIGNMENT:
1) Data sheet
a) Spirometry printout + lung volumes calculated
b) ECG printout + HR + Vector

2) Lab Report: report on the purpose and clinical application of ECG and spirometry