Final - Manuscript - Portable Heart Attack Alert System (PHAAS) - An Objective-Based Approach in Detecting ST-elevated Myocardial Infarction (S

Ateneo de Zamboanga University
Portable Heart Attack Alert System (PHAAS):
An Objective-Based Approach in Detecting ST-elevated Myocardial
Infarction (STEMI) for Patients with Ischemic Heart Disease
A Senior Design Project
Presented to the Faculty of the Engineering Department
College of Science and Information Technology
ATENEO DE ZAMBOANGA UNIVERSITY
by
Camba, James Michael M.
Ramiso, Allysa Marie R.
BS Biomedical Engineering IV
Niño Christon Y. Lazarte, ECE, ECT
Adviser
May 2, 2023
APPROVAL SHEET
This thesis hereto entitled:
Portable Heart Attack Alert System (PHAAS): An Objective-Based Approach in

Detecting ST-elevated Myocardial Infarction (STEMI) for Patients with Ischemic
Heart Disease
Prepared and submitted by JAMES MICHAEL M. CAMBA and ALLYSA MARIE R.

RAMISO in partial fulfillment of the requirements for the degree of Bachelor of Science
in Biomedical Engineering has been examined and is recommended for acceptance
and approval for ORAL EXAMINATION.
NIÑO CHRISTON Y. LAZARTE, ECE, ECT

Adviser
Approved by the Committee on Oral Examination with a grade of PASSED on May 2,

2023.
LOUIE VIRGIL A. GALLARDO, ME-ECE

Panel Chair
ZAEEFA A. PANDANGAN, ECE, ECT BIANCA DANIELLE C. ORAA

Member Member
Accepted in partial fulfillment of the requirements for the degree of Bachelor of

Science in Biomedical Engineering.
LOUIE VIRGIL A. GALLARDO, ME-ECE

Chair
Engineering Department
JOCELYN D. PARTOSA, Ph.D.

Dean
College of Science, Information Technology and Engineering
ABSTRACT
Ischemic Heart Disease (IHD) is a cardiovascular disorder characterized by the
accumulation of plaque, commonly known as atherosclerosis. According to Philippine
Statistics Authority (2022) and Khan et al. (2020), IHD is a significant contributor to
mortality rates globally and locally. Individuals diagnosed with IHD are at an increased
risk of experiencing heart attacks, as well as associated complications, such as
cardiac failure, arrest, and death.
The detection of heart attacks primarily relies on identifying symptoms, which
can be subjective and may lead to delayed diagnosis. Hospital equipment and tests,
such as chest X-rays, ECG, and blood tests, can also aid in detection, but accessibility
is limited outside of medical facilities. Additionally, some heart attacks occur silently,
with no symptoms, making them unpredictable. Given the potential for significant
cardiac damage and mortality, timely diagnosis, and rapid response are crucial.
Therefore, early detection and intervention are critical in managing heart attacks,
emphasizing the importance of prompt action to mitigate potentially fatal
consequences.
With these in mind, the PHAAS (Portable Heart Attack Alert System) was
designed and developed as a real-time, portable device capable of detecting heart
attacks, particularly STEMI, using electrocardiography (ECG) and machine learning.
The device consists of six modules, including an acquisition and signal processing
unit, a data analysis module, a storage unit, an alert system module, a display system,
and a battery module. Mainly, it functions by using the elevation of the ST segment in
the ECG signal to detect heart attacks, and machine learning algorithms were trained
to enable automatic detection. The alert system, on the other hand, automatically
contacts the user and clinician upon detection, enabling prompt medical intervention
and improving outcomes.
Results from testing of the PHAAS device demonstrate its effectiveness in
detecting STEMI heart attacks. Machine learning algorithms used in both system and
beta testing showed a relatively high accuracy of 87% and 83%, respectively, under
acceptable conditions. When the device's modules were integrated and tested as a
whole, the PHAAS system demonstrated reliability and functionality, achieving a
success rate of 95% in normal and STEMI classification. However, certain factors
such as motion artifacts, limited sensor sensitivity, and data mismatch were found to
affect model performance. Further improvement of developed filters can address
these issues.
Additionally, the alert system of the PHAAS device functioned accordingly
during testing, initiating alerts only when STEMI ECG was detected. The SMS and
call alerts were directed to the assigned contacts upon detection of a heart attack.
However, network connection and sim registration to promos may affect the device's
ability to initiate alerts, and these factors should be considered when using the device
in practical settings.
Lastly, results from the post-survey conducted during the beta testing phase of
the PHAAS device indicate that participants strongly agree with the device's portability
and comfortability. This suggests that the device is well-designed for ease of use and
can potentially be integrated into everyday life.

In summary, a portable heart attack alert system for the automatic real-time
detection of STEMI heart attacks was successfully implemented. With further
improvements, the PHAAS device represents a promising development in the field of
medical devices for heart attack detection and intervention.

ACKNOWLEDGEMENTS
The success of this thesis would not have been possible without the support,
guidance, insights, and encouragement of others. We would like to take this
opportunity to express our deepest gratitude toward those who contributed to making
this accomplishment a reality. Their invaluable contributions have been instrumental
in shaping the direction and development of this thesis.
First and foremost, we would like to thank our thesis advisor, Niño Christon Y.
Lazarte, who provided us with constant assistance and direction in creating our
proposed device and writing this paper. This paper would not have been completed
without his aid and committed involvement at every stage of the process.
To Mr. Roel Rojas and the Zamboanga City Medical Center Biomedical
Unit, especially our BME seniors, we are grateful for the patience, understanding,
support, and motivation you continue to provide us. It has helped us tremendously in
pushing through despite the challenges we have encountered.
We would also like to express our gratitude to the volunteers of our beta testing,
and respected cardiologists, Dr. Amelyn S. Ulanghutan from Zamboanga Doctor’s
Hospital and Dr. Nurhaya A.Hadjail-Ismael from HRT Medical & Maternity Complex,
who took time off their day to help us further establish our paper. Without your
willingness to participate, especially with our doctors who gracefully provided us with
their expertise, we would not have been able to proceed in successfully completing
this paper.
We would also like to extend our deepest appreciation to our families, most
especially our parents, for their financial and emotional support. A special thanks goes
to our siblings who have assisted and adjusted to us in many ways.
To our friends and fellow BME peers of this batch, we are deeply thankful for
the encouragement, support, struggle, cheers, and tears that we shared with one
another. Working and communicating with all of you has been uplifting. Everybody’s
success and grit to push through, despite the struggles, gave us the motivation to
continue and eventually, allowed us to reach success.
Most importantly, to God Almighty, whom we have confided in during moments
of doubt and demotivation. We thank you for your presence and spiritual guidance.
We also thank you for the strength and wisdom you have bestowed upon us, enabling
us to persevere and overcome the challenges we faced throughout this journey.

TABLE OF CONTENTS
CHAPTER I ............................................................................................ 1
1.1 Background of the Study ......................................................................................... 1
1.2 Problem Statement .................................................................................................. 5
1.3 Conceptual Design ................................................................................................ 12
1.4 Objectives .............................................................................................................. 15
1.5 Scope and Delimitations ........................................................................................ 16
1.6 Significance of the Study ....................................................................................... 18
CHAPTER II ......................................................................................... 21
2.1 Current Preventive Methods for Myocardial Infarction ......................................... 21
2.2 Current Diagnostic Tests for Myocardial Infarction .............................................. 33
2.3 ECG Signal Acquisition Methods .......................................................................... 38
2.4 ECG Pre-processing Methods .............................................................................. 40
2.5 Machine Learning for Detection of Heart Attack ................................................... 42
2.6 Existing Real-Time Heart Attack Detection Device .............................................. 43
2.7 Existing Studies with Similar Approach ................................................................ 44
CHAPTER III ........................................................................................ 58

3.1 Requirements......................................................................................................... 58
3.1.1 Theoretical Considerations ............................................................................. 58
3.1.2 Hardware Requirements ................................................................................. 72
3.1.3 Software Requirements .................................................................................. 80
3.2 Functional Design .................................................................................................. 81
3.2.1 Functional Analysis of Hardware Component ................................................ 82
3.2.2 Functional Analysis of Software Components ............................................... 89
3.3 Testing and Validation ......................................................................................... 102
3.3.1 Functional Testing ......................................................................................... 102
3.3.2 System Testing.............................................................................................. 110
3.3.3 Beta Testing .................................................................................................. 116
CHAPTER IV ..................................................................................... 119

4.1 Hardware Design ................................................................................................. 120
4.2 Software Design .................................................................................................. 125
4.3 Set-up, Mounting, Casing .................................................................................... 162
CHAPTER V ...................................................................................... 166

5.1 Functional Testing ............................................................................................... 166
5.2 System Testing .................................................................................................... 185
5.3 Beta Testing ......................................................................................................... 194
CHAPTER VI ..................................................................................... 199
CHAPTER VII .................................................................................... 202
BIBLIOGRAPHY ................................................................................ 205
APPENDICES .................................................................................... 222

APPENDIX A .......................................................................................................... 222
APPENDIX B .......................................................................................................... 223
APPENDIX C .......................................................................................................... 224
APPENDIX D .......................................................................................................... 225
APPENDIX E .......................................................................................................... 226
APPENDIX F .......................................................................................................... 228
APPENDIX G .......................................................................................................... 230
APPENDIX H .......................................................................................................... 231
APPENDIX I............................................................................................................ 232
APPENDIX J ........................................................................................................... 233
APPENDIX K .......................................................................................................... 234
APPENDIX L........................................................................................................... 236
APPENDIX M ......................................................................................................... 237
APPENDIX N .......................................................................................................... 238
APPENDIX O .......................................................................................................... 239
APPENDIX P .......................................................................................................... 240

APPENDIX Q .......................................................................................................... 242
APPENDIX R .......................................................................................................... 243
APPENDIX S .......................................................................................................... 246
LIST OF FIGURES
Figure 1-1. Conceptual Design of Portable Heart Attack Alert System ..................... 13
Figure 3-1. Components of Normal ECG Reading (Biopac Systems, Inc., n.d.)....... 59
Figure 3-2. Comparison of ST segment variations (Chowdhury et al., 2019) ........... 59
Figure 3-3. Possible Hyperplanes in classifying data (Gandhi, 2018) ....................... 61
Figure 3-4. Optimal Hyperplane and Maximum Margin in SVM (Gandhi, 2018) ....... 61
Figure 3-5. Linearly separable data (MLMath.io, 2019) ............................................. 62
Figure 3-6. Non-linearly separable data (MLMath.io, 2019) ...................................... 62
Figure 3-7. Application of Kernel for non-linear classification (Sharma, 2019) ......... 63
Figure 3-8. Frequency Response of a Bandpass Filter (Electronics Tutorial, n.d.) .. 64
Figure 3-9. Sample of Simple Moving Average filter application (Salain, 2022) ....... 66
Figure 3-10. Variation of Power Spectral Density of normal, ST-elevation, and T-
wave inversion ECG traces (Chowdhury et al., 2019)................................................ 68
Figure 3-11. Wavelets with small and long scale factors (MathWorks, n.d.) ............. 71
Figure 3-12. Sparkfun Analog ECG Sensor Module Kit (Alibaba, n.d.) ..................... 73
Figure 3-13. iCare Disposable ECG Electrodes (iCare, n.d.) .................................... 73
Figure 3-14. Adafruit ADS1015 12-bit ADC (Makerlab Electronics, n.d.) .................. 74
Figure 3-15. Raspberry Pi 4 Model B (Raspberry Pi, n.d.)......................................... 75
Figure 3-16. 128 GB SanDisk Ultra Micro SD Card (Amazon, n.d.) .......................... 75
Figure 3-17. SIM800L V2 5V Wireless GSM GPRS Module (Maker-lab electronics,
n.d.) .............................................................................................................................. 76
Figure 3-18. 16x2 LCD Display (Maker-lab electronics, n.d.) .................................... 77
Figure 3-19. Digital Multimeter (Fluke, 2021) ............................................................. 78
Figure 3-20. Fluke Prosim8 Vital Signs Simulator (Fluke, n.d.) ................................. 79
Figure 3-21. ACER Predator Helios 300 Gaming Laptop (Carousel, n.d.) ................ 79
Figure 3-22. Block Diagram of PHAAS ....................................................................... 82
Figure 3-23. Preliminary Design of Portable Heart Attack Alert System ................... 83
Figure 3-24. Approximate Dimensions of Portable Heart Attack Alert System ......... 83
Figure 3-25. Chest Lead II Configuration (Sampson, 2018) ...................................... 84
Figure 3-26. Main flowchart of PHAAS ....................................................................... 89
Figure 3-27. Flow diagram of Acquisition and Signal Processing Unit ...................... 90
Figure 3-28. Flow Diagram of Data Analysis Module ................................................. 92
Figure 3-29. Flow Diagram of Training Machine Learning Process........................... 92
Figure 3-30. Flow Diagram of Alert System Module ................................................. 100
Figure 3-31. Flow Diagram of Storage Module ......................................................... 101
Figure 3-32. Flow diagram of Display System .......................................................... 101
Figure 4-1 Block Diagram of the Experimental Setup of the Proposed Device ....... 119
Figure 4-2. Complete Schematic Diagram of the Proposed Solution ...................... 121
Figure 4-3. Schematic diagram of Acquisition and Signal Processing Unit ............. 121
Figure 4-4. Schematic Diagram of the Storage Module ........................................... 123
Figure 4-5. Schematic Diagram of Alert System Module ......................................... 123
Figure 4-6. Schematic Diagram of Display Module .................................................. 124
Figure 4-7. ECG Plots of Different Window Sizes .................................................... 131
Figure 4-8. Frequency Response of Moving Average Filter with Window Size 7 ... 132
Figure 4-9. Frequency Response of Moving Average Filter with Window Size 11 . 132
Figure 4-10. Frequency Response of Moving Average Filter with Window Size 15 133
Figure 4-11. Application of Moving Average and Median Filters ............................. 136
Figure 4-12. Snippet of Manual Collection of Sample Ranges of Relevant Data ... 147
Figure 4-13. Actual Experimental Design of Prototype ............................................ 162
Figure 4-14. 3D Computer Aided Design of Prototype ............................................. 163
Figure 4-15. Interior of the Experimental Design of Prototype ................................. 163
Figure 4-16. Dimensions of Modules in the Interior of Enclosure ............................ 164
Figure 4-17. Prototype Connected to a User ............................................................ 164
Figure 4-18. Prototype Strapped on a User .............................................................. 165
Figure 5-1. Functional Test Trial 8 of ECG Acquisition ............................................ 167
Figure 5-2. Normal ECG with 100% Artifact Size Test Result ................................. 171
Figure 5-3. Frequency Spectrum of Normal ECG simulation and Filter Results ..... 172
Figure 5-4. Functional Test Trial 9 of Storage Unit .................................................. 180
Figure 5-5. Functional Test Trial 1-10 of Storage Unit ............................................. 182
Figure 5-6. Functional Test Trial of Storage Unit...................................................... 184
Figure 5-7. Functional Test Trial of Storage Unit...................................................... 185
Figure 5-8. System Testing, Case 1, Phase III, Trial 1............................................. 190
Figure 5-9. System Testing, Case 2, Phase III, Trial 4............................................. 192
LIST OF TABLES
Table 2-1. Comparison of Existing Studies ................................................................. 49
Table 2-2. Comparison of Features of Existing Studies, HeartBeam, and PHAAS .. 55
Table 3-1. Summary of functional testing ................................................................. 108
Table 3-2. Case 1 for System Testing ...................................................................... 113
Table 3-3. Case 2 for System Testing ...................................................................... 115
Table 3-4. Summary of Beta Testing ........................................................................ 118
Table 5-1. Acquisition Module Test Result Summary .............................................. 168
Table 5-2. Signal Processing Unit Test Result Summary ........................................ 170
Table 5-3. Confusion Matrix using Training Data ..................................................... 174
Table 5-4. Confusion Matrix using Testing Data ...................................................... 174
Table 5-5. Data Analysis Module Test Result Summary .......................................... 175
Table 5-6. Supporting Metric Results ........................................................................ 176
Table 5-7. Storage Module Test Result Summary ................................................... 179
Table 5-8. Alert System Module Test Result Summary ........................................... 180
Table 5-.9 Display System Test Result Summary .................................................... 183
Table 5-10. Battery Module Test Result Summary .................................................. 185
Table 5-11.ST-elevation Threshold Test Summary Result ...................................... 187
Table 5-12. Artifact Size Test Summary Result ........................................................ 188
Table 5-13. System Testing Case 1 Summary Result ............................................. 189
Table 5-14. System Testing Case 2 Summary Result ............................................. 191
Table 5-15. Model Performance Using System Testing Data .................................. 193
Table 5-16. Likert-Scale Result ................................................................................. 194
Table 5-17. Interpretation of Mean Score ................................................................. 195
Table 5-18. Model Performance Using Beta Testing Data....................................... 196
LIST OF LISTINGS
Listing 4-1. Set ADC Sampling Rate and Gain ......................................................... 126
Listing 4-2. Acquisition of 2500 samples................................................................... 126
Listing 4-3. Bandpass Filter Design using HeartPy .................................................. 128
Listing 4-4. Moving Average Filter Design using Pandas Library ............................ 129
Listing 4-5. Median Filter Design using Scipy Module.............................................. 135
Listing 4-6. Power Spectral Density Extraction using Scipy ..................................... 137
Listing 4-7. Continuous Wavelet Transform Extraction using pywt.......................... 138
Listing 4-8. Acquiring Synthetic Features using gplearn .......................................... 139
Listing 4-9. Accessing Annotations ........................................................................... 143
Listing 4-10. Accessing ECG records ....................................................................... 146
Listing 4-11. Collecting relevant data using sample ranges acquired ..................... 147
Listing 4-12. Overview of Pre-processing Data ........................................................ 150
Listing 4-13. Splitting data into a 70:30 ratio............................................................. 152
Listing 4-14. Finding Optimal Hyperparameter ......................................................... 153
Listing 4-15. Saving Scaling Model ........................................................................... 154
Listing 4-16. RFECV Feature Selection .................................................................... 155
Listing 4-17. Saving Model with a Minimum of 70% K-fold accuracy ...................... 156
Listing 4-18. Code for Predicting Class..................................................................... 157
Listing 4-19. Calculation of Evaluation Metrics ......................................................... 157
Listing 4-20. Function for saving data as CSV files .................................................. 159
Listing 4-21. Alert System Module ............................................................................ 160
Listing 4-22. Display System Code ........................................................................... 161
CHAPTER I
INTRODUCTION
1.1 Background of the Study
Ischemic heart disease (IHD), also known as coronary artery disease, is a
condition that develops due to the narrowing of the heart arteries (American Heart
Association, 2016). This type of disease is due to the development of atherosclerosis,
which is the build-up of plaque (such as fats and cholesterol) within the artery walls
(Institute of Medicine, 2010). Patients with this disease are at high risk of a heart
attack.
According to the Philippine Statistics Authority (2022), IHD is one of the leading
causes of death in the Philippines. From January to May 2022, there were around
38,707 cases recorded, accounting for 18.6 percent of the total deaths in the country.
Similarly, Philippine Statistics Authority (2021) also reported a total of 56.76 thousand
cases in the first half of 2021, representing 18.7 percent of all deaths in the country.
Both are relatively higher than the recorded data from 2020, which shows 48.34
thousand cases or 16.7 percent of total deaths.
This problem also extends globally. According to Khan et al. (2020), IHD is
internationally the leading cause of death, disability, and human suffering. In 2017,
their study estimated that IHD affected around 126 million individuals worldwide,
approximately 1.72% of the world population. Among those affected, 9 million is the
estimated record of deaths globally. Moreover, they stated that the global prevalence
of IHD is increasing. There is an expectation that by 2030, the estimated prevalence
rate of 1,655 cases per 100,000 will exceed 1,845.
1
As mentioned, patients diagnosed with IHD are at high risk of a heart attack.
According to the NHS (2019), IHD is the leading cause of its development. In the
United States, a heart attack occurs every 40 seconds, with an estimated yearly
occurrence of around 805,000 cases — 605,000 being first heart attacks and the
remaining 200,000 being recurrent (Centers for Disease and Control Prevention,
2022).
A heart attack, medically known as myocardial infarction, occurs when the heart
does not receive enough blood due to a partial or complete blockage of the arteries
(Mayo Clinic, 2021). It can cause significant damage to the heart muscles, resulting in
undesirable complications. Examples include arrhythmias, cardiogenic shock, heart
failure, pericarditis, cardiac arrest, and death (Mayo Clinic, 2022).
Numerous health advocates urge the prevention of heart attacks in light of their
severity and multiple complications. According to the American College of Cardiology
(2019), the 2019 Primary Prevention of Cardiovascular Disease guidelines from the
American College of Cardiology and the American Heart Association states that the
key recommendations for prevention include the use of risk assessments, the
incorporation of healthy lifestyle changes, and the use of medications (see sections
2.1.1 to 2.1.3). Also, spreading public awareness is encouraged (see section 2.1.4),
especially regarding the known symptoms of heart attack, as it is the primary approach
for early detection. The common symptoms are aches and heaviness in the chest,
pain that spreads to the arms, neck, jaw, or back, heaviness in the chest, nausea,
shortness of breath, and lightheadedness (Mayo Clinic, 2021).
2
Unfortunately, heart attacks may also occur with no pain or symptoms, known as
silent ischemia (American Heart Association, 2015). This type of heart attack is only
identifiable via diagnostic tests (Mayo Clinic, 2022). These diagnostic tests extend
from blood tests to chest X-rays, echocardiograms, coronary angiography, and
electrocardiogram (Mayo Clinic, 2022).
Blood testing is a method that measures a specific cardiac biomarker, namely
troponin from a given blood sample (see section 2.2.1). The presence of troponin
within the blood is indicative of a heart attack as it is released by the body when
cardiac damage has occurred.
Chest X-ray, on the other hand, is an imaging procedure where organs within the
chest are scanned to produce an image with the use of an X-ray (see section 2.2.2).
This procedure is used for ruling out other possible causes of conditions that may
present similar symptoms of a heart attack such as a pocket of air trapped between
the layers of the lungs (pneumothorax).
Another imaging technique used is called an echocardiogram (see section 2.2.3).
In this procedure, sound waves are used as its modality for generating images of the
heart. This procedure can help identify areas of the heart that have already been
damaged and their corresponding effects on heart function.
Meanwhile, coronary angiography is a minimally invasive procedure (see section
2.2.4). It involves inserting a thin tube (catheter), into one of the blood vessels in the
groin or arm. A special fluid, called a contrast agent, is then pumped into the catheter
which is a form of material that is highly visible when viewed through an x-ray. With
3
this, the vision of the flow of the fluid along the blood vessel or arteries allows the
identification of specific sites of blockage and narrowing.
Lastly, an electrocardiogram (ECG) is the measurement of the electrical activity of
the heart which is shown as a signal (see section 2.2.5). Any abnormalities that occur
within the heart reflect upon its electrical activity or ECG. With this, confirmation of an
ongoing heart attack can be provided.
ECG also extends to ambulatory applications; the specific device used for this is
called a Holter monitor (Mayo Clinic, n.d.). This mainly functions as a recording device
that stores the ECG reading continuously from a patient extending from 24 to 48 hours
of use. Another similar ambulatory device is the cardiac event monitor. It works
similarly to the Holter device but is used for longer periods of time (Cleveland Clinic,
2022). Both the Holter and event monitors are mainly used for the detection and
monitoring of arrhythmias.
Overall, IHD remains a common problem up to this day, and heart attack is an
unavoidable risk. Health advocates encourage risk assessment, incorporating healthy
lifestyle changes, and using medication as the most common and only available
preventive measures against it. Furthermore, diagnostic tests for heart attacks can
only be accomplished while inside the hospital. Not to mention, heart attack detection
mainly uses known symptoms as indicators, which can be limited in cases such as
silent ischemia.
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1.2 Problem Statement
Considering the concerns stated in Section 1.1, the proponents recognize a
gap among the objective-based approaches in detecting heart attacks; First, none of
the mentioned methods offer portable real-time detection of heart attacks that can
extend services outside the vicinity of the hospital. Providing a real-time detection
approach that can be carried out during everyday activities is relatively important since
heart attacks can occur anywhere and anytime. Second, real-time detection can serve
as a pre-diagnostic tool resulting in lessened diagnostic time. This provides an
opportunity for early diagnosis and treatment which in turn, decreases the chances of
death and complications presented by heart attack to the victim. Third, real-time
detection addresses the dependence on symptoms for heart attack detection by using
objective-based parameters such as ECG. With this, subjectivity won't be a factor in
making assumptions about heart attack occurrences. Lastly, real-time detection can
help in reducing the response time in addressing heart attack victims. This can help
decrease the chances of further damaging the heart and increase the chances of
survival. The statements provided are further supported by the component problems
presented below.
1.2.1 Reliability on observation of symptoms in heart attack
A heart attack is assumed when a person showcases known symptoms
such as chest pain, pain that spreads to the arms, neck, jaw, or back, heaviness
in the chest, nausea, shortness of breath, and lightheadedness (Mayo Clinic,
2021). Among the symptoms provided, chest pain is considered the hallmark
5
of an impending heart attack (Aref, 2022). In line with this, seeking medical
attention is highly recommended for any suspicion of experiencing a heart
attack. However, according to the study by Mol et al. (2018), most patients who
displayed suspicion of having a heart attack were ruled out as non-cardiac
related. They have noted that of the 1,239 patients, around 60% referred to
emergency rooms for chest discomfort were released with non-cardiac chest
pain (NCCP). They have also stated that NCCP patients consume considerable
medical resources, which, in accordance, emphasizes the need for a good
prognosis to minimize unnecessary hospitalizations.
On the other hand, SCAI (2015) states that conditions that mimic heart
attacks exist. Examples include broken heart syndrome and musculoskeletal
pain. Broken heart syndrome induced chest pain due to a burst of stress
hormones because of severe emotional and physical trauma. Meanwhile,
musculoskeletal aches can exhibit chest pain due to a simple pulled chest
muscle. Accordingly, some psychological disorders may also cause similar
symptoms to heart attacks, such as panic disorders, anxiety, depression, and
emotional stress. Other examples of conditions also include angina,
esophageal spasm and pulmonary embolism.
Cases of misdiagnoses are also common — this is especially frequent
among women. According to Feinglass and Sun (2021), in the first year after a
heart attack, women in the United States have lower survival chances than
men. Within five years, there is an expectation that 47% of women either die,
develop heart failure, or suffer from a stroke. They claim that for women under
6
55, doctors are more inclined to discount heart attack symptoms as unrelated
to the heart. In support of this, the study conducted by Maserejian et al. (2009)
states that the diagnosis of conditions in middle-aged female patients results in
the least amount of confidence. Their results suggest that most younger women
with coronary heart disease symptoms are taken as gastrointestinal and mental
health conditions — misdiagnosis, such as this, can potentially lead to delayed
treatments. Furthermore, according to the study conducted by the Ross et al.
(2016), among the analyzed 1,180 claims against their internal medicine
physicians that closed from 2007–2014, 39% account for incorrect, delayed,
and failure in diagnosis — the most allegations, accounting for 6%, were related
to myocardial infarction incidents.
Moreover, heart attacks can occur with no symptoms, known as silent
ischemia (American Heart Association, 2015). This type of heart attack
provides cardiac damage, as a non-silent heart attack does, but with little to no
awareness on the victim's part. According to Mayo Clinic (2022), silent heart
attacks are only identifiable with diagnostic exams such as echocardiograms
and ECG. Gul and Makaryus (2019) state that the absence of pain in this
condition increases the risk of death and morbidity, given that patients do not
seek treatment on time. They have also emphasized the need for a
comprehensive diagnosis and treatment of patients with silent myocardial
infarction because they have a higher risk of developing new coronary events
than those without silent ischemia. One of the examples of coronary events
associated with silent myocardial infarction is sudden cardiac death. According
7
to Vähätalo et al. (2019), among the 5869 individuals who experienced sudden
cardiac death, the majority, around 42.4%, have experienced silent myocardial
infarction.
1.2.2 Unpredictability of heart attack
Atherosclerosis develops two types of plaque: a stable plaque and an
unstable plaque (Heart Research Institute, n.d.). From the name itself, stable
plaque stably builds over time, while unstable plaque builds over time but with
a degree of instability. Unstable plaque is considered the most dangerous and
challenging to address among the two.
Unstable plaques, also referred to as vulnerable plaques, are frequently
identified by their thin, inflamed, fibrous cap covering a huge lipid core
(Fishbein, 2010). Plaques of this type are considered dangerous because they
are prone to rupture and can happen suddenly. Upon rupture, it can lead to
thrombosis or blood clotting, leading to complete blockages of blood flow and
the occurrence of a heart attack or stroke. According to the Cardiosound (n.d.),
less than 20 percent of heart attacks are caused by severe obstruction of
plaque, 86 percent are due to vulnerable plaques that moments ago were
harmless but all of a sudden cause complete blockage upon rupture. That
means 86% of heart attack victims can pass their stress test the day before the
incident of a myocardial infarction occurs.
According to Hafiane (2019), approximately 70% of all cardiovascular
events are due to plaque developments, and the current clinical approach does
not provide accurate predictions of those prone to acute ischemic events. In

8
support of this, the study conducted by Fishbein (2010), using angiographic
data, has shown that the sites at which vulnerable plaques have ruptured
exhibited less drastic or substantial narrowing. However, upon further review,
it was found that more than 50% of the plaques considered had greater than
75% cross-sectional area stenosis. It is one of the main contributing factors to
why vulnerable plaques are unpredictable.
1.2.3 Cruciality of early diagnosis
As mentioned in section 1.2.1, heart attack detection is made via
observations of common symptoms such as chest pain. According to Xu (n.d.),
these kinds of symptoms showcase when significant narrowing (>70%) of the
arteries takes place. A heart attack, on the other hand, occurs when 100%
narrowing of the artery has been acquired (Ahmed, 2014). In line with the
blockage, little to no oxygen-rich blood is supplied to the heart, which, when left
untreated, can progress to cardiac damage, and certain complications may
occur (American Heart Association, 2016). Arrhythmia, heart failure,
cardiogenic shock, and heart rupture are some of the complications post-heart-
attack presents in which the majority require extensive treatment (NHS, 2019).
Heart attacks are also considerably costly, not just in terms of health but
also financially and mentally. According to Pierce (2021) from the Preventive
Diagnostic Center, aside from the hospital stay, other treatments involve the
use of medications, rehabilitation, physical and occupational therapy, nutrition
counseling, and regular bloodwork and monitoring, which can extend for
months or years. In terms of mental health, patients who experience heart

9
attacks are prone to depression. According to Williams (2011), in the general
population, depression is three times more common in heart attack victims
accounting for around 15-20% qualifying for a diagnosis of major depressive
disorder. Additionally, the emotional distress and suffering caused by a heart
attack may not only cause depression but can also lead to an increased risk of
another possible occurrence of heart attack over the next few months or years.
Aside from depression, Hashim et al. (2022) also stated that victims who
experienced myocardial infarction also have a relatively high association with
developing high anxiety levels.
In line with this, the emphasis on early diagnosis is crucial. According to
Vogel et al. (2019) and Gong et al. (2020), early diagnosis of heart attack is an
essential factor, given that it is crucial in improving outcomes, such as limiting
post-STEMI complications and early provision of medical care.
1.2.4 Cruciality of fast response time
In addressing heart attacks, especially in cases of sudden occurrence,
response time is a crucial factor needed to be taken into account. According to
Genesis Heart Institute (n.d.), the more time wasted, the more damage is
presented to the heart, and the more fatal it becomes — "During a heart attack,
lost time means lost heart muscle."
With this, the 2013 ACCF/AHA Guideline for the Management of ST-
Elevation Myocardial Infarction provided an ideal timeframe for addressing
heart attacks called the door-to-balloon time (O'Gara et al., 2013). The door-to-
balloon time is the time between the arrival of a patient with STEMI in the
10
emergency room and the application of recommended reperfusion therapy
called percutaneous coronary intervention, ideally within 90 minutes (Butt et al.,
2020). Reperfusion therapy is any form of procedure used to restore blood flow
through a suspected or known coronary artery that is blocked; procedure
includes intravenous thrombolysis, primary angioplasty, intracoronary
thrombolysis, or immediate coronary artery bypass grafting surgery.
Moreover, according to Menees et al. (2013), patients with a door-to-
balloon time of 90 minutes or less had a lower unadjusted mortality rate than
those with longer wait times. Additionally, Alizadeh et al. (2020) state that
adding early diagnosis and telecardiology, which is a modern medical practice
that uses telecommunications for remote diagnosis and treatment of heart
disease, can significantly reduce door-to-balloon time in STEMI patients. They
have also concluded that it can influence short-term and long-term mortality
rates.
On the other hand, according to Khowaja et al. (2021), total ischemic
time holds much more significance than door-to-balloon time. Total ischemic
time is represented by the time from the onset of the heart attack until treatment,
such as reperfusion. According to Denktas (2011), there is a strong correlation
between infarct size and mortality concerning total ischemic time and much less
with door-to-balloon time.
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1.3 Conceptual Design
The current methods of heart attack detection primarily use symptoms as an
indicator of a heart attack. While diagnostic methods can also detect heart attacks,
they are only accessible upon hospital visitations. In both cases, silent ischemia is not
accounted for, and there are no methods that offer portable real-time heart attack
detection. With this, it can be said that there is a need for objective-based devices for
real-time heart attack detection that is portable. Hence, the proponents suggest the
development of a Portable Heart Attack Alert System (PHAAS).
Mainly, this suggested device will be designed to be a portable and wearable
device wherein users can carry it along with their day-to-day activities. A machine-
learning algorithm will be incorporated into the device which will provide the capability
to automatically detect heart attack occurrences, specifically STEMI. This feature
ensures the early preliminary diagnosis of heart attack and will be supported by the
intermittent monitoring of clinicians who will access, review, and confirm diagnosis
upon hospital visitation. Furthermore, considering the cases of unpredictable and
silent heart attacks, detection will be done in real-time. Additionally, to further ensure
the reliability of detection, an objective-based method, particularly with the use of
ECG, will serve as the basis for heart attack detection. The suggested PHAAS device
will also be incorporated with an alert system to allow fast response time in addressing
heart attack detected. Moreover, this can ensure the opportunity of providing early
diagnosis and treatment when needed.
Overall, this device will be composed of six modules: the acquisition and signal
processing unit, a data analysis module, a storage unit, a display system, an alert
12
system module, and lastly, a power source. The conceptual design of the suggested
design is provided in Figure 1-1.
Figure 1-1. Conceptual Design of Portable Heart Attack Alert System
The acquisition and signal processing unit will be responsible for the acquisition
and pre-processing of the acquired ECG data. In acquiring the ECG, three electrodes
following the chest lead II placement will be used. This setup provides the view of the
ECG reading within the angle of lead II, which observes the heart from an angle of 60
degrees (ACLS, n.d.). With this, STEMI is detectable when the ST-elevation is
displayed from the ECG. Additionally, an analog-to-digital converter will be used for
the conversion of analog ECG data into digital. Upon collection, 2500 samples are
expected per acquisition.
13
On the other hand, the pre-processing techniques involve the use of digital
filters and feature extraction methods. For digital filters, a bandpass filter will be
applied to ensure that the frequency ranges involved in the signal is within frequency
range. In terms of random noises, a moving average filter will be used. And lastly, a
median filter will be provided for removing the baseline wander. Regarding feature
extraction, continuous wavelet transforms, power spectral density, and synthetic
features will be used.
Concerning the data analysis module, a simple binary classification machine
learning algorithm will be designed. The chosen model to be used is the support vector
machine which will be trained for classifying STEMI and normal ECG.
In terms of the storage unit, it will be responsible for storing ECG data which
are namely the raw and filtered data, features, and the predicted ECG class. These
data are stored locally within the device and will be used by clinicians to further review
and diagnose the involved user. This can be done by manually accessing the local
storage upon hospital visits which is advised to be done weekly. Furthermore, future
technicians, and currently, the proponents can utilize the records for the evaluation of
the pre-processing techniques. The data can also be used to further training and
enhancement of the machine learning algorithm.
The display module, on the other hand, mainly serves to provide the ECG
status for user awareness via text display. There will only be two ECG statuses that
can be presented, which will be displayed depending on the result of the data analysis
module. If the data analysis module detects STEMI within the ECG, “STEMI detected”
will be provided. Meanwhile, if there is no detection of STEMI, “Normal” will be shown
14
on the screen. The main purpose of this module is to provide user awareness,
especially for possible cases of silent myocardial infarction.
Moving on to the alert system module, it will be responsible for sending
automated notifications regarding the ECG status of the us er. This will be done
particularly when heart attacks, specifically STEMI has been detected.
Communication means will be via SMS and voice calls wherein contacts include the
user and clinicians. In line with the notification, the clinician is expected to
communicate with the user and provide advice regarding what to do with their
situation. In terms of sending notifications to the user, this serves as a second layer in
ensuring user awareness is provided.
Lastly, the battery module serves as the power source of the PHAAS. This will
mainly provide power to secure functionality for each of the modules involved. Utilizing
a battery, specifically a power bank, allows the device to be portable.
1.4 Objectives
In this section, the general and specific objectives of the study are provided.
1.4.1 General Objective
This study aims to develop a Portable Heart Attack Alert System
(PHAAS); a real-time, pre-diagnostic heart attack (STEMI) detection device for
patients with ischemic heart disease.
1.4.2 Specific Objectives
More specifically, this study aims to:
15
1.4.2.1 Acquire real-time ECG equivalent of 2500 samples from the
user using three disposable electrodes following Chest Lead II
Placement with a sampling rate of 250Hz.
1.4.2.2 Pre-process ECG signal acquired through application of digital
filters and extraction of features.
1.4.2.2.1 Design bandpass filter, moving average filter, and
median filter for cleaning the ECG signal.
1.4.2.2.2 Extract continuous wavelet transform, power spectral
density, and synthetic features.
1.4.2.3 Design and train with the use of European ST-T database, a
Support Vector Machine model that can classify STEMI and normal
ECG with a target of at least 90% k-fold accuracy.
1.4.2.4 Design an alert system that can automatically send notifications
via SMS and voice call to designated contacts such as clinicians and
the user upon detection of STEMI.
1.4.2.5 Record and store acquired ECG data including filtered data and
features extracted.
1.4.2.6 Display the ECG status of the user using an LCD screen.
1.5 Scope and Delimitations
This study is limited to developing a portable heart attack alert system — an
automatic, real-time, pre-diagnostic heart attack detection device for individuals with
ischemic heart disease.
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The device will mainly use a trained machine learning model, namely Support
Vector Machine. This model is only capable of binary classification wherein it can only
classify ST-elevated and normal ECGs. Furthermore, in training and testing the SVM,
an online open-sourced database, namely the European ST-T Database, will be used.
Moreover, the acquisition of ECG will be done using three disposable
electrodes following the chest lead II placement where ECG acquired is up to 2500
samples. In terms of the application of digital filters, a bandpass, moving average, and
median filters will be used. Regarding feature extraction, continuous wavelet
transforms, power spectral density, and synthetic features will be utilized.
In terms of the alert system module, automatic contact or sending of
notifications will only be done when STEMI is detected. Communication means are
via SMS and voice calls only, in which content only provides ECG status along with
date and time. The designated contacts considered are the user and an involved
clinician.
Regarding the storage of ECG data, it will be saved within the local storage of
the device which is the micro-SD card. It is where the data are accessed manually by
the clinicians which can be acquired during hospital visits by the user. There will be
specifically four types of data to be saved: raw data, filtered data, features, and the
predicted ECG class.
For the display of ECG status via the LCD screen, only two outputs will be
shown. If STEMI is detected, “STEMI detected” is displayed; if not, “Normal” will be
displayed. These statuses will only be shown via text. Additionally, a power bank will
17
be used as the power source of all integrated components. It is estimated to last for
approximately six hours upon continuous use.
Moreover, this study excludes addressing other cardiac events and only
focuses on providing detection for heart attacks, specifically ST-elevation myocardial
infarction only. Additionally, the device will mainly be used as a real-time, pre-
diagnostic device; the diagnosis is still yet to be conducted and confirmed by medical
professionals.
Regarding the application of beta testing, it must be noted that the participants
considered are in good health conditions. Testing the capability of the device in terms
of detecting STEMI will only be limited via the use of testing data acquired from online
databases and the use of an ECG simulator. The proponents opted for this given heart
attack is a critical condition that can be fatal; it cannot be voluntarily induced.
Additionally, the sole purpose of beta testing is to only test the user acceptance of the
device mainly in terms of portability and comfortability.
To determine the machine learning’s capability, exposure to new set of data is
conducted. The evaluation will be done using the system and beta testing data. This
test is solely to determine the extent the machine learning model can perform
accordingly.
1.6 Significance of the Study
The results of the development of the Portable Heart Attack Alert System
(PHAAS) would be significant for the following:
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Individuals who are at risk of heart attacks
The most who will benefit from this study are the people who are prone
to experiencing heart attacks, such as those diagnosed with ischemic heart
disease. The device will serve as a safety net that will decrease the risk of
subjects suffering from the repercussions of experiencing heart attacks, such
as various health complications, expensive treatments, and death. The quality
of life would also be significantly improved by reducing anxiety, worry, and
stress, given that a device can be relied upon to detect unpredictable heart
attacks objectively.
Family of individuals susceptible to heart attacks
Similar to those who are prone to experiencing heart attacks, family
members would also greatly benefit from it. The device will provide ease and
reduce psychological stress knowing that the family member concerned has a
device they can rely on in an emergency, specifically when a heart attack
occurs.
Healthcare Providers
The study provides the development of a device that can lessen the
workload of medical professionals, given that the device is designed to provide
continuous remote monitoring. With this, fewer trips will be required when
visiting the hospital, and face-to-face contact for diagnosis is also limited, which
is especially important regarding today’s pandemic. Transactions and
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diagnoses with a medical professional can also be made online, given that the
ECG data is stored and accessible within the device.
The PHAAS also incorporates an alert system that ensures fast
response by immediately sending a notification when a heart attack is detected.
This allows required medical attention to be provided as soon as possible,
which is ideal on any occasion of a heart attack happening.
Proponents of the Study
This study allowed the proponents to study a topic of great interest. Not
to mention, doing this paper allowed the proponents to develop their critical
thinking and writing skills further.
Future Researchers
The academic community can use this study as a reference, particularly
researchers working on heart attacks and heart attack-related devices. This
study can also guide further improvements with the device developed, such as
the hardware and software components. In terms of the machine learning
algorithm created, future researchers can use it as a basis for an improved
version covering a broader scope of heart diseases.
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CHAPTER II
REVIEW OF RELATED LITERATURE
2.1 Current Preventive Methods for Myocardial Infarction
This section lists and discusses the current prevention methods for IHD, and
myocardial infarction as stated in the 2019 Primary Prevention of Cardiovascular
Disease guidelines. A list of local and international programs that advocate for cardiac
health is also included.
2.1.1 Risk Assessment
Risk assessment is the estimation of a person developing blockages in
their arteries (American College of Cardiology, 2019). It is considered crucial
given that blocked arteries can ultimately lead to a heart attack or stroke, which
can be fatal. The risks are determinable with the use of the tests listed below
(Medline Plus, n.d.).
2.1.1.1 Measuring Blood Pressure Level
Blood pressure is the force of blood that pushes against the walls
of the arteries each time the heart pumps blood (Medline Plus, 2020).
Accordingly, if the blood pressure remains high for a long time, it could
lead to serious health problems, such as heart attacks. According to
American Heart Association (2022), a heart attack occurs due to the tear
high blood pressure causes to the arteries. With this, LDL (bad)
cholesterol accumulates on the tear, where blockages develop on-site,
21
resulting in a possible heart attack. A heart attack is determined if the
systolic pressure exceeds the normal value of 120 and the diastolic
pressure of 80. The higher the blood pressure, the more dangerous it
becomes. Checking for blood pressure is done using a gauge, a
stethoscope or electronic sensor, and a blood pressure cuff. Treating
high blood pressure, on the other side, includes healthy lifestyle changes
and medications.
2.1.1.2 Measuring Cholesterol Level
Cholesterol is a fat-like substance found in all the cells in the body
(Medline Plus, 2020). To produce hormones, vitamin D, and to properly
digest food, the body needs cholesterol. It can either be produced by the
body or obtained through food.
There are three known types of cholesterol: HDL (high-density
lipoprotein), LDL (low-density lipoprotein), and VLDL (very low-density
lipoprotein). HDL is considered “good” cholesterol because it provides
proper delivery of cholesterol, from other parts of the body to the liver.
The liver will be removing the cholesterol from the body. On the other
hand, LDL and VLDL are considered “bad” cholesterol because high
levels can lead to plaque build-up in arteries. The build-up of plaque can
cause the development of IHD which can potentially lead to a heart
attack. A blood test can be taken to determine an individual’s cholesterol
level. Overall, the higher the LDL and VLDL level, and the lower the HDL
level, the more at risk the heart becomes. Healthy lifestyle changes such
22
as a healthy eating plan, weight management, regular physical activity,
and medicines can help reduce cholesterol levels.
2.1.1.3 Measuring Blood Sugar Level
Blood sugar level (also known as glucose) is a major source of
energy for most of the cells in the body. While fasting, the normal blood
glucose ranges from 70 to 99 mg/dL (3.9 to 5.5 mmol/L), and cases that
exceed the normal range could indicate pre-diabetes or diabetes
(Cleveland Clinic, 2018). Concerning this, individuals with high blood
sugar levels, especially those already diagnosed with diabetes, are
prone to developing heart diseases and heart attacks. This is because
high blood sugar concentration can damage blood vessels nerves that
control the heart and increase their risk of developing risk factors
(National Institute of Health, 2021). Such risk factors include high blood
pressure and high “bad” cholesterol levels that doubles the likelihood of
experiencing a heart attack (Center and Disease Control and
Prevention, 2022). Keeping the blood sugar level in check is one way of
keeping heart health in good condition which can be kept track via blood
sample tests (MedlinePlus, 2022).
2.1.1.4 Risk Calculators
Risk calculators are screening tools used to determine the risk or
likeliness of an individual to develop a heart disease in the next 10 years
(Medline Plus, n.d.). Accordingly, results are calculated using
23
information from clinical studies on heart disease and are expressed as
percentages. The likelihood of developing heart disease is low if the risk
calculator's percentage is low. However, a high percentage indicates a
high risk of development. Examples of risk calculators are the ACC/AHA
cardiovascular risk calculator, ASCVD (atherosclerotic cardiovascular
disease) risk calculator, Reynolds Risk Score, and Framingham General
CVD Risk Profile. The mentioned test calculators can either be used
individually via online, or, with the help of a medical practitioner.
Furthermore, the assessment includes answering questions related to
health and other considered parameters such as gender, height, weight,
blood pressure, cholesterol levels, activity level, and diet.
2.1.2 Lifestyle Changes
Improving overall health is one of the best ways to avoid cardiovascular
disease. This can be achieved by incorporating healthy lifestyle changes
extending from healthy diets, being physically active, and avoidance of
unhealthy habits (Mayo Clinic, 2022).
2.1.2.1 Healthy Diet
A healthy heart is achievable through a healthy diet as it can
improve blood pressure, cholesterol, and blood sugar levels, reducing
the risk of heart disease development (Mayo Clinic, 2022). Eating foods
such as fruits, vegetables, beans, legumes, lean meat, fish, low-fat or
dairy foods, whole grains, and healthy fats is highly recommended. On
24
the other hand, limiting the intake of salt, sugar, processed
carbohydrates, alcohol, saturated fat, and trans-fat is essential.
Furthermore, specific dietary plans that are heart-friendly are also
recommendable such as the Dietary Approaches to Stop Hypertension
(DASH) and the Mediterranean diet.
2.1.2.2 Regular Exercise
Regular physical activity can also help reduce the risk of having
a heart attack (Mayo Clinic, 2022). It can also reduce the risk of other
conditions such as high blood pressure, high cholesterol, and type 2
diabetes, which are all critical factors in developing heart diseases.
Experts advise regular exercises such as walking, swimming, and
cycling for at least 150 minutes a week or at least 10-minute bursts of
activity within a day. (American College of Cardiology, 2019).
2.1.2.3 Healthy Weight
Obesity is generally associated with high cholesterol, high blood
pressure, and an increased risk of heart diseases and stroke.
Maintaining a healthy weight can help in preventing heart disease as
being overweight, especially around the middle of the body, can
increase the chances of having high blood pressure, high cholesterol,
and type 2 diabetes (Mayo Clinic, 2022). The body mass index (BMI) or
measuring belly fat are two ways of determining whether a patient is
overweight or obese as they are generally associated with high
25
cholesterol, blood pressure, and an increased risk of heart disease and
stroke. Losing weight by 3% to 5% can help in decreasing certain fats in
the blood, lowering blood sugar, and reduce the risk of having type 2
diabetes.
2.1.2.4 Avoid Smoking
According to the Centers for Disease Control and Diseases (n.d.),
chemicals used in cigarettes can cause blood to thicken and form clots
in veins and arteries, which may result in a heart attack and sudden
death. Moreover, the damages smoking can do to the body can be
extensive such as: raising triglycerides, making blood sticky, damaging
blood vessel cells, increases build-up of plaque, and causes thickening
and narrowing of blood vessels (Centers for Disease Control and
Diseases, 2022).
2.1.2.5 Stress Management
Stress can be helpful to an extent, but excessiveness can affect
an individual's overall well-being, especially with their cardiovascular
health (American Heart Association, 2020). Long-term stress results in
a high level of cortisol, which according to the University of Rochester
Medical Center (n.d.), can increase cholesterol, triglycerides, blood
sugar, and blood pressure levels. Additionally, it may also cause poor
blood flow and thickening of the blood. Healthy stress management
26
habits, such as physical activity, relaxation exercises, or medication, can
help reduce stress and improve one's health (Mayo Clinic, 2022).
2.1.2.6 Good Quality Sleep
Sleep deprivation is associated with increased risk of heart
attack. Sleeping less than six hours increases the chance of a heart
attack by 20% (Daghlas et al., 2019). Furthermore, according to Suni
(2022), sleep disruptions also increase the risk of heart attacks.
Frequent interruptions can lead to cardiac stress, which may lead to a
heart attack because both heart rate and blood pressure spikes abruptly
upon unexpected awakening. Building a consistent sleeping schedule,
with at least seven hours of sleep every day is recommended for better
heart health (Mayo Clinic, 2022).
2.1.3 Medications
One fundamental approach to preventing and treating a heart attack is
medications (Mayo Clinic, 2022). This section lists and discusses the common
medications used to lessen the risk of heart attack by targeting parameters that
risk its development. The indicated medications are acquired from the Heart
and Stroke Foundation of Canada (n.d). It is important to take note that while
most of these medications are similar in function, they come with their own use
cases, risks, and specific instructions that healthcare providers give to the
patient.
27
As stated in section 2.1.1.1, high blood pressure is a considered risk
factor that can contribute to heart attack. The medications for addressing high
blood pressure include ACE inhibitors, which reduce the risk of heart attack by
opening blood vessels. Specifically, it will make the heart pump easier, lower
blood pressure, protect the heart and blood vessels, and protect the kidneys
for people with diabetes or kidney disease. Aldosterone Antagonists, also
known as aldosterone receptor blockers, are diuretics or “water pills” used to
treat high blood pressure and heart failure. Angiotensin Receptor Blockers
(ARB) treat blood pressure and heart failure by blocking the action of the
enzyme that narrows blood vessels, called Angiotensin II. Beta-blockers, also
known as beta-adrenergic blocking agents, treat heart attacks, angina, high
blood pressure, heart failure, and arrhythmia and protect the heart from stress
and abnormal heartbeats. It does this by lowering the heart rate and blood
pressure resulting in a lesser workload. Lastly, Calcium Channel Blockers
(CCBs), also known as calcium channel antagonists, are vasodilators that help
control high blood pressure and chest pain caused by heart disease and
arrhythmia. Patients taking this medication usually take other medications,
such as beta-blockers or diuretics.
High cholesterol level is another considered risk factor that can
contribute to developing heart diseases and potential occurrence of heart
attack. The following are the known medications that address it: Cholesterol
absorption inhibitors help lower the overall cholesterol level in the blood by
reducing the amount of cholesterol stored in the liver and improving how
28
cholesterol is cleared from the blood. Fibrates, also known as Fibric Acid
Derivatives, treat high cholesterol by lowering triglyceride levels, reducing the
bad cholesterol, and increasing the good cholesterol in the body. Similarly,
Niacin, also known as nicotinic acid, treats high cholesterol by slowing down
the liver's production of bad cholesterol and increasing the good cholesterol in
the body as well. Resins treat high cholesterol by tricking the body into
producing more bile using cholesterol. With more cholesterol being used to
create more bile (which passes in stool), it results in less bad cholesterol in the
blood. Lastly, Statins help lower the long-term risk of having a heart attack by
preventing plaque from building up in the arteries and preventing existing
plaque from getting worse.
Blood clots, caused by ruptures of plaque, can eventually lead to a heart
attack. There are only two medications used in treating blood clots:
Anticoagulants, also known as blood thinners, help reduce the risk of
developing blood clots by preventing existing clots from getting bigger. When
taking this medication, patients should expect regular blood tests to check that
their blood is not too thin (which can cause bleeding) or too thick (which can
lead to clots). Antiplatelets can also be taken for anti-blood clotting. They are
taken mainly by patients who had a cardiac event. When platelets rush to a
wound when someone gets a cut, it makes the blood sticky as they bind
together and form a clump to help stop the bleeding. This leads to blood clots,
clogged arteries, heart attack, or stroke. Antiplatelets counter this by making
29
the blood less sticky, preventing arteries and stents from being plugged by
clots.
2.1.4 Health Programs and Advocacies
According to the Institute of Medicine (2010), one of the certain actions
that needs to be executed to address global cardiovascular disease is the
implementation of advocacy and leadership at global and national levels. In line
with these, international and local advocacies for preventing cardiovascular
disease, including heart attack and stroke are listed below.
2.1.4.1 HEARTS
The HEARTS technical package developed under the Global
Hearts Initiative led by WHO and the US Centers for Disease Control
and Prevention provides a strategic approach to improving
cardiovascular diseases in countries. It supports ministries of health to
strengthen CVD management in primary healthcare settings (World
Health Organization, 2020). It comprises six modules: Healthy lifestyle
counseling, evidence-based treatment protocols, access to essential
medicines and technology, risk-based CVD management, and team-
based care. With these six modules comes an implementation guide that
provides a strategic approach to improving cardiovascular health in
countries.
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2.1.4.2 Million Hearts
Million Hearts is a national initiative that began in 2012 with the
purpose of "saving more of the lives taken and protecting more of the
lives impacted by heart disease and stroke in the United States" by
averting one million preventable cardiovascular diseases (CVD) events
in the next five years (Million Hearts, n.d.). It is co-led by the Centers for
Disease Control and Prevention (CDC) and the Center for Medicare and
Medicaid Services (CVS). The main priorities of this initiative are to build
healthy communities, optimize care, and focus on health equity.
2.1.4.3 WISEWOMAN
The Well-Integrated Screening and Evaluation for Women Across
the Nation, also known as WISEWOMAN, is a program that allows
qualifying women (with low income, uninsured, underinsured, and aged
40 to 64 years) to receive free screenings and counseling about their
risk for heart disease and stroke (Centers for Disease Control and
Prevention, 2022). Additionally, these women are also supported to
participate in evidence-based lifestyle programs, individual health
coaching, or referred to other community resources. From the year 2008
to 2013, this program served almost 150,000 women, with 91% having
at least one risk factor of heart disease or stroke, which led to almost
101,000 women participating in a healthy lifestyle service to reduce the
risk of heart disease and stroke.
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2.1.4.4 Philippine Heart Association Advocacies
The Philippine Heart Association (PHA), established in 1952, has
the mission of ensuring compassionate and quality cardiovascular care
(Philippine Heart Association, n.d.). Along with their programs and
campaigns, are eight advocacies which aim to improve cardiovascular
health. Advocating for healthier habits, the PHA released vibrant and
entertaining education videos about the “Let’s Do 52100 Daily!”
movement which can be played in gatherings and events (Philippine
Heart Association, n.d.). These healthy habits include having five
servings of fruits and vegetables, two hours of screen time, one hour of
moderate physical activity, zero sugary or sweetened beverages, and
zero smoking or secondhand smoke. In relation to the 52100
advocacies, the PHA launched a campaign called “Sneakers Friday''
which, according to David D’Angelo (2018), promotes physical activity
in the workplace by encouraging personnel to wear sneakers, casual
tops and pants every Friday as a “dress down day.” A similar campaign
launched by the PHA called Fit Heart Minute, also advocates for physical
activity (Philippine Heart Association, 2018). According to the creator of
FhM, Doc Nannette, “It is a practical alternative for people who are not
capable of walking 10,000 steps a day as what Sneaker Friday requires.”
Advocating for being CPR ready, the PHA launched Save a Life, Learn
CPR (Philippine Heart Association, n.d.). It is a basic life support and
advanced cardiac life support training program which comes in the form
32
of a refresher course held virtually. In order to provide remote referral
and diagnosis of patients suspected of ST Elevation Myocardial
Infarction (STEMI), the PHA launched the mobile application
STEMIConsult which is available for free in the Apple Play Store and
Google Play Store (Philippine Heart Association, n.d.). Other
advocacies launched by the PHA include Pusong Pinay which is an
event about “The Heart Truth about Women,” World Heart Day which is
an event held every September 29, and the Angina Awareness Initiative
which spreads awareness about keeping angina under control.
2.2 Current Diagnostic Tests for Myocardial Infarction
Healthcare providers conduct diagnostic tests to check the heart's overall
health (Mayo Clinic, n.d.). This section lists and discusses the current diagnostic tests
for myocardial infarction.
2.2.1 Blood Test
According to Medical News Today (2021), doctors can determine
whether a person has experienced a heart attack through a blood test. This is
conducted by measuring the cardiac markers, known as troponin, that are
released by the heart during a heart attack. Troponins, most commonly
Troponin I and Troponin T, are released as early as 4 hours after a heart attack
making it an ideal marker for diagnosing a heart attack. It is important to take
note that doctors also perform other tests along with blood tests, as elevated
levels of troponin alone cannot solely indicate that a person had a heart attack.
33
This usually involves physical examination, asking for the patient's medical
history, and an evaluation of ECG. The level of troponin will indicate whether a
heart attack has occurred, along with its specific type; if there is an increase
from the normal range of 0–0.04 ng/ml, heart attack is considerable (Villines,
2022). Besides diagnosing a heart attack, other blood tests can be used to
diagnose and manage heart disease (Mayo Clinic, 2022). These blood tests
include cholesterol, high-sensitivity C-reactive protein, lipoprotein, and
natriuretic peptides tests.
2.2.2 Chest X-ray
According to NHS (2019), a chest X-ray can be used if diagnosis of a
heart attack is uncertain due to other possible causes of heart attack
symptoms, such as a pocket of air trapped between the layers of the lungs
(pneumothorax). It can also be used to check for complications caused by the
occurrence of a heart attack such as the build-up of fluid in the lungs
(pulmonary oedema). Besides diagnosing for the occurrence of heart attack,
chest X-rays can be used to reveal the condition of the lungs, heart-related lung
problems, the size and outline of the heart, blood vessels, calcium deposits,
fractures, postoperative changes, and medical devices inside the body, such
as a pacemaker, defibrillator, and catheter (Mayo Clinic, 2022).
2.2.3 Echocardiogram
According to NHS (2019), an echocardiogram is an imaging technique
that utilizes sound waves as its modality for creating images of the heart. This
34
procedure can help identify areas of the heart that have already been damaged
and their corresponding effects on heart function, such as those caused by
blocked arteries or heart attacks. There are several types of echocardiogram
tests, each with its use cases and risks, and will be conducted depending on
the information needed by the doctor (Mayo Clinic, 2021).
The most common type of echocardiogram test is the transthoracic
echocardiogram. This test is conducted by placing a transducer on the patient's
chest, recording the sound wave echoes in the heart, resulting in moving
images displayed on a monitor. In the case that the doctor needs clearer
images or there is difficulty in getting a clear picture with the transthoracic
echocardiogram, a transesophageal echocardiogram test is to be conducted.
This test involves sending a flexible tube down the throat and into the tube
connecting the mouth to the stomach before viewing it on a monitor. In the case
the doctor needs to check for blood flow problems and blood pressure in the
arteries in the heart, a doppler echocardiogram test is to be conducted. This
test is generally used along with transthoracic and transesophageal
echocardiogram tests. Lastly, a stress echocardiogram test is conducted to
check for coronary artery problems which only occur during physical activity.
This test is conducted by taking images of the heart before and immediately
after the start of the physical activity. In the case that physical activity is not an
option, medication delivered by injection will make the heart pump as hard as
with physical activity. The risk involved in this procedure is that it may cause an
irregular heartbeat which may cause serious complications, though rare.
35
After the procedure, people can resume normal activities (regardless of
the type), especially when the result is normal and further testing is not
required. On the other hand, doctors may require more tests if the results are
not normal.
2.2.4 Coronary Angiography
A coronary angiogram is an imaging procedure for checking heart blood
vessels (Mayo Clinic, 2021). This is conducted with the use of a dye that is
visible via X-ray, and an X-ray machine. During the procedure, a catheter is
inserted into the patient's artery, and the dye is injected into the catheter. As
the dye flows through the blood vessels, corresponding blockages, and
constricted areas are identifiable when viewed using X-ray. After conducting
the procedure, it should show how many coronary arteries are blocked or
narrowed, the location of these blockages, and the amount of blood flow
blocked. Due to the risk of complications, angiograms are conducted only after
noninvasive diagnostic tests, such as electrocardiogram or echocardiogram.
2.2.5 Electrocardiogram
An electrocardiogram (ECG or EKG) is a noninvasive test that acquires
the electrical activity of the heart. ECG can provide information about the
heart’s status and determine if there are underlying conditions such as
arrhythmias and coronary artery disease. Furthermore, ECG can also
determine if a person has experienced a heart attack (Mayo Clinic, 2022).
36
In general, the ECG is acquired through the use of sensors, which are
attached to the patient’s skin, and records the heart impulses with the use of
an ECG machine. There are three main methods in conducting ECG tests:
resting, stress, and ambulatory (NHS, 2021). Resting ECG is the acquisition of
ECG while the subject is at rest; no movement is involved. Stress ECG, on the
other hand, involves movement, where ECG is acquired after a strenuous
activity such as exercise. Lastly, ambulatory ECG, is acquiring ECG while the
patient is going through their normal day-to-day activities. The recording
devices used for this type of ECG are small portable machines such as Holter
and event monitors.
According to Mayo Clinic (n.d.), a Holter monitor is used to detect or
determine the risks of arrhythmias. It does this by continuously recording
electrical signals from the heart of the patient for one to two days. The patient
is expected to wear a Holter monitor for the entire duration of recording, even
while sleeping. They can do most of their daily activities unless their healthcare
provider tells otherwise. A form will also be given to record all daily activities
and symptoms such as pounding, fluttering, or skipped beats, shortness of
breath, chest pain, and lightheadedness. On the other hand, a cardiac event
monitor is for patients whose symptoms of arrhythmias do not happen that often
(Cleveland Clinic, 2022). There are four types of cardiac event recorders, each
with their own use cases and functionality: a patch recorder, symptom event
monitor, loop memory monitor, and implanted loop recorders. Cardiac event
monitors can be worn by a patient for up to a month which is ideal for recording
37
arrhythmias that do not happen every day. Just like the Holter monitor, the
patient is expected to keep track of their activities, the medications they are
taking, and symptoms that may occur when they are active for the entire
duration of using the device.
Furthermore, it is important to note the types of heart attacks ECG can
detect. There are namely three: ST-segment elevation myocardial infarction
(STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and
unstable angina (Roland, 2020). ST-segment elevation myocardial infarction
(STEMI) is the most serious type of heart attack. It indicates a prolonged
interruption of blood supply within the heart caused by a complete blockage of
an artery, which can result in extensive damage to a large area of the heart.
NSTEMI heart attack, on the other hand, is a less serious condition than
STEMI. Instead of a completely blocked artery, the obstruction has only
partially developed, and a small section of the heart is damaged. When left
untreated, NSTEMI can progress to STEMI. Lastly, unstable angina is the least
serious type of heart attack. Blood supply is restricted, but no permanent
damage has yet been developed. When left untreated, it can progress to
NSTEMI.
2.3 ECG Signal Acquisition Methods
Before data acquisition, it is important to take note of the several electrode
placements for acquiring ECG. The first most used electrode placement is the 3-
electrode system which uses three electrodes placed on the right arm (RA), left arm
38
(LA), and left leg (LL) with the monitor displaying the bipolar leads (I, II, and III)
(Cadogan, 2022). The second most used electrode placement, the 5-electrode
system, is similar to the previous electrode placement. It also has electrodes placed
in the right arm, left arm, and left leg with an additional two electrodes placed on the
right leg (RL), and the chest (C). This placement will also display the bipolar leads (I,
II, III) and a single unipolar lead depending on the position of the chest lead. Lastly,
the 12-lead ECG placement uses a total of 10 electrodes with four electrodes placed
on all four limbs (RA, LA, RL, LL) and six electrodes on the precordium (V1 - V6). This
placement will allow for interpretation of the inferior (II, III, aVF), lateral (I, aVL, V5,
V6), and anterior (V1-V4) areas of the heart. Other electrode placements such as the
right sided ECG electrode placement, the V4R ECG lead placement, posterior leads,
the Lewis lead configuration, and the fontaine bipolar precordial leads are used for
recording specific ECG data required by the doctor.
In terms of acquisition methods used by existing studies, the study of
Chowdhury et al. (2022) uses dry electrodes as they are preferable in obtaining ECG
signals compared to wet electrodes because dry electrodes are reusable and non-
disposable. On the other hand, wet electrodes degrade over time since the gel present
dries as time passes which effectively increases the impedance and affects the overall
quality of the ECG signal derived. Additionally, regarding electrode placement, Chest
Lead II and Chest Straight Lead were suggested, given that they yielded a similar
quality comparable to clinical-grade ECG traces. In the study made by Gusev et al.
(2017), they used ECG clips to acquire the ECG signals. However, given that the
acquisition was made using an ECG simulation, it is not desirable for human
39
application. On the other hand, another method using a wireless, mobile, and
wearable ECG biosensor is another mode of ECG acquisition. Ahmed & El-Metwally
(2015) suggested this method to enable wireless transmission. The data transmission
between the wearable ECG sensor and the smartphone is via Bluetooth.
2.4 ECG Pre-processing Methods
Concerning the acquisition of ECG, the quality of the signal is an essential
consideration. Hence, preprocessing techniques are needed.
One of the many ways that can effectively remove noises from signals such as
ECG is digital filters. According to the method used by Chowdhury et al. (2019),
average moving filters and median filters are applicable. The average moving filter
removes the random noises and allows the smoothing of signals. On the other hand,
the median filter addresses the baseline wander — it fixes the ECG signal to be
consistent on the isoelectric line. In feature extraction, a quadratic time-frequency
distribution (QTFD) using an extended modified b-distribution (EMBD) kernel was
proven effective. This method has significantly contributed to achieving a 97.4%
accuracy for STEMI detection and 96.3% for NSTEMI detection using SVM machine
learning. In addition to the digital filters and feature extraction, biorthogonal wavelet
transformation was included for synthesizing ECG signals and labeling significant
events (such as R peak detection) from the data.
Another method of noise filtering is the use of simple DSP filters. According to
the suggested approach by Ahmed & El-Metwally (2015), two DSP bandpass filters
are enough. The first DSP bandpass filter takes the ECG signal that ranges from 5-20
40
Hz to reduce feature space. The other one uses a frequency range from 0.5-30Hz to
eliminate noises. Regarding feature extraction, the method suggested is the adaptive
differential technique, which can detect the R peak in the ECG signals. Accordingly,
additional morphological processes can be applied to detect QRS length, PQ, and ST
segments.
Furthermore, one of the widely used methods for ST-segment detection,
extraction, and analysis is wavelet transformation. According to Alharbey et al. (2021),
wavelet transform is applicable for feature extraction and can be combined with
statistical parameters such as standard deviation and Shannon energy for additional
features. Six combinations of the statistical parameter with the continuous wavelet
transform have been tested. The result suggests that the continuous wavelet
transform with standard deviation taken for the third sub-signal had been the most
suitable.
The wavelet transforms, specifically the discrete wavelet transform, is also
applicable for extracting the ST segment from the ECG (You et al., 2015). In this
approach, the use of empirical mode decomposition (EMD) for denoising of the ECG
signal is incorporated. The method is tested with real exercise ECG data acquired
using a twelve-lead ECG recorder. The results showed the feasibility of the approach,
and it has been emphasized that it is effective in ECG recordings heavily affected by
noises.
Moreover, discrete wave transform has also been demonstrated to be
applicable for denoising purposes. Using various DWT coefficients representing
41
specific frequency ranges, noises such as baseline wander and 60Hz line interference
was effectively filtered (Haddadi et al., 2017).
Another approach is with the use of fast continuous wavelet transformation
(fCWT). According to Art & Broek (2022), fCWT provides an improved signal analysis
balance between speed and accuracy. With this, a real-time, wide-band, high-quality,
time-frequency analysis of non-stationary noisy signals is possible. When the method
was tested, it was concluded that “fCWT is shown to have the accuracy of CWT, to
have 100 times higher spectral resolution than algorithms equal in speed, to be 122
times and 34 times faster than the reference and fastest state-of-the-art
implementations…”.
2.5 Machine Learning for Detection of Heart Attack
Machine Learning is a computer algorithm capable of analyzing and drawing
inferences from a set of data. The utilization of machine learning in addressing heart
attacks holds potential and is widely considered in research. Various machine-learning
approaches have been developed and tested in terms of detecting heart attacks.
In the study conducted by Chowdhury et al. (2019), they tested linear
classification and twenty-two machine learning algorithms. The machine learning
algorithms are namely three decision trees, two discriminant analysis, six support
vector machines (SVM), six k-nearest neighbors (KNN), and five ensemble classifiers
with the use of Massachusetts Institute of Technology-Beth Israel Hospital (MIT-BIH)
ST Change Database. Among all those tested, the two best algorithms identified were
SVM and KNN. To further improve the application of the algorithm, time, frequency,
42
and time-frequency domains were extracted. The methods involved are Wigner–Ville
distribution (WVD), Spectrogram (SPEC), and extended modified B-distribution
(EMBD). The best candidate that stands is the SVM algorithm with the EMBD method.
They showed the highest accuracies of 97.4% and 96.3% for detecting STEMI and
NSTEMI, respectively.
In another study conducted by Gupta et al. (2021), random forest, decision tree,
gradient boosting, and logistic regression machine learning algorithms were tested out
in detecting heart attacks. They utilized the datasets from the Framingham database
and UCI Heart repository. The most suitable algorithm was found to be gradient
boosting classifiers that yielded the highest accuracy, with an average percentage of
85.5%.
Logistic regression, naïve Bayes, decision tree, random forest, support vector
machine, and k-nearest neighbor were also tested by Aravindh et al. (2021). The
utilized dataset is from Kaggle, an online source also adopted by the World Health
Organization (WHO). The result shows that the logistic regression algorithm was the
most effective among all the algorithms tested, with an accuracy of 91.8 %.
2.6 Existing Real-Time Heart Attack Detection Device
Currently, only one existing device has been developed for objective-based
heart attack detection. This device is called HeartBeam. HeartBeam is a telehealth
system that consists of a credit card-sized, 12-lead capable, 3D vectors collection
device that detects electrical signals from the heart (HeartBeam, 2022). Patients can
use this device anywhere to help physicians assess whether the chest pain
43
experienced by the patient is a result of myocardial infarction (MI). The patient is
guided through the collection process with the help of a smartphone app allowing
communication between the physician and patient. It allows the signals recorded to
be sent to the HeartBeam cloud, where the signals are analyzed and compared to the
patient's asymptomatic baseline recording. Signal analysis, along with the patient's
history and reported symptoms, are combined into a proprietary algorithm that
provides information and diagnostic recommendation to the patient's physician. The
physician determines whether a heart attack has occurred or not and informs the
patient.
A few limitations are observed in this device. Continuous monitoring of patient
is not provided since patients are only expected to use the device when heart attack
symptoms are observed, silent ischemia are not considered in this case. Additionally,
internet connection is required to access the algorithm used to make diagnostic
suggestions that is provided by their cloud system. Furthermore, it is important to note
that this product is not cleared by the Food and Drug Administration (FDA) and is not
yet available in the market.
2.7 Existing Studies with Similar Approach
Since heart attack is a widely recognized concern in the medical field, various
methods, and approaches to addressing this issue have been explored. This section
discusses the existing designs of heart attack assistive devices with similar
approaches to the proposed device, the portable heart attack alert system. A summary
of the comparison between the existing designs is provided in Table 2-1.
44
The first existing design is a wearable real-time heart attack detection and
warning system to reduce road accidents (Chowdhury, et al., 2019). The authors
aimed to design a real-time heart attack alert system device to avoid and reduce road
accidents related to heart attacks. While driving, the device strives to monitor the
driver, particularly their ECG signal. If the device detects a heart attack indicated by
the ECG, the driver would immediately be notified and suggested to seek medical
assistance. Alongside the notification, automatic communication of designated
contact personnel is also conducted.
The device comprises two subsystems: a wearable sensor and an intelligent
heart attack detector system. The wearable sensor is made using the RFduino
microcontroller. It acquires the ECG with dry electrodes, which are attached to the
driver's chest. Filters are incorporated with this subsystem, such as moving average
and median filters, for removing random noises and baseline wander. Biorthogonal
wavelet transformation was also used to detect the R peak and synthesize the ECG
signal.
On the other hand, the intelligent system, built using a Raspberry Pi 3, utilizes
a trained machine-learning algorithm to detect heart attacks. The support Vector
Machine (SVM) algorithm was determined to be the most effective in the detection of
heart attack, with a 98.3% precision and 97.4% accuracy in identifying ST-elevation
Myocardial Infarction (STEMI) and 98.7% precision and 96.3% accuracy in identifying
non-ST-elevation Myocardial Infarction (NSTEMI). Furthermore, a GSM module is
used, and it serves as the alert system responsible for sending notifications to
designated contact persons and notifying the driver upon detection. Both subsystems
45
communicate via Bluetooth. In terms of power supply, the wearable sensor subsystem
is powered by a battery, while the intelligent subsystem is powered through the DC
socket splitter of the car. The recognized limitations of this device include the
following: the limit in portability (given that the device is limited for the use of drivers),
the bulkiness of the design, the limited power source for the wearable subsystem, and
lastly, the reliability of the power source of the intelligent subsystems in cars.
ECGAlert is another existing design consisting of a cloud-based system
method for heart attack alert detection (Gusev et al., 2017). This device includes a
wearable sensor, a smartphone, and an intelligent cloud-based server. The wearable
sensor is a wireless ECG electrode capable of acquiring and transmitting ECG signals
via Bluetooth. The receiving end of the data transmission is the smartphone which
serves as the storage where the ECG data is saved. The smartphone also partially
processes the signal, such as using DSP filters to remove noise. The data is then
transmitted to the cloud-based server via LAN/WAN. It is where the ECG can be
accessed for complete analysis and diagnosis of a heart attack. The cloud server is
also made accessible to doctors and other authorized users.
Despite the unique approach, various limitations can be observed. It includes
reliability on local storage media of the patient’s smartphone for storing ECG data.
Another is the reliability of the internet connection for the analysis of data. Without an
internet connection, the analysis feature would be inaccessible, and heart attack
occurrences cannot be detected. Lastly, when data is accessed by smartphone, only
pre-processing can be done, such as filtering out the noises — data is fresh, and no
useful information regarding potential heart attack is provided.
46
For a more integrated approach, the study of Ahmed and El-Metwally (2015)
uses ZigBee wireless receiver modules established in nearby hospitals, designed to
receive alarms from a portable, low-cost heart attack detection system worn by the
patient. This system uses an Arduino shield kit coupled with ECG electrodes for data
acquisition from the patient. Once the data is acquired, it is processed to be classified
as either normal or abnormal. If the data is classified as abnormal, it will generate an
alarm transmitted via a ZigBee module connected to the Arduino kit. On the receiving
end is another ZigBee module that receives the alarm and starts contacting a list of
designated contacts given by the patient in case of an emergency. In testing the
system, a heart attack simulator was used to produce abnormal ECG signals at
specific intervals. Results show that the receiver established at a range of 1.24 km
away from the transmitter could receive accurate alarm signals in short time delays
with an accuracy of 89% of correct data transfer.
Overall, the solution allows for remote or distanced patient monitoring,
immediate intervention upon heart attack detection by contacting nearby hospitals and
designated emergency contacts, and early transmission of snippets of abnormal ECG
readings for early analysis. Despite these advantages, there is no filtering of data
acquisition incorporated in the design, in which movement from the patient can
contribute to noise in the ECG. In identifying a heart attack, the device is limited to
using a programmed ECG simulator to produce abnormal ECG signals at specific
intervals. Unlike the first previously mentioned study, the algorithm's accuracy in
determining whether a heart attack occurred was not provided. In terms of data
transmission, the limit of correct transmission is up to 1.2 km as distances greater than
47
that will result in an error in data transmission. Lastly, the study does not mention how
the patient will be notified that a heart attack is indeed occurring, despite being able
to send an alarm to the receiving module in the hospital and alert the designated
contacts of the patient.
The last approach is a minimally invasive solution that utilizes a biosensor that
can detect whether a heart attack has occurred by identifying two cardiac markers:
Myoglobin (Myo) and Myeloperoxidase (MPO) (Mondal et al., 2017). The device uses
a sensor fabricated on Whatman filter paper that is functionalized with glutaraldehyde
and a homo-bi functional crosslinker before the covalent attachment of the antibodies
specific to each biomarker is coated with polyaniline. AC impedance measurement of
the filter paper allows detection when the target proteins are bound to the specific
antibody changes in the impedance between the electrodes. This impedance is
measured using a frequency response analyzer with an AC excitation voltage of 100
mV in the frequency range of 100 Hz to 100 kHz. The biomarkers can be detected in
the buffer solution within the concentration range of 100 ng/mL to - 50 ug/mL. The
detection limit obtained for these biomarkers spiked in human serum is one ug/mL
and further blocking using human serum improves the detection limit to 500 ng/mL.
This method results in a biosensor made of inexpensive materials and
fabrication techniques that can detect the occurrence of heart attack with two
biomarkers within 20 minutes and can be disposed of in an eco-friendly manner
making this sensor more suitable for diagnostic applications. However, this method of
detecting the occurrence of heart attack is an invasive solution compared to the
48
previously mentioned solutions that are noninvasive. It is also the only solution that
does not involve continuous patient monitoring.
Table 2-1. Comparison of Existing Studies

Authors
and Date Features/Design Components Capabilities Limitations
Published
Chowdhury - uses dry - Dry - allows real time - system

et al., 2019 electrodes in Electrodes detection of heart designed are
acquiring ECG - RFduino attacks which can limited for the
signals that is - Raspberry help drivers in use of drivers
incorporated with Pi 3 preventing (portability is
FIR filters for - SIM 908 accidents and limited and
removing noise GSM Module immediately only drivers
and baseline - Lithium Ion address the issue can use it)
wander and the Battery - incorporated - prototype is
use of with an alarm bulky and
biorthogonal system that can involves a lot
wavelet inform the driver of
transformation of heart attack components
for synthesis of occurrence - the power
signal - incorporated source of the
- Machine with automatic intelligent
learning contacting of pre- heart attack
algorithm defined contact detection and
(support vector personnel to alarm
machine with which the subsystem is
extended time– message derived from
frequency includes the the car (DC
features using driver’s location
49
extended - upon acquisition car socket

modified B- of ECG signals, splitter)
distribution significant pre-
(EMBD)) with processing
high rate of methods such as
accuracy and filtering of noises
precision is and feature
utilized in extraction is
detection of heart provided
attack - uses machine
- incorporated learning in heart
with the alert attack detection
system with the to which the best
use of determined
GSM/GPRS to algorithm yields
send a 98.3% precision
notification to and 97.4%
designated accuracy in
contact person identifying ST-
and also to elevation in ECG
inform user and 98.7%
precision and
96.3% accuracy
in identifying T-
wave inversion in
ECG
Gusev et - uses ECG - Wearable - can be used for - data storage

al., 2017 signal in ECG Sensor remote patient is reliant on
determining heart monitoring local storage
50
attack that is - Dew Server - system presents media of

acquired through (Smartphone) prediction of an patient’s
the use of a - Cloud- onset heart smartphone
wireless ECG based Server attack to which - initial
biosensor can reduce analysis of
- the wireless response time for data are only
ECG biosensor addressing it provided
transmits data to - data in the when
smartphone via cloud-based transmitted to
Bluetooth server are the
- use of accessible by smartphone
smartphone for doctors - requires
pre-processing internet
signals such as connection to
application of access cloud-
DSP filters for based
noise removal processing
- from architecture in
smartphone, data order to
is sent to cloud- access a
based system more
architecture via extensive
LAN/WAN for the data
analysis, processing
prediction, and
detection of heart
attack
51
Ahmed & -Uses ECG - Two - allows remote - no filtering of

El- signal to Arduino or distanced data
Metwally, determine if a Shield Kits patient acquisition
2015 heart attack is - XBee RF monitoring was
occurring using Transmitter - allows incorporated
ECG sensors and Receiver immediate in the design
connected to Modules intervention upon (movement of
Arduino shield kit - ZigBee detection of heart patient can be
-The ZigBee Wireless attack by a factor in
wireless Transmitter automatically contributing
transmitters can and Receiver contacting nearby noise to the
transfer data Modules hospitals and ECG signal)
from the patient designated - no accuracy
to the nearest person as contact or further
hospital including emergency testing was
the designated - allows early provided
contacts in the transmission of particularly in
case of an snippets of ECG the algorithm
emergency readings used for
-The system is (particularly that determining if
integrated inside are abnormal) for there is a
the hospital for early analysis of heart attack
quick response medical (such as
time personnel accuracy rate)
- the mode of
alarm is
limited to
contacting
hospital and
contact
52
personnel (no
built-in alert
system to
notify patients
involved).
- in terms of
data
transmission,
the limit of
correct
transmission
begins at
around 1.2 km
distance
(particularly
with the 3-
second
transmission
of ECG
record);
greater than
1.2km results
in error in
data
transmission
Mondal et -Uses a - Impedance- - Can detect - the solution

al., 2017 biosensor to based biomarkers within is invasive
detect cardiac biosensor 20 minutes
biomarkers to
53
determine - inexpensive
whether a heart materials and
attack has fabrication
occurred techniques are
-AC impedance used to make the
spectroscopy can biosensor
detect when the
target proteins
(Myo and MPO)
are bound to the
specific antibody
changes in the
impedance
between the
electrodes.
-Impedance is
measured using
a frequency
response
analyzer. The
biomarkers can
be detected in
the buffer
solution within
the concentration
range of 100
ng/mL to - 50
ug/mL
54
In relation to the comparison provided in Table 2-1, the existing studies are also
compared to PHAAS. Table 2-2 provides the summary and comparison in terms of
each study and PHAAS's available features. Each feature considered is incorporated
with guide questions.
Table 2-2. Comparison of Features of Existing Studies, HeartBeam, and PHAAS

(Chowdhury et
(Mondal et al.,
(Ahmed & El-
(Gusev et al.,
Metwally,
al., 2019)
PHAAS
Beam
2017)
2015)
2017)
Heart
Portability
(Can the device be
✗ ✓ ✓ ✓ ✓ ✓
carried around by
the subject?)
Continuous
Remote
Monitoring
(Is it capable of ✓ ✓ ✓ ✗ ✗ ✓
continuous and
remote
monitoring?)
Application of
Machine Learning
(Does it use
automatic ✓ ✗ ✗ ✗ ✓ ✓
detection,
specifically with the
use of ML?)
55
Utilization of ECG
as data
(Given its
✓ ✓ ✓ ✗ ✓ ✓
reliability, is ECG
the parameter
used?)
Non-Invasive
(Is it non- ✓ ✓ ✓ ✗ ✓ ✓
invasive?)
Alert System
(Is it incorporated
with an alert
system? Can it ✓ ✗ ✓ ✗ ✗ ✓
contact personnel
in cases of
emergency?)
Pre-processed
data
(Are there ✓ ✓ ✗ N/A N/A ✓
application of
filters?)
Independence to
Internet
Connection
✓ ✗ ✓ ✓ ✗ ✓
(Will the device still
function, in terms
of detection,
56
without internet
connection?)
Incorporated with
Storage
✓ ✓ ✓ N/A N/A ✓
(Can the device
save the results?)
57
CHAPTER III
METHODOLOGY
3.1 Requirements
This section discusses the theoretical considerations, and the hardware and
software requirements necessary for the development of the Portable Heart Attack
Alert System (PHAAS).
3.1.1 Theoretical Considerations
This section explains the theories and concepts in designing the PHAAS
device as an objective-based preventive measure for heart attacks.
3.1.1.1 Electrocardiogram
Electrocardiogram (ECG) is a procedure that measures a heart's
electrical signal (American Heart Association, 2015). ECG readings
primarily consist of waves, segments, and intervals. Each component is
an indication of specific heart activity, which, when the reading does not
fall on the normal pattern can indicate heart problems such as heart
attacks. The main parameter that determines the occurrence of a heart
attack from an ECG reading is the ST segment and T wave (Chowdhury
et al., 2019).
ST segment, as shown in Figure 3-1, is the distance between the
S wave's end and the T wave's start (Biopac Systems, Inc., n.d).
Typically, in a normal ECG reading, it lasts less than 0.20 seconds and
58
is displayed along the isoelectric line. This segment represents the
interval or period between the ventricles' depolarization and
repolarization.
Figure 3-1. Components of Normal ECG Reading (Biopac Systems, Inc., n.d.)
The T wave, on the other hand, is the last waveform shown within
a single cardiac cycle and is typically displayed with a modest upward
waveform representing ventricular repolarization. Normal amplitude
values fall less than 0.5 mV with a duration of 0.10 to 0.25 seconds.
Figure 3-2. Comparison of ST segment variations (Chowdhury et al., 2019)
As mentioned, abnormalities along the ST segment and T wave
mainly indicate a heart attack (Chowdhury et al., 2019). Furthermore,
according to Roland (2020), STEMI is considered to be the most severe
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type of heart attack. With this, the proponents chose to focus the PHAAS’
heart attack detection on STEMI.
As shown in Figure 3-2, specifically under letter (B), STEMI is
determined in the ECG reading with an ST elevation (Chowdhury et al.,
2019). The ST elevation shows the J point, which is the junction of the
QRS complex and the ST segment, to be abnormally above the
isoelectric line alongside the ST segment. According to Kashou et al.
(2021), the threshold for ST elevation is 0.25mV for adult males and
0.15mV for adult females. Furthermore, along with the ST-elevation, T-
wave inversion is also observed. A downward waveform passing below
the isoelectric is shown to be displayed, instead of a typical upward
waveform.
3.1.1.2 Support Vector Machine (SVM)
Support Vector Machine is a supervised machine learning model
primarily used for classification and regression analysis. It is considered
one of the most widely used state-of-the-art machine-learning
techniques (Mahesh, 2019). In one of the studies by Chowdhury et al.
(2019), SVM yielded the highest accuracy rating in detecting heart
attacks, namely STEMI and NSTEMI — 97.4 percent and 96.3%,
respectively. With this, it is proven that SVM is a suitable machine-
learning model for detecting heart attacks.
SVM mainly functions by objectively finding the optimal
hyperplane between different datasets (Gandhi, 2018). A hyperplane is
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a decision boundary that helps classify data points. It can be in any
direction and orientation as long as it is in the position where it separates
the data classes into their respective groups, as shown in Figure 3-3.
Figure 3-3. Possible Hyperplanes in classifying data (Gandhi, 2018)
Figure 3-4. Optimal Hyperplane and Maximum Margin in SVM (Gandhi, 2018)
On the other hand, the optimal hyperplane is considered the best
among all possible hyperplanes. It is an ideal decision boundary that will
yield the maximum margin, as shown in Figure 3-4. The maximum
margin is the maximum distance between the two classes of data points
closest to the hyperplane — these data points are called support
vectors. The support vectors dictate the optimal hyperplane's position
and orientation. In addition, according to Gandhi (2018), the greater the
determined maximum margin is, the greater the reinforcing confidence
for the SVM's classification capability will be.
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Figure 3-5. Linearly separable data (MLMath.io, 2019)
Figure 3-6. Non-linearly separable data (MLMath.io, 2019)
SVM is capable of conducting both linear and non-linear
classification. Linear classification is any data group separable by a
straight line. It is done by finding the hyperplane between two classes.
An example is separating a data group in a 2D plane, as shown in Figure
3-5. Non-linear classification, on the other hand, is a data group that
cannot simply be classified using a straight line, as shown in Figure 3-6.
In order to address this, SVM makes use of kernel tricks.
The kernel trick is a method used to bridge linearity and non-
linearity (Sharma, 2019). The application of a kernel function converts
non-linear dimension space into a higher dimension space where linear
classification can be made, as shown in Figure 3-7. A varying number
of kernel tricks are available, some of which include linear, polynomial,
and radial basis functions.
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Figure 3-7. Application of Kernel for non-linear classification (Sharma, 2019)
3.1.1.3 Digital Filters
ECG signals, like other biomedical signals, are susceptible to
noises. Noises or artifacts are common, undesirable, and unavoidable
interferences that affect the quality of an ECG. A good quality ECG
provides a clear visual representation of the waves, segments, and
intervals that composes the ECG signal. A bad-quality ECG, on the other
hand, provides the opposite — the waves, segments, and intervals are
indistinguishable and unidentifiable. The known predominant noises in
ECG include baseline wander, power-line interference, and muscle
artifacts (Chatterjee et al., 2020). To address this concern, digital filters
are required.
3.1.1.3.1 Bandpass Filter
A bandpass filter is a frequency domain filter that mainly
functions to clean signals by limiting the allowed frequencies from
passing through (Electronics Tutorial, n.d.). This mainly works by
choosing a specific range of frequencies, called a bandwidth, to
pass whilst attenuating and rejecting the other frequencies.
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Figure 3-8. Frequency Response of a Bandpass Filter (Electronics

Tutorial, n.d.)
The main parameter considered in a bandpass filter are
the cut-off frequencies. These are the boundaries, typically
expressed as Hz, where attenuation of unwanted frequencies
begins (Lyn, n.dd). For a bandpass filter, two cut-off frequencies
are required: a lower and a higher cut-off frequency (Rajiv, 2022).
The lower cut-off frequency is the frequency point at which the
filter begins to reject lower frequency components. As shown in
Figure 3-8, any frequency below this given point will have higher
attenuation than the pass band (a range of frequency that can
pass through the filter with little to no attenuation). The higher cut-
off frequency, on the other hand, works similar as the low cut-off
frequency but the attenuation or rejection is applied on higher
frequencies. The bandpass filter is basically a combination of a
low pass and a high pass filter.
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3.1.1.3.2 Moving Average Filter
A moving average filter is a simple low-pass Finite Impulse
Response (FIR) filter meant for smoothing purposes that include
addressing short-term overshoots or noisy fluctuations
(Mathuranathan, 2010; Salain, 2022). This type of filter enables
the retention of the true signal representation and has a sharp
step response.
The moving average filter takes a number of samples from
the input and gives a single output point by calculating the
average of the chosen samples. According to Mathuranathan
(2010), the difference equation represented by the moving
average filter is shown as

𝐿−1
1
𝑦[𝑛 ] = ∑ 𝑥[𝑛 − 𝑘] (3.1)
𝐿
𝑘=0
The x[n] represents the signal input, the L represents the
number of samples taken from the input for averaging (also called
window length), and lastly, the y[n] is the single average output
calculated. An example of a 5-point moving average FIR filter is
provided below. It is shown as
1
𝑦[𝑛 ] = (𝑥[𝑛 ] + 𝑥 [𝑛 − 1] + 𝑥 [𝑛 − 2] + 𝑥 [𝑛 − 3] + 𝑥 [𝑛 − 4]) (3.2)
5
The window length provided in the equation above (2) is
five indicating that the number of samples or values in calculating
the average value is also five. In calculating the average, the sum
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of the sample values is divided by the number of chosen samples.
After the first point, the filter moves to another set of samples and
outputs the average value until it is able to tackle all parts of the
input signal. The overall result of applying the moving average
filter to a noisy signal would be similar to what is shown in Figure
3-9. It is essential to take note that the window length is inversely
proportional to the smoothing effect the filter provides. Hence, the
larger the window length, the clearer the signal becomes or the
more denoising effect it has (Salain, 2022).
Figure 3-9. Sample of Simple Moving Average filter application (Salain,

2022)
3.1.1.3.3 Median Filter
The moving average filter only addresses noises involving
powerline interferences and muscle movements; baseline wander
remains in the ECG signal. In order to address it, a median filter
will be used (Chowdhury et al., 2019).
The median filter is a non-linear digital filtering technique
(Poynton, 2012). The main objective of this filter is to output the
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median from a set of input data points, aiming to reduce the
intensity variation between values within a signal (Felicity, 2022).
This filter is commonly used in image processing (signals in the
spatial domain) for smoothing purposes, especially when dealing
with salt and pepper noises.
It mainly works similarly to a moving average filter using
window lengths. However, the output it yields is in terms of the
sample’s median rather than the average. Statistically speaking,
a median is a middle value in a data set arranged in an ascending
or descending order (Khan, n.d.). According to Monalakis and
Ingle (2011), an example of a five-point median filter is
represented as
𝑦[𝑛 ] = 𝑚𝑒𝑑𝑖𝑎𝑛 (𝑥[𝑛 − 1], 𝑥 [𝑛 − 2], 𝑥 [𝑛 ], 𝑥[𝑛 + 1] , 𝑥 [𝑛 + 2]) (3.3)
The number of samples or window length provided in the
equation above (3.3) is five. Therefore, five values from the input
signal (x[n]) will be considered, and among all the chosen values,
after arranging them in the proper order, the median or the middle
value will be considered as the sole output (y[n]).
3.1.1.4 Feature Extraction
Feature extraction is an essential process in the application of
machine learning. With this, the following theoretical consideration, in
this specific application are listed below.
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3.1.1.4.1 Power Spectral Density
Power spectral density is the distribution or measurement
of a signal’s power in relation to its frequency (Siemens, 2020).
This is calculable using wavelet transform.
Figure 3-10. Variation of Power Spectral Density of normal, ST-elevation, and

T-wave inversion ECG traces (Chowdhury et al., 2019)
According to Chowdhury et al. (2019), calculating the
power spectral density (PSD) is sufficient in classifying the ECGs.
Shown in Figure 3-10 are the variation in PSD peaks displayed
by the normal, ST-elevated, and T-wave inversion ECG traces.
For the case of normal ECG (A&D), the frequencies appeared up
to 30Hz; the peak is approximately at 5Hz with a PSD of
300V2/Hz. On the other hand, the ST-elevated ECG trace (B&E)
shows a dense PSD from less than 5Hz. The peak is around 2Hz,
with a PSD of greater than 400V 2/Hz. Lastly, for the T-wave
inversion (C&F), the peaks are also around less than 5Hz, but
with a peak at approximately 4Hz at 400V 2/Hz.
3.1.1.4.2 Continuous Wavelet Transform
The Continuous Wavelet Transform is a signal processing
technique for analyzing non-stationary signal content in both time
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and frequency domains (Sadowsky, n.d.). This method allows the
representation of the time-frequency relationship of the signal
(Thiamchoo & Phukpattaranont, n.d.). One of the applications of
continuous wavelet transform is R peak detection from ECG
signals (Chowdhury, 2019; Thiamchoo & Phukpattaranont, n.d.).
It is also applied as a feature extraction method and used as a
technique for data analysis (Alharbey et al., 2021; Arts & Broek,
2022).
The continuous wavelet transform enables time-frequency
representation with the use of wavelets. Wavelets, by the name
itself, means small waves, which are in the form of oscillations
that decay quickly (Sifuzzaman et al., 2009).
There are two conditions that wavelets must follow: first,
the wavelet must have a zero mean; and second, it should have
a finite energy (Kirsanov, 2022). A zero mean indicates that the
sum of areas under the curve on both the positive and negative
sides must be equivalent to zero — this ensures that the wavelet
is an oscillation or a wave. This rule is called the admissibility
condition, and it is mathematically represented as

+∞
∫ 𝜓(𝑡)𝑑𝑡 = 0 (3.4)
−∞
On the other hand, for having finite energy, the area under
the curves of a squared wavelet must yield a finite value — this
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ensures that the wavelet is localized in time. This condition is
mathematically represented as
+∞
∫ |𝜓 (𝑡)|2 𝑑𝑡 < ∞ (3.5)
−∞
The general idea of how continuous wavelet transform
works is by a family of wavelets as a basis for comparison from
the input signal. The acquired differences in each wavelet and
input signal enable the acquisition of what frequencies are
present from the input signal at specific times. There are two
parameters considered in applying this process: scale and
translation.
1 +∞ 𝑡−𝑏
𝐶𝑊𝑇 (𝑎, 𝑏 ) = ∫ 𝑥(𝑡)𝜓 ( ) 𝑑𝑡 (3.6)
√𝑎 −∞ 𝑎
The equation above (3.6) is the mathematical
representation of a continuous wavelet transform. x(t) represents
the input signal, 𝜓(t) represents the wavelet function, a represents
the scale parameter, and lastly, b represents the translation
parameter (Sifuzzaman et al., 2009.; Thiamchoo &
Phukpattaranont, n.d.). The scale parameter indicates the degree
of compression, while the translation parameter indicates the time
location of the wavelet.
It is essential to take note of the general relationship
between the scale and translation parameters (MathWorks, n.d.).
When the scaling factor is high, the translation or time-width is
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smaller — this means that the wavelet is of high frequency and is
meant to collect rapidly changing fine details from the input signal.
When the scaling factor is low, on the other hand, the translation
or time-width is larger — this entails that the wavelet is of low
frequency and is designed to collect slowly changing coarse
features. An example of a small and long-scale wavelet is shown
in Figure 3-11. The relationship, as mentioned earlier, shows that
the wavelengths have time widths adapted to their frequencies,
enabling the representation of the signal in the time-frequency
domain.
Figure 3-11. Wavelets with small and long scale factors (MathWorks,
n.d.)
3.1.1.4.1 Synthetic Features
Synthetic feature or data, from the word synthetic itself, is
a form data that is artificially generated (Saeed, 2022). These
types of data are commonly produced through various methods
such as mathematical simulations or application of machine
learning algorithms.
According to Singh (2021), in general, there are mainly two
ways to create synthetic data: first is drawing numbers from a
distribution and second is using agent-based modeling. The
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former works through observation of the statistical distribution of
real-world data and creating replications of it. The latter, on the
other hand, also observes the statistical distribution of the real
world but instead, random data is reproduced.
The use of synthetic features or data are preferred for a
various of reason. Shah (2023) stated that one of the reasons
include is due to faster and cheaper datasets creation.
Additionally, chances of facing issues regarding bias, privacy,
and licensing are lessened. It also provides complete control over
data.
3.1.2 Hardware Requirements
This section lists and discusses the hardware requirements for
developing the PHAAS device. Additionally, laboratory testing equipment is
also included.
3.1.2.1 Hardware Components of PHAAS Device
This section discusses the hardware components involved in
designing the PHAAS device. These components include an Analog
ECG Sensor, an Analog to Digital Converter, a Raspberry Pi 4 Model B
microprocessor, a Micro SD card, a GSM module, an LCD Display, and
a Power bank.
3.1.2.1.1 Analog ECG Sensor
In the study the proponents will require the use of an
Analog ECG Sensor which comprises three components:
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disposable electrodes, lead cables, and the sensor chip. The
corresponding components are shown in Figure 3-12.
Figure 3-12. Sparkfun Analog ECG Sensor Module Kit (Alibaba, n.d.)
The disposable electrodes, shown in Figure 3-13, will be
used to acquire the subject’s ECG data. To be specific, the
disposable electrodes must be compatible to a snap-on type lead
to connect to the sensor chip using the lead connector cable.
Figure 3-13. iCare Disposable ECG Electrodes (iCare, n.d.)
The sensor chip shown in Figure 3-12 is responsible for
measuring the ECG signals from the subject. It should be able to
interface with the Raspberry Pi 4 and has an output voltage that
can be read by an analog to digital converter before being fed to
the Raspberry Pi 4 to process.
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3.1.2.1.2 Analog to Digital Converter (ADC)
In this study, the proponents will require the use of an
analog-to-digital converter (ADC) that can be interfaced with the
Raspberry Pi 4. This ADC will convert the analog signals to digital
signals for the microprocessor to process. Specifically, the ADC
must have 12-bits of resolution and be capable of 250 Hz
sampling frequency to match the acquisition parameters used
from the European ST-T database to train and test the machine
learning algorithm. Figure 3-14 shows the analog-to-digital
converter to be used for this study.
Figure 3-14. Adafruit ADS1015 12-bit ADC (Makerlab Electronics, n.d.)
3.1.2.1.3 Raspberry Pi 4 Model B Microprocessor
In this study, the proponents will require the use of the
Raspberry Pi 4 Model B Microprocessor to integrate all modules
into a single system which includes the acquisition and signal
processing unit, data analysis module, alert system module, and
display system. The microprocessor features a 64-bit quad-core
processor, up to 8 GB of RAM, a micro-SD card slot for local
storage, 40 GPIO pins, and uses a USB C port for power delivery.
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To ensure smooth performance and avoid performance issues,
the proponents recommend using a variant with a minimum of 4
GB of RAM. Figure 3-15 shows the microprocessor to be used for
this study.
Figure 3-15. Raspberry Pi 4 Model B (Raspberry Pi, n.d.)
3.1.2.1.4 Micro SD Card
In this study, the proponents will require the use of a micro-
SD card to store the operating system of the microprocessor,
codes required for each module to function, and subject’s ECG
data. To ensure optimum performance and sufficient storage
capacity, the proponents recommend using a micro-SD card with
a speed class of Class 10, a UHS speed class of U1, and a
capacity of 128 GB of storage. Figure 3-16 shows the micro-SD
card to be used for this study.
Figure 3-16. 128 GB SanDisk Ultra Micro SD Card (Amazon, n.d.)
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3.1.2.1.5 GSM Module
In this study, the proponents will require the use of a
GSM Module that can be interfaced with the Raspberry Pi 4. It
should also have the capability of being programmed to send text
messages via SMS and make voice calls. This will enable the
PHAAS device to notify designated contacts when STEMI ECG
is detected. Figure 3-17 shows the GSM Module to be used for
this study.
Figure 3-17. SIM800L V2 5V Wireless GSM GPRS Module (Maker-lab

electronics, n.d.)
3.1.2.1.6 LCD Display
In this study, the proponents will require the use of an LCD
Display which can be interfaced with the Raspberry Pi 4. It should
also have the capability of being programmed to display the
necessary text the proponents require. This will enable the LCD
Display to display the ECG status of the subject in terms of
whether Normal ECG or STEMI ECG has been detected. Figure
3-18 shows the LCD Display to be used for this study.
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Figure 3-18. 16x2 LCD Display (Maker-lab electronics, n.d.)
3.1.2.1.7 Power Bank
In this study, the proponents will require the use of a power
bank with a capacity of 10,000 mAh, an output voltage of 5.0V
and a current of 3.0A, meeting the power requirements of the
microprocessor (Raspberry Pi, n.d.). This will allow the power
bank to power the microprocessor and all modules integrated to
it.
3.1.2.2 Laboratory Testing Equipment
This section elaborates on the laboratory testing equipment
needed to test PHAAS.
3.1.2.2.1 Digital Multimeter
A digital multimeter is an industry-standard tool for
troubleshooting electrical and electronic systems (Fluke, 2021).
They can precisely measure voltage, current, and resistance. The
measurements are typically displayed in a digital display allowing
the values to be read quickly by the user. This device will be used
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to avoid the use of faulty components and ensure that the
hardware-based materials and circuitry are in proper condition if
it is to be used. The device is shown in Figure 3-19.
Figure 3-19. Digital Multimeter (Fluke, 2021)
3.1.2.2.2 Fluke ProSim8 Vital Signs Simulator
The ProSim8 vital signs simulator, shown in Figure 3-20,
allows for a complete preventive maintenance testing of a patient
monitor, which can take less than 5-minutes (Fluke, n.d.). It has
specialized stay-connected ECG posts for lead connections to be
secured and has physiologically synchronized pulses across all
parameters. This simulator has multiple functions and can
simulate various physiological signals and vital signs such as
respiration, temperature, IBP, cardiac output, NIBP, SpO2, and
many more. Aside from that, this device can also simulate known
physiological outputs of common health concerns such as
bradycardia, tachycardia, and arrhythmias — the most significant
simulation the device can provide concerning this study, are
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normal ECG, ECG with artifacts, and ECG with varying ST-
elevations.
Figure 3-20. Fluke Prosim8 Vital Signs Simulator (Fluke, n.d.)
3.1.2.2.3 Laptop
Windows 10 Laptop with a 15.6-inch display and a
resolution of 1920x1080 is to be used for verification and testing
purposes (Carousel, n.d.). The laptop is powered by an Intel Core
i5-9300H and has Nvidia GeForce RTX 2060 graphics. It also has
16 GB of RAM, 256 GB of SSD storage, and 1TB of HDD storage.
The laptop will mainly be used to run software such as MATLAB
and python programming software, to test the accuracy of the
machine learning algorithm, verify the codes programmed, and
for accessing RPI for the development and testing of PHAAS.
Figure 3-21 shows the laptop to be used.
Figure 3-21. ACER Predator Helios 300 Gaming Laptop (Carousel,

n.d.)
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3.1.3 Software Requirements
This section lists and discusses the software requirements for
developing the PHAAS device.
3.1.3.1 Raspberry Pi OS
The Raspberry Pi OS will serve as the operating system for
running the function of the PHAAS device. Mainly it will allow the device
to run the software programs to process the signal acquired from the
subject, implement the machine learning algorithm, send the alert using
the GSM module in the occurrence of the heart attack, and display the
status of the ECG.
3.1.3.2 WFDB (Waveform Database) Toolbox
WFDB (Waveform Database) Toolbox for MATLAB/Octave is an
open-source toolbox that allows access to data provided by PhysioNet
Databases (Silva and Moody, 2014). It provides various functions that
allow the reading, writing, and processing of signals from the mentioned
database (PhysioNet, 2017).
3.1.3.3 Python
Python is a simple, yet powerful programming language widely
used in various applications. Such applications include web
development, automation or scripting, software testing and prototyping,
data analysis and visualization, machine learning, and many more
(Coursera, 2022). According to Python Institute (n.d.), it is beginner

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friendly, object-oriented, high-level with dynamic semantics, and a
general-purpose programming language. It is also free and hosts
thousands of third-party modules both from Python's standard library
and those contributed by the community (Python Software Foundation,
n.d.).
3.1.3.4 Scikit Learn
Scikit learn is an open-sourced machine learning library that uses
the python language and supports supervised and unsupervised
learning. It has various tools at its disposal for model-fitting, data pre-
processing, model selection, model evaluation, and more (scikit-learn,
n.d.), which will help create the chosen machine learning algorithm for
this study.
3.1.3.5 LiquidCrystal library
The LiquidCrystal library will be used to control the LCD
displaying the status of the subject's processed and analyzed ECG
signal.
3.2 Functional Design
This section discusses the functionalities of each module involved in designing
the PHAAS, specifically in terms of the hardware and software components. The block
diagram of the PHAAS device is shown in Figure 3-22.
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3.2.1 Functional Analysis of Hardware Component
This section elaborates on the functionalities of modules involved in
hardware components. The modules involved in the PHAAS device are the
acquisition and signal processing unit, data analysis module, alert system
module, storage unit, display system, and battery module. These components
are confined in a single enclosure that is portable enough for the subject to
carry around. The preliminary design and approximate dimensions of the
PHAAS are provided in Figures 3-24 and 3-25, respectively.
3.2.1.1 Acquisition and Signal Processing Unit
On the hardware side, the primary function of the acquisition and
signal processing unit is to allow the acquisition of ECG data from the
subject. Mainly, this is composed of the analog ECG sensor and analog-
to-digital converter.
Figure 3-22. Block Diagram of PHAAS
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Figure 3-23. Preliminary Design of Portable Heart Attack Alert System
Figure 3-24. Approximate Dimensions of Portable Heart Attack Alert System
3.2.1.1.1 Analog ECG Sensor
In the data acquisition process, Chest lead II configuration
is followed in acquiring the ECG from the subject, as shown in
Figure 3-25. According to Chowdhury et al. (2017), chest lead II
placement along with chest straight lead were comparable to
clinical grade ECG traces when acquired and are suitable for
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comfort in terms of portability. Additionally, a maximum of three
electrodes are only used in the provided set-ups which is
preferable given that it simplifies the ECG acquisition process.
With this, the proponents adapted the use of chest lead II
configuration. Each electrode represents a specific electrical
charge, which are namely positive, negative, and neutral. The
positive electrode will be attached aligned to the right arm while
the negative electrode will be aligned along the left arm. The
neutral electrode, on the other hand, is aligned unto the left leg.
All placements are within the premises of the subject’s chest. It is
important to take note that disposable ECG electrodes were
chosen by the proponents due to the unavailability of dry ECG
electrodes.
Figure 3-25. Chest Lead II Configuration (Sampson, 2018)
The ECG electrodes serve as the medium where the
electrical activities of a subject's heart are measured. Three lead
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connectors will correspondingly be used, allowing connection
between the electrodes and the analog ECG sensor.
The analog ECG sensor chip receives the analog
measurements of electrical impulses of the heart acquired by the
disposable electrodes connected via lead connectors. This
hardware component is connected to the analog-to-digital
converter for further processing.
3.2.1.1.2 Analog to Digital Converter
The Analog to Digital Converter allows the conversion of
analog ECG signals measured using the ECG sensor into digital
data. It will enable easy access by microprocessors like the
Raspberry Pi 4, as its GPIO pins can read digital signals only.
The analog ECG sensor is routed through the analog-to-digital
converter, which is connected to the microprocessor as it lacks
an integrated analog-to-digital converter. This is the receiving
point of the digitized ECG signal and is where the data analysis
module accesses the data.
3.2.1.2 Data Analysis Module
The main function of this module is to integrate all the hardware
and software components of the proposed device. Additionally, it makes
use of the machine learning algorithm to analyze ECG signals and
detect for heart attacks, specifically STEMI.
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3.2.1.2.1 Raspberry Pi 4 Model B Microprocessor
The microprocessor allows the machine learning algorithm
system to run or work in the PHAAS device. Raspberry Pi 4 Model
B has the processing power to run multiple processes
simultaneously with its 64-bit quad-core CPU and up to 8GB of
RAM (Raspberry Pi, n.d.). Additionally, unlike microcontrollers, it
is easier to run machine learning algorithms on microprocessors
like the Raspberry Pi.
Furthermore, the microprocessor is the main component
of the overall system of the proposed device, the Portable Heart
Attack Alert System (PHAAS). This component serves as the
integration point of all modules involved in the hardware and
software aspects — the control system of the whole PHAAS.
3.2.1.3 Storage Unit
The storage unit’s main function is to store information regarding
the analysis of ECG data. It also serves as the access point where
medical professionals can acquire the ECG recordings for further
diagnosis locally on the device. This module involves the use of a Micro-
SD card.
3.2.1.3.1 Micro SD Card
A Micro-SD card would be used as storage for the PHAAS
device. The recommended speed classes are Class 10 and U1,
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while the capacity is at least 128 GB to ensure optimum
performance of the system and sufficient storage capacity for
data to be stored. Specific folders within the SD card would be
created in order to manually access the saved ECG data
acquired. There are four types of data to be saved such as the
subject’s ECG and corresponding status, the filtered results, and
features extracted in each reading. All the mentioned data are
saved as a file with appropriate file names and information such
as date and time of each acquisition.
3.2.1.4 Alert System Module
The alert system module’s main function is to notify the
designated contacts, the user and involved clinician, when a heart attack
is detected. This module involves the use of a GSM Module.
3.2.1.4.1 GSM Module
The microprocessor controls the GSM module and
decides when to send the notifications based on the decision
made by data analysis module. When a heart attack is detected,
the GSM module will notify the designated contacts through SMS
and voice calls.
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3.2.1.5 Display Module
The display module’s main function is to show whether the device
was able to detect a heart attack or not. This module is mainly composed
of an LCD Display.
3.2.1.5.1 LCD Display
The LCD Display, which is integrated with the
microprocessor, allows for the display output based on the
conclusion reached by the data analysis module. When the
acquired data results in a heart attack being detected, the status
“STEMI ECG Detected” will be displayed on the LCD Display for
user awareness. If heart attack is not detected, the status “Normal
ECG” should be displayed.
3.2.1.6 Battery Module
The battery module is the device's power source, making it
portable. The main component of this module is a Power Bank.
3.2.1.6.1 Power Bank
The power bank is a portable power supply that is to be
connected to the microprocessor allowing it to power the modules
integrated to it. It must have a capacity of 10,000 mAh, a voltage
output of 5.0V, and 3.0A current.
The estimated length of time a 10,000 mAh power bank
can support the PHAAS device is approximately six hours. The
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total current to be utilized by the overall integration of modules is
approximately 1500mA (see appendix H). The following formula
(3.7) is used to calculate the expected battery life of the power
bank upon incorporation of other modules included.
𝐵𝑎𝑡𝑡𝑒𝑟𝑦 𝐶𝑎𝑝𝑎𝑐𝑖𝑡𝑦 (𝑖𝑛 𝐴ℎ)

𝐵𝑎𝑡𝑡𝑒𝑟𝑦 𝐿𝑖𝑓𝑒 (𝑖𝑛 ℎ𝑜𝑢𝑟𝑠) = (3.7)
𝐿𝑜𝑎𝑑 𝐶𝑢𝑟𝑟𝑒𝑛𝑡 (𝑖𝑛 𝐴)
3.2.2 Functional Analysis of Software Components
This section elaborates on the functionalities of modules involved in the
software aspect of the PHAAS device. The main flowchart of the functional
analysis of software components is provided in Figure 3-26. It shows the overall
interaction between modules upon operation of PHAAS.
Figure 3-26. Main flowchart of PHAAS
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3.2.2.1 Acquisition and Signal Processing Unit
The Signal Processing and Acquisition Unit of PHAAS will first
acquire the ECG data up to 2500 samples. Upon acquisition, the raw
data will then be pre-processed with the application of digital filters for
the removal of noise which are namely bandpass, moving average, and
median filters. Feature extraction methods, on the other hand, are also
applied for the purpose of highlighting and simplifying essential features
or components of the ECG signal, wherein, continuous wavelet
transforms, power spectral density, and synthetic features are
considered. The data, now pre-processed, will then be forwarded to the
data analysis module for further processing. The flow diagram of the
acquisition and signal processing unit is provided in Figure 3-27.
Figure 3-27. Flow diagram of Acquisition and Signal Processing Unit
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It must be taken note that the acquired raw data and the
corresponding pre-processed data are considered for storing for the
reason that it can be reused for further development of the suggested
device. It also serves as a method at which the doctor or clinician can
access the user’s data for further review. The mentioned data that are
meant for storing are forwarded for the storage module to address.
3.2.2.2 Data Analysis Module
For this module, a machine learning algorithm is trained using the
Support Vector Machine (SVM) model to analyze the data. Upon
analysis of the received pre-processed data, either of the two
classifications can be provided — either the processed ECG data is
normal or STEMI. For the latter, the information would be redirected to
the alert system module, saved in the storage module, and displayed by
the display module. If it is the former, it would only be redirected to the
storage and display modules. Figure 3-28 shows the flow diagram of the
data analysis module.
In terms of training the machine learning model, various
procedures are conducted prior to the actual training. The procedures
extend from collection, balancing, pre-processing, and splitting of data.
Upon the actual training, supporting procedures such as finding optimal
hyperparameter, scaling, and feature selection are applied. This is to
increase the chances of developing models exhibiting good
performance. The flow of this overall procedure is shown in Figure 3-29.
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Figure 3-28. Flow Diagram of Data Analysis Module
Figure 3-29. Flow Diagram of Training Machine Learning Process
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3.2.2.2.1 Data Collection for Model Construction and
Validation
The datasets for training and testing the machine learning
algorithm will be acquired from PhysioNet’s open online-source
European ST-T Database. The database consists of ambulatory
ECG recordings from 70 men aged 30 to 84, and 8 women aged
55 to 71 (PhysioNet, 2000a). Each recording is 2 two hours long
and contains two ECG signals sampled at 250 Hz with 12-bit
resolution over a nominal 20 mV input range.
Additionally, it offers string annotations (annotation that
provides the start, peak, and end of an event) and interpretations
are available in the annotation notes provided by PhysioNet. In
accessing this database, WFDB Toolbox will be used, which is a
an open-source toolbox for analyzing and processing PhysioNet
databases in MATLAB and octave.
This dataset is suitable for building the machine learning
model given it provides normal and ST-elevated ECG cases
which are the relevant data being considered in this study. This
mainly contributes to the development of the machine learning.
Given the available data, training of the model for binary
classification of normal and STEMI ECG is made possible.
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3.2.2.2.2 Balancing Dataset
According to Ali et al. (2019), when a dataset is
imbalanced, it can hinder the learning process of classifiers by
creating a bias towards the majority class and disregarding the
minority class. To tackle this issue, two primary methods were
proposed in the dealing the imbalance problem: upsampling and
downsampling. The upsampling approach attempts to balance
out the underrepresented minority class by generating new
samples through the duplication of existing ones. Conversely,
downsampling reduces the size of the majority class by removing
samples, thereby balancing the amount of class distribution.
In the case of this paper, the downsampling method is the
preferred way to address imbalanced data due to its simplicity.
Additionally, Ali et al. (2019) pointed out, that the replication of
samples in the upsampling process may lead to classifiers
overfitting the data. The upsampling method would also increase
the total number of datasets, making it computationally
demanding and time-consuming to use.
3.2.2.2.3 Pre-processing Data
The procedures applied for pre-processing data is the
same or similar to what is proposed to be used for the PHAAS
device: the application of digital filters stated under section
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3.1.1.3 and the extraction of the stated features under section
3.1.1.4.
3.2.2.2.4 Splitting Training and Testing Data
When the necessary data are secured and pre-processed,
it will then be split into two groups: one set for training and another
for testing or validation. The distribution of data follows a ratio of
70:30 where 70% of the data will be allotted for the training and
the rest of the 30% are for testing.
Both the training dataset includes labeled data which will
be the guide of the machine learning model in determining the
difference between normal ECG and ECG with ST-elevation. On
the other hand, the testing or validation dataset will be used to
evaluate the classification performance of the trained SVM.
For each data class, a minimum of 50 entries will be
utilized. The length of each ECG data will be made of 2500
samples which is equivalent to 10 seconds at a sampling rate of
250Hz.To ensure that there is a proportional distribution of
classes between training and testing dataset, stratified sampling
is considered. This sampling technique ensures that the
distribution is a close representation of the overall population of
the data collected (Baeldung, 2022). Furthermore, this method
can contribute to improving machine learning model accuracy.
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3.2.2.2.5 Training Machine Learning Algorithm
Training the machine learning simply involves the process
of feeding it with labeled training dataset (Banoula, 2023). The
model, Sector Vector Machine (SVM), will educate itself and
develop its own algorithm in classifying the provided classes
which in the case of this paper, is STEMI and normal ECG. For
the whole process of machine learning training, please refer to
Figure 3-29.
To guarantee optimal performance of the machine
learning model, necessary measures were considered.
According to Baylon and Usama (2022), the following methods
are effective in increasing machine learning performance:
3.2.2.2.5.1 Finding Optimal Hyperparameters
Hyperparameters are adjustable parameters that
greatly affect the learning process of a machine learning
model (Rouse, 2022). Hyperparameters are conditions
that the machine learning model have no control over.
Unlike parameters, which are internal, hyperparameters
are explicit which can only be controlled and managed by
the developers (Nyuytiymbiy, 2020). There are various set
of hyperparameters that can be considered, but those that
should be used should depend on the type of model to be
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developed. For Support Vector Machine, kernel sizes, C,
gamma, and degree are examples (Amy, 2022).
The kernels are mainly functions that initially allow
non-linear classification to be linear through mapping of
input data into a higher-dimensional feature space (Afonja,
2017). This is commonly known as the kernel trick. Some
kernels are influenced by the hyperparameter degree such
as the polynomial kernel. The Degree hyperparameter
mainly settles degrees of freedom the kernel will use.
On the other hand, C (Regularization) is the
hyperparameter that indicates how much of
misclassification will be allowed based on a provided
margin (Barua, 2022). It mainly controls the trade-off
between maximizing the margin and minimizing the
classification error. For the gamma, it mainly directs the
shape of the decision boundary by considering the
influence the data points at a certain distance from the
hyperplane will have.
In summary, the choice of kernel size, C, gamma,
and degree in SVM can significantly affect its
performance, and these hyperparameters should be
carefully tuned based on the specific problem and data at
hand.
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3.2.2.2.5.2 Scaling Data
Feature scaling is a technique used to normalize
data to a common range or scale, with the aim of mitigating
the impact of outliers on model performance (Chong,
2020). It involves transforming the data so that it has a
uniform scale, which helps in reducing the disparity in
magnitude between outliers and other data points. This
promotes generalization in machine learning models by
allowing them to make consistent conclusions based on a
standardized scale of values. Example of scaling method
includes z-score and min-max normalization
(Codecademy, n.d.).
Min-Max normalization works by squeezing values
to fit a specific range, such as from 0 to 1. The minimum
value within the set of data is set to 0, while the maximum
value is set to be represented by 1. every other value gets
transformed into a decimal between 0 and 1. On the other
hand, the z-score, conducts normalization by making the
set of data have a mean equal to zero and the standard
deviation by 1.
The trade-off between the two methods is that min-
max normalization has a set range to fit the data but does
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not handle the outliers well. Z-score, on the other hand, is
the opposite.
3.2.2.2.5.3 Feature Selection
Feature selection is a method that selects a set of
features that best improves a model’s performance
(Menon, 2023). This means that the features don’t have
much contribution to model performance are removed,
and those that provides relevance are retrained.
Furthermore, this method is beneficial because it can
remove features that doesn’t significantly provide
important information, or worse, that causes discrepancies
to the model. Also, limiting the features involved also
makes the algorithm less computationally extensive.
3.2.2.3 Storage Unit
The Storage Module is where the ECG data are saved. It is stored locally
wherein four types of data are considered: the raw data, filtered data, features,
and class label predicted. All the indicated data are to be saved as files in an
allotted folder within the SD card. It is where authorized personnel such as
medical professionals can access the data for further review and diagnosis.
Figure 3-30 provides the flow diagram of the storage module.
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Figure 3-30. Flow Diagram of Storage Module
3.2.2.4 Alert System Module
The alert system module of PHAAS mainly involves using a GSM
module. This module is only utilized when a STEMI is identified within the ECG
data. The alert system module is responsible for sending notifications to
designated contacts, which are the user and the clinician. The notification will
mainly include the status of the subject along with the date and time and relayed
via SMS and voice call. The alert system module flow diagram is shown in
Figure 3-31.
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Figure 3-31. Flow Diagram of Alert System Module
3.2.2.5 Display Module
The display system mainly displays the result presented by the data
analysis module via LCD. As shown in Figure 3-32, the message or text
displayed on the LCD screen mainly depends on the result. It will either display
with "STEMI detected" when an ST-elevation is detected within the ECG or a
text display of "Normal" when the ECG is classified as normal.
Figure 3-32. Flow diagram of Display System
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3.3 Testing and Validation
This section describes the process of how the system would be tested which
should provide validation for the results in evaluating the PHAAS device.
3.3.1 Functional Testing
This section explains the process involved in alpha testing. Alpha testing
evaluates the functionality of individual modules involved in the design of
PHAAS. Six modules are involved in the device: a signal acquisition unit, a data
analysis module, an alert system module, a storage module, a display system,
and a battery module. Functional testing is conducted to ensure that all
modules are correctly implemented and operational. Table 3-1 shows the
summary of the functional test for each module.
3.3.1.1 Testing Acquisition and Signal Processing Unit
The goals in testing the acquisition and signal processing unit are
to check if the sensor can acquire an ECG signal and if the digital filters
work effectively.
In testing the sensor, the proponents will serve as the subject for
gathering ECG signals. The three disposable electrodes are placed on
the subject following the chest lead II setup, and the leads are attached
to the corresponding electrodes. An ADC is incorporated with the sensor
to convert the signal from analog to digital.
The user’s ECG signal will be acquired using a pre-programmed
algorithm encoded using python and applied using Rpi. The
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corresponding data will be digitally viewed via the terminal and visually
verified if a signal is acquired. If ECG was acquired a score of 1 is given,
if not, a score of 0 will be provided instead. The expected success rate
for testing the acquisition is around 95% after conducting ten test trials.
The electrode placement quality and the unavoidable presence of
impedance caused by skin were considered.
On the other hand, the Prosim8 Vital Signs simulator will be used
to test the digital filters. The ECG artifacts from the Prosim8 simulator
include respiration, baseline wander, muscle movement, and power line
interference. For every noise, three artifact sizes can be generated
which are represented in terms of percentages namely 25, 50, and 100
percent. Given that there will be ten trials for this test, five of them will
use Normal ECG; the fifth noise for the fifth trial will be chosen randomly
from the four available noises. The remaining trials will use STEMI with
random ST-elevation values that extends from +0.5mV to +0.80mV,
wherein the tenth trial also chooses a random artifact. Visual comparison
will be made between the unfiltered and filtered ECG simulations; to
evaluate the results, the following scoring will be applied: 0 for not
effective, 0.5 for fairly effective, and 1 for most effective. A success rate
of at least 90% is expected after ten trials. Factors such as the quality
and design of the filters are considered.
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3.3.1.2 Testing Data Analysis Module
Prior to implementation of machine learning model, the
classification performance will be tested using training and testing data
acquired from European ST-T Database. There will be two stages of
testing.
The initial test will include the use of 5-fold cross-validation for
testing the generalization or estimation of performance of the built SVM
model on unseen data. This is conducted to maximize available data
and avoid overfitting tendencies when building the machine learning
model. With this, the average accuracy of the 5-fold cross-validation will
be the main metric for evaluating of the performance of the model.
True positive rate (TPR) (3.8), false positive rate (FPR) (3.9),
specificity (3.10), precision (3.11), f-measure (3.12), and general
accuracy (3.13) of the model will also be calculated in support of average
k-fold accuracy. The following equations of the parameters chosen are
shown below.
𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠
𝑇𝑃𝑅 = 𝑅𝑒𝑐𝑎𝑙𝑙 = (3.8)
𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 + 𝐹𝑎𝑙𝑠𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒
𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠
𝐹𝑃𝑅 = (3.9)
𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 + 𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒
𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠
𝑆𝑝𝑒𝑐𝑖𝑓𝑖𝑐𝑖𝑡𝑦 = (3.10)
𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 + 𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠
𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠
𝑃𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 = (3.11)
𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 + 𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠
2 𝑥 𝑃𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 𝑥 𝑅𝑒𝑐𝑎𝑙𝑙
𝐹 − 𝑠𝑐𝑜𝑟𝑒 = (3.12)
𝑃𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 + 𝑅𝑒𝑐𝑎𝑙𝑙
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𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 + 𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠
𝐴𝑐𝑐𝑢𝑟𝑎𝑐𝑦 = (3.13)
𝑇𝑜𝑡𝑎𝑙 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐸𝑥𝑎𝑚𝑝𝑙𝑒𝑠
Once the model's performance is satisfactory, final testing will
occur by testing the model using the testing dataset. The main parameter
for evaluating the performance of the model in this setting is the general
accuracy (3.13). The rest of the parameters indicated above will be used
to support the main metric considered.
The initial test expects at least 90% K-fold accuracy. Accuracy is
the rate of overall correct predictions among the provided sample. The
higher the value of the accuracy, the better the performance of the model
is. The same accuracy value is also expected with the final test using
the testing dataset. In setting the success rate, the variables such as the
availability and quality of datasets used, and the quality of filters were
considered.
In terms of the other statistical parameters, the TPR, specificity,
precision, and f-score are preferable to yield high values. The true
positive rate (TPR), also known as recall and sensitivity, indicates the
correct predictions in the positive class. A high TPR value is, the
indicates that the model is good at correctly predicting the positive class,
which in this study is the STEMI ECG. On the other hand, specificity,
also known as the true negative rate (TNR), indicates the correct
predictions in the negative class. It indicates how good the model is at
classifying normal ECG. Regarding the precision, it provides the ratio of
true positives among the predicted positive class. It tells how consistent
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the model can predict STEMI. Furthermore, the f-score is the harmonic
mean between precision and recall which sums up the predictive
performance of the model.
Regarding the FPR, it is preferable to yield a lower value. The
false positive rate (FPR) indicates the incorrect predications in the
positive class. The lower the FPR is, the better the model is in classifying
STEMI.
3.3.1.3 Testing Storage Module
Manual checking will be conducted if the ECG data has
successfully been stored in the local storage. It will be done by first
acquiring an ECG sample which will be saved as a file. It will then be
accessed and viewed if the ECG data is present and saved within the
allotted folder within the SD card with an appropriate label or file name.
All factors involved in testing this module can be guaranteed to be fixed,
therefore, after ten trials, the expected success rate is 100%.
3.3.1.4 Testing Alert System Module
In testing the alert system module, it would be set by default to
send a message via SMS and voice call using a python-coded algorithm.
It is expected to be received by the designated contact person. The time
interval when the message and call is received will also be considered.
With the parameters involved in testing this module, stability can be
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ensured. Hence, the expected success rate is 100% for each of the ten
trials.
3.3.1.5 Testing Display System
To evaluate if the display system functions accordingly, text or
message indicators must be provided or displayed on the LCD screen.
Random messages are set in a python-coded algorithm to be displayed
on the LCD. The output message shown in the LCD must match the
inputted message. Given that all variables can be guaranteed to be
secured, it is expected to have 100% success rate after ten trials.
3.3.1.6 Testing Battery Module
In evaluating the battery module, it must be tested to determine
whether the power bank can power up the other modules involved in
PHAAS upon use — all modules must be functional. Simple connection
between the modules and the power bank is required in doing this
testing; hence, the success rate is expected to be 100% after testing it
ten times.
On the other hand, the length of time as to how long the battery
can support the modules will be tested; it will be done by recording the
time from when the battery module began to power up the other modules
until the time the power runs out. The estimated amount of time it can
support the modules is around six hours; the calculation of the estimated
value is provided in section 3.2.1.6. The result of the test is expected to
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be around the same value from the estimation, yet it may be different in
actual application as some unconsidered factors may appear; hence a
95% success rate after ten trials.
Table 3-1. Summary of functional testing
No. of Trials
Objective
Expected
Success
Method
Module
Output
Rate
Test
Acquisition Determine if Visual 10 Module can At least

and Signal ECG is confirmation acquire ECG 95%
Processing acquirable of ECG signal and is
Unit and digitally using accessible
accessible python- digitally
coded
algorithm
Determine if Visual 10 Simulated At least

capable of comparison ECG noises 90%
filtering ECG of filtered are filtered
noises and clean (filtered ECG
ECG using is closely
python- similar to
coded clean ECG)
algorithm
Analysis Determine if 5-fold cross 10 Model shows At least

Module model shows validation generalization 90%
generalization using
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training
dataset
Determine if Using 10 Model At least

final model testing displays good 90%
effectively dataset performance
classify
normal from
STEMI ECG
Alert Determine if Attempt 10 Messages 100%

System GSM can sending are received
send random by assigned
messages via messages contact via
SMS and to assigned SMS and
voice call contact via voice call
SMS and
voice call
Storage Determine if Manual 10 ECG files are 100%

Unit acquired checking of found in the
ECGs are files in allotted folder
saved in local micro-SD in micro-SD
storage card card
Display Determine if Attempt 10 Texts 100%

System LCD can randomly displays
display showing accordingly
messages messages
on screen
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Battery Determine if All modules 10 All modules 100%

Module power bank that are are working
can support integrated
the are fully
integration of functional
all modules
Determine Record 10 Power bank 95%

how long the length of is expected to
power bank time from last around 5
can support start of use hours
the device until power
is out
3.3.2 System Testing
This section elaborates the process involved in system testing. It is the
evaluation of the device's overall functionality in which the individual modules'
functions are tested as an integrated system. The test will be conducted using
the Fluke Prosim8 Vital Signs simulator.
Fluke Prosim8 Vital Signs simulator is an equipment capable of
simulating various ECG conditions such as normal and ST-elevated ECGs. It
can also add artifacts, such as muscle movement, wandering baseline,
powerline interference, and respiration.
In terms of the ST-elevated ECGs, the ST-elevation value that it can
generate range from +0.05 to +0.80mV. On the other hand, for the artifacts
provided, an option for controlling the size is provided. The artifact sizes are
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represented in terms of percentages wherein the options extend to 25%, 50%,
and 100%.
To ensure consistency in the expected results when applying the system
testing, finding the ST-elevation threshold the machine learning model can
detect and the effect of various artifact size to the machine learning prediction
is needed. To conduct this test, five trials will be considered where each trial is
composed of a specific simulation. For each trial the following test cases are
considered:
Test case 1: ECG simulation without artifacts
Test case 2: ECG simulation with 60Hz powerline interference
Test case 3: ECG simulation with baseline wander
Test case 4: ECG simulation with respiration artifact
Test case 5: ECG simulation with muscle artifacts
For each trial, all the three available artifact cases and all available nine
ST-elevation, including normal ECG are considered. The results of this test will
decide the parameters considered under system testing. The ST-elevation
threshold will be determined in terms of the total STEMI predicted; a success
rate of 90% is considered, the least values that passes the success indicated
success rate will be chosen. As for the artifact size, its influence on the
prediction of the machine learning algorithm will be determined via the accuracy
of prediction. The average accuracy, per each artifact size is calculated and
compared. A success or accuracy rate of 90% is expected, the largest artifact
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size that meets the expected success rate will be considered. Upon acquiring
these parameters, system testing can be proceeded.
Proceeding towards system testing, there will be two cases of test. The
first case includes the simulation and testing of ECG with ST-elevation. The
second case, on the other hand, tests and simulates normal ECG. In each
case, there will be a total of three phases or integration of modules. Phase 1
integrates the acquisition and signal processing unit along the data analysis
and battery modules. Phase 2 combines the modules involved in phase 1 with
the storage and display modules. Lastly, phase 3 is the integration of all the
modules involved in the PHAAS device.
Per each phase, at least a 90% of success rate is expected in both
cases. Factors such as type of electrode used, the electrode placement, quality
of dataset used in training the machine learning, and quality of filters and
feature extraction are considered in the estimation of the success rates. Per
module, five trials will be conducted where each follows the test cases from the
previous test conducted which is determining ST-elevation and artifact size
threshold.
Each phase will be evaluated in terms of how each module responds to
their assigned simulated ECG. Each modules involved are expected to yield
appropriate outcomes, which are provided in tables 3-2 and 3-3. The
corresponding procedures in verifying the results per each module will adapt
the methods indicated in section 3.3.1; except for the data analysis module
wherein k-fold cross validation will not be included anymore given the input
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signal will not be from the online database but from an ECG simulator. The
function of the data analysis module will be determined by the prediction it
provides per trial. In addition to this, after the test, the data acquired will be
used and collected to determine model performance.
For the summary of details per each system testing, refer to Tables 3-2
and 3-3. The phase group, modules involved, number of trials to be conducted,
expected output, and expected success rate are included in the tables.
Table 3-2. Case 1 for System Testing

Case 1: ECG with ST-elevation
No. of Success
Phase Modules involved Expected output
Trials rate
I (1) Acquisition and - ECG is acquired and 5 At least

Signal Processing filtered 90%
Unit
(2) Analysis - Correctly predicts

Module ECG with heart attack
(3) Battery Module - Battery can power up

the modules involved
II (1) Acquisition and - ECG is acquired and 5 At least

Unit

Module ECG with a heart attack
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(4) Storage Unit - Saves ECG acquired

to local storage
(5) Display System - Displays in

accordance with what is
predicted by the data
analysis module
III (1) Acquisition and - ECG is acquired and 5 At least

Unit

Module ECG with a heart attack

(4) Storage Unit - Saves ECG acquired

to local storage
(5) Display System - Displays in

analysis module
(6) Alert System - Course of action in

analysis module
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Table 3-3. Case 2 for System Testing
Case 2: Normal ECG
Modules No. of Success

Phase Expected output
involved Trials rate
I (1) Acquisition and - ECG is acquired and 5 At least

Unit

Module Normal ECG

II (1) Acquisition and - ECG is acquired and 5 At least

Unit

Module Normal ECG

(4) Storage Unit - Saves ECG acquired to

local storage
(5) Display - Displays in accordance

System with what is predicted by
the data analysis module
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III (1) Acquisition and - ECG is acquired and 5 At least

Unit

Module Normal ECG

(4) Storage Unit - Saves ECG acquired to

local storage
(5) Display - Displays in accordance

System with what is predicted by
the data analysis module
(6) Alert System - Course of action in

analysis module
3.3.3 Beta Testing
This section explains the application of user acceptance towards the
PHAAS device, mainly in terms of portability and comfortability. This type of
testing involves a real user using the device. This test aims to expose the
developed PHAAS device to a realistic setting of applications such as common
everyday activities like walking and sitting. Moreover, five healthy volunteers
are expected to participate with a duration trial of three hours within their day.
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The beta testing will be done in three phases: pre-test, during the test, and
post-test.
In the pre-test, providing the consent form, acquisition of the participant’s
profile, and orientation about the test will be conducted. The consent form will
first be given where the participant must provide her consent in his/her
participation in the test to be conducted, see Appendix D. Afterward, if
consented, the participant’s profile will be acquired. This is mainly to confirm
that the involved individual is in good health. This will be done by answering a
set of questions as shown in Appendix E. On the other hand, the orientation
will inform the participants regarding the purpose of the test. Additionally, the
function of the device will also be explained and also what to expect during the
testing.
During the test, the proponents will guide the participants throughout the
process. The proponents will make the participants conduct a list of activities,
which in total are six namely sitting, standing, laying down, walking, running,
and jumping. For every activity, five trials are conducted. Results including the
raw data, filtered data and the ECG predictions are saved.
After the trial, the participants are expected to answer a survey regarding
their experience and assessment of the device. The post-survey will utilize a 5-
Likert scale and open-ended questions mainly revolving around the portability
and comfortability of the device as shown in Appendix F. In terms of evaluating
the survey results, this will be done only in terms of the 5-Likert scale, wherein
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the acceptable range of value is around 3.41 to 5.00 which is representative of
the overall participants agreeing with the provided statements.
In terms of determining the capability of the machine learning model to
correctly detect the type of ECG, collected data from the healthy volunteers are
used. Furthermore, the details regarding the beta testing are summarized in
Table 3-4. The corresponding perimeters and procedures are provided.
Table 3-4. Summary of Beta Testing

Beta Testing Perimeters
No. of Participants 5 Healthy Volunteers
Beta Testing Procedure
Test Phase Action
- Acquiring participant profile and health condition
using a questionnaire
- Orienting the participants about the purpose of the
Pre-test
test, the function of the device, expectation of
intermittent monitoring, and listing of activities for
during the trial.
- Volunteers conduct the list of activities.

During Test
- ECG status, raw and filtered data are recorded
- Participant to answer the evaluation survey; it is

made using 5-likert scale supported by open ended
Post-test
questions. Survey is mainly about portability and
comfort of use by the volunteer.
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CHAPTER IV
ENGINEERING DESIGN
This chapter discusses the implementation of the modules of the Portable Heart
Attack Alert System, including the hardware and software used and the integration of
each module.
Figure 4-1 Block Diagram of the Experimental Setup of the Proposed Device
Shown in Figure 4-1 is the block diagram of the experimental setup of the
proposed device. Before the acquisition of ECG data, ECG electrode patches are
attached to a user following the Chest Lead II set-up. Once the user is set-up,
acquiring and pre-processing ECG data will be done with the use of the acquisition
and signal processing unit which consists of the Analog ECG Sensor and the
ADS1015 Analog to Digital Converter. After data acquisition, filtering of data, and
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extraction of features, the SVM machine learning algorithm will classify whether the
ECG acquired is Normal or STEMI. The storage unit, which consists of the 128GB
Micro-SD Card, is responsible for storing the ECG data. This data includes the raw
and filtered data, features, and the predicted ECG class; all are stored locally within
the device and can be used by the clinicians for further review and diagnosis of the
user. The display module, which consists of the 16x2 LCD Display, will display the
ECG status for the user’s situational awareness, especially for possible cases of silent
myocardial infarction. The ECG status that are to be displayed depending on the result
of the data analysis module is either Normal ECG or STEMI ECG. In the case that
Normal ECG is detected, the LCD Display will display “Normal ECG”. On the other
hand, in cases if a STEMI ECG has been detected, the LCD will display “STEMI ECG
Detected” and the alert system module which consists of the GSM Module, will be
activated. Once activated, the GSM Module will send a text message via SMS and
make a call to the designated contacts which includes the user and the involved
clinician before repeating the entire process once again. Lastly, the battery module
which consists of the power bank, is the power source of proposed device. This
module is what allows the proposed device to be portable.
4.1 Hardware Design
This section discusses the development of the hardware components under
each module. Figure 4-2 shows the complete wiring diagram of the proposed device.
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Figure 4-2. Complete Schematic Diagram of the Proposed Solution
4.1.1 Acquisition and Signal Processing Unit
The hardware components used in the acquisition and signal processing
unit include the ADS1015 12-bit ADC and Analog ECG Sensor. Shown in
Figure 4-3 is the schematic diagram of the acquisition and signal processing
unit.
Figure 4-3. Schematic diagram of Acquisition and Signal Processing Unit
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4.1.1.1 Analog ECG Sensor
In this study, the Analog ECG Sensor was used to acquire raw analog
ECG data from the user. The output pin of the sensor is connected to the
analog output channel of the ADC. This allows the analog signals to be fed to
the ADC for conversion.
4.1.1.2 ADS1015 12-bit ADC
In this study, the ADS1015 12-bit Analog to Digital Converter was used
to automatically convert the analog signals from the Analog ECG Sensor to
digital signals before feeding that data to the Raspberry Pi 4.
4.1.2 Data Analysis Module
In this study, the Raspberry Pi 4 microprocessor serves as the main
component. It features a 64-bit quad-core processor running at 1.5 GHz, up to
8GB of RAM, a micro-SD card slot for storage, has 40 GPIO pins to control or
interface with other hardware components, and uses a USB C power to power
the device.
4.1.3 Storage Unit
The hardware component used in the storage unit includes a Micro-SD
Card placed in the micro-SD card slot of the Raspberry Pi 4. This micro-SD
card features a speed class of Class 10 and U1, and a capacity of 128 GB of
storage, all of which are compatible with the Raspberry Pi 4. Stored inside the
micro-SD card is the operating system, the necessary software, libraries, and
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files to make the proposed solution run as a whole. Shown in Figure 4-5 is the
schematic diagram of the storage module.
Figure 4-4. Schematic Diagram of the Storage Module
Figure 4-5. Schematic Diagram of Alert System Module
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4.1.4 Alert System Module
The hardware components used in the alert system module include the
GSM Module connected to the Raspberry Pi 4. This will notify the designated
contacts of the subject through SMS and call that STEMI ECG has been
detected. Shown in Figure 4-5 is the schematic diagram of the alert system.
4.1.5 Display Module
The hardware component used in the display module includes the 16x2
LCD Display connected to the Raspberry Pi 4. This will display the ECG Status
of the subject in terms of whether Normal or STEMI ECG is detected. Shown
in Figure 4-6 is the schematic diagram of the display module.
Figure 4-6. Schematic Diagram of Display Module
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4.1.6 Battery Module
In this study, the power bank utilized is power bank with a capacity of
10,000 mAh with an output voltage of 5V and a maximum output current of 3A,
all of which fit the power requirements of the Raspberry Pi 4.
4.2 Software Design
This section discusses the development of the software components under
each module.
4.2.1 Acquisition and Signal Processing Unit
This module involves the acquisition of ECGs and the application of
filters and feature extraction methods. The indicated functions involved are
discussed as follows.
4.2.1.1 Acquiring ECG Data
The acquisition of ECG data mainly involves two hardware
components which are namely the ECG sensor and ADC. The ECG
sensor is responsible for collecting the Analog ECG signal from either
an ECG simulator or an actual user following the chest lead II placement.
Meanwhile, the ADC will be receiving the analog signal values directly
from the sensor, and automatically converts them to their digital
equivalent. With this, digital signal is now accessible by the software,
mainly the Python ran by the microprocessor. To access it, Listing 4-1
shows the corresponding codes.
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Listing 4-1. Set ADC Sampling Rate and Gain
Line 54 initializes the I2C bus and specifies the pins used for I2C
communication; in this case, that is the SCL and SDA pins on the Raspberry
Pi 4. Line 55, on the other hand, initializes the ADS1015 12-bit ADC with the
argument “i2c” indicating that the ADC will use the I2C pins to interface with
the Raspberry Pi 4. Furthermore, line 56 uses the instance “AnalogIn” to read
the analog signals from the ADC. In this case, the arguments “ads” and
“ADS.P0” are indicated to specify that the analog input is to be taken from
Channel 0 of the ADS1015 12-bit ADC. Lines 57 and 58 set the data rate and
the gain of the ADC. The data rate, which specifies the sampling frequency of
the ADC is set to 250 while the gain which specifies the gain of the
programmable gain amplifier used to amplify the signal before it is converted
to a digital signal is set to 16 or +/- 0.256 V. For choosing the stated data rate
and gain of the ADC, the values are based on acquisition parameters used
from the European ST-T database with the goal of inputting conditions that is
closest to what is provided. In this case, the provided sampling rate is 250Hz
and the gain in which the signal is amplified for every 1mV is 200 adu/mV.
Listing 4-2. Acquisition of 2500 samples
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In terms of code provided under Listing 4-2, it indicates the
acquisition of 2500 samples acquired. A loop was used to ensure the
correct number of samples were collected, unless met, the loop will not
stop.
The use of 2500 samples was mainly adapted from the 10-
second interval of ECG acquisition used by Chowdhury et.al (2022) but
due to limitations of processing time of the Raspberry Pi to used, the
equivalent samples were utilized to ensure consistency in the amount of
data fed to the analysis module during application or use. This also
ensures that the input signal is in alignment to what is expected by the
machine learning algorithm used to train it, which is also in terms of 2500
samples. In calculating the corresponding samples from the indicated
time, the provided equation 4.1 is used.
1
𝑓𝑠 = (4.1)
𝑇
From the provided equation, to calculate the corresponding
samples from the indicated time (represented as seconds), it can be
simply done by multiplying the time by the sampling frequency. As
mentioned, 10 seconds was adapted, if it is multiplied to 250Hz, the
result is 2500 samples.
4.2.1.2 Designing Filters
In the proposed design of PHAAS, filters were applied after
acquiring the ECG data. This is to remove unwanted noises present in
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the ECGs such as random spikes and baseline wander. To address the
noises; bandpass, moving average, and median filters were designed.
In designing of the filters, the main platform used was Python.
Furthermore, the data from the European ST-T database were used to
provide initial test regarding filter performance to ensure the application
of filters is set to work as to how it is intended.
4.2.1.2.1 Bandpass Filter
The bandpass filter mainly functions to ensure that the
frequencies involved in the acquired signal are mainly within the
frequency range of ECG, which is around 0.5 to 100Hz
(Appathurai et al., 2018).
The bandpass filter was developed using the Heartpy
module available in Python. The module provides a wide variety
of function that allows the analysis, visualization, and pre-
processing of bio signals (Python Heart Rate Analysis Toolkit,
n.d.). In addition to this, filters are available which are utilized by
the proponents. The following function used is shown in Listing
4-3 and the main parameters considered are the cutoff
frequencies, sampling rate, the data to be processed, and the
filter type desired.
Listing 4-3. Bandpass Filter Design using HeartPy
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4.2.1.2.2 Moving Average Filter
On the other hand, for the moving average filter, the main
purpose is for smoothing effects, or simply, the removal of
random spiking noises. In designing the filter, the Pandas
module, which is an open-source library available in Python will
be used. Pandas allow data manipulation and analysis of data
and are supported by a wide variety of mathematical operations
(pandas, n.d.). The corresponding code for creating the moving
average filter is shown in Listing 4-4.
Listing 4-4. Moving Average Filter Design using Pandas Library
As can be seen from Listing 4-4, the filter was designed as
a function that is callable when the filter is ready for application.
Under these, a series of codes are provided that primarily allows
moving average filter to work. The main parameter involved in
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designing the filter is the window size as shown in code line 11.
From line 21, the data acquired was converted in a series format.
This allowed the window size to be set in motion (can move from
one sample to another) and calculate the corresponding mean of
the values included within the window size; these are represented
by code lines 24 and 27, respectively. Typically, the output of the
rolling window includes missing values represented by NaN,
specifically for the first ‘window_size – 1’ values. This is due to
the indicated window size - unless the values involved are
equivalent to the provided window size, missing values will be
returned. Nawale (2022) stated that missing values in the dataset
can affect model performance by encouraging bias. With this,
removal of the missing value was necessary which was done
along code line 30. To retain the 2500 samples length of the data,
appending of the first encountered non-missing value was
conducted which was made possible by code lines 33, 36, and
39.
In terms of choosing the value for the main parameter, the
window size, two methods will be used. First is in terms of time-
domain observations, and second is in terms of frequency
domain.
Given that the filter is applied along the time-domain, the
window size will be chosen through visual inspection of the
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effects of the filter via random sample ECGs from the online
open-source dataset. Initially, window sizes yielded the most
smoothing effect at around 7, 11, and 15; these values are then
used as options for the window sizes.
Figure 4-7. ECG Plots of Different Window Sizes
Figure 4-7 shows the plots of various window sizes
applied. As can be seen, the first plot shows the randomly chosen
raw data and it shows that there are random noises present. The
second plot, with a window size of 7, is shown to be able to
smooth out noises, yet some are still retained. In comparison to
the third plot, with a window size of 11, the ECG can smooth it
more effectively but slight distortion from the original pattern is
observed. Lastly, for the fourth plot, with a window size of 15,
evident change of pattern from the original, specifically the R-
wave was shown.
From the observed effects of window sizes, the
proponents opted to initially choose window size 11 by prioritizing
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and maximizing the smoothing effects. Despite the slight
distortion observed, no relevant ECG part was removed and no
major changes in the pattern occurred. Nevertheless, given that
the filter designed are both applied during training of the model,
and prior to application of the trained model, it can be said
compensation is expected as the same effects will occur upon
application.
To further confirm if the window size chosen is appropriate,
analysis of the frequency domain is provided. The frequency
distribution and magnitude response are acquired and compared.
The corresponding plots per each window size chosen are
provided under Figures 4-8, 4-9, and 4-10, respectively.
Figure 4-8. Frequency Response of Moving Average Filter with

Window Size 7

Window Size 11
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Window Size 15
The plot that showcases the main difference among the
application of various window size is the magnitude response: for
filter with window size 7, the attenuations occur at approximately
35Hz; for the filter with window size 11, attenuation are more
evident at frequencies around 22 Hz and 50Hz; lastly for window
size 15, the frequencies attenuated are around 18 and 32Hz. This
indicates that for each window size involved, unique or varying
frequencies are attenuated. Furthermore, the corresponding
frequency spectrum supports the indicated attenuation in the
magnitude response as the same frequencies displayed on the
frequency spectrum plot, showcased removal or reduction in
amplitude.
In choosing the window size using the frequency domain
acquired, the basis would be in terms of the unwanted
frequencies, namely noises. According to Abbaspour and Fallah
(2014), a common random noise such as electromyogram or
muscle noise contains the highest frequency power between 20
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Hz and 150 Hz. Supported by Chatterjee et.al (2020), the muscle
artifact’s spectrum range falls between 20 to 1000Hz.
Additionally, upon removal, the effects were stated to conduct
modifications of a signal’s local waveform.
Another form of common random noise is the powerline
interference which ranges to less than 1Hz where the band in
local terms is along 60Hz. Accordingly, removal of the noise may
result to distortion in amplitude, duration, and shape of low-
amplitude local waves of the ECG signal. The factors that have
contributed to the mentioned effects are due to the overlapping
ranges of frequency between EMG, ECG, and 60Hz powerline
interference. Nevertheless, the removal of the mentioned noises
are necessary given ECG signals provides important information
that ensuring reliable interpretation of the heart's electrical activity
for both medical personnel and machine learning training.
From the indicated ranges of frequencies, specifically from
muscle noise, it can be said that the most suitable window size is
11 given attenuation begins closest to 20Hz and continues
onwards. Therefore, from considering suitability and effects on
both time and frequency domain, 11 will be the chosen window
size.
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4.2.1.2.3 Median Filter
Last but not the least filter to be designed is the median
filter, which is mainly for addressing baseline wander. According
to Chowdhury et al. (2022), the combination of two median filters
with width sizes of 200ms and 600ms is an optimal way of
acquiring the baseline wander. By subtracting the ECG signal
from the resultant of the median filters, baseline wander can be
removed. With the use of the SciPy module available in Python,
the median filters were designed. SciPy offers a wide variety of
scientific computing algorithms that allows multiple application,
such as, but not limited to signal processing and analysis (SciPy,
2023).
Listing 4-5. Median Filter Design using Scipy Module
The main parameter in designing the median filters is the
kernel size or the window width as shown in Listing 4-5, code
lines 49 and 52. To acquire the window sizes in terms of samples,
the provided window width of 200ms and 600ms is simply
multiplied by the known sampling rate of 250Hz. With this, we get
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window sizes of 50 and 150 samples. Unfortunately, one of the
limitations of the median filters of the SciPy module is that it only
accepts kernel sizes of odd numbers. With this, the proponents
opted to subtract the kernel sizes by 1, which gives 49 and 149
samples for the kernel sizes. The final application of both filters is
shown under code line 55 where the results of median filter were
subtracted to the original data.
Figure 4-11 shows the results of the application of the
moving average and median filters to a sample from the online
database that displays evident baseline wander. As can be seen
in the third plot, the baseline wander was addressed by the
designed median filter and the ECG sample aligns along zero
millivolts of the y-axis.
Figure 4-11. Application of Moving Average and Median Filters
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4.2.1.3 Feature Extraction
After designing the filters, feature extraction was conducted.
Feature extraction is a vital procedure in aiding machine learning
algorithms to increase the chances of good performance by acquiring
new numerical data from considered datasets. As suggested for the
PHAAS design, the feature extraction methods include the extraction of
power spectral density, continuous wavelet transform, and synthetic
features of the filtered ECG samples. The corresponding methods used
in extracting the features are discussed below.
4.2.1.3.1 Power Spectral Density
In the extraction of power spectral density, the Scipy
module offers a function that enables the calculation of it. The
following code is shown in Listing 4-6.
Listing 4-6. Power Spectral Density Extraction using Scipy
The function, shown in code line 33, extracts the sample
frequencies (f), and the power spectral density (S) from the input
data (filtered data); the necessary output needed is only the
power spectral density (S). In terms of parameters, it includes the
sampling frequency of 250Hz, and setting the scale to ‘density’
dictates the function to calculate the power spectral density. With
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input data of 2500 samples (ECG data), the power spectral
density acquired consists of around 1251 samples.
4.2.1.3.2 Continuous Wavelet Transform
The continuous wavelet transform, on the other hand, is
extracted with the help of the PyWavelets module available in
Python. PyWavelets is an open-source wavelet transform
software that allows the use and application of wavelets for
various purposes (PyWavelets, n.d.).
Listing 4-7. Continuous Wavelet Transform Extraction using pywt
The main parameters involved in acquiring the continuous
wavelet transform are the type of wavelet to be used and the
scales of the corresponding wavelets. According to Xie et al.
(2015), the use of the Mexican Hat wavelet is an effective and
efficient way to extract features of ECG. Accordingly, scales of 2 3
and 25 enable the extraction of QRS and P/T waves, respectively.
The proponents followed the parameters accordingly and the
resulting CWT wavelet and scales yielded a total of 5000 sample
features (2500 samples per each scale). The main code used for
this extraction is shown on Listing 4-7.
138
4.2.1.3.3 Gplearn Synthetic Features
In acquiring the synthetic features, on the other hand, the
gplearn (genetic programming) module is used, which is also
available in Python. The function used to conduct this process is
the Symbolic Transformer which initially utilizes a supervised
transformer that uses random formulas to represent relationships
between the original features in order to generate new ones
(gplearn, n.d.). The code for acquiring synthetic features is shown
in Listing 4-8.
Listing 4-8. Acquiring Synthetic Features using gplearn
To acquire the formula for calculating the synthetic
features, the gplearn function is trained using all the initial
features acquired from the training data (see code line 25). The
original features acquired are namely the filtered data, the power
spectral density, and the continuous wavelet transform; a total of
8751 samples of features. After training the gplearn model, it is
then saved as a ‘-.sav’ file as provided in code lines 27 and 28,
which can be called later on to calculate the synthetic features.
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For the indicated codes from lines 17 to 20, ‘function_set’ and
‘SymbolicTransformer’ were applied following the default values
of the parameters.
Furthermore, the total number of synthetic features
calculated was set to 100 as shown in code line 14, which is the
maximum number of synthetic features that can be acquired. This
then leads us to a total of 8,851 samples of features to be used
for training the SVM machine learning algorithm.
The main development conducted under this module is the training and
testing of the SVM machine learning in the binary classification of STEMI and
Normal ECG. Other procedures included data collection, pre-processing, and
splitting of data. Mainly, the data used were acquired from the European ST-T
database.
4.2.2.1 Data Collection
Given the proposed machine learning algorithm used an online
open-source database namely European ST-T database, appropriate
data collection and analysis were required. With this, the following
methods were executed.
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4.2.2.1.1 Analysis of Database
The European ST-T Database, upon analysis, consists of
a total of 90 annotated patient records each diagnosed or
suspected of Myocardial Ischemia. Per patient record, two ECG
signals were recorded from two different channels. This entails
that from the 90 patient records provided, a total of 180 ECG
recordings are available, each with a two-hour duration.
In terms of the conditions used in the acquisition of the
provided ECGs, consistency was observed; all records followed
a sampling frequency of 250Hz, a gain of 200adu/mV, and an
ADC resolution of 12 bits.
Additionally, further analysis of the database was
conducted via PhysioBank ATM, which is an online toolbox
accessible on web browsers that allows the exploration of
PhysioNet databases (PhysioBank ATM, n.d.). The proponents
explored the general information regarding each record such as
the plots of the ECG data. A variety of ECG records were
provided in the database, where readings acquired extended
from V1, V2, V3, V4, V5, and V6, down to modified lead
placements. Unfortunately, none of the records provided includes
Lead II placements. Despite this, according to Dr. Hadjail-Ismael,
a cardiologist from the HRT Medical & Maternity Complex, ST
elevation is a consistent characteristic for all ECGs despite the
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electrode placement. Therefore, the proponents proceeded to
use the chosen database, but heavy consideration of the
similarity of the pattern to Lead II reading was conducted.
The criteria on how to choose the ECG records included
an upright display of R-wave (the R-wave is located on the
positive side of the y-axis in plots) and an observed display of P-
wave, QRS wave, and T-wave. Following the stated criteria, from
a total of 180 ECG readings from the database, 60 were chosen.
4.2.2.1.2 Data Extraction
After analyzing and acquiring the necessary information
from the database, extraction of the data was performed. In this
method, The WFDB (Waveform Database) Toolbox via
MATLAB/Octave was used. The necessary files that allowed the
extraction of the necessary data (ST-elevated and normal ECGs)
were the annotation file and ECG records which are in ‘. atr’ and
‘.dat’ format, respectively. The ECG records mainly contain the
values that make up the amplitude of the recorded ECG signal
while the annotation file contains the annotations that indicate
certain events that have occurred from the ECG such as ST-
Elevated or Normal cycles. Under this method, accessing
annotation file, accessing ECG file, and extraction of relevant
data was initiated. The main platform used in this method is
MATLAB.
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4.2.2.1.2.1 Accessing Annotation File
As mentioned, the annotation file provides the
annotation that allows the interpretation of the type of ECG
present in the provided records from the online dataset.
With this, the proponents were able to recognize what part
of the reading are Normal and ST-elevated.
Listing 4-9. Accessing Annotations
Listing 4-9 shows the code used for reading the
annotation file and acquiring the information available. The
main function that allows this is the use of ‘rdann’ shown
in code line 7. On the other hand, for lines 10 to 11, there
are six outputs provided by the function. The most relevant
of all are namely ‘ann’ and ‘comments.’ The ‘ann’ output
provides the sample value of the corresponding
annotation, while the ‘comments’ are string annotations
that provide labels for the start, peak, and end of events
present in the ECG.
There were various string annotations for various
ECG events provided in PhysioNet’s interpretation file. In
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the case of this study, the relevant string annotations were
as follows:
(N Normal sinus rhythm
(ST... Beginning of the ST episode
AST... The peak of the ST episode
ST...) End of ST episode
From the list of annotations provided, each
character indicated a specific meaning (PhysioNet, n.d.).
As can be observed in the provided list, the open
parenthesis indicates the beginning of an event. The
closed parenthesis, on the other hand, indicates the end
of an event while the letter ‘A’ indicates the peak of an
event where peak values are also included.
The labels ‘N’ and ‘ST’ indicates the event involved
in the ECG. With ‘N’, the ECG is indicated as a normal
ECG while if ‘ST’, it indicates episodes related to ST
segments.
In addition to this, for the ST-episode-related
annotations, the type of deviation is indicated using ‘+’ and
‘-’ symbols; the plus symbol for ST-elevation, and minus
symbol for ST-depression. In the case of this paper, only
the plus symbol is considered given that the proponents
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aim to acquire ST-elevated ECGs, which are indications of
a potential STEMI.
Furthermore, a signal number is also included,
given that each patient record consists of two ECG
readings. The first ECG signal is labeled as ‘0’, and the
second ECG signal is labeled as ‘1’.
Overall, if a ‘(ST0+’, annotation is encountered, it
indicates the beginning of an ST-elevation at signal
channel 0. If ‘AST0+200’ is encountered, it indicates the
peak of the ST-elevation at signal channel 0, with a peak
value of 200 microvolts. Lastly, if the ‘ST0+)’ annotation is
encountered, the ST-elevation at signal channel 0 has
ended.
Aside from reading the annotations, the proponents
also opted to save each annotation file as a ‘.csv’ file as
shown in code lines 12 and 16 from Listing 4-9. This is
done for easier accessibility especially when conducting
the manual acquisition of segments or sample ranges of
relevant data (further discussion is provided in section
4.2.2.1.2.3).
4.2.2.1.2.2 Accessing ECG Records
The process for accessing the ECG records was
simpler compared to the annotation file. It simply involves
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reading the file and saving the data stored as a ‘.csv’ file
as shown in lines 5 to 6 under Listing 4-10. Conversion of
the file to ‘.csv’ is conducted for the same reason indicated
in the previous section.
Listing 4-10. Accessing ECG records
The main function that enables the reading of ECG
records is ‘rdsamp’ as shown in code line 4 from Listing 4-
10. The contents of the output ‘data’ mainly include two
columns: both columns provide the amplitudes of ECG
readings from two different channels.
4.2.2.1.2.3 Extracting Relevant Data
Using the accessed annotations, the segments of
the relevant data via samples, are manually acquired and
noted on a Google Sheet. Figure 4-12 showcases some
examples of the manually acquired ranges of the relevant
data with respect to their corresponding ECG record and
ECG type. Overall, from the 60 ECG records, only 7
showcased ST-elevations while all 60 records contain
normal ECGs.
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Figure 4-12. Snippet of Manual Collection of Sample Ranges

of Relevant Data
Moving on, the corresponding sample ranges
obtained were used as the basis for acquiring the relevant
data from the ECG records. The sample code used for
doing so is shown in Listing 4-11, which showcases the
acquisition of normal ECG data at lines 15 to 16 (a similar
code is used for acquiring the ST-elevated ECG); the
corresponding samples used are shown on lines 11 to 12.
Listing 4-11. Collecting relevant data using sample ranges

acquired
Furthermore, as shown in code lines 19 to 23, the
relevant data are saved as ‘.csv’ files. This is to ensure that
Python can access the corresponding data when further
processing or development of the algorithm is conducted.
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4.2.2.1.2.4 Downsampling the Majority Class
Based on the obtained data, there are only 7
records of ST-elevated ECGs compared to 60 records of
normal ECGs, indicating an overwhelming majority of
normal ECG data. Therefore, it is concluded that the
dataset is imbalanced in terms of data distribution. Python
was the platform used for implementing this method; also,
for the rest of the methods that comes after, python was
also used.
To determine the appropriate level of
downsampling, all the ST-elevation ECG records are first
segmented into 2500 samples. Upon doing so, a total of
269 segmentations were collected. To maximize all the
available normal ECG records and keep a close
distribution to the STEMI class, the proponents aimed to
collect 300 segmentations of the normal ECG; a total of 5
segmentations (the first 12,500 samples) from each of the
60 normal ECG records were used.
After the downsampling process, a total of 569
segmentations were collected, wherein 47% of the data
represents the STEMI ECG class and 53% represents the
normal ECG class. Based on the guidelines from Google
Machine Learning Education (n.d.), if the minority class
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makes up 20-40% of the dataset, imbalance is only
considered mild. On the other hand, if the minority class
comprises 1-20% of the total dataset, the degree of
imbalance is considered moderate. If a minority class is
less than one percent, it is at an extreme. Given the
distribution percentage of the selected ECG data, it can be
initially said that the classes are balanced enough and
suitable for further processing. To further prove that the
distribution of data, the skewness is calculated.
Skewness is a statistical parameter that can
measure how evenly distributed or symmetrical the
distribution of data is (Chen, 2023). According to SPS
(2016), as a rule of thumb, the interpretation of calculated
value is as follows: values between -0.5 and 0.5 indicates
a fair symmetry; values between -1 and -0.5 or 0.5 and 1
indicates a moderately skewness; lastly, values less than
-1 or greater than 1 indicates high skewness. Upon
calculation, a value of 0.11 was acquired. Following the
provided range by SPS (2016), it can be said that the data
is fairly symmetrical, hence the distribution of class is
considerably balanced.
Before moving to the next procedure, the signals
are first segmented into 2500 samples. All segmentation
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were saved in one ‘.csv’ file with each of their
corresponding class labels: 1 for the ST-elevated ECG
class, and 0 for the normal ECG class.
4.2.2.2 Pre-processing Data
In processing the data, the stated filters and feature extraction
methods are provided in sections 4.2.1.2 and 4.2.1.3, respectively were
applied. As an overview, the raw data was first processed with the use
of filters in which noises were removed with the use of bandpass, moving
average, and median filters. Afterward, feature extraction was
conducted specifically collecting the power spectral density, continuous
wavelet transforms, and gplearn synthetic features. To increase the
speed of training and testing of machine learning, the resulting data after
the pre-processing were saved into a ‘.csv’ file.
Listing 4-12. Overview of Pre-processing Data
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Listing 4-12 showcases the overall filters and features utilized in
pre-processing the data. Given that all were designed as functions, the
codes were called upon application. For the filters, ‘bandpass’, ‘mov_av’,
and ‘median’, are the variables representing the application of the
bandpass, moving average, and median filters, respectively as shown in
lines 86 to 90. For the feature extraction, ‘psd’, ‘cwt_0’, ‘cwt_1’ were first
extracted which were respectively power spectral density, continuous
wavelet transforms at scale 2 3, and continuous wavelet transforms at
scale 25 shown on lines 106 to 107. Prior to finding the synthetic
features, compilation of all initial features acquired were first done as
shown on code lines 96 to 99. Afterwards all the compiled filters were
used to generate the synthetic features which was conducted under line
101 to 102 and is appending along the other filters at line 105.
4.2.2.3 Splitting Training and Testing Data
In section 3.2.2.2.4, it was indicated that the splitting of data is
done following a 70:30 ratio for training and testing the machine learning
model. This means that 70% of the data were allocated for training the
model, while the remaining 30% of the data were for testing the trained
model. Listing 4-13 shows the code used for splitting the data into
training and testing datasets.
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Listing 4-13. Splitting data into a 70:30 ratio
The splitting was mainly conducted using the train_test_split()
from sklearn module as shown on lines 26 to 27. The test_size was set
to be at 0.3 which indicates 30% of the provided data were for testing.
The same goes for the train_size set to 0.7 which indicates 70% of the
data were for training. In addition to this, stratification was considered in
the splitting of data which is represented by the parameter ‘stratify’.
Stratification ensures a uniform distribution between classes upon
splitting — the same proportions of each class is distributed among the
split dataset (Menon, 2020). Following the data splitting process, as
illustrated in code lines 30 to 38, the training and testing data are saved
as separate '.csv' files.
4.2.2.4 Training Machine Learning Model
The fundamental process of training a machine learning model,
such as Support Vector Machines (SVM), involves providing the model
with labeled data that serves as the basis for self-education, enabling it
to make predictions on new, unseen data. To ensure the chances of
developing a good model, procedures were conducted prior to actual
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training. According to Baylon and Usama (2022), the following methods
are effective in increasing machine learning performance:
4.2.2.4.1 Finding Optimal Hyperparameter
One effective method available in Python for finding the
best hyperparameters is using the GridSearchCV function from
the scikit-learn library. GridSearchCV performs an exhaustive
search over a provided set of hyperparameter values to identify
the optimal combination (scikit learn, n.d.).
Listing 4-14. Finding Optimal Hyperparameter
Listing 4-14 showcases the code used for finding the best
combination of hyperparameters. The model is set in code line 28
wherein the kernel is set to be linear. This is set as a default due
to the limitations of the RFECV feature selection function, which
is further discussed in section 4.2.2.4.3 In terms of the set of
hyperparameters chosen, it is indicated in code lines 31 to 34
which is represented by the variable ‘param_grid’. The chosen
hyperparameters are C, gamma, kernel, and degree which were
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provided hyperparameters from the scikit library available for
SVM models.
After running the GridSearchCV, which are shown under
lines 36 to 41, the acquired optimal set of parameters were as
follows: SVC (C=0.1, degree=1, gamma= ‘scale’, kernel='linear').
4.2.2.4.2 Standard Scaling of Features
In this method, standard scaling from the sklearn library
were used. The scaling is conducted through removal of the
mean and scaling the values to unit variance.
Listing 4-15. Saving Scaling Model
Listing 4-15 includes the code that demonstrates the use
of a scaling model. In line 17 of the code, the function
'StandardScaler()' is used for scaling, allowing for standard
scaling of the input values. The '.fit(X)' function is used to expose
the training data, denoted as X, to the scaler, which will be used
as a reference for scaling new values. After fitting the scaling
model using the training data, it can be saved as a '.sav' file using
Python's joblib library, as shown on lines 19 and 20. This allows
the scaling model to be stored for future use. The saved model
can be loaded also through joblib making it accessible for future
applications.
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4.2.2.4.3 Feature Selection
Recursive Feature Elimination (RFE) is a feature selection
technique that iteratively considers smaller subsets of features
based on their importance, with the least important features being
removed at each step (scikit-learn, n.d.). This process continues
until the desired number of features is reached. Recursive
Feature Elimination Cross-Validation (RFECV), on the other
hand, is a variation of RFE that incorporates cross-validation
capabilities. It also includes a scoring parameter that allows for
the calculation of model performance for each set of chosen
features, with accuracy being the chosen metric by the
proponents.
It's important to note that RFECV only works with models
that have linear kernels. As a result, the proponents of this study
have decided to limit their model options to those with linear
kernels.
Listing 4-16. RFECV Feature Selection
Listing 4-16 includes the code for implementing RFECV
feature selection. RFECV is configured to perform cross-
validation using a stratified K-fold approach with K=5.
Furthermore, the 'scoring' parameter is set to accuracy, which
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allows for the evaluation of model performance to be based
according to the yielded accuracy.
4.2.2.4.4 Saving Model
Upon applying all the mentioned methods, the models and
the corresponding list of selected features were stored in a
compressed '.zip' file using the joblib library, but only for sets of
features that achieved a minimum K-fold accuracy of 70% as
shown in Listing 4-17, code line 83. Iteration of the process is
conducted via a loop to generate multiple models with varying
accuracies and sets of features. Among all the saved models, the
chosen one is with a K-fold accuracy of 88% with 180 features
selected. Considered in choosing the model includes the
calculation of TPR, FPR, specificity, precision, F-score and
accuracy.
Listing 4-17. Saving Model with a Minimum of 70% K-fold accuracy
4.2.2.4.5 Testing Model
In this section, the model is evaluated using the testing
dataset to assess its performance on new, unseen data. Listing
4-18 showcases the code for testing the trained model.
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Listing 4-18. Code for Predicting Class
Prior to the provided code in Listing 4-18, feature scaling
was already applied. The models and the selected features from
RFECV were also loaded prior to the codes provided, wherein the
features acquired from the data, from 8851, only 180 features
were selected. Furthermore, given that the trained machine
learning contains five SVM models due to the k-fold cross-
validation, each was accessed to conduct its own prediction as
shown under lists 39 to 41. The final prediction is decided based
on the calculated quantile as shown in code line 44. The quantile
is simply the median given the set of inputs. Simply, the predicted
classes that are in majority will be the final prediction.
Listing 4-19. Calculation of Evaluation Metrics
Listing 4-19 contains the code used for additional
evaluation of performance of the chosen model. It calculates the
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same metrics as mentioned in section 3.3.1.2. Specifically, code
lines 56 to 60 for computing the accuracy of each fold using all
models collected from the cross validation, while code line 62
calculates the average accuracy across all folds. Code line 63
extracts the values for true positive (tp), true negative (tn), false
positive (fp), and false negative (fn) from the confusion matrix
function. These values are then used to calculate additional
performance metrics, such as true positive rate, false positive
rate, specificity, precision, F-score, and overall accuracy which
are shown code lines 63 to 69.
Also, it's important to note that much of the code used for
testing the data were incorporated into the main algorithm (code
to be used when the device is ready for actual use) with slight
modifications.
4.2.3 Storage Module
The storage module simply involves saving the necessary data acquired
from the pre-processes and model prediction conducted. Mainly this module is
designed to save two ‘.csv’ files: one includes the filtered data along with the
raw data and the other includes the features extracted. Both files include the
corresponding labels predicted by the data analysis module.
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Listing 4-20. Function for saving data as CSV files
Listing 4-20 showcases the code that enables the storage of data
acquired into a ‘.csv’ file. The main function used to make this possible is the
write function (code lines 49 to 52) and append function (code lines 55 to 58),
all of which were created using the CSV module. The module provides
functions that extend but are not limited to reading, appending, and writing data
in a CSV (Comma Separated Values) file format (Python, n.d).
The module responsible for alerting the designated contact person via
SMS and calls is called the alert system module. This module is only activated
when the data analysis module predicts a STEMI ECG. The code for the alert
system module can be found in Listing 4-21.
In Listing 4-21, the microprocessor commands the alert system module
using AT commands through serial communication. As shown in line 229, if the
“overall_prediction” indicates as STEMI (1 represents STEMI being detected),
the code inside this condition block will be executed. In this case, line 231
initializes a serial connection to the Raspberry Pi using the serial pin “serial0”
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and a baud rate of 115200 with line 232 clearing any input data in the serial
buffer.
Listing 4-21. Alert System Module
On the other hand, line 234 sets the phone number to which the SMS
message will be sent, line 235 sets the phone number to which the call will be
made to the designated contact, and line 237 contains the message to be sent
to the number set for SMS message. Included with the message is “STEMI
ECG Detected” is the variable “get_date” to get the date and time STEMI ECG
has been detected. Furthermore, Line 239 contains the AT command
“AT+CMGF=1” which sets the GSM module to text mode while line 243
contains the AT command “AT+CMGS=” which commands the GSM Module
to send the SMS message to the number set to the variable “number_sms.”
The command ser.write in line 246 will insert the message set to the variable
“text_message” and line 247 will command the GSM module to finally send the
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text message. The GSM module is given 10 seconds to send the SMS
message to the designated contact before moving on to the next AT command.
Line 251 contains the AT command “ATD” to dial the phone number from the
variable “number_call,” referring to the number set in line 235. The GSM
module is given 30 seconds to call the designated contact before the next
acquisition of ECG data from the subject begins. The reason for giving the GSM
Module time delays using “time.sleep” is to give time for them to process the
command and execute it in case of network delay in sending the SMS message
and call.
It is crucial to ensure that the SIM card used for the alert system module
is subscribed to an unlimited call and text plan or has sufficient balance to allow
the module to send text messages and make calls. Moreover, it's important to
note that both the subject and designated contact must be in an area with good
reception to ensure that the alert system module can effectively send text
messages and make calls. Otherwise, the alert system may not function as
intended, and the designated contact may not receive the necessary
notifications.
4.2.5 Display System
The display system is responsible for providing a text display of the ECG
status. The code used in doing so is indicated in Listing 4-22.
Listing 4-22. Display System Code
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The code on line 66 calls the 'drivers.Lcd()' function, which initializes the
LCD and makes it ready for use. Once the LCD has been initialized, messages
can be displayed on it, as demonstrated by the code on lines 70 and 71.
However, it's important to note that the LCD can only display two lines of text,
with a maximum of 15 characters per line.
In order to display new messages, it's necessary to clear the previous
message displayed on the LCD. The code on line 69 accomplishes this by
erasing the previous text before displaying new text on the screen.
4.3 Set-up, Mounting, Casing
The actual experimental setup of the prototype is shown in Figure 4-13 which
consists of the modules of the prototype integrated into a recycled plastic enclosure
and a strap made of canvas that is approximately 80 cm long. As shown in Figure 4-
14, the enclosure is 18.2 cm long cm 8.9 cm wide, and 4.6 cm tall.
Figure 4-13. Actual Experimental Design of Prototype
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Figure 4-14. 3D Computer Aided Design of Prototype
On the other hand, from Figure 4-15 the placements of the modules are shown
while Figure 4-16 shows the dimensions of each module in the interior of the
enclosure. The acquisition module is situated on the right side of the prototype, while
the alert system module is located at the bottom left corner, with its antenna extending
out the right side of the plastic enclosure. The microprocessor is positioned in the
middle of both modules while the battery module is situated below it and finally, the
display system is placed on the top side of the plastic enclosure.
Figure 4-15. Interior of the Experimental Design of Prototype
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Figure 4-16. Dimensions of Modules in the Interior of Enclosure
In terms of proper placement of device on a user, it is shown in Figure 4-17
wherein the prototype is connected to the user following the chest lead II set-up of
ECG electrode placement. Figure 4-18, on the other hand, shows the prototype
strapped on to a user.
Figure 4-17. Prototype Connected to a User
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Figure 4-18. Prototype Strapped on a User
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CHAPTER V
RESULTS AND DISCUSSION
In this chapter, the proponents discuss the results obtained after conducting
the tests recommended in section 3.3. A comprehensive overview of the results
obtained from functional, system, and beta testing is provided.
5.1 Functional Testing
The objective of this test is to verify the functionality of every module utilized in
the suggested device. The outcomes of this test are presented below.
5.1.1 Acquisition and Signal Processing Module
This module is responsible for handling the collection and processing of
ECG data. Its performance is evaluated by testing the main components - the
ECG sensor and the ADC - for their ability to acquire ECG data, as well as by
assessing the impact of filter applications.
5.1.1.1 ECG Acquisition
The acquisition module test was performed using the integrated
components under section 4.1.1. The integrated components were
mainly composed of the ECG sensor, the ADC, and the Raspberry Pi.
In line with this, the ECG signal acquired was from the proponents
themselves following the chest lead II placement. The sampling rate was
set at 250 Hz and the samples acquired are equivalent to 2500 samples;
this was established using the code or algorithm to be ran by the Rpi.
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For setting the sampling rate, it was done by programming the ADC as
shown in Listing 4-1. On the other hand, for acquiring the 2500 samples,
a loop was used as shown in Listing 4-2. The number of samples
acquired was confirmed by printing the length of the acquired signal in
the terminal using the function ‘len()’ wherein consistently the acquired
signals were 2500 samples each.
Furthermore, to confirm that the integrated components can
acquire ECG, plotting of the acquired values from the proponents was
generated. From there, visual confirmation was used to verify if ECG
pattern is displayed by the acquired data. A score of 1 is given if ECG
pattern is displayed, if not, a zero is provided. A sample documentation
of a test trial is provided in Figure 5-1. As can be seen from the image,
there is evident presence of R-peaks, P-waves, T-waves, and QRS-
wave despite the presence of a noise known as respiration.
Figure 5-1. Functional Test Trial 8 of ECG Acquisition
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The summary of results acquired from the test are provided on
Table 5-1. The expected success rate is set at 90%. The factors
considered in setting the success rate was the appropriateness of
electrode placement and the unavoidable impedance caused by the skin
upon contact. Unprecedented noise, such as shown in Figure 5-1, is also
considered.
Nevertheless, as can be seen, from the 10 trials conducted, the
integrated components were consistent in acquiring the ECG signal.
Given that the determined success rate meets the set expectations, it
can be said that the acquisition and signal processing module is
functional in terms of obtaining ECG data.
Table 5-1. Acquisition Module Test Result Summary

Total No. Determined Success Expected Success Verdict
of Trials Rate Rate
10 100% 90% Passed
This initially proves and supports that the acquisition function of
the acquisition and signal processing module is followed as stated in
specific objective under 1.4.2.1; the acquisition of ECG can be done
following the chest-lead II placement with a set sampling rate of 250Hz,
and equivalent samples of 2500.
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5.1.1.2 Filter Application
In testing the filter application, the ECG was acquired from Fluke
Prosim8 Vital Signs Simulator which is capable of simulating ECGs;
Chest Lead II placement, 250 Hz sampling rate, and 2500 samples were
followed as the conditions in the acquisition of simulated ECG.
The test was conducted with 10 trials, 5 of which represented
Normal ECG, and the rest were STEMI. Each of the trials conducted
represented a specific noise simulated by the Prosim which were namely
60Hz power line interference, baseline wander, respiration, and muscle
noise. Given that the total available noises were only eight, the fifth and
the tenth trial were decided to represent a random noise. Furthermore,
each of the noises were also tested in terms of the available
corresponding artifact sizes which were represented in percentages
namely 25, 50, and 100 percent. In terms of representing STEMI, given
that no machine learning was yet involved, random ST-elevation values
were chosen.
In evaluating the performance of filter, it was plotted for visual
confirmation of effectiveness of filter; it is checked whether the noises
were attenuated specifically random noises and baseline wander. Also,
consideration on the retention of the ECG pattern is considered.
A scoring method was used to represent the performance of the
filter, 1 is for most effective, 0.5 for fairly effective, and 0 for not effective.
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The set success rate for all artifact sizes was set to 90% wherein factors
considered include unsuitability of filter in handling the noises provided.
The summary of the results is shown in Table 5-2.
Table 5-2. Signal Processing Unit Test Result Summary

Total No. Artifact Determined Expected Verdict
of Trials Size Success Rate Success Rate
10 25% 100% 90% Passed
50% 95% 90% Passed
100% 70% 90% Failed
As can be seen from the table provided, two of the provided
artifact sizes were able to pass the success rate while only one was not
able to meet it which was the highest available artifact size from the
simulator, 100%. From this result, it suggests that the magnitude of the
noise plays a factor in the effectiveness of filters. Nevertheless, for
artifact sizes at 25 and 50 percent, the filter was effective. In relation to
specific objective 1.4.2.2.1, it can be said that the filter is effective up to
a certain threshold of magnitude of noise, specifically in this case, a
maximum of 50% artifact size.
In addition to this, from the conducted trials with 100% artifact
sizes specifically with respiration noise, a limitation in the sensor has
been observed. Checking the plots, clippings were observed along 0mV
and 3mV (refer to Figure 5-2). This indicates a limitation in terms of the
amplitudes the sensor can cater to which is specifically only within the
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range of 0 to 3 mV. The major cause of the clipping itself is due to the
noise present, which the artifact set was respiration). The noise along
the limitation of the sensor were mainly the reason why performance
under 100% artifact size yielded a low success rate.
Figure 5-2. Normal ECG with 100% Artifact Size Test Result
To further explore the application and ensure that the clippings
were a limitation of the sensor, the frequency spectrum of the simulated
ECG were provided as shown in Figure 5-3. In addition to this, the
maximum amplitude of each signal is provided along with the plot. At
first glance, no other frequencies are present starting from 40Hz and
above; the majority are found under low frequency range.
For the frequency spectrum of the ECG simulation with 100%
artifact size respiration noise, a maximum amplitude of approximately
4026.54 was observed in which accordingly to the plot is present along
the lower frequencies. Upon application of bandpass filter, it can be said
that the maximum amplitude lowered to a value of approximately 986.08
which indicates that some noises were removed. On the other hand, for
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the application of moving average filter, the maximum amplitude slightly
went up to 986.63; factors considered includes the window size used
which is 11, the calculation of averages caused some values to increase.
Lastly, for the median filter, the maximum amplitude had largely
decreased to approximately 151.01. This shows that the median filter is
working due to the change in value.
Figure 5-3. Frequency Spectrum of Normal ECG simulation and Filter Results
From the information provided from the plots of frequency
spectrum, it can be said that relatively all showcased some effects on
the present frequencies hence further verifying the effectiveness and
application of the filter. In terms of the clippings encountered, no other
distinct frequencies were observed that could suggest being the cause
of it.
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In testing the functionality of the data analysis module, it will be done
using the datasets acquired from the online database as stated on section
4.2.2. Additionally, this test was followed in choosing the model to be applied
to the suggested device designed.
This test mainly had two phases; first is evaluating machine learning
model performance using the testing data, and second was also evaluating
machine learning model performance but in terms of using the testing data.
The main metric used for determining the trained model performance is
through the calculated k-fold accuracy during the training phase, and the overall
accuracy of the model calculated upon exposure to the unseen testing data. In
addition to this, additional evaluation metrics were also considered namely true
positive rate or recall, false positive rate, specificity, precision, F-score, and
general accuracy; all were used for providing additional perspectives and
evaluation in the performance of the model. For the main metrics, a success
rate of 90% was set; factors considered were mainly the effect of the filters
upon application. The quality of the data provided by the online database was
also considered.
Prior to calculating the metrics, the confusion matrices were first
acquired from both datasets. Table 5-3 and Table 5-4 provide the
corresponding confusion matrices of the training and testing data, respectively.
The training dataset consists of a total of 398 samples while the testing dataset
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has around 171 samples. Prior to calculating the metrics, the acquired true and
false positive and negatives were used.
Table 5-3. Confusion Matrix using Training Data

Actual Positive Actual Negative
Predicted Positive TP = 171 FP = 7
Predicted Negative FN = 17 TN = 203
Table 5-4. Confusion Matrix using Testing Data

Actual Positive Actual Negative
Predicted Positive TP = 70 FP = 8
Predicted Negative FN = 11 TN = 82
Upon the provided values in the confusion matrices, majority were high
for the true positive and true negative values, compared to false positive and
false negative values. An initial interpretation can be provided that the model,
for the majority part, can correctly classify normal and STEMI ECG.
Proceeding towards conducting the tests, the results in terms of the
training k-fold accuracy and testing accuracy are shown in Table 5-5. As a side
note, these were the main metrics used for evaluation of model given
maximization on the performance of the model upon encountering new data is
prioritized. The k-fold acquired from the training data provides an estimation of
the performance of model on new data; upon application of model to testing
data, further proof if the estimation is correct using the accuracy acquired was
conducted. If the accuracies yielded are close, the model developed is more
generalized and is expected to perform better upon exposure to new data; on
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the other hand, if accuracies are far from one other, an overfitted model might
be the case.
Table 5-5. Data Analysis Module Test Result Summary

No. of Total Average Model Expected Verdict
samples No. of K-fold Accuracy Accuracy
Trials Accuracy
Training 398 10 88% -- 90% Accep-
Data table
Testing 171 10 -- 89% 90% Accep-
Data table
According to the results provided on Table 5-5, the acquired average k-
fold accuracy of the trained model is around 88%. When tested on the testing
data, the returned general accuracy of the model was around 89%. Despite not
being able to meet the set accuracies, the proponents deemed the results as
acceptable as the accuracies were very close to the set 90% accuracy; only 1
and 2 percent difference were observed. Furthermore, the chosen model
shows better generalization compared to other developed models that
surpasses or meets the provided success rate. Other generated models that
reached k-fold of around 90 to 91 percent, which were the highest, resulted in
low accuracy upon testing using testing dataset. This means that the models
were overfitted and are not ideal for application.
In addition to this, the other stated metrics provided under section
3.3.1.2 further supports the idea that the chosen model displays good
performance. The metrics were namely TPR, FPR, specificity, precision, F-
score, and general accuracy. Among all the generated models, the 88%
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accuracy model obtained the highest scores for TPR, specificity, precision, F-
score, and accuracy and the lowest for F-score. The following results are
shown in Table 5-6.
Table 5-6. Supporting Metric Results

Evaluation Metric Training Data Testing Data
True Positive Rate 0.91 0.86
(TPR)
False Positive Rate 0.03 0.08
(FPR)
Specificity 0.97 0.91
Precision 0.96 0.90
F-score 0.93 0.88
Accuracy 0.94 0.89
True positive rate (TPR) is the rate of correct prediction on the positive
class. This entails how good the model is at correctly classifying STEMI. The
closer the value is to 1, the better and more reliable the model is at correctly
classifying STEMI. As can be seen in Table 5-6, with the calculated TPRs of
0.91 and 0.86 it can be said that the model has a high rate of correctly predicting
the positive class, hence the model performs well in correctly classifying
STEMI.
False positive rate (FPR), on the other hand, is the rate of incorrect
prediction on the positive class. The closer the value is to 0, the better the
model is at correctly predicting the positive class since the chances of incorrect
prediction on the stated class is low. With the calculated values of 0.03 and
0.08, it can be said that the model has low chances of incorrectly predicting the
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positive class, hence the model is performing well in correctly classifying
STEMI which supports the interpretation provided under TPR.
In terms of specificity, also known as the true negative rate, it is the
probability of correct prediction on the negative class. This metric will tell how
good the model is at correctly predicting Normal ECG in which the closer the
value is to 1, the better. From the calculated values shown in the table, a score
of 0.97 and 0.91 entails that the model is reliable in correctly classifying normal
ECG.
For the precision, this metric provides how consistent the model is in
making correct predictions for the positive class. Similar to other metrics, the
closer the value is to 1, the better the performance of the model is in terms of
consistent correct prediction. From the values, which are 0.96 and 0.90, it can
be said that the model is reliable in terms of its consistency in correctly
predicting classes, specifically STEMI.
Moving onto the F-score, this metric shows the model’s balanced ability
in terms of correctly classifying the positive class in relation to how consistent
it is in its classification. The closer the value is to 1, the better the result is and
with values of 0.93 and 0.88, it can be said that the model has a good amount
of accuracy and precision in classifying the positive class.
Lastly, the accuracy provides the rate of overall correct prediction. With
calculated values of 0.94 and 0.89, it can be said that the model overall
performs well in correctly classifying classes. From the provided interpretation
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of metric values, it can be said that the model displays good performance in its
predictions of both classes, STEMI and normal ECG.
As a summary of the overall test conducted, the proponents infer that
despite not meeting the success rate indicated, the chosen model were able to
design and develop a good/acceptable model.
5.1.3 Storage Unit Test
The goal of this test is to determine if the expected data was saved as
files and stored within the local storage. Given that an ECG source is required
in order to acquire the filtered data and the features, the Fluke Prosim8
Simulator was used as the source; Chest Lead II placement, 250 Hz sampling
rate and 2500 samples of data length were still followed.
After the pre-processing of the data, the relevant data were collected
and saved into two corresponding files: one for filtered data, and second for
features extracted. For both, the corresponding class label of the data were
included. As for the filenames, the data of the acquisition is included, and ‘.csv’
with the feature data also include in the filename, ‘feature’ for easy indication
of file content. Similar goes for the filtered data file, ‘filter’ is used along the file
name.
In checking if the storage process was conducted properly, each file was
checked to see if they were found in their corresponding folders which was
done through Python using the Raspberry Pi. To further confirm if those were
the right files, the filename and content of the file is checked: For the filename,
the following guide questions are followed: does it go along the indicated date
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it was acquired? For the filtered data file, are there 10,001 columns saved
(2500 each for the three filters involved, a set of 2500 for raw data, and one
column for ECG status)? For the features extracted, are 8,852 columns (2500
for the final filtered data, 1251 for power spectral density, 5000 for continuous
wavelet transform, and 100 for synthetic features)? If yes, a score of 1 was
given from the 10 trials conducted, if the answer is no, a score of 0 is given. No
factors were considered that could affect storage performance, hence the
indicated success rate of 100% was used.
Table 5-7. Storage Module Test Result Summary

Total No. of Determined Success Expected Success Verdict
Trials Rate Rate
10 100% 100% Passed
From the results provided under Table 5-7, out of the 10 trials, all the
relevant data were acquired and stored. This then provides proof that the
storage module is fully functional. The results also suggest that the storage
module performs as expected and indicated under specific objective 1.4.2.5.
Figure 5-4 provides a screenshot of the feature files saved during functional
trial. All are found within the allotted folder named ‘feature_csv’.
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Figure 5-4. Functional Test Trial 1-10 of Storage Unit
The functional test of this module mainly involves testing if the GSM
module can send SMS messages and make a call towards the designated
contacts. A python code was developed to conduct this test which was ran by
the Raspberry Pi. The test was conducted following 10 trials, in which for each
trial, an SMS was sent where a random message was used followed up by a
call to the designated contact. The purpose for sending random messages is
to ensure that the GSM module can send the same set of messages inputted
by the proponents without any misspells, extra or missing characters at the end
of the receiver. Before conducting the test, the proponents first integrated the
GSM module to the Raspberry Pi and powered on the device with the use of
the power bank. Once powered up, the proponents checked the LED indicator
on the GSM module to see if it was able to connect to the network. When the
LED indicator on the GSM module blinks once every three seconds it means
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that the network connection was established Faranux (n.d.), and the
proponents can proceed with conducting the test. In case the calls and text
were received, a score of 1 is provided for the trial; if none were received, a
score of 0 is given. In setting the success rate, factors such as sufficient power
supply, baud rate and AT commands set by the proponents, sim card
registration (promos for calling and testing), and network availability and
strength upon location were considered. Nevertheless, adjustments regarding
the factors considered can be made to ensure alert system functionality. With
this the proponents ensured upon conducting the test that the battery module
is fully charged, the sim is registered to an unli-call and text promo, and also
the location where the test is done has strong cellular signal – these are the
factors that can vary depending on location and time. For the baud rate and AT
commands, it can be set to a constant within the code – this is the only factor
that cannot vary. Given the factors that varies were set to fit in fully ensuring
the GSM module to function, the set success rate is at 100%.
Table 5-8. Alert System Module Test Result Summary

Trials Rate Rate
10 100% 100% Passed
The result of the test is provided under Table 5-8. As can be seen, the
calculated success rate of this module’s functional testing is at 100%, hence,
the alert system module is fully functional given it reached the required value.
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Additionally, in terms of the time between the message being generated
and the moment it was ready for sending, it was observed to be immediate; the
same can be said for initiating a call to a designated contact. On the contrary,
the time it takes for the message and call to be sent and received will depend
on the location of the device and the designated contact as it can have an effect
on the network connection and signal strength of the module. In cases where
the sim is not registered to a text and call promo, no expected call and text
occurs.
Overall, the results suggest a success in confirming the capabilities of
GSM module and the specific objective under section 1.4.2.4 is initially met.
Further confirmation will be conducted upon integration of the alert system to
other modules. Figure 5-5 shows a documentation of trial 8 conducted during
the test.
Figure 5-5. Functional Test Trial 9 of Alert System Module
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5.1.5 Display System
Similar to the test conducted under the alert system module, random
messages were chosen to be displayed on the LCD screen. Randomization of
the messages were also used to check if all pixels within the LCD are functional
and also to see if various characters are displayable. When conducting the test,
the input message from the python file ran by the microprocessor, should match
to the output of LCD. If it matches, a score of 1 should be given; if not, the score
will be zero. A total of 10 trials were conducted. Given there is no direct
interference in displaying texts on the LCD, the success rate is set to 100%.
Table 5-.9 Display System Test Result Summary

Trials Rate Rate
10 100% 100% Passed
From the provided results under Table 5-9, the display system was able
to display the message on the LCD in accordance with what was provided in
the code for all ten trials. This suggests that the LCD is fully functional and
ready for the integration of modules, particularly with the data analysis and alert
modules. Figure 5-6 shows a sample of a trial conducted during the functional
test.
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Figure 5-6. Functional Test Trial of Display Module
5.1.6 Battery Module
This test aims to determine if the power bank can support the integration
of all modules and how long the power bank can support the device. The test
was conducted by first charging the power bank to full capacity and confirming
that the power bank is fully charged. After confirmation that the power bank is
fully charged, all modules were integrated. Afterwards, the power bank was
switched on which in turn, switches on the other modules. Immediately upon
start-up the clock app is opened, and the stopwatch is initiated to check how
much time has passed since the powering on of the device. The device was
then left on until it surpasses 5 hours. This test was conducted ten times, which
were the considered number of trials. If the battery was able to surpass five
hours, a score of 1 is given for the corresponding trial; if not, a score of 0 is
provided. Given that the battery inside the power bank is relatively new, the
expected success rate is set to 100%. However, the success rate may be
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affected if the test was conducted with the power bank not fully charged or
when the battery degrades over time because of constant use.
Table 5-10. Battery Module Test Result Summary

Trials Rate Rate
10 100% 100% Passed
The result, as shown in Table 5-10, shows that the power bank was
successful in supporting all the integrated modules and can last for up to 5
hours. It is important to note that the proponents performed each trial with the
power bank fully charged. Figure 5-7 shows a documentation of a trial
conducted during functional testing of battery module.
Figure 5-7. Functional Test Trial of Storage Unit
5.2 System Testing
System testing was conducted to ensure that the modules involved works after
stages of integration. In this testing, two cases were considered each with three
phases of integration. For this test, the Fluke Prosim8 Vital Signs simulator is used.
Regarding the acquisition of data, three electrode placements were followed with set
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250Hz and sample length of 2500 to be collected. For the pre-processing applications,
the designed filters stated under section 4.2.1.2 were used.
But before processing, a test must be conducted in order to decide the
parameters to be applied upon the system testing, which is in terms of ST-elevation
threshold and artifact size. This was necessary before as this ensures consistency
and uniformity in the system testing procedure. The same conditions in the acquisition
of ECG and filters used were applied to this test.
5.2.1 ST-elevation Threshold and Artifact Size Test
Conducting this assessment examines the capability of the machine
learning model upon exposure to various ST-elevation values and artifact sizes.
This test aims to determine at what threshold can the model effectively detect
the ST-elevation and up to what degree of artifact size can affect the model’s
prediction.
5.2.1.1 ST-elevation Threshold Test
In this testing, the level of ST-elevation the machine learning
detects was determined. There was a total of 5 trials, one of which had
no artifact, and the rest represented specific noises specifically 60 Hz
power line interference, baseline wander, respiration, and muscle noise.
Per noise involved, three artifact sizes and ten ST-elevation values were
tested. For the artifact sizes, it was represented in terms of percentages
which were namely 25, 50, and 100 percent. For the ST-elevation
values, it extended from +0.05 mV to +0.80 mV; +0.00mV was also
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included which is a representation of normal ECG. For determining the
ST-elevation threshold the machine learning effectively detects, the
success or acceptability rate is set to 90%. Factors considered include
the chances of misclassification and applicability of filters to the
corresponding indicated artifact sizes. The results are shown under
Table 5-11.
Table 5-11.ST-elevation Threshold Test Summary Result

ST- Total ST- Expected Determined Expected Verdict
elevation elevation total ST- Success Success
detected elevation Rate Rate
+0.05mV 4 13 31% 90% Failed
+0.10mV 5 13 38% 90% Failed
+0.20mV 5 13 38% 90% Failed
+0.30mV 13 13 100% 90% Passed
+0.40mV 13 13 100% 90% Passed
+0.50mV 13 13 100% 90% Passed
+0.60mV 13 13 100% 90% Passed
+0.70mV 13 13 100% 90% Passed
+0.80mV 13 13 100% 90% Passed
As can be seen in the Table 5-11, the ST-elevation values at
which the success rate was met is along +0.30mV and above;
consistency is also observed in the calculated success for all values
exceeding +0.30mV. From this, it can be said that the level of ST-
elevation the model can predict is at least +0.30mV and at most
+0.80mV. In choosing the ST-elevation threshold to be applied in the
system testing, the least value was chosen, which is +0.30mV.
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5.2.1.2 Artifact Size Test
For this test, the degree of noise and its effect towards machine
learning prediction was mainly determined. The conditions provided
were the same as indicated under ST-elevation threshold test but mainly
focusing on artifact sizes. The expected success rate of this test is also
around 90% in which factors considered are chances of misclassification
of machine learning model, and application of filters with large
magnitude of noises. The result of the corresponding test is provided in
Table 5-12. From the results provided, it must be taken note that trial 1
is not included in the calculation of accuracy given that the ECG
simulation has no noise involved.
Table 5-12. Artifact Size Test Summary Result

Artifact Total correct Determined Expected Verdict
size Prediction Success Rate Success
Rate
25% 36/40 90% 90% Passed
50% 36/40 90% 90% Passed
100% 30/40 75% 90% Failed
As can be seen from the table, only the 100% artifact size was
not able to pass the indicated success rate. From this, it can be said that
the degree of noise can influence the prediction the device’s model,
specifically of high magnitude which can be related to the provided
limitation stated under section 5.1.1.2. With this, it can be said that filter
effectiveness influences model performance.
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In terms of choosing the parameter for system testing, the highest
artifact size that was able to meet the set success rate was chosen,
which is artifact size 50%.
5.2.2 System Testing Case 1
In this test, the integration of the device was tested in terms of STEMI
ECG where ST-elevation is at +0.30mV with 50% artifact. Aside from this, the
conditions indicated under section 5.2 were applied in this test. For phases
involved, the indicated success rate was around 80%. Factors such as chances
of misclassification of machine learning, availability of network, and the level
the battery is charged, were considered. Additionally, another contributing
factor could be data mismatch. Data mismatch is when a system cannot
correctly perform due to the difference of elements from the inputted data and
elements that was used when training the model. Given that the signal fed to
the model was from a different data source, the simulated ECG may not match
to what is expected by the model, which was trained using the data acquired
from European ST-T Database. The results of the test are shown in Table 5-
13.
Table 5-13. System Testing Case 1 Summary Result

Phase Total No. of Determined Expected Verdict
trials Success Rate Success Rate
I 5 96.7% 80% Passed
II 5 94% 80% Passed
III 5 95% 80% Passed
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As can be seen, all phases of integration were able to suffice the
provided success rate. Hence, it can be said that the PHAAS device is
functional upon integration in terms of exposure to STEMI ECG. Figure 5-8
provides a documentation of trial 1 under phase III and case 1. Additionally, in
terms of the test conducted under phase III, the alert system and display
module were observed to function in accordance with the output of the data
analysis module. In cases of misclassified normal ECG prediction, the
corresponding status ‘Normal’ was displayed on the LCD and the alert system
was not initiated. On the other hand, in cases of correct STEMI ECG prediction,
the corresponding status ‘STEMI Detected!’ was also displayed on the LCD,
but this time, the alert system was initiated.
Figure 5-8. System Testing, Case 1, Phase III, Trial 1
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5.2.3 System Testing Case 2
In this test, the integration of the device was tested in terms of Normal
ECG with 50% artifact. This case also follows the conditions, in terms of
success rate and corresponding considered factors from section 5.2.2. In terms
of acquisition method or conditions, what was stated under 5.2 was followed.
Table 5-14. System Testing Case 2 Summary Result

Phase Total No. of Determined Expected Verdict
trials Success Rate Success Rate
I 5 96.7% 80% Passed
II 5 94% 80% Passed
III 5 95% 80% Passed
The results are shown in Table 5-14. As can be observed, all phases of
integration were also able to suffice the provided success rate. With this, it can
be also said that the PHAAS device is functional upon integration in terms of
Normal ECG. Similar to the test conducted with case 1, STEMI ECGs, it has
been observed that under phase III, the alert system and display module works
accordingly to the prediction provided by the data analysis module. ‘Normal’
was displayed on the LCD and no initiation of the alert system occurred when
correct normal ECG prediction was provided. Similarly, ‘STEMI Detected!’ was
displayed and alert system was initiated when misclassified predictions
occurred.
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Figure 5-9. System Testing, Case 2, Phase III, Trial 4
With inclusion of the result presented in section 5.2.2, it can be said that
the integration of PHAAS device is a success and the proponents have
successfully built the prototype. Figure 5-9 provides a documentation of trial 3
under phase III and case 2.
Overall, for the summary of results acquired from the system testing, most
especially under the integration of data analysis module, alert system, and display
module, it can be said the specific objectives 1.4.2.4 and 1.4.2.6 were satisfied. From
the results for both cases, the alert system and display module functioned accordingly
to the provided prediction of the model. If normal ECG was detected, alert system did
not initiate and a status indicating normal ECG was only displayed. On the other hand,
if STEMI was detected, the alert system was initiated to send call and SMS, which
were received by the assigned contacts and the ECG status displayed in the LCD
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indicated STEMI. Even during misclassifications, both the module functioned in
accordance with the provided prediction by the data analysis module.
Before ending the system testing, the assessment of the performance of the
machine learning model using the simulated ECGs used during the system testing
was determined. The expected success rate was set at 80% due to several factors
considered as mentioned in section 5.2.2 specifically in terms of misclassification
tendencies of the model, and chances of data mismatch.
Table 5-15. Model Performance Using System Testing Data

Case Phase Trial Accuracy Average Expected Verdict
1 2 3 4 5 Accuracy Success
Rate
1 I 1 1 1 1 1 100% 87% 80% Passed
1 II 1 1 1 0 1 80%
1 III 1 1 1 0 1 80%
2 I 1 1 1 1 1 100%
2 II 1 0 1 1 1 80%
2 III 1 0 1 1 1 80%
The result of the model performance is provided in Table 5-15. With the use of
30 simulated ECGs, the average accuracy calculated was determined to be around
87 percent; exceeding the provided success rate by 7 percent. This then indicates that
the model performs relatively well when data were acquired from other source,
specifically the Fluke Prosim8 Simulator. It must be taken note that these data were
from system testing, wherein it is set to fit acceptable conditions (+0.30 ST-elevation
and 50% size) where machine learning is reliable. This entails then, that under
acceptable conditions, the machine learning performs relatively well. This result
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further supports the indicated specific objective 1.4.2.3 regarding the capability of the
model to correctly predict STEMI and normal ECG.
5.3 Beta Testing
In determining the user acceptance of the device, evaluation of the provided
answers from the survey was utilized. Table 5-16 shows the results acquired from the
application of Likert-scale. Table 5-17, on the other hand, shows the range for
determining the interpretation of results provided in Table 5-16. In the acquisition of
ECG, chest lead II placement was followed with 250 Hz sampling rate and a required
sample length of 2500. The pre-processing methods utilized were also the same from
what was used under system testing and functional testing of acquisition and signal
processing module. In this test, five volunteers were considered in which the model
performance was monitored as they conducted the provided activities. Prior to joining,
a consent was provided by the volunteer along with their health profile in which
specifically indicates that they do not have any heart related condition. After the test,
the volunteers answer a Likert survey which determined the user acceptance of the
device specifically in terms of portability and comfortability. Table 5-16 showcases the
results of the survey wherein calculations were based on Ombea (n.d.).
Table 5-16. Likert-Scale Result

Statement Scale Score Mean Level of
Agreement
1 2 3 4 5
The device is not 0 0 0 2 3 23 4.6 Strongly
restrictive while Agree
doing the activities
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I am comfortable 0 0 0 1 4 24 4.8 Strongly

while using the Agree
device
No malfunctions 0 0 0 2 3 23 4.6 Strongly
were encountered Agree
during the test
I can use the device 0 0 0 2 2 23 4.6 Strongly
without technical Agree
assistance
Overall Mean 4.65 Strongly
Agree
As can be seen from Table 5-16, all the provided statement resulted with an
interpretation of ‘Strongly Agree’. This implies that participants found the PHAAS
device to not be restrictive while doing activities, comfortable upon use, malfunctions
were not common, and was usable without technical assistance. Overall, the level of
agreement the participants had leans toward strong agreement with the provided
statements, hence the device is favorable in terms of portability and comfortability.
The interpretation of the mean score is indicated under Table 5-17, following the
calculation provided by Valentino (2022).
Table 5-17. Interpretation of Mean Score

Scale Range Interpretation
1 1 – 1.8 Strongly Disagree
2 1.9 – 2.6 Disagree
3 2.7 – 3.4 Neutral
4 3.5 – 4.2 Agree
5 4.3 – 5 Strongly Agree
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Using the data acquired from the beta testing, performance of the trained
machine learning model was determined. The results are provided in Table 5-18. Like
the evaluation of machine learning from the system testing, a success rate of 80%
was considered.
Table 5-18. Model Performance Using Beta Testing Data

Activity Volunteer Average In terms of
1 2 3 4 5 Correct Movement
Prediction Involved
Sitting 0.8 1.0 1.0 0.8 0.2 0.76 0.83
Standing 1.0 1.0 0.8 1.0 0.6 0.88
Laying 0.8 1.0 0.8 1.0 0.6 0.84
Down
Walking 0.8 0.2 0.2 0.2 0.0 0.28 0.28
Running 0.2 0.2 0.2 0.2 0.0 0.16
Jumping 0.2 0.8 0.2 0.2 0.6 0.40
Average Accuracy 0.56
Expected Success Rate 80%
Verdict Failed
As a general observation, the accuracy provided per activities conducted varies
depending on the degree of movement the activity involves. From the table, the first
three activities showcase accuracies that were fairly high with 76% being the least
among them. On the other hand, for the last three activities, low accuracy values were
derived 16% being the lowest. Comparing the two set of activities, the most evident
difference is the degree of movement each activity requires. The greater the
movement the activity requires, the more prone the model becomes for
misclassification.
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The model was not able to meet the indicated success rate due to this
unprecedented factor. The possible explanation as to why the model’s performance
decreases per activity with increasing movement is due to the motion artifact that it
provides. According to Ding et.al (2023), motion artifact is a predominantly disruptive
interference resulting from the movement and rubbing of the body against the
electrode surface.
According to An and Stylios (2020), the most effective method in addressing
this noise involves the use of a high-end filter called adaptive filter. Compared to other
filters they have tested which are namely high pass finite impulse response (FIR) filter,
high pass infinite impulse response (IIR) filter, moving median filter, and wavelet
transform denoising, only the adaptive filter did not cause distortion while filtering the
ECGs especially those with abnormal waveforms. The most probable cause of the
distortion is due to the overlapping frequencies between the ECG and motion artifact.
The frequency range of ECG is around 0.5 to 100 Hz while motion artifact is around
0.4 to 15 Hz (Almalchy, 2021). This suggests that upon the application of filters,
corresponding removal of significant information occurs along the intended removal
of motion artifact. This discourages the use of improper denoising methods as it can
affect the waveform of the signal and contribute to misdiagnosis of heart related
conditions. In line with this, the application of adaptive filter is suggested. Despite the
stated effective application, the use of this filter falls outside the scope of the study
and has been decided to be stated under Chapter VII, the recommendation section
instead.
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Other factors that may have contributed to the low success rate includes the
limitation of the sensor and filters at which were discussed under section 5.1.1.2 and
5.2.1.2.
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CHAPTER VI
CONCLUSION
The purpose of this study is to develop an objective-based, portable, and real-
time heart attack detector that mainly addresses heart attack related concerns such
as reliability to symptoms for detection, tendency to be unpredictable and silent,
cruciality of early diagnosis, and cruciality of fast response time upon occurrence. The
proposed design in total, consist of six modules each serving a specific function. The
modules are namely the acquisition and signal processing unit, data analysis module,
storage unit, display system, alert system, and a battery.
Evaluation of the designed device was conducted via various tests, namely
alpha, system, and beta testing. Majority of the results under alpha testing suggests
that the individual modules were fully functional. For the case of application of filters
under the acquisition and signal processing unit, the filter was not able to meet the set
success rate of 90%, specifically under the case of 100% artifact size. Upon checking
the corresponding plots of the trials involved in the case, clippings were observed
around 0 to 3 millivolts. This mainly suggests that there is a limitation in the sensor,
specifically in the range of values it can cater. In the case of data analysis module, the
proponents were able to develop a good or acceptable model; considering all the
metrics used to evaluate its performance, majority of the results points out the model
to be favorable of good performance.
Moving towards system testing, from the ST-elevation and artifact size test,
results pointed out that the ST-elevation threshold the model can begin to detect
STEMI is at +0.30mV. This entails that anything below the determined threshold, are
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considered normal by the model; anything at and beyond are STEMI. Potential factors
could include the data used from the European ST-T database, and unprecedented
effects of the applied filters. In terms of the artifact size, among all the sizes included,
only test case of 100% magnitude failed to meet the set success rate. This result is
approximately the same from the functional testing of filters. This could suggest that
artifact sizes, specifically of great magnitude, along with the limitation of the sensor,
can affect machine learning model performance. Moving towards the system testing,
for both cases, results yielded were desirable in which all the determined success rate
surpasses what was indicated. This suggests that the integration of the modules is a
success.
Last but not the least, for the beta testing, in terms of the user acceptability of
the device, the participants had greatly shown their agreement in all the statement
provided on the Likert scale survey. Overall, this indicates that the designed device
is favorable for the users, specifically in terms of portability and comfortability.
In addition to the indicated test, the model performance in terms of the data
acquired from the system and beta testing is evaluated. For the system testing, the
generated accuracy is fairly well, with an accuracy of 87%, as it is able to surpass the
set success rate of 80%. The beta testing, on the other hand, is quite a different story.
The overall success rate that it was able to yield is only around 56% which is fairly
low. As provided in the discussion under section 5.3, the main factor that caused this
is due to the presence of motion artifacts. If only the activities considered are those
with low movements, the calculated accuracy is at 83%. On the other hand, if only the
activities that requires a lot of movement are considered, an accuracy of only 28% is
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achieved. This entails that the motion artifact present greatly affects the machine
learning performance.
Overall, from the results acquired, it has been recognized that the presence of
noise greatly influences the proposed device’s performance, particularly in terms of
the data analysis module. The artifact size, especially those of great magnitude and
the presence of motion artifact increases the misclassification of the machine learning
model. Furthermore, the sensor's limited capacity to capture certain values can also
play a role on the performance of the machine learning. Despite the indicated
limitations, the device is able to show good performance under appropriate or
acceptable conditions.
In conclusion, it can be said that the proponents were able to successfully
develop the proposed device: a portable, objective-based heart attack detector that is
applicable in real time. Every module performed its intended function, and upon
integration, the system operates as expected. Furthermore, the user acceptability
leans over to be in favor of the device; strong agreement is expressed towards the
ease of portability and provided comfortability of the device. In addition to this,
limitations were encountered specifically in terms of the application of filters and
sensor capacity. In regard to this, recommendations are provided under Chapter VII.
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CHAPTER VII
RECOMMENDATION
The Portable Heart Attack Alert System (PHAAS) is an objective-based
portable device designed to detect heart attacks, specifically ST-elevated Myocardial
Infarctions (STEMI), in real-time. Upon evaluating the designed device, certain
limitations were encountered specifically in terms of the sensor capacity, filter
application in handling high magnitude noises and the disruptive presence of motion
artifact.
In terms of the limitation of the sensor, the proponents suggest the use of
Python Heart Rate Analysis Toolkit, also known as HeartPy. The toolkit offers pre-
processing methods that specifically address clippings due to the limited sensitivity
range of the sensor. This process involves the detection of the clippings which
afterwards are interpolated.
In addressing motion artifacts, both software and hardware methods are
available. For the software approach, the use of a high-end filter, namely the adaptive
filter, is suggested. The adaptive filter is a time-variant filter, which takes two inputs:
one input for the signal and the other serves as the reference which acquires the noise
desired to be removed. The general idea in the application of this method is through
the subtraction of the reference input (noise reading) from the input signal in order to
acquire the clean one. According to An and Stylios (2020), the adaptive filter is an
effective method of removing artifact given upon application, it does not cause
significant distortion. The downside of using this method is that it requires an additional
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input to take the noise measured, in cases that the approach is not suitable for the
PHAAS device, the hardware method or suggestion can be used.
For the hardware approach, the Analog ECG Sensor datasheet (n.d.) provides
a circuit implementation or a battery powered cardiac monitoring system that monitors
the heart rate of patients engaging in moderate activity, such as with a Holter Monitor.
The circuit employs the AD8232 Single-Lead Heart Rate Monitor Front End and a
three-electrode patient interface with a two-pole high and low-pass filter, and a signal
gain of 400 in the pass band. The signal is sampled by a sigma-delta ADC integrated
on a low-power microcontroller, the ADuCM360 and an ADXL346 accelerometer
signal is used to minimize patient motion artifacts and conserve battery power during
inactivity. It is important to note that the previously mentioned components are meant
to demonstrate the capabilities of the AD8232 with other system components and is
not a complete system design.
Aside from addressing the limitations encountered from the PHAAS, the
proponents also have several suggestions regarding the design of each module. First,
the proponents recommend adding a piezo buzzer as the primary component of the
alert system module to provide an audible method to warn the user upon STEMI ECG
detection. The implementation of this can decrease the delay in the delivery of STEMI
indication.
Second, the proponents recommend adding a button which enables the user
to manually trigger the GSM module to send text messages and make voice calls to
the designated contacts. This will provide user control over the system, potentially
increasing the battery life of the proposed device as it reduces power consumption by
203
the microprocessor, and lastly, minimizes false alarms in case of a false positive
result.
In terms of the testing conducted, particularly under evaluating effectiveness of
filter on simulated noises namely 60Hz power line interference, baseline wander,
respiration, and muscle noise; the proponents suggest further evaluating the filter
using a combination of the noises provided given the filters were only tested in terms
of isolated artifacts.
Lastly, for the machine learning model under data analysis module,
optimization of the recall rate is suggested rather than accuracy. This is to ensure that
the rate of correctly detecting STEMI is reliable.
204
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221
APPENDICES
APPENDIX A
ZCMC LETTER OF REQUEST
222
APPENDIX B
HANDS-ON OF THE PRO SIM 8 SIMULATOR
On September 24, 2022, the proponents visited ZCMC Biomedical Engineering

Department. The goal of the visit is to confirm if the Prosim8 Vital Sign Simulator can
simulate ECGs, especially STEMI ECGs. Upon visitation, the following guide
questions were answered:
1) Can prosim8 generate Myocardial Infarction?

Yes. The ST segment of the ECG simulation is adjustable from +0.10 to
+0.80 mV (elevated ST segment = myocardial infarction).
Similar Myocardial Infarction ECG is also simulated using ACLS wave
group, 2nd degree AV black waveform.
2) Can the simulator generate ECG with artifacts?

Yes. The following artifacts that can be generated are 50/60 Hz line
interference, muscle noise, respiration noise, and baseline wander. It must be
taken note that this can only be generated one at a time.
3) Can the simulations be saved?

With the use of prosim8, no. The suggestion is to create a code or
algorithm that will save data acquired to save the simulations.
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APPENDIX C
ZCMC’S MEDICAL TECHNICIAN IV INTERVIEW
The proponents revisited the ZCMC Biomedical Engineering Department on

September 30, 2022. The purpose of the visit is to interview Medical Technician IV,
Mr. Roel S. Rojas, for his insights and suggestions regarding the proponent’s thesis
topic. The following notes were acquired:
Insights provided on the thesis topic:

- Talked and suggested searching more about other diagnostic devices such as
ultrasound, x-ray, CT-scan, MRI, blood test, and ECG in detecting heart attack
- Suggested researching about the parameters (P, QRS, T wave) and
specifications (amplitude, time) of the ECG and how it affects the ECG
- Pointed out how the paper’s approach is similar with Holter Monitors; the
proponents highlighted the difference between the two.
- Talked about the variation in ports in connecting the leads/electrodes and
display to the ECG devices
Suggestions provided:
- Talked about hardware noise typically present in medical devices and its
filtered-out hardware base but only applicable if the device is connected to AC.
Since the battery will be utilized for PHAAS, there is no need to worry about it.
- Suggested taking note of electromagnetic interference (EMI) from electronics
such as cellphones, televisions, microwaves, aircon, monitors, etc. It can affect
data acquisition; therefore, it should be noted when the user uses the device.
- Suggested the use of double insulated lead
- Suggested the use of electro-gel for ECG acquisition (make sure it is meant for
ECG, not ultrasound - available on the market and any brand will do)
- Introduced reusable and non-reusable electrodes which are readily available in
the market
- Agreed on the use of the strap for electrode placement to lessen the effects of
movement noise in the ECG
- When testing, compare the proposed device to the industry standard a.k.a
devices in the hospital
About Prosim 8 Simulator:

- Simulation can be saved or recorded via laptop.
- ECG simulations cannot be done simultaneously, but simulation types can be
done consecutively.
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APPENDIX D
CONSENT FORM
225
APPENDIX E
BETA TESTING PRE-TEST QUESTIONAIRRE
226
227
APPENDIX F
BETA TESTING POST-TEST SURVEY
228
229
APPENDIX G
ESTIMATION OF CURRENT CONSUMPTION OF PHAAS
According to the power consumption benchmarks from Raspberry Pi Dramble

(n.d.), the Raspberry Pi 4 B consumes 540 mA when idling and 1280 mA when under
400% CPU load. Since the Raspberry Pi 4 B will be used to process the data acquired
by the analog ECG sensor and analyze it with the machine learning algorithm, we took
into consideration the highest possible power consumption of the Raspberry Pi. The
datasheet provided by Sparkfun states the Analog ECG sensor typically has a low
supply current of 170 µA (0.17 mA) while the Adafruit ADS1015 12-bit ADC has a
supply current of 150 µA (0.15 mA) according to Makerlab Electronics(n.d.).
Additionally, the maximum current draw for the 16x2 LCD Display with I2C is around
200 mA according to Circuitar (n.d.), and the GSM module uses a current of 1.04 mA
in sleep mode, around 17.38 mA in idle mode, and around 159.22 mA to 211.11 mA
for voice calls (SIMCom, n.d.).
Taking these values into consideration, in the case that a heart attack is not
detected, meaning the gsm module will remain in idle mode, the estimated device
consumption on the 10,000 mAh power bank is 1,497.7 mA resulting in an estimated
battery life of 6 hours, and 40 minutes. It is to be expected that the power consumption
will increase in the case of a heart attack detected in which the patient is most likely
being brought into the hospital for medical treatment. The following figure provides the
formula used for calculation and the exact value of the estimated battery life of the
power bank upon incorporation into PHAAS modules.
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APPENDIX H
INITIAL BILL OF HARDWARE MATERIALS
Hardware Components Cost (Php)
Raspberry Pi 4 Model B Microprocessor 5,488.90
Sparkfun Analog ECG Sensor 569.00
Adafruit ADS1015 12-bit ADC 649.00
iCare ECG Electrode Patches 431.00
Sim800L v2 GSM Module 390.00
16x2 Character LCD Module Display HD44780 with I2C 149.75
Realme Power Bank 2 899.00
128 GB SanDisk Ultra Micro SD Card 759.00
Sim Card for GSM Module 20.00
Total 9,355.65
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APPENDIX I
SUMMARY OF DR. ULANGHUTAN’S INTERVIEW
Q: Can heart attack be detected using three electrodes?

A: Clinically, 12 electrodes are preferred because it shows more views where ST-
elevation can be confirmed in multiple readings. Additionally, electrode placement will
dictate which side/wall of the heart is blocked, as it can occur in one, or multiple
vessels.
Q: How many cardiac cycles are needed to confirm that STEMI is occurring?
A: More than one cardiac cycle is needed to confirm and should be consistent. Once
ST-elevation is detected due to a myocardial infarction, the rest of the ECG will be ST-
elevated. The STEMI usually lasts for 24 hours and evolves (ST elevation could
increase is one example)
Q: Is it possible to not feel the physical symptoms of a heart attack (STEMI)

when it occurs?
A: Yes, especially if the patient is diabetic, old, or female. They can manifest as silent
ischemia. If there is a high index of suspicion for silent ischemia (shortness of breath
among other symptoms), an ECG test is to be conducted. There are some cases
wherein the result is MI.
Q: What is Normal Sinus Rhythm?

A: Normal sinus rhythm is normal ECG whether in resting or active state.
Q: Does symptoms show immediately when heart attack occurs?

A: Yes, the moment that there is a blockage in the heart, physical symptoms (mainly
chest pain) will be felt by the patient. If the plaque is not removed from the artery in 6
to 12 hours, it will lead to necrosis of the heart.
Q: What should a patient do when experiencing a heart attack?

A: They can take medications. Ultimately, they should still go to the hospital for
treatment.
Q: Is it possible for someone prone to heart attack to be alone?

A: There must be someone to monitor the patient as heart attacks can occur at
anytime, anywhere. In some cases, it can happen in the morning.
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APPENDIX J
SUMMARY OF DR. ISMAEL’S INTERVIEW
Q: How long does it take for the symptoms to appear from the onset of STEMI?
A: It varies. Via ECG, there are changes occurring in the micro-level. It depends on
the size and depth of the infarction and the risk factors from the patient (age and health
conditions like diabetes). Also, the bigger the damage (to the heart), the easier it is to
notice physical symptoms on the onset of a heart attack. Additionally, silent
myocardial infarction is possible with a certain population (heart attacks with no
symptoms)
Q: Is ST-elevation a consistent characteristic that can determine STEMI on all

views (chest leads, precordial leads, etc.)?
A: Yes.
Q: How many cardiac cycles are needed in order to confirm STEMI from the
ECG reading? Does it require consistency?
A: Yes, it needs to be consistent. It cannot be determined with just one or a couple
of cardiac cycles – will be considered as artifact.
Q: How long will the ST-elevation and T-wave inversion last when STEMI has
occurred?
A: When the infarction is complete (STEMI has occurred), it will not go back to
normal unless the heart is revascularized.
Q: What is the threshold value to consider the ST segment to be elevated?

A: It depends on the placement of the leads (chest lead or precordial lead). Usually,
1 or 2 small boxes in the ECG readout/paper. It must be noted that ECG reading can
be subjective.
Q: What are your suggestions in acquiring a good ECG reading upon context?
A: Proper placement must be observed to get proper reading as there is a possibility
of misinterpretation.
Q: Would you recommend we have an actual person with IHD test the device?
A: It is not advisable.
233
APPENDIX K
FUNCTIONAL TESTING RAW RESULTS
234
235
APPENDIX L
SYSTEM TESTING RAW RESULTS ST-ELEVATION AND ARTIFACT SIZE TEST
236
APPENDIX M
SYSTEM TESTING RAW RESULTS CASE 1: STEMI ECG
237
APPENDIX N
SYSTEM TESTING RAW RESULTS CASE 2: NORMAL ECG
238
APPENDIX O
MACHINE LEARNING PERFORMANCE USING SYSTEM TESTING DATA RAW
RESULTS
239
APPENDIX P
BETA TESTING RAW RESULTS: MACHINE LEARNING PERFORMANCE
240
241
APPENDIX Q
MACHINE LEARNING PERFORMANCE USING BETA TESTING DATA RAW
RESULTS
242
APPENDIX R
PIN CONFIGURATIONS OF HARDWARE COMPONENTS
Pin configuration of Analog ECG Sensor to Raspberry Pi

Analog ECG Raspberry Pi 4 Description
Sensor Pins Pins
3.3V 3.3V power The 3.3V Pin of the Analog ECG

Sensor is connected to the 3.3V
power pin of the Raspberry Pi 4
GND Ground The GND Pin of the Analog ECG

Sensor is connected to the
Ground pin of the Raspberry Pi 4
Pin configuration of Sparkfun Analog ECG Sensor to ADS1015

Analog ECG ADS1015 ADC Description
Sensor Pins Pins
A0 Output The Output Pin of the Analog

ECG Sensor is connected to the
ADS1015 ADC
Pin Configuration of 12-bit ADC Raspberry Pi 4

ADS1015 Raspberry Pi Description
ADC Pins Pins
VDD 3.3V The VDD pin of the ADS1015 ADC
is connected to the 3.3V power
supply of the Raspberry Pi 4
GND Ground The GND pin of the ADS1015 ADC
is connected to the Ground pin of
the Raspberry Pi 4
243
SCL SCL I2C The SCL pin of the ADS1015 ADC

is connected to the SCL I2C
(GPIO) pin of the Raspberry Pi 4
SDA SDA I2C The SDA pin of the ADS1015 ADC
is connected to the SDA I2C
(GPIO) pin of the Raspberry Pi 4
Pin configuration of SIM800L v2 GSM Module to Raspberry Pi 4

GSM Module Raspberry Pi Pins Description
5VIN 5V power The VDD pin of the
SIM800L v2 GSM
Module is connected to
the 5.0V power supply
of the Raspberry Pi
GND Ground The GND pin of the
SIM800L v2 GSM
the Ground pin of the
Raspberry Pi
TXD RXD The TXD pin of the
SIM800L v2 GSM
the RXD pin (GPIO 15)
of the Raspberry Pi
RXD TXD The RXD pin of the
SIM800L v2 GSM
the TXD pin (GPIO 14)
of the Raspberry Pi
244
Pin configuration of 16x2 LCD Display
16x2 LCD Display Raspberry Pi 4 Pins Description
Pins
VCC 5V The VCC pin of the 16x2 LCD

Display is connected to the 5V
power supply pin of the
Raspberry Pi 4
GND Ground The GND pin of the 16x2 LCD

Display is connected to the
Ground pin of the Raspberry Pi
4
SCL SCL I2C The SCL pin of the 16x2 LCD

Display is connected to the SCL
I2C (GPIO) pin of the Raspberry
Pi 4
SDA SDA I2C The SDA pin of the 16x2 LCD

Display is connected to the SDA
I2C (GPIO) pin of the Raspberry
Pi 4
245
APPENDIX S
USER’S MANUAL
General Information:
The Portable Heart Attack Alert System (PHAAS) is a portable, real-time

STEMI heart attack detector. It is incorporated with an alert system that automatically
contacts designated personnel, such as the user and clinicians when a heart attack is
detected. This device is mainly designed for patients diagnosed with ischemic heart
disease which relies on the detection using the user’s ECG. This design mainly caters
to concerns such as the reliability of symptoms for detection, the unpredictability of
heart attack, and early chances of diagnosis and treatment. This device’s design
enables IHD patients to live their daily life normally while having a reliable, portable
device they can carry around to inform them early on in cases of emergency.
----------------------------------------------------------------------------------------------------------------
Disclaimer:
The Portable Heart Attack Alert System is configured for one user only. This
includes remote access to the device with a personal VNC account, and the subject
name and designated contacts specified in the device’s python code. Reconfiguration
of the device is necessary for another user to use the device. It is also important to
note that all configurations are done by a qualified technician, ensuring the device is
set up correctly and functions properly.
----------------------------------------------------------------------------------------------------------------
Setting Up VNC Server:
A Virtual Network Computing (VNC) Server is a software application that allows

for remote access and control of another computer’s screen, mouse, and keyboard.
The server is installed on the remote computer to be controlled, in this case that is the
Raspberry Pi. On the other hand, a VNC Viewer is installed on the device used for
control such as another computer, tablet, or mobile phone. This process is to be done
by a qualified technician ensures that the VNC Server on the Raspberry Pi and the
VNC Viewer on the control device of the user is set up correctly.
The following instructions show how to enable the VNC Server in the Raspberry Pi:
1. Turn on Raspberry Pi and open the terminal. Enter the command “sudo raspi-
config” as shown in the figure below. This will open a menu-based interface
which allows for certain configurations to be made including the enabling of the
VNC Server in the Raspberry Pi.
246
Figure1 – Calling software configuration tool via terminal
2. A window will pop up showing various options. To enable VNC server, use
arrow keys to select “Interfacing Options” and press Enter as shown in Figure
2. Afterwards another window will pop-up, choose VNC, as shown in Figure 3
to enable remote access of Rpi via VNC server.
Figure 2 – Software configuration tool window
Figure 3 – Enabling VNC for remote access of Raspberry Pi
3. A prompt will appear asking for confirmation of enabling VNC Server as shown
in Figure 4, select and press Enter. Another prompt will then appear saying that
VNC Server is enabled as shown in Figure 5. Press Enter to exit the prompt
and return to the terminal.
247
Figure 4 – Asking for confirmation of enabling VNC server
Figure 5 – Confirmed enabled VNC server
4. After returning to the terminal, exit it and click the VNC Server icon shown in
Figure 6. This icon is located on the right side of the taskbar on the desktop.
Once clicked, a user interface will pop up as shown in Figure 7. This interface
will show information such as the I.P. Address of the server along with the
Signature, and Catchphrase which users should check for when connecting to
the server.
Figure 6 - VNC Server Icon
248
Figure 7 - VNC Server User Interface
5. While it is possible to remote access the Raspberry Pi with the I.P. Address
alone, it is subject to change depending on which wifi-network the Raspberry
Pi is connected to. For easier access to the VNC Server, create a RealVNC
account online and sign in by clicking on the VNC Server icon in the desktop of
the Raspberry Pi, clicking on the status menu icon, and pressing “Licensing…”
as shown in Figure 8. This allows for remote access no matter what network
the Raspberry Pi is connected to.
Figure 8 - Creating a RealVNC Account to Remote Access Raspberry Pi
6. After following the instructions given and signing in the RealVNC account,
remote access can be achieved through the VNC Viewer application after
signing in the RealVNC account used for the VNC Server.
249
----------------------------------------------------------------------------------------------------------------
Setting Up Remote Access of PHAAS through VNC Viewer:
After setting up the VNC Server and creating a RealVNC to remote access the
Raspberry Pi as long as it has a wifi connection, remote access can be established by
the user, allowing them to start data acquisition.
1. To establish remote access to PHAAS, first ensure that the device to be used
for remote access has the VNC Viewer application installed. The devices can
either be a smartphone, tablet, laptop, or PC. It must be taken note that an
internet connection is required to establish the connection.
2. Sign in to the RealVNC account using the credentials provided during

creation of the VNC account.
Figure 9 - Sign in prompt in VNC Viewer Application
3. Once signed in, power on Raspberry Pi and select the corresponding name of
the server in the address book or input the I.P. Address to establish a
connection.
Figure 10 - Address book of RealVNC account of user
250
4. Enter the username and password of the VNC Server to be granted remote
access.
Figure 11 - Sign in Prompt to Access VNC Server
----------------------------------------------------------------------------------------------------------------
Configuration of Device for Specific User:
Remotely accessing the device will allow configurations to be made for a

specific user of this device. Besides the setup of the VNC account of the user, the
configurations to be made include indicating the user’s name and their designated
contacts’ phone numbers in the python code. This is to be done by a qualified
technician to ensure the configurations are set properly for the specified user. Below
is a list of instructions on how to make these configurations.
1. Open Geany App by clicking the icon shown in Figure 12.
Figure 12 - Geany App Icon
2. Upon opening the Geany application, the python file “phaas_final_code.py”

should be opened automatically as shown in Figure 13.
251
Figure 13 - phaas_final_code.py accessed in Geany Application
In the case the python code is not available upon opening of the
application, press the “Open Existing File” icon as shown in Figure 14 and
access the following directories to access the python code
/home/phaas/PHAAS_FINAL/phaas_final_code.py as shown in Figure 15.
Figure 14 - Open Existing File Icon
Figure 15 - Directory to access python code.
252
3. Once the PHAAS code has been opened, set the name of the user in line 36
of the python code under the subject variable as shown in Figure 16.
Figure 16 – PHAAS code line 35 and 36
4. Also, set the number of the designated contacts under lines 234 and 235 which
is for the first designated contact, lines 262 and 263 for second designated
contact as shown in Figure 17.
Figure 17 – Assigning of SMS and call contacts.
5. Press “Ctrl+S” to save configurations made.

6. To run the code, open the terminal and input “python3
/home/phaas/PHAAS_FINAL/phaas_final_code.py.” The code will then run
continuously unless the device is turned off or shut down.
----------------------------------------------------------------------------------------------------------------
How to use PHAAS:
1. Place three electrode patches following the chest lead II placement provided
in the list and figure shown below:
(Chest Lead II Placement)
• Right Arm (RA) - anywhere between the right shoulder and right elbow
• Left Arm (LA) - anywhere between the left shoulder and left elbow
253
• Left Leg (LL) - anywhere below the left torso and above the left ankle;
the most preferable location is around one inch below the leftmost part
of the left rib.
2. Strap the PHAAS device to the user along the waist.
3. Connect the lead connectors to the device and the electrode patches. The
placement should follow the following:
• Red Snap-on connected to RA electrode patch.
• Yellow Snap-on connected to LA electrode patch.
• Green Snap-on connected to LL electrode patch.
4. Turn on the device by pressing the button on the power bank.
5. Remotely access the PHAAS through VNC Viewer once it is booted up. Run
the code by entering the following in the terminal:
“python3/home/phaas/PHAAS_FINAL/phaas_final_code.py”
6. After executing the code, PHAAS is now working and can be left to function
independently. The LCD display module will display texts regarding what
phase of the process is the device in which is as follows:
• ‘ACQUIRING ECG SIGNAL’ - ECG signal is being acquired from the

user.
• ‘PROCESSING ECG’ - ECG is being pre-processed.
• ‘SAVING DATA’ - relevant data are being recorded.
• ‘PLOTTING ECG’ – data is being plotted and then afterwards will be
saved.
• ‘NORMAL’ - ECG is in a normal state.
• ‘STEMI DETECTED!’- ECG displays ST-elevation and STEMI heart
attack is possible (alert system is initiated in this case)
7. If the user desires to remove the device, simply turn off the power bank or shut
it down via VNC server. Then, remove the connection between electrodes and
lead, and remove and discard the electrode patches used.
----------------------------------------------------------------------------------------------------------------
IMPORTANT NOTES:
• After every use of electrode patches, a new set is expected to be used for the
next application.
• Delays are expected between the acquisition and detection of STEMI mainly
due to processing and saving data time.
• A network connection is established when the GSM Module LED Indicator
blinks once every 3 seconds. This allows messages to be sent and calls to be
made.
254
• In the case of STEMI detection, the alert system is initiated and designated
personnel will be contacted. It will be indicated on the LCD screen as follows:
• ‘CONTACTING CONTACT 1’ - sending SMS and initiating calls to
assigned contact no.1
• ‘CONTACTING CONTACT 2’ - sending SMS and initiating calls to
assigned contact no.2
• The device can be charged by plugging in a charger and a USB C cable to
the USB C port of the power bank.
• If device was removed or turned off, upon using again, configuration via VNC
server is required in order to run the PHAAS code.
• To access saved filter CSV filters, follow the directory:
“/home/phaas/PHAAS_FINAL/filter_csv”.
• To access saved feature CSV filters, follow the directory:
“/home/phaas/PHAAS_FINAL/feature_csv”.
• To check and confirm ECG events and acquisitions, ECG plots are available at
“/home/phaas/PHAAS_FINAL/filter_plots”.
----------------------------------------------------------------------------------------------------------------
TROUBLESHOOTING
If messages and calls do not send despite the display of STEMI:

• Check for network availability via the blinking lights of the device. If it blinks
erratically, the location most likely doesn’t have a good network connection.
Move to a better location with better signal reception.
• Check if the power bank is at low battery; charge accordingly if it is so.
If PHAAS always displays STEMI despite confirmation of Normal ECG state:

• Ensure proper electrode placement.
• Make sure the electrode patch is attached to clean skin (not sweaty and no
hair)
255

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Final - Manuscript - Portable Heart Attack Alert System (PHAAS) - An Objective-Based Approach in Detecting ST-elevated Myocardial Infarction (S

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Ateneo de Zamboanga University

Portable Heart Attack Alert System (PHAAS):

An Objective-Based Approach in Detecting ST-elevated Myocardial

Infarction (STEMI) for Patients with Ischemic Heart Disease

A Senior Design Project

Presented to the Faculty of the Engineering Department

College of Science and Information Technology

ATENEO DE ZAMBOANGA UNIVERSITY

Camba, James Michael M.

Ramiso, Allysa Marie R.

Niño Christon Y. Lazarte, ECE, ECT

Portable Heart Attack Alert System (PHAAS): An Objective-Based Approach in

Prepared and submitted by JAMES MICHAEL M. CAMBA and ALLYSA MARIE R.

NIÑO CHRISTON Y. LAZARTE, ECE, ECT

Approved by the Committee on Oral Examination with a grade of PASSED on May 2,

LOUIE VIRGIL A. GALLARDO, ME-ECE

ZAEEFA A. PANDANGAN, ECE, ECT BIANCA DANIELLE C. ORAA

Accepted in partial fulfillment of the requirements for the degree of Bachelor of

LOUIE VIRGIL A. GALLARDO, ME-ECE

JOCELYN D. PARTOSA, Ph.D.

accumulation of plaque, commonly known as atherosclerosis. According to Philippine

risk of experiencing heart attacks, as well as associated complications, such as

cardiac failure, arrest, and death.

The detection of heart attacks primarily relies on identifying symptoms, which

emphasizing the importance of prompt action to mitigate potentially fatal

designed and developed as a real-time, portable device capable of detecting heart

attacks, particularly STEMI, using electrocardiography (ECG) and machine learning.

and improving outcomes.

Results from testing of the PHAAS device demonstrate its effectiveness in

whole, the PHAAS system demonstrated reliability and functionality, achieving a

affect model performance. Further improvement of developed filters can address

Additionally, the alert system of the PHAAS device functioned accordingly

can potentially be integrated into everyday life.

detection of STEMI heart attacks was successfully implemented. With further

improvements, the PHAAS device represents a promising development in the field of

medical devices for heart attack detection and intervention.

guidance, insights, and encouragement of others. We would like to take this

this accomplishment a reality. Their invaluable contributions have been instrumental

in shaping the direction and development of this thesis.

pushing through despite the challenges we have encountered.

and respected cardiologists, Dr. Amelyn S. Ulanghutan from Zamboanga Doctor’s

to our siblings who have assisted and adjusted to us in many ways.

continue and eventually, allowed us to reach success.

Most importantly, to God Almighty, whom we have confided in during moments

us to persevere and overcome the challenges we faced throughout this journey.

CHAPTER III ........................................................................................ 58

CHAPTER IV ..................................................................................... 119

CHAPTER V ...................................................................................... 166

CHAPTER VI ..................................................................................... 199

CHAPTER VII .................................................................................... 202

BIBLIOGRAPHY ................................................................................ 205

APPENDICES .................................................................................... 222

APPENDIX P .......................................................................................................... 240

1.1 Background of the Study

Ischemic heart disease (IHD), also known as coronary artery disease, is a

Association, 2016). This type of disease is due to the development of atherosclerosis,

thousand cases or 16.7 percent of total deaths.

of IHD is increasing. There is an expectation that by 2030, the estimated prevalence

rate of 1,655 cases per 100,000 will exceed 1,845.

undesirable complications. Examples include arrhythmias, cardiogenic shock, heart

failure, pericarditis, cardiac arrest, and death (Mayo Clinic, 2022).

severity and multiple complications. According to the American College of Cardiology