Fundamentals of Biomedical

Applications
Unit II
 ELECTROCARDIOGRAM
(ECG)
• The recording of the electrical activity associated with the functioning of the heart is
known as electrocardiogram.
• ECG is a quasi-periodical, rhythmically repeating signal synchronized by the
function of the heart, which acts as a generator of bioelectric events.
• This generated signal can be described by means of a simple electric dipole (pole
consisting of a positive and negative pair of charge).
• The dipole generates a field vector, changing nearly periodically in time and space and
its effects are measured on the surface.
• The waveforms thus recorded have been standardized in terms of amplitude and phase
relationships and any deviation from this would reflect the presence of an abnormality.
• Therefore, it is important to understand the electrical activity and the associated
mechanical sequences performed by the heart in providing the driving force for the
circulation of blood.
• The heart has its own system for generating and conducting action
potentials through a complex change of ionic concentration across the
cell membrane.
• Located in the top right atrium near the entry of the vena cava, are a
group of cells known as the sino-atrial node (SA node) that initiate the
heart activity and act as the primary pace maker of the heart.
• The SA node is 25 to 30 mm in length and 2 to 5 mm thick. It
generates impulses at the normal rate of the heart about 72 beats per
minute at rest.
• Because the body acts as a purely resistive medium, the potential field
generated by the SA node extends to the other parts of the heart.
• The wave propagates through the right and left atria at a velocity of
about 1 m/s. About 0.1 s are required for the excitation of the atria to be
completed.
• The action potential contracts the atrial muscle and the impulse spreads
through the atrial wall about 0.04s to the AV (atrio-ventricular) node.
• This node is located in the lower part of the wall between the two atria.
• The AV node delays the spread of excitation for about 0.12 s, due to the presence of a fibrous barrier of non-
excitable cells that effectively prevent its propagation from continuing beyond the limits of the atria.
• Then, a special conduction system, known as the bundle of His (pronounced as hiss) carries the action
potential to the ventricles.
• The atria and ventricles are thus functionally linked only by the AV node and the conduction system.
• The AV node delay ensures that the atria complete their contraction before there is any ventricular
contraction.
• The impulse leaves the AV node via the bundle of His. The fibres in this bundle, known as Purkinje fibres,
after a short distance split into two branches to initiate action potentials simultaneously in the two ventricles.
• Conduction velocity in the Purkinje fibres is about 1.5 to 2.5 m/s. Since the direction of the impulse
propagating in the bundle of His is from the apex of the heart, ventricular contraction begins at the apex and
proceeds upward through the ventricular walls.
• This results in the contraction of the ventricles producing a squeezing action which forces the blood out of
the ventricles into the arterial system. Figure 2.3 shows the time for action potential to propagate to various
areas of the heart
• The normal wave pattern of the electrocardiogram is shown IN FIG.
• The PRandPQinterval, measured from the beginning of the P wave to the onset of the R
or Q wave respectively, marks the time which an impulse leaving the SA node takes to
reach the ventricles.
• The PRinterval normally lies between 0.12 to 0.2 s.
• The QRSinterval, which represents the time taken by the heart impulse to travel first
through the interventricular system and then through the free walls of the ventricles,
normally varies from 0.05 to 0.10s.
• TheT wave represents repolarization of both ventricles. The QT interval, therefore, is the
period for one complete ventricular contraction (systole). Ventricular diastole, starting
from the end of the T wave extends to the beginning of the next Q wave. Typical
amplitude of QRS is 1 mV for a normal human heart, when recorded in lead 1 position
INTERPRETATION OF ECG WAVE FORM
• P wave
• The P wave is a small deflection wave that represents atrial depolarization.
• PR interval
• The PR interval is the time between the first deflection of the P wave and the first deflection of the QRS complex.
• QRS wave complex
• The three waves of the QRS complex represent ventricular depolarization
• Labeling rule is: if the wave immediately after the P wave is an upward deflection, it is an R wave; if it is a downward deflection, it
is a Q wave:
• small Q waves correspond to depolarization of the interventricular septum. Q waves can also relate to breathing and are generally
small and thin. They can also signal an old myocardial infarction (in which case they are big and wide)
• the R wave reflects depolarization of the main mass of the ventricles –hence it is the largest wave
• the S wave signifies the final depolarization of the ventricles, at the base of the heart
• ST segment
• The ST segment, which is also known as the ST interval, is the time between the end of the QRS complex and the start of the T
wave. It reflects the period of zero potential between ventricular depolarization and repolarization.
• T wave
• T waves represent ventricular repolarization (atrial repolarization is obscured by the large QRS complex).
 Systole
This is the phase of the cardiac cycle when the heart muscle contracts,
pushing blood out of the chambers into the arteries.
During systole, the ventricles (the lower chambers of the heart)
contract, forcing blood into the aorta and pulmonary artery.
This is when the heart pumps blood to the rest of the body (systemic
circulation) and to the lungs (pulmonary circulation).
 Diastole
Diastole is the phase of the cardiac cycle when the heart muscle relaxes
and refills with blood.
During diastole, the ventricles relax, allowing blood to flow into them
from the atria (the upper chambers of the heart).
This is when the heart receives blood from the veins returning from the
body and lungs.
Together, systole and diastole make up one complete heartbeat. The
heart goes through this cycle continuously to maintain blood circulation
throughout the body.
 ELECTRICAL CONDUCTION OF HEART
The electrical conduction system of the heart is a network of specialized cells responsible for
generating and transmitting electrical signals to coordinate the rhythmic contractions of the heart
muscle. Here's a simplified overview of how it works:
1. Sinoatrial (SA) Node: The process begins in the right atrium of the heart, where the SA node acts
as the natural pacemaker. It spontaneously generates electrical impulses, initiating each
heartbeat.
2. Atrial Conduction: The electrical impulse travels from the SA node through the atria, causing
them to contract and push blood into the ventricles. This is known as atrial depolarization.
3. Atrioventricular (AV) Node: The electrical signal reaches the AV node, which acts as a delay
mechanism. It briefly slows down the signal, allowing the ventricles time to fill with blood from
the atria.
4. Bundle of His: After passing through the AV node, the electrical impulse travels down the Bundle
of His, a bundle of specialized fibers that run along the interventricular septum (the wall
between the ventricles).
5. Right and Left Bundle Branches: The Bundle of His splits into right and left bundle branches,
which carry the electrical signal toward the apex (bottom) of the heart.
6. Purkinje Fibers: The bundle branches further divide into smaller fibers known as Purkinje
fibers, which spread throughout the ventricles, ensuring that the signal reaches all parts of the
ventricles simultaneously.
7. Ventricular Conduction: As the electrical impulse spreads through the Purkinje fibers, it triggers
ventricular depolarization, causing the ventricles to contract and pump blood into the pulmonary
artery (right ventricle) and the aorta (left ventricle).
8. Repolarization: After contraction, the cardiac muscle cells undergo repolarization, resetting the
electrical state for the next heartbeat.
This coordinated electrical activity ensures that the atria contract first, followed by the ventricles,
allowing for efficient blood flow through the heart. Any disruption in this conduction system can
lead to cardiac arrhythmias or other heart-related issues.
A 12-lead ECG paints a complete picture of the
heart's electrical activity by recording information
through 12 different perspectives. Think of it as 12
different points of view of an object woven together
to create a cohesive story - the ECG interpretation.

These 12 views are collected by

placing electrodes or small, sticky patches on the
chest (precordial), wrists, and ankles. These
electrodes are connected to a machine that
registers the heart's electrical activity.
To measure the heart's electrical activity
accurately, proper electrode placement is crucial.
In a 12-lead ECG, there are 12 leads calculated
using 10 electrodes.
A lead is a glimpse of the electrical activity of the
heart from a particular angle. Put simply, a lead is
like a perspective.
 In 12-lead ECG, there are 10 electrodes providing
12 perspectives of the heart's activity using
different angles through two electrical planes -
vertical and horizontal planes.
Chest (Precordial) Electrodes and
Placement
» V1 - Fourth intercostal space on the right sternum
» V2 - Fourth intercostal space at the left sternum
» V3 - Midway between placement of V2 and V4
» V4 - Fifth intercostal space at the midclavicular line
» V5 - Anterior axillary line on the same horizontal
level as V4
» V6 - Mid-axillary line on the same horizontal level as
V4 and V5
 Limb (Extremity) Electrodes and Placement

• » RA (Right Arm) - Anywhere

between the right shoulder
and right elbow
» RL (Right Leg) - Anywhere
below the right torso and
above the right ankle
» LA(Left Arm) - Anywhere
between the left shoulder
and the left elbow
» LL (Left Leg) - Anywhere
below the left torso and
above the left ankle
Vertical plane (Frontal Leads):

By using 4 limb electrodes, you get 6 frontal leads that provide

information about the heart's vertical plane:
Lead I
Lead II
Lead III
Augmented Vector Right (aVR)
Augmented Vector Left (aVL)
Augmented vector foot (aVF)
Leads I, II, and III require a negative and positive electrode
(bipolarity) for monitoring.
On the other hand, the augmented leads-aVR, aVL, and aVF-are
unipolar and requires only a positive electrode for monitoring.
• The Einthoven's triangle explains why there are 6 frontal
leads when there are just 4 limb electrodes.
• The principle behind Einthoven's triangle describes how electrodes
RA, LA and LL do not only record the electrical activity of the heart
in relation to themselves through the aVR, aVL and aVF leads. They
also correspond with each other to form leads I (RA to LA), II (RA to
LL) and III (LL to LA).
• As a result, they form an equilateral triangle. Hence it's called the
Einthoven's triangle, named after Willem Einthoven who invented
the first practical ECG.
• Keep in mind that RL is neutral (also known as point zero where the
electrical current is measured). RL doesn't come up in ECG
readings, and is considered as a grounding lead that helps minimize
ECG artifact.
Horizontal Plane (Transverse
Leads)
• By using 6 chest electrodes, you get 6 transverse
leads that provide information about the heart's
horizontal plane: V1, V2, V3, V4, V5, and V6.

• Like the augmented leads, the transverse leads are

unipolar and requires only a positive electrode. The
negative pole of all 6 leads is found at the center of
the heart. This is calculated with the ECG.
 HOW TO REDUCE ARTIFACTS IN ECG SIGNIFICANT

• A slight ECG artifact is not uncommon. However, you can

reduce further interference through the following steps
• Switch off non-essential electrical devices and equipment
within the vicinity if possible.
• Check for cable loops and avoid running cables adjacent to
metallic objects as they can affect the signal.
• Inspect wires and cables for cracks or breaks. Replace as
needed.
• If possible, use surge suppressors with the power supply.
• Ensure that filters and preamplifiers are appropriately adjusted.
• Ensure securely connection between patient cable and the ECG
device. Double check for gaps between connectors.