Electrocardiography with a Smartphone

Lars-Jochen Thoms, Giuseppe Colicchia, Bianca Watzka, and Raimund Girwidz

Citation: The Physics Teacher 57, 586 (2019); doi: 10.1119/1.5135782

View online: https://doi.org/10.1119/1.5135782
View Table of Contents: https://aapt.scitation.org/toc/pte/57/9
Published by the American Association of Physics Teachers

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Electrocardiography with a Smartphone
Lars-Jochen Thoms, Giuseppe Colicchia, Bianca Watzka, and Raimund Girwidz, Ludwig-Maximilians-Universität,
München, Germanyz

M
yocardial contraction is triggered whenever a wave
Bundle of His
of electrical impulses passes through the heart. The
pattern of electrical excitation spreads coordinately
Sinoatrial Left bundle
over the structure of the heart. This results in a measurable node branch
change in potential across the surface of the body of a sub-
ject. The recording of the resultant signal from specific body
points is known as an electrocardiogram (ECG). Students
can directly record an ECG signal from the headset input of
a smartphone with an electric lead and a suitable sound app. Atrioventricular
(AV) node
This allows interdisciplinary teaching by applying physics
concepts to physiology.

The heart electric dipole

Each cardiac cycle begins with the spontaneous generation
of an action potential in the sinoatrial node, which is located
in the superior lateral wall of the right atrium. The action
Right bundle branch Purkinje fibers
potential travels from there at 3 to 5 m/s through the walls
of the atria and then through the AV node into the ventricles
Fig. 1. Pathway of the cardiac impulse through the heart.
(Fig. 1). The impulse then moves through the His bundle and
further along to the Purkinje fibers, where the contraction is
triggered.1 The propagation of electric impulses establishes a
complicated charge and potential distribution that changes in
time as different parts of the heart are stimulated.
+0.5mV
Differences in the concentration of ions between the
interior and the exterior of a cell lead to a voltage called the C
ur
membrane potential. Myocardial cells at rest have a negative re
nt
ax
membrane potential (greater positive charge just outside the is
cell boundary than just inside). Stimulation above a threshold
value induces the opening of voltage-gated ion channels and
a flood of cations into the cell. The positively charged ions
A
+
++ +

entering the cell cause the depolarization characteristic of an

+ +
+ +
+ +
+ +
+

action potential. After a delay, potassium channels reopen, + + + +

+ + + +
+ +
+ + +
+ + +

and the resulting flow of cations out of the cell causes repolar-
+ +
+

B
+ +
+ +
+
+ + + +

ization to the resting state. tia

In a first approximation, the total electric charge of the
heart can be modeled as an electric dipole. This heart dipole
changes both direction and magnitude during the cardiac cy-
cle and generates a variable potential on any point of the body
(see Fig. 2).2
Recording electrical potentials
When the cardiac impulse passes through the heart,
electrical current also spreads from the heart to the adjacent
tissue surrounding the heart and extends to the surface of
the body. If two electrodes are placed on the skin on opposite
sides of the heart, electrical potentials generated by the field
of the dipole can be recorded.
The detected waveform features depend not only on the
magnitude variation of the dipole in the heart, but also on
the orientation of the electrodes with respect to the dipole.
At any instant, the potential difference recorded between two
l
t en
po
o
-0.2mV Zer
+0.3mV
of
ne
Li
Fig. 2. Heart dipole model around partially depolarized ventricles.
The dipole model shown here is an often used but strongly simpli-
fied illustration, and does not represent the full complexity of the
physics. The black curves represent the electric field lines. The red
and blue curves represent the positive and negative equipotential
lines. The heart can be modeled as a bipolar source having the
negative pole at point A and the positive pole at point B.
electrodes is proportional to the component of the dipole
moment vector of the heart projected on the connection line
of the two electrodes. In other words, the ECG waveform will
look slightly different when measured from different elec-
trode positions.
As far back as 100 years ago, Einthoven showed that the

586 THE PHYSICS TEACHER ◆ Vol. 57, December 2019 DOI: 10.1119/1.5135782

+0.5mV
-0.2mV +0.3mV
Fig. 3. Placing electrodes on the left and the right wrist (limb lead
I in Einthoven’s triangle) measures a potential difference that
depends on the projection of the instantaneous heart vector on
the line formed by the shoulders.
projections on the three sides of a triangle of the cardiac di-
pole are sufficient to perform a useful electrocardiogram.3
Figure 3 shows the electrical connections between the pa-
tient’s limbs and the electrocardiograph from the standard
bipolar so-called “limb lead I.” In recording limb lead I, the
negative terminal of the electrocardiograph is connected to
the right arm and the positive terminal to the left arm. Limb
lead I gives a very good indication of the electrical phenom-
ena at play when moving from left to right in the heart, but a
poor view of events moving perpendicular to the limb lead I
axis.
Different views of the heart dipole are accomplished by the
other two Einthoven leads: limb lead II (right arm to left leg)
and III (left arm to left leg). The electrodes can be placed any-
where on the arms as long as the left and the right electrode
have the same distance from the heart. The signals in the
leads may be regarded as projections of the electric heart vec-
tor on the respective lead vectors. Although the power of the
measured signal decreases with increasing distance between
the electrodes and the heart, the shape of the signal remains
almost unchanged. The intensity of the signal also depends
on the amplification of the measuring system and the elec-
trode-skin contact resistance.
Electrodes
There are two types of electrodes that are commonly used
to measure biological surface potentials. For clinical use,
non-polarizable electrodes, which behave as resistors, e.g.,
silver chloride electrodes (Ag/AgCl), produce a constant con-
tact potential and have a low electrode-skin impedance, low
noise and low motion artifact, and are therefore favorable.
Polarizable electrodes, which act as capacitors, are made of
metals that resist corrosion and oxidation (e.g., platinum or
stainless steel), do not have to be replaced after a short time,
THE PHYSICS TEACHER ◆ Vol. 57, December 2019
Depolarization
2
Atria R Ventricles R
Amplitude (mV)
1
P T
0
Q
-1
S
QRS Ventricular
duration repolarization
-2
0 200 400 600 800 1000 1200 1400
Time (ms)
Fig. 4. P wave, QRS complex, and T wave of a normal ECG.6
and are used, e.g., in non-medical applications (e.g., fitness
tracker).4 While the resistance through the human body is
relatively low (0.3 to 1 kΩ), the electrode-skin contact resis-
tance may vary greatly (from 1 kΩ to 100 kΩ). Therefore,
electrode gel is used to improve skin conductivity.
Electrocardiogram
The ECG is a time-varying signal reflecting the ionic
current flow that causes the cardiac fibers to contract and
subsequently relax. A single normal cycle of the ECG rep-
resents the successive heart depolarization and repolarization
that occurs in every cardiac cycle (Fig. 4). The analysis of
the electrocardiogram pattern can provide a wealth of useful
information. However, without profound cardiac knowledge,
only the heart rate can be recognized and partially evaluated.
Unusual heart rate – < 60/min or >100/min – may be harm-
less. The latter occurs most often as a physiological response
to physical exercise or psychological stress.
Smartphone single lead ECG
Several options exist for getting electric signals into the
smartphone. One of the most obvious ways to get analog sig-
nals into a smartphone is through the headset input when a
headset connector with a microphone input is present.5 How-
ever, this port may be AC coupled, preventing the module
from directly tapping into the phone’s DC power, and from
transmitting the low frequency signals. One should also be
aware that:
1. The headset microphone input is very sensitive (it ex-
pects a low-level microphone signal).
2. A bias voltage is present on the headset input to power
electret microphones.
3. The headset input expects to see a particular load in
order to signal the operating system that an external mi-
crophone is present.
4. The smartphone must not cut off low frequencies when
acquiring or processing the audio signal.
Two plates of stainless metal are used as electrodes to cre-
ate contact with the body (Fig. 5). To be sure the smartphone
587
 10kΩ
N
(a)
(b)
Fig. 5. Recording limb lead I in the smartphone ECG using
electrodes made from espresso spoons. (a) Schematic,
(b) image.
will select the microphone input signal, one must place a
suitable resistor (1 to 10 kΩ) in parallel with the input. We
have had good success by dropping the bias voltage with a 10
kΩ resistor. We tested the circuit on both an Apple iPhone 6s
and a Samsung Galaxy S8. The signal processing (amplifica-
tion and low-pass filter) of the acquired cardiac cycle will be
performed directly on the smartphone (Fig. 6). Particularly
suitable for this is the app Stethoscope7 that was developed to
record phonocardiograms and was previously used for con-
text-based teaching of acoustics in schools.8 If the app used
does not allow signal processing, it can record the signal and
send it to a device (computer) for processing with an audio
editor (Fig. 7), e.g., the free Audacity.9
When the smartphone does not have a headset/micro-
phone connector, there are usually adapters available that
allow for connection of a microphone to the smartphone, e.g.,
lightning adapters. The Apple Watch 4 uses nearly the same
principle (one titanium electrode and one chromium silicon
carbon nitride electrode). However, we were not able to test
an Apple Watch 4 because the ECG capability is disabled in
Germany.
588 THE PHYSICS TEACHER ◆ Vol. 57, December 2019
Fig. 6. ECG with Stethoscope app.7 (Left) direct measurement and
(right) RMS plot (root mean square power).
Fig. 7. ECG obtained with an iPhone 6s and sent to a PC for
further analysis. (Above) the y-axis on the ECG is skin voltage
without scale for lack of calibration. It is easy to note that the
heart has a regular rhythm of about 60 beats/min. (Below) the
ECG after computer signal processing by a 50-Hz low-pass filter.
Horizontal units in both graphs are in seconds.
Discussion
Student engagement in learning processes plays a cru-
cial role in facilitating intellectual development. Recent
approaches use authentic objects as learning anchors and as
starting points of learning paths.10 Much attention is given
to the use of smartphones and tablets in physics education as
supplements, or even as substitutes for conventional experi-
mental materials.11 On occasion, it is shown that learners can
carry out their own measurements of authentic physical data
with their own mobile device.12 To foster student motivation
and engagement, we combined authentic contexts, proce-
dures, and materials by assessing biomedical physics topics
with a smartphone.
The ECG can be an interesting teaching resource for
young people because of its reference to an important bodi-
ly organ, and because it can be carried out with the use of 8. L.-J. Thoms, G. Colicchia, and R. Girwidz, “Phonocardiogra-
a smartphone. The apparatus can easily be built in only a phy with a smartphone,” Phys. Educ. 52 (2), 023004 (2017).
few minutes by teachers and even by school students using 9. Audacity, https://www.audacityteam.org/ (2019).
the tutorial available for download.13 Thereby we observed 10. K. Hochberg, J. Kuhn, and A. Müller, “Using smartphones as
special interest in how a smartphone registers a plugged-in experimental tools—Effects on interest, curiosity, and learning
microphone and that the 10-kΩ resistor is needed to emulate in physics education,” J. Sci. Educ. Technol. 59 (2), 215 (2018).
this situation. 11. J. Kirstein and V. Nordmeier, “Multimedia representation of
experiments in physics,” Eur. J. Phys. 28 (3), S115–S126 (2007).
The physical concepts and theory underlying the ECG can
12. P. Klein, M. Hirth, S. Gröber, J. Kuhn, and A. Müller, “Classical
be explored without having in-depth knowledge of the sub-
experiments revisited. Smartphones and tablet PCs as exper-
ject. Thereby, a model of the generation of the rotating dipole
imental tools in acoustics and optics,” Phys. Educ. 49 (4), 412
has proven to be intuitively accessible and very helpful (see (2014).
appendix). It is therefore suitable for both secondary school 13. Tutorial for improved and more stable smartphone-ecg
students and university students. electrodes: https://www.en.didaktik.physik.uni-muenchen.de/
In general, noise contributes to mask the recorded signal, materials/ecgtutorial.pdf .
which is of a low intensity. For this reason, all efforts should 14. H. Theyßen, and D. Schumacher, “Experimente zum Verständ-
be made to maximize the signal and minimize electrical nis der Entstehung des Elektrokardiogramms,” PdN-Ph. 8 (53),
noise. Special attention should be paid to minimize muscle 7 (2004).
contraction during the measurement (i.e., students must be
instructed to hold still). Otherwise EMG signals will also be Appendix
recorded. For better understanding of how electrical potentials are
It is important to remark that the smartphone ECG pre- placed in the human body when a heart electric dipole is gen-
sented here should be used only for teaching purposes, erated, a simple experiment should be done.14
and not for medical diagnosis. A wetted sheet of absorbing kitchen paper is shaped in the
form of a body. A 9-V block battery is placed upside down on
An ECG measurement that seems anomalous should not the wetted sheet at the position of the heart. The two poles
necessarily be any cause for concern with this homemade de- of the battery create a dipole between the two points that are
vice; however, medical attention should be sought if in doubt. connected to the terminals of a voltmeter (Fig. 8). An ion cur-
rent and a potential field will then be generated. It is easy to
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Fig. 8. Experiment to show the electrical effects in the body of
6. Traditional medical terminology, see J. W. Hurst, “Naming of the heart dipole by placing a 9-V block battery upside down on a
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