ELECTROCARDIOGRAPHY

Process of recording electrical activity of the heart.

Recorded waveform in terms of amplitude and phase relationship is called
electrocardiogram.

Block diagramof ECG machine:

 The potentials picked up by the patient electrodes are
taken to the lead selector switch.
 The signal from lead selector switch is given to
preamplifier.
 Preamplifier is a 3 or 4 stage differential amplifier.
 Single ended output from preamplifier is given to power
amplifier.
 Power amplifier is a push pull differential amplifier.
 The output of the power amplifier is fed to the pen motor.
 Frequency selective network is an R-C network, which
provides necessary damping of the pen.
 The auxiliary circuits provide a 1 mV calibration signal
and automatic blocking of the amplifier during change in
the position of the lead switch.
ECG Lead Configuration
 Tracing of voltage difference between any two points on
the heart due to the electrical activity of the heart is
called a “lead”.
 Bipolar Leads:

 ECG is recorded by using two electrodes such that

the final trace corresponds to the difference of electrical

potentials existing between them.
 Also called standard leads or Einthoven leads.
 Lead I has a positive electrode on the left arm and a
negative electrode on the right arm.
 Lead II has a positive electrode on the right arm and a
negative electrode on the left foot.
 Lead III has a positive pole on the left foot and a
negative pole on the left hand.
 Potential difference is measured with respect to a
reference point which is the right leg(RL).
 Einthoven principle:
 Einthoven postulated that at any given instant of the
cardiac cycle, the electrical axis of the heart can be
represented as a two dimensional vector.
 The ECG measured from any of the three basic limb
leads is a time-variant single-dimensional component
of the vector.
 He proposed that the electric field of the heart could
be represented diagrammatically as a triangle, with
the heart ideally located at the centre.
 known as the "Einthoven triangle”.
 The sides of the triangle
represent the lines along
with the three projections
of the ECG vector are
measured.
 The instantaneous
voltage measured from
any one of the three limb
lead positions is
approximately equal to
the algebraic sum of the
other two
 the vector sum of the
projections on all three
lines is equal to zero.
Unipolar Leads:
 The standard leads record the difference in electrical potential
between two points on the body produced by the heart's action.
 Better sensitivity can be obtained if potential of a single electrode
is recorded.
 if the electrode is placed on the chest close to the heart, higher
potentials can be detected than normally available at the limbs.
 This leads to the development of unipolar leads.
 The electrocardiogram is recorded between a single exploratory
electrode and the central terminal,which has potential
corresponding to the centre of the body.
 The reference electrode or central terminal is obtained by a
combination of several electrodes tied together at one point.
 Two types of unipolar leads are employed
 (i) limb leads
 (ii) precordial leads.

 (i) Limb Leads:

 Two of the limb leads are tied together and recorded with
respect to the third limb.
 AVR -the right arm is recorded with respect to a
reference established by joining the left arm and left leg
electrodes.
 AVL -the left arm is recorded with respect to the
common junction of the right arm and left leg.
 AVF -the left leg is recorded with respect to the two arm
electrodes tied together.
 They are also called augmented leads or 'averaging
leads’.
 The resistances inserted between the electrodes-machine
connections are known as 'averaging resistances'.
Precordial leads:
 Employs an exploring electrode to record the potential of
the heart action on the chest at six different positions.
 Designated by the capital letter 'V' followed by a
subscript numeral -represents the position of the
electrode on the pericardium.
Measurement of blood pressure:
 Pressure measurements are a vital indication in the
successful treatment and management of critically ill
patients.
 All blood pressure measurements are made with
reference to the atmospheric pressure.
 The most frequently monitored pressures, which have
clinical usefulness in medium and long- term
patient monitoring are arterial pressure and the venous
pressure.
 Two basic methods for measuring blood pressure
(i) direct method
(ii) indirect method.
 The indirect methods consist of simple equipment
and cause very little discomfort to the subjects
(but they are intermittent and less informative).
Direct Methods of Monitoring Blood Pressure
 Direct methods provide continuous and much more
reliable information about the absolute vascular pressure
from probes or transducers inserted directly into the
blood stream.
 Used when highest degree of absolute accuracy,
dynamic response and continuous monitoring are
required.
 Used to measure the pressure in deep regions
inaccessible by indirect means.
 Here a catheter or a needle type probe is inserted through
a vein or artery to the area of interest.
 Two types of probes are used:
(i) catheter tip probe
(ii) fluid-filled catheter type
Catheter Tip Probe:
 Here the sensor is mounted on the tip of the probe and the
pressures exerted on it are converted to proportional
electrical signals.
Fluid-filled Catheter Type:
 This will transmits the pressure exerted on its fluid-filled
column to an external transducer.
 This transducer converts the exerted pressure to electrical
signals.
 These electrical signals can then be amplified and displayed
or recorded.
 Catheter tip probes provide the maximum dynamic response
and avoid acceleration artefacts.
 The fluid-filled catheter type systems require careful
adjustment of the catheter dimensions to obtain an optimum
dynamic response.
Typical set up of a pressure measuring system
by direct method (fluid filled system) Circuit diagram
 Before inserting the catheters into the blood vessel it is
important that the fluid-filled system should be
thoroughly flushed
 In practice a steady flow of sterile saline is passed
through the catheter to prevent blood clotting in it.
 As air bubbles dampen the frequency response of the
system, it should be ensured that the system is free from
them.
Measurement of systolic pressure:
 A conventional peak reading type voltmeter is used.
 When a positive going pressure pulse appears at A, diode
D3 conducts and charges C3 to the peak value of the
input signal, which corresponds to the systolic value.
 Time constant R3C3 is chosen in such a way that it gives
a steady output to the indicating meter.
Measurement of diastolic pressure:
 Derived in an indirect way.

 A clamping circuit consisting of C1 and D1 is used to

develop a voltage equal to the peak-to-peak value of the
pulse pressure
 This voltage appears across R1.

 Diode D2 would then conduct and charge capacitor C2 to

the peak value of the pulse signal.
 The diastolic pressure is indicated by a second meter
M2 which shows the difference between the peak systolic
minus the peak-to-peak pulse pressure signal.
Frequency Response and Damping Adjustment of the
Fluid-filled Catheters:
 The frequency components of a normal pressure pulse
consist of:
A zero frequency (dc) component
A fundamental component at the heart rate
Harmonics of the fundamental rate.
 To record a pressure pulse without any distortion, the
measuring system should be capable of recording all the
frequency components with equal amplification and phase
shift.
 The range of uniform frequency response starting from
 dc is determined from an estimation of the highest heart
rate expected and the number of harmonics(to 10th
harmonics produce significant components)
➢ Important factor which require special consideration
in relation with the fluid column pressure measuring
system is the natural frequency or the resonant
frequency of the system.

➢ measuring system can respond accurately only for

frequencies well below the natural frequency.

➢
➢ Where D = diameter of the fluid column
➢ L = length of the fluid column
➢ ΔP = pressure change
➢ ΔV = volume change for a given ΔP
 Fluid column systems usually have a very low-natural
frequency-due to their large inertia and compliance
 to accurately record the pressure pulses, some form of
compensation is necessary to improve the frequency response
 This compensation is called damping.
 damping is provided by the viscous resistance of the liquid in
the catheter and is given by

 where D = damping coefficient

 ρ = liquid density in g/cm3
 η = viscosity of the liquid in poises
 γc = radius of the catheter bore in cm
 lc = length of the catheter bore in cm
 E = volume elasticity of the sensing element in dynes/cm5