ELECTROCARDIOGRAPHY (ECG)

Electrocardiography is the process of recording the

electrical activity of the heart over a period of time using
electrodes placed over the skin.
Cells in humans act like little batteries. These cells have
different ion concentrations inside and outside of their
membranes which create small electric potentials called
biopotentials. When there is a disturbance in a
biopotential this gives rise to an action potential which is
the depolarization and repolarization of the cell.

the action potentials from different nodes in the heart are

what make up electrocardiograph (ECG) signals. ECG
signals are comprised of the superposition of the different
action potentials from the heart beating. ECG machines
use electrodes to convert the ionic signals from the body
into electrical signals to be displayed and used for data
analysis. However, due to the size of the signals and
outside noise, ECG requires amplification and filtering to
produce high quality signals.
ECG BLOCK DIAGRAM

An ECG’s job is to amplify the small signal measured

from the heart as well as to filter outside an internal noise.
There is also the Right Leg Drive circuit which cancels
noise and maintains the common mode voltage.
Amplifier

ECG signals vary from the microvolt to the millivolt

range. Due to this small range, the signals measured need
to be amplified in order to be better interpreted. Typical
biopotential amplifiers have high input impedance and are
designed for safety first. This is due to the fact that the
signal amplified is being drawn from a living organism so
precautions must be taken in order to prevent macro and
micro shock. Isolation and protection circuitry are used to
limit current through electrodes to safe levels. The output
impedance of the amplifier should be very low to drive
any external load with minimal distortion. Again, due to
the small size of the signal, the gain should be large.
Typically a gain of over 1000 is implemented in
biopotential amplifier circuits. The amplifiers should have
a high common mode rejection ratio to eliminate large
offset signals. Finally, most biopotential amplifiers are
differential. Differential amplifiers are used to make sure
that noise from the inputs are not amplified thus yielding
a higher integrity signal. Differential amplifiers with such
characteristics are difficult to find. Thus combinations of
differential amplifiers are used to construct what is called
an instrumentation amplifier. A basic three-op-amp
instrumentation amplifier is shown in figure.
There are two stages for the instrumentation amplifier that
help make it meet the characteristics of an ideal
biopotential amplifier. The first stage is the input stage of
the amplifier followed by the gain stage as shown in
figure below.

The input stage ideally supplies no common mode gain

thus eliminating common mode noise. The three op-amps
give the input stage high input impedance and the
configuration gives a gain.
(𝑉3 − 𝑉4 ) (2𝑅2 + 𝑅1 )
𝐺= =
(𝑉1 − 𝑉2 ) 𝑅1
The input stage also buffers the gain stage. Finally, the
outputs of the input stage are the inputs of gain stage. The
gain stage has low impedance and supplies a differential
gain. Overall the amplifier amplifies only the differential
component with a gain given by;
(2𝑅2 +𝑅1 ) 𝑅4
𝐺=
𝑅1 𝑅3

It also provides a high common mode rejection ratio.

NOISE IN ECG SIGNAL
Mainly two types of noises are present in the ECG signal.
Noises with high frequency include Electromyogram
noise, Additive white Gaussian noise, and power line
interference. Noises with low frequency include baseline
wandering. The noises contaminated in the ECG signal
may lead wrong interpretation.
ARTIFACTS
Artifacts are distorted signals caused by secondary
internal or external sources, such as muscle movement or
interference from an electrical device. ECGs are subject
to many different kinds of noise internally and externally.
Different kinds of artifacts that ECGs typically experience
are shown in figure below
FILTERING

Distorted signal can be filtered digitally as well as

through analog practices. For example, for power line
interference, the analog band stop filter shown in figure
can be used to modulate 50 Hz noise from power lines
based on what resistor, capacitor, and inductor values are
chosen.
In wandering baseline, the isoelectric line changes
position. One possible cause is the cables moving during
the reading. Patient's movement, dirty
leads/electrodes, loose electrodes, and a variety of other
things can cause this as well. This type of noise can be
filtered by using a high pass filter.

Low-pass filters on the ECG are used to remove high

frequency muscle artifact and external interference.
They typically attenuate only the amplitude of higher
frequency ECG components

The high-pass and low-pass filters together are known as

a bandpass filter, literally allowing only a certain
frequency band to pass through.

Common mode rejection is often done via right-leg

drive, where inverse signals of the three limb electrodes
are sent back through the right leg electrode.
RIGHT LEG DRIVE
The right leg drive circuit is required to reduce
interference from the amplifier. It is possible to amplify
an ECG signal and create a DC common mode bias
electrically off the inputs of the differential amplifier.
However, when this is done there is extreme susceptibility
to common mode interference which is where the need for
the right leg drive comes in. The right leg drive inverts
and amplifies the average common mode signal back into
the patient’s right leg. This action cancels 50 Hz noise
from AC power and creates a cleaner ECG output signal.

ISOLATION AMPLIFIER
Isolation amplifiers are a form of differential amplifier
that allows measurement of small signals in the presence
of a high common mode voltage by providing electrical
isolation and an electrical safety barrier. They protect data
acquisition components from common mode voltages,
which are potential differences between instrument
ground and signal ground. In an ECG, an Isolation
Amplifier protects the circuitry and the Patient from
Leakage Current from 50Hz line operated equipment and
from High-Voltage transients caused by other equipment

ELECTRODES AND LEADS

Two types of electrodes in common use are a flat paper-
thin sticker and a self-adhesive circular pad. The former
are typically used in a single ECG recording while the
latter are for continuous recordings as they stick longer.
Each electrode consists of an electrically conductive
electrolyte gel and a silver/silver chloride conductor. The
gel typically contains potassium chloride sometimes silver
chloride as well to permit electron conduction from the
skin to the wire and to the electrocardiogram.
Electrodes are the actual conductive pads attached to the
body surface. Any pair of electrodes can measure the
electrical potential difference between the two
corresponding locations of attachment. Such a pair forms
a lead.
Commonly, 10 electrodes attached to the body are used to
form 12 ECG leads, with each lead measuring a specific
electrical potential difference. In a conventional 12-lead
ECG, ten electrodes are placed on the patient's limbs and
on the surface of the chest. The overall magnitude of the
heart's electrical potential is then measured from twelve
different angles ("leads") and is recorded over a period of
time (usually ten seconds). In this way, the overall
magnitude and direction of the heart's electrical
depolarization is captured at each moment throughout the
cardiac cycle. The graph of voltage versus time produced
by this noninvasive medical procedure is an
electrocardiogram.
Leads are broken down into three types: limb leads;
augmented limb leads; and precordial or chest leads. The
12-lead ECG has a total of three limb leads and three
augmented limb leads and six precordial leads or chest
leads.
Driver: We use a driver motor of suitable specification
to drive the paper roller. Normally the ECG waveform is
to be plotted on a moving chart paper to find out the
irregularities (if there is ) in the P,Q,R,S,T and U regions
of the ECG waveform. So the paper movement and the
moving speed can be controlled by the driver motor,
which supplies the trigger the roller.

PMMC Galvanometer: PMMC (Permanent Magnet

Moving Coil) galvanometer is a special type of device,
where the deflection of the coil depends on the amplitude
and the polarity of the signal applied to its input. The
writing tip of the hot tip pen is connected to the chart
paper. So the pen will be at rest in the center of its travel
when no current flows in the coil. So the direction of
deflection in the coil and the amount of deflections is
determined by the amplitude and polarity of the ECG
waveform.

Hot - tip stylus and stylus heater: In most common

ECG recording techniques, we use hot tip stylus for
thermal writing. It is because; we normally use thermal
recorders for the plotting of waveforms. The stylus is kept
hot always by the stylus heater power supply. The writing
tip is a stylus heated by a resistance wire.

Recorders: usually we use thermal recorders for the

representation of ECG waveform. The paper used in
thermal recorders is of special material which turns black
when heated. The hot tip of the stylus will turn the white
paper black whenever it touches. The tip of the stylus
moves in accordance with the movement of the coil which
in turn is proportional to the amplitude and polarity of the
ECG waveform. Since the tip of the stylus is in contact
with the thermal chart recorder, a clear representation of
the ECG waveform is obtained.