A

PROJECT REPORT
ON

STUDY ON PATIENT MONITOR, TELECARDIA, ECG MACHINE

(ASAAN & ESY-G )

BY
Mr. Adesh Shantaram Temkar

IN PARTIAL FULFILMENT FOR THE DEGREE

OF

INTEGRATED MASTER OF TECHNOLOGY IN BIOENGINEERING

SUBMITTED TO

MIT School of Bioengineering Sciences & Research,

A Constituent Unit of MIT-ADT University, Pune.

2017 - 2022
 A
PROJECT REPORT
ON

STUDY ON PATIENT MONITOR, TELECARDIA, ECG MACHINE

(ASAAN & ESY-G )

BY
Mr. Adesh Shantaram Temkar

Under the guidance of

Mr. Yashwant Samant
Mrs. Manjiri Date
M. Vasudha Pawar

IN PARTIAL FULFILMENT FOR THE DEGREE

OF

INTEGRATED MASTER OF TECHNOLOGY IN BIOENGINEERING

SUBMITTED TO

MIT School of Bioengineering Sciences & Research,

A Constituent Unit of MIT-ADT University, Pune.

2017 - 2022
 DECLARATION

I declare that this report reflects my original work about the subject in my own words. I have
sufficiently cited and referenced the original sources, referred or considered in this work. I have
not plagiarized or submitted the same work for the award of any other degree, plagiarism report is
attached here with. I also declare that I have adhered to all principles of academic honesty and
integrity and have not misrepresented or fabricated or falsified any idea/data/fact/source in my
submission. I understand that any violation of the above will lead to disciplinary action by the
Institute.

Adesh Temkar

Student Name & Sign

Date:

Place: MIT School of Bioengineering Sciences & Research, Loni Kalbhor, Pune.
 ACKNOWLEDGMENT

First and foremost, I gratefully acknowledge Dr. Renu Vyas, Head of department MIT School of
Bioengineering Sciences and Research, MIT ADT University, and Prof. Vinayak Ghaisas,
Director of MIT School of Bioengineering Sciences and Research, MIT ADT University for their
support, supervision, advice, lab facility and work environment in my progress as a student.

I am thankful and fortunate enough to get constant encouragement, support, and guidance from
all the Teaching staff of MIT SBSR, and MIT ADT University which helped me in successfully
completing my project work. Also, I would like to extend my sincere esteem to all staff in the
laboratory for their timely support.

The internship opportunity with Nasan Medical Pvt. Ltd. Pune was a great chance for learning
and professional development in a Healthcare environment. During the tenure of training at,
Pune. I learned about how the process in the D&D department is conducted from a commercial
point of view. Therefore, I consider myself very lucky as I was provided with an opportunity to
be a part of it. I am also grateful for getting a chance to meet so many wonderful people and
professionals who led me though this internship period.

I take this opportunity to express my deepest gratitude and special thanks to my guides Mr.
Yashwant Samant, CEO of Nasan Medical Pvt. Ltd., Mrs. Manjiri Date, Head of department
Design and development, Mrs. Vasudha Pawar, D&D engineer, and Mrs. Manisha Likhate, D&D
engineer for their valuable guidance. I am heartily thankful to him for providing his valuable
suggestions, guidance and teaching gave me the inspiration and interest to successfully complete
the project. I would also like to thank my colleagues Tejas Nakate, Bhagesh Chillah & Prakash
kudalkar, Sandip Patil, Imam Hawaldar for their valuable support and sharing their work
experiences throughout my dissertation period. I would also like to thank the administrative staff
of Nasan Medical Pvt. Ltd Pune for their support.
 ABSTRACT

The medical device industry in India is ever-growing and lands fourth position in India and
amongst at top 30 in the world. As per statistics by the Bureau of Labour Statistics (BLS) in the
US, there were nearly 20,000 positions in the country in 2018 and estimated to grow at a rate of 4
percent by 2028. In India, medical technology is estimated to reach $50 billion by 2025. Several
schemes have been launched by the Indian government to promote an R&D and start-up culture
with regard to medical devices such as Production Linked Scheme (PLI) under the Atmanirbhar
Bharat mission. Working in Nasan Biomedical roles such as Product owner, Document executive,
and Quality assurance engineer. Working as a Quality Assurance Engineer – To inspect the
working of patient monitor, asaan, TeleCardia unit. To maintain the efficacy of the manufactured
products. As a Document Executive of the products. To regulate and update assembly Job Guides
as well as create new assembly Job Guides of the products. Filling input-output form as well as
annexure forms of respective products. Create and update packaging Job Guide. To learn the
purpose of electronic components like PCBs used in the different products. In my internship got
real experience on working on ISO 14971- 2019 document including Risk management file and
Usability file of Medical devices such as Patient Monitors, and ECG machine (Asaan, Esy-G,),
Along with that to learn about different medical patient parameters like electrocardiography,
plethysmography, spirometry, Automated external defibrillators, PACER, Invasive and non-
invasive blood pressure monitoring system, end-tidal carbon dioxide, and Heart/pulse rate..

Key responsibilities include:

➢ Collaborating with prospective users and clients to understand and anticipate their needs
and translate them into product requirements
➢ Defining the vision for the team’s product
➢ Overseeing all stages of product creation including design and development.
➢ Monitoring and evaluating product progress at each stage of the process
➢ Liaising with the product team and end-users to deliver updates.
➢ Participating in meetings and discuss on progress of regular product and upcoming
development of product.
➢ Adhering to regulatory requirements.
➢ Working with colleagues to ensure consistency of documentation practice across the
 company.
➢ Training employees on efficient documentation usage. And Removing documents that are
obsolete

➢ Ensuring documentation integrity and controlling access to documents.

➢ Ensuring product quality through regular testing

➢ Recording the results of your testing and observations for reference, including statistical
data about the quality of your product

Keywords: ISO 14971- 2019, Medical devices, Document executive, Quality assurance
engineer,
 CONTENTS

Certificate i
Declaration ii
Acknowledgment iii
Abstract iv
Contents v
List of Figures vi
List of Tables vii
List of Abbreviations viii

1. Introduction and Literature review

1.1 Brief about Nasan medical Pvt. Ltd 13
1.2 General description of Heart 14
1.3 Product description 20

2. Methodology
2.1 Telecardia 29
2.2 Asaan 40
2.3 Esy-G 45

3. Results and Discussion

3.1 Telecardia 57
3.2 Asaan 57
3.3 Esy-G 58

4. Conclusion 59

5. Ref. and bibliography 60

 LIST OF FIGURES

Fig. Page
Details
No. No.
1.1 Anatomy of Heart 14
1.2 conduction system of Heart 16
1.3 Patient monitor 20
1.4 Classification of patient monitor 21
1.5 CMS panorama WiFi16 22
1.6 asaan 23
1.7 Telecardia 24
1.8 CellG-BT 25
1.9 Biphasic defibrillator 26
1.10 Stress test machine 27
1.11 Digital Holter 27
2.1 Installation of Telecardia 29
2.2 5 lead ECG cable 30
2.3 Leads placement on body 30
2.4 10 lead ECG cable 31
2.5 Leads placement on body 31
2.6 SPO2 probe 31
2.7 NIBP cuff 32
2.8 Temperature probe 32
2.9 Tab ON/OFF button 33
2.10 Monitoring mode screen 34
2.11 Monitoring mode screen (with values) 34
2.12 Gmail composer 35
2.13 12 lead ECG monitoring home screen 35
2.14 Patient search page screen 36
2.15 Registration page screen 36
2.16 Event log page screen 37
2.17 Acquisition screen 37
2.18 Gmail composer screen 37
2.19 Review test 38
2.20 Event log screen 38
2.21 Emergency log screen 39
2.22 12 lead ECG cable 41
2.23 Leads placement on body 41
2.24 Home screen 42
2.25 Patient search screen 42
2.26 Patient registration screen 43
2.27 Event log screen 43
2.28 Acquisition screen 43
2.29 Mopriya WiFi printing option 44
2.30 ECG screen 44
2.31 Median screen 44
2.32 Main screen 45
2.33 10 lead ECG cable 46
2.34 Leads placement 46
2.35 Home screen 47
2.36 Acquisition screen 47
2.37 ECG send message window 48
2.38 ECG send acknowledge messege screen 48
2.39 Home screen 48
2.40 Patient screen 49
2.41 Registration enabled screen 49
2.42 Patient registration screen 49
2.43 Patient details screen 50
2.44 Event log screen 50
2.45 Acquition screen 50
2.46 ECG report on Heartnet app 51
2.47 Patient history screen 52
2.48 Patient registration screen 52
2.49 Emergency log screen 53
2.50 Home screen 53
2.51 Patient registration screen 53
2.52 Patient searching screen 54
2.53 Review screen 54
2.54 Acknowledgement message to doctor 55
2.55 Heartnet app screen 55
2.56 Patient report review screen 56
2.57 Gmail composer screen 56
3.1 Monitoring and 12 lead ECG report on A4 paper 57
3.2 Resting ECG and All leads measurement report on A4 paper 57
3.3 Report on Heartnet app 58
3.4 Resting ECG report on A4 paper 58
 LIST OF TABLES

Table Page
Details
No. No.

2.1 5 lead ECG guide 30

2.2 12 lead ECG guide 31
2.3 12 lead ECG guide 41
3.5 12 lead ECG guide 46
 Section 1: Introduction and Literature review

1.1 Brief about NASAN medical Pvt. Ltd.:

NASAN Medical Electronics is a Pune-based organization involved in the development,

manufacturing, and trading of medical electronic equipment. NASAN has been a consistent
player in Cardiology centric medical electronic devices for almost the last three decades.
NASAN’s wide product range consists of indigenously developed hi-tech equipment such as
✓ Central Monitoring Systems,
✓ Stress Test Machines,
✓ Patient Monitors
✓ ECG Machines (Asaan, Eys-G)
✓ Defibrillators & Amrut
✓ Holter Recorders.
✓ Telemedicine (Telecardia)

NASAN is not only the first but also the only Indian manufacturer of many of the above
products-Biphasic Defibrillators and Digital Holter
Recorders.
Increasing demand of Biomedical instrument in india will beneficial to Indian Healthcare
sector. Rising number of medical facilities will boost the demand for medical devices in the
market. Various government initiatives such as ‘Production Linked Incentives (PLI) Scheme
for Medical Devices 2020’ and establishing medical parks will augment demand. The medical
technology sector in India is projected to reach US$ 50 billion by 2025.
In October 2021, the government announced plan to draft a new drugs, cosmetics and
medical devices bill to increase the acceptability of Indian medical devices in the global
market.
1.2 General description of Heart:

Fig. 1.1 Anatomy of Heart

Circulatory system, which is made up of a network of blood arteries that pumps blood
throughout your body, is led by your heart. It also collaborates with other physiological
systems to keep your blood pressure and heart rate in check. Your heart's performance is
influenced by your family history, personal health history, and lifestyle. The heart is a fist-
sized organ that is responsible for pumping blood throughout your body. It's your circulatory
system's principal organ.
Your heart is comprised of four main portions (chambers) that are powered by electrical
impulses and are formed of muscle. Your heart's function is controlled by your brain and
nerve system.
The parts of your heart are like the parts of a house. Your heart has:
• Walls.
• Chambers (rooms).
• Valves (doors).
• Blood vessels (plumbing).
• Electrical conduction system (electricity).
 Your heart’s conduction system is like the electrical wiring of a house. It controls the rhythm
and pace of your heartbeat. It includes:
Sinoatrial (SA) node: Sends the signals that make your heartbeat.
Atrioventricular (AV) node: Carries electrical signals from your heart’s upper chambers to its
lower ones.
Your heart also has a network of electrical bundles and fibers. This network includes:

➢ Left bundle branch: Sends electric impulses to your left ventricle.

➢ Right bundle branch: Sends electric impulses to your right ventricle.
➢ Bundle of His: Sends impulses from your AV node to the Purkinje fibers.
➢ Purkinje fibers: Make your heart ventricles contract and pump out blood.

What conditions and disorders affect the human heart?

Heart conditions are among the most common types of disorders affecting people. In the United
States, heart disease is the leading cause of death for people of all genders and most ethnic and
racial groups.

Common conditions that affect your heart include:

• Atrial fibrillation (Afib): Irregular electrical impulses in your atrium.

• Arrhythmia: A heartbeat that is too fast, too slow or beats with an irregular rhythm.
• Cardiomyopathy: Unusual thickening, enlargement or stiffening of your heart muscle.
• Congestive heart failure: When your heart is too stiff or too weak to properly pump blood
throughout your body.
• Coronary artery disease: Plaque build-up that leads to narrow coronary arteries.
• Heart attack (myocardial infarction): A sudden coronary artery blockage that cuts off
oxygen to part of your heart muscle.
• Pericarditis: Inflammation in your heart’s lining (pericardium).
1.2.1 Conducting system of Heart:

Fig. 1.2 conduction system of Heart

The cardiac conduction system is made up of nodes and specialised conduction cells that control
and trigger heart muscle contractions. It consists of the following components:

• Sinoatrial node
• Atrioventricular node
• Atrioventricular bundle (bundle of His)
• Purkinje fibres

The sequence of electrical events during one full contraction of the heart muscle:

An excitation signal (an action potential) is created by the sinoatrial (SA) node. The wave of
excitation spreads across the atria, causing them to contract. Upon reaching the atrioventricular
(AV) node, the signal is delayed. It is then conducted into the bundle of His, down the
interventricular septum. The bundle of His and the Purkinje fibres spread the wave impulses
along the ventricles, causing them to contract.

Anatomy of the individual components involved in the conducting system.

Components of the Cardiac Conduction System

Sinoatrial Node

The sinoatrial (SA) node is a collection of specialised cells (pacemaker cells), and is located in
the upper wall of the right atrium, at the junction where the superior vena cava enters. These
pacemaker cells can spontaneously generate electrical impulses. The wave of excitation created
by the SA node spreads via gap junctions across both atria, resulting in atrial contraction (atrial
systole) – with blood moving from the atria into the ventricles. The rate at which the SA node
generates impulses is influenced by the autonomic nervous system:

Sympathetic nervous system – increases firing rate of the SA node, and thus increases heart rate.

Parasympathetic nervous system – decreases firing rate of the SA node, and thus decreases heart
rate.

Atrioventricular Node

After the electrical impulses spread across the atria, they converge at the atrioventricular node –
located within the atrioventricular septum, near the opening of the coronary sinus. The AV node
acts to delay the impulses by approximately 120ms, to ensure the atria have enough time to fully
eject blood into the ventricles before ventricular systole. The wave of excitation then passes from
the atrioventricular node into the atrioventricular bundle.

Atrioventricular Bundle

The atrioventricular bundle (bundle of His) is a continuation of the specialised tissue of the AV
node and serves to transmit the electrical impulse from the AV node to the Purkinje fibres of the
ventricles. It descends the membranous part of the interventricular septum, before dividing into
two main bundles:

Right bundle branch – conducts the impulse to the Purkinje fibres of the right ventricle

Left bundle branch – conducts the impulse to the Purkinje fibres of the left ventricle.

Purkinje Fibres
The Purkinje fibers (sub-endocardial plexus of conduction cells) are a network of specialized
cells. They are abundant with glycogen and have extensive gap junctions. These cells are located
in the subendocardial surface of the ventricular walls and are able to rapidly transmit cardiac
action potentials from the atrioventricular bundle to the myocardium of the ventricles. This rapid
conduction allows coordinated ventricular contraction (ventricular systole) and blood is moved
from the right and left ventricles to the pulmonary artery and aorta respectively.

1.2.3. Electrocardiogram:
An electrocardiogram is a simple, painless test that measures your heart’s electrical activity.
It’s also known as an ECG or ECG. Every heartbeat is triggered by an electrical signal that
starts at the top of your heart and travels to the bottom. Heart problems often affect the heart’s
electrical activity.
Measuring the electrical activity of the heart may help your doctor determine if chambers of
the heart are possibly too large or overworked. In other cases, an ECG can help determine the
cause of your symptoms along with what type of treatment might be necessary.

If you have a family history of heart disease, your doctor may also order an ECG to look for
early signs of heart disease. No matter your age, it’s important to be aware of any symptoms
that may indicate a heart problem and talk with a doctor about possibly scheduling an ECG.

Types of electrocardiograms
An ECG records a picture of your heart’s electrical activity for the time that you’re being
monitored. However, some heart problems come and go. In these cases, you may need longer
or more specialized monitoring.
Stress test
Some heart problems only appear during exercise. During stress testing, you’ll have a
continuous ECG while you’re exercising. Typically, this test is done while you’re on a
treadmill or stationary bicycle.
Holter monitor
Also known as an ambulatory ECG or ECG monitor, a Holter monitor records your heart’s
activity over 24 to 48 hours or up to 2 weeks while you maintain a diary of your activity to
help your doctor identify the cause of your symptoms. Electrodes attached to your chest
record information on a portable, battery-operated monitor that you can carry in your pocket,
on your belt, or on a shoulder strap.
Event recorder
Symptoms that don’t happen very often may require an event recorder. It’s like a Holter
monitor, but it records your heart’s electrical activity just when symptoms occur. Some event
recorders activate automatically when they detect arrhythmia. Other event recorders require
you to push a button when you feel symptoms. You can send the information directly to your
doctor over a phone line.
Loop recorder
A loop recorder is a device that functions as an electrocardiogram would but allows for
continuous remote monitoring of your heart’s electrical signals. It’s looking for irregularities
that can cause fainting or palpitations.

Interpreting the results of an ECG

If your ECG shows normal results, your doctor will likely go over them with you that same
day during your visit or at a follow-up visit.
If results appear abnormal or show signs of any health problems, your doctor should contact
you immediately to go over options to improve your heart’s condition. Signs of abnormalities
that may show up in an ECG could include:

• Irregular heartbeat: heart defects, including an enlarged heart, a lack of blood flow, or
birth defects electrolyte problems, chamber dilation, chamber hypertrophy, or how
electricity is moving through the heart blocked arteries, or coronary artery disease
• If the test shows signs of these abnormalities, your doctor will go over options to
improve your heart’s condition. This may include prescribing medication or
suggesting lifestyle changes such as modifying your diet or exercising more.
1.3 Product Description:
1.3.1 Multipara Monitor:

Fig. 1.3 Patient Monitor

The intended use of this device is a portable (intra-hospital) multiparameter unit designed for
monitoring, recording of, and generating alarms for adult, pediatric, and neonate patient vital
signs in a hospital environment. Patient Monitor monitors and displays oscillometric-invasive
blood pressure (systolic, diastolic, and mean arterial pressure), heart/pulse rate, respiration rate,
ECG, temperature, and functional oxygen saturation (SpO2) and pulse rate via spot-checking and
continuous monitoring.

The Monitor is intended for use under the direct supervision of a licensed health care practitioner.
The monitors are additionally intended for use in transport situations within the hospital
environment. The monitors are only for use on one patient at a time. Patient Monitor also detects
alarm limit conditions . Using this monitor a clinician can view, and record clinical data derived
from each parameter. The critical outputs obtained from monitoring are required to be reviewed
and verified by Clinical Experts by referring to other clinical symptoms or using other clinical
means before any conclusion.

Multipara Monitor includes the following parameters:

• ECG
• SPO2
• NIBP
• Respiration
• Temperature
 • EtCO 2

Product Features

• Highly user-friendly.
• Easy access to all the functions and settings of parameters through the encoder
• Monitoring of ECG, SpO2 and NIBP, Respiration, Temperature, and EtCO2 of a patient.
• View the trends of the past 24 hours.
• Display ECG waveform, heart rate (HR), Plethysmograph, SpO2%, and NIBP i.e.
systolic, diastolic and mean values, respiration waveform, respiration rate, temperature
values, and
EtCO2.
• Three modes for NIBP Manual, Auto & STAT, and 3 patient types i.e. Adult,
Neonatal, and Pediatric.
• It displays a countdown of the time interval for Auto mode; it also displays Cuff pressure.
• Facility to change parameter settings like gain and sweep speed of ECG waveform.
• Facility to have user-definable limits and settings of parameters as well as default settings.

Fig. 1.4 classification of patient monitor

1.3.2 Panorama WiFi16 (Central Monitoring System)

Fig. 1.5 CMS Panorama WiFi16

Central Monitoring System is a kind of intelligent central multi-bed and multi-physiological

parameter monitoring system, connected by network with bedside units, suitable for performing
continuous monitoring of several patients in ICU wards simultaneously. The central monitoring
system PANORAMA16 gives a complete view of the ICU at one glance. This system records and
enables review of the following parameter for the 16-bed model.
• ECG
• SPO2
• NIBP
• Respiration
• Temperature
System features: -
• Highly User Friendly.
• Bi-directional Communication
• Storage and review of last 72-hours data.
• High-resolution display.
• Reliable patient monitoring
• Trace selection for each bed
• Editing of settings for bed’s selected trace in its parameter panel window.
• Online review of patient data.
• Data storage and output (Can record data to disc)
• Trend diagram, Trend chart and dynamic waveform review function
• Clinical report printing
• LAN connection
1.3.3 asaan:

Fig. 1.6 asaan

ECG machine is mainly intended to use in a hospital environment, for providing preliminary
treatment to cardiac patient by the clinically qualified personnel trained for operating critical
medical operations

The 12-channel electrocardiograph of the ECG machine is intended to use acquire and transmit
the electrical signal at the body surface to a processor that produces an electrocardiogram (ECG).
It acquires and records 12 channel electrocardiographic waveforms to interpret the condition of
Heart of the patient. The critical outputs obtained from monitoring are required to be reviewed
and verified by Clinical Experts by referring to other clinical symptoms or using other clinical
means before any conclusion.

Specification:

• Comparing the latest ECG with the old one is at a click of the button
• Save paper cost by printing on A4 plain paper & emergency print out on 55mm thermal
printer
• Go Green! by selective printouts in ICU, wards, and camps
• With 10000 ECG memory storage, freedom of not taking printout if not required
• Send ECG through Email for a second opinion
• Facility to overwrite measurement and interpretation

1.3.4 Esy-G:
NASAN has launched the Esy-G product, and provides service as Heartnet app which enables a
direct and easy data exchange between the junior doctor and the senior doctor through the inter-
net. This technology promises quick referral and quality data provision to the senior doctor and,
in turn, quality diagnosis to the patients approaching their respective junior doctor.
The junior doctor will wirelessly transfer the data to the senior doctor. The data will be forwarded
through the Heart-net server. On the arrival of the data, the Heart-net server will send a text-
message (SMS) to the senior doctor on his phone. And senior doctor will receive notification.

The senior doctor can then use his Mobile to view the ECG with “Heartnet” app. On accessing
and studying the ECG, the senior doctor can enter his comments online and send the report back
through the Heart-net server to the junior doctor. This will be intimated to junior doctor by SMS
on his mobile.

Specification:

• 12 lead simultaneous ECG acquisition.

• Full frequency response from 0.05 Hz to 150 Hz.
• Ability to transfer data wirelessly.
• 7" inch display to view ECG data.
• Two printers - Thermal printer & Wi-Fi enabled A4 printer.

1.3.5 TeleCardia

Fig. 1.7 Telecardia

Tele-Cardia machine provides the facility to display 5 parameters in patient monitoring such as
• ECG (5 lead and 12 lead ECG)
• Spo2
• NIBP
• Temperature
• Respiration rate
And sends this data directly to the respective doctor or clinicians via email. As well as also
provides the facility to record and generate pdf files of twelve-channel ECG reports on A4 paper
with measurement & interpretation. And send to respective doctors or clinicians via email.
Tele-Cardia takes full advantage of today's digital technology and has been built to perform
reliably for a long time. It is controlled by a microcontroller.
1.3.6 CellG_BT

Fig. 1.8 CellG-BT

• CellG_BT is the new upcoming product of NASAN Company. Now it is in the develop-
ing stage.
• It’s a combination of hardware and software. Also, it’s a portable device and a very small
size we can carry this device in our pocket also.
• It is an ECG device. By using leads we can capture the ECG and the best part is we can
see ECG reports on our phone by simply installing the CellG_BT app.
• CellG-BT records 12 lead ECG of patient and display on mobile screen, then we can send
data to respective doctor or clinician via email.
• Also provide the facility to directly send for print as well as we can mail this ECG graph
to the physicians or clinicians.

1.3.7 Biphasic Defibrillator

Fig. 1.9 Biphasic Defibrillator

• The defibrillator is a lightweight, portable, defibrillator. It provides four modes of

operation: Defibrillation, Monitoring and optional: Pacer& AED. In Monitor Mode
you can monitor three ECG waveforms, acquired through a4-lead ECG Set, Option-
al monitoring of pulse oximetry (SpO2), noninvasive blood pressure (NIBP), and
measurements from these parameters is presented on the display.
• Alarms are available to alert you to changes in the patient’s condition.
 • A Vital Signs Trending Report can be viewed for all key parameters and their meas-
urements over time, at a glance. DEFIB Mode offers simple, 3-step defibrillation.
You analyze the patient’s ECG and, if appropriate:
Select an energy setting
Charge
Deliver the shock.

▪ Defibrillation is performed using paddles.

▪ DEFIB Mode also allows you to perform defibrillation in synchro-

nized and non-synchronized mode. The DEFIBRILLATOR incor-
porates low energy Biphasic waveform for defibrillation. The DE-
FIBRILLATOR is powered by rechargeable lead-acid battery.
▪ Available battery power is easily determined by viewing the conven-
ient battery power indicators located on the device keypad. Addition-
ally, AC/DC Power Module may be applied as a Primary power
source and for continual battery charging. The battery acts as the
Secondary power source.
▪ The DEFIBRILLATOR automatically stores critical event data,
such as Event History, Heart Rate and Vital Signs Trending, in its
internal and external memory.

1.3.8. Stress Test Machine:

Fig. 1.10 Stress Test Machine

 • Capable of offering a rock steady baseline at heart rate more than 180
• Complying with full frequency response of 0.05 Hz. to 150 Hz. as stipulated by
American Heart Association.
• Enabling accurate computation of ST levels, assuring you of excellent correlation
with angiography.
• Offering clean ECG without muscle tremor or 50 cycle noise.

1.3.9 Digital Holter –

Fig. 1.11 Digital Holter

• Store three channels ECG data of 24 hours.

• 10-, 20-, 30- and 60-minutes disclosure.
• Selection of normal beat automatically or manually.
• Reversing selected channel polarity. View the ECG data of all channels of all beats in
selected template.
• Facility to edit arrhythmia type of individual beat.
• View trends of HR detected arrhythmias, ST level of all channels.
• Facility to view maximum HR and minimum HR, longest Pause, longest V-Tach,
• longest SV Tach, longest ST episode, maximum delta ST.
• 1 min, 10 min, 20 min, 30 min and 60 min disclosure prints.
• View medians in entire test.
• View ECG data of selected event.
• Reanalyse test.
1.3.9 ISO 14971:2019 Medical devices — Application of risk management to medical
devices

ISO 14971 is a risk management standard for medical devices. It defines the rules and
describes procedures that the manufacturers of medical devices, including software, have
to adhere to concerning risk management. The aim of ISO 14971 is to help the
manufacturers identify, estimate, evaluate, monitor, and control risk associated with a
medical device. It also helps minimize risk by giving guidance on how to check whether
the control measures were implemented correctly.

ISO 14971 specifies that the risk management process should be iterative and
implemented at every stage of product manufacturing: from the very beginning to the end
of a product lifecycle. Risk management should be managed not only during the
manufacturing and implementation of medical devices but also after they are released to
the end users.
 Section 2: Methodology
2.1 TeleCardia:
2.1.1 Step to prepare Telecardia unit:

Fig. 2.1 Installation of Telecardia

• Install the Telecardia application in a Tablet

• Give Storage and data usage permission to TeleCardia.
• Give Storage permission to the Gmail.
• Set screen time out to Never, form setting option
• Connect to the Wi-Fi network.
• sign in for the play store
• set Gboard keypad as default keypad
• Turn notifications OFF
• Turn location OFF
• Remove the unwanted application from the tablet or disable notifications of an unwanted
application.
• Do the Force stop, turn off the notification, disable, and Clear data of remaining apps.

2.1.2 Preparation of Patient:

• Telecardia has 5 parameters such as ECG (10 lead and 5 lead), Spo2 percentage,
Respiration Rate, Temperature, and Non-invasive blood pressure.
• So, for measure values need to connect probes to patient
Preparation of the patient for ECG:

• Prepare the patient’s skin before applying monitoring electrodes. Skin is a poor conduc-
tor of electricity, so skin preparation is important in achieving good electrode-to-skin
contact.
 • Identify the appropriate electrode sites.
• If necessary, clip hair at the electrode sites (or shave sites if needed).
• Clean and abrade the skin at the electrode site.
• Dry the electrode sites briskly to increase capillary blood flow in the tissues and to re-
move oil and skin cells.
• Apply some jelly to the electrode site and thoroughly rub the site with gauze till it be-
comes slightly red. This removes the horny non-conducting layer of the epidermis ena-
bling good electric contact with the body fluids.
• Remove all the traces of jelly by wiping the abraded site with a warm dry cloth and
completely drying up the site with a dry towel. The skin must be clean, dry, and com-
pletely free of jelly for the electrodes to remain well in position till the end of ECG ac-
quisition. If the jelly has dried out then discard the electrode.
• Apply the electrode to the prepared site and run your fingers around the foam pad
smoothing it from the center out. Repeat this procedure for all sites.
• Connect the 5-lead ECG patient cable to the Telecardia unit and then connect it to the
respective electrodes

Leads position for 5 lead ECG:

Fig. 2.2 5 lead ECG cable Fig. 2.3 leads placement on body

RA/W Directly below the clavicle and near the right shoulder.

RA/W Directly below the clavicle and near the left shoulder.

RL/G On the right lower abdomen.

LL/R On the left lower abdomen.

V/V1 On the chest.

Table 2.1 5 lead ECG placement guide

Leads position for 10 lead ECG:

Fig. 2.4 10 lead ECG cable Fig. 2.5 leads placement on body
cable

RA (Red) Right Arm

LA (Yellow) Left Arm

RL (Black) Right Leg

LL (Green) Left Leg

V1 Fourth intercostal space to the right of the sternum

V2 Fourth intercostal space to the left sternum

V3 Directly between leads V2 &V4

V4 Fifth intercostal space at midclavicular Line

V5 Level with V4 at anterior axillary line

V6 Level with V5 at the midaxillary line.

Table 2.2 12 Lead ECG Placement

Guide

Apply Spo2 probe to patient:

Fig. 2.6 SPO2 probe

• Make sure the sensor is dry.
• If the patient is moving, secure the sensor cable loosely to the patient.
• Make sure the transducer is not too tight. Too much pressure can cause venous pulsation or
can impede the blood flow, resulting in low readings.
• Keep power cables away from the sensor cable and connection.
• Avoid placing the sensor in an environment with bright lights. If necessary, cover the sensor
with opaque material.
• Avoid placing the sensor on an extremity with an arterial catheter, blood pressure cuff, or
intravenous infusion line.
Apply NIBP cuff to patient;

Fig. 2.7 NIBP cuff

• Select the appropriately sized cuff for the patient. The cuff width should be either 40% of
the limb circumference or 2/3 of the upper arm length. The inflatable part of the cuff
should be long enough to encircle 50%-80% of the limb. The wrong cuff size may give
false and misleading results. If you do not have the correct cuff size, use a larger one to
minimize error.
• Attach the cuff to the NBP tubing, making sure that air can pass through the tubing and
that the tubing is not squeezed or kinked.
• Apply the blood pressure cuff to the patient’s arm or leg as follows:
• Ensure that the cuff is completely deflated.
• The cuff should not be placed on the same extremity as a SpO2 sensor. Wrap the cuff
around the arm, making sure that the artery marker is aligned over the brachial artery.
Ensure that the cuff is not wrapped too tightly around the limb. Excessive tightness may
cause discoloration and eventual ischemia of the extremities. Also ensure that the NIBP
tubing from the multi-parameter monitor to the cuff is not compressed, crimped, or
damaged.
• Place the limb used for taking the measurement at the same level as the patient’s heart.

Applying the temperature Sensor

 Fig. 2.8 Temperature probe

The temperature sensor used is surface temperature probe. Apply the temperature probe on
the area of the human body where the temperature needs to be measured. Normally it is
placed under the armpit or on the elbow. The placement is decided by trained medical
professional.

How to take/Run test in Telecardia:

1) Take all accessories of the unit
2) Press the power button of the tab for 5 sec and wait for the tab to start.

Fig. 2.9 Tab ON/OFF button

3) Turn On the Tab ON/ OFF switch. Use the button shown in the below figure to turn on the
screen and wait till complete boot.
4) Once the screen is completely ON, connect unit to WiFi
5) Add your Gmail account in the Gmail application to use the email facility in Tele-Cardia.
6) Insert Fuse in the fuse holder.
7) Connect the adaptor to the mains and switch ON the mains supply.
8) Now switch ON by pressing the ON/OFF switch of the machine.

1. Main Screen of the Tele-Cardia is as shown below.

2. Here you can see two modes are given:

I. Monitoring Mode

II. 12 lead ECG

Monitoring Mode:

1) Click on Monitoring mode, the following screen will appear.

 Fig. 2.10 Monitoring mode screen
button
Fig. Monitor mode home screen

o Send –As per configuration page will redirect to Gmail account.

o Gain- To change the gain.
o Back- To exit from the acquisition screen
2) After connecting all accessories to the unit, the screen display looks like this.
3) On display, one NIBP button is present, when you click on that it’ll start taking a reading.
And after that NIBP reading is displayed on the screen.

Fig. 2.11 Monitoring mode screen button (with values)

Monitoring Mode has the following parameters:

- ECG (Lead II, III, and V)

- Spo2 %

- NIBP (systolic diastolic and mean value)

- Respiration Rate

- Temperature value
 4) Just below the save tab there is Heart value is present, by clicking on ‘HR’ it converts into
‘PR value’ and vice versa.
5) After getting all the parameters, click on the save button, the page redirects to the email,
and the following screen will appear. In that enter respective doctor or clinician email Id.
And press sends button.

Fig. 2.12 Gmail Composer

12 lead ECG:
1. Click on 12 lead ECG mode, following screen will appear.

Fig. 2.13 12 lead monitoring home screen

3. Click on the ‘patient’ option on Tele-Cardia main screen.

4. The next page is the patient search page, as shown in fig. below
 Fig. 2.14 patient search page screen

5. You can view the patient list by clicking the ‘search’ button or Entering patient details like
patient name, DOB, mobile number to search particular patient.

6. After entering patient details, click on the search button, this will provide you registered pa-
tient with the same details. If a patient with the same details is not registered, then the mes-
sage “No records found” will appear on the screen.

7. You can do registration by entering the personal patient details. Click on the ‘Update’ button
to register the patient.

Fig. 2.15 registration page screen

8. After registration following window will be displayed.

 Fig. 2.16 Event log page screen

9. Press the “New ECG” button, you can view the ECG of the patient on the acquisition screen
where 12 leads are displayed in 6 X 2 channel format as shown below.

Fig. 2.17 acquisition screen

10. In the acquisition screen, the save button gets enabled after 10 sec, click on the “Save”
button. This page redirects to the Gmail app. And here you can enter the respective doctor or
clinician email Id.

Fig. 2.18 Gmail composer screen

11. ‘ECG’ button is given to view old and current Resting ECG report of the selected patient

12. ‘Retest’ is given to take the test again.

13. You can see the log and status of the ECG in “Review tests” window as shown below.

Fig. 2.19 review tests

13. In an emergency case, you can take the ECG without doing registration by pressing the
emergency button on the main screen. When the emergency is pressed acquisition screen
will appear and the “save” button is enabled after 10 sec & ECG data of the patient will be
saved. And the page redirects to the Gmail account. If the “exit button on the emergency ac-
quisition screen is pressed, then the test conducted is not saved.

14. You can link the emergency data by clicking on the patient name and clicking ‘select’ fol-
lowing screen will appear.

Fig. 2.20 Event log screen

15. Click on the ‘link emergency’ button following screen will appear. By simply clicking on
‘Link’. ECG data will link with a particular patient
Fig. 2.21 Emergency log screen
 2.2 asaan
2.2.1 Step to prepare asaan unit:

1. Take the all accessories of the unit.

2. Turn On the screen. By click on the power button given to side panel
3. Once screen is completely ON, turn on Wi-Fi and search Wi-Fi printer. Connect machine
to printer.
4. If machine is not connected to printer then Go-to settings- printing – print service plugin -
turn service plugin ON – check your printer is displayed in service plugin.
5. Add your Gmail account in Gmail application to use email facility in asaan,
6. Insert Fuse in fuse holder.
7. Connect adaptor to the mains and switch ON the mains supply.
8. Now switch ON by pressing ON/OFF power switch button at left side of the machine for
4-5 seconds.
9. Following is the main screen as soon as you switch ON the unit

2.2.2 Preparation of Patient:

• Prepare the patient’s skin before applying monitoring electrodes. Skin is a poor conduc-
tor of electricity, so skin preparation is important in achieving good electrode-to-skin
contact.
• Identify the appropriate electrode sites.
• If necessary, clip hair at the electrode sites (or shave sites if needed).
• Clean and abrade the skin at the electrode site.
• Dry the electrode sites briskly to increase capillary blood flow in the tissues and to re-
move oil and skin cells.
• Apply some jelly to the electrode site and thoroughly rub the site with gauze till it be-
comes slightly red. This removes the horny non-conducting layer of the epidermis ena-
bling good electric contact with the body fluids.
• Remove all the traces of jelly by wiping the abraded site with a warm dry cloth and
completely drying up the site with a dry towel. The skin must be clean, dry, and com-
pletely free of jelly for the electrodes to remain well in position till the end of ECG ac-
quisition. If the jelly has dried out then discard the electrode.
• Apply the electrode to the prepared site and run your fingers around the foam pad
smoothing it from the center out. Repeat this procedure for all sites.
• Connect the 5-lead ECG patient cable to the Telecardia unit and then connect it to the
respective electrodes
Leads position for 10 lead ECG:
Fig. 2.22 12 lead ECG cable Fig. 2.23 leads placement on body

RA (Red) Right Arm

LA (Yellow) Left Arm

RL (Black) Right Leg

LL (Green) Left Leg

V1 Fourth intercostal space to the right of the sternum

V2 Fourth intercostal space to the left sternum

V3 Directly between leads V2 &V4

V4 Fifth intercostal space at midclavicular Line

V5 Level with V4 at anterior axillary line

V6 Level with V5 at the midaxillary line.

Table 2.3 12 lead placement guide

2.2.3 Working of Asaan:

1.Main Screen of the asaan is as shown below.

 Fig. 2.24 Home screen

2.Click on ‘patient’ option on asaan main screen.

3.The next page is patient search page, as shown below

Fig. 2.25 patient search screen

4.You can view patient list by clicking ‘search’ button or Enter patient details like patient
name, DOB, mobile number to search particular patient.

5. After entering patient details, Click on search button, this will provide you registered pa-
tient with the same details. If patient with same details is not registered then message “No
records found” will appear on screen.
6. You can do registration by entering the personal patient details. Click on ‘Update’ button
to register the patient.
7. There are Compulsory Fields ‘*’ – These fields are mandatory.
 Fig2.26: Patient registration screen

8. After registration following window will be displayed.

Fig2.27 Event log screen

9. Press “New ECG” button, You can view the ECG of patient on the acquisition screen
where 12 leads are displayed in 6 X 2 channel format as shown below.

Fig 2.28 acquisition screen

10. In acquisition screen, save and print button gets enabled after 10 sec
11. When you click on the ‘print’ button, it will redirect you to the Mopria WiFi printing
option.
 Fig2.29 Mopria WiFi printing option.

12. When you click on “Save” button, as per set ECG mode in configuration median screen
OR ECG screen will be displayed.

Fig 2.30 ECG screen

Fig 2.31: median screen

2.3 ESY-G
2.3.1 Step to prepare Esy-G unit:

10. Take all accessories of the unit.

11. Turn On the screen. By clicking on the power button given to side panel
12. Once screen is completely ON, turn on Wi-Fi and search Wi-Fi printer. Connect machine
to printer.
13. If machine is not connected to printer, then Go-to settings- printing – print service plugin
- turn service plugin ON – check your printer is displayed in service plugin.
14. Add your Gmail account in Gmail application to use email facility in asaan.
15. Insert Fuse in fuse holder.
16. Connect adaptor to the mains and switch ON the mains supply.
17. Now switch ON by pressing ON/OFF power switch button at left side of the machine for
4-5 seconds.
18. Following is the main screen as soon as you switch ON the unit

Fig 2.32 main screen

Preparation of Patient:

• Prepare the patient’s skin before applying monitoring electrodes. Skin is a poor conduc-
tor of electricity, so skin preparation is important in achieving good electrode-to-skin
contact.
• Identify the appropriate electrode sites.
• If necessary, clip hair at the electrode sites (or shave sites if needed).
• Clean and abrade the skin at the electrode site.
• Dry the electrode sites briskly to increase capillary blood flow in the tissues and to re-
move oil and skin cells.
• Apply some jelly to the electrode site and thoroughly rub the site with gauze till it be-
comes slightly red. This removes the horny non-conducting layer of the epidermis ena-
bling good electric contact with the body fluids.
 • Remove all the traces of jelly by wiping the abraded site with a warm dry cloth and
completely drying up the site with a dry towel. The skin must be clean, dry, and com-
pletely free of jelly for the electrodes to remain well in position till the end of ECG ac-
quisition. If the jelly has dried out then discard the electrode.
• Apply the electrode to the prepared site and run your fingers around the foam pad
smoothing it from the center out. Repeat this procedure for all sites.
• Connect the 5-lead ECG patient cable to the Telecardia unit and then connect it to the
respective electrodes
Leads position for 10 lead ECG:

Fig 2.33 10 lead ECG cable Fig 2.34 leads placement

RA (Red) Right Arm

LA (Yellow) Left Arm

RL (Black) Right Leg

LL (Green) Left Leg

V1 Fourth intercostal space to the right of the sternum

V2 Fourth intercostal space to the left sternum

V3 Directly between leads V2 &V4

V4 Fifth intercostal space at midclavicular Line

V5 Level with V4 at anterior axillary line

V6 Level with V5 at the midaxillary line.

Table 2.4 12 lead placement guide

Working of Esy-G unit:
1) Main Screen of the Esy-G is as shown below.

Fig 2.35 Home screen

2) The green button in the corner of the screen shows that the device is in online mode. i.e is
connected to an active network.
3) The grey button with cross in the corner of the screen shows that the device is in Offline
mode. i.e is not connected to an active network.
4) Emergency patient: - When patient with emergency comes to the doctor/cardiologist,
emergency ECG can be taken with emergency button.

Fig 2.36 Acquisition screen

Steps to take ECG in emergency condition

➢ Click on emergency button.
➢ Wait for 10 seconds.
➢ Send emergency data with send button.
➢ Before the ECG data is sent the Check the signal quality of the waveforms. The following
dialogue box is seen
➢ Then click on ‘Ok’ to send ECG data or click on ‘Cancel’ for Retest
 Fig 2.37 ECG send message window

5) It is necessary to receive comments for printing the report.

Fig 2.38 ECG send acknowledge message screen

6) Once ECG is sent the following message is seen. Click Ok to proceed.

➢ QRS lead can be changed with QRS button on screen.
➢ Change gain/ speed with buttons gain and speed respectively.
7) New Patient for regular checkup: - When patient comes for regular check up, and he is
new patient. To check whether patient is new or existing, click on patient button on the
following screen.

Fig 2.39 Home Screen

 Fig 2.40 patient Screen

8) You can view patient list by clicking ‘search’ button.

OR

9) Enter details name, middle name, last name, mobile number and birth date to search the
particular patient
10) If patient with same details is not registered then message “No records found” will appear
on screen.

Fig 2.41 Registration enabled screen

11) For new patient, register patient by pressing button ‘Register new’.
 Fig 2.42 Patient registration screen

12) You can do registration by entering the personal patient details. Click on ‘Update’ button
to register the patient.
13) If ‘Short Details’ checkbox from configuration is checked then only mandatory fields will
appear in the new registration window

Fig 2.31 Patient details screen

14) After registration following window will be displayed.

Fig 2.44 Event log screen

15) New ECG of new patient, Press “New ECG” button to take new ECG.
16) You can see the ECG of patient on the acquisition screen where 12 leads are displayed in
6 channel formats as shown below.

Fig 2.45 Acquisition screen

17) Send button will get enabled after 10 secs with that send ECG to senior doctor.
18) When ‘Send’ button is pressed latest 10 sec patient’s data is sent to the senior doctor
through server.
19) Senior doctor will receive the sms and voice notification as “Dear Doctor, New ECG from
Heartnet”, for the ECG report. He/she can download and view the ECG of patient
through’ Heartnet’ app and sends comment for the ECG data

Fig 2.46 acknowledge message to

doctor screen

20) The Heartnet app is installed in the phone, and voice notification is heard as following
“Dear Doctor, New ECG from Heartnet”
Click on the app icon to see view the ECG.

Fig 2.47 ECG report on Heartnet app

screen
21) Medical history: - Enter medical history by clicking medical history button.

Fig 2.48 Patient history screen

22) Click on save to save medical history.

23) ‘Patient History updated’ event will be displayed on event log page.

24) Patient details: - Patient details can be edited with patient details button. When patient
details button is pressed, following screen will appear.

Fig 2.48 Patient registration screen

25) After entering or editing details, click on update button to save the details
26) ‘Patient details updated’ event will be displayed on event log page.
27) Link Emergency: List of emergencies are displayed on this screen. You can select the one
and link to the patient with ‘link’ button.

Fig 2.49 Emergency log screen

28) Existing Patient for regular checkup: - When patient comes for regular check up and he is
existing patient, click on patient button on the following screen.

Fig 2.50 Home screen

29) Click on patient button

Fig 2.51 Patient registration screen

 30) You can view patient list by clicking ‘search’ button.
OR

31) Enter details name, middle name, last name, mobile number and birth date to search the
patient
32) After entering patient details, click on search button, this will provide you registered pa-
tient with the same details.
33) When existing patient comes, this patient will be displayed in search result as shown be-
low.

Fig 2.52 Patient searching screen

34) Select the patient with ‘select’ button.

35) After clicking on ‘select’, Patients event log will be displayed on screen.

36) Then Doctor can take ECG of Patient. You can follow the steps given under heading
“New Patient for regular checkup”.

37) Review tests: You can see the log and status of the ECG in “Review tests” window as
shown below.

Fig 2.53 Review screen

38) After sending data, following message goes to senior doctor with Voice notification, with that
he/she can view the ECG of patient in ‘heartnet’ app. Doctor can send the comments from
this app. Image below shows the screenshot of the application.
 Fig 2.54 Acknowledgement message to Doctor

Fig 2.55 Heartnet app screen

39) After receiving comments, Status of ECG will change in review tests log. Click on ‘View
report’ to take thermal print or A4 print with the comments.

40) When View report is clicked, following screen will appear

 Fig 2.56 patient report review screen

Note: When Print A4 is clicked email page will get open, as shown below, click on send to
give the A4 print.

Fig 2.57 Gmail composer screen

➢ Send to Email: The senders email address can be configured in the ‘Configuration menu’
➢ Back: If back is pressed, view report screen will open, and email will not be sent.
 Results
3.1 Telecardia reports:

Fig. 3.1 Monitoring and 12 lead ECG report on A4 paper

3.2 Asaan Reports:

Fig 3.2 Resting ECG and All leads measurement report on A4 paper
3.3 Esy-G reports:

Fig 3.3 Report on Heartnet app Fig. 3.4 Resting ECG report on A4 paper
 CONCLUSION

The internship gave us a wide view of different biomedical devices which in turn opened the
treasure of knowledge regarding how the healthcare sectors work. The medical industry has
a very diverse field. In internship understand the need of medical devices and how vast the
medical industry is. In India, the medical industry will be the booming industry in the next 5
years. I was work on different projects such as Telecardia and, CellG-BT, and learned many
new things from design and development to the marketing of the product. As well as work as
a product owner of patient monitor, Asaan, & Esy-G products. Working as a product owner
did regular monitoring and new development in the product as per the customer request. This
task gave me the importance of upgradation of the system and products from a marketing
perspective. Quality assurance engineer is also a very interesting task in the medical field, in
that we have to have ensure the product is safe for a patient. And safe for a doctor as well.
Along with the medical devices got the importance of the documents as well as certification.
The medical industry is not only about the manufacturing and marketing of medical devices
but is also so much bigger than that. Quality check is also a big factor in medical devices.
Including quality assurance, quality control, purchasing components required for
manufacturing the product, and Administration of all departments.
These diversifying approaches in the internship gave me a broad idea of the medical
industry, learned more and more about technical knowledge as well as got an idea about
exactly how a company run, from manufacturing to marketing, from dealer to end customers.
Interact with customers gave the idea about what customers want. This is done only when
there is proper support orientation, enough supports, choose the correct expansion and
orientation the restorations and this is achieved with the help of the software’s and
technology.
During the internship got opportunity to interact with different professionals from different
institutions, companies, and services. In addition, gave a whole lot prospective about how to
reach the potential customers and how interact with them making a product keeping the
criteria and requirement of the targeted customers in mind. a positive attitude while
preaching is what plays an important role, but the patience will always remain the key to
success.
 References and bibliography

➢ https://www.nasanmedical.com/

➢ https://my.clevelandclinic.org/

➢ https://www.ncbi.nlm.nih.gov/books/NBK83160/

➢ https://medlineplus.gov/ency/anatomyvideos/000021.htm

➢ https://teachmeanatomy.info/thorax/organs/heart/conducting-system/

➢ https://teachmeanatomy.info/thorax/organs/heart/conducting-system/