ECG Recording Setup

ECG Waveform

Depolarisation
When electrical activity occurs, heart muscle fibers are contracted and
produces a movement. This condition is refered as Depolarisation. When
blood is pumped around the body, it results in contraction. When chambers
are contarcted, it is called systolic.
Repolarisation
The realxation of heart muscles are called electrical repolarisation. Relaxed
heart chambers are called diastolic.
Amplitude Duration
Wave Origin
(mV) (seconds)

0.12 to 0.22
P wave Due to depolarization of atria 0.25
(PR interval)
R wave (QRS Due to repolarization of atria
1.60 0.07 to 0.1
Complex) and ventricle contraction

Due to relaxation of 0.05 to 0.15

T wave 0.1 to 0.5
myocardium ST interval

S T interval Contraction of ventricles – –

Due to slow expansion of 0.2 (T – U

U wave
purkinje fibers interval)

ECG Recording Setup

Defibrillator Protection Circuit

The one end of the electrode leads are connected along RA, LA, chest and LL
of the patient. The other end of electrode passes through defibrillator
protection circuit. The protection circuit has buffer amplifier and over-load
voltage protection circuit.

Lead Selection Logic

This block helps to select the type of electrode lead system. We can choose
either bipolar or augmented electrode system.

Calibration Circuit
Calibration is a process that helps to eliminate errors in the system. Here, any
changes in the lead selection circuitresults in artefacts in the ECG output.
Therefore, the calibration unit helps the technician to correct the error in ECG
output.
Pre Amplifier
An instrumentation amplifier and a differential amplifier with high gain and
high CMRR is used as pre amplifier.
Power Amplifier
The output unit is driven with power amplifier. After the signal is amplified
using pre-amplifier it goes to the power amplifier. The output unit is attached
with a pen motor. A high electrical power is required to initiate recording
with pen recorder. Hence, a high power gain amplifiers are used as power
amplifier.

Feedback Network
Feedback network is used to provide damping to the pen motor.

Output Display Unit

Either a CRO or a pen chart recorder acts as the output device.
Electroencephalography | EEG
The recording and study of electrical activity of the brain is
Electroencephalography. To record the signals, the electrodes (needle
electrodes) are attached on the skull of the patient. Neural depolarization
occurs in brain due to stimuli from five senses and thought process. Brain
waves are the summations of this neural depolarization. The voltage level on
the brain surface is around 10mV. Due to propagation of signals, voltage
value may range between 1 to 100µV. EEG electrodes are used to pick up
these signals. During EEG, measurement electrodes are placed around frontal,
temporal and occipital lobes of brain.
Evoked Potential of the Brain
When brain responds to external stimuli like light, sound, etc. they develop a
potential called Evoked Potential. The various sense organs detect the evoked
potential and change the electrical activity of the brain.
Anatomy of the Brain
Human brain has four lobes namely cerebrum, cerebellum, medulla oblongata
and spinal cord. In our body functions like breathing, heart rate and kidney
functions depends on medulla. The interconnecting area is Pons. They are
responsible for face expressions and auditory system. Cerebellum is required
for a person to maintain the stability and balance. Thalamus has the region for
visual and auditory system. The area named Hypothalamus is responsible for
emotions in our brain. Another important part of cerebrum is cerebral cortex.
It has billions of neurons in it. The cerebrum has four lobes named as Frontal,
Parietal, Temporal and Occipital. Frontal lobe is responsible for human
intelligence. Parietal for eye movement and control. Temporal is for hearing
and to store process in long-term memory. Finally, occipital is for vision of the
human system.

Analysis of EEG Waveforms

The continuous electrical activity of the brain is recorded from the outer
surface of the brain. The excitation level of the brain decides the intensity and
pattern of this electrical activity. This results in functions like reticular
activating system, which makes us to wake from sleep. In the recorded
electrical potentials, we find some variations, which are Brain Waves. We have
four major type of brain waves given as Alpha, Beta, Theta and Delta waves.
At most, of the instance, our brain waves will be irregular and does not have
regular pattern.

Alpha Wave
 8 – 13 Hz.
 Alpha waves occur in the occipital region of a person. It occurs when he
is awake and stays in quiet state. When he sleeps, it disappears. The
wave has an amplitude of 20 – 200µV.
Beta Wave
 13 – 30 Hz.
 Beta wave arises from the parietal and frontal regions of cerebrum. It
can be either beta I or beta II waves. Mental activity of a person like
tension, results in excited beta waves.
Theta Wave
 4 – 8 Hz.
 Theta wave arises from the parietal and temporal regions of cerebrum.
It occurs commonly in children. In adults, it occurs when they are
depressed and frustrated.
Delta Wave
 0.5 – 4 Hz.
 Delta wave occurs during deep sleep in premature babies for every 2 to
3 seconds. They occur in cortex of the brain.
Electromyography
May 27, 2019 by Vidya Muthukrishnan
The recording of electrical activity from muscles is called electromyography.
It helps to determine whether the muscles contract or other. The
depolarization of muscles causes muscular contractions. Recording the action
potential of peripheral nerve is known as Electro neurography. Two types of
electrodes are used for recording EMG. Surface electrodes are used when
signals are recorded on the surface and it cannot detect deep potential from
within the cell. Needle electrodes are inserted deep into the tissue, which
records the muscle potential.
EMG Recording System
Electrodes record EMG potentials from the tissue. Disc shaped surface
electrodes made of Ag/AgCl are used to pick the signals. The skin surface is
cleaned and electrode gel is applied on the skin surface. Elastic bands are used
to attach the electrodes to the skin. When electrodes are affixed tight on the
skin, it reduces the skin contact impedance to below 10kΩ. By convention, two
types of electrodes are used. In Bipolar Electrodes, the electric potential is
calculated between two surface electrodes attached on the skin surface.
However, in Unipolar Electrodes two electrodes are used. Reference surface
electrode is attached on the skin and one needle electrode is penetrated deep
into the muscle. Needle electrode acts as active electrode. The potential
difference between these two electrodes is measured in unipolar electrode
system. Another type is coaxial electrodes, in which needle electrodes consists
of insulated wire with a tip that can penetrate easily into the muscle. Here the
reference is covering steel jacket and metal wire acts as exploring electrode.
Microelectrode is used to record action potential from single nerve.
The amplitude of EMG signal depends on various factors like type of
electrode used, placement of electrode on the muscle and the degree of
muscular exertions. When surface electrodes are used, it picks signals from
nearby spikes. Therefore, it produces average voltage value from the muscles
ad motor units. Whereas needle electrodes pick signal from single nerve fiber
and it produces one voltage value. The voltage value of EMG signals varies
between 0.1 to 0.5 mV. The frequency of the EMG signal is the range of 20 Hz
to 10 KHz, which lies in the audio range. The normal frequency of EMG is 60
Hz. The recorded EMG potentials are sent to the differential amplifiers. This
amplifier has high gain and frequency range between 10 Hz to 10 KHz. In
addition, the amplifier has CMRR between 80 to 100 dB and input impedance
of 10 MΩ. Since we have only two electrodes, there is no necessity for lead
selector switch. The amplified output is given to the power amplifier that
helps to amplify the signal to a higher level. Then the amplified signal is given
to the loudspeaker, tape recorder and CRO. The final output is given to CRO
that displays the signal. The tape recorder is used sometime to record the
signals from the differential amplifier.
Applications of Electromyography
1. To study Neuromuscular functions.
2. To know the neuromuscular condition.
3. To study reflex responses.
4. To know about the extent of nerve lesions.
5. Helps to diagnose the muscular diseases.
Measurement of Conduction Velocity in Motor
Nerves

In the motor nerves, to indicate the location and type of nerve lesions,
conduction velocity is measured. At various segments of nerve, nerve function
is examined. An electric shock of duration 0.2 – 0.5 milliseconds is stimulated
on the nerves. Conduction velocity along the peripheral nerve is measured to
calculate the latency. Hence, latency is defined as difference in time between
stimulating impulse and action potential of the muscle.
On the skin at two points separated at a length of l1, EMG electrode and
stimulating electrodes are placed. Via the stimulating electrodes electric shock
is applied. A short twitch occurs, when the excitation reaches the muscle. All
the nerve fibers get stimulated at the same. Therefore, the conduction velocity
is same and muscle fibers are activated in a synchronous manner. The EMG
electrode picks up the action potential generated and displays the output on
the CRO. Finally the time t1(latency time) is measured. After this, the
electrodes are repositioned on the skin and placed at a distance of l 2. The
elapsed time t2 is calculated. The distance should be such that l21.
The conduction velocity is calculated using the below formula.

Normally the value of conduction velocity is 50 m/s.

ECG Lead System Configuration

May 27, 2019 by Vidya Muthukrishnan
The electrical signals from the heart are measured with surface electrodes. The
resulting electrode potential in the heart conducts to the body surface.
Standardized electrode positions are used to record the ECG. The three types
of electrode systems are
1. Bipolar limb leads or standard leads
2. Augmented unipolar limb leads
3. Chest leads
Bipolar Limb leads – Standard Lead I, Lead II
and Lead III
This lead system is also known as Einthoven lead system. Two electrodes
record the ECG signal. As shown in figure from four body locations of our
body namely Right Arm(RA), Left Arm(LA), Right Leg(RL) and Left Leg(LL)
potentials are recorded.
Final output is the difference between the electrical potential generated
between these two electrodes. Right leg is the ground reference electrode.

Lead I

Voltage drop occurs from left arm to right arm. Generated voltage is VI.
Lead II

Voltage drop occurs from left leg to right arm. Generated voltage is VII.
Lead III

Voltage drop occurs from left leg to left arm. Generated voltage is VIII.
Einthoven Triangle
Einthoven triangle is the closed path formed between right arm, left arm, left
leg and right arm. Einthoven has defined that cardiac electric vector is two
dimensional along the frontal plane of the body. Along the projections of the
triangle, vector sums on three sides of triangle is zero. We can tell, by
Kirchhoff’s law, the amplitude of R wave along the lead III is equal to the
summation of amplitude of R wave along lead I and lead II.

Augmented Unipolar Leads

A person named Wilson introduced augmented unipolar limb lead system. In
this system, ECG is recorded between single exploratory electrode and central
terminal. Central terminal relates to the center of the body. Two equal and
large resistors are used. Pair of limb electrodes is connected to the resistors.
The center joint connection of this resistive network forms the central
terminal. The remaining portion of the limb electrode forms the exploratory
electrode. In this lead system, a very small increase in ECG voltage can be
found. Three types of connections are used.
Lead aVR

Two resistors are connected to left arm and left leg. The middle point of the
resistor connection is connected with negative terminal. Right arm is
connected with the positive terminal of the amplifier. Here also right leg acts
as a reference terminal.

Lead aVL
Two resistors are connected to right arm and left leg. The middle point of the
resistor connection is connected with negative terminal. Left arm is connected
with the positive terminal of the amplifier. Right leg acts as a reference
terminal.

Lead aVF
Two resistors are connected to right arm and left arm. The middle point of the
resistor connection is connected with negative terminal. Left leg is connected
with the positive terminal of the amplifier. Here also right leg acts as a
reference terminal.

Chest Leads

V1 – Fourth intercostal space of right sternal margin,

V2 – Fourth intercostal space at left sternal margin,
V3 – Midpoint between V2 and V4,
V4 – Fifth intercostal space at mid – clavicular line,
V5 – Same as V4 position but on anterior auxiliary line,
V6 – Same as V4 position but on mid auxiliary line.

EEG Measurement
May 27, 2019 by Vidya Muthukrishnan
EEG Lead System
International Federation of EEG society has suggested 10 – 20 electrode
placement system for EEG recording. Silver / silver chloride electrodes are
used as surface electrodes in this setup. On the scalp, distances between two
electrodes are given as 10% and 20% of the distance between specified points.
Nasion and Inion are the two reference points near the ear lobes of the
human. Over the head, the distance between nasion and inion are divided into
5 points. The nasion – inion distance via the vertex is measured and three
electrodes are placed as 1 in frontal, 1 in central and 1 in parietal. They are
placed at a distance of 10%, 20%, 20%, 20%, 20% and 10% of this length. Now,
similarly nasion – inion distance is measured along the temporal lobes and
five electrode are placed as two in frontal, 2 in temporal and 1 in occipital
lobes respectively. They are also placed at a distance of 10%, 20%, 20%, 20%,
20% and 10% of this length on either side. Lastly, on the peripheries of the
circle remaining six electrodes are fixed as 2 in frontal, 2 in central and 2 in
parietal. So, in the setup totally 19 electrode are placed on the brain scalp and
one electrode which acts as reference is placed at the ear lobe. This is
popularly known as 10 – 20 EEG system.

EEG Recording Setup

Here 21-electrode system is used. Electrodes are connected to 8-channel

selector. Output from 8-channel connector goes to the differential amplifier
bank. Differential amplifier is made of preamplifiers that are used to reduce
noise. 50 Hz noise is created due to A.C interference that can be reduced using
differential amplifier. The output obtained from differential amplifier is
connected with signal processing unit. After further processing, the display
unit displays the data.
This system helps to record the potentials generated from the sensory parts of
the brain. To achieve this, output unit is connected with audio stimulus,
visual stimulus and touch stimulus. It can also measure the time delay
between stimulus and response from brain. In addition, we have a filter bank
consisting of low pass, high pass and band pass filters. They help to remove
noise from the brain waves. For the output recording, we can use either pen
recorder or CRO. Three modes namely Unipolar, Average mode and bipolar
recording are used to measure EEG.
Applications of EEG
 Epilepsy diagnosis.
 Anesthetic level.
 Brain injury.
 Monitoring during surgery.

Cardiac Output Measurement

May 27, 2019 by Vidya Muthukrishnan
Cardiac output is termed as the measurement of blood that the heart delivers
per minute to the aorta. For a normal human being cardiac output is in the
range of 4 – 6 liters per minute. During each heart beat blood pumps around
70 to 100 ml of blood. Blood is pumped from the right ventricle into
pulmonary circulation. At the same time, some measurable amount of blood is
pumped into systemic circulation from left ventricle. Cardiac output can be
given as product of stroke volume and heart rate.
Heart Rate
It is given as the speed at which heart beats. It is calculates the contractions
per minute (bpm). During each ventricular contraction, blood flows through
arteries. The flow is detected as one pulse. Heartbeat is affected due to various
external factors like age, diseases, exercise, temperature and emotions.

Stroke Volume
Stroke volume is defined as amount of blood being pumped regularly from
left ventricle per beat. Factors affecting stroke volume are blood volume in the
body, heart contractility and resistance level from blood vessels. Every change
in stroke volume affects the blood pressure.
Conditions Affecting Cardiac Output
No change: Sleep and Moderate temperature changes.
Increased: Anxiety, Exercise, Pregnancy, Anemia.
Decreased: Standing / Sitting, Rapid Changes in Heart Beat, Heart Disease.
Indirect measurements are employed to measure cardiac output as given
below.
1. Fick’s Method
2. Indicator dilution method
3. Thermo dilution
4. By impedance change
Fick’s Method
In this method, analysis of gas keeping of the organism is considered to
measure cardiac output. Oxygen is continuously infused into the blood or it is
removed from the blood. The amount of oxygen left out in the blood before
and after the infusion of oxygen into the blood is measured. Let I be the
amount of oxygen infused inside or removed per unit time. It will be equal to
the difference between the amount of blood that arrives and departs from the
measurement point.

Where, Q – Measured cardiac output in liters/minute

CA – Oxygen concentration in arterial (outgoing) blood
CV – Oxygen concentration in venous (incoming) blood
Indicator Dilution Method
In this method, a known amount of dye (indocyanine – cardio green dye) acts
as an indicator in the blood circulation. It uses rapid injection. The
concentration of indicator per unit time is measured at the measurement
point. Doing this helps us to estimate the volume of blood flow. Assume M
mg of indicator is injected into the vein or into the right heart directly. From
right heart, the dye passes to the lungs, left heart and finally appears at the
arterial circulation. An indicator is used at the peripheral artery. A measuring
chamber is used to draw an amount of blood from artery and detector
continuously analyses the blood samples. The concentration of the indicator is
directly related to the detector output. Finally, the detector output is
displayed on the chart recorder with respect to the unit time. The major
disadvantage of this method is injection of foreign substance into the human
blood.

Thermo Dilution Technique

In dye dilution, technique the main drawback is the presence of foreign body
inside the blood. Even without taking the blood out for sample analysis, the
photoelectric detector can be used to measure the dye concentration. Even
radioisotope can be used if radiation detector is used. Again, the foreign body
accumulation in the body creates a problem. To avoid this entire problem,
Thermo Dilution Techniques are used. At a room temperature 10 ml of 5%,
dextrose in water is injected as dye (indicator) into the right atrium. A
thermistor is attached to the tip of the catheter. The indicator is mixed and at
the pulmonary artery, thermistor is used to detect the temperature. At the
pulmonary artery, the thermistor measures the difference in temperature of
the dye during injection and its temperature after circulating in the blood.
Temperature will be reduced and it is integrated with respect to time.
Calibration and corrections are applied to the obtained value, which finally
gives the cardiac output.

Where, Q = cardiac output per second

V = volume of dye injected into the body
ρ = density
S = specific heat
T = temperature in oC

= integral of blood temperature change

Subscript i – injectate and b is blood
From the block diagram, to reduce the non-linearity of the thermistor, a
resistor is connected parallel to it. This helps to attain a linear relation between
temperature and resistance of thermistor. After linearizing, the value is sent to
the linearizing amplifier. Next block is the integrator block. This block
calculates the integral change of blood temperature with respect to time. The
data about density, specific heat capacity of blood and thermal indicator,
volume of dye injected is fed to the system. Finally, computer displays the
cardiac output in liter / minute.
Impedance Change Technique
Here cardiac output is measured electronically. Four electrode probes are
used around the thorax. Electrode pair 1 and 4 acts as current electrode and
other pair 2 and 3 picks voltageacross the thorax. Assume ρ to be resistivity of
the patient, A cross sectional area of thorax, L is the separation length between
the 2 and 3 electrodes. Therefore, the resistance of thorax is given as