Lecture On EEg and ECG

Biomedical
Instrumentation
B. More Biopotentials
B18/BME2
Dr Gari Clifford
(Based on slides from

Prof. Lionel Tarassenko)
Biomedical Instrumentation B18/BME2
Diagnostic uses of ECG
 Foetal monitoring (both before birth & during)
 Patient monitoring in Ambulance, Intensive Care

Unit or Coronary Care Unit
 S-T segment elevation to diagnose heart attacks
 Evidence of cardiac muscle damage (infarct)
 Detection of precursors to heart attacks:
 Abnormal heart beats (e.g. many ectopic beats, TWA)
 Abnormal heart rhythms
Use of ECG in CCU
 The ECG is highly informative in the diagnosis of a heart
attack (Myocardial Infarct). Insufficient blood supply to the
cardiac cells due to a blockage in the coronary arteries
(ischaemic heart condition) causes S-T segment elevation.
 Following the heart attack, cardiac muscle damage (infarct)

generally leads to a loss of amplitude in the ECG.
ECG abnormalities
(possible precursors to heart attacks)
 Analysis of the ECG can provide early warning of potential
problems.
 Ectopic beats originate somewhere other than the Sino-

Atrial (SA) node and often have different shapes
(morphologies).
 Abnormal heart rates (arrhythmias) can be treated.

Other intervals in ECG analysis
 The most important interval in the ECG is the QT interval

 A longer than normal QT interval is a good indicator of
long QT syndrome (LQTS)

Q-T interval measurement
 LQTS is a potentially fatal condition that renders

sufferers vulnerable to an arrhythmia known as torsade
de pointes.
 When this rhythm occurs the heart is unable to beat

effectively and the blood flow to the brain falls
dramatically.
 The result is a sudden loss of consciousness and

possible cardiac death.
Detecting ECG abnormalities
 Two methods are in common use:
 Ambulatory monitoring
 Exercise stress ECGs

Ambulatory ECG monitoring
 ECG monitored for 24 hours.
 Results printed out:
 24-hour summary detailing the heart rate and S-T
segment changes over the period of the test.
 Detailed information on ECG recorded at the time
of a significant event (e.g. arrhythmia).

Analysis of ECG waveform
 Diagnostic information can be obtained by
analysis of the amplitude and relative timing
of the various segments.
 The simplest interval to measure is the R-R

interval (from which the heart rate is derived).
 Two types of heart rate meters:

 Averaging heart rate meter
 Beat-to-beat heart rate meter
Heart Rate Meters
 Heart rate is usually given in beats per minute
(BPM).
 The easiest way to obtain this is to count an
identifying feature in the ECG which occurs once
per heart beat.
 The most obvious such feature is the QRS
complex which is a sharp spike.
 Both averaging and beat-to-beat devices need
to perform this detection.
QRS detection
 There are 4 main problems in detecting the QRS
complex in ECG traces:
 Artefacts due to electrode motion

QRS detection
 There are 4 main problems in detecting
the QRS complex in ECG traces:
 Artefacts due to electrode motion
 Baseline wander (mostly caused by breathing

and torso movements)
 Muscle artefact (broadband)
 T-waves with high-amplitude content

QRS detection
 The solution to these problems is to use a band-

pass filter to remove:
 Low-frequency changes such as baseline wander
 High-frequency changes e.g. movement/muscle artefact
 Most of the frequencies in the QRS complex are

around 5-20 Hz.
 A pass-band of 10 – 40 Hz is therefore
appropriate.... Why?

 Look at the signal below 10Hz .. Why do we want to remove it?

QRS detection
 Once the “non-QRS” sections of the ECG

have been attenuated, the QRS complex
can be detected with a threshold detector.

R-Wave pulse generator
 This should trigger a pulse generator so

that a short pulse of a fixed duration is
generated once (and only once) for each
QRS complex.

Averaging heart rate meter
 The “average power” of the pulse train from the

pulse generator circuit will be indicative of the
Heart Rate.
 This can be determined using a “leaky integrator”

(a form of low-pass filter).
 The time-constant of the R-C circuit should be

several beats long to minimise output ripple.

Averaging heart rate meter

Beat-to-beat heart rate meter
This is best achieved using a digital circuit which:

- Counts the time between consecutive QRS complexes
- Inverts this in order to obtain a heart rate (rather than interval)

Beat-to-beat heart rate meter

Heart rate variability
 Under resting conditions, the heart rate of a healthy individual is not

constant. (Notice compressions and rarefactions above)
 During expiration, the vagus nerve is stimulated, which slows down
the heart rate (the right vagus innervates the sinoatrial node).
 During inspiration, the vagus nerve is not stimulated.
 This gives rise to a phenomenon known as respiratory sinus
arrhythmia (RSA); cardio-acceleration during inspiration, cardio-
deceleration during expiration.

Autonomic Regulation
Rest & Digest Fight & Flight

Heart rate variability
 Upper trace: respiration rate from electrical impedance

plethysmography – see next lecture.
 Middle trace: beat-to-beat R-R interval.
 Lower trace: R-R interval series re-sampled at 4Hz and
cubic spline fitted to time series (smoothing).
The sympathovagal balance:
 Ratio of LF power to HF power in PSD of heart rate

time series is though to reflect sympathovagal balance

The circadian rhythm

HRV and sleep state
 HRV is also circadian Wakefulness Deep Sleep
 Autonomic balance
changes over 24 hours
 Significantly in different
sleep cycles
 Also changes based on

disease. Light Sleep REM (Dream) Sleep
• HR & HRV are not specific enough to identify sleep stages
• So what is ...?

Other biopotentials
 There are other biopotentials which can be
recorded from the body using similar circuitry:
 The Electroencephalogram (EEG, electrical activity of
the brain)
 The Electromyogram (EMG, electrical activity of
muscle)
 The Electro-oculogram (EOG, electrical activity of the
eyes)
 All are used in sleep staging

Brief intro to the Electroencephalogram
 The EEG signal is also
measured with Ag-AgCl
electrodes
 Placed in standard positions

on the scalp
 Signal is <100μV – Why?

 (Recall ECG is ~1mV)
 Heart: ~3x109
 Brain: ~1011
 Due to skull attenuation
Characteristics of the EEG
 The important information is in the frequency domain.
 The frequency range from 0.5 to 30 Hz has been

arbitrarily divided into 5 bands:
 Delta 0.5-4Hz Deep Sleep

 Theta 4-8 Hz Drowsiness / light sleep
 Alpha 8-13 Hz Relaxed
 Beta 13-22 Hz Alert
 Gamma 22-30 Hz Short term memory tasks?

Diagnosis use of EEG
EEG helps the diagnosis of brain death, epilepsy and sleep
disorders
10-20 Montage
EEG during an epileptic seizure

Sleep analysis
 Quality of life is heavily dependent on quality of sleep.
 Between 5 and 10% of the adult population suffers from some form
of sleep disorder (insomnia, heavy snoring, Obstructive Sleep
Apnoea (OSA), etc…)
 Such people may be referred to a “sleep clinic” by their GP where

various signals, including four channels of EEG, the EOG and
oxygen saturation, will be recorded throughout the night.
 The EEG and the other signals are printed out and reviewed by a
trained sleep technician (requiring 2 to 5 hours for each record).

Sleep EEG
 The channels of sleep EEG are analysed using a rule-
based system
 Consecutive 30s segments are assigned to one of six

stages (to form hypnogram)
 Wake, Stage 1, Stage 2, Stage 3, Stage 4 & REM sleep
 1= light, 3 & 4 = deep sleep

 (Recently stages 3 &4 merged)

EEG rules for scoring ...
 For example, two rules for stage 3:
 an EEG record in which at least 20% but not
more than 50% of the epoch consists of waves of
frequency 2 Hz or lower which have amplitudes
greater than 75 μV peak to peak.
 sleep spindles may or may not be present in
stage 3.

EEG in different sleep stages

Sleep structure is age-dependent
 Over the night:
 REM sleep
duration increases
& SWS decreases
 Sleep changes in
adolescence
 As we age this
pattern fragments
Automating sleep analysis
 The important information is in the

frequency domain.
 Use the Short-term Fourier Transform or

an Auto-Regressive (AR) model to extract
the frequency-domain information.

Automated sleep analysis
 Work performed in the 90’s and 00’s (in this Department)
has led to methods for analysing sleep on a 1s basis.
 Sleep is treated as having three states:
 Wakefulness, REM/light sleep, deep sleep
 Sleep-wake continuum is represented by interpolation

between these states.

Short-term Fourier transform
 First extract N samples of signal and then window
(using Hamming, Kaiser or Hanning windows) to
avoid sharp discontinuities at edges.
 Then apply the Discrete Fourier Transform

[O(N2) operations] or the Fast Fourier Transform
[O(N log N) operations] if N is a power of 2.

AR models for spectral estimation
 The notation AR(p) refers to the autoregressive model of

order p. The AR(p) model is written as follows:
X t =  ai X t-i +  t (1  i  p)
where the ai’s are the parameters of the model and εt is a white-noise
process with zero mean.
 An autoregressive model is essentially an infinite

impulse response filter which shapes the white-noise
input. The poles are the resonances of the filter and
correspond to the spectral peaks in the signal.

AR-model vs FFT spectra (for EEG)
 AR model is
parametric
 Requires only a
few coefficients
 Useful for
estimation on
short time series

Automated sleep analysis
 AR model parameters inputted to a neural network
 Sleep is treated as having three states:
 Wakefulness, REM/light sleep, deep sleep
 1s epochs – continuous scoring ... But it maps to sleep

stages too ...

EMG
 The electromyogram is used to identify
muscle activity
 In sleep is it used to identify mastication
 Eye flicks are not constant, so EMG under

chin increases confidence in REM score
EOG
 The electro-oculogram is used to identify
rapid eye movement (indicates dreaming)
 Try it in the lab!

Complex example - OSA
 SNA: Sympathetic Nerve Activity (recorded from peroneal nerve)

EEG is also used for sedation
 Look at coherence between different regions of
the brain
 E.g. BIS monitor
 Scale of 1:100 ... Proportional to hypnotic dose of
intravenous or volatile agents used, correlating well with
the hypnotic state and importantly is agent independent.
 Does not identify movement or non-movement
response, especially in the presence of opiates
 Anaesthesia is more than just a loss of
consciousness
Evoked potentials
 This is a technique whereby a stimulus, such as a light
flash or loud click, is repeatedly applied.
 The EEG signal is recorded from a particular area of the
brain.
 Normal EEG activity, however, masks the brains response
to a single stimulus.
 Repetitive stimuli have to be used and the evoked
response is distinguished from the background activity by
using the technique of signal averaging.

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Biomedical

(Based on slides from

 Patient monitoring in Ambulance, Intensive Care

 Following the heart attack, cardiac muscle damage (infarct)

 Ectopic beats originate somewhere other than the Sino-

 Abnormal heart rates (arrhythmias) can be treated.

Biomedical Instrumentation B18/BME2

 The most important interval in the ECG is the QT interval

Biomedical Instrumentation B18/BME2

 LQTS is a potentially fatal condition that renders

 When this rhythm occurs the heart is unable to beat

 The result is a sudden loss of consciousness and

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 The simplest interval to measure is the R-R

 Two types of heart rate meters:

Biomedical Instrumentation B18/BME2

 Baseline wander (mostly caused by breathing

 Muscle artefact (broadband)

 T-waves with high-amplitude content

Biomedical Instrumentation B18/BME2

 The solution to these problems is to use a band-

 Most of the frequencies in the QRS complex are

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Once the “non-QRS” sections of the ECG

Biomedical Instrumentation B18/BME2

 This should trigger a pulse generator so

Biomedical Instrumentation B18/BME2

 The “average power” of the pulse train from the

 This can be determined using a “leaky integrator”

 The time-constant of the R-C circuit should be

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

This is best achieved using a digital circuit which:

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Under resting conditions, the heart rate of a healthy individual is not

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Upper trace: respiration rate from electrical impedance

 Ratio of LF power to HF power in PSD of heart rate

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Also changes based on

• HR & HRV are not specific enough to identify sleep stages

Biomedical Instrumentation B18/BME2

 All are used in sleep staging

 Placed in standard positions

 Signal is <100μV – Why?

 The frequency range from 0.5 to 30 Hz has been

 Delta 0.5-4Hz Deep Sleep

Biomedical Instrumentation B18/BME2

EEG during an epileptic seizure

 Such people may be referred to a “sleep clinic” by their GP where

Biomedical Instrumentation B18/BME2

 Consecutive 30s segments are assigned to one of six