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THE ELECTRICAL FUNDMENTAL OF THE ECG

The ECG is graphical recording of the electrical potentials generated in

association with heart activity. In 1901 Einthoven first described the use of a string
galvanometer to detect the presence of electrical activity in the adult heart that
resulted in the birth of electrocardiography. The ECG shown in Figure1 is an ideal
tool for the cardiologists. It is non-invasive, inexpensive, easy to use and it yields a
wealth of information.

Figure 1 normal ECG

In the normal human heart, the valves maintain a unidirectional flow of blood with
minimal frictional resistance, whilst almost completely preventing reverse flow.

The left ventricular free wall and the septum are much thicker than the right
ventricular wall as shown in Figure 2. This is logical since the pumping action that
forces blood out to the body and lungs are provided by the ventricles. This
ventricular contractile phase is called the systole, while the atrium is responsible
for storing the blood during this time. After ventricular contraction, the atria
contract to force blood into relaxing ventricles. This ventricular relaxation phase is
called diastole.

There are two types of electrocardiography invasive, which use to measure

the cardiac signal direct from the heart surface, and the common method that is the
non-invasive electrocardiography; it has been used to obtain valuable clinical
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information about the patient well being by applying the electrodes on the chest
surface. The current generated by the heart spreads out on the body surface
regularly. That is due to the properties of the cardiac cells, automaticity and the
ability to trigger electrical signals.

Figure 2 the anatomy of the heart

In order to measure the ECG signal, different electrodes can be used for this
purpose (usually and the most used is piece of silver or it may be covered with
silver chloride Ag/AgCl) where the contact area of the skin should be covered with
a gel regarding good conduction between the electrode and the skin surface. It used
also in stress ECG to reduce the motion artifact.

In addition to that there are electrocardiographic leads system, consists of 12

leads are used for recording the electrical activity of the heart. Each lead is
responsible for recording a cardiac signal from special selected location on the
chest. These signals are known and written as follow: I, II, III - aVR, aVL, aVF -
V1,V2, V3, V4, V5 and V6.

1-Einthoven’s method (bipolar):

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I, II, III is called also Einthoven’s triangle or can be known as limb leads.
This type of measurements also is identified as bipolar configuration. These ECG
electrodes are placed on the right and left arms and the left leg, where the voltages
across the three pairs of these electrodes are monitored. It represents the potential
difference between each two electrodes, and are called I (VI = Vleft arm − Vright
arm), II (VII = Vleft leg − Vright arm), and III (VIII = Vleft leg − Vleft arm),
These three electrodes act as if they probe at the vertices of a triangle, which is
usually called the Einhoven’s triangle, as shown in Figure 3. Because the arms and
legs do not have new sources of electric fields and the tissue in each is a conductor,
the probes on the arms actually sense the same voltages as if they were instead
placed on the respective shoulders and the probe on the leg has the same voltage as
if it were placed on the bottom of the torso (upper body) near the pubic area, an
electrode is positioned on the right leg (not shown in this figure) to serve as an
electrical ground.

Figure 3 Einthoven’s method

I represents the electrical potential between R(RA) and L(LA)

II represents the electrical potential between R(RA) and F(LL)
III represents the electrical potential between L(LA) and F(LL)

Then the sum of these potentials as close circuit equal zero

I - II +III =0
II = I + III
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Lead I or 1 = LA – RA
Lead II or 2 = LL – RA
Lead III or 3 = LL – LA

This is known as Einthoven’s Law. Thus if any two of the three potential
differences are measured the third can be calculated.

2 - Goldberger’s method (augmented):

In a unipolar configuration, one electrode is placed over the region of interest and
the other electrode is located at some distance away from the tissue as shown in
Figure 4.

aVR represents the electrical potential between the right arm and
indifferent electrode, which connect between LA and LL.
aVL represents the electrical potential between the left arm and
indifferent electrode, which connect between RA and LL.
aVF represents the electrical potential between the left leg and indifferent
electrode, which connect between LA and RA.

Figure 4. Goldberger’s method

These electrodes are usually referred to as the exploratory and indifferent

electrodes (point between each two resistance), respectively. Unipolar signals
represent electrical activity from an entire region and only the electrical events at
the exploratory electrode.
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3 - wilson’s method (unipolar):

It is unipolar method used for recording the electrical potential from 6 point on the
chest, V1, V2, V3, V4, V5, and V6. In standard ECG registering, the indifferent
electrode is replaced by Wilson’s terminal, and Figure 5 illustrates all the locations
of the three methods Einthoven, Goldberger and Wilson.

Figure 5. Th e 12 ECG leads and the Einthoven’s triangle.

The electrical potential should be measured between each one of V1, V2,
V3, V4, V5, and V6 electrode with the Wilson Terminal (WT) for all three
electrodes together, the right arm, left arm and left leg as shown in Figure 6b.

The electric current generated by the heart is conducted through the wires or
transmitted wireless by radio to the recording device, which consists fundamentally
of an amplifier that magnifies the electric signals and a galvanometer that moves
the inscription needle. The needle moves in accordance with the magnitude of the
electrical potential generated by the patient’s heart. The needle inscribes a positive
or negative deflection, depending on whether the explorer electrode of a given lead
faces the head or the tail of the depolarisation or repolarisation vector.
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Figure 6. Location of the precordial leads: (a) frontal plane with the scheme of unipolar
register.WT stands for Wilson’s terminal, (b) galvanometric recorder.

There are different types of the ECG needles, which can be used for ECG
recording (thermal traces, pigment traces or color paste traces), where thermal
traces needle is the most use. In addition to that the ECG recording device are
divided according the number of the needles required (designed), one channel,
three channels or six channels ECG recorder. These recorders usually used 25
mm/s recorder speed, where 50 mm/s speed is used for special cases only. At the
end of the electrocardiography process the data can be recorded on thermal paper,
display on monitor (CRT) or stored for analyzing in digital form (memory).

How to calculate the heart rate (HR):

Calculating the HR is one of the ways to assist the physician to diagnose the
situation of the Patient, different methods are used to calculate the HR, the main
step for all these methods is to detect the R peaks of the QRS complexes, using
special algorithm for real time, or manually for ECG paper according Figure 7.

After detecting the R peaks, the time can be calculated as follow

(a) ECG in digital form :

T = t(R2) - t(R1) or T = the time between two adjacent R peaks in (sec).

HR = (1/T)*Fs*60 (beat/minute) this method usually used in research areas.

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Figure 7. intervals and segements of ECG signal

(b) ECG on thermal paper:

The area of this paper is divided to square units (5mm x 5mm), each unit
consists of 25 small squares, and the area of each small square is 1mm x 1mm. All
these squares are separated by red Lines. In order to calculate the HR, the doctor
should determine the locations of the R peak and the location of the next R peak,
then calculates the number of the squares (1mm x 1mm) between the two R peaks,
where the time required for 1mm is 0.04 (second), then the HR can be calculated as
follow:
1 *60 (beat/minute)
HR = {[number of the squares * 0.04(sec)]}

In addition to that there are another possibilities for calculating the HR using
different techniques, such as Phonocardiography (PCG) Magnetocardiogram
(MCG) and Doppler Ultrasound.

The nature of the ECG signal usually is weak (in milivolt), due to the noise
from the electrical sources and other bioelectric interference, some kind of signal
processing is included in the electrocardiograph device to enhance the ECG signal
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by attenuating the noise. An example of such signal with and without noise is
illustrated in Figure 8.

In order to avoid and reduce the interference or the noise, some rolls should
be followed: the patient and the recorder should be grounded very well, patient
should be relaxed and in supine position and breathing should be calmly.

Figure 8. ECG signal before and after processing

There are two Patient cable standards for distinguishing the ECG leads by
mark or color according to their location on the body surface as in Table1.

Table1: standards electrodes

Patient cable, IEC standard patient cable, AHA standard

Marked plug color electrode location Marked plug color

R red right arm (RA) white
L yellow left arm (LA) black
F green left leg (LL) red
N black right leg (RL) green
C1…C6 chest V1…V6