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Contents
 Motivation
 Introduction
 Development
 Electrocardiography
 Electrocardiographs
 Electrodes and leads
 Theory
 Medical Uses
 References

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 Motivation
• The biomedical instrument market is always adjusted and controlled for its
functionality, quality, safety, and manufacturing cost.
• The biomedical instrument market is very competitive, price sensitive and
controlled by advanced technologies.
• Also, wide use of these instruments like, for instance, curing diseases like peptic
ulcer or use in hemostasis during endoscopy inevitably demand for advancement
of technologies.

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 INTRODUCTION
“Biomedical instruments” refer to a very broad class of devices and systems. A biomedical
instrument is an ECG machine to many people. To others, it’s a chemical bio-sensor.
Current estimates place the worldwide market for biomedical instruments at over $200 billion.
Biomedical instruments are significant to the broader technology and biotechnology sectors;
and, finally, they are vital to many medical and scientific fields. Biomedical instrumentation is
the field of creating such instrument that help us to measure, record and transmit data to or
from body. Biomedical instruments form the bridge between medical sciences and engineering
to advance health care treatment including surgery, diagnosis, monitoring and therapy.

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 Electro-cardio-gram Greek words
Electro-Kardio-graph

ELECTRICITY HEART VISUALISE

That is Electrocardiogram is a tool used to visualize the electricity that flows through
the heart.

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 Development

Willem Einthoven, used

By 1927, General Electric In 1937, Taro
the string galvanometer (the
developed a portable Takemi invented a new
first practical
apparatus that could portable electrocardiograph
electrocardiograph) he
produce electrocardiograms machine.
invented in 1901.

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 Electrocardiography

Electrocardiography (ECG or EKG) is the process of recording the electrical activity of the
heart over a period of time using electrodes placed on the skin. These electrodes detect
the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic
pattern of depolarizing and repolarizing during each heartbeat.
In a conventional 12-lead ECG, ten electrodes are
placed on the patient's limbs and on the surface of the chest. The overall magnitude of the
heart's electrical potential is then measured from twelve different angles ("leads") and is
recorded over a period of time (usually ten seconds). In this way, the overall magnitude and
direction of the heart's electrical depolarization is captured at each moment throughout the
cardiac cycle. The graph of voltage versus time produced by this non invasive medical
procedure is referred to as an electrocardiogram.

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 Electrocardiographs

An electrocardiograph is a machine that is used to perform

electrocardiography, and produces the electrocardiogram.

According to Merriam Webster Definition of

ELECTROCARDIOGRAPH : an instrument for recording the
changes of electrical potential occurring during the
heartbeat used especially in diagnosing abnormalities
of heart action.

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 Electrodes and leads
An electrode is a conductive pad in contact with the body that makes an electrical circuit
with the electrocardiograph, a lead is a connector to an electrode. Since leads can share
the same electrode, a standard 12-lead ECG happens to need only 10 electrodes. For the
limb leads, they are "bipolar" and are the comparison between two electrodes. For the
precordial leads, they are "unipolar" and compared to a common lead (commonly
the Wilson's central terminal).
Leads are broken down into three sets: limb; augmented limb; and precordial or chest.

For a 12-lead ECG, there are three limb leads and three augmented limb leads arranged
like spokes of a wheel in the coronal plane (vertical), and six precordial leads or chest
leads that lie on the perpendicular transverse plane (horizontal).

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The 10 electrodes in a 12-lead EKG are listed below.
Electrode
Electrode placement
name
RA On the right arm, avoiding thick muscle.
LA In the same location where RA was placed, but on the left arm.
On the right leg, lower end of medial aspect of calf muscle. (Avoid
RL
bony prominences)
LL In the same location where RL was placed, but on the left leg.
In the fourth intercostal space (between ribs 4 and 5) just to the right
V1
of the sternum (breastbone).
In the fourth intercostal space (between ribs 4 and 5) just to the left of
V2
the sternum.
V3 Between leads V2 and V4.
In the fifth intercostal space (between ribs 5 and 6) in the mid-
V4
clavicular line.
V5 Horizontally even with V4, in the left anterior axillary line.

V6 Horizontally even with V4 and V5 in the midaxillary line. 10

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 Each electrode consists of an electrically conductive electrolyte gel and a silver/silver
chloride conductor. The gel typically contains potassium chloride — sometimes silver
chloride as well — to permit electron conduction from the skin to the wire and to the
electrocardiogram.
The common lead, Wilson's central terminal VW, is produced by averaging the
measurements from the electrodes RA, LA, and LL to give an average potential across
the body:
1
VW = (𝑅𝐴 + 𝐿𝐴 + 𝐿𝐿)
3

In a 12-lead ECG, all leads except the limb leads are unipolar (aVR, aVL, aVF, V1, V2, V3,
V4, V5, and V6). The measurement of a voltage requires two contacts and so,electrically,
the unipolar leads are measured from the common lead (negative) and the unipolar
lead (positive).

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 Limb leads
Leads I, II and III are called the limb leads. The electrodes that form these signals are
located on the limbs—one on each arm and one on the left leg. The limb leads form
the points of what is known as Einthoven's triangle.

• Lead I is the voltage between the (positive) left arm (LA) electrode and right arm
(RA) electrode:
I = LA - RA
• Lead II is the voltage between the (positive) left leg (LL) electrode and the right arm
(RA) electrode: II = LL - RA
• Lead III is the voltage between the (positive) left leg (LL) electrode and the left
arm (LA) electrode:
III = LL - LA
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 Augmented limb leads

Leads aVR, aVL, and aVF are the augmented limb leads.
• Lead augmented vector right (aVR)' has the positive electrode on the right arm. The
negative pole is a combination of the left arm electrode and the left leg electrode:

• Lead augmented vector left (aVL) has the positive electrode on the left arm. The
negative pole is a combination of the right arm electrode and the left leg electrode:

• Lead augmented vector foot (aVF) has the positive electrode on the left leg. The
negative pole is a combination of the right arm electrode and the left arm electrode:

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 Precordial leads
The precordial leads lie in the transverse (horizontal) plane, perpendicular
to the other six leads. The six precordial electrodes act as the positive poles
for the six corresponding precordial leads: (V1, V2, V3, V4, V5 and V6).
Wilson's central terminal is used as the negative pole.

Lead locations on an ECG report

A standard 12-lead ECG report (an electrocardiograph) shows a 2.5 second tracing
of each of the twelve leads. The tracings are most commonly arranged in a grid of
four columns and three rows. the first column is the limb leads (I, II, and III), the
second column is the augmented limb leads (aVR, aVL, and aVF), and the last two
columns are the precordial leads (V1-V6).

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Limb Leads Augmented Limb Leads Chest Leads
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 Theory
Interpretation of the ECG is ultimately that of pattern recognition. In order to
understand the patterns found, it is needed to understand the theory of what ECGs
represent. The theory is rooted in electromagnetics and boils down to the four
following points:
• Depolarization of the heart toward the positive electrode produces a +ve deflection
• Depolarization of the heart away from the positive electrode produces a -ve deflection
• Repolarization of the heart toward the positive electrode produces a -ve deflection
• Repolarization of the heart away from the positive electrode produces a +ve deflection

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At rest cells are negatively charged relative to these slightly positively charged environment.
And when they depolarize cells become positively charged leaving a slightly negative charge
at outside environment.

Cells at rest

When Cells
are depolarized

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 When a wave of
depolarization is paused.

When a wave of
repolarization is paused.

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 Negative charged Positive charged

When a wave of depolarization is paused. A positive deflection on ECG tracing.

When a wave of repolarization is paused. A Negative deflection on ECG tracing.

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When direction of dipole vector is not parallel to line joining electrodes then it is divided
into two vector components on parallel to the line(going towards the positive electrode)
and other perpendicular to the same. Only parallel vector will cause deflection,
perpendicular vector does not cause any deflection.
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 Amplitudes and intervals
All of the waves on an ECG tracing and the intervals between them have a predictable time duration, a
range of acceptable amplitudes (voltages), and a typical morphology. Any deviation from the normal
tracing is potentially pathological and therefore of clinical significance.
For ease of measuring the amplitudes and intervals, an ECG is printed on graph paper at a standard
scale: each 1 mm (one small box on the standard ECG paper) represents 40 milliseconds of time on the
x-axis, and 0.1 millivolts on the y-axis.
Feature Description Duration
The p-wave represents depolarization of the atria. Atrial depolarization spreads from the SA node towards the AV node, and from the
P wave <80 ms
right atrium to the left atrium.

The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. This interval reflects the time the electrical
PR interval 120 to 200 ms
impulse takes to travel from the sinus node through the AV node.

The QRS complex represents the rapid depolarization of the right and left ventricles. The ventricles have a large muscle mass compared to the
QRS complex 80 to 100 ms
atria, so the QRS complex usually has a much larger amplitude than the P-wave.

J-point The J-point is the point at which the QRS complex finishes and the ST segment begins.

ST segment The ST segment connects the QRS complex and the T wave; it represents the period when the ventricles are depolarized.

T wave The T wave represents the repolarization of the ventricles. It is generally upright in all leads except aVR and lead V1. 160 ms

Corrected QT The QT interval is measured from the beginning of the QRS complex to the end of the T wave. Acceptable ranges vary with heart rate, so it
<440 ms
interval(QTc) must be corrected to the QTc by dividing by the square root of the RR interval.
The U wave is hypothesized to be caused by the repolarization of the interventricular septum. It normally has a low amplitude, and even more
U wave
often is completely absent.
Schematic diagram of normal sinus rhythm for a human
heart as seen on ECG
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 Medical Uses
The overall goal of performing electrocardiography is to obtain information about
the structure and function of the heart. Medical uses for this information are
varied and generally relate to having a need for knowledge of the structure and
function. Some indications for performing electrocardiography include:

• Suspected myocardial infarction (heart attack) or new chest pain

• Suspected pulmonary embolism or new shortness of breath
• A third heart sound, fourth heart sound, a cardiac murmur or other findings to
suggest structural heart disease
• Perceived cardiac dysrhythmias either by pulse or palpitations
• Monitoring of known cardiac dysrhythmias
• Fainting or collapse
• Cardiac stress testing

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Thank you

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