EC8073 MEDICAL ELECTRONICS

MAHESWARAN U1 Dr.NIRMALAPRIYA G2 KARUNAKARAN A3

Assistant Professor1,3 , Professor2

Department of Electronics And Communication Engineering
Rajalakshmi Institute of Technology
Chennai
What is Medical Electronics?

Branch of Engineering that deals with the study of design and development of medical
equipment/devices based on the knowledge acquired through electronics and
Communication Engineering.
In Medical electronics a student will be studying about the following:
Electrophysiology of living cells Design and Development of various
Origin of Bio-electric potentials Physiotherapeutic Units
Design and Different types of Bio-signal Principles of Radio Telemetry and
amplifiers Telemedicine
Several types of Bio-Waveform Recording Advanced Medical Instruments and
Setups Recently developed Biomedical
Instruments
Measurement setup of various non
electrical parameters from the Human Futuristic Trends in this field
body And Other related topics
Design and Development of various Assist
Devices and Therapeutic Instruments
 TYPES OF MEDICAL INSTRUMENTS
• DIAGNOSTIC INSTRUMENTS
 Bio Potential Recording Instruments
 Image Recording/Visualizing Instruments
 Sound Recording instruments

• THERAPEUTIC INSTRUMENTS
 Invasive
 Non-Invasive/ Physiotherapeutic

• BIO-CHEMICAL TESTING INSTRUMENTS

• ASSIST DEVICES

• ARTIFICIAL ORGANS
DIAGNOSTIC INSTRUMENTS
• Instruments used to detect anomalies /abnormalities in human physiological
functions.
• Types:
 Bio Potential Recording Instruments
– ECG,EEG,EMG,ENG,EOG
 Image Recording/Visualizing Instruments
– X-Rays, Endoscopy units, Doppler
Scan, Ultra Sound Imaging,
CT Scan, MRI Scan, Doppler Scan
 Sound Recording instruments
–Stethoscope,PCG, Contact Microphones
 Other Measuring Instruments
–Thermometers,Sphygmomanometer,
Oximeters
 THERAPEUTIC INSTRUMENTS
• Instruments used to treat and cure the abnormalities in human
physiological functions /during treatment of certain medical condition.
Invasive Therapeutic Instruments:
A medical instrument that invades (enters) the body, usually by cutting or
puncturing the skin for a surgical procedure. – Surgical Units, Haemostatic
Forceps, Coagulation units, Micro and Nano fluidic injections
Non-Invasive Instruments:
Non invasive instruments do not break the skin or physically enter the
body.-- hearing aids, external splints, and casts.
Physiotherapeutic Instruments:
Physical medicine units are those which uses the principles of electronics
and physics to provide rehabilitation and to relieve pain without chemical
medicines. – Diathermy units, heating units
BIO-CHEMICAL TESTING INSTRUMENTS
• Instruments and Devices that are used to measure certain non
electrical parameters , through which a clinical condition of a patient
can be diagnosed are called Bio-Chemical Testing instruments.
• The following instruments are examples of Bio-chemical Testing
instruments.
Auto analyzer
Blood Gas Measurement Unit
pH, pCO2,PO2,PHCO3 Measurement Setups
Blood Cell Counters
Pulse Oximeter
Blood flow meters
Respiratory rate measurement setup
ASSIST DEVICES
• Any device that is designed, made, or adapted to assist a person
perform a particular task.
• Assist devices are those used to provide temporary relief to a suffering
patient.
• Examples:-
Pacemakers
Defibrillators
Ventilators
Oxygenators
Dialyzers
Augmentative communication devices
Walking Frames
ARTIFICIAL ORGANS
• An artificial organ is a human made organ device or tissue that is
implanted or integrated into a human, interfacing with living tissue to
replace a natural organ, to duplicate or augment a specific function or
functions so the patient may return to a normal life as soon as possible.
Prosthetic Implants such as Artificial limbs, hands
Artificial urinary bladder
Neuro-prosthetics with motor, sensory or cognitive modality
Visual prosthesis which emulates the function of an eye through digital
camera
Implantable artificial kidney
Artificial lung etc.. are few examples for artificial organs.
 UNIT-I
ELECTRO-PHYSIOLOGY AND BIO-POTENTIAL RECORDING
Objective:
To gain knowledge about the various electrophysiological parameters and their
recording methods.
Outcome:
Students can be able to know the human body electrophysiological parameters and
the recording of bio potentials.

Syllabus:
Sources of bio medical signals, Bio-potentials, Bio potential electrodes,
biological amplifiers, ECG, EEG, EMG, PCG, typical waveforms and signal
characteristics
 BIO-POTENTIAL /BIO-ELECTRIC POTENTIAL/
CELLULAR POTENTIAL
• The various system of our body generates its own monitoring signals while
carrying out various functioning. Such generated signals convey useful
information about the function of each system. These signals are bioelectric
potentials associated with nerve conduction, brain activity, heart beat, muscle
activity etc.
• The Electric potential that are developed across the cell membrane due to the
chemical activity of certain excitable cells are known as Bio-potential/Bio-Electric
Potential/Cellular Potential of the cell.
• It is the Ionic voltage developed as a result of electrochemical activity of certain
special type cells such as nerve cells /Muscle cells.
• Animal Cells have Definite Cell membrane(Eukaryotic). The fluids inside the cell
are called Intra cellular fluid and those that are present outside are known as
extra cellular fluid.
• Special types of cells like nerve and muscle cells in the body are encased in
semipermeable membrane that permits some substance to pass through the
membrane while others are kept out.
• The cells are surrounded by fluid. The fluid contains ions such as sodium,
potassium, chloride etc.
• The fluid outside the cell membrane is called as External cell fluid or extracellular
fluid (ECF) and the fluid inside the cell membrane is called as internal cell fluid or
intracellular fluid (ICF).
• ICF is rich in K+, Mg++, phosphates and ECF is rich in Na+, Cl-.
 Under normal condition(No muscle activity)
• In normal condition when the semipermeable membranes are in polarized state, Sodium
(Na+) ions will be outside the membrane.
ie.
Under normal condition,
at ECF, the conc.of Na+ is more and K+ is less
at ICF, the conc.of K+ is more and Na+ is less

• This ionic configuration gives rise to a potential across the cellular membrane and that
potential is known as resting potential.
• Normally the Resting potential of a grown adult is -70mV. (in the range of -60 to -90 mV)
• The resting potential is normally measured negative because of the size of Na+ are more
than the size of K+ ions.
• Sodium ions are +ve. It tends to make outside of cell more +ve than inside and the
measurement is made with reference to ECF. Hence resting potential is always negative.
• Since the size of Na+ ions is more than the size of holes in semipermeable membrane,
they cannot enter inside whereas other ions like potassium (K+) and Chloride (Cl-) can
enter the membranes and exhibits resting potential.
• This process stops when equilibrium is reached.
• Equilibrium is reached with a potential difference across the membrane, -ve on inside
and +ve on the outside. And this membrane potential is known as resting potential of
cell. (always less than -90mV).
• Normally the sodium ions can’t enter the Semipermeable membrane without excitation.
• The sodium ions can enter the membrane when the holes of it are increased by stimulation
(excitation).
• As the cellular potential is measured ,when the cell is in resting state, it is known as resting
potential.
• This potential is maintained until some disturbance (Muscular activity / Nerve excitation)
upsets the equilibrium.
• Thus, the Process of developing an ionic (-ve) voltage across the cell membrane due to the
electrochemical activity under the resting condition is called Polarization of the cell.
Under Excited condition(Muscle/Nerve activity)
• When a muscle activity like folding of arms, walking, blinking of eyes or a nerve
activity like thinking of something happens, the polarized cell starts to depolarize
which leads to the exchange of ions between ECF and ICF.
• The Na+ which is abundant in ECF and less in ICF starts to move inside the cell
and like wise, the K+ ions which is abundant in ICF and is less in ECF starts to
move outside the cell due to the excitation.
• Hence the concentration of ICF and ECF changes as follows
ie.
Under excited condition,
at ECF, the conc.of K+ is more and Na+ is less
at ICF, the conc.of Na+ is more and K+ is less
• This process is called Depolarization of the cell. This Results in the formation of a
new potential across cell membrane, which is known as Action potential.
• When a cell is excited and displays an action potential, it is said to be "depolarized" and
the process of changing from resting state to action potential is called as depolarization.
• As the cellular potential is measured ,when the cell is in active state, it is known as action
potential.

• The Value of action potential for any type of excitation never exceeds 20mV. The reason
for the positivity of the action potential is again the size of ions and the reference being
ECF.
• Once the rush of sodium ions through the cell membrane has stopped (a new state of
equilibrium is reached), the ionic currents that lowered the barrier to sodium ions are no
longer present and the membrane reverts back to its original, selectively permeable
condition.
• Now passage of sodium ions from the outside to inside of the cell is again blocked.
However, it would take a long time for a resting potential to develop again. But such is
not the case.
• Thea is the depolarized state of the cell will not long last.
• The Depolarized cell again starts to polarize in opposite direction and tries to attain the
polarized state which is its natural state.
• This process is called Repolarization. After Repolarization the cellular potential becomes
close to -90mV and the state of the cell is known as Repolarized state.
• This is an iterative and cyclic process, and the cycle of the exchange of ions between the
fluids inside and outside the cell is known as Sodium-Potassium Pump (Na-K Pump).
• This Na-K Pump happens to continue whenever there is a small muscle activity / nerve
activity. That is , it continues till there is life in the body.
• (In other words, Na-K pump gives life to a living body.)
The Na-K Pump
 Origin of Biological signal Waveform from Bio-potential
• The rate of pumping is directly proportional to the sodium concentration in the cell. It is also
believed that the operation of this pump is linked with the influx of potassium into the cell, as if a
cyclic process involving an exchange of sodium for potassium existed.
• This repetitive occurrences of Na-K pump results in a signal waveform from that part of the
muscle.
• [Polarization(-90mV) Depolarization(20mV)  Repolarization(-90mV)  Depolarization
(20mV)……….]  Bio-Signal.
• The Figure below shows a typical action-potential waveform, beginning at the resting potential,
depolarization, and returning to the resting potential after repolarization.
• The time scale for the action potential depends on the type of cell producing the potential.
• In nerve and muscle cells, repolarization occurs so rapidly following depolarization that the action
potential appears as a spike of as little as 1msec total duration.
• That is ,In nerve cells, the duration of one occurrence of Na-K pump is almost 1 m sec.
• In heart muscles , the duration for one cycle of Na-K pump ranges between 150 m sec to 300 m sec.
 All or Nothing Law & Timing parameters of Na-K Pump
“Regardless of the method by which a cell is excited or the intensity of the stimulus (provided it is sufficient to
activate the cell), the action potential is always the same for any given cell”. This is known as the all-or-nothing
law.
• That is , however strong be the exciting impulse ( impact of muscle activity) the action potential developed in
a cell is a fixed quantity.
• There are certain timing parameters, that gets significant in this context of Na-K pump. They are
1. Absolute Refractory Period (ARP)
2. Relative Refractory Period (RRP)
3. Total Refractory Period (TRP = ARP+RRP) *all these parameters are measured in m sec
• Following the generation of an action potential, there is a brief period of time during which the cell cannot
respond to any new stimulus. (minimum timing between two polarized state instances).
• This period is called the Absolute Refractory Period (ARP), lasts about 1msec in nerve cells.
• Following the absolute refractory period, there occurs a relative refractory period, during which another
action potential can be triggered, but a much stronger stimulation is required. . (minimum timing taken by a
cell to completely repolarize from depolarized state)
• In nerve cells, the Relative Refractory Period (RRP) lasts several milliseconds.
• The total time taken by a cell to completely depolarize and then to completely repolarize itself is known as
Total Refractory Period (TRP).
Propagation of Action potentials
• When a cell is excited and generates an action potential, ionic currents begin to flow.
• This process can, in turn, excite neighboring cells or adjacent areas of the same cell. In the
case of a nerve cell with a long fiber, the action potential is generated over a very small
segment of the fiber's length but is propagated in both directions from the original point of
excitation.
• As the action potential travels down the fiber, it cannot re-excite the portion of the fiber
immediately upstream, because of the refractory period that follows the action potential.
• The rate at which an action potential moves down a fiber or is propagated from cell to cell is
called the propagation rate. In nerve fibers the propagation rate is also called the nerve
conduction rate, or conduction velocity.
• This velocity varies widely, depending on the type and diameter of the nerve fiber. The usual
velocity range in nerves is from 20 to 140 meters per second (m/sec). Propagation through
heart muscle is slower, with an average rate from 0.2 to 0.4m/sec.
 Bio-Electrodes
• Devices that are used to pick up the voltages developed are called electrodes.
• Those used to pick up bio signals are called bio-electrodes.
• In general, to measure any voltage , the electric potential difference between two points (using two
electrodes) are measured. One electrode is measuring electrode and one electrode is reference
electrode.
• But in case of picking up of biological signals, only one electrode is used as the measuring surface is
an electrode-electrolyte interface. (The electrode has only one type of charge carrier (electron),
whereas the electrolyte has 2 types of charge carriers (cation and anion).
• Ions in solution combine with metallic electrodes which in turn decreases free electrons in electrode
and decreases positive cations in solution.
• As a result, a charge gradient builds up between the electrode and electrolyte and this in turn
creates a potential difference i.e., the electrode potential or half cell potential, Vh.
• Hence the bio electrodes, directly measure the potential developed and it is a half cell potential
with electrolyte as its reference.(here, ECF ==GND)
• The voltage developed at an electrode-electrolyte interface is known as Half-cell potential.
Polarizable and Non-polarizable Electrodes
• There are two basic types of Bio-potential electrodes
Perfectly polarizable electrodes
Perfectly Non-polarizable electrodes
 Forms of Bio-potential Electrodes
• Many different forms of electrodes have been developed for different types of biomedical
measurements. But some of the most commonly used electrodes can be classified as,
1. Microelectrode
2. Skin surface Electrode
3. Needle Electrode
• All these 3 types of Bio-potential electrodes have the metal-electrolyte interface. In each
case, an electrode potential is developed across the interface proportional to the exchange
of ions between electrode and the electrolytes of the body.
• The double layer of charge at the interface acts as a capacitor. Thus the equivalent circuit of
Bio-potential electrode in contact with the body consists of a voltage in series with a
resistance capacitance network.
• Since measurement of bioelectric potential requires 2 electrodes, the voltage measured
is the difference between the potential of 2 electrodes as shown in the figure below.
• If two electrodes are of same type, then the potential difference depends on the ionic
potential between two points of the body from which measurements are taken.
• If two electrodes are of different type then the electrodes may produce a DC voltage that
cause current to flow through both the electrodes as well as through the input circuit of
the amplifier to which they are connected.
• The DC voltage due to the difference in electrode potential is called the electrode offset
voltage. The most commonly used electrode is Ag/AgCl.
Broader Classification of Bio-Electrodes
• Micro Electrodes - Used to measure potential from a single cell
 Metal micro electrode
 Micro pipette
• Body surface electrodes - Used to measure potential from a group of
similar cells
 Metal plate electrode
 Metal disk electrode
 Disposable foam pad electrode
 Metallic Suction cap electrode
 Floating metal body surface electrode
 Flexible body surface electrode

• Needle electrodes - Used to measure potential from a particular part of a

tissue
Micro Electrodes
METAL MICRO ELECTRODE
• Formed by electrolytically etching the
tip of fine tungsten or stainless steel
wire to the desired size.
• Wire is coated with an insulating
material/chloride almost to the tip to
reduce the tip impedance.
• The electrode-electrolyte interface
takes place where the metal tip
contacts the electrolyte either inside
or outside the cell.
 MICROPIPETTE
• The electrode is filled with an electrolyte
solution (3m KCl).
• A cap containing a metal electrode is then
sealed to the pipette. The metal electrode
contacts the electrolyte within the pipette.
• The electrode used is silver wire prepared with
an electrolytic AgCl surface. Platinum or
Stainless steel wires are also used.
• A thin, flexible metal wire from chlorided silver,
stainless steel or tungsten is inserted into the
stem of the micropipette. The friction between
the wire and the stem of the micropipette and
the fluid surface tension hold the micropipette
on the wire.
• The other end of the metal wire is mounted to a
rigid support and the other free end of it resting
on the cell as shown in the figure below.
 Body surface Electrodes
• Surface Electrodes are used to measure Bioelectric potential available from the surface of the
skin. These electrodes are placed in contact with the skin of the subject.
• Surface Electrodes vary in diameter from 0.3 to 5 cm.
• Human skin has high impedance when compared with voltage sources. The skin impedance
may vary from 0.5 kΩ for sweaty skin surface to more than 20kΩ for dry skin surface.
• Surface Electrodes are used to record ECG, EEG & EMG signals.
• Large surface Electrodes are used for ECG measurement and smaller surface electrodes are
used for EEG and EMG measurements. Types are as follows.
 Metal plate electrode
 Metal disk electrode
 Disposable foam pad electrode
 Metallic Suction cap electrode
 Floating metal body surface electrode
 Flexible body surface electrode
 Metal plate electrode, Metal disk electrode, Disposable foam pad electrode
• Oldest form of ECG electrode • Preferred for EEG and EMG • Disposable after usage
• Ag or Nickel or other alloys • Stainless steel or Pt or Au • Adhesive tape or gel is already
• 1-2 sq. inches surface area tipped present

• Conductive gel to be applied before • Smaller Diameter • Silver plated disk on a plastic
use, to reduce body impedance. • Elliptical or circular in shape. foam

• Rectangular or circular in shape. • Larger surface area

Metallic Suction cap electrode, Floating electrode, Flexible electrode
• Preferred for ECG • Preferred for EMG and ENG • For measurements at irregular
• A modification of the metal-plate • Hat like structure surface areas
electrode & requires no traps or • Two types
• The metal disk made up of
adhesives for holding
silver and coated with AgCl, i. Carbon-filled silicone rubber
• consists of a hollow metallic surrounded by electrolyte gel electrode. – for ECG
cylindrical electrode that makes is recessed in a cavity measurement in premature
contact with the skin at it base. infants – Pin connector-Lead
• Uses double sided adhesive
• electrolyte gel to be applied before tape ring to fix it in position. setup
use, to clean the surface and to ii. Flexible thin film neonatal
reduce body impedance. electrode. -- a 13μm thick
Mylar film on which an Ag
and AgCl film have been
deposited.
Needle electrodes
• Basic needle electrode consists of a solid needle
usually made of stainless steel with a sharp
point.
• The shank of the needle is Insulated with a
coating such as an Insulating varnishes.
• Only the tip Is left exposed.
• A lead wire is attached to the other end of the
needle and the joint is encapsulated in a plastic
hum to protect it.
• This electrode is frequently used in
electromyography.
• When placed in a particular muscle it obtains an
EMG from that muscle acutely and can then be
removed.
Biological Amplifiers/Bio-Signal Amplifiers
• Amplifiers are circuits that increases the amplitude of a signal without changing its time period
(frequency).
• Electronic signal Amplifiers that are preferred to amplify the acquired biological signals are known
as Biological amplifiers or Bio-signal amplifiers.
• Unlike other applications, Transistorized multi stage CE Amplifiers are not preferred in medical
applications, due to the fact that the required gain is very much higher than a few staged CE
amplifier can provide.
• A non-ideal operational amplifier's equivalent circuit has a finite input impedance, a non-zero
output impedance, and a finite gain.
• Hence LIC amplifiers such as instrumentation amplifiers are supposed to be used in Biological
signal amplification.
• An instrumentation amplifier combines very high input impedance, high common-mode
rejection, low DC offset, and other properties used in making very accurate, low-noise
measurements
• It is made by adding a non-inverting buffer to each input of the differential amplifier to increase
the input impedance.
 Requirements of a good Bio signal Amplifier
• The typical requirements for the amplifiers to be used in ECG include:
Low internal noise (<2 mV)
Gain over 1000
High Input Impedance (Zin > 10 MΩ)
Bandwidth ranging from 0.16–250 Hz.
Bandwidth cutoffs (>18 dB/octave).
Notch filter (50 or 60 Hz, depending on country/region)
Common mode rejection ratio (CMRR > 107 dB)
Common mode input range (CMR > ±200 mV)
Static electricity shock protection (>2000 V)
Gain stability > ±1%

• An instrumentation amplifier satisfies almost every requirement of a good bio-amplifier.

• An instrumentation amplifier is a type of differential amplifier that has been outfitted with
input buffer amplifiers, which eliminate the need for input impedance matching and thus
make the amplifier particularly suitable for use in measurement and test equipment.
• The rightmost amplifier, along with the
resistors labelled R2 and R3 is just the
standard differential amplifier circuit,
with gain = R3/R2 and differential input
resistance = 2R2.
• The two amplifiers on the left are the
buffers. With Rgain removed (open
circuited), they are simple buffers with
unity gain.
• The most commonly used
instrumentation amplifier circuit is
shown in the figure. The gain of the
circuit is Av.
BIO-POTENTIAL RECORDING
• Bio-potentials can be measured with electrodes and electronic instrumentation to
provide insight into the functioning of various biological systems.
• It include skeletal muscle, the brain, the heart, and the eye. Each of these organs
produce electrical activity that can be recorded on the surface of the skin.
• With the recorded bio-potential waveform, by comparing it with the standard
normal waveform, abnormalities in that particular functional organ can be
diagnosed.
• The following are the list of bio-potential recording methods widely used in clinical
diagnosis.
 Electrocardiography (ECG) – to measure potentials from heart muscles
 ElectrodermalActivity (EDA) –to measure the potentials from external layers of skin
 Electroencephalography (EEG) – to measure the bio-potentials from brain
 Electrogastrography (EGG) – to measure the bio-potentials from stomach
 Electromyography (EMG) – to measure the potentials developed at muscle fibers
 Electrooculography (EOG) – to measure the electrical activity of eye
 Impedance Cardiography (ICG) -- alternative method to measure the potentials from heart muscles
 Electroneurography (ENG) – to measure the electrical activity of nerves
• In this Course , the following bio-potential Recording methods and
their related contents will be discussed.
 Electrocardiography - ECG
 Electroencephalography -EEG
 Electromyography-EMG
 Phonocardiography- PCG (Heart Sounds)
 ELECTROCARDIOGRAPHY -ECG
• ECG-Basic Information
• Typical ECG Signal and its characteristics
• Abnormal ECG Signals and its related diseases
• Various Lead systems for ECG
Bipolar Limb leads
Unipolar Limb leads
Unipolar chest leads
• ECG recording setup
ECG/EKG -Basic Information
• The electrocardiography is a technique of recording the bio-electric potentials generated by the
muscle activity by heart.
• Technique: Electrocardiography
• Waveform : Electrocardiograph
• Recording Unit : Electrocardiogram
• Used to reveal the condition of the heart and to diagnose cardiac illnesses.
• This has been possible because the cardiac muscle cells generate bio-potentials which can be
detected inside the body or on its surface using some special electrodes.
• Unlike the bio-potentials generated by some other muscles, the currents generated by the
heart muscles are periodic, that is, they consist of a repeated sequence of characteristic
waveforms which correspond to a heart beat.
• ECG is the graphical representation of the bio-potentials generated by the myocardial cells. The
body conductivity allows the detection of these potentials on its skin.
• By placing a pair of electrodes on the body, an ECG voltage potential between them can be
measured and recorded.
• This graphical representation (ECG) can be either printed on a paper or displayed on a monitor.
• The device capable of recording and printing the ECG on paper is called
electrocardiograph. The device which displays the ECG on a screen is called monitor or
cardiac monitor.
• An electrocardiograph consists of electrodes, electrode cables, amplifiers, filters, control
modules, paper recording module and special graph paper.
• Modern electrocardiographs also contain a monitor screen, to display the ECG, and some
of them are even capable of providing an interpretation of the electrocardiogram.
• Einthoven was the inventor of the first device capable of printing the ECG on paper.
• Einthoven named the waves using five capital letters from the alphabet: P, Q, R, S, and T.
• So one cycle of ECG wave is denoted as PQRST complex.
Typical ECG Signal and its characteristics
• A typical representation of the ECG waves is as shown in the figure below.
• The description of the five ECG waveforms is as follows:
• P wave : represents the depolarization impulse across the atria
• Q, R and S region : all these three waves represent the ventricular depolarization (the
downward stroke followed by and upward stroke is called Q wave, the upward stroke is
called R wave and any downward stroke preceded by an upward stroke is called S
wave)
• T wave : represents the repolarization of the ventricles
Duration:
• P-R interval 0.12 to0.20 msec
• Q-T interval 0.35 to 0.44 msec
• S-T interval 0.05 to 0.15 msec
• P interval 0.11 msec
• QRS interval 0.09 msec
• U interval 0.2 msec
Abnormal ECG Signals and its related diseases
• The Normal ECG waveform will be a repetitive
cycle of PQRST complex with correct periodicity.
The rhythm in which the PQRST appears is in
sync. With the heart functioning.
• Any irregularity in the heart activity can be
identified by the arrhythmia in the ECG.
• The following are few cardiac irregularities that
can be identified through the arrhythmia in ECG
wave forms.
Ventricular Tachycardia –Beating rate
abnormality
Ventricular Fibrillation – Blockage in
ventricular fibres
Premature Ventricular contraction –Extra
systole
Atrial flutter – Excessive beating of atria
Atrial Fibrillation –Blockage in atrial fibres
Myocardial infraction –Cardiac Myopathies
 Various Lead systems for ECG
• ECG signals can be measured between pairs of electrodes placed on the human body.
• However, the ECG waves from these signals have different shapes and amplitudes,
depending on the position on the human body where they are placed.
• In electrocardiography, a pair of electrodes are called as ECG lead.
• A standard has been established in electrocardiography and this standard specifies 12
separate leads and the corresponding positions of the electrodes on the human body.
• Also, this standard provides a means of obtaining the 12 standard ECG leads by combining
the signals from different electrodes.
• The reason for recording and analyzing more than a single ECG lead is that different parts
of the heart can be "seen" better from different angles (provided by different leads).
• Each ECG lead provides a different view of the same cardiac activity.
• The 12 standard ECG leads are divided in to 3 main groups
i) Bipolar limb leads or Standard Leads or Einthoven lead system
• 1. Lead I
• 2. Lead II
• 3. Lead III
ii) Unipolar limb leads or Wilson Lead System or Augmented unipolar limb lead
• 4. aVR
• 5. aVL
• 6. aVF
iii) Unipolar chest leads
• The limb leads provide views of the cardiac activity in the frontal plane and the chest leads
provide views in the horizontal plane of the heart.
• The description of the 12 ECG leads and the corresponding electrode positions is explained
in further sections.
Bipolar limb leads or Standard Leads or Einthoven lead system
• In this lead system, the potentials are tapped from four locations of our body. They are
i) Right arm –RA
ii) Left arm – LA
iii) Right Leg -- RL
iv) Left Leg –LL
• The Right Leg (RL) electrode acts as the reference electrode.
• Lead I: It is a lead obtained between a negative electrode placed on the right arm and a
positive electrode placed on the left arm. It gives voltage VI, the voltage drop from the left
arm(LA) to the right arm(RA).
• Lead II: It is a lead obtained between a negative electrode placed on the right arm and a
positive electrode placed on the left foot. It gives voltage VII, the voltage drop from the left
leg (LL) to the right arm (RA).
• Lead III: It is a lead obtained between a negative electrode placed on the left arm and a
positive electrode placed on the left foot. It gives voltage VIII, the voltage drop from the
left leg (LL) to the left arm (LA).
Einthoven Triangle:
• The closed path RA to LA to LL and back
to RA is called as Einthoven Triangle.
• The Einthoven triangle is as shown in the
figure.
• The vector sum of the projections on all
the three sides is equal to zero.
• Applying KVL, the R wave amplitude of
lead II is equal to the sum of the R wave
amplitudes of Lead I and Lead III.
• The R wave nominal voltage from
different lead is as given below.

 Lead I - 0.53 mv (0.07 – 1.13)mv

 Lead II - 0.71 mv (0.18 – 1.68)mv
 Lead III - 0.38 mv (0.03 – 1.31)mv

• By KVL, Lead II ≈ Lead I + Lead II

 Augmented Unipolar Limb Leads
• Augmented unipolar limb lead system was introduced by Wilson.
• The electrocardiogram is recorded between a single electrode and the central terminal
which has a potential corresponding to the center of the body.
• Thus two equal and large resistors are connected to a pair of limb electrodes and the
center of this resistive network.
• The remaining limb electrode acts as exploratory single electrode.
• By means of augmented ECG lead connections, a small increase in the ECG voltage can be
realized.
• The augmented lead connections are,
augmented voltage Right arm (aVR)
augmented voltage Left arm (aVL)
augmented voltage Foot arm (aVF)
• aVR: is a lead obtained between the average signal obtained from three negative
electrodes (left arm, left leg and right foot) and the signal obtained from a positive
electrode placed on the right arm
• aVL: is a lead obtained between the average signal obtained from three negative
electrodes (right arm, left foot and right foot) and the signal obtained from a positive
electrode placed on the left arm
• aVF: is a lead obtained between the average signal obtained from three negative
electrodes (left arm, right arm and right foot) and the signal obtained from a positive
electrode placed on the left foot .
 Unipolar chest leads
• In unipolar chest leads, the exploratory electrode is obtained from one of the chest
electrodes. The chest electrodes are placed at six different points on the chest close to the
heart.
• By connecting 3 equal large resistors to RA, RL, LL, a central terminal is obtained.
• This lead system is known as Wilson lead system.
• V1: is a lead obtained between the reference negative electrode and a positive electrode
placed on the chest in the V1 position
• V2: is a lead obtained between the reference negative electrode and a positive electrode
placed on the chest in the V2 position
• V3: is a lead obtained between the reference negative electrode and a positive electrode
placed on the chest in the V3 position
• V4: is a lead obtained between the reference negative electrode and a positive electrode
placed on the chest in the V4 position
• V5: is a lead obtained between the reference negative electrode and a positive electrode
placed on the chest in the V5 position
• V6: is a lead obtained between the reference negative electrode and a positive electrode
placed on the chest in the V6 position.
 ECG recording setup
Important Units/Blocks and their Functions
• The connecting wires for the patient electrodes originate at the end of a patient cable,
the other end of which plugs into the ECG recorder. The wires from the electrodes
connect to the lead selector switch, which also incorporates the resistors necessary for
the unipolar leads.
• A push button allows the insertion of a standardization voltage of 1mV to standardize
or calibrate the recorder.
• Changing the setting of the lead selector switch introduces an artifact on the recorded
trace. (artifacts- A signal artifact is any feature which appears in a signal which is not
present in the original signal.)
• A special contact on the lead selector switch turns off the amplifier momentarily
whenever this switch is moved and turns it on again after the artifact has passed.
• From the lead selector switch the ECG signal goes to a preamplifier, a differential amplifier
with high common-mode rejection. It is ac-coupled to avoid problems with small dc
voltages that may originate from polarization of the electrodes.
• The preamplifier also provides a switch to set the sensitivity or gain, For adjustment a
standard 1mV signal for calibration can be used .
• The preamplifier is followed by a dc amplifier called the pen amplifier, which provides the
power to drive the pen motor that records the actual ECG trace .
• The ECG recorder can be used to record the output of other devices, such as the
electromotograph, which records the Achilles reflex.
• A position control on the pen amplifier makes it possible to center the pen on the
recording paper.
• Beside the recording stylus, there is a marker stylus that can be actuated by a pushbutton
and allows the operator to mark a coded indication of the lead being recorded at the
margin of the electrocardiogram.
• electrocardiograms are recorded at a paper speed of 25 mmls, but a faster speed of 50
mmls is provided to allow better resolution of the QRS complex at very high heart rates or
when a particular waveform detail is desired.
• The power switch of an ECG recorder has three positions.  ON,OFF,RUN
Electroencephalography -EEG
• Electroencephalography – Basic Information

• Significance and application areas of EEG

• Typical EEG Waveform and its Characteristics

• Electrodes for EEG and Electrode Placement Setup for EEG

• EEG Recording unit

Electroencephalography – Basic Details, Significance and applications
• Electroencephalography: This is the technique by which the electrical activities of the
brain are studied.
• Electroencephalograph: This is the instrument by which the electrical activities of the
brain are recorded.
• Electroencephalogram: This is the record or graphical registration of electrical activities of
the brain.
Significance of EEG:
• EEG is useful in the diagnosis of neurological disorders and sleep disorders.
• EEG is primarily used for diagnosis of the following
i) Helps to detect and localize cerebral brain lesions.
ii) Aid in studying epilepsy
iii) Assist in diagnosing mental disorders
iv) Assist in studying sleep patterns
v) Allow observation and analysis of brain responses to sensory stimuli.
 Typical EEG Waveform and its Characteristics
• The electrical recordings from the surface of the brain or from the outer surface of the head
demonstrate continuous electrical activity in the brain.
• The intensities of the brain waves on the surface of the scalp range from 0-300uV and their
frequencies range from 0.5 Hz to 100Hz.
• Brain waves are irregular and no general pattern can be discerned in the EEG. However at
other times distinct patterns will appear.
• In normal persons it is classified as
 Alpha-(α),
 Beta –(β),
 Theta- (θ) and
 Delta – (δ) waves.
Delta(δ) Waves:
• Frequency : 0.5 to 4 HZ
• Occurrence : These occur only once in every 2 or 3 seconds. These deep sleep, premature
babies and in very serious organic diseases. These can occur strictly in the cortex
independently by the activities in the lower regions of the brain.

Theta(θ) Waves:
• Frequency: 4 to 8 Hz
• Occurrence: These are recorded from the parietal and temporal regions of the scalp of
children. These also occur during emotional stress in some adults particularly during
disappointment and frustration.
Alpha(α) Waves:
• Frequency: 8 to 13 Hz
• Occurrence: They found in normal persons when they are awake in a quiet
resting state. They normally occur in the occipital region. During sleep they
disappear.

Beta(β) Waves:
• Frequency: 13 to 30 Hz
• Occurrence: These are recorded from the parietal and frontal regions of scalp.
These are divided into two types as beta I which inhibited by the cerebral activity
and beta II which is excited by the mental activity like tension. Significance of beta
waves is REM.
Electrodes and Electrode Placement Setup for EEG
• EEG electrodes transform the bio-potential from cerebral tissue into EEG preamplifier.
• In EEG , 5 types of electrodes are used.
1. Scalp: silver pads, discs or cups, stainless steel rods, chlorided silver wires.
2. Sphenoidal: Alternating insulated silver and bare wire and chlorided tip inserted through
muscle tissue by a needle.
3. Nasopharyngeal: Silver rod with silver ball at the tip inserted through the nostril.
4. Electrocorticographic: Cotton wicks soaked in saline solution that rests on brain surface.
5. Intracerebral: sheaves of Teflon coated gold or platinum wires used to stimulate the brain.
Placement of Electrodes:
In EEG, electrodes are placed in standard positions on the skull in an arrangement 10-20
system, a placement scheme devised by the International Federation of societies of EEG.
10-20 EEG Lead Placement System
I. Draw a line on the skull from the nasion, the root of the nose, to the inion,
ossification center (bump) on the occipital lobe.
II. Draw a similar line from the left pre-auricular (ear) point to the right pre-
auricular point.
III. Mark the intersection of these two lines as Cz which is the mid point of the
distance between the nasion and inion (or) the distance between the auricular
points.
IV. Mark points at 10, 20, 20, 20, 20 and 10% of the total nasion - inion distance.
These points are Fpz, Fz, Cz, Pz and Oz·
V. Mark points at 10, 20, 20, 20, 20 and 10% of the total distance between the
pre-auricular points. These points are T3, C3, Cz, C4 and T4.
In these odd numbered points T3 and C3 are on the left and even numbered
points C4 and T4 are on the right.
VI. Measure the distance between Fpz and Oz along the great circle passing
through T3 and mark points at 10, 20, 20, 20, 20 and 10% of this distance. These are
the positions of Fp1, F7, T3, T5 and O1.
VII. Repeat this procedure on the right side and mark the positions of Fp2, F8, T4,
T6 and O2.
VIII. Measure the distance between Fp1 and O1 along the circle passing through C3
and mark points at 25% intervals. These points give the positions of F3, C3 and P3.
IX. Repeat this procedure on the right side and mark the positions of F 4, C4 and
P4.
X. Check that F7, F3, Fz, F4 and F8 are equidistant along the transverse circle
passing through F7, Fz and F8 and check that T5, P3, Pz, P4 and T6 are equidistant
along the transverse circle passing through T5, Pz and T6.
• In the above figure the positions of the scalp electrodes are indicated. Further
there are nasopharyngeal electrodes Pg1 and Pg2 and ear electrodes Al and A2.
• Before placing the electrodes, the scalp is cleaned, lightly abraded and electrode paste
is applied between the electrode and the skin.
• By means of this application of electrode paste, the contact impedance is less than 10
kilo ohm.
• Generally disc like surface electrodes are used. In some cases, needle electrodes are
inserted in the scalp to pick up EEG.
• Both bipolar and unipolar electrode systems are used to facilitate the location of foci,
that is cortical areas from which abnormal waves spread.
• In the bipolar technique the difference in potential between two adjacent electrodes
is measured.
• In the unipolar technique, the potential of each electrode is measured with respect to
a reference electrode attached to ear lobe or nostrils.
• In the Wilson technique (or) average mode recording techniques the potential is
measured between one of the electrodes (exploring electrode) and the central
terminal which is formed by connecting all electrodes through high, equal resistors to
a common point.
 EEG Recording Setup
• Multichannel electroencephalographs having as many as the channels permits simultaneous
recording from several pairs of electrodes, reducing the total time required to complete the
recordings.
• Eight channel recorders are very popular.
• The patient cable consists of 21 electrodes and is connected to the eight channel selector.
• The electrodes are attached to the channel selector in groups of eight called a montage of
electrodes.
• The right ear electrode acts as reference electrode for the right brain electrodes and the left
ear electrode acts as reference electrode for the left brain electrodes.
• 50 Hz interference is reduced by employing differential amplifiers as preamplifiers with
more than 80 dB CMRR and by use of 50 Hz notch filters.
• The effect of notch filter on signal distortion is not so much because important EEG signals
have frequencies below 30 Hz.
• Further if the room, in which EEG unit is placed, is covered with ferrous metal screen, 50 Hz
a.c. interference is greatly reduced.
• By cascading, the gain of the amplifier is increased to 106 so as to drive the
recorder or imaging CRT without any difficulty.
• The output voltage from the amplifier may either be applied directly to the eight
channel display through the filter bank or it may be stored as data on a tape
recorder or in a computer memory for further processing.
• The filter bank consists of appropriate filters to select different types of brain
waves.
• Other facilities are also available to record evoked potentials from sensory parts of
the brain such that there are external stimuli like visual stimulus, audio stimulus
and tactile (touch) stimulus.
• The time delay between the stimulus and response can also be measured in the
signal Processing unit.
• In the eight channel pen recorder there are 8 pens such that a pen for each
channel. The normal paper chart speed is 30 mm/second.
• There are also 60 mm/second for higher frequency recording and 15 mm/second
to conserve paper during setup time.
 Electromyography-EMG
• EMG –Basic Details
• Types of Electrodes used
• EMG Recording Setup
• Determination of Latency in Motor nerves using EMG
 EMG-Basic Details
• Electromyography (EMG) is the technique of recording and interpreting the electrical
activity of muscle’s action potential.
• Meanwhile recording of peripheral nerve’s action potential is called as
Electroneurography. (ENG)
• Surface Electrodes for superficial muscle layers and needle electrodes for deeper
layers and at tissues of nerve muscle interface.
• EMG indicates the amount of activity of a given muscle or a group of muscles and not
an individual nerve fiber.
• The action potentials occur both positive and negative polarities at a given pair
electrodes; so they may add or cancel each other.
• Thus EMG appears, very much like random noise wave form. The contraction of a
muscle produces action potentials.
• When there is stimulation to a nerve fiber, all the muscle fibers contract
simultaneously developing action potentials.
• In a relaxed muscle, there is no action potential
EMG Recording Setup
• There are two conventional electrodes:
 Bipolar electrodes
 Unipolar electrodes
• In the case of bipolar electrode, the potential difference between two surface electrodes
resting on the skin is measured.
• In the case of unipolar electrode, the reference surface electrode is placed on the skin and
the needle electrode which acts as active electrode, is inserted into the muscle.
• Because of the small contact area, these unipolar electrodes have high impedances from 0.5
to 100 Mega ohms.
• The amplitude of the EMG signals depends upon the type and placement of electrodes used
and the degree of muscular exertions.
• EMG Amplitude Range :0.1 to 0.5 mV.
• EMG Frequency Range :20 Hz to 10 kHz .
• But using low pass filter, the electromyographer restricts this frequency range from 20 Hz to
200 Hz for clinical purposes. The normal frequency of EMG is about 60 Hz.
• Tape /Paper Recorder speed:
For, continuous recording, the paper speed is about 5 to 25 cm/second.
For short duration it is about 50 to 400 cm/second.
The paper width is about 10 cm.
• The amplifier should have uniform frequency response in the frequency range from 10Hz to
1 kHz with high CMRR (100 dB) and input impedance greater than 10 Mega ohm. The signal
is also recorded in the tape recorder for future reference.
• Further the myographer can listen the sounds from the loud speaker and from that the
doctor can diagnose the neuromuscular disorders.
Determination of conduction velocities in motor nerves
• The measurement of conduction velocity in motor nerves is used to indicate the
location and the type of nerve lesion.
• Here the nerve function is examined directly at various segments of the nerve by
means of stimulating it with a brief electric shock having a duration of 0.2 - 0.5
milliseconds and by measuring the latencies, the conduction velocity in that
peripheral nerve can be calculated.
• Latency is defined as the elapsed time between the stimulating impulse and the
muscle's action potential.
The conduction velocity, v = (l1 – l2) / (t1 – t2) m Sec
• The EMG electrode and the stimulating electrode are placed at two points on the skin
separated by a known distance l1.
• A known electrical pulse is applied through the stimulating electrode.
• When the excitation reaches the muscle, the muscle contracts with a short twitch.
• Since all the nerve fibers are stimulated at the same time and the conduction velocity is
normally the same in all nerve fibers, there is synchronous activation of the muscle fiber.
• This action potential of the muscle is picked up by the EMG electrode and is displayed on
the oscilloscope along with the stimulating impulse.
• The elapsed time 't1' (latency) between the stimulating impulse and muscle's action
potential is measured.
• Now the two electrodes are repositioned with the distance separation as l2 metres. Among
the distances 11 and 12, 12 < 11 .The latency is now measured as ‘t2’ seconds.
• By the formula, conduction velocity, v = (l1 – l2) / (t1 – t2) m Sec conduction velocity is
found.
• conduction velocity in peripheral nerves is normally 50 m/s. If V< 40 m/s  Motor Nerve
disorder.
 Phonocardiogram -PCG
• Basic Details of PCG
• Classification of heart sounds
• PCG Recording System
• Microphone placement Positions for PCG
• Types of Microphones used in PCG
 Basic Details of PCG & Classification of heart sounds
• Graphical record heart sound –Through Microphones - Phonocardiography
• Technique of recording the sounds connected with the pumping action of heart
-Auscultations
• Basic function – to pick up the different heart sound, filter the required and
display.
• Used to perform a correlative analysis with ECG in disorder identification.
Classification of heart sounds
• Heart sound – transient characteristics with short duration.(closing and
opening of valves)
• Murmurs – noisy characteristics with long duration.(turbulent blood flow in
heart)
• Classification of heart sounds
• 1st sound:
Closure of mitral and tricuspid valves.
Freq – 30 to 100 Hz and duration 50 to 100 ms
• 2nd sound:
Closure of aortic and pulmonary valves(slight back flow of blood).
Freq – 30 to 100 Hz and duration 25 to 50 ms .
3rd and 4th sounds are normally with low intensity and inaudible.
(heard among children).
• 3rd sound:
Blood rapid movement into relaxed ventricular chambers
Freq – 10 to 100 Hz and duration 0.04 to 0.08 s.
• 4th sound:
atrial contraction.
Freq – 10 to 50 Hz and duration 0.03 to 0.06 s.
Correlative analytical study of ECG and PCG
PCG Recording System
 Microphone placement Positions and Types of
Microphones used in PCG
• Microphone placement Positions - 4 positions are preferred.
1. Aortic Area
2. Pulmonary Area
3. Tricuspid Area
4. Mitral Area
• Types of Microphones used in PCG - 2 types
1. Air Coupled Microphone- Sounds from heart is transferred through air
cushion. Provides low mechanical impedance.
2. Contact Microphone – Direct contact over the walls of chest muscles- low
weight, high impedance, high sensitivity, Low noise.