Download UConn Biomedical Engineering

The EKG
Biomedical Engineering
The University of Connecticut
BME Program Director: Dr. John D. Enderle
Instructors:
April Dixon
Pete Flosdorf
Chris Liebler
Laura Romonosky
Beth Showers
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UConn Biomedical Engineering
Welcome to the University of Connecticut Biomedical Engineering lab. In this
session, you will learn about an electrocardiogram machine (EKG). You will begin
by learning about some background information on EKGs. From there, we will cover
some basic electronics, such as resistors and capacitors and how they function. Then,
we will show you how to build your own EKG, and how to test it out.
BACKGROUND
Electrocardiography
Electrocardiography is a method of monitoring and recording the electric currents
generated during the alternating contractions of the atria and ventricles of the heart.
The device used to monitor and record these signals is an electrocardiogram, or ECG
for short. An ECG is commonly called an EKG, which is what we will refer to an
electrocardiogram as from this point on. When using an EKG, electrodes are applied
to the skin in places where the heart’s signals can be measured easily. Usually, these
spots are between muscles on the upper arms and lower legs. Cables connect the
electrodes to the EKG, where the electrical signal is turned into a waveform on a
computer or a paper plot. The results produced from this machine allow doctors to
observe the performance and condition of the heart as well as diagnose any problems
they may find in the signal. A normal EKG signal is shown in Figure 1.
Figures 1 and 2: A normal EKG signal and the different segments of a single
waveform respectively.
The heart’s electrical system is quite complex. Electrical rhythms begin as impulses
emitted from the sinoatrial (SA) node, also known as the heart’s “natural
pacemaker.” The impulse then travels across a specific route, or pathway, moving
through the atrioventricular (AV) node and into the ventricles. Once the impulse
reaches the ventricles, it serves as a set of instructions, causing the heart’s chambers
to contract in a routine and consistent manner. The path of this electrical signal,
called the PQRST waveform (Fig. 2), may be followed through the heart in Figures 2
and 3. This path constitutes a single heartbeat. The EKG breaks down each heartbeat
into a set of three distinct waves: the P wave, the QRS complex and the T wave.
These waves indicate behavior of the impulse at each location along its pathway.
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The P wave is associated with the spread of the impulse through the heart’s upper
chambers (atria). The QRS complex and the T wave reflect the contraction and
relaxation of the ventricles respectively.
Figure 3: A cross-section of the anatomical structure of the heart. Blue indicates
passages bringing blood into the heart (oxygen poor); red indicates passages through
which blood exits (oxygen rich).
What is an EKG used for?
If this set of rhythms is interrupted, delayed or sent down the wrong path, the
heartbeat may become irregular, moving too fast or slow. These abnormal rhythms
are produced if a patient has suffered a heart attack or heart disease. An EKG is used
to detect these changes. EKGs may also be used if patients experience any of the
following symptoms:

Angina (chest pain resulting from the heart not getting enough oxygen)

Palpitations (strong, fast or otherwise irregular heartbeat)

Arrhythmias (irregular, fast or slow heart rhythms)

Dyspnea (shortness of breath)

Syncope (lightheadedness or loss of consciousness)

Pericarditis (inflammation of the pericardium - a thin, fluid-filled sac
surrounding the heart)
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
Long Q-T syndrome (a disorder that could lead to fainting (syncope) or
sudden cardiac death)

Myocarditis (Inflammation of the heart muscle due to viral infection)

Certain congenital heart defects
Many people with coronary artery disease, heart valve disease or heart muscle
disease will eventually have abnormal EKG readings. Because many EKGs are done
while the patient is at rest, certain abnormalities that occur during periods of stress
may not appear even in patients with significant disease. In fact, it has been
estimated that the resting EKG is accurate only about 50 percent of the time. Because
it is very common to see this false-negative result (i.e., the EKG doesn’t find the
damage or abnormality that is really present), a normal EKG is not enough to rule
out suspected heart disease.
You will have the opportunity to create a plot of your own EKG and analyze your
heart rate using a real electrocardiogram machine, called the Siemens Burdick EK10.
Instructions on how to operate the EKG are located at the end of this booklet in
APPENDIX A.
After creating your own EKG in this project you will apply the electrodes to your
arms and legs and observe your heart’s own signal on a computer screen.
BASIC ELECTRONICS
Before discussing the elements used to create a circuit, the nature of electricity should
first be discussed. Current is known as the flow of electricity through is circuit.
Resistance is the opposition to the flow current. Voltage refers to the amount of
electrical force that must be used to move current through the circuit.
In the case of a circuit, electricity acts much like water in a pipe. In this analogy
voltage is the pressure in the pipe, current is how fast the water flows through the
pipe, and resistance acts like a valve that, only allows a certain amount of water to
pass through the circuit. The circuit acts as the different pathways the water can take.
Each of the different circuit elements acts to manipulate the “water” in different
ways. To understand what is happening in the circuit, keep this analogy of water in
mind as you read the following section.
Printed Circuit Board
A Printed Circuit Board, or PCB, is what connects all of the electrical components
together to form a circuit. A normal PCB is constructed with a thin sheet of a
fiberglass substrate, which is an insulator. An insulator keeps the electricity from
traveling down paths that it is not supposed to. The fiberglass substrate has solder
covered copper lines called traces that conduct electricity between components.
These traces can be on one or both sides of the fiberglass substrate. Components are
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always mounted on the top layer of the board and soldered on the bottom layer of
the board. Some special PCB’s can contain layers of traces embedded in between the
top and bottom layers, these are called Multilayer PCB’s and are usually found in
electronic devices where space and weight are a large concern like cell phones,
laptop computers, airplanes, and satellites. PCB’s are used in every electronic device.
Resistors
A resistor acts exactly like its name. It resists the flow of current through the circuit.
As the strength of a resistor increases, it becomes more difficult for current to flow in
the circuit. A color-coded band indicates the strength of each resistor. The unit of
resistance is the Ohm (Ω). Our EKG will consist of six resistors with resistance
values of 1K (1,000) ohm and 1M (1,000,000) ohm. The schematic symbol of a resistor
is shown below in Figure 4.
Figure 4: The schematic symbol for a resistor
Reading the Color Code
Color Code Chart:
Black
Brown
Red
Orange
Yellow
Green
Blue
Violet
Gray
White
0
1
2
3
4
5
6
7
8
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First find the tolerance band; it will be gold. Starting from the other end,
identify the first band. Write down the number associated with that
color from the color code chart on the previous page. In the example
here, the blue band is 6. Now read the next color, here it is red so write
down a '2' next to the six. Now read the third or 'multiplier' band and
write down that number of zeros. In this example it is two, so we get
'6200' or '6,200'. If the 'multiplier' band is Black (for zero) don't write any
zeros down. This is the strength of your resistor!
Capacitors
A capacitor is a circuit element that is used for storage. The capacitor
itself is made of two conductor plates that are separated by an insulator
(dielectric) such as air, glass or water. A capacitor is “charged” when
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one plate of the capacitor has more electrons than the other. The unit of capacitance
is the Farad (F). Your project will include two capacitors, a 3.2 micro (0.0032) farad
and a 1 pico (0.000000001) farad. A diagram of a simple capacitor and its schematic
symbol are shown below in Figure 5.
Figure 5: A model of a simple capacitor and the schematic symbol for a capacitor
Integrated Circuit Chips
Integrated Circuit Chips are usually called IC chips. An IC chip is a specific circuit
that has been miniaturized to fit into a small package. There are thousands of
different types of IC chips, each performing a different function in a circuit. One type
of IC chip is an Operational Amplifier, which is usually referred to as an op-amp. In
this project, the op-amp acts similarly to the volume control on your TV. It enlarges
the power, current, or voltage of the circuit without physically changing the signal.
In the case of the EKG, the “volume” of the heart’s impulse is being turned up so we
can see it in the tracing. In Figure 6 below is a picture of what some typical IC chips
look like. There is also a diagram, called a pinout, of an op-amp. In the pinout
diagram each of the legs of the chip is labeled to indicate a specific connection it has
with the rest of the circuit. Some of these connections are input, output, voltage
source (Vcc+), and ground (Vcc-).
Figure 6: Some typical IC chips and op-amp pin out
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Soldering Techniques
Soldering is the way that the components are connected to the traces on the PCB.
This process can be tricky because bad connections will result in problems with your
circuit. Therefore, soldering requires some concentration and patience. Here are
some tips for better soldering.

Keep parts clean: grease, fingerprints, and dirt will keep solder from sticking
properly.

Keep the soldering iron clean: clean the soldering iron by wiping it on a wet
sponge. Make sure the iron is not blobbed with solder.

Keep your hands clean: solder contains lead, so it’s a good idea to wash your
hands when you are done.

Heat parts: use the soldering iron to heat the parts. Touch the solder to the
parts, not the iron. The hot parts melt the solder. Don't melt the solder with
the iron directly because a blob of molten solder will not stick to your cold
parts.

Amount of Solder: too little solder will not attach the parts, too much gets in
the way and may touch other components.

Amount of Heat: you need to heat things up enough to melt the solder, but
don't overheat components - most electrical components can only take a
couple of seconds of heat.

Keep hands cool: remember, heat conducts along parts and wires...don't hold
them in your hand. Use pliers, clamps, etc.

Cooling: things don't cool instantly. You need to hold the parts together a few
seconds after removing the iron before you let go.

Wire-to-component: For things such as switches, there is often a little tab
(often with a hole in it) to solder to. It is tempting to twist up the wire in and
around the tab-hole and then heat and solder the whole mess. This usually
produces a big messy blob that often doesn't conduct properly as it is hard to
heat all that metal at once. It's better to pre-tin the wire and the tab (even if
you fill the hole). Then heat the tab, stick the wire a short way into the hole
(the solder plugging the hole will be molten) and heat the wire as well. A tiny
bit more solder will fuse it all together. Keep in mind that large components
take a long time to cool.

PCB: printed circuit boards are the easiest to solder. Push
component/tab/wire through the hole. Lay the iron against both the wire and
the pad for a second or two on one side and then touch the solder to the other
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side of the wire/tab and pad. The solder should melt and flow all around the
wire/tab and pad. Be sure to hold components such as sockets firmly down to
the board. To solder an IC socket down, do the two opposite corners first.
Instructions for Soldering
1. Solder the leads in place.
2. Obtain cone-shaped soldered joints.
3. Do not apply round solder joints. This will result in a bad connection.
4. Trim the excess wires up to the level of the solder.
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Equipment
Oscilloscope
An oscilloscope (right) is a machine that draws a graph of an
electric signal. In most applications the graph shows how
signals change over time, or time dependency. The vertical
(Y) axis represents voltage and the horizontal (X) axis
represents time. The Z axis in this case would represent the
intensity of the signal. Figure 7 shows a sample-readout.
This simple graph can tell you many things about a signal:

Specific voltage values per time.

Calculate the frequency of a signal.

Determine what portions of a signal are direct current (DC) and alternating
current (AC).

Determine what portion of the signal is noise and whether the noise is time
dependant.
Figure 7: X, Y, and Z Components of a Displayed Waveform
For more information refer to APPENDIX B: Oscilloscope.
Software
When viewing the EKG signal, software must be used to convert the electrical
impulse into a visual representation that we can see and understand. There are
different software packages for different applications.
LabView
LabView (Laboratory Virtual Instrument Engineering Workbench) is a software
package developed to build programs with symbols (icons) rather than writing out
lines and lines of text. LabView uses symbols, terminology and formats that are
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familiar to technicians, scientists, and engineers. LabView is programmed to act as an
interface, helping pieces of hardware “communicate” with each other. LabView also
has built-in libraries that allow the user to work over the internet and use different
programming formats and systems.
LabView Applications
The applications to LabView are endless. In the past, multiple instruments were
necessary to obtain the data a researcher wanted. In the case of the EKG, several
oscilloscopes would be needed to view more than one heartbeat simultaneously.
Instead, LabView has virtual instruments (VIs). These are programs that are built
into LabView and perform the same function as another piece of equipment such as
an oscilloscope. In our case we can view as many heartbeats as we want. We just
need to specify how many channels we will need rather than use multiple
oscilloscopes to do the same thing.
There are many advantages to LabView. Virtual instruments may be modified for
each specific application. This means the user can manually add functions to their VI
at any time. Furthermore, LabView can be “plugged” into the internet, so progress
can be controlled from remote locations. In other words, someone in the U.S. could
monitor and control the heat in their house in Russia!
Of course, LabView would be one component in an entire system. In our system, we
have a circuit board, a power source (the batteries), a data acquisition board that
collects the data, LabView, and a computer. These components can be categorized
into one of the following groups that comprise the entire system.

Computer

The acquisition board

The supervised system itself
An example of another system is shown in the figure below.
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Computer with
Virtual instrument
System
Figure 8: A typical virtual system.
How does LabView look?
LabView has two different screens. There is a front screen is cosmetic. It actually
looks like the front of an instrument. There are buttons, meters, gauges and
whatever else the user needs to monitor the data. The second screen is known as the
back screen. This is where all the icons are arranged and programmed. This screen
is the control center for your LabView application. It is here where changes can be
made to the function of the VI.
The back screen has two sub-panels known as palettes. These palettes are used to
build the VI. The tools palette changes the function of the mouse. An arrow can be
used to select different controls and place them on the screen. A finger might be
used to press the buttons and turn the dials on the front screen. The cursor allows
labels to be added to the program so it is better organized and clear to follow. The
front panel has a control palette where different knobs, switches and monitors may
be selected. The back panel has a functions palette that allows one to choose icons
that make the VI work specifically. Figures 9 and 10 show the front and back screens
respectively.
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Figure 9: The front screen with the tool and control palettes.
Figure 10: The back screen with the tool and functions palettes.
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Figure 11 shows an example of a constructed front panel. This VI is a converter from
Celsius to Fahrenheit temperature scales. The “Numeric” palette is one of the options
within the control palette. To construct the instrument, simply drag the components
from the palettes to the desired location.
Figure 11: A sample front panel that monitors temperature conversion, the numeric
palette where the thermometers and readouts are obtained.
In order to convert temperature from Celsius to Fahrenheit, we know that the
following mathematical conversation must be used
DegF=(DegC)(1.8)+32
Therefore, this mathematical operation must be constructed in the back screen.
Figure 12 shows the addition and product operations and constants taken from the
numeric sub-palette and constructed on the back screen to build this conversion.
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Figure 12: Construction of the back panel using different mathematical operations and
constants.
This is only a small example of the capability of LabView. A more complex
application will be used for the visualization of your EKG project. The application
involves composite levels of programming such as for loops, do loops, and charts for
the drawing of the signal on the computer screen.
Assembly Instructions
Checklist
When you receive your EKG kit, go through the parts list below and make sure your
kit contains everything listed to complete your project. Record the contents of your
kit by checking the box next to each part name. If you have trouble identifying a
part, or a part is missing from your kit, let someone know, and they will help you.
QTY
1
1
2
2
1
4
2
ITEM
Black Project Box
Printed Circuit Board (PCB)
9 Volt Batteries
9 Volt Battery Holders
4 Wire Bundle - Black Brown
White Red
Single Wires: 2 Orange, 1 Black, 1
Green
IC Chips
Check
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2
2
4
2
4
4
1
IC Sockets
1K Ohm Resistors – Brown Black
Red
1M Ohm Resistors – Brown Black
Green
Capacitors: 1Green, 1Brown
Screws
Banana Jacks: 2 Orange, 1 Black, 1
Green
Toggle Switch
Procedure
1. The circuit board will be assembled from left to right. First place the 3.2 uf
(microfarad) capacitor into the C1 slot.
2. Bend both ends of the wire to the back, solder, and clip. Refer to the
instructions in the Soldering section.
3. Place the 1 pf (picofarad) capacitor into the C2 slot. Solder and cut.
4. Insert the 1M ohm resistor into slot R1. To make insertion easier, bend the
wire straight down on both sides of the resistor, and place in the holes. Solder
and clip. Put the second 1M ohm resistor into R2, solder and clip.
5. Strip both ends of the black wire with the strippers. Insert into the hole
labeled BLK, solder and clip.
6. Repeat Step 5 for both orange wires and the green wire. These holes are
labeled OR and GR, respectively.
7. Insert sockets into the circuit board at slots IC1 and IC2. Solder two opposite
corners first. To avoid damaging the chips do not insert them into the socket
now. The heat from the soldering iron could ruin the chip.
8. Repeat Step 2 for the other 4 resistors. Put a 1K ohm resistor into R3, a 1M
ohm resistor into R4, a 1K ohm resistor into R5, and a 1M ohm resistor into R6.
9. Insert the red wire of one of the battery straps into the hole labeled V1+.
Solder and cut. Do the same for the black (ground) wire of the same strap into
the V1-. Repeat for the second battery strap, using slots V2+ and V2-.
10. Before inserting the switch into the board wires must be soldered to it. Then
place one wire into one of the holes labeled SW. Place the other wire into the
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other SW hole. Solder and clip each. Do not be concerned with polarity of the
switch.
11. Now insert the IC Chips in the sockets at slots IC1 and IC2. Each chip has a
left and a right side. The left side has a small black dot on the bottom corner.
This must go over the shiny notch on the circuit board.
12. The circuit board is now complete. Place a piece of double sided tape , which
we will supply individually, on the dot in the center of the box. Place it in the
bottom of the black box. Put the screw in the corner of the PCB
13. Attach the jacks to the box in the color order orange, orange, green, black.
14. Tape the battery straps to the top of the box with the double-sided tape
15. Close the box with the four screws.
16. After completion we will instruct you on how to connect the EKG to the
computer.
Have Fun!
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Appendix A:
Using the “SIEMENS Burdick EK10” EKG Machine
The Basics of an Electrocardiogram
The electrical activity of the heart can be recorded at the surface of the body using an
electrocardiogram. The electrocardiogram (EKG) is simply a voltmeter that uses up
to 12 different leads (electrodes) placed on designated areas of the body.
Why is an Electrocardiogram Done?
This test will help the doctor to evaluate the patient's cardiac condition related to:

If a heart attack has occurred

What part of the heart was damaged

If there are any irregular heart beats or rhythm

If there is a decreased supply of blood and oxygen to the heart
What do the Waves and Intervals mean?
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P-Wave
If it is longer than .20
seconds, it may indicate
first-degree heart block.
SA Node fires.
Atrial Depolarization
Sinus initiated rhythm.
QRS.
Depolarization of the
ventricles.
Ventricular Contraction.
Atrial Repolarization.
(Can't always be seen on
EKG)
T-Wave.
Ventricle
Repolarization.
May be affected by
changes in serum K
levels.

The P wave is caused by atrial depolarization. The P wave is usually smooth
and positive. The P wave duration is normally less than 0.12 sec.

The PR interval is the portion of the EKG wave from the beginning of the P
wave (onset of atrial depolarization) to the beginning of the QRS complex
(onset of ventricular depolarization). It is normally 0.12 - 0.20 seconds.

The PR segment is the portion on the EKG wave from the end of the P wave to
the beginning of the QRS complex. The PR segment corresponds to the time
between the ends of atrial depolarization to the onset of ventricular
depolarization. It is an isoelectric segment, during which the impulse travels
from the AV node through the conducting tissue (bundle branches, and
Purkinje fibers) towards the ventricles.

The QRS complex represents the time it takes for depolarization of the
ventricles. - Due to ventricular depolarization. The normal QRS interval range
is from 0.04 sec - 0.12 sec measured from the first deflection to the end of the
QRS complex.

The ST Segment represents the period of ventricular muscle contraction before
repolarization. The ST segment is normally isoelectric (no electrical activity is
recorded). However, the ventricles are contracting.

The QT interval begins at the onset of the QRS complex and to the end of the T
wave. It represents the time of ventricular depolarization until ventricular
repolarization.

The T wave due to ventricular repolarization. The wave is normally rounded
and positive.
EKG Procedure:

Remove one limb sensor, (sticky pad) and place it on your right bicep,
between your bone and muscle.
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
Repeat step 1 for left arm.

Remove a limb sensor and place it on the inside of your right calf between
your bone and muscle.

Repeat step 3 on left leg.

Attach lead LA to the tab of the limb sensor on your left arm.

Attach lead RA to the tab of the limb sensor on your left arm.

Attach lead RL to the tab of the limb sensor on your right leg.

Attach lead LL to the tab of the limb sensor on your left leg.

Press auto button.

Press 1 or 2, and use the EKG that looks most like the model EKG.

Press the stop button when satisfied with your reading.
Figure A-1: Model EKG format, showing P wave, QRS complex, and T wave.
Calculating Heart Rate
You can measure your heart rate from your EKG print out.

Take a ruler and measure in centimeters from the peak of a QRS complex to
the peak of an adjacent QRS complex of to adjacent waves.

Convert centimeters to millimeters by multiplying this number by ten.
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
Divide that number by 50 mm/s.

Multiply this number by 60. That will give you your heart rate in beats per
minute.

Fill out the back of the EKG paper with your general information. The
number you calculated in part 4 can be placed as “Rhythm.”

On the reverse side of the given paper, peel off the stickers and place you r
four best EKG readings on it.
EKG Paper
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APPENDIX B:
Oscilloscope
Electronic equipment can be divided into two types: analog and digital. Analog
equipment works with continuously variable voltages, while digital equipment
works with discrete binary numbers that may represent voltage samples. For
example, a conventional phonograph turntable is an analog device; a compact disc
player is a digital device. The oscilloscope we will be using is capable of both analog
and digital signals.
The generic term for a pattern that repeats over time is a wave - sound waves, brain
waves, ocean waves, and voltage waves are all repeating patterns. An oscilloscope
measures voltage waves. One cycle of a wave is the portion of the wave that repeats.
A waveform is a graphic representation of a wave. A voltage waveform shows time
Figure B-1: Common Waveforms
on the horizontal axis and voltage on the vertical axis.
You can classify most waves into these types:
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
Sine waves

Square and rectangular waves

Triangle and sawtooth waves

Step and pulse shapes
For our purposes, we will be using sine waves and square waves. The sine wave is
the fundamental wave shape for several reasons. It has harmonious mathematical
properties - it is the same sine shape you may have studied in high school
trigonometry class. Test signals produced by the oscillator circuit of a signal
generator are often sine waves. The square wave is another common wave shape.
Basically, a square wave is a voltage that turns on and off (or goes high and low) at
regular intervals. It is a standard wave for testing amplifiers - good amplifiers
increase the amplitude of a square wave with minimum distortion. Television, radio,
and computer circuitry often use square waves for timing signals.
If a signal repeats, it has a frequency. The frequency is measured in Hertz (Hz) and
equals the number of times the signal repeats itself in one second (the cycles per
second). A repeating signal also has a period - this is the amount of time it takes the
signal to complete one cycle. Period and frequency are reciprocals of each other, so
that 1/period equals the frequency and 1/frequency equals the period. So, for
example, the sine wave in Figure 7 has a frequency of 3 Hz and a period of 1/3
second.
Figure B-2: Frequency and Period
Voltage is the amount of electric potential (a kind of signal strength) between two
points in a circuit. Usually one of these points is ground (zero volts) but not always you may want to measure the voltage from the maximum peak to the minimum peak
of a waveform, referred to at the peak-to-peak voltage. The word amplitude
commonly refers to the maximum voltage of a signal measured from ground or zero
volts.
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The volts per division (usually written volts/div) setting varies the size of the
waveform on the screen. A good general purpose oscilloscope can accurately display
signal levels from about 4 millivolts to 40 volts. The volts/div setting is a scale factor.
For example, if the volts/div setting is 5 volts, then each of the eight vertical
divisions represents 5 volts and the entire screen can show 40 volts from bottom to
top (assuming a graticule with eight major divisions). If the setting is 0.5 volts/div,
the screen can display 4 volts from bottom to top, and so on. The maximum voltage
you can display on the screen is the volts/div setting times the number of vertical
divisions.
**IMPORTANT--Setting the Oscilloscope Controls**
Some oscilloscopes have an AUTOSET or PRESET button that sets up the controls in
one step to accommodate a signal. If your oscilloscope does not have this feature, it is
helpful to set the controls to their standard positions before taking measurements.
Standard positions include the following:

Set the oscilloscope to display channel 1

Set the volts/division scale to a mid-range position

Turn off the variable volts/division

Turn off all magnification settings

Set the channel 1 input coupling to DC

Set the trigger mode to auto

Set the trigger source to channel 1

Turn trigger holdoff to minimum or off

Set the intensity control to a nominal viewing level

Adjust the focus control for a sharp display

Turn the three red knobs all the way to the right