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Electrocardiogram (ECG) Hsiao-Lung Chan Dept Electrical Engineering Chang Gung University [email protected] ECG measurements First Electrocardiograph (ECG) by William Einthoven in 1903 Patient Monitors Portable ECG system ECG Holter Embedded ECG ECG chip HL Chan , EE, CGU ECG 2 Heart anatomy and electrical conduction HL Chan , EE, CGU ECG 3 Pacing rate of cardiac cells John G. Webster, Bioinstrumentation, John Wiley & Sons, 2003. HL Chan , EE, CGU ECG 4 Formation of ECG HL Chan , EE, CGU ECG 5 Deporalization of atrial muscles Atrial reporalization Ventrical depolarization Ventrical repolarization R. Rangayyan, Biomedical Signal Analysis, John Wiely & Sons, 2002. 12-lead ECG Precordial leads: V1-V6 Einthoven leads: I, II & III Goldberger augmented leads: VR, VL & VF HL Chan , EE, CGU ECG 7 HL Chan , EE, CGU ECG 8 Limb leads and augmented leads HL Chan , EE, CGU ECG 9 Bipolar limb leads in frontal plane Precordial leads in transversal plane HL Chan , EE, CGU ECG 10 Precordial leads (chest leads) Referenced to Wilson central terminal HL Chan , EE, CGU ECG 11 Vectorcardiogram (VCG) HL Chan , EE, CGU ECG 12 ECG features P wave : Atrial depolarization QRS complex : Ventricular depolarization T wave : Ventricular repolarization R-R : Heart period P-Q : Conduction delay in the atria Q-T : Ventricular repolarization time HL Chan , EE, CGU ECG 13 Power spectrum of P, QRS complex, and T wave HL Chan , EE, CGU ECG 14 Noise and artifacts in the ECG Baseline wander Electrode motion artifacts Electromyographic noise HL Chan , EE, CGU ECG 15 Pan-Tompkins QRS detection ECG Band-pass Filter d dt 2 1 32 32n1 Adaptive threshold HL Chan , EE, CGU ECG 16 Heart rate variability (HRV, 心率變異度) Parasympathetic modulation Sympathetic modulation 心率變異度 HL Chan , EE, CGU ECG 18 Sinus rhythm Normal sinus rhythm Respiratory sinus arrhythmia HL Chan , EE, CGU ECG 19 Respiratory sinus arrhythmia HL Chan , EE, CGU ECG 20 Premature beat A supraventricular premature beat with a small, negative P wave A premature ventricular beat followed by a compensatory pause HL Chan , EE, CGU ECG 21 Ectopic beats with different origins Bigeminy Trigeminy Interpolated ventricular premature beat HL Chan , EE, CGU ECG 22 Atrial and ventricular tachyarrhythmias Atrial flutter Atrial fibrillation Ventricular flutter Ventricular fibrillation Atrial flutter (心房撲動) Atrial fibrillation (心房顫動) J. Malmivuo, Bioelectromagnetism, Oxfold University Press, 1995. HL Chan , EE, CGU ECG 24 Atria fibrillation Atrial fibrillation Sinus rhythm • Blood that remains in the atria becomes "sluggish“ • Allows blood clots to form, ‘Risk of stroke’ Atria activity analysis HL Chan , EE, CGU ECG 25 Detecting VT and VF by TCI Thaker et al, IEEE Trans. Biomed. Eng. 1990 HL Chan , EE, CGU ECG 26 Threshold crossing interval (TCI) 1000 TCI T2 T3 ( N 1) T1 T 2 T 3 T 4 HL Chan , EE, CGU ECG 27 Detecting VT and VF by TCI HL Chan , EE, CGU ECG 28 Lempel-Ziv complexity (複雜度) HL Chan , EE, CGU ECG 29 Detecting Ventricular Tachycardia and Fibrillation by Complexity Measure (Xu-Sheng Zhang, et al, 1999) window length 3s 5s 7s HL Chan , EE, CGU ECG 30 Sudden cardiac death • Major risks for coronary artery disease • Myocardial infarction • Induced lethal cardiac arrhythmia by myocardial ischemia • Major causes of sudden deaths in congestive heat failure • Life‐threatening cardiac arrhythmia Ventricular tachycardia Ventricular fibrillation HL Chan , EE, CGU ECG 31 Myocardial Infarction QRS complex after myocardial infarction Normal QRS complex Infarcted area Lead aVF ST-segment elevation upon arrival at emergency room after 10 days after 6 months HL Chan , EE, CGU ECG 32 Stress test: Diagnosis and prognosis of coronary artery disease (CAD) ST-segment depression due to myocardia ischemia 33 ST-Segment Elevation for Heart Attack Detection Robert Fischell on medical inventing, www.ted.com ST segment elevation, a sign of a heart attack ST segment elevations related to blockages Implantable medical device Acute myocardial infarction from implanted copper stents AngelMed Guardian System Reference Leif Sörnmo, Pablo Laguna, Bioelectrical Signal Processing in Cardiac and Neurological Applications, Academic Press, 2005. John Enderle, Susan Blanchard, Joseph Bronzino, Introduction to Biomedical Engineering, Academic Press, 2000. John G. Webster, Medical Instrumentation, application and design, 3rd Ed., Houghton Mifflin, 2000. Joseph J. Carr, John M. Brown, Introduction to Biomedical Equipment Technology, Pearson Education, 2000.
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