ECE ECE PRINCIPLES OF BIOMEDICAL SYSTEMS & DEVICES LAB 1 - ELECTROCARDIOGRAM
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1 ECE ECE PRINCIPLES OF BIOMEDICAL SYSTEMS & DEVICES LAB 1 - ELECTROCARDIOGRAM The purpose of this laboratory is to introduce you to electrocardiogram, its acquisition and interpretation. Design of an electroencephalograph will be the subject of another lab. Overview of Cardiovascular System (in part from Iworx AK214 Laboratory Manual) The heart is a pump that pushes blood around the body. Blood enters the heart at a low pressure and leaves at a higher pressure, and this high pressure provides the force to propel the blood through the circulatory system. Figure 1 shows the organization of the human heart and the circulatory system, where the four chambers of the heart are indicated as RA (right atrium), LA (left atrium), RV (right ventricle) and LV (left ventricle). Blood returning from the body is sent to the right side of the heart and then to the lungs to pick up oxygen and release carbon dioxide. This oxygenated blood is sent to the left side of the heart and back to the body, where oxygen is released and carbon dioxide is collected. The complete division of the heart insures that there is no mixing of deoxygenated blood (in the right side) with oxygenated blood (in the left side). The mammalian heart is autorhythmic, since it will continue to beat if removed from the body (and kept in an appropriate solution). Heart contractions are, therefore, not dependent upon the brain, but rather on the rhythm that comes from within the heart itself. The heart is composed almost entirely of large, strong muscle fibers, which are responsible for the pumping action of the heart. Other cardiac muscle cells are weakly contractile and produce the rhythm for, and conduct it to, the rest of the heart. A group of these weak muscle cells is located in the sinoatrial (SA) node (Figure 2), which acts as the pacemaker for the heart. These cells rhythmically produce small electrical signals, called action potentials, which spread to fibers of both atria. The resulting contraction pushes blood into the ventricles. The action potential spreads slowly through the atrioventricular (AV) node and then rapidly excites both ventricles. s u p of RA LA r of s fro RV LV Figure 1. The cardiovascular system: pulmonary circulation and systemic circulation
2 Figure 2. The propagation of electric current (action potential) from the SA node to the rest of the heart. The four valves located in the heart control the blood flow between different chambers of the heart, as well as the rest of the body. These valves are shown in Figure 3. The semilunar valves are located between the ventricle and the artery on each side of the heart. In the relaxed heart, the high arterial pressure shuts the se- milunar valves and prevents blood flow from the artery into the ventricle. Ventricular contraction increases the pressure of the blood in the ventricle. When the ventricular pressure is greater than the arterial pressure, the semilunar valves open and blood flows into the artery. The myocardium then relaxes, the ventricular pressure declines and the semilunar valves close. The rhythmical and continuous operation of the heart, as mentioned above, depends on electrical activation of the heart muscles, starting at the SA node. However, the propagation of electrical charges throughout the heart generates what is known as the electrocardiogram (ECG), a graphical representation of the overall electrical activity of the entire heart. A typical ECG, its components, and the associated physiological events are shown in Figure 4. Looking at various components of the ECG, cardiologists can often diagnose most cardiovascular disorders. For example, an elevated ST segment is considered as a strong indicator of an upcom- ing myocardial infarction (heart attack).
3 Figure 3. Heart valves control the flow of blood from among the heart chambers, as well as between the heart, lungs and the systemic circulation. Figure 4. The electrocardiogram (ECG) The entire cardiovascular circulation in fact takes advantage of the pressure gradient in the body. The blood flows from high pressure areas (e.g., the left ventricle and aorta), to low pressure areas (e.g., smallest capillaries at the tip of the limbs or other internal organs). The pressure at any point in the circulation actually fol-
4 lows a periodic oscillation, pressure going up every time the heart beats, and dropping as the blood is carried away (see Figure 5). The two extreme values of the arterial pressure are of particular importance and are used commonly as vital signs: the systolic and diastolic pressure. Figure 5. Pressure gradient at various points in the systemic circulation What is in this experiment? Today you will acquire your own ECG from primarily two lead configurations. These will be direct measurements. From these direct measurements, you will also make various calculations and indirect measurements to gain further insight to the electrocardiography. Equipment: (Your instructor will introduce each of the following to you) Iworx AHK214 Four channel optically isolated biopotential amplifier USB Cable to connect AHK214 to a PC LabScribe Software for data acquisition and analysis ECG leads and associated cables, Disposable ECG electrodes Pulse plethysmograph (measures pulse pressure based on volumetric changes on your finger) Alcohol swaps Initial Set-up 1. Connect the bioamplifier to the PC using the USB cable, and to the power outlet using the AC adaptor. This device has four channels, for making four simultaneous measurements. Two of the four channels are optically isolated, and are used for acquiring electrical signals, such as the ECG. The other two channels are typically used for non-electrical (mechanical) measurements, such as blood flow or respiratory measurements (Figure 6). The non-electrical signals are converted into electrical signals using transducers so that they can be amplified and displayed. All signals are also digitized so that they can be processed by the computer. The two non-isolated channels can also be used to display computed measurements, obtained from raw acquired measurements. 2. Run the Labscribe software. You will see the four channels as shown in Figure When the program opens, select Load Group from the Settings menu.
5 4. Select hk214.iws from the menu and click Load. 5. Click on Settings again, and select the Heart#2 settings file. Steps 3 through 6 loads preset channel settings so that you don t have to spend time learning intricate details of this software. You will see three channels setup on the screen. 6. Have one volunteer of your group remove all jewelry from wrists and ankles, remove shoes (and socks) and have his/her left & right wrists and ankles exposed for affixing the electrodes. 7. Use an alcohol swap to clean and gently scrub a region of each wrist and ankle that has little or no hair. Let the area dry. 8. Remove the plastic disk from the disposable electrodes and apply the electrodes on the scrubbed area on each wrist and the right ankle. 9. Attach one end of the ECG lead cable to the Channel1/2 input of the AHK214, and three of the five leads to the electrodes as follows: The white +2 lead attaches to the right wrist; the brown -2 lead attaches to left wrist; the green C lead connects to the right leg. This electrode serves as the ground, and the ECG is actually measured as the potential (voltage) difference between the brown and the white electrodes across your upper body). 10. Place the plethysmograph on the volar surface of the middle finger or thumb tip, and wrap around the Velcro to firmly attach it to the finger. Make sure that the student whose signal is to be acquired sits quietly. Connect the other end to Channel 3. Experiment 1: Acquiring ECG and Finger Pulse Figure 6. Set-up 1. First, write down the following info for (each) student whose measurements are being taken: Age, male or female, smoking or nonsmoking, athletically active (exercise regularly) or not. 2. Click start. The ECG will appear on channel 2, your blood pressure (blood flow) changes will be on Channel 3, and Channel 4 will display the integral of the trace in Channel 3. Channel 1 is not being used (yet). If Channel 2 (ECG) appears upside down (the R wave is negative), click stop and switch the left and right electrodes. If Channel 3 is upside down right click on Channel 3 and choose invert from the menu. Select Voltmeter from the View menu, so that you can see the actual voltage of the signals being acquired. The display should resemble that of Figure Do not be alarmed if your ECG does not look exactly like the one in Figure 4 above. You are likely to see significant amount of sharp, rapid changes in the signal, as opposed to a smoother signal. This is called noise. Three things are certain in the life of an electrical engineer: taxes, death and noise. There are many sources of noise. For example, the lights and many instruments in the lab create what is known as the 60 Hz noise, so called due to the frequency of the mains creating this noise. This noise can be removed using an appropriate filter. Those in ECE will study filters in detail later. But here is another source of noise: Slowly close one of your hands and make a fist. Then slowly make your fist tighter and tighter (more contraction of your hand muscles). Notice the change in the signal. What you are observing is the noise added to the ECG from the electrical activity of the muscles. This is also known as the electromyogram noise. In order to reduce noise, you can also apply a digital filter. Right click on the ECG
6 channel (while recording has been stopped) and find click Raw Signal 0.3 ~35 Hz. You have then removed all signal corresponding to all other frequencies. 4. Try to move as far away from the computer and the desk as possible, relax your fist, and wait for several seconds (30 ~ 60s) to obtain a cleaner signal, and then click stop. You can type ECG and Finger Pulse in the comment line to the right of Mark button to attach a comment to the data. 5. Repeat for all members of your group who are willing to participate in this experiment. 6. For all measurements made during this experiment, you can press Ctrl+Alt+Print Screen to take a snapshot of the current window, which you can then paste into Word file for your report. Clicking stop halts the measurement. After any data collection episode, you can select Export your data into a Matlab file. Data Analysis: (all measurements and calculations must be in your report) 1. Click the 2-cursor icon and observe two blue vertical lines appear on the recording window. 2. Drag the cursors to the left and right so that at least four complete heart beat cycles are located between the two blue lines 3. Click the Analysis icon to open the analysis window. 4. Drag the blue lines so that each appears on top of the first two R waves. From the left menu click on T2- T1 to measure the time difference between the two R waves 5. Drag the second line so that it coincides with third R wave. Again measure the T2-T1 time difference. Repeat for the fourth R wave 6. Leaving the first cursor on the top of the first R wave, place the second blue line on top of the first blood flow peak. Again measure T2-T1 difference. 7. Place the second blue line on top of the first integral peak. Again, measure the T2-T1 difference. 8. Repeat the above measurements for other members of your group. 9. Also on the left panel, click V2-V1 and select the ECG channel. Also select (using ctrl+left click) the units from the left panel. Measure the peak to peak amplitude difference of a QRS complex. Questions (to be answered in your lab report): 1. What does the T2-T1 difference you measured in step 4 above represent? How can you calculate the heart rate from this measurement? How about the T2-T1 difference in step 5? How can you measure the heart rate from these measurements? You will notice that the heart rate measurements you calculate will be similar, but not identical. Which one do you think is the most accurate? Why? 2. How about the T2-T1 difference calculated in step 6? What does this represent? Can you estimate how fast your blood flows from this measurement? 3. BONUS: And, yes, we will ask the same question for the measurement made in step 7. But first, what is the measurement in Channel 4 represent to being with? Remember that Channel 4 is a calculated measurement, not a raw measurement, obtained as the integral of Channel 3. Discuss among yourself, consult websites if you wish, and try to figure out what does this integral in fact represent. Once you find out the answer, comment on the T2-T1 difference. 4. Notice the small transient plateau during the falling phase of the integral on Channel 4. This is called the dicrotic notch. Consult the Oracle Google about the dicrotic notch. What is it? What event on the blood flow recording corresponds to the dicrotic notch? 5. Compare the numbers you have obtained in steps 4 ~ 7 above among the members of your group. Do you see any apparent correlation among these numbers and the age, fitness level, smoking habit (if any) or gender? 6. Later, after the experiments are over, obtain these values from members of the other groups. Calculate the mean and the standard deviation of the heart rate as well as T2-T1 difference for steps 6 and 7 (above). Plot and compare the averages in terms of male/female, smoking / non-smoking, athletically active / not active. Do you see any differences?
7 7. Notice the units of the ECG measurement. It is in milivolts (mv). The highest amplitude of an R wave, as you have found out, is typically about 0.1 ~ 0.3 mv, or to V. This is an extremely small value, not large enough to be properly displayed by most instruments. It is for this reason that you are using the AHK214 biopotential amplifier. The particular amplifier you have used is a biopotential, or medical quality amplifier. What does this mean? What properties an amplifier needs to satisfy to qualify as a medical quality amplifier? How does it differ from an audio amplifier? Hint: This is an optically isolated amplifier. Find out what that means, and why it is important in this application. Main view Analysis view Scope view Zoom in Zoom out Add 2 markers Add 1 marker Start / Stop recording Channel 1 recording area Channel 2 recording area Channel 3 recording area Channel 4 recording area Handles to change the height of the channel window Figure 7. Labscribe main window
8 QRS complex / R wave of ECG Dicrotic Notch Figure 8. Typical view of Labscribe after data collection Experiment 2: Other Lead Configurations 1. The ECG you acquired so far is the Lead I ECG. We would like to acquire Lead II ECG as well. Carefully look at how the connections was done above, and apply all electrodes such that Channel 1 (red and black ) acquires Lead I, and Channel II (brown and while) acquires Lead II ECG. 2. Right click on channel 3 and 4 and then select Cardiac from the menu. You will see a series of options to calculate other lead configurations. Select Lead III for channel 3 and avf for channel Acquire several seconds of data. 4. After data collection, go to the analysis window, make sure that you have at least 6-8 ECG beats visible on the monitor. Export this data to Matlab and plot.
9 Data Analysis and Questions (to be answered in your lab report) 1. Note that Lead III and avf are calculated. We already know how Lead III can be obtained from Leads I and II. Calculate Lead III in this manner (see class notes, if you do not remember the expression) and compare that to one computed by AHK214. Is it the same? Comment. 2. Find out from the web how augmented leads can be calculated from the other lead recordings. Yes, out of the 6 leads, only two of them are independent, any four can be obtained from the other two. Calculate avf as the expression you found recommends and compare that to the one calculated by AHK214. Are they identical? Similarly calculate and plot avr and avl. 3. Do you see any amplitude difference between the standard leads and the augmented leads? If everything worked as they should, you should see a roughly 50% amplitude gain with the augmented leads. Find out why is this the case? 4. Notice that this setup allows us to make at most two channel recordings, using the limbs. What if we wanted to acquire precordial ECG? Find out how we can make precordial measurements using this setup (that is which electrode would be connected where?). Instructions: The lab report must be written in groups of no more then 2. The report must be typed, all plots must be annotated and labeled. IT should consist of the following sections 1. Introduction what is this lab about? 2. Equipment used (use proper names, a gray cable is not good enough!) 3. Procedure followed (and why) and plots of your recordings (screen shots or Matlab plots) 4. Answers to questions 5. Discussion and conclusion (what have you learned from this lab) 6. Suggestions What would you recommend to add / modify to make this lab more informative.
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