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Biomedical Signal Processing

Unit II

Cardio Vascular and Nervous System

Edited By : Nishikant Surwade

Biomedical Signal Processing

2.1 Cardio Vascular System: Cardiovascular system, Coronary and Peripheral Circulation

Edited By : Nishikant Surwade

H an db o ok of B iome dic al ln s tr um ent at ion

Pathophysiology relates to the pathological (study or symptoms of disease) functions of the


In addition, ciassification into various sub-areas dealing with diffrent organs can be made.

For exampie:

Circulatory physiology is the study of blood circulation relating to functioning of the heart. Respiratory physiology deals with the functioning of breathing organs.


Humanbody is a complex engineering

marvel, which contains various types of systems such as

chemical and thermal etc. These systerns communicate

external environment. By means of a multi-level

the individual systems enable the humanbody to

electrical, mechanical, hydraulic, pneumatic,

internally with each other and also with an

control system and communications network,

perform useful tasks, sustain life and reproduce itself.

Although, the coverage of detailed information on

the physiological systems is outside the

malor sub-s"ysterns of the body is given

scope of this book, nevertheless a brief description of the

below to illustrate the engineering aspects of ihe human body.

1.2.1 The Cardiovascular System

The cardiovascular system is a complex closed

hydraulic system, which performs the essential

numerous chemical compounds and the blood

parts. Each part has two chambers called

servic-e of transportation of oxygen, carbon dioxide,

cells. Structurally, the heart is divided into right and left

atrium and ventricle. The heart has four valves (Fig. 1.1):



The Tricuspid valve or right atrio-ventricular valve-between right atrium and venkicle. It

three flaps or cusps. It prevents backward flow of blood from right ventricle to

consists of


Bicuspid Mitral or left atrio-ventricular valve-between left atrium and left ventricle.

The valve has two flaps or cusps. It prevents backward flow of blood from left ventricle to




Pulmonary valve-at the right ventricle. it consists of three ha,f moon shaped cusps. This

does not allow blood to come back to the right ventricle.

Aortic valve-between left ventricle and aorta. Its construction is like

pulmonary valve.

This valve prevents the return of blood back to the left ventricle from aorta.

The heart wall consists of three

It keeps the outer surface moist and

layers: (1)Thepericardium,which is the outer layer of the heart.

prevents friction as the heart beats. (ii) Themyocardium is gne

muscle of the heart, which is made up of s"hort cylindrical

contracting and relaxing rythmically throughout life.

middle layer of the heart. It is the main

fibres. This muscle is automatic in action,

(iii) The endocardiumis the inner layer of the heart. It provides smoJthiini.,g rorine utoJa to flon,.

The blood is carried to the various parts of the body through blood vessels,

which are hollon,

tubes. There are three types of blood vessels. (1) Arteries-aie thick walled and

oxygenated blood away from the heart. (ii)Veins-are thin walled and carry de-oxygenated blood

they carry the


smal-i d




of the c


The pu

each pr stage i I

to the h

In tt!


The art

In sr

The blc

its bran


re made.


s such as



rbody to

Eide the

is given



rs called

rtricle. It

F undamentals of Medical lnstrumentation

Right atrium

Superior vena cava





Tricuspid valve

> Fig. 1 .1 Structure of the heart

Aortic valve

Mitral valve

Left ventricle


ttricle to

towards the heart. (nr)Capillaries-are the smallest and the last level of blood vessels. They are so small that the blood cells, which make blood, actually flow one at a time through them. There are


estimated to be over 800,000 km of capillaries in human being, which include all the arteries and

fricle to

veins, which carn' blood.

ps. This

y valve.


rn is the


out life.





From an engineering point of view, the heart which drives the blood through the blood vessels

of the circulatorv svstem (Fig. 1.2) consists of four chamber muscular pump that beats aboutT2

times per minute (on an average for a normal adult), sending blood through every part of the body.

The pump acts as two slmchronized but functionally isolated two stage pumps. The first stage of

each pump (the atrium) collects blood from the hydraulic system and pumps it into the second

stage ( the vmtride). in this process, the heart pumps the blood through the pulmonary circulation

to the lungs and through the systemic circulation to the other parts of the body.

hr the pulmonary circulation, the venous (de-oxygenated) blood flows from the right ventricle,

through the pulmonary artery, to the lungs, where it is oxygenated and gives off carbon dioxide.

The arterial (oxygenated) blood then flows through the pulmonary veins to the left airium. In systemic circulation, the blood is forced through blood vessels, which are somewhat elastic. The blood flows from the left atrium to the left ventricle and is pumped through the aorta and

its branches, the arteries, out into the body. Through the arterioles (small arteries), the blood is

Handbook of Biomedical lnstrumentation





Right atrium



Right ventricle

Location of

sinus node


> Fig. 1"t The Circulatory systeffi



Left atrium

Aortic valve

Mitral valve

Left ventricle




]F{ Ef,M

mltril fi









it€ :mm

distributed to the capillaries in the tissues, where it gives up its oxygen and chemical compounds,

takes up carbon dioxide and products of combustion. The blood returns to the heart along different routes from different parts of the body. It usualil,

passes from the venous side of the capillaries directly via the venous system to either the superior

vena cava or the inferior vena cava, both of which empty into the right atrium. The heart itself is

supplied by two small but highly important arteries, the coronary arteries. They branch from the

aorta just above the heart. If they are blocked by coronary thrombosis, myocardial infarction follows, often leading to a fatal situation.

The heart rate is partly controlled by autonomic nervous system and partlyby harmone action.

These control the heart pump's speed, efficiency and the fluid flow pattern through the system.

The circulatory systern is the transport system of the body by which food, oxygen, water and

other essentials are transported to the tissue cells and their waste products are transported awav.

This happens through a diffusion process in which nourishment from the blood cell diffuses

F undamentals of Medical lnstrumentation


the capillary wall into interstitial fluid. Similarly, carbon dioxide and some waste

produ-cts from the interstitial fluid diffuses through the capillary wall into theblood cell.


The condition of the cardiovascular system is examined by haemodynamic measurements and

by recording


the electrical activitv of the heart muscle (electrocardiography) and listening to the

sounds (phonocardiography). For assessing the performance of the heart as a PumP/

measurement of the cardiac output (amount of blood pumped by the heart per unit time), blood

pressure, blood flow, rate and blood volume are made at various locations throughout the

circulatory system.

1.2.2 The Respiratory System

The respiratory system in the human body (Fig. 1.3) is a pneumatic system in which-an air Pump

(diaphragm) altemately

cavi?y) ,id .urr", air to

are connected to the outside environment through a passage way comprising nasal cavities,

creates negative and positive pressures in a sealed chamber (thoracic be sucked into and forced out of a pair of elastic bags (lungs). The lungs







(air passage)


(smallest air





p.It usually


eart itself is

dr from the

I infarction

Alveoli '


(brarrch from bronchiole where exchange occurs)



,water and


dl diffus€s

> Fig.1.3 TheRespiratory system

Biomedical Signal Processing

2.2 Electrical Activity of the heart, Lead configurations , ECG data acquisition, ECG recorder

Edited By : Nishikant Surwade



Biomedical Recorders



which records the eiectrical activity of the hear.

Tire electrr:cardiograph (ECG) is

Electrical signals

an instrument,

characteristically prececle the normal mechanical function and

ECC provides valuable information "" of an inactive pari (infarction) or an

from the heart

monitoring of

these ,ignut, has great clinical significance'

dis"orders such as ii-r" po"t"t

alrout a r.vide range of Jardiac

mrlargement 1cur,lluc

tion lal:oratoriur, .o.oirlry

although the eiectric field

it is generally

hifeitrophy) of the heart muscle' Electrocardiographs are used in catheteriza-

ancl for routine diagnostic applications in cardiology'


generated by the heart

can be best characterized by vector quantities' scalar quantities' i'e' a voltage difference of m\'

convenient to directly measure only

*rderbetween the gi'en points of inemay'

accepteci as (').05 to i 50 liz (Golden et al

reprociuce signals in this range. A good the basetrine. High frequency"rerpo:nr"

use{ul ECG signrl

TIr" diagnostically useful frequency range is usualh'

and writing

part should faithfullr'

essential to ensure stability of

1'973).The implifier

low frequen.y i"'po"'" is

is a compromise of several factors like isolati.n between a

(myographic potentials) and limitations

rroJ1 othJ, signals of biologiial origin

to riass,

of tire tlirect writing p"r, ,u"ori"rs due

biologicai origin .ur, iu handled by

inertia and friction' The interference of non-

usingmodern differential amplifiers' which are capable oi

the order of L00-120 dB with 5 kO unbalance

machines. In addition to this, under specially adverse

providing excellent."i"J.".rp"uiryillcrvrRRof

in ihe leads is a desirable feature of ECG


it becomes necessary to

to power

mains. rrre inJaUility oithe baseline,

impedance, demands the applicationof

twt paper speecls ir rru."rru,.v (25 and


include a notch filter tuned to 50 Hz to reject hum due


from the changes of the contact

automaticbaseline stabilizing circuit' A minimum of

50 mm Per sec) for ECG recording'


of an electrocardiograph machine' The potentials picked up

Figure 5.1 shows the block diagram

bi, ihe patient electrodes are tafe'r

tc the leacl selector u*it.h- In the lead selector, the etrectrodes are

=ele -tetd




::cs'r dlee

:rlad up

:rra push'


slsrlai res

"'rf rri.le fxlr

.-rr: th"r Fia

rirmtai h



,eaj =rt-i'l


:le st]-



-nes a











Biomedical Recorders


:elected twoby two according to the lead program. Bymeans of capacitive coupling, the signal is

connected symmetrically to the long-tail pair differential preamplifier. The preamplifier is usually a three or four stage differential amplifier having a sufficiently large negative current feedback, irom the end stage to the first stage, which gives a stabilizing effect. The amplified output signal is

picked up single-ended and is given to the power amplifier. The power amplifier is generally, of

the push-pull differentical type. The base of one input transistor of this amplifier is driven by the preamplified unsymmetrical signal. The base of the other transistor is driven by the feeclback

signal resulting from the pen position and connected via frequency selective network The output of the power amplifier is single-ended and is fed to the pen rr.otor, rvhich deflects the writing arm

on the paper. A direct rt'riting recorder is usually adequate since the ECG signal of interest has

limited bandwidth. Frequency selective network is an R-C network, u,hich provides necessary

damping of the pen motor and is preset by the manufacturer. The auxiliary circuits provide a 1 mV

calibration signal and automatic blocking of the amplifier during a change in the position of tire lead switch. It may include a speed control circuit for the chart drive motor.

roi tne neari. ftur,:r-cn and ' ini.- r::'.atlon

lctr):] i Or an



or quantihes, erenie of m\'

ge is u,<uallr'

dd larthfullr-

re stallitr-of

mr beiir-een a

d limitations

ence Lrf non-

rc capable of Q unt,alance

iallv adr-erse


hum due

I the contact


tls picked up {eckodes are



(,) !

LlJ o

5 0)





> Fig. $.t Block diagam of an ECG machine

A 'stand by' mode of operation is generally provided on the electrocardiograph.

In this mude,

the stylus moves in response to input signals, but the paper is stationar.v. This mode allows the operator to adjust the gain and baseline position controls without wasting paper.

Electrocardiograms are almost invariablv recorded on graph paper with horizontal and vertical lines at 1 mm intervals with a thicker line at 5 mm intervals. Time measurements and heart rate measurements are made horizontally on the electi'ccardiogram. For routine work, the paper

recording speed is 25 mm/s. Amplitude measurements are made vertically in millivoits. The

sensitivity of an electrocardiograph is typically set at 10 mm/mV.

lsolated Preamplifier:lthad been traditional for all electrocardiographs to have the right leg (RL) electrode connected to the chassis, and from there to the ground. This provided a ready path for

any ground seeking current through the patient and presented an electrical hazard. As the

microshock hazard became better understood, particularly when intracardiac catheters are

employed, the necessity of isolating the patient from the ground was stressed. The American Heart Association guidelines state that the leakage current should notbe greater than 10 microamperes

when measured from the patient's leads to the ground or through the main instrument grounding


Handbook of Biomedical I nstrumentat ion

wire with the ground oPen or

ground for all line operated units.

intact. For this, patient leads would have to be isolated from ttre

Figure 5'2 shows a block diagram of an isolation

preamplifier used in modern electru

1RA1, left arm (LA) and rig6t leg IRL


cardiographs. Difference signals obtained from the right arm

is pven to a

electrosurgery and respiration detection.

low-pass filter' Filtering is required on thJinput leadsto reduce interference caused tn-

radio frequency emissions and sometimes from the 50 kHz current

The filter usually has a cut


off frequency higher than 10 kHz. A multistage

filter is needed to achieve a suitable reduction in high frequency s"ignal.





lsolated power


[n- ftF n

C ht



r u6Pl




> Fig. $.2 Blockiliagramof anisolationpreamplifier(transformeil_coupled)

commonly useil in modern ECG machines

The filter circuit is followed by high voltage and

over voltage

protection circuits so that the

price of this protection

amplifier can withstand_large voltages during defibrillation. Hoirever, the

is a relatively high amplifier noise level arising from the high series resistance in each lead.

The lead selector switch is used to derive the required lead

configurations and give it to a

powu, ,rp"ply, which

dc-coupled amplifier. A dc level of 1 mV is obtained by dividing down-the

can be given to this

amplifier through a push button foicalibratiJn of the amilifier. Isoiauon of the

winding is driven


patient circuit is obtained

using a low capacitance transformer whose primary

from a 100 kHz oscillator. The

of t5 V for operating the devices in

transforrner second.ary is used to obtain an isolated power

the isolated portion of the circuit and to drive the slzrchronous

modulates an ECG signal given to it. The oscillator frequency

modulator at 100 kHz, which linearly

of 100 kHz is chosen as a compromise so that

reasonable size transformers (higher the frequency

the switching time is not too fast, so that

the smaller the transformer) could be used and that

inexpensive transistors and logic circuitry can be utilized. A square wave is utilized to minimize








Ed r:m:r &p

hm eisrc'


ecu-"eri Lry

frrt u-<€d for



eo that the



trive it to a

p\,u'hich nirr of the






sL so that rminimize


Biomedical Recorders


the power requirements of the driven transistors.

lolv noise performance utilizing switching FET,s.

A synchronous demodulator is chosen to give

Isolation of the

patient preamplifier can also be_obtained using an

optical isolator. The high


colrunon-mode rejection

from the input leads to the

of the amplifier is obtained by proper shielding. 'ihe effective

earth is made negligible. Thepreamplifier circuitry should is preferablv

between the body of the patient and the floating ground,

The common-mode signals after arnplificition in a

right leg electrode,"reducing the comrnon mcde

gro"ia. Winter and webi'ter (19s3) examine6

be shielded in a separate case" To minimize the common-mode signal

a right leg drive circuit (Fig. 5'3) is used.

preamplifier are inverted and fed back to the

voltage on the input with respect to the floating

optimal design parameters for a driven-right-leg circuit.



rejectiofr mpiif ier





> Fig. 5.S Imptooement in CMKR using ight leg drioe (Courtesy: Hewlett packard,



of stray capacitance atthe input of thepreamplifiercausescorunon-mode currents

and RA, resulting in a

voltage arop at ihe electrode resistors. An imbalance of the

causes a difference signal. This difference signal can be

currents of stray-capacitances are not allowed to

by currents delivered

to stray capacitances

to flow in LA

stray capacitance or the electrode resistors

almost eliminated, in that the common-mode

flow through the electrode resistors but are neutralized

from the common-mode rejection amplifier. In other words, the potentials at A, B and C are


Handbook of Biomedical lnstrumentation

equalised through

delivers via C,

an in-phase component of the common-mode voltage, which the amplier

*a C, to LA and RA. As a result, the potentials at A, B and C are kept eou''

independent of the imbalance in the electrode resistors and stray capacitance.

The modern ECG machines with their completely

shielded patient cable and lead u'ires a:r';

their high common-mode rejection, are sufficiently

could be locations where such interference cannot be eliminated by reapplying the electrods 'ar

resistant to mains interference. However. tllee

moving the cable, instrument or patient. To overcome this problem, some ECG machines har-e ar

additional filter to sharply could be up to 40 dB. In

frequency interference.

attenlate a narrow band centred at 50 Hz. The attenuation providei

this way, the trace is cleaned up by the substantial reduction of iirc

Isolation amplifiers are available in the modular form. One such amplifier is Model 274ttos

Analog Devices. This amplifier has the patient safety current as 1.2 pA at 115

a noisJof 5 pV pp. It has u CUnn of 11rdB, differential input impedance of

V ac 60 Hz and ones

1012 fl paralleled rrif

3 pF ancl common mode impedance as 1011Q and a shunt capacitance of 20 pF' It is optimized ro:

signal frequencies in the range of 0.05 to 100 Hz. Metting van Riin ef al (1990) detail out methocs

for high-quality recording of bioelectric events with special reference to ECG.

5."1.2 The ECC Leads

Two electrodes placed over different areas of the heart and connected to the galvanometer n-ill pick up the electiical currents resulting from the potential difference between them. For example,

if under one electrode a wave of L mV and under the second electrode a wave of 0.2 mV occur at the

same time, then the two electrodes will record the difference between them, i.e. a wave of 0.8 m\ ' The resulting tracing of voltage difference at any two sites due to electrical activity of the heart ts called a"LE.LD" (Figs 5.4 (a)-(d)).

Bipolar Leads: In bipolar leads, ECG is recorded by using two electrodes such that the final frace



to the difference of electrical potentials existing between them. They are calied

leads and have been universally adopted. They are sometimes also referred to a-s

Einthoven leads (Fig. 5.4(a)). In standard lead I, the electrodes are placed on the right and the left arm (RA and LA). In lead tr'

the electrodes are placed on the right arm and the left leg and in lead Iil, they are placed on the

left arm and the left leg. In all lead connections, the difference of potential measured betw'een

two electrodes is always with reference to a third point on the body. This reference point Ls

conventionally taken as the "right leg". The records are, therefore, made by using three eleckode:

at a time, the right leg connection being always present.

In defining the bipolar leads, Einthoven postulated that at any given instant of the cardiac

cycle, the electrical axis of the heart can be represented as a two dimensional vector. The ECG

measured from any of the three basic limb leads is a time-variant single-dimensional comPonent

that the electric field of the heart couldbe rePresented diagrammaticallr'

of the vector. He proposed

as a triangle, with the

heart ideally located at the centre. The triangle, known as the "Einthoaat

triangle" ,is shown in Fig. 5.5. The sides of the triangle represent the lines along which the three

projections of the ECG vector are measured. It was shown that the instantaneous voltage measured

Biomedical Recorders





Ept equC


Bipolar Limb Leads

rires and


rTtr. tlwe

drrodes clr



m of line

C-M means'bommon






ded rr-ith


tdzed tor


&r n-ill


curat dre


Unipolar limb leads


aheart is

ml hace

E celled

cd to as

Llead tr,

ilcr the


point is



be ECG






Lead AVR--

Lead AVF**


> Fig. S.4. Typ,es of lead connections with

typical ECG waaefonns (a)


limb leads (b) unip orar rimb reaitsibourtesy : Hezabh p ackard, rrsA)








Handbook of Biomedical Instrumentation

(c) Unipolar chest leads



Vr Fourth intercostal sPace'


at right sternal margin.

V^ Fourth intercostal spacB'

at left sternal margin.

Vg Midway between V2 and V4.




Fitth intercostal sPace' at

mid-calvicular line.

Vs Same level as V4, on anterior

axilliary line' V6 Same level as V4, on mid


axilliary line.


Ensiform, base of slemum'

CH positions





Fig. 5.4 Types of lead connections


oi'tt e ihest lead in

with typical

EcG waoeforms (c) position

unipolar precordial lead rccording u) c leads

(C o utt e sY : H ew I ett P a ck ar d, US A)

roEn irr'l


in eil







o-f LtrIiP









Biomedical Recorders


> Fig. $.S The Einthoaen tiangle for itefining ECG leads

from any one of other two or that

the three limb lead positions is approximately equal to the

algebraic sum of the

the vector sum of the projectioni on all threeiines is equal to zero.

In all the bipolar

lead positions, QRS of a normal heart is such that the R wave is positive and

is greatest in lead II.

unipolat Leads (v Leads);The standard two points on the body produced by the

changes than either of the potentials and so

single electrode is recorded. Moreover, if the higher potentials can be detected than normally

leads record the difference in electrical potential between

heart's action. Quite oftery this vottage14,,itt show smaller

better ,"r,Jtirrity an be obtain"iif th" potential of a

electrode is placed on the chest close to the heart,


available at the timbs. This lead to the


,rrrr,j"*"r,t, the electrocardiogram is

the centrfl terminal, which has a potential

point. Two types of unipolar

are tied together and

illit arm is


of unipolar leads introduced by wilson in rbg-+. In

recorded between a single exploratory electrode and corresponding to the centre of the body. In practice,

obtained by a combination of several eiectrodes tied

Ieads are

the reference electrode or central terminal is

together at one

employed which are: (i) limb reads, and (ii) piecordial reads.

(i) Limb

leadsrnunipolar limb leads (Fig. 5.4</