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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
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

Figures 1 and 2: A normal EKG signal and the different segments of a single
waveform respectively.

normal EKG signal is shown in Figure 1.

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. 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)
• 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 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 9

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 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


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 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.


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 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.


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.
Figure 9: The front screen with the tool and control palettes.

Figure 10: The back screen with the tool and functions palettes.
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.
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.

Chec
QTY ITEM
k
1 Black Project Box
1 Printed Circuit Board (PCB)
2 9 Volt Batteries
2 9 Volt Battery Holders
4 Wire Bundle - Black Brown
1
White Red
Single Wires: 2 Orange, 1
4
Black, 1 Green
2 IC Chips
2
IC Sockets
1K Ohm Resistors – Brown
2
Black Red
1M Ohm Resistors – Brown
4
Black Green
2 Capacitors: 1Green, 1Brown
4 Screws
Banana Jacks: 2 Orange, 1
4
Black, 1 Green
1 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 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!
1

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?


2

P-Wave QRS. T-Wave.

If it is longer than .20 Depolarization of the Ventricle


seconds, it may indicate ventricles. Repolarization.
first-degree heart block. Ventricular May be affected by
SA Node fires. Contraction. changes in serum K
Atrial Depolarization Atrial Repolarization. levels.
Sinus initiated rhythm. (Can't always be seen
on EKG)

• 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.
3
EKG Procedure:
• Remove one limb sensor, (sticky pad) and place it on your right
bicep, between your bone and muscle.

• 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.
4
• 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.

• 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
5

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

Figure B-1: Common Waveforms

representation of a wave. A voltage waveform shows time on the


horizontal axis and voltage on the vertical axis.

You can classify most waves into these types:


6
• 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.
7
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