Biomedical Instrumentation I

Chapter 8 in
Introduction to Biomedical Equipment Technology: Electrocardiography
By Joseph Carr and John Brown

Schematic
Representation of
Electro-Conduction
System

SA Node
AV Node
Bundle of
His
Bundle
Branches
Purkinjie
Fibers

From Berne and Levy Physiology 3rd Edition Figure 23-25

Pathway of Electro-Conduction System

of the calf heart starting at AV Node
AV Node
Bundle of
His
Bundle
Branches
Purkinjie
Fibers

From Berne and Levy Physiology 3rd Edition Figure 23-28

Electrocardiograph (ECG)

Components:
P wave = Atrial
Contraction
QRS Complex =
Ventricular Systole
T Wave =
Refractory Period

Carr and Brown Figure 8-1

Typical measurement
from right arm to left
arm
Also see 1 mV
Calibration pulse

Different Segments of ECG

P wave: the sequential activation (depolarization) of the right and left atria
QRS complex: right and left ventricular depolarization (normally the ventricles are
activated simultaneously)
ST-T wave: ventricular repolarization
U wave: origin for this wave is not clear - but probably represents
"afterdepolarizations" in the ventricles
PR interval: time interval from onset of atrial depolarization (P wave) to onset of
ventricular depolarization (QRS complex)
QRS duration: duration of ventricular muscle depolarization
QT interval: duration of ventricular depolarization and repolarization
RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate)
PP interval: duration of atrial cycle (an indicator or atrial rate

Typical Leads
RA = right arm
LA = Left arm
LL = left leg
RL = right leg
C = Chest
Different leads
result in different
waveform shapes
and amplitudes
due to different
view and are
called leads

Cardiac Axis by different Leads

Carr and Brown Figure 8-2

Types of Leads
Bipolar Limb Leads: are those designated by
Lead I, II, III which form Einthoven Triangle:
Lead I = LA connection to noninverting amp. input
And RA connecting to inverting amp. Input

Lead II = LL connection to amp. Noninverting input RA connect to

inverting input and LA shorted to RL

Lead III = LL connected to noninverting input LA connected to

inverting input

LL

LL

LL

Einthoven
Triangle:
Note potential
difference for each
lead of triangle

Carr and Brown Figure 8-3

Each lead gives a slightly different

representation of electrical activity of heart

Types of Leads

Unipolar Limb Leads= augmented limb leads: leads that look at

composite potential from 3 limbs simultaneously where signal from 2 limbs
are summed in a resistor network and then applied to an inverting amplifier
input and the remaining limb electrode is applied to the non-inverting input
Lead aVR = RA connected to non-inverting input while LA and LL are summed at inverting input
augmented (amplified) Voltage for Right arm (aVR)

Lead aVL = LA connected to non-inverting input while RA and LL are summed at inverting input
augmented (amplified) Voltage for Left arm (aVL)

Lead aVF = LL connected to non-inverting input while RA and LA are summed at inverting input
augmented (amplified) Voltage for Foot (aVF)

LL

LL

LL

Types of Leads
Unipolar Chest Leads: measured with signals from
certain specified locations on the chest applied to
amplifiers non-inverting input while RA LA, and LL are
summed in a resistor Wilson network at amplifier
inverting inputs

LL

Wilsons Central Terminal

Configuration
used with
Unipolar Chest
Leads where
RA LA and LL
are summed in
resistor network
and this is sent
to the inverting
input of an
amplifier

Electrocardiograph Traces from different

leads

Normal ECG with RA, LA, LL connected

Artrial Tachycardia with RA, LA, LL connected

Ventricular Tachycardia with RA, LA, LL

connected

Variations in Chest Leads C with RA and LA connected

C1

C2

C3

1st Degree block RA LA LL connected

PR wave is prolonged >0.2 sec have a prolongation of delay
between atrial and ventricle depolarization

Normal

2nd Degree Block

Intermittent failure of AV conduction, such that not every P wave
is followed by QRS complex

Normal

3 Degree Block
rd

Complete failure of conduction between atria nd ventricles.

Common cause is AMI (Acute Myocardial Infarction

Normal

R Bundle Branch Block

Widened QRS complex abnormalities in R S as well as T wave Q is not
as affected because the left bundle branch initiates depolarization

Normal

Other ECG Signals

Interdigital ECG: Signal taken between 2
fingers usually for home monitoring
Esophageal ECG: electrode placed in
esophagus close to heart typically used to
record atrial activity where P and R wave
are used to determine position
Toilet Seat ECG: used to detect cardiac
arrhythmias that can occur during
defecation

Block Diagram of ECG

ECG Pre-Amplifier
High Impedance input of bioelectric
amplifier
Lead selector switch
1mV calibration source
Means of protecting amplifier from high
voltage discharge such as a defibrillator
used on a patient
Amplifier will have instrumentation
amplifier as well as isolation amplifier

Isolation Amplifier

Needed for safety! Want to isolate patient from high

voltages and currents to prevent electric shock where
there is specifically a barrier between passage of
current from the power line to the patient.
Can be done using light (photo emitter and photo
detector) or a transformer (set of inductors that are
used in a step up / step down configuration)

Isolation of Signal of Patient from

Power needed for safety

Typical Representation of an
Isolation Amplifier

Common Mode Rejection

Until now we assumed Amplifiers were
ideal such that the signal into each
terminal would completely cancel lead to
complete common mode rejection
However with practical Op Amp there is
not perfect cancellation thus you are
interested in what common mode rejection
is.

Simplistic Example of ECG Circuit

Would like to analyze what type of common mode voltage (CMV) can be derived

Common Mode Voltage (CMV)

If 2 inputs are hooked together into a differential amplifier
driven by a common source with respect to ground the
common mode voltage should be the same and the ideal
output should be zero however practically you will see a
voltage.
CMV is composed of 2 parts:
DC electrode offset potential
60Hz AC induced interference caused by magnetic and electric
fields from power lines and transformers
This noise is a current from in signal, common and ground wires
Capacitively coupled into circuit
(Other markets that work at 220-240 V will experience 50Hz noise)

Analysis to reduce noise in ECG

Common Mode Rejection:
Instrumentation amplifier
(EX. INA128) using a
differential amplifier which
will cancel much of the 60
Hz and common DC offset
currents to each input
If each signal is carrying
similar noise then the some
of the noise will subtract out
with a differential amplifier

Analysis to reduce noise in ECG

Right leg driver circuit
is used in a feedback
configuration to
reduce 60 Hz noise
and drive noise on
patient to a lower
level.

Use of Feedback to reduce Noise

Derivation: V 1 Vin Vo
V 2 V 1G1 Vn

V 2 Vin Vo G1 Vn

Vn = Noise

Vin +

V1
B Vo

V1G1 +
G1

V2

G2

Vo V 2G 2

V2G2

Vo Vo Vin Vo G1 Vn G 2
Vo G1G 2Vin G1G 2 Vo G 2Vn
Vo G1G 2 Vo G1G 2Vin G 2Vn

Vo 1 G1G 2 G1G 2Vin G 2Vn

Vo

G1G 2Vin G 2Vn

1 G1G 2

G1G 2Vin
G 2Vn

G1

Thus Vn is reduced by Gain G1

1 G1G 2 G1 1 G1G 2
Note Book forgot V in equation 5-35
G1G 2
G1G 2
Vn
Vo
* Vin
*
1 G1G 2
1 G1G 2 G1
Vo

Vo

Vn
G1G 2

1 G1G 2 in G1

Analysis to reduce noise in ECG

Isolation Amplifier also will attenuate noise
Shielding of cables further reduce noise

Review of Five ways to reduce

Noise in ECG
Common Mode Rejection (differential
Amplifier)
Right Leg Drive (feedback loop to
decrease noise)
Shielding of wires
Isolation amplifier
Notch filter to reduce 60 Hz noise

How to overcome offset voltage

Instrumentation Amplifier Gain (A1,A2,A3) =

Non-Inverting Amplifier A4

Vout ( A4) Rf
25K
Vout ( A3) 2 Rf noninverting Rf diff 2(25K) 25K

1
1 50

1
10

Vin
Vin
Rin 510
Rinnoninverting Rindiff 5.5K 25K

Problems of offset voltage and

how to correct

If you had 300 mV of DC offset sent through two gains of

10 and then 50 you would have an offset of (300mV)(10)
(50) = 150V thus you would saturate your amplifiers and
not see any of your signal
3V offset after first set of noninverting amplifiers goes
through differential amplifier A3 which reduces the offset
voltage.

Other Corrections for Offset

Feedback circuit where output of A4 goes
through HPF of A5 so only responses larger than
cutoff frequency pass through thus the DC offset
is attenuated

R and C should
be switched
because this is
really a LPF

Affect of High Pass Filter of A5

Feedback through HPF has a

time constant of RC

3 Modes:

Diagnostic Mode (most time) where

RC = 1x10-6F*3.2x106 = 3.2 sec
Cutoff Freq = 1/(2RC) = 0.05Hz
Monitor Mode (medium time) where
RC = 1x10-6F*318x103 = 0.318 sec
Cutoff Freq = 1/(2RC) = 0.5Hz
Drawn Incorrectly Quick Restore (least time) where
R and C should be RC = 1x10-6F*80x103 = 0.08 sec
switched
Cutoff Freq = 1/(2RC) = 2Hz

With Feedback the DC offset is eliminated

and thus can have a gain of 50 on the
2nd Non-inverting Amplifier Stage
without Saturating the Circuit

High Pass Active Filters

Attenuates High frequency where
cutoff frequency is 1/(2)
=1/ 2RiCi
Rf

Ci

Ri

A
Vinput

Vinput

Ci

Ii

Rf

Voutput

Rf

Voutput

Voutput
Vinput

IRf

When frequencies (w) is large gain ~ -Rf/Ri

Gain (1MHz, Ci=1mF)

Vout

Vin

Rf
0 Vinput
Ii
1
Ri
jCi
I Rf Ii
Voutput 0

+
Ri

IR f

Voutput 0

Rf
Rf
Rf

4
1
Ri
1
.
59
x
10
Ri
Ri
6
3
j 2(3.14)(1x10 )(1x10 )
j

0 Vinput

1
Ri
jCi

Rf
1
Ri
jCi

When frequencies (w) is small gain is reduced

Gain (1Hz, Ci =1mF)

Vout

Vin

Rf
Rf
Rf

1
159 Ri number
Ri
Ri

j
j 2(3.14)(1)(1x10 3 )

Low Pass Active Filters = Integrator

Attenuates High frequency where cutoff

frequency is 1/2=1/2RfCf

Cf

Voutput 0
Icf
1
j C
Voutput 0
IRf
Rf
0 Vinput
Ii
Ri
Icf IRf Ii

Rf
Ri

Vinput

Voutput

Cf
Vinput

Ri

Rf

ICf

Voutput

Voutput 0 Voutput 0 0 Vinput

1
Rf
Ri
j C
Vinput
j C
jCRf 1
1
Voutput

Rf
Rf
Ri
1

Voutput
Voutput

Ii

Vinput

IRf

Vinput

Rf

Ri

Rf 1 Rf
1

CRf

1
Ri
0

1
Ri

Rf
Ri

CRf

When frequencies (w) are high gain is reduced

Gain (1M Hz, C=1mF)

When frequencies (w) are low gain ~ -Rf/Ri

Gain (0 Hz, C=1mF)

Voutput

Voutput
Vinput

Rf
Ri

Rf

1
1
Rf

Ri j1M *1m * Rf 1 Ri number
jCRf 1

Defribillator
A Defribillator = a high voltage electrical heart
stimulator used to resuscitate heart attack
victims
When a physician applies this high voltage the
high voltages and currents can cause damage to
medical equipment BUT physician still needs to
view ECG of the patient
How do you protect your medical equipment
from excessively voltages and currents?

Protection Devices in ECGs: Glow Lamps

Glow Lamps are pair of electrodes mounted in a glass

envelope in a atmosphere of lower pressure neon gain
or a mix of inert gases
Typically impedance across electrodes is high but if
voltage across electrodes exceeds ionization potential
of gas then impedance drops so you create a short to
ground so vast majority of current goes safely to
ground and avoids your amplifiers

Protection Devices in ECGs: Zener Diodes

Diode: device that conducts electricity in one direction

only
Zener Diode: Turns-On when a minimum voltage is
reached so in this configuration if a large voltage is
applied (ie defibrillator) the zener diode will allow
current to flow and shunts it to grounds thus current
goes to ground and not to the amplifiers

Protection Devices in ECGs: CurrentLimiting Diodes

Diode: device that conducts electricity in one direction

only
Diode acts as a resistor as long as current level remains
below limiting point. It current rises above the limit, the
resistance will change and the current will become
clamped
Can also use a varistor (variable resistor) which functions
like a surge protector that clips spikes in voltages

Types of Defibrallitor Damage

Defibrillator is 6X greater than normal working
voltage so damage will eventually occur
Two forms of Damage:
Both Amplifier inputs are blown thus readout is a flat
line
One amplifier input is blown so the ECG appears
distorted

Cause is from zener diodes becoming open or

from glow lamps becoming defective from an air
leak, or recombination or absorption of gases
Recommended that lamps are changed every 12 years or sooner if ECG is in Emergency Room

Effect of Voltage Transient on ECG

Sometime a high voltage transient is applied to the patient

(defibrillator) which cause magnitudes much greater than
biopotential signal (ECG) which saturates the amplifier
Once the voltage transient signal is removed the ECG
signal takes time to recover

Example of bandwidth and

magnitude of various biopotentials
ECG is approximately 1 mV and spans from DC to 500 Hz
Book assumes Diagnostic mode is 0.05 Hz to 100 Hz

Electro-Surgery Unit (ESU)

Filtering
While a surgeon is conducting surgery he/she will
want to see their patients ECG
ESU can introduce frequencies into the ECG of
100KHz to 100 MHz and with magnitudes up to
kVolts which can distort the ECG
ESU introduces:
DC offsets
Obscures the signal

ESU needs to be of diagnostic quality thus you

must eliminate higher frequencies which are noise

Correct for high frequency noise using LPF

so ECG can function with ESU

RC Filters
Vs

Frequency

FH

Low Pass Filters will pass frequencies lower than cutoff frequency of
FH =1/2RC

Vs
FL

High Pass Filters will pass frequencies greater than cutoff frequency
of FL =1/2RC

Schematic of Multi-channel Physiological

Monitoring System

Instrumentation Inputs:

Figure 8-11

Up to 12 leads to ECG
Lead 13 is for RL driver (feedback to patient and then machine needed to reduce common mode
voltage
Blood pressure
Body Temperature
Blood gases

Buffers which are noninverting amplifiers to give high input impedance or large resistor
Wilson Network: series of resistors
Digitization of Signal
Serial data output to display

Instrumentation Amplifier using

OPA621
Differential resistors are the same
thus this stage of the circuit has a
gain of 1

2 Rf
G 1
Rg

2 * 249
1
5
124

CMR OPA621

Vout

Adiff
magnificationofdifferentialsig nal V 2 V 1
CMRR

Acomm
magnificationofcommonsignal
Vout

Vin

Vin = V1 = V2
Frequency has an effect on CMR!

Circuit Schematic of an example of ECG

Lead I (LA RA) means LA is going to the noninverting input and RA is going to
inverting input
Precordial are the chest leads

Block diagram of Entire ECG Circuit

Digitization of Signal

DC Offset severely affect the resolution of your signal and if DC offset is too high
You may not see your ECG Signal
More bits to A/D board (10, 12, 19, 22) the more resolution to your signal because you
Can represent you signal with better resolution

Homework
Read Chapter 9
Derive the gain equation for an instrumentation
amplifier.
What resistor values could be used to produce a
gain of 10 for an instrumentation amplifier?
Why do you use non-inverting Op Amps in the
first stage of an instrumentation amplifier?
Prove that feedback used for the right leg driver
can decrease the overall noise in your circuit.
Problem 1 Chapter 8

Schedule
Home Ch8 due 4/4
Exam 2 on 4/11
Material on Exam 2 Chapters 7, 2, 8, 9, studio exercises,
labs, homework, class notes

ECG design labs due 5/2

ECG team presentations 5/5 (Dr. Alvarez presenting at conference,
Florence Chua and class will grade presentations)

Final Exam 5/13 from 2:30 to 5:00 in Colton 327

(same room that we meet)
Cumulative, anything discussed during the semester will be
on the final, more emphasis on the material not covered on
Exam 1 & 2

ECG Example