Biomedical Sensors

Electrocardiogram (ECG) Sensors/Circuit

Lecture 3
Prof. Amira Salah Ashour

22 February 2025
Electrocardiogram (ECG or EKG)
oThe ECG records the electrical activity of the heart over a period using
electrodes placed on the patient's body.

oThese electrodes detect the tiny electrical changes on the skin that arise
from the heart muscle depolarizing during each heartbeat.
oThe ECG records measure the heart's electrical activities, including:
✓Heart-beat rate
✓Heart-beat rhythm
✓Heart strength and timing
Electrocardiogram (ECG or EKG)

• The ECG machine works by detecting and amplifying the tiny potential changes
on the skin that caused when the electrical signal in the heart’s muscles is
charged and spread during each heart-beat.

• This is detected as tiny rises and falls in the voltage between two electrodes
placed either side of the heart.
ECG Uses
➢An ECG can be used to measure:

◦ The effect of cardiac drugs

◦ The rate and rhythm of heart-beats

◦ The function of implanted pacemakers

◦ The size and position of the heart chambers

◦ The presence of any damage to the heart muscle cells or conduction system

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Types of ECG
1. Stress Electrocardiography
The ECG is used to assess the patient’s response
to an increased cardiac workload during exercise
using treadmill or stationary bicycle.

2. Continuous Electrocardiographic Monitoring

It is standard for patients who are at risk and
suffer from dysrhythmia.
Heart Electrical (conduction) System

oSinoatrial (SA) node

oAtrioventricular (AV) node

oHis-Purkinje system
Electrical Conduction System
ECG pulse formation due to the electrical activity of the heart as follows:

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ECG waveform

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 ECG waveform
oA typical ECG tracing is a repeating cycle of three electrical
entities:
o P wave (atrial depolarization)
o QRS complex (ventricular depolarization)
o T wave (ventricular repolarization).

➢A typical ECG beat mainly has 5 different waves (P, QRS, T, U

and B):
◦ P wave: Atrial depolarization
◦ QRS complex: Ventricular depolarization
◦ T wave: Ventricular repolarization
◦ U wave: Repolarization of the Purkinje fibers
◦ Baseline: The polarized state
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Schematic representation of normal ECG
❑ P wave: signal spread from SA node to make
the atria contract.

❑ P-Q Segment: signal arrives AV node stay for

an instant to allow the ventricle to be filled with
blood.

❑Q wave: After the Buddle of His, the signal is

divided into two branches and run through the
septum.

❑R-S wave: Left and right ventricle contraction

are marked by the R,S wave.
❑T wave: ventricle relaxing
❑Base line
ECG Graph Paper
Voltage
0.04 seconds
(millivolts; mV)
y

(1  1) mm2 0.1 mV

x’ x
Time (seconds; s)

Question: What would the bigger

square, i.e. the (5  5) mm2, represent?

y’ Answer: 0.2 seconds.

 3. Ventricular repolarization
2. Ventricular
depolarization

1. Atrial
depolarization

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Electrocardiogram (ECG)
•The electrocardiogram (ECG or EKG) is the graphical recording of the electrical activity of the heart
over a period.
•It is usually recorded by a set of surface electrodes placed on the chest.

•The ECG can be measured as a multi- or single- channel signal, depending on the application.
◦ During regular measurement of the standard clinical ECG, 12 different leads (channels) are recorded
from the body surface.
oIn a conventional 12 lead ECG ten electrodes are placed on the patient’s:
•limbs and
•on the surface of the chest recorded over a period (usually 10 seconds).

◦ In arrhythmia analysis, only one or two ECG leads are recorded to investigate the life-threatening
disturbances in the rhythm of the heartbeat.
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ECG SIGNAL
The typical ECG bio-signal has the following characteristics:

o low differential voltage from 0.4 to 3 mV

o high common-mode rejection ratio level
o low frequency range
o high noise
ECG SIGNAL
Artifacts (disturbances) can have many causes. Common causes are:
1. Movement

Sudden movement

Baseline drift
ECG SIGNAL
2. Electrical interference
oIt can be produced from a nearby electrical appliance

oA typical example is a 100 Hz background distortion from fluorescent lights.

oIt can be confused with diagnosing atrial fibrillation.
ECG Basics
Amplitude: 0.4 to 3 mV
Bandwidth: 0.05-100 Hz

Largest measurement error sources:

◦ Motion artifacts
◦ 50/60 Hz power-line interference

Typical applications:
◦ Diagnosis of ischemia
◦ Arrhythmia
◦ Conduction defects

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Types of ECG Leads
Types of the leads used to obtain the ECG signal:

1. Standard 12 Lead
Most used tool to diagnose:
o Dysrhythmias
o Conduction abnormalities
o Enlarged heart chambers
o Myocardial ischemia or infarction
o High / low calcium and Potassium level
o Effects of some medications
Types of ECG Leads
2. 15 Lead ECG

o 3 chest leads are added across the right precordium

o A valuable tool for early diagnosis of right ventricular and posterior left
ventricular infarction

3. 18 Lead ECG

o 3 chest leads are added from the 15 lead ECG

o Early detection of Myocardial Ischemia and injury
Placement of Electrodes

oElectrodes are placed on chest in a predetermined order

oTen electrodes are used for a 12-lead ECG

oThe electrodes placement mechanism usually consist of a conducting gel, embedded in the
middle of a self-adhesive pad onto which cables clip.

oProper placement of the limb electrodes, color-coded.

oThe limb electrodes can be far down on the limbs or close to the hips/shoulders, but they must
be even (left vs right).
Electrode
Electrode placement
label
RA On the right arm, avoiding thick muscle.
LA In the same location where RA was placed, but on the left arm.
RL On the right leg, lateral calf muscle.
LL In the same location where RL was placed, but on the left leg.
oInstruct patient to be calm and no movement, then print the result
oThe test is completely painless and takes less than a minute to perform once the leads are
in position.
oAfter the test, the electrodes are removed & clean the skin
ECG Electrode System

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 ECG Electrode
Leads
oThe resulting potential in the heart conducts to the
body surface.
oThe electrical signals from the heart are measured
with surface electrodes.
oStandardized electrode positions are used to record
the ECG.
oThe signal recorded as the difference between two
potentials on the body surface is called an "ECG
lead".
oEach lead is said to look at the heart from a
different angle.
ECG Leads System
•The ECG Leads are electrodes that measure the difference in the electrical
potential between either:
1. Two different points on the body (bipolar leads)
2. One point on the body and a virtual reference point with zero electrical potential,
located in the center of the heart (unipolar leads)

•The three types of electrode systems are

oBipolar limb leads (standard leads) (3 electrodes): I, II, III
oAugmented unipolar limb leads (3 electrodes): aVR, aVL, aVF
oChest leads ‘Precordial Leads’ (6 electrodes) (unipolar):V1,V2,V3, V4, V5, V6
The axis of a particular lead represents the viewpoint from which it
looks at the heart.
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 ① Limb Leads (Bipolar)
12-Lead ECG measurement ② Augmented Limb Leads (Unipolar)
③ Chest Leads (Unipolar)

oThe signal is measured non-invasively with electrodes + 1 reference electrode (right leg)

Einthoven leads: I, II & III Goldberger augmented leads: VR, VL & VF Precordial leads: V1-V6

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ECG Electrodes

Lead position

Lead III Lead 12

1) Three Bipolar Limb leads – Standard Lead I, Lead II and Lead III
oThis lead system is also known as Einthoven
lead system.
o Two electrodes record the ECG signal.
oFrom four body locations, namely Right
Arm(RA), Left Arm(LA), Right Leg(RL) and Left
Leg(LL), the heart potentials are recorded.
oFinal output is the difference between the
electrical potential generated between these
two electrodes.

oRight leg is the ground reference electrode.

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Lead I
•Voltage drop occurs from left arm (LA) to right arm (RA).
•Generated voltage is VI.

•The electrode at the LA (+) is considered the exploring

electrode.
•The electrode at the RA (-).

•The electrode at the RL is considered a reference electrode.

•Thus, a vector moving from the right to left should yield a

positive deflection in Lead I.
•Lead I defines 0-degree angle in the frontal plane, means it
views the heart at angle of 0 degree.
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Lead II
•Voltage drop occurs from left leg to right arm.
•Generated voltage is VII.

•The electrode at the LL (+) is considered the exploring

electrode.
•The electrode at the RA (-).

•The electrode at the RL is considered a reference

electrode.

•Lead II views the heart at angle of 60 degree.

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Lead III
•Voltage drop occurs left leg to left arm.
•Generated voltage is VIII.

•The electrode at the LL (+) is considered the

exploring electrode.
•The electrode at the LA (-).
•The electrode at the RL is considered a reference
electrode.

•Lead III views the heart at angle of 120 degree.

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Einthoven Triangle
• Each lead gives a slightly different representation of electrical activity of heart.
• Note potential difference for each lead of triangle.
• Einthoven triangle is the closed path formed between right arm, left arm, left
leg and right arm.

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•Einthoven has defined that cardiac electric vector is two dimensional along the frontal plane of
the body.
• Along the projections of the triangle, vector sums on three sides of triangle is zero.

•Using Kirchhoff’s law, the amplitude of R wave along the lead II is equal to the summation of
amplitude of R wave along lead I and lead III.

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2) Three Augmented Unipolar Leads
•In the augmented unipolar limb lead system, the ECG is recorded between
single unipolar exploratory electrode and central virtual terminal.
•Central terminal relates to the center of the body.
•Two equal and large resistors are used.
•Pair of limb unipolar electrodes is connected to the resistors.
•The center joint connection of this resistive network forms the central
terminal.
• The remaining portion of the limb electrode forms the exploratory
electrode.
•In this lead system, a very small increase in ECG voltage can be found.
•Three types of connections are used as follows.
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Lead aVR

•Right arm is connected to the positive

terminal of the amplifier. (exploring)

•Two resistors are connected to left arm and

left leg.
•The middle point of the resistor connection
is connected to negative terminal.

•The right leg acts as a ground terminal.

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Lead aVL

•Left arm is connected to the positive

terminal of the amplifier. (exploring)

•Two resistors are connected to right arm

and left leg.
•The middle point of the resistor connection
is connected to negative terminal.

•Right leg acts as a ground terminal.

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Lead aVF
•Left leg is connected to the positive terminal of the amplifier.
(exploring)
•The electrode on the LL serves as the exploring electrode.

•Two resistors are connected to right arm and left arm.

•The middle point of the resistor connection is connected to
negative terminal >> average of the arm electrodes.

•Right leg acts as a reference terminal.

•Thus, any vector moving downwards in the chest should yield a

positive wave in lead aVF.
•This aVF lead views the heart’s electrical activity at 90 degree.

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•The limb leads, both bipolar and unipolar, are closely related.
•In fact, if any two of the six limb leads are recorded simultaneously, the other
four can be derived from them.

For example, aVF is as follows:

1
𝑎𝑉𝐹 = −𝑉3 − 𝑉1
2

(𝑉1 and 𝑉3 are bipolar lead voltage)

Proof the different relations (Equations)

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3) Six Chest Leads (Precordial Leads)

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 12-Lead ECG measurement >> Bipolar: 3 Standard Limb 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 noninverting amp. input and RA connect to inverting input and LA shorted to
RL
- Lead III = LL connected to noninverting input LA connected to inverting input
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12 Lead ECG System >> Unipolar: 3 Augmented Limb Leads

Unipolar Limb Leads= augmented limb leads 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
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augmented (amplified) Voltage for Foot (aVF)
Any Question!!

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