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Mobile Cardiac Monitoring

New way to care... S NAVEEN III ECE Naveensingamsetty398@gmail.com DBS INSTITUTE OF TECHNOLOGY P. NO: 8500756446 S VINEEL III ECE vineel300@gmail.com DBS INSTITUTE OF TECHNOLOGY P. NO: 9553735762

Abstract
Physical activity is one of the most basic human functions and essential for physical and mental health and sometimes, may effect on chronic diseases such as heart disease, stroke, etc. Awareness of this condition has been one of the focuses for researching over recent years. With the adoption of 2G and 3G cellular network technologies, mobile phones now have the bandwidth capability to stream data back to monitoring stations in real-time. The basic idea is to develop a user-friendly mobile wireless ECG and motion activity recording device. This paper describes a complete remote monitoring solution where Bluetooth electrocardiogram sensor transmits the patients medical data to a cell phone. This data is displayed and stored on the phone. The GPRS network connected to the system will provide continuous monitoring of a patients heart where cellular coverage is available. This is an effective and secure tool that transfers data from different measurement devices to the health care provider via a mobile platform by using mobile phone networks. This solution ensures that the results displayed on mobile phone are accurate and both cost and time effective, providing the best communication between patient and doctor. Timely review of patient data with close to real time feedback is a critical success factor in todays disease management environment. With this solution, maintenance and treatment become faster and easier.

and analyzing is the electrocardiography (ECG) signal. For the patient suffering from the cardiac disease it is very important to perform accurate and quick diagnosis. For this purpose, a continuous monitoring of the ECG signal and the patients current heart activity are necessary. This has been achieved by using the latest generation of mobile phones. This paper gives a survey of todays solutions for ECG telemonitoring , from an engineers point of view.

Figure 1 . Mobile phone displaying ECG, Temperature, Blood pressure level and oxygen saturation level

1. Introduction
There are many heart diseases, where a long term real time ECG monitoring is necessary. With the development of electronics and its applications in medicine, it is possible to transmit and process many vital parameters of the human body. The most important and interesting signal for monitoring

The equipment consists of ECG electrodes, a small control unit and a smart mobile phone. ECG data is collected by the control unit and wirelessly transferred tot the mobile phone. The mobile phone analyzes the data; if it deviates from normal values, it is forwarded to a decision support system. The data is then transferred to the healthcare providers system for analysis. With a medical sensor relaying EKG data via a cell phone, it is possible to track a patient at home or anywhere a cell phone signal is available. If a cardiac event is detected by the monitor or a medical professional at a remote monitoring station, the patients location can be obtained via a Global Position Satellite (GPS) unit attached to the phone and relayed to emergency personnel.

2. Prototype Design

The flow of data from the electrocardiogram (EKG) sensor is shown in Figure 2. The EKG sensor is attached to the patient with three leads, two on the chest, and one on the left leg or in an alternative configuration with the leads attached on the arms. The sensor outputs an analog signal which is then converted by the analog-todigital converter (ADC). The serial-toBluetooth module transmits the digital output of the ADC to the cell phone. On the phone, the sampled EKG is displayed and stored. The next stage is to implement code to relay the EKG data via General Packet Radio Service (GPRS) and evaluate the transmission to a website via the cellular network.
EKG Sensor

convention, lead I has the positive electrode on the left arm (LA), and the negative electrode on the right arm (RA), and therefore measures the potential difference between the two arms. An electrode on the right leg serves as a reference electrode for recording purposes. The main signal measured is Lead I that is obtained by measuring the electrical potential between left arm and right arm. Since the left arm is the positive pole, an electrical wave moving towards the left arm will cause an upward deflection of the electrocardiograph. Lead has I angle that is 0 relative to the heart therefore it is most useful for detecting electrical activity in a horizontal direction.

Analog-toDigital Converter

Serial-to- Bluetooth Module Serial-to-Bluetooth Module

Figure 3. Standard limb led positions, bipolar. Einthoven triangle

EKG DATA FLOW

These pads are actually small leads connected back to a monitoring system that will measure the potential voltage differences around the heart. 2.2. Waves and Intervals A typical ECG tracing of a normal heartbeat (or cardiac cycle) consists of a P wave, a QRS complex and a T wave as shown in Figure 4. A small U wave is normally visible in 50 to 75% of ECGs. The baseline voltage of the electrocardiogram is known as the isoelectric line. Typically the isoelectric line is measured as the portion of the tracing following the T wave and preceding the next P wave. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It is usually 120 to 200ms long. On an ECG tracing, this corresponds to 3 to 5 small boxes. Based on the type of

Figure 2. EKG data flow

2.1. ECG Sensor An ECG involves placing small pads in a triangular fashion on the patients chest, with the perimeter of the triangle completely encompassing the heart as shown in Figure 3. The lead placements are labeled according to the location on the body (LA Left Arm, RA Right Arm, RL - Right Leg and LL Left Leg). The corresponding waveforms are numbered using Roman Numeric. By

variations during PR interval, different kinds of heart attacks can be predicted. Patient Electrical Output Bluetooth Module

Filtering signal of noise

Gain and Voltage Correction

Microprocessor ADC

Figure 5. Overview of sensor

2.4. ECG Hardware The design of the ECG sensor circuit was successful. Figure 6, shows an ECG signal acquired by the sensor on a Cathode Ray Oscilloscope. Noise was reduced through implementation of a ground plane and reduction of electromagnetism by twisting lead wire. Filtering techniques attenuated unwanted noise to highlight the ECG signal. It can be seen from Figure 6 that the signal was rectified into realms of ADC, with only positive voltages being delivered. Figure 7 shows the final PCB for the sensor circuit. It can be seen that the PCB is small, around 3 square inches.

Figure 4. Representation of normal ECG

The QRS complex is a structure on the ECG that corresponds to the depolarization of the ventricles. A normal QRS complex is 0.06 to 0.10 sec (60 to 100 ms) in duration represented by three small squares or less, but any abnormality of conduction takes longer, and causes widened QRS complexes. The QT interval is measured from the beginning of the QRS complex to the end of the T wave. Normal values for the QT interval are between 0.30 and 0.44 (0.45 for women) seconds. The QT interval is very important for the diagnosis of long and short syndromes. The QT interval varies based on the heart rate, and various correction factors have been developed to correct the QT interval for heart rate. 2.3. Sensor Overview Two major problems were encountered in the design of the ECG sensor. One is that the signal being measured was quite small, and many other signals such as noise were larger and stronger; and other is that the signal is varied into positive and negative quantities at different times. This is due to the microcontrollers A/D converter as it could only read voltages from zero to five volts, and the power supply of the microcontroller only allowed positive voltages to be delivered. The main stages of the final design are depicted in Figure 5. The signal is picked up from the patient, before undergoing signal processing to remove noise, then being amplified and put in the correct range of the Analog to Digital converter.

Figure 6. CRO output Assembled of the ECG sensor circuit board

Figure 7. ECG printed

3. ECG Transmission at patients end


An electronic hardware is designed using Analog to Digital converter, Microcontroller, LCD display and Bluetooth. Patient is connected to 3-Lead ECG miniature sensor. This output is sent to the hardware that has been constructed. This electronic hardware measures ECG and other vital medical parameters and transmits the data through GSM Connection as shown in Figure 8. The ECG electrodes that are used are disposable. They do not cause any irritation on the patients body. Any kind of wireless connection can be used like GPRS, Wi-Fi, Bluetooth, GSM etc.

heart rate limits is done. Based on the patients condition, the mobile phone displays the heart beat level and also the comparison with the threshold levels as shown in Figure 10. This gives the clear idea for the patient about his health condition. This data is automatically sent to the Doctors mobile as per the settings made in mobile phone.

Figure 8. ECG Monitoring and Transmission at patients end

4. ECG Reception at Doctors End


The data which is transmitted through the GSM connection or Bluetooth from patients end is sent to the Doctors Windows Mobile phone and also to the Telemedicine Server. The Desktop Telemedicine server maintains the database of the medical records. Doctor gets the information in his mobile from the server and also directly from the patients mobile. Immediately, the doctors advice is sent to the server as well as to the patients mobile phone. This is shown in Figure 9.
Figure 10. Heart rate on mobile

5.1. Check ECG leads and Battery ECG leads and batteries must be checked continuously. During the night time, smart phone will be in the cradle recharging. ECG sensor must be attached for 24 hours every day. Bluetooth sensor ranges 20 meters from smart phone. 5.2. Synchronizing of data with health centre Automatic synchronization is done when phone is in cradle. Emergency data is send immediately via GPRS or SMS to the Doctors mobile phone. 5.3. New place and detecting location

Figure 9. ECG Reception at Hospital and Doctors End

5. Health check
For the health check to determine which sensors to use and their thresholds, ECG recording is made and the setting of

Figure 11. Identification of Location using mobile

When ever a patient is visiting a new place, the location of the patient can be

detected through the GSM services and also exact location is known to emergency services. Figure 11 shows the displaying of location identification on mobile.

Once the Acquire ECG Data Button is pressed as shown in Figure 14, then Enter phone number dialog opens as shown in Figure 15. Enter the phone number in the Edit Box, and press Options->Select Line.

6. Emergency
Under emergency situations, the mobile phone detects the Heart Failure or Heart Fall conditions. Then, the mobile phone automatically dials for ambulance and other numbers in contact list. The phone plays recorded message stating emergency as shown in Figure 12. The mobile phone also displays the kind of diagnosis required, heart rate and address.
Figure14. Acquire Enter Phone Number Figure 15 ECG Data

A pop up screen appears as shown in Figure 16.

Figure mobile

12.

Emergency

display

on

Message is played continuously indicating the problem and instructing (potential) bystanders what to do.

7. Windows Mobile Device Application


The application on Windows Mobile device provides two options for the user. One is to acquire the ECG data and other is to plot the ECG data.

Figure 16 Pop up screen

Select Cellular Line as the Line and press OK as shown in Figure 17.

Figure 13. Menu option

Figure 17 Selecting Cellular line

Press the right menu button labeled Menu to view the options as shown in Figure 13. 7.1. Acquire ECG data

To view the ECG waveform, press Plot ECG Button in the main Window menu of the application. A File Open Window opens, which allows the user to select a file, to be viewed as ECG as shown in Figure 21.

Figure 18. Pressing Dial

Now press Dial to make the data call as shown in Figure 18. 7.2. Data Call A data call is made, and once the call is connected, data is transferred onto a text file in the mobile phone. A display of connected data call on mobile phone is shown in Figure 19.
Figure 3. ECG files

Once a file is selected, the ECG waveform is plotted on the screen. While the ECG is being plotted, Press 1 to zoom or shrink the waveform and Press 2 to pause or play the waveform. Figure 22 shows the ECG waveform that is captured and Figure 23 shows the ECG waveform after zooming.
Figure18. A connected data call

After successful data transfer, a message box pops up, informing the user that the data is transferred. A display of successful transfer of data on mobile is shown in Figure 20. Once the data is received, Hang Up and Quit the data call Window.
Figure 4. Plot of ECG Zoomed ECG plot Figure 5. version of

8. Real Time Application


Sometimes, a high blood pressure may be a reason for a heart attack. In Loughborough University, this system has been tested practically for monitoring both heart and blood pressure.

Figure 2. Successful transfer of data

7.3. Plot the ECG data

Figure 6. ECG leads connected to patient

Figure 24 shows an ECG sensor with its leads connected to the patient and signals are received via Bluetooth in patients mobile phone. In Figure 25, mobile phone displays the details of the patients heart rate, blood pressure temperature, oxygen saturation level and also the ECG signal.

The Mobicare Cardio Monitoring System consists of a cellular phone embedded with real time ECG processing algorithms (MobiECG), a wireless ECG sensor, a web based server, a patients' database and a user interface. The key role of MobiECG here is to works as a local processor to process data in real time. It receives ECG and accelerometer data from wireless ECG sensor via Bluetooth, filters the data, detects QRS complex, identifies Q onset and T offset in ECG waveform, and calculates intensity of patient's body movement using obtained accelerometer data.

Figure 9. Mobicare Cardio Monitoring Hand phone Figure 7. Patient health details on mobile

ECG processing is carried out by MobiECG and it will send the abnormal ECG data over a cellular network (GPRS/3G) to hospitals or care centers to alarm physician only when it detects abnormal ECG signal. A Web server is set up to receive data from the cellular network and route the data to terminals in hospitals or care centers. Mobicare cardio monitoring hand phone is shown in Figure 27. 9.1. Mobicare monitoring ECG in Real Time

Figure 8. Display on a laptop at the doctors place

The patients mobile phone details and health condition is displayed on Laptop which is at the doctors place. With this, the doctor takes the necessary steps needed to take for the treatment of the patient and also sends SMS to the patients mobile for giving the advice at the right time. Figure 26 displays the patients details on doctors laptop.

In Real Time, ECG sensor is attached onto a person for testing. The person was asked to go through a series of non-strenuous activities like moderate jogging and stair climbing shown in Figure 28. It was observed that the ECG signal though received, processed and recorded on the mobile phone was not sent to the Mobicare Monitoring GUI as the heart rate was normal.

9. Mobicare System

Cardio

Monitoring

GSM to these systems, allows the wireless transmission to health or control centers.

11. Limitations
While monitoring the patient continuously, the battery life of the devices used must be taken into consideration. The ECG sensor battery lasts for approx 60 hours. The smart mobile phones battery only lasts for approx eight hours when continuously connected to the ECG Bluetooth device which can be an issue if the wearer is not close to the charger (less than 10 meters). This can be solved by charging the smart phone while being monitored. 11.1. Handling of Security and Privacy Issues The transmission of binary data is often seen as a possible security threat. Because of its nature, a binary can contain any sort of data including for example viruses and other malware. Thus, it is extremely important to positively authenticate the sender when exchanging binary data. This is done by using unique session keys and secured protocols. With this, the security and privacy for patients details is achieved.

Figure 10. MobiECG Processing ECG Signal in Real Time

Later, the ECG data was forwarded as the persons heart rate crossed the threshold of 140 beats per minute signaling that his heart beat is too fast. These are pre-cautionary in nature. Thus, MobiECG forwards the ECG signal only when it is under abnormal condition.

10. Advantages
Monitoring of ECG using mobile is simple, efficient and useful to everyone. It gives a quick access to the doctor and provides the right advice at the right time. The patient is monitored and reassured without needing to be continuously connected to a healthcare center, thus, reducing the communication costs. 10.1. For Patients For patients, their life quality and possibilities to live a normal life increases with this system. Everyone feel more secured to travel at work and for leisure. Mobile telemedicine systems are available all the time, especially in the care of patients that are isolated or traveling, far from a reference hospital. 10.2. Care There is a relieved pressure on equipment and personnel. Earlier warning and basic data is provided for decision of care through correct diagnosis. Health care quality improves. There will be immediate evaluations of effects from medical treatment. 10.3. Low Cost and Simple Technology These systems are embedded in low cost, small devices with low power consumption, and have an interface that is usable by the patient. Incorporating technologies such as Bluetooth, GPRS or

12. Conclusion
Cardiac patients can now be mobile and at the same time under the observation. This system provides a good solution for ambulatory and continuous monitoring when cardiac patients are out of hospital and going about their daily life. This system exists in reality and has been proved in real time applications. For an anywhere at anytime monitoring system, devices used have to be actually mobile. Hence, the usage of mobile phones is considered as the core of these kinds of monitoring systems. Thus, this system is a step towards promoting patients autonomy and by providing personalized monitoring and advice and it will give the patients more confidence and improve their quality of life.

13. References

[1] Electronics for you, December 2007 edition [2] www.alivetec.com [3] www.kiwok.com [4] www.aerotel.com [5] www.google.com