A MICROCONTROLLER-BASEDPORTABLE ELECTROCARDIOGRAPH

SYSTEM
J.J.Segura-Jucirez,D.Cuesta-Frau and LSamblas-Pena

Department of Computer Science, Polytechnic University of Valencia (EPSA), Alcoi, Spain, EU

ABSTRACT
The ambulatory acquisition and monitorization of electro-
cardiograms (ECG) under not controlled conditions, is a
practice of paramount importance in cardilogy diagnosis
nowadays. The ECGs are acquired while patients develop
their normal life, using a portable device. The storage ca-
pacity of such devices usually ranges from 24 to 48 hours.
The systems used to perform this task are the so-called
Holter systems. In this paper we describe a low cost sin-
gle channel Holter system, based on a microcontroller,
to register the ECG signal continuosly during up to 48 Figure 1. Main blocks of the system. For the sake of sim-
hours. This microcontroller system runs off batteries, and plicity, some block interconnections have been omitted.
includes many peripherals such as a display, keyboard, se-
rial interface, solid-state memory, and some electronic cir-
cuits. plex and time consuming tasks are usually carried out off-
line, in a personal computer. Moreover, the sampling fre-
quency required to obtain a good quality ECG is fairly low,
1. INTRODUCTION of some 100Hz. Therefore, the microcontrollercan devote
more time to the rest of tasks, such as error generation,
Electrocardiography is a non-invasive technique to ascer-
memory card operations, etc.
tain the state of the heart, based on the electrical potential
generated by it and measured on the body surface using, in The organization of this paper is as follows. In the next
section, Methodology, all the stages of the process will be
its basic configuration, two electrodes and a galvanome-
ter. This technique is widely known and nearly a cen- described Acquisition, probe, amplifier, analog to digital
tury old already. Nevertheless, in the last decades mainly, conversion, processing, storage, visualization, serial inter-
due to the availability of powerful and low cost comput- face, and power source. In the last section, Conclusion,
ers, electrocardiography has witnessed the development of we will summarize the main points of this paper and the
new systems and applications, such as the ambulatory ac- future work.
quisition of ECGs using the so-called Holter systems [l].
These systems are used to register the signal during a long
2. METHODOLOGY
period of time, between 24 and 48 hours, in order to detect
some heart malfunctions difficult to find using a simple
The system description will he performed according to the
electrocardiogram.
logical order of the stages. We will first address the ac-
In this paper we present the development of a com-
quisition stage, follow the signal path through the probe,
plete Holler system based on microcontroller. ?he cir-
amplifier and analog to digital converter, and finish with
cuit uses standard integrated circuits and components, and
the data storage in memory and the power source. Fig. 1
therefore, it is a low cost set easy to build. It can be used
is a schematic diagram of the system main blocks.
in clinical practice, since it fulfils all the required speci-
fications, and in microcontroller and electronics teaching
purposes, as it covers a wide range of topics related to mi- 2.1. Acquisition
crocontrollers and signal conditioning. Many other similar
circuits have been repotted so far in the technical litera- The ECG signal acquisition is obviously the first stage of
ture, as those described in [Z],[31, and [41, hut, as far as the process. Three electrodes are used, placed at different
we know, none of them describes a portable and affordable points on the patient’s body surface. The exact position
device with the performance of a commercial Holter. depends on the type of analysis required or the lead de-
Computational power of a simple microcontroller is sired. Two of the electrodes are the differential input, and
enough to implement a Holter system, since the most com- the third is used to reduce the noise due to the power line

0-7803-8163-7/03/$17.00 0 2003 IEEE ICECS-2003

922
interference, and to provide a return way for the polariza-
tion currents [51.
2.2. Probe
The probe is the electrical connection between the elec-
trodes and the amplifier, the system input. It consists of
three wires, which are shielded and twined in order to re-
duce as much as possible the induced electrical noise. In
the amplifier end, the probe has a shielded tripolar connec-
tor and a fastening system to prevent the accidental uncou-
ple due to sudden jerks or patient movement during their
usual activities.
The probe shield is connected to the common mode
voltage of the differential amplifier through a voltage fo-
llower, which derives the interference currents induced in
the wire towards ground. This connection allows us to
reduce the parasitic capacitance that appears between the
wires and the ground when it is connected to ground, and
therefore avoids input impedance reduction.
2.3. Amplifier
The first block of the system is the differential instrumen-
tation amplifier. Since the level of the electrocardiograph
signal is only of some p V , it is necessary to amplify it to
match the levels of the analog to digital converter, avoi-
ding saturation either in the amplifier or the converter. A
precise amplifier has been designed with very low pola-
risation currents and small offset voltages to fulfil these
requirements. A high common mode rejection of around
120dB is also achieved.
This amplifier includes a high pass filter, formed by a
quadruple precision operational amplifier, to filter out the
base line wandering. The amplifier also creates a virtual
ground, applies the common mode voltage to the probe
shield, and reduces the third electrode impedance to mini-
mize the power line interference. This amplifier satisfies
the American Heart Association specifications about the
bandwidth of the amplifier, O.lHz-Il"z, in order not to
lose i m p o m t information of the signal. This margin is
the minimum required to avoid a distortion greater than
10% in the signals.
In Fig. 2, the different electrocardiographic amplifier
stages are shown. It is basicaly composed of a first stage
of an instrumentation amplifier and four more stages based
on different configurations using operational amplifiers.
Following the probe connected to the human body surface,
it can be noticed that the derivation enters directly to the
instrumentation amplifier, and then the baseline wander is
filtered out using an operational amplifier with adjustable
gain. The rest of the stages are support stages for the previ-
ous ones with the following rationale: the operational am-
plifier AO(U1C) is used to create a virtual ground with
a voltage level half that of the power supply. The stage
with the OA(U1A) is a voltage follower whose ouput is
connected to the probe shield. Therefore, the loses due
to parasitic capacitances are reduced, and moreover, the
lead is protected against the electrical noise of the circuit
923
..
Figure 2. Differential instrumentation amplifier.
environment. The last stage with the OA(U1D) is an in-
verter amplifier. The third electrode impedance is reduced
using this configuration, and a high impedance is applied
to prevent the ground-fault h,uard. Nevertheless, electri-
cal shock is very unlikely since the system only mns off
batteries.
2.4. A/D Conversion
Once the ECG signal has been amplified and filtered, it
must be digitized. The analog to digital converter utilised
is the AD7888 [SI. This converter has 12 bits of resolu-
tion, and 8 input ports, although in this application only
two are used. The amplifier is software controlled and the
conversion takes place during the error calculation of each
memory sector. Each sample converted is stored in the cor-
responding memory area, which, after completing a whole
data page, will be written in memory alongside error cal-
culations computed in parallel with the analog to digital
conversion.
The AD7888 is capable of a 125KSPS rate. The input
track and hold acquires a signal in 50011sand this circuit
operates with a power supply voltage from 2.7 V to 5.25
V. CMOS construction ensures low power dissipation, tipi-
cally 2mW for normal operation and 3pW in power-down
mode. The DC accuracy of th,: AD7888 is tipicaly 1 LSB
of integral nonlinearity, -U+] .5 LSB differential nonlin-
earity, and an offset error of & 6 LSB.
Communication with the AD converter is perfomed
through the SPI port of the microcontroller, and by means
of an enable signal also controlled by the processor. Am
other converter input is used to measure the power source
voltage and thus monitorize the battery charge level. This
level can also be checked by the user using the interac-
tive menu shown on the display. All its features regarding
the low power consumption, power source voltage require-
ments, control, and communications, make it a very suit-
able choice for this application.
2.5. Processing
This is the most important stage of the system. On one
hand, it is devoted to interact with the user through a nav-
igating menu shown on the I.CD display. On the other
hand, it stores the data obtained from the analog to digital
converter in memory, using a suitahle format in order to
be read by the operating system properly. It also has the
serial port control through which data can be transmitted
in real time if desired. The LCD control where the interac-
tive menu is shown is included. The display contrast level
can be adjusted by means of a microcontroller pin. It also
controls the calendar and power failure protection circuit
which will be described in section 2.9. The user can also
interact with the system using a simple keyboard.
The CPU of the system is the ATMEL microcontroller
T89C51RC2 [IO], compatible with the Intel family of mi-
crocontrollers MCS5 l . This microcontroller has embed-
ded peripherals such as:
Two timers of 16 hits.
One UART with the possibility of using masks
A watchdog clock.
Six bidirectional parallel ports.
Power saving modes,
A matrix of programmable counters.
A keyboard interface.
The parallel pan, aw used to chaw data amung thv periph-
cralr. sXcsDt the LCD the S , , , d v d i n card. which
are memory mapped. The microcontroller ports 0 and 2
are used as data and addresses ports respectively, for the
devices directly memory mapped. Port 1 is used for com-
munications through the integrated SPI interface, which
can be put in shutdown mode to reduce the power con-
sumption. Port 3 hits are used for different tasks: serial
communications through the embedded UART, write and
read signals of the memory mapped devices, external in-
terrupts, some other peripherals control, etc.
The system is programmed to perform a wide range of
operations such as memory card formatting, activate po-
wer saving functions, sample frequency adjustment, ac-
quire and store the electrocardiographic signal, data and
time set, alarms programming, LCD contrast adjustment,
etc. Programming language used has been C.
The computational burden of the microcontroller is ma-
inly due to the error calculations. This process takes around
2 seconds for each sector, which is a delay unaccetably
large for the sampling process. In order to obtain a uni-
form sampling, the data acquisition is embedded in the er-
ror calculation algorithm.
Regarding the memory card, the control is canied out
on a hardware level by means of the ports, as mentioned
before. The software to control this card checks if the card
inserted is valid, and its capacity, whether it is formatted
or not, the free memory available, writes the data files, etc.
This p a t is transparent to the user.
2.6. Storage
The storage system chosen for this device is a solid state
memory, based on the SmartMedia model [9], whose for-
mat is regulated by the SSFDC [ I I , 121, where the ope-
ration, hardware and software of this kind of cards is des-
924
.>rn"/.UC
*S"CUI
-
F-rlP#
1
p,*r
f
Figure 3. Schematic diagram of the memory card. In this
device, a SmartMedia memory card is used.
crihed, as well as the data format needed to assure com-
patibility. The memory capacities available cover a fairly
wide range, from 2MB to 128MB, and they can he powe-
red using two voltages: 5 and 3.3 volts. This card model is
cheaper and easier to use than others with similar perfor-
mance, and the reliability of the data storage is very high,
making it appropriate for this medical application. In Fig 3
the schematic of this card is depicted.
The system prrvcntsthc uscrIromutiliJing invalidcard\.
For instance, i f it is detscvd that the card intormatim sys-
tem (CIS) is damaged or missing, a warning message will
be issued. On the other band, if the blocks are present,
but the format is invalid, another warning will be shown.
The system suppolts all the cards powered with 3.3 volts,
which are the ones with the highest capacities, whereas
those powered with 5 volts are of low capacity and not
supported.
2.7. Visualization
For menu visualization, warning messages, process infor-
mation, etc, the system has a E D . It is controlled through
ports 4 and 5. The display has a character matrix of 2 rows
per 16 columns, whose size is 84x44 mm. The display data
bus width can be configured to work with 4 or 8 bits. This
feature allows the display to be used either with 8 or 4 bit
microcontrollers. Asserting its busy line, the data flow can
be controlled.
2.8. Serial Interface
The microcontroller can share data with a personal com-
puter through a RS-232 serial interface or directly by me-
ans of the memory card, which is the usual case. Never-
theless, in order to have the possibility of real time data
transmission, this serial interface has been added to the
system. In Fig. 4 a visualization example is shown.
The serial interface needs 3.3 volts, with a consump-
tion of 1.3mA during normal operating mode, and 0.01pA
in shutdown mode. The connector is a typical male DB9
for printed circuits.

Figure 4. ECG data visualization and editing in a personal
computer.
2.9. Power Source
This portable Holter system tuns off two AA batteries se-
rial connected, which can he rechargeables, yielding a vol-
tage of 3V. Since the system needs 3.3 volts, the voltage
must be increased. Moreover, due to the fact that the ha-
tteries voltage is not constant with the use, an extra protec-
tion against voltage level drops is needed, using a control
loop. This two objectives are achieved using the circuits
M A X 8 5 6 [I41 and DS1305 [151.
The integrated circuit M A X 8 5 6 is a step-up DC-DC
converter used to increase the power source voltage. This
circuit also has a control loop to keep the ouput voltage at
the level desired. This level is indicated by an input of the
circuit, with two possibilities, 3.3 volts in case it its con-
nected to Vcc, or 5 volts if connected to ground. There is
also an internal circuit to assert a signal in case the out-
put falls below the desired level. This signal is used to
request an intermpt. The integrated circuit DS1305 con-
sists of a calendar, two programmable alarms (for only
once, every day, every hour, every minute), communica-
tions using port SPI and 96 bytes of non-volatile RAM.
One of the main features of this circuit is that it can switch
the power source to an auxiliary battery in case of power
failure. This battery can he rechargeable or not. In the first
case, it can he recharged in the circuit itself. When the po-
wer level goes under the level of the auxiliary battery, this
circuit COMEISthe auxiliary battery to the system and as-
serts a signal. This is implemented in order to have an
non-intemptable power system in the circuit. If the batte-
ries are about to be exhausted, the system raises an alarm
to wam the user. After ten minutes, if the batteries have
not been replaced, the data is stored in the memory card,
and the whole system shuts down.
3. CONCLUSION
In this paper, a low cost, microcontroller-based Holler sys-
tem has been presented. Unlike other similar circuits des-
cribed in the technical literature, this system is fully por-
table, and only uses standard components easily available.
Nevertheless, the performance qualities of the system are
comparable to those available in professional systems.
925
Acknowledgment
The authors would like to thank the department of cardiol-
ogy of the Verge dels Lliris :Hospital of Alcoi (Spain) for
their clinical tests and advice. The authors also wish to
acknowledge the support of the INNOVA project, of the
Polytechnic University of Valencia (Spain).
4. REFERENCES
[I] N.J. Holter, “New methods for heart studies”, Science,
no. 134, pp. 1214,1961.
[2] E. Jovanov et al., “Real Time Holter Monitoring of
Biomedical Signals”, DSP Technology and Education
Conference. DSPS-99, Houston, Texas (USA), August
4-6, 1999.
[3] Massachusetts Institute of Technology, Bioelectron-
ics Project Laboratory, Illectrocardiogram Amplifier,
November 2002.
[4] C.M. Tenedero, M.A.D. Raya, L.G. Sison, “Design
and implementation of a single-channel ECG a n -
plifier with DSP post-processing in Matlab”, Third
National Electronics a i d Engineering Conference,
Philippines, November 27-29,2002.
[SI Jose M. Ferrero Corral, Bioelectrdnica, senyales
bioelictricas (in Spanish). Valencia: SPUPV, 1994.
[6] S. Franco, Design with operational amplifiers and
analog integrated circuii’s, McGraw-Hill, New York,
1997.
[7] Berson A.S., Lau F.Y., Wojick J.M., Pipberger H.V.,
“Distortions in infant electrocardiograms caused by
inadecuate high-frecuency response”. American Heat7
J o u m l , no.93, pp. 730-734, 1977.
[SI AD7888 Analog Devices, 2.7 to 5.25, Micmp-
owe6 8-Channel, IZSKSPS, 12-Bit ADC datasheet,
www.analog.com
[9] Samsung Electronics, SrlanMedia Format Intmduc-
tion, Memory Product & Technology Division, 1999.
[IO] T89C5 IRB21RC2 Atmal Micmcontrollerdatasheet ,
www.atmel.com
[l 11 SmartMedia, Logical Amur Specifications, Techni-
cal committee of the SSFDC Forum, 1999.
[I21 SmarlMedia, Physical F o m t Specifications, Tech-
nical committee of the SSFDC Forum, 1998.
[I31 MAX749 MAXIM Digitally adjustable LCD bias
supply datasheet, wwwmaxim-ic.com
[I41 MAX8561859 MAXIM Step-up DC-DC converters
datasheet, wwwmaxim-ic.com
[I51 DS1305 MAXIM Serial Alarm Real-lime Clock
datasheet, www.maxim-ic.com