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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


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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- Figure 2. Differential instrumentation amplifier.
tor and a fastening system to prevent the accidental uncou-
ple due to sudden jerks or patient movement during their
usual activities. environment. The last stage with the OA(U1D) is an in-
The probe shield is connected to the common mode verter amplifier. The third electrode impedance is reduced
voltage of the differential amplifier through a voltage fo- using this configuration, and a high impedance is applied
llower, which derives the interference currents induced in to prevent the ground-fault h,uard. Nevertheless, electri-
the wire towards ground. This connection allows us to cal shock is very unlikely since the system only mns off
reduce the parasitic capacitance that appears between the batteries.
wires and the ground when it is connected to ground, and
therefore avoids input impedance reduction. 2.4. A/D Conversion
Once the ECG signal has been amplified and filtered, it
2.3. Amplifier
must be digitized. The analog to digital converter utilised
The first block of the system is the differential instrumen- is the AD7888 [SI. This converter has 12 bits of resolu-
tation amplifier. Since the level of the electrocardiograph tion, and 8 input ports, although in this application only
signal is only of some p V , it is necessary to amplify it to two are used. The amplifier is software controlled and the
match the levels of the analog to digital converter, avoi- conversion takes place during the error calculation of each
ding saturation either in the amplifier or the converter. A memory sector. Each sample converted is stored in the cor-
precise amplifier has been designed with very low pola- responding memory area, which, after completing a whole
risation currents and small offset voltages to fulfil these data page, will be written in memory alongside error cal-
requirements. A high common mode rejection of around culations computed in parallel with the analog to digital
120dB is also achieved. conversion.
This amplifier includes a high pass filter, formed by a The AD7888 is capable of a 125KSPS rate. The input
quadruple precision operational amplifier, to filter out the track and hold acquires a signal in 50011sand this circuit
base line wandering. The amplifier also creates a virtual operates with a power supply voltage from 2.7 V to 5.25
ground, applies the common mode voltage to the probe V. CMOS construction ensures low power dissipation, tipi-
shield, and reduces the third electrode impedance to mini- cally 2mW for normal operation and 3pW in power-down
mize the power line interference. This amplifier satisfies mode. The DC accuracy of th,: AD7888 is tipicaly 1 LSB
the American Heart Association specifications about the of integral nonlinearity, -U+] .5 LSB differential nonlin-
bandwidth of the amplifier, O.lHz-Il"z, in order not to earity, and an offset error of & 6 LSB.
lose i m p o m t information of the signal. This margin is Communication with the AD converter is perfomed
the minimum required to avoid a distortion greater than through the SPI port of the microcontroller, and by means
10% in the signals. of an enable signal also controlled by the processor. Am
In Fig. 2, the different electrocardiographic amplifier other converter input is used to measure the power source
stages are shown. It is basicaly composed of a first stage voltage and thus monitorize the battery charge level. This
of an instrumentation amplifier and four more stages based level can also be checked by the user using the interac-
on different configurations using operational amplifiers. tive menu shown on the display. All its features regarding
Following the probe connected to the human body surface, the low power consumption, power source voltage require-
it can be noticed that the derivation enters directly to the ments, control, and communications, make it a very suit-
instrumentation amplifier, and then the baseline wander is able choice for this application.
filtered out using an operational amplifier with adjustable
gain. The rest of the stages are support stages for the previ- 2.5. Processing
ous ones with the following rationale: the operational am-
plifier AO(U1C) is used to create a virtual ground with This is the most important stage of the system. On one
a voltage level half that of the power supply. The stage hand, it is devoted to interact with the user through a nav-
with the OA(U1A) is a voltage follower whose ouput is igating menu shown on the I.CD display. On the other
connected to the probe shield. Therefore, the loses due hand, it stores the data obtained from the analog to digital
to parasitic capacitances are reduced, and moreover, the converter in memory, using a suitahle format in order to
lead is protected against the electrical noise of the circuit be read by the operating system properly. It also has the

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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-
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ded peripherals such as:


Figure 3. Schematic diagram of the memory card. In this
Two timers of 16 hits. device, a SmartMedia memory card is used.

One UART with the possibility of using masks


A watchdog clock. crihed, as well as the data format needed to assure com-
patibility. The memory capacities available cover a fairly
Six bidirectional parallel ports. wide range, from 2MB to 128MB, and they can he powe-
red using two voltages: 5 and 3.3 volts. This card model is
Power saving modes,
cheaper and easier to use than others with similar perfor-
A matrix of programmable counters. mance, and the reliability of the data storage is very high,
making it appropriate for this medical application. In Fig 3
A keyboard interface. the schematic of this card is depicted.
The parallel pan, aw used to chaw data amung thv periph- The system prrvcntsthc uscrIromutiliJing invalidcard\.
cralr. sXcsDt the LCD the S , , , d v d i n card. which For instance, i f it is detscvd that the card intormatim sys-
are memory mapped. The microcontroller ports 0 and 2 tem (CIS) is damaged or missing, a warning message will
are used as data and addresses ports respectively, for the be issued. On the other band, if the blocks are present,
devices directly memory mapped. Port 1 is used for com- but the format is invalid, another warning will be shown.
munications through the integrated SPI interface, which The system suppolts all the cards powered with 3.3 volts,
can be put in shutdown mode to reduce the power con- which are the ones with the highest capacities, whereas
sumption. Port 3 hits are used for different tasks: serial those powered with 5 volts are of low capacity and not
communications through the embedded UART, write and supported.
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 2.7. Visualization
operations such as memory card formatting, activate po-
wer saving functions, sample frequency adjustment, ac- For menu visualization, warning messages, process infor-
quire and store the electrocardiographic signal, data and mation, etc, the system has a E D . It is controlled through
time set, alarms programming, LCD contrast adjustment, ports 4 and 5. The display has a character matrix of 2 rows
etc. Programming language used has been C. per 16 columns, whose size is 84x44 mm. The display data
The computational burden of the microcontroller is ma- bus width can be configured to work with 4 or 8 bits. This
inly due to the error calculations. This process takes around feature allows the display to be used either with 8 or 4 bit
2 seconds for each sector, which is a delay unaccetably microcontrollers. Asserting its busy line, the data flow can
large for the sampling process. In order to obtain a uni- be controlled.
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 2.8. Serial Interface
before. The software to control this card checks if the card
inserted is valid, and its capacity, whether it is formatted The microcontroller can share data with a personal com-
or not, the free memory available, writes the data files, etc. puter through a RS-232 serial interface or directly by me-
This p a t is transparent to the user. 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
2.6. Storage
system. In Fig. 4 a visualization example is shown.
The storage system chosen for this device is a solid state The serial interface needs 3.3 volts, with a consump-
memory, based on the SmartMedia model [9], whose for- tion of 1.3mA during normal operating mode, and 0.01pA
mat is regulated by the SSFDC [ I I , 121, where the ope- in shutdown mode. The connector is a typical male DB9
ration, hardware and software of this kind of cards is des- for printed circuits.

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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.
Figure 4. ECG data visualization and editing in a personal
computer. [2] E. Jovanov et al., “Real Time Holter Monitoring of
Biomedical Signals”, DSP Technology and Education
Conference. DSPS-99, Houston, Texas (USA), August
2.9. Power Source 4-6, 1999.
This portable Holter system tuns off two AA batteries se- [3] Massachusetts Institute of Technology, Bioelectron-
rial connected, which can he rechargeables, yielding a vol- ics Project Laboratory, Illectrocardiogram Amplifier,
tage of 3V. Since the system needs 3.3 volts, the voltage November 2002.
must be increased. Moreover, due to the fact that the ha-
[4] C.M. Tenedero, M.A.D. Raya, L.G. Sison, “Design
tteries voltage is not constant with the use, an extra protec-
and implementation of a single-channel ECG a n -
tion against voltage level drops is needed, using a control
plifier with DSP post-processing in Matlab”, Third
loop. This two objectives are achieved using the circuits
National Electronics a i d Engineering Conference,
M A X 8 5 6 [I41 and DS1305 [151.
Philippines, November 27-29,2002.
The integrated circuit M A X 8 5 6 is a step-up DC-DC
converter used to increase the power source voltage. This [SI Jose M. Ferrero Corral, Bioelectrdnica, senyales
circuit also has a control loop to keep the ouput voltage at bioelictricas (in Spanish). Valencia: SPUPV, 1994.
the level desired. This level is indicated by an input of the
circuit, with two possibilities, 3.3 volts in case it its con- [6] S. Franco, Design with operational amplifiers and
nected to Vcc, or 5 volts if connected to ground. There is analog integrated circuii’s, McGraw-Hill, New York,
also an internal circuit to assert a signal in case the out- 1997.
put falls below the desired level. This signal is used to [7] Berson A.S., Lau F.Y., Wojick J.M., Pipberger H.V.,
request an intermpt. The integrated circuit DS1305 con- “Distortions in infant electrocardiograms caused by
sists of a calendar, two programmable alarms (for only inadecuate high-frecuency response”. American Heat7
once, every day, every hour, every minute), communica- J o u m l , no.93, pp. 730-734, 1977.
tions using port SPI and 96 bytes of non-volatile RAM.
One of the main features of this circuit is that it can switch [SI AD7888 Analog Devices, 2.7 to 5.25, Micmp-
the power source to an auxiliary battery in case of power owe6 8-Channel, IZSKSPS, 12-Bit ADC datasheet,
failure. This battery can he rechargeable or not. In the first www.analog.com
case, it can he recharged in the circuit itself. When the po- [9] Samsung Electronics, SrlanMedia Format Intmduc-
wer level goes under the level of the auxiliary battery, this tion, Memory Product & Technology Division, 1999.
circuit COMEISthe auxiliary battery to the system and as-
serts a signal. This is implemented in order to have an [IO] T89C5 IRB21RC2 Atmal Micmcontrollerdatasheet ,
non-intemptable power system in the circuit. If the batte- www.atmel.com
ries are about to be exhausted, the system raises an alarm
[l 11 SmartMedia, Logical Amur Specifications, Techni-
to wam the user. After ten minutes, if the batteries have
cal committee of the SSFDC Forum, 1999.
not been replaced, the data is stored in the memory card,
and the whole system shuts down. [I21 SmarlMedia, Physical F o m t Specifications, Tech-
nical committee of the SSFDC Forum, 1998.
3. CONCLUSION [I31 MAX749 MAXIM Digitally adjustable LCD bias
supply datasheet, wwwmaxim-ic.com
In this paper, a low cost, microcontroller-based Holler sys-
tem has been presented. Unlike other similar circuits des- [I41 MAX8561859 MAXIM Step-up DC-DC converters
cribed in the technical literature, this system is fully por- datasheet, wwwmaxim-ic.com
table, and only uses standard components easily available. [I51 DS1305 MAXIM Serial Alarm Real-lime Clock
Nevertheless, the performance qualities of the system are datasheet, www.maxim-ic.com
comparable to those available in professional systems.

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