Electrical activity of heart

ECG

EEG
Electromyogram(EMG)

The contraction of skeletal muscles results in the
generation of action potentials in the individual
muscle fibres, a record of which is known as EMG.
Repolarization takes place rapidly as compared to
ECG.
The EMG is usually a summation of the individual
action potentials from the fibres constituting the
muscle or muscles under study.
In voluntary contraction of skelatal muscle, the
muscle potential ranges from 50micro volts to 5mv.
Recording electrodes
Used to pick bioelectric events from the surface of a
body before giving to amplifier for subsequent
record or display.
Electrodes makes a transfer from the ionic
conduction in the tissue to the electronic
conduction which is necessary for making
measurements.
Required when physiological parameters are to be
measured and irritable tissues are to be stimulated
in electrotherapy.
Two types:
Surface electrodes
Deep seated electrodes

Electrode-tissue interface

Electrode tissue interface
Most commonly used: surface electrodes.
Ex: ECG, Eeg etc.
In order to avoid movement artifacts and to obtain
a established contact, an electrolyte or a electrode
paste is usually applied as an interface between the
electrode and the surface of source of event.
The characteristic of a surface electrode composed
of a metal electrode and attached to the surface of
the body through an electrolyte depends on the
conditions at the metal-electrolyte interface, the
electrolyte-skin interface and the quality of the
electrolyte.



Metal-electrolyte interface:
At this interface, there is a tendency for each electrode
to discharge ions into the solution and for ions in the
electrolyte to combine with each electrode.
As a result a charge gradient is created at each
electrode, called electrical double layer., present in the
region immediately adjacent to the electrode and can
be represented as two parallel sheets of charge of
opposite sign separated by a thin film of dielectric.
Therefore, the metal electrolyte interface appears to
consist of a voltage source in series with a parallel
combination of a capacitance and reaction resistance.
The vtg developed is called the half-cell potential.



The difference in half cell potentials that exist
between two electrodes is also called offset
potential
Differential amplifiers designed to cancel the
electrode offset potential.
May be unstable and unpredictable. Long term
changes appear as a baseline drift and short term as
noise on recorded trace.

Warburg model(1899)

Electrolyte-skin interface:
An approx can be made assuming that the skin acts as a
diaphragm between two solutions( electrolyte and body
fluids) of different concentrations containing same ions,
which is bound to give potential differences.
The simplest equivalent can be represented as a voltage
source in series with a parallel combination of
capacitance and resistance.
The above discussion shows that there is a possibility of
the presence of voltages of non physiological origin.
These voltages are called contact potentials.
The voltage presented to measuring instrument contains
two components:
Contact potentials
Biological signal of interest.

When bioelectric events are recorded, interference
signals are produced by the potential differences of
the metal electrolyte and electrolyte skin interface.
These PDs are connected in opposition during
measurement.


Polarization
If a low voltage is applied to two electrodes placed
in a solution, the electrical double layer is
disturbed. Depending on the metals constituting
the electrodes, a steady current may or may not
flow.
In some metal/liquid interfaces the electrical
double layer gets temporarily disturbed and a very
small current flows after the first surge, thus
indicating a high resistance. This type of electrode
will not permit the measurement of steady or
slowly varying potentials in the tissues. They are
said to be polarized or nonreversible.
The electrodes in which no net transfer of charge
takes place across the metal-electrolyte interface
are termed as perfectly polarized.
Those in which unhindered exchange of charge is
possible are called non-polarizable or reversible.
polarizable electrodes employ stainless steel and
are useful in ECGs or other situation where there is
small likelihood that the electrodes would be
exposed to a large pulse of energy in which case
they would retain a residual charge, become
polarized and will no longer transmit the relatively
small bioelectric events.

Non-polarizing electrodes on the other hand, are
designed to rapidly dissipate any charge imbalance
induced by powerful electrical discharge such as
defibrillation procedure. Rapid depolarization
enables the immediate reappearance of bioelectric
events on the monitor after defibrillation.
Used in ICUs and stress testing procedures.
Other properties in choosing electrodes:
mechanical properties, skin irritation, and skin
staining.
Skin contact impedance

The impedance of the electrode skin junction
comes in the overall circuitry of the recording
machine and therefore has a significant effect on
the final record.
Skin electrode imp is of a value much greater than
the electrical imp of the body tissue as measured
beneath the skin.
Measurement of skin-contact impedance: method
suggested by Miller as shown below.
The three electrodes A,B and C have contact
impedance resply of Za, Zb and Zc. an oscillator
provides a constant current in the frequency range
of 0.1Hz-100Hz through the 47k series resistor.

By suitably positioning a switch, a sensitive
oscilloscope can be used to monitor either the
voltage dropped across 1k resistor or the vtg
dropped across Zb. The voltage dropped across Zb
can be neglected since the input imp of the
oscillator is usually high.
From the voltage dropped across 1k
Silver-silver chloride electrodes
One of the most desirable characteristics of
electrodes being, they should not polarize.
Standing voltage of mot more than 0.1mV with a
drift over 30 min. of about 0.5mV was achieved in
properly selected Silver-Silver Chloride electrodes.
Non toxic and are preferred over Zinc-zinc Sulphate,
which also produce low offset potential
characteristics but highly toxic to exposed tissues.


Production of silver-silver chloride electrodes
Prepared by electrolysis.
Two silver discs are suspended in a saline water.
The positive pole of the dc supply is connected to the
disc to be chlorided and the negative to the other.
A current at the rate of 1mA/cm
2
is passed through the
electrode for several minutes.
A layer of silver chloride is developed on the anode.
Reaction at anode(+ve) and cathode respectively are:
Nacl = Na
+
+ Cl
-
Cl
-
+ Ag
+
AgCl

The positively charged sodium ions generate
hydrogen when they reach the cathode surface.
2Na
+
+ 2H2O +2 electrons 2NaOH + H2.


Pure silver to be used and saline solution should be
made of analar grade sodium chloride . Before
chloriding the silver must be cleaned preferably by
the electrolytic method.




Electrodes for ECG

Electrodes for ECG
Limb Electrode
Most common type of electrode used in ECG(rectangular
or circular).
Material used in German silver, Nickel Silver or Nickel
plated steel.
The typical value of contact imp of these electrodes is
nearly 2 to 5kohms at 10Hz.
Are held in position by elastic straps.
Most suitable for application on limbs.
Size is usually 3*5cm.
Usually prefered during surgery, as limbs are relatively
immobile.


Not suitable for long term use as the long flowing
leads are inconvenient for the patient.

Floating electrodes

Limb electrodes generally suffer from what is
known as motion artifacts caused due to relative
motion at the interface between the metal
electrode and the adjacent layer of electrode jelly.
The interface can be stabilized by the use of floating
electrodes in which the metal electrode does not
make direct contact with the skin.
Consists of a light weighted metalled screen or plate
held away from the subject by a flat washer,
connected to the skin.
Can be recharged, i.e., the electrolyte can be
replenished, if desired.
Patten described spray-on chest electrodes where a
conducting spot is developed on the skin by
spraying a film of conducting adhesive.
Connection is established using silver-plated copper
wires fixed in the conducting adhesive.
Extremely light-weighted n do not use electrolyte.
Ideal for use in monitoring of ECG of exercising
subjects and aero plane pilots as they give rise to
minimal motion artifacts.
Contact imp of the order 50kohms.


Pregelled disposable electrodes.


Electrodes employed in stress testing or long term
monitoring present problems such as perspiration
and ,major body movement is encountered.
To overcome problems due to prolonged
applications, a special disposable electrodes have
been used .
The main design feature is the high absorbancy
buffer layer with isotonic electrolyte. This layer
absorbs the effects of movement of the electrode in
relation to the skin and attempts to maintain the
polarization associated with the half cell potential
const.
Skin electrode adhesion.
Perspiration is resisted by the use of an additional
porous overlay disc and ensures placement of
electrode on the skin under stress conditions.
Ideally gels should possess the following properties:
Stay moist for the intended shelf life and during use.
Controlled by including a humectant in the gel.
Prevent micro-organism and mould growth.
Provide low electrolyte skin impedance by having ionic
salts and surfactants.
Cause minimum skin irritation, for which gels should
have a pH range 3.5-9.

Electrodes for EEG

Most common are chlorided silver discs, having approx 6-
8mm diameters.
Contact with scalp made via an electrolyte paste through a
washer of soft felt.
Resistance varies from 3-20K.
Small needle electrodes used for carrying out special EEG
studies when they are inserted subcutaneously.
Silver ball or pellet electrodes covered with a small cloth
pad when recorded from exposed cortex, but have high dc
resistance.
Above fig shows a pad electrode which is made of silver rod
belled out at the end and padded with a sponge, or similar
material contained in gauze.
Screwed into insulating mount and held in place with a
rubber cap. Tripod mount employed.

Another type multiple fine chlorided silver wires
fixed in a rigid plastic cup.
Fixed to the scalp with an adhesive.
Filled with an electrode jelly through a hole in the
top.
Contact is made via an electrolyte bridge so that
the jelly in contact with electrode metal is not
disturbed by scalp movement.
Silver wires used as output lead.
Electrodes for EMG

Usually needle type.
Investigation of muscle tissues underneath the skin and in
deeper tissues. Generally made of stainless steel, due to
mechanical solidity and low price.
Monopolar electrode usually consists of Teflon coated
stainless steel wire which is bare only at the tip.
After a number of uses, the teflon coating will recede,
increasing the tip area and needle must be discarded after
this occurs.
Bipolar(double coaxial) needle electrodes two insulated
wires within metal cannula.
Two wires bared at tip, provide contact to the patient.
Cannula acts as a ground. No polarity difference.
A concentric(co axial) core needle electrode contains both
the active and reference electrodes within same structure.
The inner wire is exposed at the ip and forms one electrode.
Concentric needle is very convinient to use and has very
stable electric characteristics.
Made by moulding fine platinum into a hypodermic needle
having an outside diameter less than 0.6mm.one end is
bevelled to expose the end of the wire and provide easy
penetration.
Surface area of exposed wire tip is les than 0.0005mm.

Recording surfaces are two concentric steel rings. A
third ring attached to the casing of the electrode is
the earth contact.
The rings are separated from each other by teflon,
an insulating material.
Produce the effect of recording signals mainly from
fibres near to the axis of the electrode and makes
the electrode more selective.
Obviates the problem of alignment relative to
direction of muscle fibres.
Microelectrodes

To study the electrical activity of individual cells.
Small enough w.r.t size of the cell in which it is inserted so
that the penetration by the electrode does not damage the
cell.
Size of intracellular microelectrode is determined by the
size of the cell and the ability of its enveloping membrane to
tolerate penetration by micro electrode tip.
Single living cells being rarely larger than 0.5mm(500
microns) and are usually less than one tenth of this size.
Typical microelctrodes have tip dimensions ranging from
0.5 to 5 microns.
Two types generally used:
Metallic
Glass microcappilaries

Metallic electrodes are formed from a fine needle of suitable
metal drawn to a fine tip.
Glass electrodes are drawn from pyrex glass of special grade.
These microcapillaries are usually filled with an electrolyte.
Metal electrodes-Low resistance due to direct contact with the
tissue. But they tend to polarize.
Glass electrodes has a substantial current carrying capacity
because of the large surface contact area between the metal
and electrolyte.
Microelectrodes have a very high impedances as compared to
conventional electrodes due to the characteristics of the small
area metal electrolyte interface.
Llly, a micropipette is filled with an electrolyte which
substitutes an electrolytic conductor of small cs area, giving
high resistance.
Amplifiers with high input impedances are required to avoid
loading effect.
Glass microcapillary electrodes:
For drawing electrodes of uniform and accurate
diameters, it is essential to maintain constant timing,
temperature, strength, direction of pull.
Difficult to control when drawn manually.
Mechanical method employs gravitational force for
extension and electrodes which are drawn in one or more
stages can readily produce capillary tubes between 3-
30m diameter, but difficult to produce electrodes of
less than 1m.
Most commonly used method: circumferential
application of heat to a small area of glass tubing which
is placed under some in initial tension.

When the glass softens the tension is rapidly and the heat is
turned off.
Proper timing, controlled adjustment of the amount of heat
as well as the initial and final tensions and cooling result in
production of capillaries with controlled dimensions.
Metal Microelectrodes:
With very fine tips are relatively robust as compared to
glass micropipettes.
Steel electrodes can be made from ordinary darning needles
but preferably should be good stainless steel wire.
Can be made up to 10m, but care to be taken for diameters
s small as 1m(extremely brittle and very high input
impedance).

Hubel(1957) described a method to make tungsten
electrodes with a tip diameter of 0.4 m. He used
electropoining technique which consists in etching a
metal rod while metal rod ois slowly withdrawn
from the etching solution, thus forming a tapered
tip on the end of the rod. The etched metal is then
dipped into a insulating solution for placing an
insulation on all but tip area.
Fig below.
G:\LP\BMI 2011-12(CK).doc
Electrocardiograph

The signals picked up by the patient electrodes are
taken to the lead selector switch.
In lead selector, the electrodes are selected two by
two according to the lead program.
By means of capacitive coupling, the signal is
connected to the long tail pair differential amplifier,
which is usually a three or four stage amp, with
sufficiently large negative current feedback from
the end stage to first stage.
Power amplifier
Frequency selective network-provides damping of
the pen motor.

Auxiliary circuit- 1mv calibration sig and automatic
blocking of the ampl during the change in lead
position switch.
Stand by mode
Graph paper- horizontal and vertical lines of 1mm
intervals, thicker lines at 5 mm intervals.
Recording speed is 25mm/s.
Time and heart rate measurements are made
horizontally and amplitude measurements are
made vertically.
Sensitivity- 10mm/mV
The ECG leads
The resulting trace of voltage difference between at
any two sites due to electrical activity of the heart is
called a LEAD.
Bipolar leads: using two electrodes such that the final
trace corresponds to the diff of elec. Potentials existing
between them. Called as standard leads. Sometimes
called as Einthoven leads.
Standard lead I--- electrodes are placed on right arm and
left arm(RA and LA)
Lead II--- right arm and left leg.
Lead III--- left arm and left leg.


The ECG leads

In all three leads potential difference is measured
with reference to third point on the body.
Conveniently taken as right leg.
Einthovens postulate- the electrical axis of heart
can be represented as a two dimensional vector.
The ECG measured from any of the three basic limb
leads is time variant single dimensional component
of the vector.
The electric field could be represented
diagrammatically as a triangle, with heart at center,
known as Einthoven triangle.

Unipolar leads(V leads):measured using single
electrode and a central terminal, which has a
potential corresponding to the center of the body.
in practice the reference electrode is obtained by a
combination of several electrodes tied together at
one point.
Two types are employed:
Limb leads
Precordial leads.
limb leads: two of the limb leads are tied together
and recorded with respect to the third limb.
AVRright arm is recorded wrt a ref established by
joining the left arm and left leg electrodes.






AVL left arm is recoded wrt right arm and left leg.
AVF left leg is recorded wrt two arm electrodes
tied together.
Precordial leads: records the potential of heart
action on the chest at six different positions. These
leads are deisgnated by V with a numeral subscript
represnting the position of electrode on the
pericardium.




Multichannel ECG machine

Carry several amplifiers and a corresponding
number of recording pens. This facilitates recording
of several ECG leads simultaneously and
considerably reduces the time taken.
The waveforms are recorded simultaneously and
they can be shown in their proper time relationship
with respect to each other.
Modern multichannel ECG m/cs use microprocessor
to capture heart signals from a standard 12-lead
configuration, sequencing the lead selector to
capture four groups three lead signals and switching
groups every few seconds.
The operating program for the above is stored in
ROM.
The eCg s/gs selected by the processor are
amplified, filtered and sent to a three channel
multiplexer. Then given to A-to-D converter.
For 10v resolution referred to an input, it is
necessary to use a 10 bit A-DC.
Ten bits provide resolution of one part in 1024(2
10
=1024), which for a 10mV range equals 10v.
The p stores the digitized signals in Ram.
The contents of Ram are sent to D-AC. For
reconstructing the analog signals.


The analog signals are Demultiplexed and passed to
video display or chart recorder.
Modern digital ECG machines:
9 amplifier systems, 32 bit dsp and cpu, 16 bit A-DC
The recording system also operates digitally. The
machine o/p is produced by X-Y drive mechanism
which uses drive wheels to move the ECG paper in
the paper axis while moving a carriage mounted
pen in the carriage axis direction. Each direction of
movement is caused by identical low inertia dc
servo motors with attached encoders to provide
position feedback.
Processor controls the plotting process by sending
plot commands to control the motors to the X and Y
servo chips.

ELECTROENCEPLHALOGRAPH

Montages : a pattern of electrodes on head and the
channels they are connected to is called as a
montage. Are always symmetrical.
Reference electrode generally placed on ear lobe or
forehead.
EEG electrodes are placed acc. to the standard
known as 10/20 system.
There are 21 electrode locations in 10/20 system.
involves placement of electrodes at distances of
10% and 20%of measured coronal, sagittal and
circumferential arcs between landmarks on the
cranium.
Electrodes are identified acc. to their position :
Fp for frontal polar
F for frontal
C for central
P for parietal
T for temporal
O for occipital.line.
Z for mid
One electrode is placed at relatively neutral site of
head usually midline forehead named iso ground.


Electrode montage selector:
EEG signals transmitted from electrodes to the head
box, labeled acc. To 10/20 system and then to
montage selector.
Large panel containing switches that allow the user
to select the electrode pair which will have signals
subtracted from each other to create an array of
channels of o/p called montage.
Bipolar or referential.
Reference often chosen, for each side of head.

10-20 system of placement of
electrodes


Pre amplifier
Individual, multistage ac coupled, very sensitive
amplifier with differential input and adjustable gain
in a wide range.
Calibrating signal voltage step of adequate
amplitude to the i/p of channels.50uV/cm.
Premplifier high gain and low noise
characteristics, because EEG potentials are small in
amplitude. Very high CMRR.
Free from drift.


Sensitivity control :
Gain of the amplifier multiplied by the sensitivity of
the writer.
If writer sensitivity- 1cm/V, the amp should have a
gain of 20000 for a 50uV signals.
Two types: continuously variable to equalize
sensitivities of all channels and in steps to increase
or reduce the sensitivity of a channel by known
amounts.
Usually calibrated in decibels.
Gain generally adjusted such that for a signal of
about 200uV deflect the pen over their full linear
range.
Filters:
Labeled in terms of time constants.
0.03, 0.1, 0.3, 1.0s correspond to 3db points at
frequencies 5.3, 1.6, 0.53, 0.16hz.
Upper cut off- typically 1,30,70, and 300Hz.
Notch filter tuned at sharp 50Hz.
Noise:
Amplifiers selected for a minimum noise level.
2uV is often stated as acceptable range.
Components of all frequencies, thereby increases
with the bandwidth of the system.
Necessary to restrict B.W.

Writing part
Usually a ink type direct writing recorder.
Best types of pen motors have a frequency
response of about 90Hz.
Machines, lower than this, some have it as low as
4HZ.
Paper driver:
Provided by synchronus motor.
Speeds of 1, 30 and 60mm/s.
Time scale usually registered on the record by one
or more time marker pens which make a mark per
second.

Channels



Computerized analysis of EEG

Computerized analysis of EEG
Assessment of frequency and amplitude is crucial
for rapid and accurate interpretation.
Constant analysis by skilled technician and
acquisition of recording paper..
Frequency analysis:
Takes raw EEG waves, mathematically analyses and
breaks them down in component frequencies.
Method fast fourier transform.
FFT of a digitized waveform is a mathematical
transformation of a complex waveform into simpler,
more uniform waveforms.

Converted to simpler waveform called spectrum.
Separated into frequency bands at intervals of 0.5
Hz over a range of 1 to 32 Hz.
Amplitude analysis:
Changes in amp result in changes in the power of
the resulting freq spectrum.
Amp increases, so power increases.
Most common num: total power of EEG spectrum.
Due to uV amp of EEG, the power is either
nanowatts or picowatts.
The power spectrum is calculated by squaring the
amplitudes of individual freq components.


Powers of individual bands used and expressed as
absolute or a percentage of total power.
Display formats

Display formats
Compressed spectral array(CSA)
A series of computer-smoothed spectral arrays are
stacked vertically, usually at 2s intervals, with most
recent at bottom.
Peaks appear at freqs which, which contain more
power or make larger contributions to the power
spectrum.
Produces a pseudo 3-D graph.
Easy to pick up changes in freq and amplitude of each
sample over a longer period of time as it compresses a
large amt of data into a compact easy to read trend.


Dot-density modulated spectral array(DSA
Method for displaying power spectrum.
Displays power spectrum as a line of variable
intensities and/or densities with successive epochs
again stacked vertically.
Areas of greatest density represent freqs which
make greatest contribution.
Adv. -No data is hidden by the peaks as in CSA
display.
In the form of gray or colour scaled densities.

Recording of a basic ECG video - YouTube.flv