EC2021 - Medical Electronics Notes For Al PDF

EC2021 – Medical Electronics- Study Material
Introduction
Introduction:
The human body is the most deeply studied and frequently portrayed object in the
history. Despite its familiarity, it is instinctively absorbing and eternally fascinating.
The number of humans in the world is racing towards seven billion. More than 5
babies are born every minute, while 150,000 people die daily. With the population increasing by
almost three humans per second. Each of these people lives, thinks, worries, and day dreams
with and within the most complex and marvelous of possessions- a human body. An enduring
feature of this body and its behavior is self-curiosity. We continually look inside ourselves in
enormous and ever-increasing detail in order to comprehend the action within.
Levels of organization:
The body is viewed to be a series of integrated systems. Each system carries out one
major role or task. In the cardiovascular system, for example the heart pumps blood through
vessels, to supply every body part with essential oxygen and nutrients. The systems are in turn
composed of main parts known as organs. The stomach, intestines and liver are the organs of
digestive system. Moving through further levels in the hierarchy the organs consist of tissues and
tissues made up of cells.
Cells are often called the microscopic building blocks of the body. However they are
active and dynamic, they continually grow and specialize function die and replenish themselves
by the millions every second. The whole body contains 200 different kinds. Science in
increasingly able to deliver deeper than cells to the organelles within them and onwards and
inwards to the ultimate components of ordinary matter molecules and atoms.
Anatomy:
The study of the body’s structure and how it cells, tissues and organs are assembled is
known as human anatomy. In reality, the inside of the body is a crowded place. Tissues and
organs push and press against one another. There is no free space, and no stillness either. Body
parts shift continually in relation to each other. We move about, breathe, pump blood shift
digestive matter and eat. For example, swallowed food does not simply fall down inside the
gullet {oesophagus}. The gullet is normally pressed flat by internal chest pressure so that food
must be forced down into the stomach by waves of muscular contraction.
Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 1

Physiology:
The anatomical drawing of a large factory or orifice would show the arrangement of
rooms, location of machinery and furniture, and service ducts for electricity water and service
ducts for electricity, water and air-conditioning. For a rounded understanding we need to see the
premises in action, with people goods and information on the move. Similarly human anatomy is
combined with its twin; physiology focuses on the dynamic chemical minutiae at atomic ionic
and molecular level. It investigates the working of such processes as enzyme action, hormone
stimulation, DNA synthesis and how the body stores and uses energy from food. As researchers
stare harder and more physiological secrets are unlocked. Much of this work is directed at
preventing, treating or alleviating disease and allows us to appreciate the latest wonder drug or
take a meditation
Health and illness:
Medical science amasses mountains of evidence every year for the best ways to stay
healthy and avoid disease. At present an individual’s genetic inheritance which is a matter of
chance in the given starting point for maintaining healthy and wellbeing. In coming years
treatments such as pre-implantation genetic diagnosis {PGN} carried out as part of assisted
reproductive techniques such as In vitro-fertilization {IVF} and gene therapy could remove or
negate some of these elements. Many aspects of upbringing have a major impact on health.
Factors such as diet, whether it is rich, bringing with it the risk of obesity or too poor leading to
malnutrition particularly affect children as their bodies are still developing. The body can be
affected by different types of disorder such as infection by a virus or bacteria. Injuries resulting
from an accident or long-term repetitive activities, inherited faulty genes or exposure to toxins in
the environment.
Body Cell:
Everyone is made up of Billions of cells, which are the basic structural units of the body.
Bones, muscles, nerves, skin, blood and all other tissues are formed from different types of cells.
Each cell has a specific function but works with other types of cells. Each cell has a specific
function but works with other types of cells to perform the enormous number of tasks needed to
sustain life. Most body cells have a similar basic structure. Each cell has an outer layer (called
cell membrane) and contains a fluid material (cytoplasm). Within the cytoplasm are many
specialized structures(organelles). The most important organelle is the nucleus which contains
vital generic material and acts as the cell’s control centre.
The structure of DNA’s is like spiral ladder DNA contains all the vital generic
information and instruction codes necessary for the maintenance and continuation of life.

Skeleton:
The skeleton is a mobile frame work made up of 201 bones, approximately half of which
are in the hands and feet. Although individual bones are rigid, the skeleton as a whole is
remarkably flexible and allows the human body a huge range of movement. The Skelton serves
as an anchorage for the skeletal muscles and as protective cage for the body’s internal organs.
Female bones are usually smaller and higher than male bones, and the female pelvis is shallower
and has wider cavity.
Head:
In a new born body, the head accounts for one quarter of total body length, by adulthood,
the proportion has reduced to one eighth contained in the head are the body’s main sense organs,
eyes, ears, olfactory nerves that defect smells, and the taste buds of the tongue. Signal from these
organs pass to the body’s great coordination centre. The brain housed in the protective bony
dome of the skull. Hair on the head insulates against heat loss, and adult males also grow thick
facial hair. The face has three important openings two nostrils through which air passes and the
mouth which takes in the nourishment and helps from speech. Although all heads are basically
similar, differences in the size, shape and color of features produce an infinite variety of
appearances.
Body organs:
All the body organs except for the brain are enclosed within the trunk or torso(the body
apart from the head and limbs). The trunk also contains two large cavities separated by a
muscular sheet called the diaphragm. The upper cavity contains the stomach, intestines, liver and
pancreas which all play a role in digesting the food. Also within the trunk are the kidneys and
bleeder, which are part of the urinary system, and the reproductive organism which hold the
seeds of new human life. Modern imaging techniques such as contrast X-rays and different types
of scans make it possible to see and study body organs without eh need to cut through their
protective covering of skin, fat, muscle and bone
Bones and joints:

Bones form the body’s hard, strong skeletal framework. Each bone has a held compact
exterior surrounding a spongy, lighter interior. The long bones of the arms and legs, such as the
femur (thick bone) hale a central cavity containing bone marrow,. Bones are composed chiefly of
calcium, phosphorous and a fibrous substance known as collagen. Bones must at joints, which
are of several different types. For example, the hip is ball and socket joint that allows the femur a

wide range of movement, whereas finger joints are simple hinge joints that allow only bending
and straightening. Joints are held in place by bands of tissue called ligaments. Movement of joint
is facilitated b the smooth hyaline cartilage that covers the bone ends and by the synovial
membrane that lines and lubricates the joint.
Muscles:
There are three main types of muscles skeletal muscle (also called voluntary muscle
because it can be consciously controlled); smooth muscle (also called involuntary muscle
because it is not under voluntary control) and specialized muscle tissue of the heart. Humans
have more than 600 skeletal muscles which differ in size and shape according to the jobs they do.
Skeletal muscles are attached directly or indirectly (via tendons) to bones and work in opposing
pairs (one muscle in the pair contracts while the other relaxes) to produce body movements as
diverse as making threading a needle and an array of facial expression. Smooth muscles occur in
the wall of internal body organs and perform actions such as forcing food through the intestines,
contracting the uterus (womb) In child birth and pumping blood through blood vessels some
other muscle in the body.
Iris:
The muscle fibers contract and dilate (expand) to alter pupil size.
Tongue:
Interacting layer of muscle allow great mobility

Ileum:
Opposing muscle layers transport semi-digested food.
Movement of the forearm:

Controlled movement of the limbs relies on coordinated relaxation and contraction of
opposing muscles. To raise the forearm, the biceps (two-rooted muscle) contracts and shortens
while the triceps (three-rooted muscle) relaxes, the reverse occurs when the forearm is lowered.
Muscles 2:
Muscles of facial expression:

A single expression is the result of movement of many muscles.
Hands:

The human hand is an extremely versatile root, capable of delicate manipulation as well
as powerful gripping actions. The arrangement of its 27 small bones, moved by 37 skeletal
muscles that are connected to the bones by tendons, allows a wide range of movements. Out
ability to bring the tips of out thumbs and fingers together combined with the extra ordinary
sensitivity of our fingertips due to their rich supply of nerve endings, makes out hands uniquely
dextrous.
Feet:
The feet and toes are essential elements in body movement. They bear and propel the
weight of the body during walking and running and also help to maintain balance during changes
of body position. Each foot has 26 bones, more than 100 ligaments and 33 muscles some of
which are attached to the lower leg. The heel pad and the arch of the foot act as shock absorbers,
providing and cushion against the joints that occur with every step.

Physiological system
2.1.Information Processing
The human body is alive with information. Being a complex, dynamic mechanism, its interacting
and interdependent parts require control and co-ordination. This is done by passing information
between them. Two body systems are responsible for command-control and data management –
The nervous and the endocrine systems.
Information processing involves inputs evaluation and decision making followed by
outputs. The body has inputs from the various senses such as sight and hearing. Its brain is CPU
(Central Processing Unit) whose outputs control the physical action of muscles and chemical
responses of glands. Both nerves and hormones are involved in data management.
2.1.1.Electrical and chemical pathways

The “language” of the nervous system is tiny electrical impulses. They are small and fast – each
just one-tenth of a volt in strength and lasting hardly one-thousandth of a second and numerous.
Every second millions pass through the networks of long pale, string – like pathways called
nerves. Information’s from the senses flow to the brain as electrical impulse. Here it is shifted,
analyzed and evaluated causing millions more signals to pass around and within the brain
between numerous, complex areas. Decisions are reached and command messages are produced
in the form of electrical impulses. The brain’s electrical output travels along motor nerves to the
muscles to stimulate and co-ordinate their contraction for movements. Different information
carriers-hormones-instruct the endocrine glands on the timing and quantity of secretion required
for the desired effect. More than 50 hormones circulate in the blood stream. The specific
molecular structure of each hormone stimulates only cells with suitable receptors on their
surface, instructing the cells to carry out certain procedures. In general nerves work fast – within
fraction of a second. Most hormones function over longer times – within minutes, days or even
months. Long-lasting effects as in growth of hormones are continuously secreted over many
years, as individual dose would last only few days.
2.2.Body – Clock Input

The body has built-in rhythms of activity. People in experimental timeless surroundings
(of constant light, temperature food availability and other conditions) still tend to sleep, wake ,
eat , become alert and move about in a roughly 24 hours style. A small part of the brain known as
the suprachiasmatic nucleus located just above the place where the visual or optic nerves meet, is
the body clock. It is continually adjusted by external cues such as light levels and temperature
fluctuations and our mental acknowledgement of clock times. In turn, it feeds information to
many brain parts that deal with cyclical activities such as hormone release, tissue repair, body
temperature control, urine production and digestive matter. In this way, the natural rhythms of
the body are co-ordinate.
2.2.1.The Importance of Input
As can be seen by the workings of the body clock, feeding information into the brains processing
center relies on more than the five senses. The continuing environmental adjustment of the body
clock is one example of more subtle and complex sensory input within the body, There are

thousands of micro receptors that continually monitor variables, for example oxygen, waste
carbon dioxide and blood glucose. These data feed to automatic or subconscious parts of the
brain, which make decision that, do not register in the conscious mind. In this way a huge
amount of information processing occurs, of which we are hardly ever aware.
2.3.Nerves and Neurons
The brain has over 100 billion nerve cells or neurons, and the body contains millions
more. Bundle of nerve fibers projecting from the neurons from body-wide networks of nerves.
Neurons are highly specialized in their structure, function and the way they link together to
communicate.
Like all other cells, typical neurons have a main cell body with a nucleus. But a neuron
also has a long wire. Process that read out to transmit messages to other neurons at junction
called synapse. These processes are of two kinds. Dendrites receive messages from other neurons
or from nerve-like cells in sense organs and conduct them towards the cell body of neurons.
Axons convey messages away from the cell body to other neurons or to muscle or gland cells.
Dendrite tend to be short and have many branches, while axons are usually longs and branchless
along their length. Neurons in the brain and spinal cord are protected and nurtured by supporting
nerve cells known as glial cells.
2.3.1.Types of Neurons
The shapes and sizes of the bodies of neuron cells vary greatly as do the type, number
and length of their projections. Neurons are classified according to the number of process that
extends from the cell body. Bipolar neurons are the original neuronal design in the embryo, but
adulthood, they are found in only a few locations, such as the eye’s retina and the olfactory nerve
in the nose. Most neurons in the brain and spinal cord are multipolar, unipolar neurons are
present mainly in the sensory nerves of the peripheral nervous system.
Unipolar Neuron: - A single short process, an axon extends from the cell body and splits into
tow.
Bipolar Neuron: - The cell body is located between two processes-an axon and a dendrite.
Multipolar Neuron: -These have three or more processes several dendrites and one axon.
2.4.ORIGIN OF BIOPOTENTIALS:
Nerve cells or neurons are excitable. When stimulated, they undergo chemical changes
that produce tiny traveling waves of electricity.- nerve signals or impulses. These pass to other
neurons, eliciting similar response from them.
Throughout the nervous system, information is conveyed as tiny electrical signals called
nerve impulses or action potentials. These impulses are the same all over the body about 100
milli volts in strength and lasting just 1 millisecond. The information carried depends on their
position in the nervous system, and their frequency from one impulse every few seconds to
several hundreds per second. Typically when a neuron receives enough pulses from other
neurons it fires one of its own as wavelike movements of ions (electrically changed particles)
impulses jump from one neuron to another at junctions known as synapses.
2.4.1.IMPULSE MOVEMENT WITHIN A NERVE CELL:
The nerve impulse is based chiefly on movement of positively charged sodium and
potassium ions through the neuron’s cell membrane. Impulses travel at speeds between 1 and
120 m/s. depending on the type of nerve. Movement is much faster in sheathed
(myelinated),axons in which the action potential jumps along successively myelin-coated
sections from one node to the next.

2.4.1.Nerve Impulse
Nerve cells or neurons are excitable. When stimulated they undergo chemical changes that
produce tiny travelling waves of electricity – nerve signals or impulses. These pass to other
neurons, exciting similar responses from them.
Throughout the nervous system, information is conveyed as tiny electrical signals called
nerve impulses or action potentials. These impulses are the same all over the body – about 100
millivolts (0.1 volts) in strength and lasting just 1 millisecond. The information carried depends
on their position in the nervous system and their frequency from one impulse every few seconds
to several hundreds from other neurons it fires one of its own, as wave-like movements of ions
(electrically – changed particles) .Impulses jump from one neuron to another at junctions known
as synapses.
2.4.2.Crossing the gap between neurons
When and electrical impulse arrives at the junction (synapse) it triggers the release of chemicals
called neurotransmitters. They cross the incredibly thin gap (synaptic cleft) between the
membranes of presynaptic (sending) and postsynaptic neurons (receiving). They either trigger a
new impulse in the receiving neuron or actively inhibit in from firing.
2.4.3.Resting Potential
With no impulse, there are more positively charged ions, particularly sodium ions outside the cell
membrane and more negative ions inside. This produces an electrical resting potential of -70
millivolts. The membrane is polarized, with the inside negative.
2.4.4.Depolarization
During this phase (depolarization) positive sodium ions rush in through ion rush in through ion
channels in a patch of neuron membrane. The membrane is first depolarized then its polarity is
reversed to become slightly positive, resulting in an action potential of +30 millivolts on the
inside.
2.4.5.Repolarization
Positively charged potassium ions flow in the opposite direction, restoring the charge membrane
and the next and so on. The impulse moves along the membrane as a wave of depolarization and
repolarization.
2.4.6.Excitement and Inhibition

When neurotransmitters on their receptors sites they can either excite or inhibit the receiving
cell. Both responses are equally valuable in relaying messages through the nervous systems. To
excite a receiving cell, positive sodium ions flow into it, depolarizing the membrane in a similar
way to a nerve impulse. The depolarizing effect spreads through the membrane for a few
milliseconds, fading as it does so. If further signals enter the cell, they may become strong
enough to file a new nerve impulse. To inhibit the cell, negatively charged particles rush into the
cell. The negative effect spreads through the cell membrane and prevents its excitement.
2.4.6.1.Parts of Neurons: - Projection of neurons: collect nerve impulses from other neurons
or sensory nerve endings.
2.4.6.2.Dendrites: - Main part of neuron, containing the nucleus and cell.
2.4.6.3.Neuron fibril node: - Also called node of ranvier, portion of axon not covered by
myelin.

2.4.6.4.Schwann cell: - Sheet-like cell that grows around a portion of axon (fiber) to form
the myelin sheath.
2.4.6.5.Myelin Sheath: - Also called neurilemma or Schwann sheath; spiraling structure of
fatty myelin that helps to speed an impulse and prevent it fading or leaking.
2.4.6.6.Axon: - Main nerve fiber of the neuron conveys impulses away from the cell body.
2.4.6.7..Neurotubule: - Specialized micro tube that works as a conveyer
belt to bring synaptic vesicles from the cell body to the axon terminal.
2.4.6.8.Synaptic Knob: - Enlarged end of axon terminal.
2.4.6.9Membrane Channel Protein: - Complex protein embedded in cell membrane; when
enough ions flood through the channel they cause a response in the receiving cell.
2.4.6.9.Receptor: - Sits in membrane channel into which neurotransmitter molecules slot,
altering the shape of the channel to admit charged ions.
2.4.6.10.Synaptic Cleft: - Fluid-Filled gap between the sending and receiving neuron just 25
nanometers wide.
2.4.6.11.Microfilament: - Thinnest element of the flexible, supporting scaffolding found in
most cells.
Presynaptic Membrane: - Membrane of sending cell’s axon.
Postsynaptic Membrane: - Membrane of receiving cell’s dendrite.
2.5.Respiratory system
 Respiratory system – a pneumatic system-
 an air pump (diaphragm ) alternately creates negative and positive pressures in a sealed
chamber (thoriac cavity) and causes air to be sucked into and forced out of a pair of
elastic bags (lungs).
 The respiratory system supplies the oxygen needed by the body cells and carries off their
carbon dioxide waste.
 Inhaled air passes via the trachea (windpipe) through two narrower tubes, the bronchi to
the lungs.
 chambers called alveoli
 Each lung comprises many fine, branching tubes called bronchioles that end in tiny
clustered

 Lungs -outside environment through a passage way comprising nasal cavities, pharynx,
larynx, trachea, bronchi, and bronchioles.
 Oxygen is taken into the blood from the incoming air and carbon dioxide is transferred
from the blood to the air
 Thus, the blood circulation forms link in the supply of oxygen to the tissues and in the
removal of gaseous waste products of metabolism.
 Gases cross the thin alveolar walls to and from a network of tiny blood vessels.
 Intrercostal (rib) muscles and the muscular diaphragm below the lungs operate the lungs
like bellows, drawing air in and forcing it out at regular intervals.
2.6.Urinary system
 The urinary system filters waste products from the blood and removes them from the
body via a system of tubes.
 Blood is filtered in the two kidneys which are fist-sized. Bean-shaped organs.
 The renal arteries carry blood to the kidneys.
 The renal veins remove blood after filtering
 Each kidney contains about one million tiny units called nephrons.
 Each nephron is made up of tubule and a filtering unit called glomerulus, which consists
of a collection of tiny blood vessels surrounded by the hollow Bowman’s capsule.
 The filtering process produces a watery fluid that leaves the kidney as urine.
 The urine is carried via two tubes called ureters to the bladder where it is stored until its
release from the body through another tube called urethra.
2.7.Nervous system
 The nervous system -control and communication network.
 Rapid communications between various parts, the effective integrated activity of different
organs and tissues and coordinated contraction of muscle are almost entirely dependent
upon the nervous system.
 The brain consists of three parts, namely the cerebrum, cerebellum, and the brain stem.
2.7.1.cerebrum
 The cerebrum consists of two hemispheres right and left.
 Each hemisphere is sub divided into two lobes.
 Frontal lobe and temporal lobe In the left hemisphere
 Parietal and occipital lobe in the right hemisphere.
 The outer layer of the brain is called the cerebral cortex.
 All sensory inputs from various parts of the body eventually reach the cortex.
 Various areas are responsible for hearing, sight, touch and control of the voluntary
muscles of the body.
2.7.2.Cerebellum
 The cerebellum acts as a physiological microcomputer which intercepts various sensory
and motor nerves to smooth out the muscle motions which could be otherwise jerky.
 It also consists of two hemispheres which regulate the coordination of muscular
movements elicited by the cerebrum.
 The cerebellum also enables a person to maintain his balance

2.7.3.Brain stem
 Brain stem- connects the spinal cord to the center of the brain just below the cerebral
cortex.
 Essential parts –
 medulla oblongata
 The pons
 Midbrain
 Diencephalon – thalamus, hypothalamus.
2.7.4.spinal cord:
 The spinal cord is a downward continuation of medulla oblongata
 The cord consists of white matter on the surface and gray matter inside.
 The cord containing motor and sensory fibres running between the brain and the body
and reflex action
 Billions of specialized cells –neurons are functionally active as signal transmitters
 Fundamental property of neuron- is the ability to transmit electrical signals, called
nerve impulses in response to the changes in their environment
2.7.4.5.Neuron
 A typical neuron consists of a nucleated cell body and has several processes or branches.
 The size and distribution of these branches vary greatly at different sites in cells with
different functions, but two main kinds are the axon and the dendrite.
2.8.Endocrine system
 The endocrine system works by using harmones which are carried through circulatory
system.
 The harmones are generated in the endocrine glands.
 The principal endocrine gland is PITUTIARY which governs several other endocrine
glands.
 The pitutiary is controlled by hypothalamus.
 The thyroid gland secretes thyroxin which increases the metabolism in the body.
 The deficiency of thyroid gland secretes thyroxin which increases the metabolism of
the body.
 The adrenal gland secretes corticoids and they regulates the metabolism of glucose.
 A deficiency of insulin results in increase glucose in the blood which leads the
condition called diabetes.
2.9.Ear
 The ear is the organ of hearing and balance.
 The outer ear consists of a flap called the auricle or pinna and the auditory canal.
 The main functional parts-the middle and inner ears are enclosed within the skull.
 The middle ear consist of three tiny bones known as auditory ossicles and the eustachian
tube, which links the ear to the back of the nose.

 The inner ear consist of the spiral-shaped cochlea and also the semicircular canals and the
vestibule which are the organs of balance.
 Sound waves entering the ear travel through the auditory canal to the tympanic
membrane (ear drum) where they are converted to vibrations that are transmitted via the
ossicles to the cochlea.
 Here the vibrations are converted by millions of microscopic hairs into electrical nerve
signal to be interpreted by the brain.

2.10.Eye
 The eye is the organ of sight.
 Two eyeballs, protected within bony sockets called orbits and on the outside by the
eyelids, eyebrows, and tear film are directly connected to the brain by the optic
nerves.
 Each eye is moved by six muscles.
 Which are attached around the eyeball.
 Light rays entering the eye through the pupil are focused by the cornea and lens to
form the image on the retina.
 The retina contains millions of light-sensitive cells, called rods and cones which
convert image into a pattern of nerve impulses These impulses are transmitted along
the optic nerve to the brain.
 Information from the two optic nerves is processed in the brain to produce a single
coordinated image.
2.11.Body cells
 Every one is made up of billions of cellsWhich are the structural units of the body.bones,
muscles, nerves, skin blood, and all other body tissues are formed from different types of
cells.Each cell has an outer layer (cell membrane) and contains fluid
material(cytoplasm)Within the cytoplasm many specialized structures called
organelles.The most important is the nucleus which contains vital genetic material.The
structure of DNA is like a spiral ladder.DNA contains genetic information and instruction
codes necessary for maintenance and continuation of life.In DNA we have four basic
materials.
 They are - adenine, guanine, thymine and cytocine.Nucleus is centrally located.It is
separated from surrounding fluids by cell membrane.Protoplasm is present in the
cell.This protoplasm is composed by water, electrolytes, protein, lipids and
carbohydrates.
 The principal fluid medium of the cell is water.Its concentration is about 70-85
percent.Water serves as solvent for various chemicals to produce chemical reactions.The
inorganic chemicals for chemical reactions are provided by electrolytes.In the electrolytes
we have sodium ions, potassium ions, phosphate ions, sulphate ions, bicarbonate ions and
a small quantity of proteins.Proteins- structural proteins, globular proteins.Lipids are
composed of different types of phospho lipids and cholesterol.Carbohydrates play a
major role in the nutrition of the cell. They are stored in the cells in the form of glycogen

which supplies energy needs for the cells. Ribosomes are also present in the
cystol.Lysosomes are vesicular organelles.
 They provide an intracellular digestive system that allows the cell to digest and thereby
remove unwanted substances and damaged foreign structures such as bacteria. The
mitochondria organelles are called power house of the cell. The cell extract significant
amounts of energy from the nutrients and oxygen by means of mitochondria. Nucleolus is
present inside the nucleus. The size of the cell is in the range of 5-10 micrometer.
2.11.1.Transport of ions through cell membrane

 Fluid is present inside the cell and outside the cell. This fluid is called intracellular fluid
and extra cellular fluid respectively. The extra cellular fluids contain large amount of
sodium ions and small amount of potassium ions. But in the intra cellular fluid it is vice
versa.
 The concentration of phosphates and proteins are more in intracellular fluid.
Concentration of chloride ions are more in extra cellular fluid. a lipid bilayer is present in
the cell membrane. This consists of large number of protein molecules are present in the
cell membrane.
 The cell membrane constitutes a barrier for the movement of the water soluble substances
between the extra cellular and intracellular fluid organs. With the help of diffusion
process transport of substances take place. This type of transport is called passive
transport. Ions like sodium potassium, calcium, chloride and most amino acids are
actively transported through cell membrane..
The active transport can be subdivided into two types according to the source of energy used to
cause the transport. They are primary active transport and secondary active transport.
Blood and its types
3.1.Fluid Body
Roughly (2/3)rd of the body is composed of water and the various essential substances
dissolved within it. These fluids have innumerable vital roles within many body systems. They
are found in cells, around the body’s tissue and most obviously in blood and lymph.
Most body parts are largely composed of water. Tissues are 70-80% fluid which means that
organs such as the brain and intestines are typically three quarters water. Blood plasma is over
90% water while bones contain almost 25%. Fat has 10-50% water composition.
3.2.Fluid Compartments
The body’s different fluids can be grouped into physiological categories that are known
as compartments. There are two major fluid compartments – intracellular and extra cellular.
Intracellular fluid (also known as cytoplasm) is found within the body’s cells. Extracellular fluid

accounts for all other fluids in the body. Its sub compartments are interstitial fluid, which
occupies the spaces between cells and tissues; blood plasma and lymph. The fluids found in
bones, joints and dense connective tissue; and Tran’s cellular fluid which includes saliva and
other digestive juices, mucus, sweat and urine.
3.3.Function of fluids
Water is excellent solvent. Thousands of substances that are dissolved in it are used in the
body’s biochemical reactions. These reactions are the very basis of life. Water is also an
effective transport system. It moves around the body distributing nutrients and collecting and
delivering waste materials. Fluids spread heat from active parts of the body, such as exercising
muscles, to cooler areas and in doing so they aid I thermoregulation. The body uses fluid as
shock absorbers to cushion sensitive areas such as brains, the eyes and the spinal cord. Fluid also
works as lubricants within the body, so that tissues and organs slip past each other with minimal
friction. Small amount of specific fluids that specialize in this role include the pleural fluid
around the lungs, the pericardial fluid around the heart and the synovial fluids inside joints.
3.4.Blood and Lymph

The blood and lymph circulatory system are closely linked because they are constantly swapping
fluids. Blood plasma, the fluid in which blood cells are suspended, transports red blood cells
(which carry oxygen and remove carbon dioxide) around the body. Blood plasma leaks from
capillaries into the tissues around them, becoming interstitial fluid. Most of this leaked fluid is
reabsorbed into the blood, but some of it is drawn into the capillaries of the lymphatic system
where it is used as lymph fluid. This transports white blood cells (which produce antibodies to
fight infection and disease) around the body. After flowing through the lymphatic system, lymph
drains back into the blood system, once again to be used as blood plasma.

Blood Plasma: The pressure

produced by the heart’s
pumping squeezes blood
plasma through capillary walls
Blood plasma
and lymph
cycle:-
Interstitial Fluid: The fluid now
Blood plasma
Lymph: Lymph vessels collect under little pressure flows
leaks out from
and circulate the fluid then randomly and slowly around
capillaries to
route it back into the blood cells and tissues.
become
circulation
interstitial fluid.
Some of this drains into lymph

vessels and becomes lymph fluid.
Eventually this fluid is returned to
blood circulation as lymphatic
vessels empty into large veins.

3.5.Balance and Recycling

The average adult body consists about 40 liters 170 pints of water. Every day water is lost form
the body in the form of urine, sweat, water vapor from the lungs and in feces. Water is used up
and also produced by the body in biochemical reactions, for example glands producing saliva
and digestive juices. To maintain a healthy balance of fluids, we need to drink at least 2 liters (3
½ pints) of water per day. But If were not for the body’s amazing water conservation and
recycling measures (such as recycling blood plasma as lymph and vice versa) we would need to
consume at least 100 times more water than the recommended amount every day
3.6.Components of blood plasma
Blood cells are transported by blood plasma a liquid that accounts for about 55% of blood
volume and is itself about 90% water, it contains many important substances.
Plasma Proteins: Such as albumins (stop water leaking into tissues) fibrinogen (involved
blood clotting) and globulins (such as antibodies).
Electrolytes: Mainly mineral salts that form ions when dissolved principally sodium
chloride, potassium, calcium and phosphate.
Hormones: Like insulin and glucagon (regulate blood glucose levels) thyroid
hormones (control rate of cell metabolism) and sex hormones.
Nutrients: Such as glucose (for energy) amino acids and lipids, such as cholesterol
and triglycerides (for cellular components and energy).
Waste: Such as Carbon dioxide, lactic acids, creatine and uric acid. These are transported
out of the blood circulation by the kidneys.
3.6.1.Blood and Blood Vessels

Blood is collection of specialized cells suspended in straw colored liquid called plasma.
Blood delivers oxygen and nutrients to body cells, collects waste, distributes hormones, spreads
heat around the body to control temperature and plays a part in fighting infection and healing
injuries.
3.6.2.What is Blood?
Blood forms about 1/10th of the body weight of an adult amounting to 5 liters in volume.
Roughly 50-55% of blood plasma consists of the liquid-only portion in which cellular
components are distributed. Plasma is 90% water containing dissolved substances such as
glucose (blood sugar) hormones, enzymes and also waste products such as urea and lactic acid.
Plasma also contains proteins such as albumins, fibrinogens (important in blood clotting) and
globular proteins or globulins. Alpha and beta globulins help to transport lipids, which are fatty
substances such as cholesterol. Gamma globulins are mostly the disease fighting substances
known as antibodies. The remaining 45-50% of blood is made up of three types of specialized

cells. Red cells or erythrocytes carry oxygen; various white cells known as leucocytes are part of
the defense system; and cellular fragments (platelets or thrombocytes) are involved in the
process of clotting.
3.6.3.Parts of Blood
Blood is made up of liquid portion (plasma) red blood cells, a small band of platelets and white
blood cells.
Red Blood Cell Structure:
A biconcave disc with no nucleus or discrete nibble inner structure, each red blood cell
contains 300 millions hemoglobin molecules.
Role of Hemoglobin:
Hemoglobin is composed of hem, an iron-rich pigment and globins, ribbon-like protein
chains. Oxygen in the lungs latches onto hem to make oxyhemoglobin. In this conjoined form,
oxygen travels through the blood stream to all parts of the body.
3.7.Blood Groups
Every individual belongs to one of four blood groups which are determined by markers or
red blood cells known as antigens (agglutinogens). The antigens may be either A, B, both (AB)
or neither (O) and blood groups are named correspondingly. Plasma contains different antibodies
(isohemoagglustinins). For example, a person with blood group A has plasma containing B
antibodies. If mixed with type B blood with A antibodies in its plasma) A antibodies clump
(agglutinate) with ‘A’ antigens. This is the reason why blood types must be matched to transfuse
blood safely from donor to recipient.

Blood Group B
Blood Group A A - Antibody; B - Antigen Blood Group AB
A – Antigen; B - Antibody A & B Antigen with neither
A or B in Plasma
Blood Group O
Lack of A & B antigen but plasma
contains both A & B antibodies.
3.7.1Arteries
Arteries carry blood away from the heart towards organs and tissues. Apart from the
pulmonary arteries, all arteries carry oxygenated blood. Their thick walls and muscular and
elastic layers can withstand the high pressure that occurs when the heart contracts. An artery
narrows when the heart relaxes, helping to push blood onwards. The largest artery is aorta.
3.7.2.Veins
A vein is more flexible than an artery and its walls are considerably thinner. The blood
inside a vein is under relatively low pressure and as a result, it flows slowly and smoothly. Many
larger veins particularly the long veins in the legs contain valves that are formed from pouch –

like pockets of single cell lining tissue (endothelium). These prevent blood flowing back down
the legs; a job helped by muscles around the veins that contract during movement. The two main
veins returning from the upper and lower halves of the body are known as the superior and
inferior vena cava.
3.7.4.Capillaries
The smallest and most numerous of the blood vessels capillaries convey blood between arteries
and veins. Many capillaries enter tissue to form a capillary bed, the area where oxygen and other
nutrients are released. Capillary bed connects small arteries (arterioles) to veins (venules).
3.8.Cellular Respiration
Glucose (blood sugar) is the body’s main energy source. Cellular respiration occurs in
every body cell when oxygen reacts with glucose to free its energy in chemical form. The end
products are carbon dioxide and water, which is known as metabolic water and amounts to about
300ml daily throughout the body. The whole process is called aerobic (oxygen requiring) cellular
or internal respiration.
3.8.Respiration Reaction
Cells take up oxygen to drive the key respiration reaction that release energy from glucose.
3.8.1.Gas Exchange in Blood
The body cannot store oxygen and needs continuing supplies. It also constantly produces carbon
dioxide as a waste product. Gas exchange swaps oxygen and carbon dioxide in the lungs and
tissues.
Oxygen gas is physically drawn into the body by expanding lungs (above right) when it reaches
the microscopic blind ends of the lungs airways, the gas dissolves into the fluid thing the air
spaces (alveoli, top, left). It then passes into blood stream, which distributes oxygen to each body
cell. Inside cells, the chemical changes known as cellular respiration use oxygen to break apart
glucose for energy. Toxic carbon dioxide is a by product of the process, but gas exchange
discharges it into the air. In both lungs and body tissues, gases pass by diffusion (the process of
flowing from region of high to low density).
Step1:
Oxygen in air dissolves into fluid lining the alveolus and diffuses through alveolar wall
and blood capillary wall.
Step2:
Oxygen enters blood plasma inside capillary.
Step3:
Oxygen quickly bonds to hemoglobin in red blood cells.
Step4:
Carbon dioxide diffuses out of blood plasma and enters air in the alveolus (air-space).

Step5:
Bright red, oxygenated blood leaves heart along the aorta (the body’s main artery) and
circulates through a network of arteries to the body’s tissues.
Step6:
Oxygenated blood is carried through the tissues in capillaries thinner than hair.
Step7:
Arriving red blood cells are rich in oxygen, which is bound to hemoglobin in the body of
each cell.
Step8:
Oxygen leaves the hemoglobin within the red blood cells, diffuses across the blood
capillary walls and into tissue cells.
Step9:
Carbon dioxide diffuses out of tissue cell, across wall of blood capillary and into blood
plasma.
3.8.3. Exchange in the Lungs
When fresh, oxygen-rich air reaches the alveoli the tiny dead end air spaces in the lungs – it must
pass through several layers to reach the red cells in the blood. But these layers are so thin that the
total distance is 0.001mm.
3.8.4.Exchange in the Body Tissues

Oxygen levels are higher in the blood than in surrounding tissues. The difference in levels forces
oxygen to break its bonds to the hemoglobin in red blood cells and diffuse out of the blood into
the adjacent cells. The reverse applies to carbon dioxide, which diffuse from the tissue into blood
plasma.
3.9.Blood Pressure
The heart is a dynamic, untiring, precisely adjustable double-pump that forces blood around the
body’s immense network of blood vessels, perhaps more than three billion times during lifetime.
The heart’s power comes from its two lower chambers (ventricles) which have thick muscular
walls. That contact to squeeze blood out into the arteries. The upper chamber (arterial) have
thinner walls and function partly as passive reservoirs for blood oozing in from the main veins.
Each heartbeat has two phases. In the first phase (diastole) the heart relaxes and refills with
blood; during the second stage (systole) it contracts, forcing the blood out. The whole cycle takes
on average less than second. During vigorous activity or stress, both beating rate and the volume
of blood pumped out of the heart increases greatly.
3.9.1.Relaxation (Late Diastole)
During this phase of the heart beat sequence, the muscular walls of the heart relax the
arterial chambers balloon slightly as they fill with blood coming under quite low pressure from
the main veins. Deoxygenated blood from the body enters the right atrium, while oxygenated

blood from the lungs enters the left atrium. Some of the blood in the atria flows down into the
ventricles. By the end of this phase, the ventricles are filled to 80% of capacity.
3.9.2.Contraction of the Atria (Atrial Systole)
The hearts natural pacemaker, known as the sinoatrial node, is located in the upper part of
the right atrium. It fires electrical impulses, much like those generated by nerves, which set off
the contraction phase. Some impulse spread through the atrial walls and stimulate their cardiac
muscle to contract. This squeezes blood inside the atrioventricular (tricuspid and mitral) valves
into the ventricles whose walls remain relaxed.
3.9.3.Contraction of the ventricles (Ventricular Systole)
During this most active and powerful stage of the heartbeat, the thick cardiac muscle in
the ventricle walls contracts stimulated by electrical impulses relayed by the atrio-ventricular
node, this cause a rise in ventricular pressure, which opens the aortic and pulmonary valves at the
exits of the ventricles. Blood is force out into the main arteries, making the atrio-ventricular
valves snap shut.
3.9.4.Relaxation (Early Diastole)

The walls of the ventricle begin to relax, causing ventricular pressure to reduce. The pressure of
the recently ejected blood in the main arteries is now high. So both the aortic and pulmonary
valves close. This prevents back-flow into the ventricles as ventricular pressure on the atrio
ventricular valves relaxes, the valves open. This reduces pressure in the atria, allowing blood to
enter once again from the main veins.
3.9.5.Control of heart rate

Without control, the heart would beat at its natural intrinsic rate of about 100 times per
minute. However, a region known as the cardio regulatory center in the medulla of the brain stem
sends electrical impulses along nerves (especially the cranial vagus nerve) to set an average
resting rate of about 70 beats per minute. During activity or stress, the sympathetic cardiac nerve
signals, controlled by the hypothalamus, convey over riding signals to speed up the heart rate.
The rate is also influenced by hormones such as adrenaline.
Sino Atrial Node

The Sino atrial node is inactive during most of the diastole. As systole approaches, it
begins to send out a wave of electrical impulses which will co-ordinate the heartbeat.
Electrical Impulses
Electrical impulses spread over surface of both atria, stimulating them to contract.

Electrical Impulses spread

Impulses travelling through atrial muscles make them contract within 0.1 seconds. Some signals
pass faster along conducting fibers to the atrio-ventricular node.
Atrio-ventricular Signals Fire

The Atrio-ventricular node fast-tracks impulses along conducting fibers within the septum
(dividing wall) to the lower ventricles and up through ventricle muscle.
Electrical Impulse Fade

Impulses spread through the ventricular walls back towards the atria within 0.2 seconds of
leaving the sinoatrial node which then fires again to continue the cycle.
Blood cell counters

4.1.Introduction:
Changes in the normal functioning of an organism are often accompanied by changes in

the blood cell count. The determination of the number and size of blood cells per unit
volume provides valuable information for accurate diagnosis. Blood consists of
corpuscles suspended in a fluid called plasma in the proportion of 45 parts of corpuscles
(cells) of plasma.
The percentage of cells in the blood is called the haematocrit value or packed
cell volume (PCV). The majority of the corpuscles in blood are red blood cells
(erythrocytes) others being white blood cells (leucocytes) and platelets (thrombocytes)
Erythrocytes (RBC) have no nucleus. But it has a membrane and is filled with a
solution containing an iron-containing protein hemoglobin. They are responsible for
carrying oxygen from the lungs to the tissues and carbondioxide from the tissues to the
lungs. Anaemia (reduction in the oxygen carrying capacity of the blood) can develop
from a change in the number caused by bone marrow dysfunction resulting in the poor
production rate of RBCs.
Leucocytes (WBC) are spherical cells having nucleus. There are normally 5000 -
10,000 white cells per cubic mm of blood. But their number varies during the day. They
alive for seven to fourteen days and there is a rapid turnovers with constant destruction
and replacement.
Thrombocytes (platelets) are usually tiny, round oblong or irregularly shaped

cells of the blood with an average diameter of approximately 2 microns. They play an

important role in the blood coagulation process. There are usually 250,000 – 750,000
platelets in every cubic mm of blood. They are colorless and have no nucleus.
By spinning blood in a centrifuge, the blood cells can be sedimented. The blood
plasma with the blood cells removed is a slightly viscous, yellowish liquid that contains
large amounts of dissolved proteins. One of the proteins fibrinogen, participates in the
process of blood clotting and forms thin fibers called fibrin. The plasma from which the
fibrinogen has been removed by precipitation is called blood serum.
Blood clotting can be inhibited by the injection of heparin, a natural

anticoagulant extracted from the liver and lungs of cattle.
A count of the blood cells, an inspection of the size and shape, or a chemical
analysis of the blood serum can, therefore provide important information for the
diagnosis of diseases similarly other body fluids, smears and small samplesof live tissue,
obtained by a biopsy are studied through the techniques of bacteriology, serology and
histology to obtain clues for diagnosis of diseases.
Mean cell volume(MCV):

It is calculated from the packed cell volume (PCV) and the number of red cells
present per litre of blood. It is indicated in f/l (femolitres 1 f/l = 10 -15)
Mean cell haemoglobin (MCH):

It is calculated from the HB and red cell count (it is expressed in picograms)
Mean cell haemoglobin concentration(MCHC):

It can be calculated if PCV Hb per dl are known.
Mean platelet volume(MPV):

It is the ratio of the integrated platelet volume to the platelet count and is
expressed in femolitres.
Plateletcrit:
It is the percentage of the total specimen volume occupied by the platelets.
Red cell distribution width (RDW):

It is a numerical expression of the width of the size distribution of red cells.
Platelet distribution width (PDW):

This index is related to the size range covered by those platelets lying between the
sixteenth and eighty fourth percentile.
4.2.Tests on blood cell:

When whole blood is centrifuged, the blood cells sediment and form a packed
volume at the bottom of the test tube. Most of this column consists of the red blood cells,
with the other cells forming a thin buffy layer on the top of the red cells. The volume of
the packed red cells is called the hematocrit. This is expressed as a percentage of the
total blood volume.
The hematocrit can be determined by aspirating a blood sample into a capillary

tube and closing one end of the tube with a plastic sealing material. The tube is then spun
for 3 to 5 minutes in a special high-speed centrifuge to separate the blood cells from the
plasma. Because the capillary tube has a uniform diameter, the blood and cell volumes
can be compared by measuring the lengths of the columns. This is usually done with a
simple nomogram.
The red blood cells have a much higher electrical resistivity than the blood plasma in
which they are suspended and so the resistivity of the blood shows a high correlation with
the hematocrit.
Manual blood cell counts are performed by using microscope. For this, the blood is first
diluted 1 :100 or 1:200 for counting of red blood cells (RBC) and 1:10 or 1:20 for white
blood cell count (WBC). For counting WBC, a diluents is used that dissolves the RBCs,
whereas for counting RBCs, an isotonic diluent preserves these cells. The diluted blood is
then brought into a counting chamber of 0.1mm deep, which is divided by marking lines
into a number of squares, when magnified about 500 times, the cells in a certain number
of squares can be counted.
Today simple RBC and WBC counts are normally performed by automatic or
semiautomatic blood cell counters. The most commonly used devices of this kind are
based on the conductivity(coulter) method, which makes use of the fact that blood cells
have a much lower electrical conductivity than the solution in which they are suspended.
Such a counter contains a beaker with the diluted blood. A closed glass tube that contains
a very small orifice is placed inside the diluted blood. The conductance between the
solution in the glass tube and the solution in the beaker is measured with two electrodes.
The result is a pulse at the output of the conductance meter, the amplitude of which is
proportional to the volume of the cell.

1. First Contact 3
2. Second Contact
3. Suction Pump
4. Electrodes
( Platinum)
Conductivity
4 meter
Threshold unit
2 1
Pulse gate
BLOCK gives
start stop signal to
counter
counter
Conductivity Method (Coulter Method)
A threshold circuit lets only those pulses pass that exceed a certain amplitude
gate. The first contact and closes when it reaches the second contact. Thus counting the
number of cells contained in a given volume, of the solution passing through the orifice.
A count is completed in less than 20 seconds. With counts of upto 100,000 the result is
statistically accurate. Care must be taken to keep the aperture from clogging. From these
measurements, the mean cell volume, the mean cell hematocrit and mean cell hematocrit
concentration are calculated and the corresponding results are taken out on a preprinted
report form.

Blood cell counter (Dark field microscope method):

The diluted blood flows through a thin cuvette. The cuvette is illuminated by a
cone-shaped light beam obtained from a lamp, through a ring aperture. And an optical
system. The cuvette is imaged on the cathode of a phototube by means of lens and an
aperture. normally no light reaches the photo tube until a blood cell passes through the
cuvette and reflects a flash of light on the phototube.
4.2.BLOOD GAS ANALYZERS

4.2.1Introduction:
Blood gas analyzers are used to measure the pH, partial pressure of carbon dioxide (pCO2)
and partial pressure of oxygen (pO2) of the body fluids with special reference to the human
blood. A sudden change in the pH and pCO2 could result in cardiac arrhythmias , ventricular
hypotension and even death.
4.2.2.Acid- base balance:

The normal pH of the extra cellular fluid lies in the range of 7.35 to 7.45 indicating that
the body fluid is slightly alkaline. When the p H below 7.35, it indicates acidosis. When the p H
exceeds 7.45, the body is considered to be alkalosis. With the help of three physiological
mechanisms as
 Respiration
 Excretion into urine by kidneys
 Buffering by chemical means
it is possible for us to analyze the deviation of pH of the blood.
The blood and tissue fluids contain chemical buffers, which react with added acids and
bases and minimize the resultant change in hydrogen ions.
The respiratory system can adjust sudden changes in carbon dioxide, tension back to
normal levels in just a few minutes. Carbon dioxide can be removed by increased breathing and
therefore hydrogen concentration of the blood can be effectively modified. The kidney requires
many hours to readjust hydrogen ion concentration by excreting highly acidic or alkaline urine to
enable body conditions to return towards normal condition.
Arterial blood has a pH of approximately 7.40. Venous blood acquires carbon dioxide
forms carbonic acid and hydrogen ions, the venous blood p H falls to approximately 7.36. this pH
drop of 0.04 units occurs when the CO2 enters the tissue capillaries. When CO2 diffuses from
pulmonary capillaries into the alveoli, the blood pH rises 0.04 units to bring the normal atrial

value of 7.40. it is difficult to measure the pH of fluids inside the tissue cells, but from estimates
based on CO2 and HCO3 ion concentration, intracellular pH probably ranges from 7.0 to 7.2.
The three important chemical factors regulating alveolar ventilation are the arterial
concentration of CO2, H+ and O2. Carbon dioxide tension in the blood stream and cerebrospinal
fluid (CSF) is the major chemical factor regulating alveolar ventilation.
4.2.3.Gas exchange and distribution:
Once air is in the lungs, oxygen and carbon dioxide must be exchanged between the air
and the blood in the lungs and between the blood and the cells in the body tissues. These gases
must be transported between the lungs and the tissue by the blood.
The mixing of gases within the lungs ventilation of the alveoli and the exchange of
oxygen and carbon dioxide between air and blood in the lungs takes place through a process
called diffusion. Diffusion is the movement of gas molecules from a point of higher pressure to
a point of lower pressure to equalize the pressure difference. This process can occur when the
gas is unequally distributed in a chamber on two sides of membrane permeable to that gas.
Measurements required for determining the amount of diffusion involve the partial
pressures of oxygen and carbon dioxide, pO2, pCO2, respectively.
Methods for analyzing pO2, pCO2

Chemical analysis method
Diffusing capacity using CO infrared analyzer
Gas chromatograph.
4.2.4.Chemical analysis methods

These analyzers are developed by Haldane and modified by Scholander.
In this analyzer, a gas sample of approximately 0.5ml is introduced into a reaction
chamber by use of a transfer pipet at the upper end of the reaction chamber capillary. An
indicator droplet in this capillary allows the sample to be balanced against a trapped volume of
air in the thermo-barometer. Absorbing fluids for CO2 and O2 can be transferred in from side
arms without causing any change in the total volume of the system. The micrometer is adjusted
so as to put mercury into the system in place of the gases being absorbed. The volume of the
absorbed gases is read from the micropipette barrel calibration.
4.2.4.1.Gas Chromatograph:
The quantities of various gases in the expired air can also be determined by means of a
gas chromatograph, an instrument in which the gases are separated as the air passes through a
column containing various substances that interact with the gases. The reactions cause different
gases to pass through the column at different times. The quantity of each gas is measured as it
emerges. To identify the gases in the expired air other than oxygen nitrogen or CO 2, a mass
spectrometer is used in conjunction with the gas chromatograph. The mass spectrometer
identifies the ions according to their mass/charge ratio.

4.2.4.2.Diffusion capacity using CO infrared analyzer:

With the help of this analyzer, it is possible to measure O2,CO2,pH and bicarbonate in
arterial blood. If we try to measure the diffusion of oxygen from the aleovli, into the blood, it is
usually assumed that all alveoli have an equal concentration of oxygen. Actually this condition
does not exist because of the unequal distribution of ventilation in the lung, hence the terms
diffusing capacity or transfer factor (rather than diffusion) is used to describe the transfer of
oxygen from the alveoli into the pulmonary capillary blood.
Carbon mono oxide (CO) resembles oxygen in its solubility and molecular weight and
also combines with hemoglobin reversibly. Its affinity for hemoglobin is about 200 to 300 times
that of oxygen. Carbonmonooxide can thus be used as a tracer gas in measuring the diffusion
capacity of the lung. It passes from the alveolar gas into the alveolar walls, then into the plasma
from which it enters the red blood cells where it combines with hemoglobin
1 / TF = 1/ Dm + 1/θVc
Where TF = diffusing capacity for the lung for CO.

Dm = diffusing capacity for alveolar membrane
Vc = volume of blood in the capillaries.
θ = reaction rate of CO with oxyhemoglobin.
TF, the diffusing capacity for the whole lung in normal adults ranges from 20 to 38 ml/min/mm
HG during exercise, and decreases with anemia or low hemoglobin.
In the single-breath method, the last 75 to 100 ml of the expired air is collected so that
enough end-tidal air containing CO is available for the measurement. CO in the blood is
negligible, for it combines with the hemoglobin I the red blood cells and exerts no significant
back pressure. The commonly used carbon mono oxide analyzer utilizes an infrared energy
source, a beam chopper, sample and reference cells, plus a detector and amplifier. A milli
ammeter or a digital meter may be used for display. Two infrared beams are each measured by a
differential infrared detector. The output signal is proportional to the amount of monitored gas in
the sample cell. The signal is amplified and presented to the output display meter or to a
recorder.

Study of the Lungs, Temperature, pulse, Cardiac

output, Blood flow meters
4.3.Respiratory system
The respiratory system in close conjunction with circulatory system is responsible for
supplying all blood cells with essential oxygen and removing potentially harmful carbon dioxide
from the body. The mouth and nose channel air from outside the body through a system of tubes
of diminishing size that eventually reach the two lungs situated on either side of the heart within
chest cavity.
Air enters the body mainly through the nostrils (but sometimes through the mouth) . the
nostrils lead into the nasal cavity which opens up within the skull and joins with the pharynx
(part of the throat) towards the rear. The pharynx is a short-funnel –shaped tube that extends
partway down the neck. The first part of the pharynx conveys only air, but lower down, food and
liquids also travel through. The larynx, home to vocal cords, joins the pharynx to the wind pipe.
(trachea). A loose flap of cartilage the epiglottis, lies just above the larynx and blocks it off
during swallowing to prevent food and liquids entering the trachea. The trachea splits into two
air ways called primary bronchi, one of which enters the right lung and the other the left lung.
Each brounchus divides further into secondary and teritiary bronchi and eventually into tiny
bronchioles. The continuous branching is referred to as the bronchial tree. Deep within the paired
cone-shaped lungs exchange of gases takes place.
4.3.1.Parts of Lung :
Nasal cavity:
Main route for air to and from the lungs, lined with a sticky mucus covered membrane
that traps dust particles and germs; divided into two by central plate of cartilage (nasal septum)
fuzzy –looking patches (olfactory epithelia)in roof of cavity are the sensory organs of smell.
Nose hairs:
Situated inside entrance of nostrils help in filter large particles of dust and debries.
Epiglotis:
Cartilage flap that tilts over entrance to larynx when swabling to prevent food and drink
and saliva entering trachea.

Larynx:
Short cartiginous tube joining pharynx with trachea together with vocal cards within the
larynx, it has a vital role in speech production.
Rib:
Twelve pairs of ribs curve around chest and protect lungs and heart from physical
damage.
Intracostal muscles:
Double layer of muscles between each pairs of ribs; external layer lifts ribs up and out
during contraction enlarging the lungs to that air is breathed in; inner layer does the opposite
forcing air out.
Right lung:
Slightly larger than the left lung, averaging 55 -60 percent of total lung volume.
Pleural cavity:
Space occupied by the lings; lined with lubricated double layer of pleural membranes.
Pleural membrane:
Sac composed of two thin membrane layer encloses each lung; fluid secreted by one of
the membranes allows them to slide smoothly over each other during breathing.
Diaphragm:
Dome-shaped muscle that divides chest and abdomen and together with inter costal
muscles from body’s main breathing muscle; during contraction it flattens and increases size of
chest cavity.
Nasopharynx:
Allows the passage of air only.

Oropharynx:
Permits passage of foods and fluids.

Pulmonary artery:
Thick-walled vessel that transports deoxygenated blood lungs from right side of heart.
Pulmonary vein:

Vessel carrying bright red oxygenated blood from each lung to left side of heart for
supply to the rest of the body.
Primary bronchus:
One of the five branches of the primay bronchus each one supplies a defined segment of
the lung, bronchus further divides into air ways of diminishing diameter called tertiary bronchi.
Lobes of Left lung:
Has only two lobes, to make room for heart (right lung is tri-lobed)
Bronchioles:
Miniscule terminals of the bronchi; gas exchange occurs in tiny sacs (alveoli) at their
ends.
Heart :
Nested in the pericardial cavity.
Pericardial cavity:
Formed mainly by a scoop like shape in the left lung.
Alveoli:
The lung’s microscopic air sacs, alveoli are elastic thin walled structures arranged in
clumps at the ends of respiratory bronchioles. They resemble bunches of grapes, although the
alveoli are partly merged with each other. White blood cells known as macrophages are always
present on their surfaces, where they in digest and destroy air borne irritants such as bacteria,
chemicals and dust.
Around the alveoli are networks of capillaries. Oxygen passes from the air in the alveoli
into the blood by diffusion through the alveolar and capillary walls. Carbon di oxide diffuses
from blood into the alveoli. There are more than 00 million alveoli in both lungs.
Breathing and vocalization:
The movements of breathing also known as bodily respiration, bring fresh air containing
oxygen deep into the lungs and then remove stale air containing the waste product carbon di
oxide.
4.3.2.Breathing:

The physical movement of air into and out of the lungs is generated by differences in
pressure within the lungs compared to the surrounding atmospheric pressure. The pressure
differences are produced by forcefully expanding the chest and lungs by muscular action and
then passively allowing them to return to their former size. The rate and depth of breathing can
be consciously modified. However the underlying need to breathe is controlled by ares within the
brain stem, where responses to regulate the breathing muscles (of which we are usually not
aware) occur according to the levels of carbon dioxide and oxygen in the blood.
4.3.2.1.Diaphragm movement:
The abdominal contents are flattened by the diaphragm muscle during inhalation and then
rise up during exhalation.
4.3.2.2 Inhalation:
The chief muscles used in respiration at rest are the diaphragm at the base of the chest
and the external intercostal between the ribs. For forceful inhalation, additional muscles assist in
moving the ribs and sternum to expand the chest further and stretch the lungs even more.
4.3.2.3.Volume and pressure:
Breathing alters the volume of the chest (thoracic activity). The lungs suck onto the inner
chest wall, so that as the cavity expands, they also become larger. The main expanding forces are
provided by the diaphragm and intercostal muscles. At rest, the diaphragm carries out most of
the work. 0.5 liters of air – the tidal volume-shifts in and out with each breath 912 to 1 times
every minute) rate and volume increases automatically if the body needs more oxygen as during
exercise. Then forced inspiration can suck in an extra liters and forced expiration expels almost
as much leading to a total air shift or vital capacity, of more than .5 liters in a large healthy adult.
The breathing rate can be ripple producing a total air exchange more than times greater than at
rest.
4.3.2.4.Breathing in:
The diaphragm contracts to become less dome like while the ribs swing upward and
outward with a bucket handle action to raise the sternum.
4.3.2..5Breathing out:
The diaphragm relaxes and the elastic stretched lungs recoil to become smaller again,
allowing the sternum and ribs to move down and inward.s
Negative pressure:

As lung volume increases, air pressure within decreases. Atmospheric pressure outside
the body is now higher and air is drawn down the airways and into the lungs –in effect air is
sucked in.
Positive pressure:
As lung volume diminishes, when exhaling, the air is compressed, raising its pressure
within the lungs. So the air is pushed back along the airways and out of the mouth.
Respiratory Reflexes:
The two important respiratory reflexes are coughing and sneezing. Both aim to blow
out excess mucus, dust irritants and obstructions- coughing from lower pharynx, larynx, trachea
and lung air ways and sneezing from nasal chambers and naso-pharynx. In both cases, a deep
inhalation is followed by sudden contraction of the muscles involved in forceful exhalation. For
a cough, the lower pharynx, epiglottis and larynx close so that air pressure builds up in the lungs
and is released explosively, rattling the vocal cords. In a sneeze, the tongue closes off the mouth
to force air up and out through the nose.
4.4.Spirometry:
Flow-Volume loop showing successful FVC maneuver. Positive Values represent

expiration, negative values represent inspiration. The trace moves clockwise for expiration
followed by inspiration. (Note the FEV1, FEV1/2 and FEV3 values are arbitrary in this graph
and just shown for illustrative purposes, they must be recorded as part of the experiment).
Spirometry (meaning the measuring of breath) is the most common of the Pulmonary
Function Tests (PFTs), measuring lung function, specifically the measurement of the amount
(volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important
tool used for generating pneumotachograph to assessing conditions such as asthma, pulmonary
fibrosis, and COPD.
4.4.1.Spirometry testing
The spirometry test is performed using a device called a spirometer, which comes in several
different varieties. Most spirometers display the following graphs:
a volume-time curve, showing volume (liters) along the Y-axis and time (seconds) along the X-
axis
a flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total
volume inspired or expired on the X-axis

The most commonly used guidelines for spirometric testing and interpretation are set by the
American Thoracic Society (ATS) and the European Respiratory Society (ERS).
Procedure
The basic FVC test varies slightly depending on the equipment used.
Generally, the patient is asked to take the deepest breath they can, and then exhale into the sensor
as hard as possible, for as long as possible. It is sometimes directly followed by a rapid
inhalation (inspiration), in particular when assessing possible upper airway obstruction.
Sometimes, the test will be preceded by a period of quiet breathing in and out from the sensor
(tidal volume), or the rapid breath in (forced inspiratory part) will come before the forced
exhalation.
During the test, soft nose clips may be used to prevent air escaping through the nose. Filter
mouthpieces may be used to prevent the spread of microorganisms, particularly for inspiratory
maneuvers.
Limitations of test
The maneuver is highly dependent on patient cooperation and effort, and is normally repeated at
least three times to ensure reproducibility. Since results are dependent on patient cooperation,
FEV1 and FVC can only be underestimated, never overestimated.
Due to the patient cooperation required, spirometry can only be used on children old enough to
comprehend and follow the instructions given (typically about 4-5 years old), and only on
patients who are able to understand and follow instructions - thus, this test is not suitable for
patients who are unconscious, heavily sedated, or have limitations that would interfere with
vigorous respiratory efforts. Other types of lung function tests are available for infants and
unconscious persons.
Related tests
Spirometer can also be part of a bronchial challenge test, used to determine bronchial hyper
responsiveness to either rigorous exercise, inhalation of cold/dry air, or with a pharmaceutical
agent such as methacholine or histamine.
Sometimes, to assess the reversibility of a particular condition, a bronchodilator is administered

before performing another round of tests for comparison. This is commonly referred to as a
reversibility test, or a post bronchodilator test (Post BD), and is an important part in diagnosing
asthma versus COPD.
Explanation of common test values in FVC tests Abbreviation Name Description

FVC Forced Vital Capacity This is the total amount of air that you can forcibly blow out after
full inspiration, measured in liters.

FEV1 Forced Expiratory Volume in 1 Second This is the amount of air that you can
forcibly blow out in one second, measured in litres. Along with FVC it is considered one of the
primary indicators of lung function.
FEV1 / FVC FEV1% This is the ratio of FEV 1 to FVC. In healthy adults this should be
approximately 75 - 80%.
PEF Peak Expiratory Flow This is the speed of the air moving out of your lungs at the
beginning of the expiration, measured in liters per second.
FEF 25-75% or 25-50% Forced Expiratory Flow 25-75% or 25-50% this is the average
flow (or speed) of air coming out of the lung during the middle portion of the expiration (also
sometimes referred to as the MMEF, for maximal mid-expiratory flow).
FIF 25-75% or 25-50% Forced Inspiratory Flow 25%-75% or 25%-50% this is similar
to FEF 25%-75% or 25%-50% except the measurement is taken during inspiration.
FET Forced Expiratory Time This measures the length of the expiration in seconds.
SVC Slow Vital capacity
TV Tidal Volume During the respiratory cycle, a specific volume of air is drawn into and
then expired out of the lungs. This volume is tidal volume.
MVV Maximum Voluntary Ventilation a measure of the maximum amount of air that can
be inhaled and exhaled in one minute, measured in liters/minute.
Note that functional residual capacity (FRC) cannot be measured via spirometry, but it can be
measured with a plethysmograph.
Results are usually given in both raw data (liters, liters per second) and percent predicted - the
test result as a percent of the "predicted values" for the patients of similar characteristics (height,
age, sex, and sometimes race and weight). The interpretation of the results can vary depending
on the physician and the source of the predicted values. Generally speaking, results nearest to
100% predicted are the most normal, and results over 80% are often considered normal.
However, review by a doctor is necessary for accurate diagnosis of any individual situation.
4.5.Temperature Measurements:
Body temperature is one of the oldest known indicators of the general well being of a
person. Techniques and instruments for the measurement of temperature have been common
place in home. Two basic types of temperature measurements can be obtained from the human
body. Systematic and skin surface measurements. Both provides valuable diagnostic information
although the systematic temperature measurement is much more commonly used.
4.5.1.Temperature Regulation:
One of the skin’s functions is to contribute to thermo regulation maintenance of a
constant body temperature. It does this in three main ways: Widening and narrowing of blood
vessels, sweating and hair adjustments, if the body becomes hot, blood vessels in the dermis
widen (vasodilate) to allow extra blood flow so more warmth can be lost from the surface. The
skin may look flushed, and sweat oozes from sweat glands and evaporates , drawing away body
heat. If the body is cold, the peripheral blood vessels (vasoconstrict) to minimize heat loss and

sweating is reduced. Tiny body hairs are pulled upright by the erector pili muscles to trap air as
an insulating.
Feeling cold ( Hair stands more upright)
Tiny body hairs, raised by the contraction of the erector pili muscles, create small
mounds known as goose pimples at their bases, the peripheral blood vessels constrict and sweat
reduce their activity.
Feeling Hot (Hair Lies Flatter)
Tiny body hairs lie flatter as the erector pili muscles relax, and the small mounds at their
bases disappear. Dermal blood vessels dilate , increasing blood flow and the sweat glands raise
their o/p.
Ultraviolet Defences:
The sun’s rays include a spectrum of colour wavelength including infra red or IR rays (
the warming component) and ultraviolet, UV rays. Both UV-A and UV-B wavelengths are
invisible to human eyes, but exposure to the latter in particular is linked to forms of skin cancer.
Skin’s self-defence is its dark colouring substance or pigment, melanin. This forms a screen in
the upper epidermis that shields the actively multiplying cells in the base of the epidermis.
Melanin Production:
Melanocytes are melanin- producing cells in the base of the epidermis, They make parcels of
melanin granules melanosomes which pass inti surrounding cells.
Skin Pigmentation:
Skin colour depends on the type and quantity of two main melanin pigments-reddish
pheomelanin and brown-black eumelanin. Darker skin has layer melanocytes with more
melanosomes which break down to give even pigmentation through skin cells. Lighter skin has
smaller melanocytes and grouped melanosomes. Exposure to UV light stimulates melanocytes so
the skin becomes darker or tanned.
4.6.Systematic Temperature:
It is the temperature of the internal regions of the body. This temperature is maintained through a
carefully controlled balace between the heat generated by the active tissues of the body mainly
the muscles and the liver and the heat lost by the body to the environment. Measurement of
systemic temperature is accomplished by temperature sensing devices placed in the mouth, under
the arm pits or in the rectum. The normal oral (mouth) temperature of a healthy person is about
31 C . The under arm temperature is about 1 degree lower, whereas the rectal temperature is
about 1 degree higher than the oral reading.

Systemic temperature is not affected by the ambient temperature, even if the latter drops
to as low as - 18 C (0 F ) or rises to over 38 C (100 F ) . This balance is upset only when the
metabolism of the body cannot produce heat as rapidly as it is lost or when the metabolism of the
body cannot produce heat as it is lost or when the body cannot rid itself of heat fast enough.
The temperature control center for the body is located deep within the brain . Here the
temperature of the blood is monitored and its control functions are coordinated. In warm,
ambient temperatures cooling of the body is aided by production of perspiration due to secretion
of the sweat glands and by increased circulation of the blood near the surface. In this manner, the
body acts as a radiator. If the external temperature becomes too low, the body conserves heat by
reducing blood flow near the surface to the minimum required for maintenance of the cells. At
the same time metabolism is increased. If these measures are insufficient , additional heat is
produced by increasing the tone of skeletal muscles and sometimes by involuntary contraction of
skeletal muscles(shivering) and of the arrector muscles in the skin (gooseflesh).
In addition to the central thermostat for the body, temperature sensors at the surface of
the skin permit some degree of local control in the event a certain part of the body is exposed to
local heat or cold. Cooling or heating is accomplished by control of the surface blood flow in the
region affected.
Derivation from the temperature control is a rise in temperature. This is known as fever,.
This fever can be experienced with cerrain types of infection. If the heat elimination mechanism
gets affected means, we will get fever. The body temperature increases due to the thermostat in
the brain were suddenly turned up. Because of this, additional metabolism occurred, this will
accelerate the chemical reactions of the body. The increase in temperature can be analysed
through the skin. The skin is often pale and dry shivering usually takes place and the skin
muscles react to coolness. Finally as the body temperature is lowered to normal increased
sweating (breaking of the fever) is observed as the means by which the additional body heat is
eliminated. Surface or skin temperature is also a result of balance. The skin temperature is a
function of the surface circulation in a local area and the cooling of that area by conduction,
radiation convection and evaporation.
4.6.1.Measurement of systemic Body Temperature:

The internal or systemic body temperature is a good indicator of the health of a person,
measurement of this temperature is considered one of the vital signs of medicine. It is not
necessary to get an accurate measurement for temperature analysis , but the method which we
adopt for measuring temperature must be easy to perform.
Mercury thermometer is the device which is used for measuring temperature, this the
standard method of measurement. This type of thermometer is inexpensive, an accurate
measurement can be obtained from this thermometer. Electronic thermometers are available as
replacement for mercury thermometers with disposable tips, these electronic thermometers
require much less time for a reading and are much easier to read than the conventional
thermometer.
For obtaining continuous recording of the temperature or whenever greater accuracy is
needed then, this can be obtained with the help of electronic thermometers.

Thermocouple and thermistor are the two types of electronic temperature sensing devices
used in thermocouple, a junction of two dissimilar metals that produce an o/p voltage nearly
proportional to the temperature at that junction with respect to a reference junction.
Thermistor a semiconductor element whose resistance varies with temperature.
Thermistors are used more frequently than thermocouples. This preference is primarily because
of the greater sensitivity of the thermistor in the temperature range of interest and the
requirement for a reference junction for the thermocouple.
Thermistors are variable resistance devices formed into disks, beads , rods or other
desired shapes. They are manufactured from mixtures of oxides (sometimes sulphates or
silicates) of various elements such as nickel, copper, magnesium, manganese, cobalt,titanium and
aluminium. After the mixture is compressed into shape, it is sintered at a high temperature into a
solid mass. The result is a resistor with large temperature coefficient. The relationship between
resistance change and temperature change is nonlinear. The resistance, Rt1 of a thermistor at a
1 1
given temperature T1 can be determined by Rt1  Rt 0e     the non linear characteristics of
 T1 T0 
the thermistor can be overcome by the instrumentation circuit in which the resistance is
measured often incorporates special linearizing circuits. Some of the other problems occur when
we use
thermistors, as the danger of error due to self heating, the possibility of hysterisis and the
changing of characteristics because of aging. If the power dissipation of the thermistor can be
kept to about a milliwatt, the error should not be excessive, even when temperature differences
as small as 0.01 C are sought. Self heating effect can be reduced by limiting the amount of
current used in measuring the resistance of the thermistor.
Skin Temperature Measurements:
The systemic temperature remains constant throughout the body, skin temperatures can
vary several degrees from one point to another. The range is usually from about 30 to
35 C (85to95 c) . The purpose of using skin temperature measurements is to detect or locate
defects in the circulatory system by showing differences in the pattern from one side of the body
to the other.
Skin temperature measurements from specific locations on the body are frequently made
by using small flat thermistor probes taped in the skin. The simultaneous readings from a number
of these probes provide a means of measuring changes in the spatial characteristics of the
circulatory pattern over a time interval or with a given stimulus.
The human skin also emits infrared radiation. With the help of infrared thermometer, it is
possible to measure the infrared radiation. For measuring this infrared radiation, the patient has
to be allowed to remain in a room at about 21 C (70 F ) without clothing over the area to be
measured. Infrared thermometers can be used to detect the areas of poor circulation and other
sources of coolness. They can also be used to locate breast cancer other unseen sources of heat.
An extension of this method of skin temperature measurement is the thermograph. A
thermograph is a device in which an infrared thermometer is incorporated into a scanner so that
the entire surface of a body or some portions of the body is scanned in much the same way that a
television camera scans an image, but the process is little bit slower. The scanner scans the body
the infrared energy is measured and used to modulate the intensity of a light beam that produces

a map of the infrared energy on photographic paper. This presentation is known as thermogram.
The advantage of this method is that relatively warm and cool areas are immediately evident.
4.7.Measurement of pulse:
When the heart muscles contracts, blood is ejected from the ventricles and a pulse of
pressured is transmitted through the circulatory system. A vessel-wall displacement is caused by
vessels when the pressure pulse is traveling. The pulse can be measured at various points of the
peripheral circulatory system. We can analyze the pulse rate if we keep the finger tip over the
radial artery in the wrist or some other location where an artery seems just below the skin. The
timing and wave shape of the pressure pulse are diagnostically important because they provide
correct information.
The pulse gives the measure of pulse wave velocity and can be reduced and compared
with the ECG signal. The pulse wave travels at 5 to 15 m/s depending on the size and rigidity of
the arterial walls, the larger and more rigid the artery walls, the greater the velocity. The velocity
is 10-15 times faster than blood flow and is relatively independent of it.
The methods used for the detection of volume(pulse) changes due to blood flow are:
(i) optical changes (changes in density)
(ii) Electrical impedence changes
(iii) Strain gauge or microphone (mechanical)
The most common used method to measure plusatile blood volume changes is by the
photoelectric method . Two methods are common : Reflectance method and transmittance
method.
In the transmittance method, a light emitting diode (LED) and photoresistor are mounted
in an enclosure that fits over the tip of the patients finger. Light is transmitted through the finger
tips of the subjects’ finger and the resistance of the photoresistor is determined by the amount of
light reaching it. With each contraction of the heat, blood is forced to the extremities and the
amount of blood in the finger increases. This alters the optical density with the result that the
light transmissions through the finger reduce and the resistance of the photo resistor increases
accordingly. The photo resistor is connected as part of the voltage divider circuit and produces a
voltage that varies with the amount of blood in the finger. This voltage that closely follows the
pressure pulse and its waveshape can be displayed on an oscilloscope or recorded on a strip
chart.
An electric impedance method measures the impedance change between two electrodes
caused by the changes in blood volume between them. The change in impedance (0.1 ohm) may
be small as compared to the total impedance (several hundred ohms) . An alternating current is
applied between electrodes that are attached to the body. With this set the impedance can be
measured. An alternating signal (10- 100khz) is used (rather than dc) in order to polarization of
the electrodes.
The mechanical method involves the use of a strain gauge connected to a rubber-band
placed around a limb or finger. Expansion in the band due to change in blood volume causes a
change in resistance of the strain gauge. In some other technique, a sensitive crystal microphone
is placed on the skin’s surface to puck-up the pulsation.

A piezo electric crystal can also be used to detect the pulse wave at certain places of the
peripheral system, where considerable displacement of the tissue layer above the artery is
involved. A piezo electric crystal is clamped in a hermetically sealed capsule subject to
displacement stresses. The displacement can be transmitted to the crystal through a soft rubber
diaphragm. The crystal can be connected to an ECG recorder for recording the pressure pulse
measurement.
4.8.Cardiac output:
The blood flow at any point in the circulatory system is the volume of blood that passes
that point during a unit of time. It is normally measured in millimeters per minute or liters per
minute. Blood flow is highest in the pulmonary artery and the aorta, where these blood vessels
leave the heart. The flow at these points called cardiac output is between 3.5 and 5 litres/min in a
normal adult at rest. On the other hand in the capillaries blood flow can be slow , that the travel
of individual blood cells can be observed under a microscope.
With the help of cardiac output or the blood flow in a given vessel, it is possible for us to
calculate so many other variables. The cardiac output divided by the number of heart beats per
minute gives the amount of blood that is ejected during each heart beat, it is known as stroke
volume. If the total amount of blood circulation is known and this stroke volume is divided by
the cardiac output, the mean circulation time is obtained. From the blood flow through a vessel ,
divided by the cross sectional area of the vessel, the mean velocity of the blood at the point of
measurement can be calculated.
In the arteries, blood flow is pulsatile. In fact, in some blood vessels, a reversal of the
flow can occur during certain parts of the heart beat cycle. Because of the elasticity of their walls
the blood vessels tend to smooth out the pulsations of blood flow and blood pressure. Both
pressure and flow are greatest in the aorta where the blood serves the heart.
Blood flow is a function of the blood pressure and flow resistance of the blood vessels in
the same way as electrical current flow depends on voltage and resistance. The flow resistance of
the capillary bed can vary ever a wide range. The body reduces the blood flow through the skin
by means of vasoconstriction (narrowing) of the capillaries . This symptoms occur whenever a
body is exposed to low temperatures or under the influence of certain drugs (eg: nicotine)
Vasodilation (widening) of the capillaries occur when heat excitement or local
inflammation among other things, this increases the blood flow locally. Wide variations that are
possible in the flow resistance, the determination of blood pressure along is not sufficient to
access the status of the circulatory system.
The velocity of blood flowing through a vessel is not constant throughout the cross
section of the vessel but is a function of the distances from the wall surface. A thin layer of blood
actually adheres to the wall, resulting in zero velocity at this place, whereas the highest velocity
occurs at the centre of the vessel. Some blood flow meters do not actually measure the blood
flow but measures the mean velocity of the blood.
The laminar flow of blood has been changed to turbulent flow pattern , when the local
blood velocity exceeds a certain limit, it is difficult to determine the flow rate.
Based on the flow of blood to all parts of the organs, the body has to be functioned
properly. If there is a reduction of blood occurs by a narrowing of the blood vessels, the function
of that organ can be severely limited. When the blood flow in a certain vessel is completely

obstructed (by a blood clot or thrombus) the tissue in the area supplied by this vessel may die.
Such an obstruction in a blood vessel of the brain is one of the causes of a cerebrovascular
accident (CVA) or stroke. An obstruction of part of the coronary arteries that supply blood for
the heart muscle is called a myocardial ( or coronary) infarct or heart attack, whereas merely a
reduced flow in the coronary vessels can cause a severe chest pain called angina pectoris . A
blood clot in a vessel in the lung is called an lubolism. Blood clots can also afflict the circulation
in the lower extremities (Thrombosis)
4.9.Blood Flow Meter:
An adequate blood supply is necessary for all organs of the body infact an impaired
supply of blood is the cause of various diseases. The ability to measure blood flow in the vessel
that supplies a particular organ would therefore be of great help in diagnosing such diseases. The
rate of flow of a liquid or gas in a pipe is expressed as the volume of the substance that passes
through the pipe in a given unit of a time. Flow rate are therefore usually expressed in liters per
minute or millimeters per minute. (cm3 / min)
Methods used in industry for flow measurements of other liquids, like the turbine
flowmeter and the rotatometer are not very suitable for the measurement of blood flow because
they require cutting the blood vessel. These methods also expose the blood to sharp edges, which
are conductive to blood clot formation. Practically all blood flow meters currently used in
clinical and research applications are based on one of the following physical principles:
(i) Electromagnetic induction.
(ii) Ultrasound transmission or reflection
(iii) Thermal convection
(iv) Radiographic principles
(v) Indicator (dye or thermal) dilution.
Commonly used flowmeters such as orifile or turbine flowmeters are unsuitable for measuring
blood flow because hey require cutting the vessel and can cause formation of clots.
4.9.1.Magnetic and ultrasonic blood flow meters:
Velocity of the blood stream. These techniques measure the require that a transducer
surround, an excised blood vessel, they are mainly used during surgery. When compare to
indicator-dilution methods, this electromagnetic flow meter has a greater capability. It is possible
for us to use electromagnetic flow meters for any conductive liquid such as saline or blood.
Plethysmograph actually indicates volume changes in body segments, can be used to
measure the flow of blood in the limbs.

Electromagnetic Blood flow meters:
The most commonly used instrument for the measurement of blood flow is of the
electromagnetic type. The blood flow can be measured in intact blood vessels without
cannulation. The blood vessel has to be exposed so that the electromagnetic flow meter measures
instantaneous pulsatile flow of blood.
Principle:
The operating principle underlying all electromagnetic type flowmeters is based on

Faraday’s Law of Electromagnetic induction The law of electromagnetic induction states that
when a conductor is moved at right angles through a magnetic field in a direction at right angles
both to the magnetic field and its length, an emf is induced in the conductor.
The electric generator generates electricity by induction. Here copper wire move through
a magnetic field, cutting the lines of magnetic flux and inducing an emf in the wire.
In the flow meters an electromagnetic assembly provides the magnetic field placed at
right angles to the blood vessel in which the blood flow is measured. The flow meter depends on
the movement of blood, which has a conductance similar to that of saline. The blood stream
which is a conductor cuts the magnetic field and voltage is induced in the blood stream. The
induced voltage is picked up by two electrodes incorporated in the magnetic assembly. The
magnitude of the voltage picked up is
directly proportional to the strength of the magnetic field, the diameter of the blood vessel and
the velocity of the blood flow i.e., e = CHVd
Where e = induced voltage
H=strength of the magnetic field
V= velocity of blood flow
d=diameter of blood vessel
C=constant of proportionality
If the strength of the magnetic field and the diameter of the blood vessel remain
unchanged, then the induced voltage will be a linear function of the blood flow velocity.
Therefore, e = C1 V where C1 is a constant and equal to CHd
Flow rate Q through the tube Q = VA
Therefore V = Q/A
A is the cross sectional area of the tube.
Q
e  C1   C2Q
A
The induced voltage picked up by the electrodes is amplified and displayed/recorded on a
suitable system. The system is calibrated in terms of volume flow as a function of the induced
voltage. The diameter of the blood vessel is held constant by the circumference of the hole in the
probe that surrounds it.
Flowmeter, consists of a generator of alternating current a probe assembly, a
demodulator, a dc amplifier and a suitable recording device. The shape of the energizing current
waveform for the electromagnet may be sinusoidal or square.

Factors that cause error in electromagnetic flow meter:
1. Regions of high velocity generate higher incremental emf’s than regions of low
velocity. So circulating currents flow in the transverse plane. These currents cause
varying drops in resistance within the conductive blood and surrounding tissues.
2. The ratio of the conductivity of the wall of the blood vessel so that of the blood varies
with the hematocrit (percentage of volume to blood volume). So the shunting effects
of the wall cause the variable error.
3. Fluid outside the wall of the vessel has the greater conductivity than the wall. So it
shunts the flow signal.
The magnetic flux density is not uniform in the transverse plane; this accentuates the
problem of circulating current.
The magnetic flux density is not uniform along the axis, which causes circulating current
to flow in the axial direction.
4.9.2.Ultrasonic Blood Flow meter:

With the help of ultrasonic energy it is possible for us to measure the velocity of flowing
blood.
There are basically two types of ultrasonic blood flow velocity meters. The first type is
the transit time velocity meters and the second is the Doppler-shift type.
In transit time ultrasonic flow meter, a pulsed beam is directed through a blood vessel at a
shallow angle and its transit time is then measured. The transit time is shortened when the blood
flows in the direction of energy transmission. If the blood flows in the opposite direction of
energy transmission, the transit time is prolonged.
Popularly used ultrasonic blood flow metals are based on the Doppler principle. An oscillator
operating at a frequency of several megahertz, excites a piezoelectric transducer (made by
barium titanate). This transducer is coupled to the wall of an exposed blood vessel and sends an
ultrasonic beam with a frequency F into the flowing blood. A small part of the transmitted
energy is scattered back and is received by a second transducer arranged opposite the first one.
Scattering occurs mainly as a result of the moving blood cells, the reflected signal has a different
frequency due to Doppler Effect. Its frequency is either F  FD or F  FD , depending on the
direction of flow. The Doppler component FD is directly proportional to the velocity of the
flowing blood. A fraction of the transmitted ultrasonic energy however reached the second
transducer directly with the frequency being unchanged. After amplification of the composite
signal, the Doppler frequency can be obtained at the output of a detector as the difference
between the direct and the scattered signal components. The Doppler frequency is typically in
the low audio frequency range. Because of the velocity profile of the blood, the Doppler signal is
not a pure sinewave, but has more the form of marrow-band noise. Doppler frequency can be
calibrated directly in flow-rate units.

4.9.3. Blood Flow measurement by indicator Dilution Method:

The indicator or dye dilution methods are the only methods of blood flow measurements
that really measure the blood flow and not the blood velocity. Any substance can be used as a
indicator if it mixes readily with blood and its concentration in the blood can be easily
determined after mixing. The substance must be stable but should not be retained by the body. It
must have no toxic side effects.
An indocyanine dye, cardiogreen used in an isotonic solution was long favored as a
indicator. Its concentration was determined by measuring the light absorption with a
densitometer (calorimeter) . Radio isotopes (Radio iodited serum albumen) have also been
employed for this purpose.
Blood flow measurements by Thermal convection:
A hot object in a colder-flowing medium is cooled by thermal convection. The rate of

cooling is proportional to the rate of the flow of the medium. This principle is used to measure
gas flow has also been applied to the measurement of blood velocity. In one application, an
electric heater is placed between two thermocouples or thermistors that are located some distance
apart along the axis of the vessel. Temperature difference between the upstream and the down
stream sensor is a measure of the blood velocity.
Blood flow determination by Radiographic method:
Blood is not generally visible on an x-ray image because it has about the same radio
density as the surrounding tissue. But with the help of a injection of a contrast medium into a
blood vessel (eg: an iodated organic compound) it is possible for us to make the blood to be
visible by x-ray image (either photographic) or on a videorape recording the process of the
contrast medium can be followed obstructions can be detected and the blood flow in certain
blood vessels can be estimated.
4.10.Colorimeter
Colorimeter :
Introduction:
A colorimeter, an instrument used in colorimetry, measures the absorbance of particular

wavelengths of light by a specific solution. This device, invented by Jan Szczepanik, is most
commonly used to determine the concentration of a known solute in a given solution by the
application of the Beer-Lambert law, which states that the concentration of a solute is
proportional to the absorbance.

Composition of blood serum is determined by specialized chemical techniqus. The

different components of biological substances can be determined by measuring how they either
absorb or emit visible light. Colorimeter uses light absorption to determine blood proteins and
irn levels. In order to enhance the color of these substances in blood serum, it is necessary to mix
it with reagents. The basic principle behind these colorimeters is that, many chemical cmpounds
in slution appears coloured with saturation of the color depending on the concentration of the
compund. By analyzing the transmitted light through the sample or emitted light by the sample.
The concentration of the substance can be determined as
TRANSMITTANCE T = I1/ Io
I1 = transmitted light intensity.

Io = incident light intensity.
ABSORBANCE OR OPTICAL DENSITY:
A = - Log (I1/ Io)
Or A = log (1/T)
Thus A = α CL.
α = absorbitivity which depends on the absorbing substance and optical wavelength at

which measurement is performed.
C= concentration of the absorbing substance
L = path length of the cuvette.
The essential parts of a colorimeter are:
 a light source (often an ordinary low-voltage filament lamp)

 an adjustable aperture
 a set of colored filters
 a cuvette to hold the working solution
 a detector (usually a photoresistor} to measure the transmitted light
 a meter to display the output from the detector
In addition, there may be:
 a voltage regulator, to protect the instrument from fluctuations in mains voltage.

 a second light path, cuvette and detector. This enables comparison between the working
solution and a "blank", consisting of pure solvent, to improve accuracy.

By measuring the optical density or absorbance A, the concentration of a given substance in a

sample can be determined. Colorimeter can be filter photometer or spectrophotometer. When an
interference filter is used to select a given wavelength, it is called filter photometer. When a
diffraction grating or prism is used as a monochromatic to get different spectral components or
wavelengths of interest in colorimeter, then it is called spectrophotometer. This
spectrophotometer allows the determination of absorption of samples at various wavelengths.
Fluorescence is an optical phenomenon in which the light kof shorter wavelength is incident
kon a sample absorbs and reemits light on a longer wavelength. The concentration of such
chemicals can be determined by fluorometers and spectrofluorometers are used to select the
emission wavelength respectively.
Filter photometer:
Fig shows the schematic diagram of a simple filter photometer which is used to measure
transmittance. Light from a halogen lamp incident on filter F. it transmits only suitable
wavelength range at which the measurement is performed. The divergent of transmitted light is
converted into two parallel beams buy an optical arrangement. One beam falls on a reference
selenium photoelectric cell CR, and other beam falls on a sample selenium photoelectric cell Cs
after passing through sample in the cuvette. Without output from photoelectric cells are the same.
When the sample is placed in the light path, the output of the sample cell is reduced and hence
the potentiometer is adjusted by the full deflection in the galvanometer G. since the
potentiometer is calibrated in terms of transmittance, we can determine the concentration of a
given substance in the sample. Generally potentiometers are calibrated in terms of concentration
of a given substance in the sample. Generally potentiometers are calibrated in terms of
concentration directly using a standard known concentration.
Filters
Changeable optics filters are used in the colorimeter to select the wavelength of light which the
solute absorbs the most, in order to maximize accuracy. The usual wavelength range is from 400
to 700 nanometres (nm). If it is necessary to operate in the ultraviolet range (below 400 nm)
then some modifications to the colorimeter are needed. In modern colorimeters the filament
lamp and filters may be replaced by several light-emitting diodes of different colors.
Cuvettes
In a manual colorimeter the cuvettes are inserted and removed by hand. An automated
colorimeter (as used in an AutoAnalyzer) is fitted with a flowcell through which solution flows
continuously.
Output
The output from a colorimeter may be displayed by an analogue or digital meter and may be
shown as transmittance (a linear scale from 0-100%) or as absorbance (a logarithmic scale

from zero to infinity). The useful range of the absorbance scale is from 0-2 but it is desirable to
keep within the range 0-1 because, above 1, the results become unreliable due to scattering of
light.
In addition, the output may be sent to a chart recorder, data logger, or computer.
Graphic design
In graphic design, colorimeters are used to generate color profiles for equipment in the
workflow. Accurate color profiles are important to ensure that screen displays match the final
printed products.
Flame photometer:
A flame photometer is used to analyze urine or blood in order to determine the
concentration of potassium (K) sodium (Na) calcium(Ca) lithium (Li). Sometimes lithium is used
as a calibration substance in the analysis of the other three substances. A known amount of
lithium is added to the sample and the emitted light intensity of the sample under analysis is
measured relative to that of the lithium. By this way, any error due to varying flame temperature
is eliminated.
The sample whose concentration is to be analyzed is taken in a beaker. This sample is
sprayed into fine droplets using an atomizer. This fine droplets are passed through oxygen or air
past opening in it.
4.11.Electrophoresis
Electroporesis Introduction:
Devices based on electrophoresis principles are used in clinical laboratory to measure

quantities of the various types of proteins in plasma, urine and CSF; to separate enzymes into
their component isoenzymes to identify antibodies, and to serve in a variety of other applications.
Electrophoresis is the most known electrokinetic phenomena. It was discovered by

Reuss in 1809 . He observed that clay particles dispersed in water migrate under
influence of an applied electric field. Generally, electrophoresis is the motion of
dispersed particles relative to a fluid under the influence of an electric field that is
space uniform. Alternatively, similar motion in a space non-uniform electric field is
called dielectrophoresis.

Electrophoresis occurs because particles dispersed in a fluid almost always carry an electric
surface charge. An electric field exerts electrostatic Coulomb force on the particles through
these charges.
Another force is electrostatic as well. It is known from double layer theory that all surface
charges in fluids are screened with a diffuse layer. This diffuse layer has the same absolute
charge value, but with opposite sign from the surface charge. The electric field induces force on
the diffuse layer, as well as on the surface charge. The total value of this force equals to the
first mentioned force, but it is oppositely directed. However, only part of this force is applied to
the particle. It is actually applied to the ions in the diffuse layer. These ions are at some distance
from the particle surface. They transfer part of this electrostatic force to the particle surface
through viscous stress. This part of the force that is applied to the particle body is called
electrophoretic retardation force.
Basic Principles:
Electrophoresis may in general be defined as the movement of solid phase with respect to
a liquid movement of solid phase with respect to a liquid (the buffer solution) the main functions
of the buffer solution are to carry the current and t keep the P H of the solution constant during
migration. The buffer solution is supported by a solid solition called medium. In th\is technique,
the sample is applied to the medium and under the effect of the electric field, groups of particles
that are similar in charge, size and shape migrate at similar rates. This results in migration of the
particles in the field.
Magnitude of charge:

The mobility of the given particle is directly related to the net magnitude of the particles
charge. Mobility is defined as the distance in centimeters a particle moves in unit time per unit
field strength, expressed as voltage drop per centimeter.
Ionic strength of the buffer:
The more concentrated the buffer, the slower the rate of migration of the particles. This is
because the greater the properties of buffer ions present,the greater the proportion of the current
they carry. It is also due to interaction between the buffer ions and the particles.
Time:
The distance of migration is directly related to the time the electrophresis takes. Other factors
that influence migration include electrophoresis chromatography,particle shape.
Applications
There are many applications of electrophoresis for measurements and various operations with
particulates
Measurement
Electrophoresis is used for studying properties of dispersed particles.
Gel electrophoresis
Gel electrophoresis is an application of electrophoresis in molecular biology. Biological

macromolecules – usually proteins, DNA, or RNA – are loaded on a gel and separated on the
basis of their electrophoretic mobility. (The gel greatly retards the mobility of all molecules
present.)
Electrophoretic displays
Electrophoretic displays (EPD's) are a class of information display that form images by
electrophoretic motion of charged, colored pigment particles.
Electrophoretic fingerprinting:
Electrophoresis is also used in the process of DNA fingerprinting. Certain DNA segments that
vary vastly among humans are cut at recognition sites by restriction enzymes (restriction
endonuclease). After the resulting DNA fragments are run through electrophoresis, the distance
between bands are measured and recorded as the DNA "fingerprint."

Electrophoretic deposition:
Coatings, such as paint or ceramics, can be applied by electrophoretic deposition. The

technique can even be used for 3-D printing.
4.12. pCO2 (Partial Pressure of Carbon Dioxide) reflects the amount of carbon
dioxide gas dissolved in the blood.
Indirectly, the pCO2 reflects the exchange of this gas through the lungs to the outside
air. Two factors each have a significant impact on the pCO2. The first is how rapidly
and deeply the individual is breathing:
 Someone who is hyperventilating will "blow off" more CO2, leading to lower
pCO2 levels
 Someone who is holding their breath will retain CO2, leading to increased
pCO2 levels
The second is the lungs capacity for freely exchanging CO2 across the alveolar
membrane:
 With pulmonary edema, there is an extra layer of fluid in the alveoli that
interferes with the lungs' ability to get rid of CO2. This leads to a rise in pCO2.
 With an acute asthmatic attack, even though the alveoli are functioning
normally, there may be enough upper and middle airway obstruction to block
alveolar ventilation, leading to CO2 retention.
Increased pCO2 is caused by:
 Pulmonary edema
 Obstructive lung disease
Decreased pCO2 is caused by:
 Hyperventilation
 Hypoxia
 Anxiety
 Pregnancy
 Pulmonary Embolism (This leads to hyperventilation, a more important
consideration than the embolized/infarcted areas of the lung that do not
function properly. In cases of massive pulmonary embolism, the infarcted or

non-functioning areas of the lung assume greater significance and the pCO2
may increase.)
4.12.1.Measurement of PCO2
The measurement of PCO2 is based on the fact that the relationship between log PCO 2 and pH is
linear over the range of 10 to 90 mm Hg which includes essentially all the values of clinical
interest. This result can be established by examining some fundamental chemical relationships
among H+, H2CO3, and PCO2. The first three quantities are related by the equilibrium equation
H2O + CO2 H2CO3 H+ + HCO3- ------------

(1)
In addition, the relationship between PCO2 and the concentration of the CO2 dissolved in the
blood, [CO2] is given by
[CO2] = a(PCO2) ------------------------------------------(2)

Where a = 0.0301 mmol/liter per mm Hg PCO2. The mass relationship corresponding to eq(1)
k' = ---------------------------------------------------------(3)
Next we use the fact that [H2CO3] is proportional to [CO2] to obtain the result
k= --------------------------------------------------------------(4)
where k represents the combined values of k' and the proportionality constant between [H2CO3]
and [CO2] using eq(2) we obtain the following result
k= ----------------------------------------------------------------(5)
next taking the base-10 logarithm of eq(5) and rearranging, we obtain
log[H+] + log[HCO3-] – log k – log a – log PCO2 = 0 ---------------------(6)
using the definition of pH yields
pH = log[HCO3-] - log a – log PCO2 --------------------------------------(7)
this shows that pH has a linear dependence on the negative of log PCO2. The assembly includes
two chambers, one for the specimen and a second containing a pH electrode. In contrast to the
basic pH measurement device in which the pH electrode is placed in the specimen. In this case
the pH electrode is bathed by a buffer solution of bicarbonate and NaCl.

The two chambers are separated by a semi permeable membrane, usually made of Teflon or
silicone rubber. This membrane allows dissolvedCO2 to pass through but blocks the passage of
charged particles, in particular H+ HCO3 -. When the specimen is placed in its chamber, Co2
diffuses across the membrane to establish the same concentration in both chambers. If there is a
net movement of CO2 into (or out of) the chamber containing the buffer,[H +] increases (or
decreases), and the pH meter detects this change, because the relationship between pH and the
negative log PCO2 is only a proportional one, it is necessary to calibrate the instrument before
each use with two gases of known PCO2. Fig.1. shows PCO2 electrode
Fig. 1.PCO2 Electrode

Semipermeable Glass
membrane Electrode
Exit H+ + HCO3- +
HCO3- Voltmeter
H+ +
AgCl – Ag0
H2CO3 H2CO3
V
For blood k k
Or calibrating
gas CO2 CO2
(Dissolve
Entrance d
Sample Chamber Buffer Reference
electrode

Fig. 1.PO2 Electrode

Semipermeable Glass
membrane Electrode
Exit Cathode
e- Voltmeter
V
For blood Anode
Or calibrating O2
gas O2 AgCl – Ag0
-
e
(Dissolve
Entrance d
Sample Chamber Reference
electrode
Base Excess or Base Deficit
Whenever there is an accumulation of metabolically-produced acids, the body

attempts to neutralize those acids to maintain a constant acid-base balance.
This neutralizing is achieved by using up various "buffering" compounds in the blood

stream, to bind the acids, disallowing them from contributing to more acidity.
About half of these buffering compounds come from HCO3, and the other half from
plasma and red blood cell proteins and phosphates.
The words "base deficit" and "base excess" are equivalent and are generally used
interchangeably. The only difference is that base deficit is expressed as a positive
number and base excess is expressed as a negative number.
A "Base Deficit" of 10 means that 10 mEqu/L of buffer has been used up to neutralize
metabolic acids (like lactic acid). Another way to say the same thing would be the
"Base Excess is minus 10."

More Negative Values of Base Excess may Indicate:
 Lactic Acidosis
 Ketoacidosis
 Ingestion of acids
 Cardiopulmonary collapse
 Shock
More Positive Values of Base Excess may Indicate:
 Loss of buffer base

 Hemorrhage
 Diarrhea
 Ingestion of alkali
4.13. RESTING POTENTIALS AND ACTION POTENTIALS
When a cell membrane moves molecules or ions uphill against a concentration gradient, then the
process is known as active transport. The transport of the substances through the cell membrane
occurs by diffusion is called passive transport. The diffusion and drift processes give rise to
membrane potential.
The interface of metallic ions in solution (or) with their associated metal results in an electrode
potential. The voltage developed at an electrode- electrolyte interface is designated as half- cell
potential or electrode potential. In the case of a metal- solution interface electrode potential
results from the difference in the rates between two opposing processes. They are passage of ions
from the metal into the solution, combination of metallic ions in solution with electrons in the
metal to form atoms of the metal.
Various ions seek balance between the inside and outside of the cell by diffusion and drift
process give rise to membrane potential. The membrane potential caused by the different
concentration of ions is called the resting potential of the cell. Resting potential is defined as the
electrical potential of an excitable cell relative to its surroundings when not stimulated or
involved in passage of an impulse. It ranges from -60mV to -100mV
The nerve and muscle cells permit the entry of potassium and chloride ions it blocks the entry of
sodium ions. The permeability of sodium ions is about 2 x 10-8 cm/s and for potassium and
chloride ions is 4 x 10-6 cm/s
Action potential is defined as the change in electrical potential associated with the passage of an
impulse along the membrane of a cell.
The various ions seek a balance between the inside and outside of the cell by diffusion and drift.
When the cell is in resting state, then it is said to be polarized. The process of changing from the
resting potential state to the action potential state is called depolarization.
When the cell fires however, the outside of the cell becomes momentarily negative with respect
to the interior. A short time later, the cell regains the normal state in which the inside is again
negative with respect to outside. The discharging and recharging of the cell is known as
depolarization and repolarization.
Regardless of the method of excitation of cells or the intensity of the stimulus, this is assumed to
greater than the threshold of stimulus. The action potential is always- the same for any given cell.
This is known as all- or nothing law.
Absolute refractory period is the time duration of the cell non response to further stimuli. It is
about 1 millisecond in nerve cell. Following the absolute refractory period there is a brief period
of time during which another action potential can be triggered but a much stronger stimulation is
required. This period is called relative refractory period.
The rate at which an action potential moves down a fiber of a nerve cell or is propagated from
cell to cell is called the propagation rate or conduction velocity. The conduction velocity varies
in nerves depending on the type and diameter of the fiber and is from 20 n/s to 140 m/s. But in
heart muscle, it is very slower ranging from 0.2 to 0.4 m/s.
Due to the difference in permeability the concentration of sodium ions inside the cell becomes
much lower than the outside the cell. Since the sodium ions are positive, the outside of the cell is
more positive than inside. The concentration of potassium and chloride ions is negative on the
inside and positive on the outside.
An equation relating the potential across the membrane and the two concentrations of the ion is
called Nernst equation.
RT C1 f1
Where, E   ln
nF C2 f 2
R – gas constant(8.315 x 107 ergs/mole/degree Kelvin)
T – absolute Temperature, degrees Kelvin
n – valence of the ion (the number of electrons added or removed to ionize the atom)
F – Faraday constant (96,500 coulombs)
C1, C2 – two concentrations of the ion on the two sides of the membrane
f1, f2 – respective activity coefficients of the ion on the two sides of the membrane
The approximate value of the resting potential for living cell is – 70mV. The resting potential
ranges from -60 to -100nV.
The characteristics of resting potential are .

 The value of the resting potential is maintained as a constant until some kind of
disturbance occurs.
 It is strongly depending on the temperature.
 Since the permabilities of the different cell types vary, the corresponding resting
potentials vary.
Bio electric potential related to

Heart – ElectroCardioGram (ECG)
Brain – ElectroEncephaloGram (EEG)
Muscle – ElectroMyoGram (EMG)
Eye (Retina) – ElectroRetinoGram (ERG)
Eye (Cornea - Retina) – ElectroOculoGram (EOG)
Bioelectric potential Function Peak Frequency Observation

amplitude response
ElectroCardioGram Records 0.1 to 4mV0.05 to Used to measure
(ECG) electrical 120 Hz heart rate,
activity of heart arrhythmia and
abnormalities
ElectroEncephaloGram Records 2 to 200μV 0.1 to 100 Used to analysis
(EEG) electrical Hz evoked potential,
activity of certain patterns,
brain frequency
response
ElectroMyoGram Records 50μV to 5 to 2000 Used as indicator
(EMG) muscle 1mV Hz of muscle action
potential for measuring
fatigue

4.14. Pacemaker –
Inroduction
 Pacemaker is an electrical pulse generator for starting /maintaining the normal heart beat.
The output of the pacemaker is either externally to the chest or internally to the heart
muscle. In the case of cardiac stand still, the use of the pacemaker is temporary – just
long enough to start a normal heart rhythm. In the cases requiring long term pacing, the
pacemaker is surgically implanted in the body and its electrodes are in direct contact with
the heart. The contraction of heart (cardiac) muscle in all animals with hearts is initiated
by electrical impulses. The rate at which these impulses fire controls the heart rate. The
cells that create these rhythmical impulses are called pacemaker cells, and they directly
control the heart rate. The normal heart rate is 60-100 beats per minute.
 A higher rate than this ( above 100 beats per minute) is called Tachycardia. slower
rate(Below 60 beats per minute) than this is called Bradycardia .
IMPLANTING THE PACEMAKER
Definition of Pacemaker
A small battery powered device, implanted into a patient Paces the heart when normal
rhythm is slow, when there is a heart block not allowing the ventricles to contract when the SA
node fires, or any arrhythmia causing a slow rate.
Determining Pacemaker Types

In humans, and occasionally in other animals, a mechanical device called an artificial

pacemaker (or simply "pacemaker") may be used after damage to the body's intrinsic conduction
system to produce these impulses synthetically. The pacemaker is located in the wall of the right
atrium.
Cardiac Pacemaker
The sinoatrial node (SA node) is a group of cells positioned on the wall of the right atrium,
near the entrance of the superior venacava. These cells are modified cardiomyocyte. They
possess rudimentary contractile filaments, but contract relatively weakly.
Primary Pacemaker
Cells in the SA node spontaneously depolarize, resulting in contraction, approximately 100 times
per minute. This native rate is constantly modified by the activity of sympathetic
and parasympathetic nerve fibers, so that the average resting cardiac rate in adult humans is
about 70 beats per minute. Because the sinoatrial node is responsible for the rest of the heart's
electrical activity, it is sometimes called the primary pacemaker.
Secondary Pacemaker
If the SA node does not function, a group of cells further down the heart will become the ectopic
pacemaker of the heart. These cells form the atrioventricular node(or AV node), which is an area

between the left atrium and the right ventricle, within the atrial septum. The cells of the AV node
normally discharge at about 40-60 beats per minute, and are called the secondary pacemaker.
Pacemaker Potential
The pacemaker potential (also called the pacemaker current) is the slow, positive increase in
voltage across the cell’s membrane (the membrane potential) that occurs between the end of
one action potential and the beginning of the next action potential. This increase in membrane
potential is what causes the cell membrane, which typically maintains a resting membrane
potential of -70 mV, to reach the threshold potential and consequently fire the next action
potential; thus, the pacemaker potential is what drives the self-generated rhythmic firing
(automaticity) of pacemaker cells, and the rate of change (i.e., the slope) of the pacemaker
potential is what determines the timing of the next action potential and thus the intrinsic firing
rate of the cell.
In a healthy sinoatrial node (SAN, a complex tissue within the right atrium containing pacemaker
cells that normally determine the intrinsic firing rate for the entire heart), the pacemaker potential
is the main determinant of the heart rate. Because the pacemaker potential represents the non-
contracting time between heart beats ( diastole), it is also called the diastolic depolarization. The
amount of net inward current required to move the cell membrane potential during the
pacemaker phase is extremely small, in the order of few pAs, but this net flux arises from time to
time changing contribution of several currents that flow with different voltage and time
dependence
Artificial Cardiac Pacemaker

A pacemaker (or artificial pacemaker, so as not to be confused with the heart's natural
pacemaker) is a medical device that uses electrical impulses, delivered by electrodes contracting
the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to
maintain an adequate heart rate, either because the heart's natural pacemaker is not fast enough,
or there is a block in the heart electrical conduction system. Modern pacemakers are externally
programmable and allow the cardiologist to select the optimum pacing modes for individual
patients. Some combine a pacemaker and defibrillator in a single implantable device. Others

have multiple electrodes stimulating differing positions within the heart to improve
synchronization of the lower chambers (ventricles) of the heart.
Pacemaker Pulses
 These Pulses should have the pulse to space ratio 1:10000.
 It should be negatively going pulses to avoid the ionization of the muscles.
 The pulse voltage is made variable to allow adjustments in the energy delivered by the
pacemaker to the heart during each pulse.
Methods of stimulation
 External stimulation
 Internal stimulation
External stimulation is employed to restart the normal rhythm of the heart in the case of cardiac
standstill. Internal stimulation is employed in cases requiring long term pacing because of
permanent damage that prevents normal self triggering of the heart.
External Stimulation
It is employed to restart the normal rhythm of the heart in the case of cardiac stand still.
Stand still can occur during openheart surgery or whenever there is a sudden physical shock or
accident.
Internal Stimulation
Internal stimulation is employed in cases requiring long term pacing because of permanent
damage that prevents normal self triggering of the heart.
Comparision between external pacemaker and internal pacemaker.

External pacemaker Internal pacemaker

It does not necessitate open heart surgery The pacemaker is surgically implanted
beneath
The skin near the chest or abdomen with its It requires open chest minor surgery to
output leads are connected directly to he place the circuit
heart muscle
These are used for temporary heart These are used for permanent heart
irregularities. There is no safety or damages. There is cent percent safety for
pacemaker. circuit from external disturbances
Electrodes for Stimulation

 Bipolar and unipolar electrodes are used.
 In the bipolar electrode, there are stimulating electrode and contact electrode which
serves as a return path for current to the pacemaker.
 In the unipolar electrode, there is only stimulating electrode.
 The return path for current to the pacemaker is made through the body fluids.
Modes of operation of pacemaker

 Ventricular asynchronous pacemaker ( Fixed rate pacemaker)
 Ventricular synchronous pacemaker
 Ventricular inhibited pacemaker ( Demand pacemaker)
 Atrial synchronous pacemaker.
 Atrial sequential ventricular inhibited pacemaker.
Ventricular asynchronous pacemaker

It can be used in atrium or ventricle. It has simplest mechanism and longest battery life.
This pacemaker is suitable for patients with either a stable, total AV block, a slow atrial rate or
atrial arrhythmia. This produces a stimulus at a fixed rate irrespective of the behavior of heart
rhythm. There may be competition between the natural heart beats and pacemaker beats.It is
possible that such an event can be dangerous because if the pacemaker impulse reaches the heart
during a certain vulnerable period, the ventricular fibrillation may occur.
Advantages and disadvantages of ventricular synchronous pacemaker.
Advantages:
 To arrest the ventricular fibrillation, this circuit can be used.
 If the R wave occurs with its normal value in amplitude and frequency, then it would not
work. Therefore the power consumption is reduced, and there is no chance of getting side
effects due to competition between natural and artificial pacemaker pulses.
Disadvantages:

 Atrial and ventricular are not synchronized.

 I the olden type when the pacemaker is attached with the patients, the circuit is more
sensitive to external electromagnetic interferences such as electric shavers, microwave
ovens, ignition systems.
Ventricular synchronous Pacemaker

Patients with only short periods of AV block or bundle block can be supplied with a ventricular
synchronized pacemaker.This type of pacemaker does not compete with normal heart activity
Working of Ventricular Synchronous Pacemaker

Using the sensing electrode, the heart rate is detected and is given to the timing circuit in the
pacemaker. If the detected heart rate is below a certain minimum level, the fixed rate pacemaker
is turned on to pace the heart. The lead used to detect the R wave is now used to stimulate the
heart. If the natural contraction occurs, the asynchronous pacer’s timing circuit is reset so that it
will time its next pulse to detect the heart beat
Advantages of ventricular synchronous pacemaker:

 To arrest the ventricular fibrillation, this circuit can be used.
 If the R wave occurs with its normal value in amplitude and frequency, then it would not
work. Therefore the power consumption is reduced, and there is no chance of getting side
effects due to competition between natural and artificial pacemaker pulses.
Disadvantages of ventricular synchronous pacemaker:

 Atrial and ventricular are not synchronized.
 I the olden type when the pacemaker is attached with the patients, the circuit is more
sensitive to external electromagnetic interferences such as electric shavers, microwave
ovens, ignition systems.
Ventricular inhibited Pacemaker (Demand Pacemaker)

The R- Wave inhibited pacemaker also allows the heart to pace at its normal rhythm when it is
able to . However if the R- wave is missing for a preset period of time, the pacer will supply the
stimulus. Therefore if the heart rate is below a predetermined minimum, pacemaker will turn on
and provide the heart a stimulus. For this reason it is called demand pacemaker.
The sensing electrode pickup R wave. The refractory circuit provides a period of time following
an output pulse or a signals. The sensing circuit detects the R wave and resets the oscillator. The
reversion circuit allows the amplifier to detect the R- wave in low level signal to noise ratio. In
the absence of R wave, it allows the oscillator in the timing circuit to deliver pulses at its preset
rate. The timing circuit consists of an RC network, a reference voltage source and a comparator
which determines the basic pulse rate of the pulse generator. The output of the timing circuit is
fed into pulse delivered to the heart. Then the output of the pulse width circuit is fed into the rate
limiting circuit which limits the racing rate to a maximum of 120 pulses per minute.
Atrial synchronous pacemaker

This type of pacing is used for young patients with a mostly stable block. Atrial pacing as a
temporary pacing is used in stress testing and coronary artery diseases. It is used to terminate
atrial flutter and in the evaluation of various conduction mechanisms. The atrial activity is picked
up by a sensing electrode placed in a tissue close to the dorsal wall of the atrium. The detected P
wave is amplified and a delay of 0.12 second is provided by the AV delay circuit. This is
necessary corresponding to the actual delay in conducting the P wave to the AV node in the
heart. The signal is then used to trigger the resetable multivibrator and the output of the
multivibrator is given to the amplifier which produces the desired stimulus to be applied to the
heart


Heart
5.1.Electrical conduction system of the heart
The EKG complex.

P=P wave,
PR=PR interval,
QRS=QRS complex,
QT=QT interval,
ST=ST segment,
T=T wave
• The normal electrical conduction in the heart allows the impulse that is generated by the
Sinoatrial node (SA node) of the Heart to be propagated to (and stimulate) the
myocardium (muscle of the heart).
• After myocardium is stimulated, it contracts.
• It is the ordered stimulation of the myocardium that allows efficient contraction of the
heart, thereby allowing blood to be pumped throughout the body.

5.2.SA node:
5.2.1P wave
• Under normal conditions, electrical activity is spontaneously generated by the SA node,
the physiological pacemaker.
• This electrical impulse is propagated throughout the right and left atria, stimulating the
myocardium of the atria to contract.
• The conduction of the electrical impulse throughout the atria is seen on the ECG as the P
wave.
5.2.2.INTERNODAL TRACTS,
• As the electrical activity is spreading throughout the atria,
• it travels via specialized pathways, known as internodal tracts,
• from the SA node to the AVnode.
• The P wave is the electrical signature of the current that causes atrial depolarization.
• Both the left and right atria contract simultaneously. Its relationship to QRS complexes
determines the presence of a heart block.
• Irregular or absent P waves may indicate arrhythmia.
• The shape of the P waves may indicate atrial problems.
5.2.3.AV node/Bundles: PR interval

• The AV node functions as a critical delay in the conduction system.
• Without this delay, the atria and ventricles would contract at the same time, and blood
wouldn't flow effectively from the atria to the ventricles.
• The delay in the AV node forms much of the PR segment on the ECG.
• And part of atrial repolization be represented by PR segment.
5.3.Bundle of His

• The distal portion of the AV node is known as the Bundle of His .

• The Bundle of His splits into two branches in the interventricular septum, the left bundle
branch and the right bundle branch.
• The left bundle branch activates the left ventricle, while the right bundle branch activates
the right ventricle.
• The left bundle branch is short, splitting into the left anterior fascicle and the left
posterior fascicle.
• The left posterior fascicle is relatively short and broad, with dual blood supply, making it
particularly resistant to ischemic damage.
5.4.Purkinje fibers/ventricular myocardium: QRS complex
• The two bundle branches taper out to produce numerous Purkinjie fibers,
• which stimulate individual groups of myocardial cells to contract.
• The spread of electrical activity through the ventricular myocardium produces the QRS
Complex on the ECG.
• The QRS complex corresponds to the current that causes contraction of the left and right
ventricles,
• which is much more forceful than that of the atria and involves more muscle mass,
• thus resulting in a greater ECG deflection.
• The Q wave, when present,
• represents the small horizontal (left to right) current as the action potential travels
through the interventricular septum.
• Very wide and deep Q waves do not have a septal origin, but indicate myocardial
infraction that involves the full depth of the myocardium and has left a scar.

Abnormalities in the QRS complex
• Bundle branch block (when wide), ventricular origin of tachycardia, ventricular

hyperthrophy or other ventricular abnormalities.
• The complexes are often small in pericarditis or pericardial effusion
5.5.R and S wave
• The R and S waves indicate the spread of the action potential along the ventricular
myocardium itself.
5.6.ST Segment
• The ST segment connects the QRS complex and the T wave.
• ST segment elevation or ST segment depression) may indicate coronary ischemia or
myocardial infraction.
5.7.Ventricular repolarization: T wave

• The last event of the cycle is the repolarization of the Ventricles.
• In most leads, the T wave is positive.
• An impulse (action potential) that originates from the SA node at a rate of 60 - 100
beats/minute (bpm) is known as normal sinus rhythm.
• If SA nodal impulses occur at a rate less than 60 bpm, the heart rhythm is known as sinus
bradycardia.
• If SA nodal impulse occur at a rate exceeding 100 bpm, the consequent rapid heart rate is
sinus tachycardia.
• These conditions are not necessarily bad symptoms, however.
• Trained athletes, for example, usually show heart rates slower than 60bpm when not
exercising
5.8.ECG waveforms Lead III

5.9.USES OF ECG :
• It is the gold standard for the evaluation of cardiac arrhythmias .

• The 12 lead ECG stands at the center of risk stratification for patients with suspected
acute myocardial infraction .
• It can be useful for detecting electrolyte disturbances (e.g. potassium or calcium).
• Allows the detection of conduction abnormalities (e.g. right and left bundle branch
block).
• As a screening tool for ischemic heart disease during an cardiac stress test.
• Can suggest non-cardiac disease (e.g. pulmonary embolism or hypothermia).
5.10.Normal ECG
• The baseline voltage of the electrocardiogram is known as the isoelectric line.

• A typical ECG tracing of a normal heartbeat consists of a P wave, a QRS complex and a
T wave.
• A small U wave is normally visible in 50 to 75% of ECGs.
5.10.1.ECG lead configurations

• Surface electrodes are used with jelly as electrolyte between skin and electrodes.
• The potentials generated in the heart are conducted to the body surface.
• The potential distribution changes in a regular and complex manner during each cardiac
cycle.
• To record electrocardiograms standard electrode positions must be selected.
• four types of electrode systems are there. They are:

• Bipolar limb leads (or) standard leads.

• Augumented unipolar limb leads.
• Chest leads (or) precordial leads.
• Frank lead system (or) corrected orthogonal leads.
• The baseline voltage of the electrocardiogram is known as the isoelectric line.
• A typical ECG tracing of a normal heartbeat consists of a P wave, a QRS complex and a
T wave.
• A small U wave is normally visible in 50 to 75% of ECGs.
5.10.2.Bipolar limb leads
• In standard leads the potentials are tapped from four locations of our body.
• They are
• Right arm
• Left arm
• Right leg
• Left leg.
• Usually right leg electrode is acting as ground reference electrode.
• Gives voltage VI, the voltage drop from left

arm(LA) to right arm (RA).
+
Electrode from
LA
Output VI
Electrode from RA
- Ground electrode RL

Einthoven triangle.
- Lead I +
Right arm Left arm -

-
Cardiac vector
Lead III
Lead II
+ +
Left leg
• The closed path RA to LA to LL and back to RA is called Einthoven triangle.

• The ECG is measured from any one of the three limb leads is a time variant single
dimensional component of that vector.
• According to kirchoff’s voltage law ,
• the R wave amplitude of lead II is equal to the sum of the R wave amplitudes of leads I
and leadIII
• VII = VI + VIII
5.10.3.Augmented unipolar limb leads
• Unipolar limb lead system is introduced by Wilson.

• Here ECG is recorded between a single exploratory electrode and the central
terminal.The central terminal has a potential corresponding to the center of the body.Two
equal and large resistors are connected to a pair of limb electrodes and the center of this
resistive network acts as central terminal. The remaining limb electrode acts as the
exploratory electrode. By means of augmented ECG lead connections, a small increase in
the ECG voltage can be realized.
• The augmented lead connections are
• Augmented voltage right arm (aVR)
• Augmented voltage left arm (aVL)
• Augmented voltage foot (aVF)
5.10.4.Unipolar chest leads
• In case of unipolar chest leads, the exploratory electrode is obtained from one of the chest
electrodes.The chest electrodes are placed are placed on the six different points on the
chest closed to the heart.

• V1 : fourth intercostal space at right sternal Margin.

• V2: fourth intercostal space at left sternal
Margin.
• V3: midway between V2 and V4.
• V4: fifth intercostal space at mid-clavicular line
• V5: same level as V4 on anaterior axillary line
• V6: same level as V4. On mid-axillary line.
Color codes for ECG leads
• The ECG potentials are measured with color coded leads according to the convention:
• White – right arm
• Black – left arm.
• Green – right leg.
• Red – left leg.
• Brown - chest
5.10.4.Frank lead system

• The corrected orthogonal leads system (or ) frank lead system is used in vector
cardiography. Here we can get informations from above said 12 leads.
5.11.ANALYSIS OF ECG SIGNALS
• If PQ segment has prolonged condition I.e. extended f normal condition means

Result :First degree AV block
• If QRS complex is widened I.e. QRS interval extended from the normal condition means
Result : Bundle block.
• If ST segment is elevated means Result : Myocardial infraction.
• If train of pulses occurs instead of PQRST waves means Result : Ventricular fibrillation
which may lead to death if it is not properly corrected by defibrillator.
5.12.DIFFERENT TYPES OF HEART BLOCK
• I degree AV block: due to prolonged conduction time.

• II degree AV block : Due to conduction of few pulses instead of all from atrium
• III degree AV block: Due to asynchronous action of atrium and ventricle
• Adams-stokes attack: Due to sudden attack of total block.
• Bundle block: due to improper conduction of the stimulus to the ventricle.

• Atrial fibrillation: Due to fast beating rate (300-500 beats/minute) of the atrium. Here
ventricles beat very slowly.s
• Ventricular fibrillation: due to fast beating rate of the ventricles. No pumping of the
blood to different parts of the body.
5.13.Heart Transplantation
5.13.1.allo graft
• Heart transplantation or cardiac transplantation, is a surgical transplant procedure
performed on patients with end-stage heart failure or severe coronary artery disease.
• The most common procedure is to take a working heart from a recently deceased organ
donor (allo graft) and implant it into the patient.
• The patient's own heart may either be removed (orthotopic procedure) or, less commonly,
left in to support the donor heart (heterotopic procedure).
5.13.2.xenograft
• It is also possible to take a heart from another species (xenograft), or implant a man-
made artificial one,
• although the success of these two procedures has been less successful in comparison to
the far more commonly performed allograft
5.13.3.Indications
• In order for a patient to be recommended for a heart transplant they will generally have
advanced, irreversible heart failure with a severely limited life expectancy.
• Other possible treatments, including medication, for their condition should have been
considered or attempted prior to recommendation.

5.14.Causes of heart failure

• Cardiomyopathy
• Congential heart disease
• Coronary artery disease
• Heart valve disease
• Life-threatening arrhythmias.
5.15.Patient cable and defibrillator protection circuit:
The patient cable connects the different leads from limbs and chest to the defibrillator
protection circuit.. it consists of buffer amplifiers and over voltage protection circuit. The leads
are connected with the buffer amplifiers such that one buffer amplifier for each patient lead. By
this meanss the input impedance is increased and the effects arising from the variations in the
electrode impedance are reduced.further the over voltage protection circuit is necessary to avoid
any damage to the bioamplifiers in the recorder. The over voltage of the order of 1000V may
occur when the electrocardiograph is used during surgery in conjunction with radio frequency
diathermy units for cutting and coagulation or during the treatment pf ventricular fibrillation
using defibrillators. This over voltage protection circuit consists of a network kof resistors and
neon lamps which fire when a pulse from a defibrillator is present. During firing of the neon
lamp, there is no input to the preamplifier of the recorder.
5.15.1.LEAD SELECTOR SWITCH:

After the defibrillator protection circuit, there is lead selector switch which is used to feed
the input voltage from the appropriate electrode to the preamplifier.
5.15.2.CALIBRATOR:
A push button allows the insertion of a standardization voltage of 1mV to the
preamplifier. This enables the technician to observe the output on the display unit and adjust the
scale so that a known deflection corresponds to a 1mV input signal. Changing the setting of the
lead selector switch introduces an artifact on the recorded trace. But by means of a special
contact on the lead selector switch the amplifier is momentarily turned off during the change of
setting of the lead selector switch and after the passage of the artifact the amplifier is turned on.
From the lead selector swithc the ECG signal goes to bio-amplifier.
5.15.3.BIO-AMPLIFIER:
The bio-amplifier consists of a preamplifier and power amplifier. The sensitivity or the
gain of the amplifier can be varied. Folllowed by the preamplifier, there is a power amplifier
which is used to drive the recorder. Pen motors in the recorder requires suffficient electrical
power to activate the recording or display. therefore power amplifiers are required with high
power gain. Generally transistor circuits are favourable because a relatively large surface area is
necessary to dissipate the heat genertd in the circuit due to passage of high current.
Power amplifier circuit used to drive ECG chart recorder stylus. It is push pull type.
Furtehr it is provided with crossover distortion compenstation and offset control. It consists of
two silicon power transistors such that the emitters of the transistors are joined together and

connected with a load resistor RL.when VB is sufficiently positive, transistor Q1 is forward

biased and conducts while Q2 is reverse biased and remains off.
Output power POUT =V2OUT / RL.
To avoid the crossover distortion in a pushpull amplifier, an ideal noninverting amplifier is
inserted at the input. Since the input impedance of the noninverting amplifier approaches
infinity, the power gain also approaches infinity. The crossover distortion is eliminated because
the feedback resistance., Rf is so large and hence it raises the gain in a linear manner and in turn
raises the output voltage. The offset control is provided by the resistance R 2 and is used to
position the output stylus pen. Gain adjustment is provided with the resistance Ro.
5.15.4.AUXILIARY AMPLIFIER:
Since the electrode impedances are not equal, a differential amplifier does not completely
reject the common mode signals. The common mode signals can be reduced to a minimum level
by means of adding an auxiliary amplifier between the driven right leg lead and the ECG unit.
By this way, the right leg is not connected to ground but it is connected to the output of the
auxiliary amplifier. If the body common mode voltage is different from zero, a summing network
produces the sum of all common mode voltages from all other electrodes and feeds that sum of
the voltages as input to inverting terminal of the auxiliary amplifier. Meanwhile its noninverting
terminal is grounded. The output of the auxiliary amplifier is connected to the right leg.
Therefore it drives the body to zero common voltage. Thus the common mode rejection ratio of
the overall system is increased. Further in the right leg electrode the current flow is reduced.
5.15.5.ISOLATED POWER SUPPLY:

The isolated power supply is used to give power to the bio-amplifier and by means of
that, the electrical safety for the patient is increased.
5.15.6.OUTPUT UINT:
The output unit is a cathode ray oscilloscope. Or a paper chart recorder. In case of paper
chart recorder, the power amplifier or pen amplifier supplies the required power to drive pen
motor that records the ECG trace on the wax coated heart sensitive paper. A position control on
the pen amplifier is used to position the pen at the center on the recording paper. The stylus pen
is heated electrically and the temperature of the stylus pen can be adjusted with a stylus heat
control. There is a marker stylus which is actuated by a push button and allows the technician to
mark a coded indication of the lead being recorded. The paper speed is about 25 mm/s or 50
mm/s. the faster speed of 50 mm/s is provided to allow better resolution of the QRS complex at
very high heart rates.
5.15.7.POWER SWITCH:
The power switch of the recorder has three positions. In the on position the powet to the
amplifier is turned on; but the paper drive is not running. In order to start the paper drive the
switch must be placed in the RUN position. In the off position, the ECG unit is in switched off
condition.

5.16.Echocardiography
An echocardiogram. Image shows that the human heart has four chambers. Apical view - left
side of the heart to the right. Right side-up - heart's apex at bottom. The trace in the lower left
shows the cardiac cycle and the red mark the time in the cardiac cycle that the image was
captured.
An abnormal echocardiogram. Image shows a mid-muscular ventricular septal defect. The trace
in the lower left shows the cardiac cycle and the red mark the time in the cardiac cycle that the
image was captured. Colours are used to represent the velocity of the blood.
The echocardiogram is an ultrasound of the heart. Using standard ultrasound techniques, two-
dimensional slices of the heart can be imaged. The latest ultrasound systems now employ 3D
real-time imaging.
In addition to creating two-dimensional pictures of the cardiovascular system, the

echocardiogram can also produce accurate assessment of the velocity of blood and cardiac tissue
at any arbitrary point using Pulsed or Continuous wave Doppler ultrasound. This allows
assessment of cardiac valve areas and function, any abnormal communications between the left
and right side of the heart, any leaking of blood through the valves (valvular regurgitation), and
calculation of the cardiac output as well as the ejection fraction.

Echocardiography was the first medical application of ultrasound. Echocardiography was also
the first application of intravenous contrast-enhanced ultrasound. This technique injects gas-
filled microbubbles into the venous system to improve tissue and blood delineation. Contrast is
also currently being evaluated for its effectiveness in evaluating myocardial perfusion. It can also
be used with Doppler ultrasound to improve flow-related measurements.
Echocardiography is usually performed by cardiologists or cardiac sonographers
5.16.1.Transthoracic echocardiogram
The standard echocardiogram is also known as a transthoracic echocardiogram, or TTE.

In this case, the echocardiography transducer (or probe) is placed on the chest wall (or thorax) of
the subject, and images are taken through the chest wall. This is a non-invasive, highly accurate
and quick assessment of the overall health of the heart. A cardiologist can quickly assess a
patient's heart valves and degree of heart muscle contraction (an indicator of the ejection
fraction).
The TTE is commonly used to help diagnose endocarditis. Diagnostic findings by the
Echocardiogram include definitive evidence of vegetation or thrombus on valves or other
endocardiac structures, abscesses, or disruption of a prosthetic heart valve.
The TTE is highly accurate for identifying vegetations, but the accuracy can be reduced in up to
20% of adults because of obesity, chronic obstructive pulmonary disease, chest-wall deformities,
or otherwise technically difficult patients. Transesophageal echocardiography, if available, may
be more accurate than TTE because it excludes the variables previously mentioned and allows
closer visualization of common sites for vegetations and other abnormalities. Transesophageal
echocardiography also affords better visualization of prosthetic heart valves.
Transesophageal echocardiogram
Another way to perform an echocardiogram is to insert a specialised scope containing an
echocardiography transducer (TEE probe) into the patient's esophagus, and record pictures from
there. This is known as a transesophageal echocardiogram, or TEE (TOE in the United
Kingdom). The advantages of TEE over TTE are usually clearer images. The transducer is closer
to the heart and doesn't have the ribs and lungs to deflect the ultrasound beam. Some structures
are better imaged with the TEE. These structures include the aorta, the pulmonary artery, the
valves of the heart, and the left and right atria. While TTE can be performed easily and without
pain for the patient, TEE may require light sedation and a local anesthetic lubricant for the
esophagus. Children are anesthetized. Unlike the TTE, the TEE is considered an invasive
procedure.
In some centers, sedation is used to ease the discomfort to the individual. The use of local
anesthetic agents and sedation can decrease the gag reflex, making the ultrasound probe easier to
pass into the esophagus. The transducer and cable are then coated in a lubricant, placed in the

patient’s mouth, and then passed down the patient's throat. The individual is instructed to
swallow while the probe is being passed down, to prevent it from going into the trachea.
Although the placement of the thumb-wide transducer is uncomfortable, there are very few
complaints of gagging from the patient once the transducer is in the correct location.
6.Study of the brain

6.1.Fields of study
Neuroscience seeks to understand the nervous system, including the brain, from a biological and
computational perspective. Psychology seeks to understand behavior and the brain. The terms
neurology and psychiatry usually refer to medical applications of neuroscience and psychology
respectively. Cognitive science seeks to unify neuroscience and psychology with other fields that
concern themselves with the brain, such as computer science (artificial intelligence and similar
fields) and philosophy.
6.1.1.Methods of observation
6.1.2.Electrophysiology
Each method for observing activity in the brain has its advantages and drawbacks.
Electrophysiology allows scientists to record the electrical activity of individual neurons or
groups of neurons.
6.1.3.EEG
By placing electrodes on the scalp one can record the summed electrical activity of the cortex in
a technique known as electroencephalography (EEG). EEG measures the mass changes in
electrical current from the cerebral cortex, but can only detect changes over large areas of the
brain with very little sub-cortical activity.The abbreviation of electroencephalograph is called
EEG. It deals with the recording and study of electrical activity of the brain. EEGs are recorded
by means of electrode attracted to the skull of a patient the brain waves can be picked up and
recorded. Graded potentials are variations around the average value of the resting potential. Thus
the EEG potentials originate within the dendrite.
.6.1.4.MEG
Apart from measuring the electric field around the skull it is possible to measure the magnetic
field directly in a technique known as magnetoencephalography (MEG). This technique has the
same temporal resolution as EEG but much better spatial resolution, although admitedly not as
good as fMRI. The main advantage over fMRI is a direct relationship between neural activation
and measurement.

6.1.5.fMRI and PET
Functional magnetic resonance imaging (fMRI) measures changes in blood flow in the brain, but
the activity of neurons is not directly measured, nor can it be distinguished whether this activity
is inhibitory or excitatory. fMRI is a noninvasive, indirect method for measuring neural activity
that is based on BOLD; Blood Oxygen Level Dependent changes. The changes in blood flow
that occurs in capillary beds in specific regions of the brain are thought to represent various
neuronal activities. Similarly, a positron emission tomography (PET), is able to monitor glucose
metabolism in different areas within the brain which can be correlated to the level of activity in
that region.
6.1.6.Other methods
Attempts have also been made to directly "read" the brain, which has been accomplished in a
rudimentary manner through a brain-computer interface. Brain activity can be detected by
implanted electrodes, raising the possibility of direct mind-computer interface. The reverse
method has been successfully demonstrated.
6.1.7.Other matters
Computer scientists have produced simulated neural networks loosely based on the
structure of neuron connections in the brain. Artificial intelligence seeks to replicate brain
function—although not necessarily brain mechanisms—but as yet has been met with limited
success.
Creating algorithms to mimic a biological brain is very difficult because the brain is not a static
arrangement of circuits, but a network of vastly interconnected neurons that are constantly
changing their connectivity and sensitivity. More recent work in both neuroscience and artificial
intelligence models the brain using the mathematical tools of chaos theory and dynamical
systems. Current research has also focused on recreating the neural structure of the brain with the
aim of producing human-like cognition and artificial intelligence.
6.2.ElectroEncephaloGraphy (EEG)
The recorded representation of bioelectric potential generated by neuronal

activity of the brain is called electroencephalogram(EEG). With the help of electrodes
attached to the skull of a patient, the brain waves can be picked up and recorded. EEG wave
form has a very complex pattern, which is much more difficult to recognize than the ECG.
The brain waves are the summation of neuronal depolarization in the brain. Due to stimuli
from the five senses as well as from the thought process on the surface of the brain, these
voltages are about 10 mV. Due to propagation through skull bone, they are attenuated to
levels from 1v to 100µv,which are picked up by EEG electrodes. They are in the frequency
range from 0.5 to 3000hz.. These potentials vary with respect to position of electrode on the

surface of skull. The waveform varies greatly with the location of the measuring electrodes
on the surface of the scalp. EEG potentials measured at the surface of the scalp, actually
represent the combined effect of potentials from a fairly wide region of the cerebral cortex
and from the various points beneath. During recording the electrodes are placed around the
frontal, parietal, temporal and occipital lobe of the lobes, the EEG waveforms is generally
affected by the mental activity of a person.
Evoked potentials are the potentials developed in the brain as the responses to external stimuli
like light, sound etc. the external stimuli is detected by the sense organs, which cause changes in
the electrical activity of the brain. Nowadays the term event related potential has been used
instead of evoked potential.
6.2.1.Brain Waves:
Wide variation among individuals and the lack of repeatability in a given person
from one person to another make the establishment of specific relationships. But some
characteristics EEG waveforms can be related to epileptic seizures and sleep. The EEG
waveforms obtained with the help of intensity and patterns of this electrical activity due to
overall level of excitation of the brain. This includes various activities of a person when in
alert condition, sleepy condition, tension condition etc.
Normally the brain waves are irregular, no general patterns can be discerned in the
EEG. But during abnormal conditions we can obtain the specific wave form.
The normal Brain waves that occur in the human being can be classified into Alpha,
Beta, delta and theta waves.
Brain waves Frequency
Delta wave below 3½ hz

Theta wave from 3½ hz to about 8hz .
Alpha wave from about 8hz to about 13hz .
Beta wave above 13hz .
Activity types
One second of EEG signal

Historically four major types of continuous rhythmic sinusoidal EEG activity are recognized
(alpha, beta, delta and theta). There is no precise agreement on the frequency ranges for each
type.
 Delta is the frequency range up to 4 Hz and is often associated with the very young and
certain encephalopathies and underlying lesions. It is seen in stage 3 and 4 sleep.
Delta waves.
 Theta is the frequency range from 4 Hz to 8 Hz and is associated with drowsiness,

childhood, adolescence and young adulthood. This EEG frequency can sometimes be
produced by hyperventilation. Theta waves can be seen during hypnagogic states such as
trances, hypnosis, deep day dreams, lucid dreaming and light sleep and the preconscious
state just upon waking, and just before falling asleep.
Theta waves.
 Alpha (Berger's wave) is the frequency range from 8 Hz to 12 Hz. It is characteristic of

a relaxed, alert state of consciousness. Alpha rhythms are best detected with the eyes
closed. Alpha attenuates with drowsiness and open eyes, and is best seen over the
occipital (visual) cortex. An alpha-like normal variant called mu is sometimes seen over
the motor cortex (central scalp) and attenuates with movement, or rather with the
intention to move.
Alpha waves.

 sensorimotor rhythm (SMR) is a middle frequency (about 12–16 Hz) associated with
physical stillness and body presence.
 Beta is the frequency range above 12 Hz. Low amplitude beta with multiple and varying
frequencies is often associated with active, busy or anxious thinking and active
concentration. Rhythmic beta with a dominant set of frequencies is associated with
various pathologies and drug effects, especially benzodiazepines.
Beta waves.
 Gamma is the frequency range approximately 26–100 Hz. Gamma rhythms appear to be
involved in higher mental activity, including perception, problem solving, fear, and
consciousness.
Gamma waves.
Rhythmic slow activity in wakefulness is common in young children, but is abnormal in

adults. In addition to the above types of rhythmic activity, individual transient waveforms such
as sharp waves, spikes, spike-and-wave complexes occur in epilepsy, and other types of
transients occur during sleep.
In the transition from wakefulness, through Stage I sleep (drowsiness), Stage II (light) sleep, to
Stage III and IV (deep) sleep, first the alpha becomes intermittent and attenuated, then
disappears. Stage II sleep is marked by brief bursts of highly rhythmic beta activity (sleep
spindles) and K complexes (transient slow waves associated with spindles, often triggered by an
auditory stimulus). Stage III and IV are characterized by slow wave activity. After a period of
deep sleep, the sleeper cycles back to stage II sleep and/or rapid eye movement (REM) sleep,
associated with dreaming. These cycles may occur many times during the night.
EEG under general anesthesia depends on the type of anesthetic employed. With halogenated
anesthetics and intravenous agents such as propofol, a rapid (alpha or low beta), nonreactive
EEG pattern is seen over most of the scalp, especially anteriorly; in some older terminology this
was known as a WAR (widespread anterior rapid) pattern, contrasted with a WAIS (widespread
slow) pattern associated with high doses of opiates. Anesthetic effects on EEG signals are
beginning to be understood at the level of drug actions on different kinds of synapses and the
circuits that allow synchronized neuronal activity

6.3.Coma
In medicine, a coma (from the Greek - koma, meaning deep sleep) is a profound state of
unconsciousness. A comatose patient cannot be awakened, fails to respond normally to pain or
light, does not have sleep-wake cycles, and does not take voluntary actions. Coma may result
from a variety of conditions, including intoxication, metabolic abnormalities, central nervous
system diseases, acute neurologic injuries such as stroke, and hypoxia. It may also be
deliberately induced by pharmaceutical agents in order to preserve higher brain function
following another form of brain trauma.
The difference between coma and stupor is that a patient with coma cannot give a suitable
response to either noxious or verbal stimuli, whereas a patient in a stupor can give a crude
response, such as screaming, to an unpleasant stimulus.
Some psychiatric diseases appear similar to coma. Some forms of schizophrenia, catatonia, and
extremely severe major depression are responsible for behaviour that appears comatose.
Coma is also to be distinguished from the persistent vegetative state which may follow it. This is
a condition in which the individual has lost cognitive neurological function and awareness of the
environment but does have noncognitive function and a preserved sleep-wake cycle.
Spontaneous movements may occur and the eyes may open in response to external stimuli, but
the patient does not speak or obey commands. Patients in a vegetative state may appear
somewhat normal and may occasionally grimace, cry, or laugh.
Likewise, coma is not the same as brain death, which is the irreversible cessation of all brain
activity. One can be in a coma but still exhibit spontaneous respiration; one who is brain-dead,
by definition, cannot.
Coma is different from sleep; sleep is always reversible.
6.4.Distinctive phases of coma

Within coma itself, there are several categories that describe the severity of impairment.
Contrary to popular belief, a patient in a comatose state does not always lay still and quiet. They
may talk, walk, and perform other functions that may sometimes appear to be conscious acts, yet
are not.
Two scales of measurement frequently used in TBI diagnosis to determine the phase of
coma are the Glasgow Coma Scale and the Ranchos Los Amigos Scale. The GCS is a simple 15-
point scale used by medical professionals to assess severity of neurologic trauma, and establish a
prognosis. The RLAS is a more complex scale that describes up to eight separate levels of coma,
and is often used in the first few weeks or months of coma while the patient is under closer
observation, and when shifts between levels are more frequent.
There are several levels of coma, through which patients may or may not progress. As
coma deepens, responsiveness of the brain lessens, normal reflexes are lost, and the patient no

longer responds to pain. The chances of recovery depend on the severity of the underlying cause.
A deeper coma alone does not necessarily mean a slimmer chance of recovery, because some
people in deep coma recover well while others in a so-called milder coma sometimes fail to
improve.
The outcome for coma and vegetative state depends on the cause, location, severity and
extent of neurological damage: outcomes range from recovery to death. People may emerge from
a coma with a combination of physical, intellectual and psychological difficulties that need
special attention. Recovery usually occurs gradually, with patients acquiring more and more
ability to respond. Some patients never progress beyond very basic responses, but many recover
full awareness. Gaining consciousness again is not instant: in the first days, patients are only
awake for a few minutes, and duration of time awake gradually increases.
Comas generally last a few days to a few weeks, and rarely last more than 2 to 5 weeks.
After this time, some patients gradually come out of the coma, some progress to a vegetative
state, and others die. Many patients who have gone into a vegetative state go on to regain a
degree of awareness. Others may remain in a vegetative state for years or even decades.
Predicted chances of recovery are variable due to different techniques used to measure the extent
of neurological damage. All the predictions are statistical rates with some level of chance for
recovery present: a person with a low chance of recovery may still awaken. Time is the best
general predictor of a chance for recovery, with the chances for recovery after 4 months of brain
damage induced coma being low (less than 15%), and full recovery being very low.
The most common cause of death for a person in a vegetative state is secondary infection such as
pneumonia which can occur in patients who lie still for extended periods.
6.5.ELECTROMYOGRAPHY:
Electromyography is the science of recording and interpreting the electrical activity of the
muscle’s action potentials. Meanwhile the recording of the peripheral nerve’s action potentials is
called electroneurography. The electrical activity of the under lying muscle can be measured by
placing surface electrodes on the skin. To determine whether the muscle is contracting or not, or
displaying on the CRO and loud speaker the action potentials spontaneously present in a muscle
or induced by voluntary contraction as a means of detecting the nature and location of the motor
unit lesions. So to record the action potentials of individual motor units, the needle electrode is
inserted into the muscle. The EMG indicates the amount of activity of a given muscle or a group
of muscles and not an individual nerve fiber.
The action potentials occur both positive and negative polarities at a given pair of
electrodes, so they may add or cancel each other. Thus EMG appears, very much like a random
noise waveform. The contraction of a muscle produces action potentials. Where there is
stimulation to a nerve fiber, all the muscle fiber contract simultaneously developing action
potentials. In a relaxed muscle, there is no action potential. EMG is usually recorded by using
surface electrodes or more often needle electrodes inserted directly into the muscle. The surface
electrodes pick-up the potentials produced by the contracting muscle fibers. The signal can then

be amplified and displayed on the screen of an audio amplifier connected to the loud speaker.
The oscilloscope displays EMG waveforms. The tape recorder is included in the system to
facillate play-back and study of the EMG sound waveforms at a later convenient time. the
waveform can also be photographed from the CRT screen by using a synchronized camera.
Oscilloscope
Tape recorder
EMG
Input amplifier Speaker
A.F.Amplifier
Block diagram of typical set up for EMG recording
The surface electrodes or needle electrodes pickup the potentials produced by the
contracting muscle fibers. The surface electrodes are from Ag-Agcl and are in disc shape. The
surface of the skin is cleaned and electrode paste is applied. The electrodes are kept in place by
means of elastic bands. By that way, the contact impedance is reduced below 10kiloohms. There
are two types of conventional electrodes: bipolar and unipolar type electrodes. In the case of
bipolar electrode, the potential difference between two surface electrodes resting on the skin is
measured. In case of unipolar electrode, the reference surface electrode is placed on the skin and
the needle electrode which acts as active electrode, is inserted into the muscle. Because of small
contact area, these unipolar electrodes have high impedances ranging from 0.5 to 100mega ohms.
With needle electrodes, it is possible to pickup action potentials from the selected nerves or
muscles and individual motor units. In the case of coaxial electrode which consists of an
insulated wire threaded through a hyperdermic needle with a oblique tip for easy penetration, the
surrounding steel jacket acts as reference and the metallic wire acts as exploring electrode. The
needle is inserted into the muscle further to record the action potentials for a single nerve
microelectrodes are used.
The amplitude of the EMG signals depends upon the type and placement of
electrodes used and the degree of muscular exertions. That is the surface electrode pick up many

overlapping spikes and produces an average voltage from various muscles and motor units. The
needle electrodes pick up the voltage from a single nerve fiber. Generally EMG signals range
from 0.1 to 0.5 mv. They may contain frequency components from 20 Hz to 10 KHz., which are
in the audio range, but using low pass filter, the electromyography restricts this frequency range
fro 20 Hz to 200 Hz for clinical purposes. The normal frequency of EMG is about 60 Hz.
Therefore the slow speed strip chart recorders are not useful and the signals are displayed on a
cathode ray oscilloscope and photographic recordings are made. Normally there are two cathode
ray tubes, one for viewing and other one for recording. A light sensitive paper moves over the
recording cathode ray tube and the image is produces on that paper. After developing it, one can
see the visible image. For continuous recording, the paper speed is about 5 to 25 cm/second. For
short duration it is about 50 to 400 cm/second. The paper width is about 10 cm. treading a
needle, and an array of facial expressions. Smooth muscles occur in the walls of internal body
organs and perform actions such as food through the intestines contracting the uterus (Womb) in
child birth and pumping blood through blood vessels.
6.6.ELECTRORETINOGRAPHY:
The recording and interpreting the electrical activity of eye is called electroretinography.
All sense organs are connected to the brain but the eye has a special relationship as the retina is
an extension of the cerebral cortex. Potentials within the eye may be recorded relatively easily
because of its exposed position. The cornea is about 20mv positive relative to the fundus of the
eye. The fundus is the back of the interior of the eye ball. If the illumination of the retina is
changed, the potential changes slightly in a complex manner. The recording of these changes is
called retinogram. A silver- silver chloride electrode on a contact lens and a distinct electrode on
the cheek are used to record the eye potential changes.
Electrode placement:
The bipolar recording technique is used. The exploring electrode is placed on a saline
filed contact lens. The contact lens is placed on a saline filled contact lens. The contact lens is
tightly attached to the eye. During eye movement there is no slip of contact lens by using
negative pressure (between the corneal cavity and the cornea) attachment techniques. The
common contact lenses used for corrections or cosmetic purposes ride on a tear film over the
cornea, do not follow eye movements well and are unsuitable for recording purposes. Therefore
specially made contact lenses used to record the action potentials of eye during flash of light
incident on eye.

Recording Techniques:
When light falls on the retina, the absorption of photons by photo pigments localized in
the outer segment of the retina’s photoreceptors is taking place. This causes the breakdown or
bleaching of photo pigments which results in the liberation of ions that cause a change in the
membrane potential. This in turn results in the development of action potential that is transmitted
down the optic nerve. This action potential is picked up the electrodes and are fed to the bio
amplifier and then to the recorder. The recording set up is similar to the ECG recorder.
Electroretinogram waveform
D
1 mV
Action
potential A 1 Sec C
Light on
Time
Figure shows the typical eletroretinogram. Before the flash of light is incident on eye, there is a
constant d.c. horizontal line in the recorder. In response to a 2 seconds flash of light, a
retinogram is developed. Probably the curve originates from the pigment layer beyond photo
receptors (extra retinal).
The first part A of the response to a brief flash of light is due to the early receptor
potential (ERP) generated by the incident light which induces changes in the photo pigment
molecules. The second component part B with a delay of 1 to 5 milliseconds is due to later
receptor potential (LRP) produced by syruptic ending of the photoreceptors. This is the
maximum output of the receptors. The part C wave recorded with the off response of ERP and
LRP.
In the earlier recording of the eye potentials, the corneal electrodes were not used. Instead
the rotation of the contact lens was measure by means of a mirror (on contact lens) which reflects
the incident light on a moving photographic film or photo cell. After developing the
photographic film, we can see the image and from that we can get some information’s about the
eye potentials. In the case of photocells, the output from the photocell was amplified and then
given to the recorder. There was also a nonoptical method for measuring contact lens rotation.
Two sets of magnetic coils, normal in the space and oscillating in phase quadrature at 4.8kHz
create crossed magnetic fields which excite two small search coils embedded in the contact lens.
Rotations of the eye cause induced voltages of few millivolts, which can give information about
the eye potential.

The diseases which affect the steady potential of the eye.

 The effects of certain drugs on the eye movement system can be determined.
 The state of semicircular canalizes analyzed by EOG.
 Diagnosis of the neurological disorders may be possible.
 The level of anesthesia can be indicated by characteristic eye movements.
TELEMEDICINE
7.1 Introduction :
7.1.1 Wireless telemetry:
Wireless telemetry gives analysis of the physiological data of man or animal under
normal conditions and in natural surroundings without any discomfort or obstruction to the
person or animal
Biotelemetry is the branch of biomedical instrumentation that deals with the measuring
physiological variables to a method of transmission of resulting data. Telemetry is most
convenient during transportation within the hospital area as well for the continuous monitoring
of patients sent to other wards or clinics for check-up or therapy.
Biotelemetry is the measurement of biological parameters over a distance. The means of

transmitting the data from the point of generation to the point of reception can take many forms.
Measurements can be applied to two categories.

 Biological variables such as EEG, ECG and EMG.
 Physiological variables that require transducers such as blood pressure,
gastrointestinal pressure, blood flow and temperatures.
In first category, a signal is obtained directly in electrical form, whereas the second category
requires a type of excitation. The physiological parameters are eventually measured as variations
of resistance, inductance or capacitance. The differential signals obtained from these variations
can be calibrated to represent pressure, flow, temperature and so on.
The analog signal that is obtained from the electrodes (the signal may be in the form of
voltage, current etc) is converted into a form or code capable of being transmitted at the
transmitter end with the help of transmitter set up.

The transmitter end comprises of transducer that converts physical signals into analog
electrical signal. That electrical signal has to be amplified with the help of preamplifier set up.
The amplified signal has been modulated with the help of modulator and encoder, this processed
signal is transmitted through the multiplexer circuit.
At the receiver end the signal is converted back into its original form. The receiver end
comprises of demultiplexer, decoder, and demodulator circuit.
The demultiplexer circuit demultiplexes the received signal. Now this demultiplexed
signal is passed through the decoder and demodulator. Finally the original signal is retrieved
back for analyzing purpose.
Currently the most widespread use of biotelemetry for biotelemetric potentials is in the
form of the electrocardiogram. A simple set up is sufficient in the transmitting end. That set up
comprises of only electrodes and amplification circuit that is needed to prepare the signal for
transmission.
7.1.2 Telemedicine:
It is the application of telecommunications and computer technology to deliver health
care from one location to another. This telemedicine uses the modern information technology to
deliver timely health services to those in need by the electronic methods. The patient may be
present at the remote location. In that location, the specialized doctors are not there means, we
can give protection to the life of the patient with the help of this telemedicine. Nowadays for
investigation purpose only, we are using this telemedicine. In future with the help of this set up
and robot, the doctor can able to do operation for the needed patient who is present in remote
location.

Components of biotelemetry system
Amplifier
Direct
biopotential
Subject
Processor
Transducer
Modulator
Exciter
Carrier
Block Diagram of a Biotelemetry transmitter

Tuner Demodulator Chart Recorder

or Oscilloscope
Tape Recorder
Receiver – Storage Display units
7.2 Modulation systems:
Wireless telemetry system uses modulating systems for transmitting biomedical signals.
Two modulators are used here. A lower frequency sub-carrier is employed in addition to very-
high frequency (VHF). This transmits the signal from the transmitter. The purpose behind this
double modulation , it gives better interference free performance in transmission, and this
enables the reception of low frequency biological signals. The submodulators can be a FM
(frequency modulation) system, or a PWM (pulse width modulation) system or a final
modulator is practically always an FM system.
7.2 Frequency modulation ( FM ):
In FM systems, the signal can be trasnsmitted by varying the instantaneous frequency in

connection with the signal to be modulated on the wave. Here the amplitude of the signal t(plus
carrier wave) is constant. The rate at which the instantaneous frequency varies is the modulating
frequency. The magnitude to which the carrier frequency varies away from the centre frequency
is called frequency deviation. This is proportional to the modulating signal. Generally FM
signal is produced by controlling the frequency of an oscillator by the amplitude of the
modulating voltage. The frequency of oscillations for most oscillators depend on a particular
value of capacitance.

In the above diagram, the tuned oscillator serves as a frequency modulator. The diode used here
is a varactor diode. The varactor diode is operating in a reverse biased mode, because of this;
the varactor diode gives a depletion layer capacitance to the tank circuit.
This capacitance is a function of the reverse biased voltage across the diode and therefore
produces an FM wave with modulating signal applied.
7.2.1 Pulse width Modulation (PWM):

PWM method has an advantage of being less perspective to distortion and noise. Figure
shows a typical pulse width modulator, transistor q1 and Q2 from free running multivibrator.
Transistors Q3 and Q4 provide constant current sources for charging the timing capacitors
C1 and C2 and driving transistors Q1 and Q2. when Q1 is off and Q2 is ‘on ‘, capacitor C21
chrges through R1 to the amplitude of the modulating voltage e m . the other side of this capacitor
is connected to the base voltage of Q2 drops from approximately zero to –em. transistor Q2 will
remain off until the base voltage charges to zero volt. Since the charging current is constant at I,
the time required to charge C2 and restore the circuit to the initial stage is
T2 = (C2/I ).em
Similarly, the time that the circuit remains in the original stage is
T1 = ( C1/I ).em

Variation of Pulse width with amplitude
W
W
Q
P
W= Pulse width generated by the multi-vibrator

P= Variable pulse width, in accordance with input signal
Q = off – Period, which also gets varied.
7.2.2 Choice of radio carrier frequency:
In every country, there are regulations governing the use of only certain frequency and
bandwidth for medical telemetry. Therefore, the permission to operate a particular telemetry
system needs to be obtained from the postal department of the country concerned. The
transmitter is typically of 50 ohms, which can give a transmission range of about 1.5 Km in the
open flat country. The range will be less in built-up areas. In USA, two frequency bands have
been designated for short range medical telemetry work by the FCC ( federal communication
commision). The lower frequency band of 174-216 MHz, coincides with the VHF television
broad cast band(channels 7-13) therefore the output of the telemetry transmitter must be limited
to avoid interference with TV sets. In higher frequency band of 450-470 MHz, greater
transmitter power is allowed but an FCC license has to be obtained for operating the system.
Radio waves can travel through most of non-conducting material such as air, wood and
plaster with relative ease. But these radio waves are hindered, blocked or reflected by most
conductive material and by concrete. This is due to the presence of reinforced steel in the
concrete buildings. Because of this phenomenon, transmission may be lost or be of poor quality

when a patient with a telemetry transmitter moves in an environment with a concrete wall or
behind a structure. Reception may also get affected by radio frequency reception or null spots.
One of the important problems can be minimized by the careful selection of transmitter
frequencies by the use of suitable antenna system and by the equipment design.
Based on the output power and frequency obtained, it is possible for us to decide the
range of the radio system. Care should be taken for designing the receiver and antenna. Only the
transmitted signal from the remote location can be analyzed properly otherwise it is difficult for
the doctor to give proper medicine.
The transmitter:
The commonly used FM transmitter is shown below. This circuit can be used for medical
telemetry also. The circuit comprises of a transistor, feedback circuit, and a tank circuit. The
transisytor used here is a grounded base colpitts R.F. oscillator with L1, C1, C2 as the tank circuit.
Transmitter circuit diagram:
Inductor
A capacitive divider circuit is plced in the collector circuit, that is formed with the
help of C1 and C2. inductor L1 functions both as a tuning coil and a transmitting antenna.
With the help of this set up, a positive feedback is provided to the amplifier circuit. We can able
to set the transmission frequency to a precise level. This can be done by adjusting the trim
capacitor C2. with this set up, we can able to set the frequencyrange of 88 to 188 MHz.
Frequency modulation can be achieved by variation in the operating point of the transistor,
which in turn varies its collector capacitance, thus changing the resonant frequency of the
tranistor circuit. The operating point can be changed by the sub-carrier input. Thus the
transmitter,s output consists of an RF signal, tuned in the FM broad cast band and frequency
modulated by the sub-carrier oscillator (SCO), which in turn is frequency modulated by the
physiological signals of interest.

The Receiver:
The receiver can be a common broadcast receiver with a sensitivity of 1 microvolt. The
output of the hf unit of the receiver is fed to the sub cab-modulator HF unit of the receiver is fed
to the sub-modulator to extract the modulating signal. In a FM/FM system, the sub-modulator
first converst the FM signal into an AM signal. This is followed by an AM detector, which
demodulates the newly created AM waveform. With this arrangement, the output is linear with
frequency deviation only for small frequency deviations. Other types of detectors can be used to
improve the linearity. Two major problems that has been faced in biotelemetry at the system
interfaces. The first problem is the interface between the biological system and the electrical
system.
The second problem is the interface between transmitter and receiver.
7.3.Radio Pill
The earliest biotelemetry units was the endoradiosonde, developed by Mackay and
Jacobson. The pressure sensing electrode is a radio pill less than 1 cm3.in volume. This radio pill
can be swallowed by the patient. Radio pill now travels through the gasterointestinal tract on the
way of passing into the gastrointentinal tract, the radio pill is capable of measuring various
parameters that are available in the tract. With the help of radio pill type devices, it is possible
for us to measure or sense temperature, pH, enzyme activity, and oxygen tesion values. These
measurements can be made in associated with transducers. Pressure can be sensed by using
variable inductance, temperature can be measured by using temperature-sensitive transducer.
7.4.NERVE AND MUSCLE STIMULATORS:

Stimulators are the devices which are used to stimulate innervated muscles denervated
muscles and nerves. further these are used for the treatment of paralysis with totally or partially
denervated muscles, for the treatment of pain. muscular spasm and peripheral circulatory
disturbances. this technique is called electrotherapy which uses low volt, low frequency impulse
currents.
7.4.1.STIMULATION OF NERVES:
There is normally a potential difference of about 100mv across a nerve membrane. if this
potential is reversed for more than about 20 milliseconds, the nerves will be stimulated and an
action potential will be propagated along the nerve fiber.
the nervous system is the body's internal, electrochemical, communication network. its
main poarts are the brain and spinal cord from the central nervous system (CNS) the body's chief
controlling and coordinating centres. Billions of long neurons, many grouped as nerves, make up
the peripheral nervous system, transmitting nerve impulses between the CNS and other regions
of the body. Each neurons has threee parts: a cell body, branching dendrites that receive
chemical signals from other neurons, and a tube -like axon that conveys these signals as
electrical impulses.

Types of neurons:
Three types of neurons are there. they are Multipolar, unipolar, bipolar.
Types of nerve ending:

free nerve ending, Meissner's corpuscle. Merkel's disc. Ruffini corpuscle, Pacinian
corpuscle.
7.4.2.ACCUPUNCTURE:
Accu-means needle, puncture- means making a highly concentrated presssure over the
skin, in order to relief the pain over the partiular area of the skin. This kind of treatment is
popular in CHINA from 2600B.C. onwards. in accupuncture, care should be taken for the
patient, not for the diseases. iin our body electric energy is there. It is possible for us to adjust the
electric energy in proper way. 12 paths are there in our body. in these 12 paths 900 needle points
are there. in these points, with the help of stainless steel needle we are puncturing our body. by
doing like this we can increase or decrease the electric energy in our body. In olden days people
had used this acupuncture in place of anasthesia. With the help of these acupunctre we can stop
the poain information, which passes to our brain. In our heart there are no nerves. so if we are
acupuncturing our heart means, we dont feel no pain. With the help of this accupunctur , we can
stimulate our nerves. nowadays with the help of electric current these nerves are stimulated.
7.4.3.DIFFERENT TYPES OPF WAVEFORMS USED IN

STIMULATOR(ELECTROTHERAPY)
Various types of waveforms are used for stimulation of nerves and muscles to carry out
treatment of various diseases.
(i) Galvanic current:
galvanic current is a constant or direct current. the maximum amount of current passed
through the body is about 0.3 to 0.5 mA/cm2 of electrode surface. the duration of the passage of
current is about 10 to 20 minutes. The passage of current creates the movement of ions. it is used
for the preliminary treatment of atonic paralysis and for the disturbance of blood flow in the
arteries.
(ii) Interrupted galvanic current:

Interrupted galvanic current pulses are a series of negative going rectangular pulses. the
pulse duration is about 100 milliseconds with a repetition rate is between 12 per minute and 70
per minute. A silghtly different form of interrupted galvanic pulses is the triangular wavepulses.
fig shows the unidirectional interrupted galvanic pulses which create ionization of the skin of the
patient and produce discomfort and inflammation. it is overcome by the application of a positive
current in between the negative pulses proportional to the time interval.
(iii) Faradic current:

Faradic current pulses are usually between 50 per second in duration with a triangular
waveform as shown in fig (b). The repetition rate is invariably 50 per second. Faradic current can
produce muscular contractions. There is no ion movement due to the passage of faradic current.
This is used primarily for the treatment of muscle weakness. There are two types of faradic
current pulses , plain faddism is a train of faradic pulses of unvarying amplitude. These are rarely
used. Surged faradism is a series of surges of pulses shown in fig (c). Thus the amplitude of the
pulses applied to the patient increases in a slow manner and the number of surges per minute is
known as contraction rate. these faradic pulses are mainly used in the treatment of functional
paralysis and spasm. the muscular contraction occurs for each surge which gradually increases in
intensity from zero to maximum at the desired rate for muscular contraction, and relaxation of
muscles occurs when the surge ceases. Each surge has duration of 1500ms and approximately 70
impulses. its repetition rate is about 2 to 3 seconds.
(iv) Exponential current:

Fig(d) shows the exponential pulses used for the treatment of severe paralysis. By this
kind of pulses, the surrounding healthy muscles even in the immediate neighborhood of the
diseases be varied to provide selective stimulation.
Electrical Shock
8.1 Introduction:
Electric shock is a traumatic state caused by the passage of electric current can flow
through the human body either accidentally or intentionally. The kind and amount of damage
depends on the intensity, type and duration of the current, the point where the electricity first
touched the body and the path it took through the body. Burns may be superficial or very deep
with widespread tissue death. Severe shock may cause muscle contractions, respiratory paralysis,
unconsciousness and cardiac arrest. A high voltage electric shock may cause sudden muscle
spasm that may through the victim away from the power source with extreme force, resulting in
further injuries, such as fracture. Lightening causes injuries similar to those sustained from a
high voltage electric shock. Electrical currents are administered intentionally in the following
case.
 For measurement of respiration rate by impedance method, a small current at high
frequency is made to flow between the electrodes applied on the surface of the body.
 High currents are also passed through the body for therapeutic and surgical purposes.
 When recording signals like ECG, and EEG, the amplifiers used in the preamplifier stage
may deliver small currents themselves to the patient. These are due to bias currents.
Accidental transmission of electrical current takes place because of defect in the

equipment; excessive leakage and simultaneous use of other equipment on the patient
which may produce potentials on the patient circuit.
8.2 Electric shock hazards:

It is a common experience that the hazards due to electric shock are also
associated with equipment other than that used in hospitals. However, the equipment’s used in
medical practice have to operate in special environments. Which differ I certain respects from
others. Some such special situations are as follows:
 A patient may not be usually able to react in the normal way. He/she is either ill,
unconscious anaesthetized or strapped on the operating table. He/she may not be able to
withdraw him/herself from the electrified object, when feeling tingling in his/her skin,
before any danger of electrocution occurs.
 The patient or the operator may not realize that a potential hazard exists. This is because
potential differences are small and high frequency and ionizing radiations are not directly
indicated.
 Considerable neutral protection and barrier to electric current is provided by human skin.
In certain applications of electro medical equipment, the natural resistance of the skin
may be passed. Such situations arise when the tests are carried out on the subject with a
catheter in his/her heart or an large blood vessels.
 Electro medical equipment, example : pacemakers may be used either temporarily or
permanently to support or replace functions of some organs of the human body. The
interruption in the power supply or failure of the permanent injuries or even prove fatal
for the patient.
 Medical instruments are quite often used in conjunction with several other instruments
and equipment. These combinations of high power equipment and extremely sensitive
low signal equipment. Each of these devices may be safe in itself, but can become
dangerous when used in conjunction with others.
 Environmental conditions in the hospitals particularly in the operating theatres cause
explosion or fire hazards due to the presence of anesthetic agents, humidity and cleaning
agents etc.
8.3 Effects due to 50 Hz current passage:
This electric shock can cause unwanted cellular depolarization. This is associated with
muscular contraction, or it may cause cell vaporization and tissue injury. The effect of
commercial frequency currents on the human body should be considered. This assists in
establishing allowable leakage currents for electrical appliances and electric hand tools. Most of
the electrical accidents involve a current pathway through victim from one upper limb to the feet
or to the opposite upper limb. At commercial frequencies, the body acts as a volume conductor.
For commercial frequencies (50 Hz – 60 Hz) specific physiological effects due to passage of
current through the body are listed below:
 Type of current range (mA)

 Physiological effect
 Threshold1-5
 Tingling sensation5-8
 Intense or painful sensation
 Let go 8-20
 Threshold of involuntary muscle contraction paralysis >20.
Respiratory paralysis and heart fibrillation 80-1000, ventricular and heart defibrillation 1,000 to
10,000 sustained myocardial contraction, temporary respiratory paralysis and possible tissue
burns.
Let-go current is the minimum current to produce muscular contraction. For men it is
about 16 mA and for women it is about 10.5 mA.
8.4 Microshock and Macroshock:
8.4.1 Macroshock:
A physiological response to a current applied to the surface of the body that produces
unwanted or unnecessary stimulation like muscle contractions or tissue injury is called macro
shock. All hospital patients and medical attendants are exposed from defective electric devices
and bio-medical equipment.
8.4.2 Microshock:
A physiological response to a current applied to a surface of the heart that results in
unwanted stimulation like muscle contractions or tissue injury is called microshock. Micro
shock is most often caused when currents in excess of 10 microamperes, flow through an
insulated catheter to the heart. The catheter may be an insulated, conductive-fluid filled tube, or a
solid wire pacemaker cable. The micro shock results because the current density at the heart
become high in the situation depicted there, in which the catheter touches the heart.

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EC2021 – Medical Electronics- Study Material

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 1

Health and illness:

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 2

Bones and joints:

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 3

Interacting layer of muscle allow great mobility

Opposing muscle layers transport semi-digested food.

Movement of the forearm:

Muscles of facial expression:

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2.1.1.Electrical and chemical pathways

2.2.Body – Clock Input

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2.4.6.Excitement and Inhibition

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Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 11

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2.11.1.Transport of ions through cell membrane

Blood and its types

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3.4.Blood and Lymph

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 14

Blood Plasma: The pressure

Some of this drains into lymph

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 15

3.5.Balance and Recycling

3.6.Components of blood plasma

3.6.1.Blood and Blood Vessels

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3.8.1.Gas Exchange in Blood

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 19

3.8.3. Exchange in the Lungs

3.8.4.Exchange in the Body Tissues

3.9.1.Relaxation (Late Diastole)

Dhanalakshmi College of Engineering, Chennai. Dept/ ECE Page 20

3.9.2.Contraction of the Atria (Atrial Systole)

3.9.3.Contraction of the ventricles (Ventricular Systole)

3.9.4.Relaxation (Early Diastole)

3.9.5.Control of heart rate

Sino Atrial Node

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Electrical Impulses spread

Atrio-ventricular Signals Fire

Electrical Impulse Fade

Blood cell counters

Changes in the normal functioning of an organism are often accompanied by changes in

Thrombocytes (platelets) are usually tiny, round oblong or irregularly shaped

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Blood clotting can be inhibited by the injection of heparin, a natural

Mean cell volume(MCV):

Mean cell haemoglobin (MCH):

Mean cell haemoglobin concentration(MCHC):

Mean platelet volume(MPV):

Red cell distribution width (RDW):

Platelet distribution width (PDW):

4.2.Tests on blood cell: