Biomedical Instrumentation ECG Analysis

Biomedical
Instrumentation
B. More Biopotentials
B18/BME2
Dr Gari Clifford
(Based on slides from

Prof. Lionel Tarassenko)
Biomedical Instrumentation B18/BME2
Diagnostic uses of ECG
 Foetal monitoring (both before birth & during)
 Patient monitoring in Ambulance, Intensive Care

Unit or Coronary Care Unit
 S-T segment elevation to diagnose heart attacks
 Evidence of cardiac muscle damage (infarct)
 Detection of precursors to heart attacks:
 Abnormal heart beats (e.g. many ectopic beats, TWA)
 Abnormal heart rhythms
Use of ECG in CCU
 The ECG is highly informative in the diagnosis of a heart
attack (Myocardial Infarct). Insufficient blood supply to the
cardiac cells due to a blockage in the coronary arteries
(ischaemic heart condition) causes S-T segment elevation.
 Following the heart attack, cardiac muscle damage (infarct)

generally leads to a loss of amplitude in the ECG.
ECG abnormalities
(possible precursors to heart attacks)
 Analysis of the ECG can provide early warning of potential
problems.
 Ectopic beats originate somewhere other than the Sino-

Atrial (SA) node and often have different shapes
(morphologies).
 Abnormal heart rates (arrhythmias) can be treated.

Other intervals in ECG analysis
 The most important interval in the ECG is the QT interval

 A longer than normal QT interval is a good indicator of
long QT syndrome (LQTS)

Q-T interval measurement
 LQTS is a potentially fatal condition that renders

sufferers vulnerable to an arrhythmia known as torsade
de pointes.
 When this rhythm occurs the heart is unable to beat

effectively and the blood flow to the brain falls
dramatically.
 The result is a sudden loss of consciousness and

possible cardiac death.
Detecting ECG abnormalities
 Two methods are in common use:
 Ambulatory monitoring
 Exercise stress ECGs

Ambulatory ECG monitoring
 ECG monitored for 24 hours.
 Results printed out:
 24-hour summary detailing the heart rate and S-T
segment changes over the period of the test.
 Detailed information on ECG recorded at the time
of a significant event (e.g. arrhythmia).

Analysis of ECG waveform
 Diagnostic information can be obtained by
analysis of the amplitude and relative timing
of the various segments.
 The simplest interval to measure is the R-R

interval (from which the heart rate is derived).
 Two types of heart rate meters:

 Averaging heart rate meter
 Beat-to-beat heart rate meter
Heart Rate Meters
 Heart rate is usually given in beats per minute
(BPM).
 The easiest way to obtain this is to count an
identifying feature in the ECG which occurs once
per heart beat.
 The most obvious such feature is the QRS
complex which is a sharp spike.
 Both averaging and beat-to-beat devices need
to perform this detection.
QRS detection
 There are 4 main problems in detecting the QRS
complex in ECG traces:
 Artefacts due to electrode motion

QRS detection
 There are 4 main problems in detecting
the QRS complex in ECG traces:
 Artefacts due to electrode motion
 Baseline wander (mostly caused by breathing

and torso movements)
 Muscle artefact (broadband)
 T-waves with high-amplitude content

QRS detection
 The solution to these problems is to use a band-

pass filter to remove:
 Low-frequency changes such as baseline wander
 High-frequency changes e.g. movement/muscle artefact
 Most of the frequencies in the QRS complex are

around 5-20 Hz.
 A pass-band of 10 – 40 Hz is therefore
appropriate.... Why?

 Look at the signal below 10Hz .. Why do we want to remove it?

QRS detection
 Once the “non-QRS” sections of the ECG

have been attenuated, the QRS complex
can be detected with a threshold detector.

R-Wave pulse generator
 This should trigger a pulse generator so

that a short pulse of a fixed duration is
generated once (and only once) for each
QRS complex.

Averaging heart rate meter
 The “average power” of the pulse train from the

pulse generator circuit will be indicative of the
Heart Rate.
 This can be determined using a “leaky integrator”

(a form of low-pass filter).
 The time-constant of the R-C circuit should be

several beats long to minimise output ripple.

Averaging heart rate meter

Beat-to-beat heart rate meter
This is best achieved using a digital circuit which:

- Counts the time between consecutive QRS complexes
- Inverts this in order to obtain a heart rate (rather than interval)

Beat-to-beat heart rate meter

Heart rate variability
 Under resting conditions, the heart rate of a healthy individual is not

constant. (Notice compressions and rarefactions above)
 During expiration, the vagus nerve is stimulated, which slows down
the heart rate (the right vagus innervates the sinoatrial node).
 During inspiration, the vagus nerve is not stimulated.
 This gives rise to a phenomenon known as respiratory sinus
arrhythmia (RSA); cardio-acceleration during inspiration, cardio-
deceleration during expiration.

Autonomic Regulation
Rest & Digest Fight & Flight

Heart rate variability
 Upper trace: respiration rate from electrical impedance

plethysmography – see next lecture.
 Middle trace: beat-to-beat R-R interval.
 Lower trace: R-R interval series re-sampled at 4Hz and
cubic spline fitted to time series (smoothing).
The sympathovagal balance:
 Ratio of LF power to HF power in PSD of heart rate

time series is though to reflect sympathovagal balance

The circadian rhythm

HRV and sleep state
 HRV is also circadian Wakefulness Deep Sleep
 Autonomic balance
changes over 24 hours
 Significantly in different
sleep cycles
 Also changes based on

disease. Light Sleep REM (Dream) Sleep
• HR & HRV are not specific enough to identify sleep stages
• So what is ...?

Other biopotentials
 There are other biopotentials which can be
recorded from the body using similar circuitry:
 The Electroencephalogram (EEG, electrical activity of
the brain)
 The Electromyogram (EMG, electrical activity of
muscle)
 The Electro-oculogram (EOG, electrical activity of the
eyes)
 All are used in sleep staging

Brief intro to the Electroencephalogram
 The EEG signal is also
measured with Ag-AgCl
electrodes
 Placed in standard positions

on the scalp
 Signal is <100μV – Why?

 (Recall ECG is ~1mV)
 Heart: ~3x109
 Brain: ~1011
 Due to skull attenuation
Characteristics of the EEG
 The important information is in the frequency domain.
 The frequency range from 0.5 to 30 Hz has been

arbitrarily divided into 5 bands:
 Delta 0.5-4Hz Deep Sleep

 Theta 4-8 Hz Drowsiness / light sleep
 Alpha 8-13 Hz Relaxed
 Beta 13-22 Hz Alert
 Gamma 22-30 Hz Short term memory tasks?

Diagnosis use of EEG
EEG helps the diagnosis of brain death, epilepsy and sleep
disorders
10-20 Montage
EEG during an epileptic seizure

Sleep analysis
 Quality of life is heavily dependent on quality of sleep.
 Between 5 and 10% of the adult population suffers from some form
of sleep disorder (insomnia, heavy snoring, Obstructive Sleep
Apnoea (OSA), etc…)
 Such people may be referred to a “sleep clinic” by their GP where

various signals, including four channels of EEG, the EOG and
oxygen saturation, will be recorded throughout the night.
 The EEG and the other signals are printed out and reviewed by a
trained sleep technician (requiring 2 to 5 hours for each record).

Sleep EEG
 The channels of sleep EEG are analysed using a rule-
based system
 Consecutive 30s segments are assigned to one of six

stages (to form hypnogram)
 Wake, Stage 1, Stage 2, Stage 3, Stage 4 & REM sleep
 1= light, 3 & 4 = deep sleep

 (Recently stages 3 &4 merged)

EEG rules for scoring ...
 For example, two rules for stage 3:
 an EEG record in which at least 20% but not
more than 50% of the epoch consists of waves of
frequency 2 Hz or lower which have amplitudes
greater than 75 μV peak to peak.
 sleep spindles may or may not be present in
stage 3.

EEG in different sleep stages

Sleep structure is age-dependent
 Over the night:
 REM sleep
duration increases
& SWS decreases
 Sleep changes in
adolescence
 As we age this
pattern fragments
Automating sleep analysis
 The important information is in the

frequency domain.
 Use the Short-term Fourier Transform or

an Auto-Regressive (AR) model to extract
the frequency-domain information.

Automated sleep analysis
 Work performed in the 90’s and 00’s (in this Department)
has led to methods for analysing sleep on a 1s basis.
 Sleep is treated as having three states:
 Wakefulness, REM/light sleep, deep sleep
 Sleep-wake continuum is represented by interpolation

between these states.

Short-term Fourier transform
 First extract N samples of signal and then window
(using Hamming, Kaiser or Hanning windows) to
avoid sharp discontinuities at edges.
 Then apply the Discrete Fourier Transform

[O(N2) operations] or the Fast Fourier Transform
[O(N log N) operations] if N is a power of 2.

AR models for spectral estimation
 The notation AR(p) refers to the autoregressive model of

order p. The AR(p) model is written as follows:
X t =  ai X t-i +  t (1  i  p)
where the ai’s are the parameters of the model and εt is a white-noise
process with zero mean.
 An autoregressive model is essentially an infinite

impulse response filter which shapes the white-noise
input. The poles are the resonances of the filter and
correspond to the spectral peaks in the signal.

AR-model vs FFT spectra (for EEG)
 AR model is
parametric
 Requires only a
few coefficients
 Useful for
estimation on
short time series

Automated sleep analysis
 AR model parameters inputted to a neural network
 Sleep is treated as having three states:
 Wakefulness, REM/light sleep, deep sleep
 1s epochs – continuous scoring ... But it maps to sleep

stages too ...

EMG
 The electromyogram is used to identify
muscle activity
 In sleep is it used to identify mastication
 Eye flicks are not constant, so EMG under

chin increases confidence in REM score
EOG
 The electro-oculogram is used to identify
rapid eye movement (indicates dreaming)
 Try it in the lab!

Complex example - OSA
 SNA: Sympathetic Nerve Activity (recorded from peroneal nerve)

EEG is also used for sedation
 Look at coherence between different regions of
the brain
 E.g. BIS monitor
 Scale of 1:100 ... Proportional to hypnotic dose of
intravenous or volatile agents used, correlating well with
the hypnotic state and importantly is agent independent.
 Does not identify movement or non-movement
response, especially in the presence of opiates
 Anaesthesia is more than just a loss of
consciousness
Evoked potentials
 This is a technique whereby a stimulus, such as a light
flash or loud click, is repeatedly applied.
 The EEG signal is recorded from a particular area of the
brain.
 Normal EEG activity, however, masks the brains response
to a single stimulus.
 Repetitive stimuli have to be used and the evoked
response is distinguished from the background activity by
using the technique of signal averaging.

Biomedical Instrumentation ECG Analysis

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Biomedical Instrumentation ECG Analysis

Diunggah oleh

Hak Cipta:

Format Tersedia

Biomedical

(Based on slides from

 Patient monitoring in Ambulance, Intensive Care

 Following the heart attack, cardiac muscle damage (infarct)

 Ectopic beats originate somewhere other than the Sino-

 Abnormal heart rates (arrhythmias) can be treated.

Biomedical Instrumentation B18/BME2

 The most important interval in the ECG is the QT interval

Biomedical Instrumentation B18/BME2

 LQTS is a potentially fatal condition that renders

 When this rhythm occurs the heart is unable to beat

 The result is a sudden loss of consciousness and

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 The simplest interval to measure is the R-R

 Two types of heart rate meters:

Biomedical Instrumentation B18/BME2

 Baseline wander (mostly caused by breathing

 Muscle artefact (broadband)

 T-waves with high-amplitude content

Biomedical Instrumentation B18/BME2

 The solution to these problems is to use a band-

 Most of the frequencies in the QRS complex are

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Once the “non-QRS” sections of the ECG

Biomedical Instrumentation B18/BME2

 This should trigger a pulse generator so

Biomedical Instrumentation B18/BME2

 The “average power” of the pulse train from the

 This can be determined using a “leaky integrator”

 The time-constant of the R-C circuit should be

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

This is best achieved using a digital circuit which:

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Under resting conditions, the heart rate of a healthy individual is not

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Upper trace: respiration rate from electrical impedance

 Ratio of LF power to HF power in PSD of heart rate

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 Also changes based on

• HR & HRV are not specific enough to identify sleep stages

Biomedical Instrumentation B18/BME2

 All are used in sleep staging

 Placed in standard positions

 Signal is <100μV – Why?

 The frequency range from 0.5 to 30 Hz has been

 Delta 0.5-4Hz Deep Sleep

Biomedical Instrumentation B18/BME2

EEG during an epileptic seizure

 Such people may be referred to a “sleep clinic” by their GP where

Biomedical Instrumentation B18/BME2

 Consecutive 30s segments are assigned to one of six

 1= light, 3 & 4 = deep sleep

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

Biomedical Instrumentation B18/BME2

 The important information is in the