Diagnostic Medical

Equipment

Electrocardiography
Electrocardiograph ECG

 The ECG and the heart

 Limitations of ECG

 The ECG reveals the heart rate and rhythm only during the time that the
ECG is taken. If intermittent cardiac rhythm abnormalities are present,
the ECG is likely to miss them. Ambulatory monitoring is needed to
record transient arrhythmias.

 The ECG can often be normal or nearly normal in patients with

undiagnosed coronary artery disease or other forms of heart disease
(false negative results.)

 Many “abnormalities” that appear on the ECG turn out to have no

medical significance after a thorough evaluation is done (false positive
results).

3
ECG Machines

Leads:
 Limb leads I,II, and
III bipolar

 Einthoven’s triangle
ECG Machines

 Augmented Limb leads

unipolar aVR, aVL and
aVF
 Derived from the leads
I,II, and III.
 View the heart from
different angles, thus
vectorial.
 Two leads grounded
negative, the third is
augmented at the positive
ECG Machines

 Augmented means amplified or

large voltage
 Electrodes on two sides
combines to negative and
augments the other positive.

 The augmented electrode is then

labelled following its nearest
limb.

 Records the potential of the

heart on the side nearest to that
limb
ECG Machines

 ECG signals on each augmented limb

ECG Machines

 Angles and signals in augmented leads

ECG Machines

Chest Leads V1, V2, V3,

V4, V5 and V6
 Also called precordial
unipolar leads.
 They encircle the
precordium.

 Provide information
about the anterior,
posterior,right and
left depolarization
vectors.
ECG Machines

 All three limb electrodes

are connected together
as a negative electrode
of an ECG meter at about
zero potential

 Being unipolar, can

explore the potential on
various chest locations.

 Their proximity to the

heart makes them not
requiring augmentation
ECG Machines

Six chest leads

 V1- 4th intercostal space to
the right of sternum
 V2- 4th intercostal space to
the left of sternum
 V3- halfway between V2
and V4
 V4- 5th intercostal space in
the left mid-clavicular line
 V5- 5th intercostal space in
the left anterior axillary line
 V6- 5th intercostal space in
the left mid axillary line
ECG Machines

Comparison of 6 limb leads v/s 6 chest leads

 Placement of Electrodes

 Apply Gel on electrodes evenly.

 Place the limb electrodes to hand (near the wrist) and
legs (near the ankle).

 The electrodes need to be in proper contact with the

skin at all times to maintain a good reading
throughout the ECG monitoring process.

 The patient is now ready for the electrode placement.

Apply the electrodes and if needed add ECG
conductive gel to the electrodes.
 Types of ECG Machines

ECG MACHINE

Single Channel Multichannel

Multichanne

Interpretative

16 July 2014 Armando Darino Ngojo 14

ECG Machines

Single Channel ECG

Multi-channel ECG

Interpretative ECG
Block Diagram of ECG Machine
The MAC5500 ECG Machine

 The MAC 5500 HD

combines the proven
12SL
analysis(program)
with technological
innovations to the
most advanced ECG
pacemaker detection
systems that are
available today.
Noisy or Poor Quality ECG traces

 Poor quality, or noisy, traces cannot be used for

evaluation by the physician or cardiologist

 Some noises or artifacts on the ECG can be

caused by patient or cable movement, shivering
or seizures and electrical 50/50Hz interference.

 ECG traces with artifacts are more difficult to

interpret.
Noisy or Poor Quality ECG traces

Other factors for noisy traces;

 Poor patient preparation.
 Environmental interference around the ECG machine, e.g too close
transformers or large metal conductors carrying 50 or 60 Hz power.
 Defective electrodes or poor electrode-skin contact or interface.
 Defective lead wires or ECG cables.
 Electrode misplacement on the body.
 Faulty acquisition module, computer system or instrumentation
error.
 Uncorrected lead systems-effect of inhomogeneity of the thorax.
 Blood resistivity or variation in respiration.
 Variations in conductivity and geometrical parameters on the
electrocardiogram.
ARTIFACT ON THE ECG
ECG Simulators

Devices that can depict a

patient and produce ECG
signals to view on an ECG
machine.
 Can be a single device with
only ECG simulator or Mult-
parameter patient simulator
with ECG feature.
 Can help students interpret
ECG signals prior to using
ECG machines with patients
or during troubleshootings.
ECG Simulators

 Others can produce a

variety of ECG
simulations such as a
complete P-QRS-T
waveform at all rates
as well as square
waves.

 Parameters of
amplitude, rate and
arrhythmias are
selectable.
ECG Simulators

 Available from a
range of 3 to a full 12-
lead simulators.

 Some can simulate

respiration, blood
pressure,
temperature and
cardiac output .
ECG Simulators

 Some can be made by yourselves as a DIY project.

 Example is a Frank’s ECG simulator shown below.
ECG Simulators

The Frank’s ECG simulator circuit diagram.

ECG Simulators
The Frank’s ECG simulator parts list.

C1 = 22 p
R1 = 4K7 C2 = 82 p
R2, R8 = 1M C3, C4, C5, C6 = 220n
R3, R4, R9, R10, R11, R12, R13 = 100K IC1 = 4521
R5 = 1K IC2 = 4017
R6, R7 = 470K D1, D2, D4 = 1N4148
R14, R15 = 220 cristal = 4.1943 Mhz
D3 = LED 3 mm
2 x IC sockets 16 pin
 ECG Simulators
The Frank’s ECG simulator description.

The above shown ECG signal is complex and will be created by different
single signals. The P,Q,R,S,T signals are formed in different steps and then
are put together in the right sequence. A shift register does the sequence job,
RC combinations the frequency and amplitude of the single waves.
IC1 contains an oscillator and a shift register. At the output of pin10 a signal
with 16 Hz triggers IC2. IC2 is a counter with 10 outputs. When output 0 of IC2
is active (pin3) the R-C combination R8, C5 creates the P-wave. When the
counter jumps to output 3 (pin7) the R-wave is created by R4, C4. The
negative part is reduced by the two diodes and simulate the following S-wave.
When output 5 is active (pin1) the T-wave is created by R7 and C5. The
outputs which are not connected create the needed pauses between the
signals. All signals are put together through R3 and R6 which level the
respective amplitudes.
ECG Simulators
The Frank’s ECG simulator description.
When one sequence is finished the shift register stops. Output 9 (pin11) is
connected with EN-input (pin13). Only when a reset pulse reaches the counter
(pin15) the counter starts again. This reset is also created by IC1. Because in
addition to the 16 Hz trigger signal the IC also provides a 1 Hz and a 0.5 Hz
signal at pin14 and pin13 which correlate a heart beat rate of 60 and 120 (switch
2). Therefore the square signal has to be transformed in a positive needle pulse.
This is the duty of the combination C6, R11, D4, R10. Because this pulse comes
earlier or later (0.5 Hz or 1 Hz) only the lengths of the U period is shorter or
longer. The PQRST wave form is not effected.
A small LED D3 with resistor R5 connected to output 3 (pin7, IC2), flashes during
the
R- period.
The final resistor combination R12-R15 converts the bipolar signal from the
electronic board into the needed three pole output signal.
ECG Simulators
The Frank’s ECG simulator description.

Note: The circuit is designed for common electronic devices. All parts
can be found on old electronic boards or at the nearest electronic
shop. But if you have problems to find the clock-crystal of 4.1943
MHz you can take a 4.43 MHz PAL-crystal from a TV. Your output
signal is as good as with the clock-crystal but the heart rate will
change to 63 and 127 beats per minute.
 Trouble Shooting - User Checklist

HOSPITAL : DEPARTMENT:
CHECKLIST PASS FAIL

PHYSICAL CONDITIONS
- Panel, keypad, chassis, controls, cables
CLEANLINESS
- Are Chassis, Paddles clean?
ACCESSORIES
- Are Leads, extension cables, gel pads, recording
paper, chest Electrodes present?
POWER UP
- No abnormal heat, smell, smoke, electrical shock?
INDICATORS
- Is AC Mains, Battery lit?
DISPLAY
- Is display well lit and normal?
CONTROLS
- Is all keys/controls operating properly?
BATTERY
- Is battery fully charged?
ALARM
- Is alarm functioning properly?
 Trouble Shooting – User Checklist

CHECKLIST PASS FAIL

MONITOR
Can lead selection and sensitivity be changed?
Are HIGH/LOW alarm ranges set?
Can QRS volume be adjusted?
Is test waveform displayed properly?

RECORDER
Is Paper feed working?
Is waveform printout is clear and satisfactory?
Is date and time printed on paper correctly?

PACER (if applicable)

Is Fixed/DEMAND modes get selected and working ?
Is rate and intensity setting working properly?
 Trouble Shooting
ERROR MESSAGE DESCRIPTION CORRECTIVE ACTION

Noise in ECG Waveform No QRS waveform is Check for lead connection.

generated. Check for chest electrode.
Check for external interference.

Baseline Drift. Baseline shifted out Check for dry electrodes.

and waveform is Replace the electrodes.
clear. Check leads.
Check for patient movements.

No ECG print on paper No print on paper Check for sides on thermal paper.
Change the paper.

Paper Empty? No Paper Replace recording paper.

Check for proper placement of paper.
Paper sensor faulty.
 General Safety

 Avoid moisture or contact with water, excessive

humidity and temperature. The ECG machine should
keep in clean and dry place whenever not in use.

 Keep away the ECG machine from any x-ray,

Ultrasonic or other electronic instruments.

 Use only 3-prong power cord provided with ECG

machine.

 Clean all the accessories and reusable electrodes,

wipe out extra jelly and clean patient cable properly.
 General Safety

 The ECG machine which to be tested should be

dry and clean.

 Checkthe patient lead wire and cable for any

damage or mishandling, otherwise replace the
same immediately.

 Recommend using proper size and placement of

recording paper.

 Clean the print head regularly for clear printout

 Specific Safety

Battery :
 The ECG machine battery should be kept charging
before and after use.
 Check the battery status regularly or as per the
manufacturer recommendation, otherwise replace
the same.
 Always install the battery when the ECG machine
is used on AC power.
 Do not short the battery plus (+) terminal and
minus (-) terminal.
 If battery is damaged, disassemble or leak,
replace immediately.
 Specific Safety

Electrical :
 Check that instrument is grounded properly.
 ECG machine should have proper grounding to reduce
interference.
 Attach ground terminal for interference free ECG.

Storage :
 The prolonged storage under high temperature, direct
sunlight and fluorescent light and excessive humidity may
cause the fading of recording result. Which may
deteriorate the print head of recorder. Store the recording
paper in cool, dry and dark place.