ECG

1. What is vector cardiography(VCG)?

Vectorcardiography (VCG) is a method of recording the magnitude and direction of the electrical forces that
are generated by the heart by means of a continuous series of vectors that form curving lines around a
central point.

1. The electrical activity of the heart can be described by the movement of an electrical dipole which
consists of a positive charge and a negative charge separated by a variable distance
2. The cardiac vector is the line joining the two charges. To fully describe the cardiac vector, its
magnitude and direction must be known.
3. The electrical activity of the heart does not consist of two moving charges, but the electric field
which is the result of the depolarization and repolarization of the cardiac muscle can be
represented by the simple model of a charged dipole

2. Describe cardiac vector.

The electrical activity of the heart can be described by the movement of
an electrical dipole which consists of a positive charge and a negative
charge separated by a variable distance.
The cardiac vector is the line joining the two charges. To fully describe
the cardiac vector, its magnitude and direction must be known. The
electrical activity of the heart does not consist of two moving charges,
but the electric field which is the result of the depolarization and
repolarization of the cardiac muscle can be represented by the simple
model of a charged dipole.

3. Describe the eithoven's Triangle.

Einthoven's triangle : It is an imaginary formation of three
limb leads in a triangle used in electrocardiography, formed
by the two shoulders and the pubis. The shape forms an
equilateral triangle with the heart at the center.
 It is named after Willem Einthoven, who theorized its existence.

4. types the ECG leads.

A. limb leads

v Lead I — This axis goes from shoulder to shoulder, with the negative electrode placed on the right
shoulder and the positive electrode placed on the left shoulder. This results in a 0 degree angle of
orientation. I = LA – RA

v Lead II — This axis goes from the right arm to the left leg, with the negative electrode on the shoulder and
the positive one on the leg. This results in a +60 degree angle of orientation. II = LL – RA

v Lead III — This axis goes from the left shoulder (negative electrode) to the right or left leg (positive
electrode). This results in a +120 degree angle of orientation. III = LL - LA

B. argumented limmb leads

There are three augmented unipolar limb leads. These are termed unipolar leads because there is a single
positive electrode that is referenced against a combination of the other limb electrodes.

v The positive electrodes for these augmented leads are located on the left arm (aVL), the right arm (aVR),
and the left leg (aVF).

v In practice, these are the same electrodes used for leads I, II and III. (The ECG recorder does the actual
switching and rearranging of the electrode designations).

v The three augmented leads are depicted as shown to the figure using the axial reference system. v The
aVL lead is at -30° relative to the lead I axis; aVR is at -150° and aVF is at +90°

C. Precordial Chest leads

5. Prove Augmented lead is 1.5 X unipolar lead

6. Describe Wilson Central Terminal (WCT) with fig
The Wilson Central Terminal (WCT) is an artificially constructed reference for electrocardiography, which is
assumed to be near zero and steady during the cardiac cycle; namely it is the simple average of the three
recorded limbs (right arm, left arm and left leg) composing the Einthoven triangle and considered to be
electrically equidistant from the electrical center of the heart.

7. Block diagram of electrocardiograph

8. What is power line interference.?

9. Instrumentation amplifier in ecg (CMI) with circuit

Figure : Driven-right-leg circuit for minimizing common-mode interference. The circuit derives common-mode
voltage from a pair of averaging resistors connected to v3 and v4 in Figure. The right leg is not grounded but is
connected to output of the auxiliary op amp.

10. What is ECG?

Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the

heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the

electrical activity of the heart using electrodes placed on the skin.

 P Wave: the depolarization being generated in and spreading through the Sinoatrial node. The SA node is too small for its depolarization

to be detected on most ECGs. The depolarization travels through the atria, towards the Atrioventricular node. The depolarization travels

through the largest amount of tissue in the atria, which creates the highest point in the P wave.

 PR Segment: Depolarization travels through the AV node. Like the SA node, the AV node is too small for the depolarization of its tissue to

be detected on most ECGs. This creates the flat PR segment.

 Q Wave: The action potential starts traveling down the left bundle branch about 5 milliseconds before it starts traveling down the right

bundle branch. This causes the depolarization of the interventricular septum tissue to spread from left to right. This gives rise to a

negative deflection after the PR interval, creating a Q wave.

 R Wave: Following depolarization of the interventricular septum, the depolarization travels towards the apex of the heart, which creates

the R wave.
  S Wave: Then the depolarization travels throughout both ventricles from the apex of the heart, following the action potential in

the Purkinje fibers. This phenomenon creates a negative deflection in all three limb leads, forming the S wave on the ECG.

 ST segment: Ventricular contraction occurs between ventricular depolarization and repolarization. During this time, there is no movement

of charge, so no deflection is created on the ECG. This results in the flat ST segment after the S wave.

 T Wave: The epicardium is the first layer of the ventricles to repolarize, followed by the myocardium. The endocardium is the last layer to

repolarize. This causes repolarization to start from the apex of the heart and move upwards. This creates the T wave.

 U wave: The U wave is hypothesized to be caused by the repolarization of the interventricular septum. It normally has a low amplitude,

and even more often is completely absent.

11. 3 layer and valves of heart?

**Layers of the Heart:**

1. **Pericardium:** The outermost layer of the heart is the pericardium, a double-walled sac that contains the heart and the roots of the great

vessels. It consists of two layers: the outer fibrous pericardium and the inner serous pericardium.

2. **Epicardium:** This is the thin, outermost layer of the heart wall. It is also known as the visceral layer of the serous pericardium. The epicardium

is composed of connective tissue and fat and serves to protect the heart.

3. **Myocardium:** The middle and thickest layer of the heart is the myocardium. It is composed of cardiac muscle cells and is responsible for the

contraction of the heart to pump blood throughout the body.

4. **Endocardium:** The innermost layer is the endocardium, which lines the chambers of the heart and covers the heart valves. It consists of

endothelial cells and connective tissue.

**Types of Valves in the Heart:**

1. **Aortic Valve:** Located between the left ventricle and the aorta, the aortic valve allows blood to flow from the left ventricle to the aorta, which

then carries oxygenated blood to the rest of the body

2. **Pulmonary Valve:** Situated between the right ventricle and the pulmonary artery, the pulmonary valve allows blood to be pumped from the

right ventricle to the lungs for oxygenation.

3. **Tricuspid Valve:** Found between the right atrium and the right ventricle, the tricuspid valve prevents the backflow of blood from the ventricle

to the atrium during contraction.

4. **Mitral Valve:** Positioned between the left atrium and the left ventricle, the mitral valve (also known as the bicuspid valve) prevents the

backflow of blood from the ventricle to the atrium during contraction.

12. Described the conduction pathway

13. What is action potential?? Describe cardiac and muscle Action potential
Action potential graph of heart
the cardiac action potential:

1. **Resting Membrane Potential:** Around -90 mV, maintained by potassium efflux, sodium, and calcium influx.

2. **Depolarization (Phase 0):** Rapid increase in membrane potential due to sodium influx through voltage-gated channels.

3. **Early Repolarization (Phase 1):** Brief repolarization with some potassium efflux.

4. **Plateau (Phase 2):** Sustained membrane potential near 0 mV, balanced by calcium influx and potassium efflux.

5. **Late Repolarization (Phase 3):** Potassium efflux continues, calcium channels begin to close.

6. **Restoration of Resting Membrane Potential (Phase 4):** Sodium-potassium pumps restore resting state, preparing for the next action potential.

Action potential graph of muscle

**Cardiac Muscle Action Potential:**

1. **Duration and Phases:** The action potential in cardiac muscle cells is longer and more prolonged than in
skeletal muscle cells. It consists of five phases: 0, 1, 2, 3, and 4.

2. **Phase 0 (Depolarization):** Rapid depolarization occurs due to the influx of sodium ions (Na+) through
voltage-gated sodium channels. This phase is triggered by the opening of these channels when the membrane
potential reaches a certain threshold.

3. **Phase 1 (Initial Repolarization):** Brief repolarization happens due to the transient opening of potassium
channels, leading to a small outward flow of potassium ions (K+).
 4. **Phase 2 (Plateau Phase):** This phase is characterized by a prolonged period of relatively stable membrane
potential. Calcium ions (Ca2+) slowly enter the cell while potassium ions continue to flow out. The balance
between these ions maintains the plateau.

5. **Phase 3 (Rapid Repolarization):** Repolarization resumes due to increased potassium ion efflux, primarily
through delayed rectifier potassium channels, leading to the restoration of the resting membrane potential.

6. **Phase 4 (Resting Potential):** The cell remains at rest until the next depolarization event. During this phase,
the membrane potential slowly drifts back to the resting state, maintained by the activity of sodium-potassium
pumps and leak channels.

**Skeletal Muscle Action Potential:**

1. **Duration and Phases:** Skeletal muscle action potentials are briefer and consist of only three phases:
depolarization, repolarization, and the refractory period.

2. **Depolarization:** Similar to cardiac muscle, depolarization occurs in response to the opening of voltage-
gated sodium channels, leading to a rapid influx of sodium ions into the cell.

3. **Repolarization:** Repolarization follows rapidly, initiated by the closure of sodium channels and the opening
of voltage-gated potassium channels. Potassium ions exit the cell, restoring the resting membrane potential.

4. **Refractory Period:** After repolarization, there is a refractory period during which the muscle cell cannot be
restimulated. This period ensures that the muscle cell completes its contraction before receiving another signal.

14. Describe Membrane polarization hypothesis

15. What is the Volume Conductor Principles

Volume conduction .

"Volume conduction" in the context of the heart refers to the transmission of electrical signals through the
fluid (blood) and conductive tissues of the heart.
 If you put a cell into the center of a container filled with salt solution, the solution will be charged and
become a volume conductor. The nearer a point away from the positive pole, the higher the potential is. The
potential at a given point can be calculated by the equation:

V = E (cos a/r2)

(V, voltage. E, electromotive force)

The body acts as a conductor of the electrical currents generated by the heart, it is possible to place
electrodes on the body surface and measure cardiac potentials.

By convention, a wave of depolarization heading toward the positive electrode is recorded as a positive
voltage (upward deflection in the recording).

16. What is ECG theory?

 Depolarization of the heart towards the positive electrode produces a positive deflection
 Depolarization of the heart away from the positive electrode produces a negative deflection
 Repolarization of the heart towards the positive electrode produces a negative deflection
 Repolarization of the heart away from the positive electrode produces a positive deflection

17. ECG Electrode Placement

18.
Types

Standard Limb Leads

Augmented Limb Leads

Precordial Leads

7, graph diagram of diffeerent leads

Remember ,, only aVR’s graph in downward direction

Others in upward direction

19..transverse plane lead.

The transverse plane ECG is recorded unipolarly with respect to an indifferent electrode formed by summing
the signals from the left and right arms and the left leg (LA + RA + LL). Six electrodes are usually used,
labelled V1 to V6. The electrodes are placed close to the heart and their position is more critical than the
position of the frontal plane electrodes. They are placed on a line running round the chest from right of the
midline to beneath the left axilla.
EMG

1. What is EMG? Describe Electromyography and electromyogram

EMG:
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles.
qThe instrument used to measure the electrical activity of muscles is called Electromyograph.
qThe recorded pattern of the electrical activity of muscles is called Electromyogram.

2. Types of EMG
qIntramuscular: -Invasive recording of EMG directly from the Motor Unit
-Needle electrode & Fine wire electrode
-Used in Nerve Conduction study
qExtramuscular: -Noninvasive recording of EMG from the surface of the muscle
-Surface electrode
-Used in muscle study
There are two types of EMG signals:

1. **Surface EMG (sEMG):** This type of signal is obtained by placing electrodes on the skin above the muscle of
interest. sEMG captures the summation of electrical activity from multiple muscle fibers underneath the
electrode area.

2. **Intramuscular EMG (iEMG):** This involves inserting a needle electrode directly into the muscle tissue to
record electrical activity within a specific muscle or muscle group. iEMG provides more detailed information
about individual motor units and their firing patterns.

3. Source of EMG signal

qThe source of the SEMG signal is the motor unit action potentials (MUAP)
Motor unit: One motor neuron + all the muscle fibres it innervates.
qA motor unit is composed of one motor neuron & all the muscle fibres it innervates.

Electromyography (EMG) signals originate from the electrical activity produced by muscles during contraction or
relaxation. These signals are generated by the depolarization of muscle fibers, creating electrical impulses that
can be detected and recorded. The primary source of EMG signals is the neuromuscular junction, where motor
neurons transmit electrical signals to muscle fibers, causing them to contract.

Both types of EMG signals provide valuable information about muscle function, neuromuscular control, and can
 aid in diagnosing neuromuscular disorders, evaluating muscle activity during movement, or assessing muscle
rehabilitation progress.
4. How EMG signal is generated
qElectromyogram signal is the summation of individual Motor Unit Action Potential generated by the Motor
Units at the activation zone of the muscle.
qAfter the motor units are stimulated , their pulses are recorded (as a sum) by the electrode and displays as
Electromyogram signal within the pickup range of the recording electrode.

5. EMG electrode placement

❑ EMG electrodes should be placed between the motor unit and the tendinous
insertion of the muscle, along the longitudinal midline of the muscle.
❑ The distance between the centre of the electrodes or detecting surfaces
should only be 1-2 cm.
❑ The longitudinal axis of the electrodes (which passes through both detecting
surfaces) should be parallel to the length of the muscle fibres.
6. EMG signal acquisition configuration
Monopolar Configuration:
❑ The monopolar configuration is implemented using only a single electrode on
the skin with respect to a reference electrode.
❑ This method is used because of its simplicity, but is strictly not
recommended as it detects all the electrical signals in the vicinity of the
detecting surface

Bipolar Configuration:
❑ Bipolar configuration is used to acquire EMG signal using two EMG detecting
surfaces with the help of a reference electrode.
❑ The two detecting surfaces are placed only 1-2 cm from each other.
❑ The signals from the two EMG surfaces are connected to a differential
amplifier.
❑ The limitations of the monopolar configuration are removed by this
configuration. This is the most commonly used electrode configuration

7. Differential Amplification & Common Mode Rejection

❑ In differential amplification , three electrodes are necessary: two recording
 electrodes and one reference electrode.
❑ The recording electrodes are placed over the muscles, with the reference
electrode simply making good contact some where on the body.
❑ The biological energy that reaches both recording electrodes is then compared
to the reference electrode.
❑ Only the energy that is unique to each recording electrode is passed on for
further signal conditioning and display

8. Applications of EMG
❑ EMG is used as a diagnostic tool for identifying:
▪ Neuromuscular diseases, assessing low back pain
▪ Disorders of motor control
❑ EMG signals are also used as :
▪ A control signal for prosthetic devices such as prosthetic hands , arms
and lower limbs
Electromyography (EMG) finds a wide range of applications across various fields
due to its ability to measure and analyze muscle activity and electrical signals
generated by muscles. Here are several notable applications:

1. **Clinical Diagnosis:** EMG is extensively used in clinical settings to

diagnose neuromuscular disorders, such as muscular dystrophy, myasthenia gravis,
neuropathies, and nerve compressions. It helps identify abnormal muscle activity
and patterns indicative of these conditions.

2. **Rehabilitation and Physical Therapy:** EMG assists in evaluating muscle

function and monitoring progress during rehabilitation after injuries or
surgeries. Physical therapists use EMG feedback to develop personalized
rehabilitation programs, facilitating muscle strengthening and motor control
improvement.

3. **Prosthetics and Orthotics:** EMG signals are employed in the development of

prosthetic devices and orthoses. They allow for the creation of myoelectric
prostheses, which are controlled by EMG signals from residual muscles, enabling
more natural movements for amputees.

4. **Sports Science and Biomechanics:** EMG is used to analyze muscle activation

patterns and assess muscle fatigue in athletes. It aids in optimizing training
programs, improving performance, and preventing injuries by identifying
inefficient or overstrained muscle groups during activities.

5. **Human-Computer Interaction (HCI):** EMG-based interfaces enable gesture

recognition and control of devices through muscle activity. These interfaces are
utilized in gaming, virtual reality, and assistive technology for people with
disabilities.

6. **Research and Motor Control Studies:** In scientific research, EMG helps

understand motor control mechanisms, muscle coordination, and movement patterns.
It provides valuable insights into how the nervous system controls muscles
during various activities.
 7. **Occupational Ergonomics:** EMG is used to assess muscle loading and fatigue
in occupational settings, helping design workstations and tools to minimize
musculoskeletal disorders caused by repetitive tasks or poor ergonomics.

8. **Biofeedback Therapy:** EMG biofeedback assists individuals in becoming more

aware of and controlling their muscle activity. It is used in stress management,
relaxation techniques, and treating conditions like tension headaches and
temporomandibular joint disorders (TMJ).

9. **Gait Analysis:** EMG contributes to analyzing muscle activity during

walking and other movements. This analysis aids in diagnosing gait
abnormalities, designing orthotics, and evaluating the effectiveness of
interventions to improve gait patterns.

EMG's versatility in assessing muscle function and activity makes it a valuable

tool in clinical diagnostics, research, rehabilitation, and various other fields
aimed at understanding and optimizing human movement and function.

Electrodes

1. What is action potential, resting potential,

2. What is bio electrode?
3. Working principal of electrode. Describe with ag/agcl electrode
4. Type of bio electrode.
5. Equivalent circuit of bio potential electrodes
6. Equivalent circuit of electrode skin interface