Syllabus

Heart and cardiovascular system (brief discussion), electro conduction system of the heart.
Electrocardiography, ECG machine block diagram, ECG lead configurations, ECG recording
system, Einthoven triangle, analysis of ECG signals. Measurement of blood pressure: Direct,
indirect and relative methods of blood pressure measurement, auscultatory method,
oscillometric and ultrasonic non- invasive pressure measurements. Measurement of blood
flow: Electromagnetic blood flow meters and ultrasonic blood flow meters.

I. Heart and cardiovascular system

Cardio vascular system can be viewed as closed hydraulic system with 4 chamber pump.
It is mainly used for transportation of oxygen, Carbon dioxide, numerous chemical
compounds and the blood cells.
In some part of the system, diameter of the arteries are changed to control pressure.Heart is an
isolated two stage synchronized chamber
1. The first stage is to collect blood from the system and pump it in to 2nd stage.
2. The second stage then pump these blood to the system

Structure of Heart

Heart wall consists of three layers

1. Pericardium: Outer most layer, keeps outer surface moist, prevents friction
2. Myocardium: Middle layer, Main muscle of heart, made up of short cylindrical fibres
3. Endocardium: Inner layer of heart, Provides smooth lining for blood flow
Heart has 4 valves

1. Tricuspid/Right Atrio-Ventricular valve

Between Right A and V, Prevents blood flow from right V to A
2. Bicuspid/ left Atrio-Ventricular valve
Between left A and V, Prevents blood flow from left V to A
3. Pulmonary valve
At right ventricle, It has 3 cusps
4. Aortic Valve
Between left ventricle and aorta, It has 3 cusps.

Blood Flow inside the heart

 One of the two stage pump (Right side) collect fluid from the system and pump it
through oxygenation system (Lungs).
 Other side pump receives blood from oxygenation system (Lungs) and pump blood to
main hydraulic system.
 Blood act as communication and supply network for all parts of the body

The blood is carried out to the various parts of the body through blood vessels. There are
three types of blood vessels
1) Arteries--- Thick, Carries oxygenated blood
2) Veins--- Thin, De-oxygenated blood
3) Capillaries---Smallest, Last level of blood vessels, 800000 km of capillaries
 Heart pumps blood through the pulmonary circulation to the lungs and through the
systemic circulation to the other parts of the body.
1) Pulmonary circulation
2) Systemic circulation
 In pulmonary circulation, venous blood (de-oxygenated) flows from right ventricle
through pulmonary artery to lungs.
 The arterial (oxygenated) blood flows to left atrium through pulmonary veins.
 In systemic circulation blood flows from left auricle to left ventricle and it is pumped
to aorta and its branches

II. Electro Conduction System of the Heart

 The heart is able to create it's own electrical impulses and control the route the
impulses take via a specialised conduction pathway.
 The conducting system of the heart consists of cardiac muscle cells and
conducting fibers that are specialized for initiating impulses and conducting them rapidly
through the heart.
 They initiate the normal cardiac cycle and coordinate the contractions of cardiac
chambers. Both atria contract together, as do the ventricles, but atrial contraction occurs first.
 The conducting system provides the heart its automatic rhythmic beat. For the
heart to pump efficiently and the systemic and pulmonary circulations to operate in
synchrony, the events in the cardiac cycle must be coordinated.

The conduction pathway made up of 5 elements:

1. The sino-atrial (SA) node

2. The atrio-ventricular (AV) node
3. The bundle of His
4. The left and right bundle branches
5. The Purkinje fibres
  Electrical impulses from your heart muscle (the myocardium) cause your heart to
beat (contract). This electrical signal begins in the sinoatrial (SA) node, located at the top of
the right atrium.
 The SA node is sometimes called the heart's "natural pacemaker." When an
electrical impulse is released from this natural pacemaker, it causes the atria to contract.
 The electrical stimulus from the SA node eventually reaches the AV node and is
delayed briefly so that the contracting atria have enough time to pump all the blood into the
ventricles.
 The impulse leaves the AV node through bundle of His. The fibers in this bundle
known as Purkinje fibers after a short distance split into two branches to initiate action
potentials simultaneously in the two ventricles.

III. Electrocardiography

⚫ Bio electric potentials generated by heart muscles are called Electro Cardio Gram.
⚫ It is sometimes called EKG(Electro Kardio Gram)
⚫ Electrocardiography (ECG) is an interpretation of the electrical activity of the heart over a
period of time.
⚫ The recording produced by this noninvasive procedure is termed as electrocardiogram (also
ECG or EKG).

IV. ECG machine block diagram

 Lead Selector Switch
The potentials picked up by the patient electrodes are taken to the lead selector
switch. Here the electrodes are selected two by two according to the lead
program.
Preamplifier
The signal from lead selector switch given to preamplifier. A preamplifier is an
electronic amplifier which prepares an electronic signal for further amplification
or processing. It is usually 3 or 4 stage dual input unbalanced output differential
amplifier.
Power Amplifier
It is a push pull differential amplifier.
Single ended output from preamplifier is given to power amplifier.
Another input is from frequency selective network.
Output is single ended
The output of the power amplifier is fed to the pen motor which deflects the
writing arm of the paper.
Frequency selective network is an R-C network, which provides necessary
damping of the pen.
Auxiliary Circuits
The auxiliary circuits provide a 1 mV calibration signal and automatic blocking
of the amplifier during change in the position of the lead switch. It also includes a
speed control circuit for the chart driver motor.

V. ECG lead configurations

To record ECG 12 electrodes connected to the body of the patient. Electrodes connected to
ECG machine using wires called leads. Leads are electrodes which measure the difference in
electrical potential between either:
1. Two different points on the body (bipolar leads)
2. One point on the body and a virtual reference point with zero electrical potential, located in
the center of the heart (unipolar leads).

Classification

1. Standard Limb Leads or Bipolar Leads or Einthoven Leads : I, Il & III

2. Augmented Limb Leads (Unipolar): aVR, aVL & aVF
3. Precordial Leads: V1- V6
1. Standard Limb Leads or Bipolar Leads or Einthoven Leads : I, Il & III

 The Standard Limb Leads are used to display a graph of the potential difference recorded
between two limbs at a time. In these leads, one limb carries a positive electrode and the
other limb, a negative one.
 The three limb electrodes, I, II and III form a triangle (Einthoven’s Equilateral Triangle), at
the right arm (RA), left arm (LA) and left leg (LL).

 Lead I has a positive electrode on the left arm and a negative electrode on the right arm.
Lead I is a bipolar, indirect lead.
 Lead II has a positive electrode on the left leg and a negative electrode on the Right arm.
Lead II is a bipolar, indirect lead.
 Lead III has a positive pole on the left foot and a negative pole on the left hand. Lead III is a
bipolar, indirect lead.

Einthoven’s Equilateral Triangle

The three limb electrodes, I, II and III form a triangle (Einthoven’s Equilateral Triangle), at
the right arm (RA), left arm (LA) and left leg (LL).
2. Augmented Limb Leads (Unipolar): aVR, aVL & aVF
3. Precordial Leads: V1- V6

VI. Analysis of ECG Signals

 The recording of electrical activity associated with the functioning of the heart is known as
electrocardiogram.
 It‟s a quasi periodical, rhythmically repeating signal synchronized by the function of the
heart, which act as a generator of bioelectric events.
 This generated signal can be described by means of an electric dipole. i.e. pole consisting of
positive and negative pair of charge.
 The dipole generates a field vector changing periodically in time and space and its effects are
measured on the surface.
 The waveform thus recorded standardized in terms of amplitude and phase relationship and
any deviation from this reflect the presence of abnormality.

⚫ The “P” wave is called base line or isopotential line.

⚫ P wave ------ De polarization of Auricles.
⚫ Combined QRS wave ---- Re-polarization of atria and depolarization of ventricles
⚫ T wave------ Ventricular re polarization.

1. PR Interval

 Time taken by the impulse to travel from atria to AV node.

 It‟s the autrio-ventricular conduction time.
 Measured from the onset of the P wave to onset of the QRS complex.
 Duration is from 0.12 to 0.20 sec.
 Prolonged pR interval>0.20 secs is first degree heart block.
 2. QRS Complex

 Represents the time taken by the heart impulse to travel first through the intro-ventricular
system and then through the free walls of the ventricles. ventricular contraction
 Measured from the onset of Q wave to end of S wave.
 Duration is between 0.05 and 0.10 secs.
 Amplitude is 1 mv
 Since the ventricles contain greater muscle mass than the atria, the QRS complex is larger
than the P wave.

BLOOD PRESSURE MEASUREMENTS

⚫ The systolic pressure is the maximum pressure in an artery at the moment when the heart is
beating and pumping blood through the body.
⚫ The diastolic pressure is the lowest pressure in an artery in the moments between beats when
the heart is resting.
⚫ Both the systolic and diastolic pressure measurements are important
⚫ If either one is raised, it means you have high blood pressure (hypertension).

⚫ Blood pressure measurement can be classified in to

1. Indirect
2. Direct
 Indirect Method

 Simple equipment ,Very little discomfort, Less informative and Intermittent

 The indirect method is also somewhat subjective, and often fails when the blood pressure is
very low (as would be the case when a patient is in shock).
1. Auscultatory
⚫ Auscultatory method uses aneroid sphygmomanometer with a stethoscope.
⚫ The auscultatory method comes from the Latin word "listening.
2. Oscillometric
⚫ The oscillometric method was first demonstrated in 1876 and involves the observation of
oscillations in the sphygmomanometer cuff pressure which are caused by the oscillations
of blood flow, i.e., the pulse.
3. Ultrasonic

1. AUSCULTATORY METHOD

Blood pressure measurements using

sphygmomanometer

⚫ First, a cuff is placed around your arm and

inflated with a pump until the circulation is
cut off.
⚫ A small valve slowly deflates the cuff, and
the doctor measuring blood pressure uses a
stethoscope, placed over your arm, to listen
for the sound of blood pulsing through the
arteries.
⚫ That first sound of rushing blood refers to
the systolic blood pressure; once the sound fades, the second number indicates the diastolic
pressure.

⚫
2. Oscillometric Measurement Method
3. Ultrasonic Doppler Shift Method
Direct Method

There are used when the highest degree of absolute accuracy, dynamic response and Continuous monitoring are
required.
For direct measurement, a catheter or a needle type probe is inserted thorough a veine or artery to the area of
interest.

2 types of probes can be used.

3. Catheter tip probe in which sensor is mounted on the tip of the probe and the pressure exerted on it
converted to the proportional electrical signals.
 4. Fluid filled catheter type, which transmits the pressure exerted on its fluid filled column to an external
transducer. This transducer converts the exerted pressure to corresponding electrical signals.

MEASUREMENT OF BLOOD FLOW

Blood Flow Meters

• Blood flow is the one of the important physiological parameter and the most difficult to
measure accurately.
• The average velocities of blood flow vary over a wide range depending on diameter of blood
vessel.
• The Blood flow at any point in the circulatory system is the volume of blood that passes a
point during a unit of time.
• Its unit is L/min
• Blood flow is highest in the pulmonary artery and Aorta, where these blood vessels leave the
heart.
• The flow at these points, called cardiac output is between 3.5 and 5 L/min for a normal adult
at rest.
• There are many techniques for measuring the blood flow and velocity.
• They are categorized into

1. Invasive (surgical).

2. Non invasive (through the skin).

Need for blood flowmeter

• Inspection for block in blood flow.

• Testing artificial blood vessels during organ transplantation.

Most widely used blood flow meters are:

 Electromagnetic blood flow meter

 Ultrasonic blood flow meters

ELECTROMAGNETIC BLOOD FLOWMETER

• Measures instantaneous pulsatile flow of blood

• Works based on the principle of electromagnetic induction
• The voltage induced in a conductor moving in a magnetic field is proportional to the velocity
of the conductor
• The conductive blood is the moving conductor

Structure
• A permanent magnet or electromagnet positioned around the blood vessel generates a
magnetic field perpendicular to the direction of the flow of the blood.
• The blood stream which is a conductor cuts the magnetic field and voltage is induced in the
blood stream.
• Voltage induced in the moving blood column is measured with stationary electrodes located
on opposite sides of the blood vessel and perpendicular to the direction of the magnetic field.
• This method requires that the blood vessel be exposed so that the flow head or the measuring
probe can be put across it.
• The magnitude of the voltage picked up is directly proportional to the strength of the
magnetic field, diameter of the blood vessel and the velocity of blood flow.
Types of Electromagnetic Flow Meters

Basically, all modern flowmeters consist of a generator of AC, a probe assembly, a series of
capacitance coupled amplifiers, a demodulator, a DC amplifier and a suitable recording
device.

Basing shape of the energizing current waveform for the electromagnet 2 types of EM
Flowmeters are :

A. Sine wave flowmeter.

B. Square wave flowmeter.

SINE WAVE FLOWMETERS

Probe magnet is energized with a sine wave and the induced voltage will also be sinusoidal.

Since the flow of blood acts as a secondary terminal of a transformer w.r.t probe magnet, an
additional artifact voltage induced is called transformer voltage.

This voltage is 90° out of phase with the original signal corresponding to flow of blood .

A method for eliminating transformer voltage by using a gated amplifier (amplify signal
onlyduring flow induced voltage is maximum).

This type of instrument is known as 'gated sine wave flowmeter',

SQUARE WAVE FLOWMETER

Transducer
• consist of an electromagnet, a pair of electrodes.
• Electrodes may be in contact with either flowing blood or outer surface of the blood vessel
Preamplifier
• The induced voltage pick up by the electrodes, is given to a low noise
differential amplifier through a capacitive coupling
• Must have a very high CMRR and input impedance
Gating circuit
• It helps to remove spurious voltages generated during magnet current reversal
• The gating action is controlled by the circuit which provides an excitation
current to the electromagnet
Band pass filter
• It is an active RC band pass amplifier , which selectively pass through it
the amplified square wave signal
• Peak response is kept for 4(X)Hz
Detector
• A phase sensitive detector is used to recover the signal
• It also helps in the rejection of interfering voltages at frequencies
below the carrier frequency
Low pass filter and output stage
• Demodulated signal is given to an RC LPF, which provides a uniform
frequency response and a linear phase shift
• Followed by an integrator provide output corresponding to the mean flow
Magnet current drive
• The square wave input to the power amplifier stage which supplies
current to the electromagnet is fed from a free running multivibrator
Zero flow reference line
• it establish the signal corresponding to zero-flow before measurement.

ELECTROMAGNETIC BLOOD FLOWMETER.

Electromagnetic blood flow meters are based on the principle of electromagnetic induction.
According to Fleming's right hand rule, the EMF induced in the conductor under the influence
of magnetic field is directly proportional to the velocity of motion of conductor.
Here we consider the blood vessel carrying blood as the conductor.
So here the velocity of motion is simply the blood flow through the blood vessel.

PRINCIPLE

BLOCK DIAGRAM
uses an oscillator of low frequency (up to 400 Hz) to drive the electromagnet which is
placed in such a way that the magnetic field is perpendicular to the direction of blood flow.
 set of electrodes are placed across the blood vessel mutually
perpendicular to both magnetic field and direction of blood flow.

The EMF induced across the blood vessel will be proportional to the velocity of blood, Lumen
probes with varying diameters are used for the accuracy of measurement.

the amplifier.

arization may cause some problems with electromagnetic

type flow meters.

ULTRASONIC BLOOD FLOW METERS

◦ A beam of ultrasonic energy is used to measure the velocity of flowing blood.

◦ There are basically two types of ultrasonic blood flow-velocity meters.

1. Doppler-shift type.
2. Transit time velocity meter
ULTRASONIC BLOOD FLOW METER - DOPLER TYPE
• It is a non-invasivc technique to measure blood velocity in a particular vessel from the
surface of the body.
• lt is based on the analysis of echo signals from the erythrocytes in the vascular structures.
Because of the Doppler effect, the frequency of these echo signals changes relative to the frequency
which the probe transmits.
• The Doppler frequency shift is a measure of the size and direction of the flow velocity.
• The principle is illustrated in Fig.

◦ An oscillator, operating at a frequency of several MHtz, excites a piezoelectric transducer

◦ 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 is received by a second transducer arranged
opposite the first one.
◦ Since scattering occurs mainly as a result of the moving blood cells, the reflected signal has a
different frequency due to the Doppler effect.
◦ Its frequency is either F + Fd or F - Fd, depending on the direction of the flow.
◦ The Doppler component Fd is directly proportional to the velocity of the flowing blood
◦ A fraction of the transmitted ultrasonic energy, reaches the second transducer directly, with the
unchanged frequency.
◦ After amplification of the composite signal, the Doppler frequency can be received at the output of
a detector as the difference between the direct and the scattered signal components.
◦ With blood velocities in the range normally encountered, the Doppler signal is typically in the low
audio frequency range
◦ Because of the velocity profile of the flowing blood, the Doppler signal is not a pure sine wave, but
has more the form of narrow-band noise.

The incident ultrasound is scattered by the blood cells and the scattered wave is received by
the second transducer. The frequency shift due to the moving scatterers is proportional to the
velocity of the scatterers. Alteration in frequency occurs first as the ultrasound arrives at the
„scattered and second as it leaves the scattcrer.

 The piezo-electric crystal A is electrically excited to generate ultrasonic waves,

which enter the blood. Ultrasound scattered from the moving blood cells excites
the receiver crystal.
 The electrical signal received at B consists of a large amplitude excitation
 frequency component, which is directly coupled from the transmitter to the
receiver, plus a very small amplitude Doppler-shifted component scattered from
the blood cells.
 The detector produces a sum of the difference of the frequencies at D. The low-
pass filter selects the difference frequency, resulting in audio frequencies at E.
Each time the audio wave crosses the zero axis, a pulse appears at G. The
filtered output level at II will be proportional to the blood velocity

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.
If blood flows in the direction of the energy transmission, the transit time is
shortened and vice versa

The transit-time ultrasonic flow meter is an instrument designed for measuring the volume flow
rate in clean liquids or gases. It consists of a pair of ultrasonic transducers mounted along an axis
aligned at an angle _ with respect to the fluid-flow axis, as shown in Figure.
Each transducer consists of a transmitter–receiver pair, with the transmitter emitting ultrasonic
energy which travels across to the receiver on the opposite side of the pipe. These ultrasonic
elements are normally piezoelectric oscillators of the same type as used in Doppler shift flow
meters. Fluid flowing in the pipe causes a time difference between the transit times of the beams
travelling upstream and downstream, and measurement of this difference allows the flow velocity
to be calculated. The typical magnitude of this time difference is 100 ns in a total transit time of
100 μs, and high-precision electronics are therefore needed to measure it.