DIGITAL ELECTROCARDIOGRAPH

Operation Manual

Model No. EKG-3A/EKG-6A

Digital Electrocardiograph Operation Manual Meditech

Copyright©
Meditech Equipment Co., Ltd (hereinafter short as Meditech) makes no warranty of any kind with regard to this material,
including, but not limited to the implied warranties of merchantability and fitness for a particular purpose. Meditech
assumes no responsibility for any errors that may appear in this document, or for incidental or consequential damage in
connection with the furnishing, performance or use of this material.
No part of this document can be photocopied, reproduced or translated to another language without prior written
consent of Meditech.
Meditech will make continuous improvement in features and functions for future publication
of new equipment without prior notice. We beg your pardon for the inconvenience, if any.

Responsibility of the manufacturer

Meditech only considers itself responsible for any effects on safety, reliability and performance of the equipment if:
Assembly operations, extensions, re-adjustments, modifications or repairs are carried out by
personnel authorized by us, and the electrical installation of the relevant room complies with
safety standards.

NOTE :

This device is not intended for home use.

WARNING :
This device is not intended for treatment.
Digital Electrocardiograph Operation Manual Meditech

Table of contents
1. Notice for operation ......................................................................................................................................................... 2
1.1 Notice for use ........................................................................................................................................................ 2
1.2 Notice for safety .................................................................................................................................................... 2
1.3 Manufacturer illustration........................................................................................................................................ 2
1.4 Icons for safety................................................................................................................................................... 2-3
1.5 Explanation of the symbols ................................................................................................................................... 3
1.6 Precautions ........................................................................................................................................................ 3-5
2. Summary ......................................................................................................................................................................... 5
2.1 Features ................................................................................................................................................................ 5
2.2 safety classification ............................................................................................................................................... 5
3. General Information......................................................................................................................................................... 5
3.1 Name of components ............................................................................................................................................ 5
3.2 Content on LCD as follows ................................................................................................................................... 7
3.3 Content on color keyboard as follows ................................................................................................................... 9
4. Operation preparation ..................................................................................................................................................... 9
4.1Connecting to power .............................................................................................................................................. 9
4.2 Paper loading .......................................................................................................................................................11
4.3 Connection of patient cable..................................................................................................................................11
4.4 Inspection before Startup .....................................................................................................................................11
5. Operation Instructions ..................................................................................................................................................... 9
5.1 Operation mode .................................................................................................................................................... 9
5.2 Operation Menu ...................................................................................................................................................11
6. Daily maintenance ......................................................................................................................................................... 21
6.1 Battery charging, capacity indicator and replacement......................................................................................... 21
6.2 Recording paper ................................................................................................................................................. 22
6.3 Maintenance Following Operation....................................................................................................................... 22
6.4 Patient cable maintenance .................................................................................................................................. 22
6.5 Silicon rubber axis maintenance ......................................................................................................................... 23
6.6 Thermal Printer Maintenance .............................................................................................................................. 23
6.7 Fuse Replacement .............................................................................................................................................. 23
7. Troubleshooting and solution ........................................................................................................................................ 24
7.1 Some lead without waveform .............................................................................................................................. 24
7.2 Vertical broken track of printed waveform ........................................................................................................... 24
7.3 Control Panel Failure .......................................................................................................................................... 24
7.4 AC Interference ................................................................................................................................................... 24
7.5 EMG interference ................................................................................................................................................ 25
7.6 Baseline drift ....................................................................................................................................................... 25
8. Specifications ................................................................................................................................................................ 26
9. Accessory List ............................................................................................................................................................... 28
Appendix A ........................................................................................................................................................................ 29
Appendix B ........................................................................................................................................................................ 35
Information of manufacturer: ................................................................................................ Error! Bookmark not defined.

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Digital Electrocardiograph Operation Manual Meditech

1. Notice for operation

1.1 Notice for use

Thank you for purchasing medical electrical product made by us.
This manual is provided necessary illumination for your first use of electrocardiograph, and any of this manual which is
protected by The People's Republic of copyright law. All the information cannot be copied, amended or translated without
permission. The content of this manual is subject to change without notice. Please read the manual carefully before using
and get to know how to use the machine correctly.

1.2 Notice for safety

If ignore this symbol, it may cause die or severe injured, otherwise the device
would be partly damaged or resulted in fire hazard.
Danger
If ignore this symbol, it may cause human die or severe injured, otherwise the
device would be partly or entirely damaged.
Warning
If ignore this symbol, it may cause human injured or the device damaged.
Attention
Although it is not indication of warning, it provides the right method of use and
Notice operation in order to avoid error operation.

Example of the symbol

Indicating the contents of danger, warning and attention, which are illustrated
on the corresponding area.
⚫ Warning and Attention
⚫ Precaution of using thermal paper
 Don’t exposure thermal paper under the direct sunshine and high temperature.
 Don’t put into the fluorescence light for a long time.
 Don’t store thermal paper with PVC.
 Don’t pile up thermal paper in long period to avoid waveform transfer.

1.3 Manufacturer's Declaration

As a specialized manufacturer of production and sale medical electronics, we take every effort, is dedicating on the
precise security and reliability for each device.
In order to ensure the reliable operation of the medical device, the user of ECG must take the responsibilities to guarantee
the details as follows:
1. For the sake of guarantee the safety of the device, maintenance, repair and replacing the accessories should be
operated by our company staff or the person who we have trained.
2. This unit only use or replace the accessories we recommend, which is the requirement for the safety of the device.
3. Insure to use the proper voltage and frequency according to the demand of the icons.
4. The device only can be used according to the user manual, and other purpose cannot be satisfied.
5. All the technical data (circuit diagram, list of components etc.) only are provided to the specialized staff that passed
our technical training. For improving the technique, we will not notice in advance, and apologize to cause your
inconvenience.

1.4 Icons for safety

ECG device strictly follows the standardIEC60601-1 that is the electromagnetism compatibility of medical equipment,
corresponding to Type CF, Class I.

For sake of the patient’s safety, please the electrodes connected with the body of
patient and other unconnected electrodes don’t touch electric conducting products,
Attention for example, your hands don’t touch the ground.

Connected with other equipment increases leakage current may cause latent danger,
please strictly operate according to the requirements. Connect with our company if
Attention necessary.

While using synchronously with cardiac pacemaker and other electric stimulator, this
equipment occur baleful current, should adopting necessary measures to reduce the
influence on the diagnosis which are resulted from these devices.
Attention

If non-isolating signal enters from external input, the end of this signal is not
connected with protection ground, it will cause malfunction because of difference of
is potential point.
Attention

Only the devices under IEC 60601-1 Type I can be connected with the input and
Attention
output port of this device, please consult to the technical staff if necessary.

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 Explosion-proof requirements
Don’t use ECG device in the presence of inflammable gas and flammable gas such as
anesthesia gas, oxygen, hydrogen, otherwise may be caused explosion and fire
Danger
hazard.

 Magnetic resonance interference

Don’t use ECG device during magnetic resonance imaging. Magnetic conduction can
lead burning. ECG device can interfere magnetic resonance equipment meanwhile
Danger
can be interfered by magnetic resonance equipment.

 Defibrillation protection
Don’t touch the device during defibrillation, which may cause electric short circuit for the patient and operator.
When the device is used synchronously with defibrillator, to avoid danger, please confirm the sort of lead cable, electrode
fixing condition, and sort of electro cardio-electrodes, conductive gel used for defibrillator and the output energy of
defibrillator. Besides, please confirm whether other devices are connected with ground.

1.5 Explanation of the symbols

Remarks for special attention

Type CF equipment equipped with
(see operating instructions for
protector against defibrillation
details)

Output of the analog signal Iso-potential point

Input of the analog signal Protective earth terminal

POWER 1mV Scaling/ Function setting

Forward and backward Printing /Recording Mode
Start/End record

1.6 Precautions

⚫ For the sake of improving the quality of product, specifications and design is subject to change without notice.

⚫ AC power cable must be connected to medical three-cord electrical outlet. Using the power cable in the accessories

to connect with medical three-cord electrical outlet can insure grounding reliably. Please use suitable sockets which

can supply sufficient power to load for this device.

⚫ Upgrading the procedure and maintenance should be operated by our technical staff, error operation may occur error.
User doesn’t do it without allowance.

⚫ All the accessories must be used the appointed ones. If use other accessories, maybe cannot correspond to the

device properly.

⚫ Don’t open the shell of the device.

⚫ Must switch off the power while doing connection.

⚫ Don’t leak any liquid such as alcohol to the internal of the device and socket.

⚫ Don’t use any abstergent and dilution containing organic liquid, methyl benzene, gasoline etc., which is harmful to the

BAL shell.

⚫ Don’t scrape shell with grinding ointment and chemical detergent.

⚫ Don’t touch input signal connector and output signal connector simultaneously, for example RS-232 and patient isn’t

allowed to touch at the same time.

⚫ Don’t apply vapor sterilization to the device and accessories. Don’t sterilize with high-temperature or γ-Ray or apply

electrical beam.

⚫ While using sprayer of physic liquor to sterilize, please don’t spray the liquid to the internal device and socket.

⚫ Don’t install the device near to the interfere source such as wireless transistor, hypercator, mobile phone or wireless

telephone. Otherwise, the interference will impact on the device.

⚫ After effective life time is over, please deal with the device according to the local law or return to the manufacturer for

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recycle in order to protect environment.

⚫ Pay attention to the following ECG measurement and interpretations:

(1) AC/EMG Interference might cause mistakes in reading P Wave and Q Wave; baseline drift

might cause misunderstanding in reading ST Segment and T Wave.

(2) Measuring error might occur due to blur endings of S wave and T Wave.

(3) Low voltage of QRS might cause the measurement result of HR not reliable.

(4) Low voltage of QRS might cause the ECG coordinate axes calculation or QRS not reliable.

(5) With frequent ventricular systole, at accidental situation, will be inspected out as heartbeat.

(6) Multi arrhythmia might make it difficult to recognize P Wave and the relative parameters might be unreliable.

(7) This device has self-interpretation function, which only analyze automatically the

obtaining ECG trace, but don’t reflect on all the conditions of patient. Maybe the analyzing result is

different with the diagnosis by doctor, so the final conclusion must be made out by doctor to combine

with patient clinic data and other analysis result.

⚫ Precautions for using electrode

➢ Whether clean the axunge on the skin of patient (where connect with electrodes) and wipe conductive gel on it.
➢ When electrodes are sterilized and disinfected, please use cotton cloth to wipe and clean with medical alcohol or

Glutamyl acetaldehyde disinfection.

➢ If the electrodes are too dirty to clean, please use emery-paper to abrade gently, and repeat the above disinfecting

method.

➢ Whether the assembly of electrodes is loose. If it is too loose, please clamp closer.

➢ Whether mix to use together different sorts of electrodes.

➢ While the device is used synchronously with defibrillator, there will be super-voltage resulted from defibrillation which

causes polarized voltage on the electrodes, so it can’t measure in several seconds.

⚫ Precaution for cable lines

➢ Please use ECG cable line assembled with device. (or the accessories our factory provide)
➢ Please use three-cord power line assembled with device, which can connect to the three-cord

socket and realize grounding well.

➢ When the device is used synchronously with defibrillator, please make sure to use the patient

Cable. line which we assembled with defibrillating function.

➢ Please check whether the connection of patient cable is loose or not.

➢ Please notice whether patient cable is too closed to power cord during measuring. Please check

whether the connection between each patient cable end and corresponding electrode is right or not.

➢ Periodic inspect patient cable, and clean and disinfect it if it is necessary. Please use cotton with

medical alcohol wipe gently, don’t drag forcibly patient cable.

⚫ Precaution for rechargeable batteries

➢ The batteries built in the device are rechargeable batteries specialized for ECG-213.Please don’t use for other

equipment. Otherwise, maybe cause batteries to weep heat or rupture.

➢ Don’t throw the batteries into fire.

➢ Don’t weld directly the batteries to the device.

➢ Don’t disassemble and reconstruct battery. There is protecting circuit in the batteries to avoid danger. Maybe cause

batteries weep or rupture after it is damaged.

➢ Batteries contain the structure for discharging internal waste gas, which must be not obstructed, otherwise, will
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damage of batteries.

➢ The liquid of batteries is harmful for your eyes. When it is splashed into your eyes, don’t knead or wipe, please clean

with water and see a doctor immediately.

➢ Don’t contact metal to the “+””-” polar of battery.

➢ Don’t flake or scrape the shell of batteries.

➢ During charging, the process of charging isn’t finish but exceeds rated charging time; please switch off AC power in

time. Otherwise the batteries will heat severely until damage.

➢ Internal liquid of batteries is rubbed to skin, which may cause burn, please clean with cleaner immediately.

➢ Don’t use or put battery in homeothermic places. Otherwise may cause battery weep, decrease life time and function.

➢ Don’t immerge battery into water, and moisten with medical liquid. Otherwise maybe cause battery heat or go moldy.

➢ If any abnormality is found during using battery, please stop using immediately.

➢ Don’t store battery in the places out of touch by children.

➢ Don’t impact strongly or throw battery.

➢ While battery is not used for a long period, please switch off the device, and pull out power cable from socket.

➢ Please paste isolated belt on the ends and connection cable of scrap battery, and hand in them to our service staff to

deal with.

2. Summary

ECG is mainly designed to record physiological electrical signal, resulted from activities of cordis and analyze rhythm and

configuration for clinic diagnose and research.

Intended use: The cardiogram and heart rate recorded by the ECG can help doctors to analyze and

diagnose heart disease or arrhythmia in hospitals. Its compact size makes it suitable for use while

visiting patients at home.

NOTE :

➢ The patient who has a heart disease may have a normal electrocardiogram, so other tests are
required for a full heart appraisal. This equipment cannot be connected to the heart directly

2.1 Features
 Digital signal processor for effective inhibition of baseline drift, AC interference filter, EMG interference filter and the
heart rate, to guarantee the authenticity and dependability.
 Auto-regulation of baseline drift can effectively inhibit baseline drift, optimizing the printing position to achieve
high-quality ECG.
 Have regular automatically measuring and analyzing function for ECG parameters to lessen doctor’s load.
 With a high –resolution thermal printer to print out ECG trace, describing the trace clear and accurate, annotation as
well as related parameters for diagnostic reference.
 Roll recording paper for ECG is 80mm in width, simultaneous 12 lead acquisitions and 3 lead live record, high
affectivity of ECG examination, good effect and economic utility.
 Function of rhythm lead for observing abnormal ECG trace & heart rate.
 Supported by AC/Rechargeable battery for continuous examination whenever necessary. For Battery operation, ECG
is equipped with a battery charger and a system for battery capacity management and protection.
 Safety level for ECG corresponds to Type CF, Class I according to the IEC60601-1 criterion. The amplifier is floating
input circuit which can examine human cordis directly with safety and reliability.

2.2 safety classification

➢ Shock proof type: Class I, internal power device
➢ Shock proof degree: CF device
➢ Anti-splash degree: common device
➢ Safety degree used in the presence of atmosphere (or oxygen, lachgas) mixed with flammable anesthesia gas: not
suitable to be used in the presence of atmosphere (or oxygen, lachgas)mixed with flammable anesthesia gas
3. General Information
3.1 Name of components

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1
3 1. LCD display screen
2. List button
3. Recorder

Fig. 1 top panel

4
5

Fig. 2 bottom panel

Fig. 3 right side panel of ECG

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Fig. 4 left side panel of ECG

Fig. 5 Upper side panel of ECG

3.2 Content on LCD as follows

Display on LCD is as follows after power on:

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No Icon name Description

Display the ID of the currently inspected patient;

ID is automatically generated by the system according to the printing time. The
① Patient ID format of the ID number is the year, month, day, hour, minute, and second. For
example, printing at 12:00:44 on January 11, 2019, the ID will be generated:
20190111120044.
The gender of the patient being examined is entered by the operator
② Gender & Age Gender : Male, Female;
The age of the patient being examined is entered by the operator.
Heart rate❤& Displays the actual heart rate; the heart rate icon flashes when the ECG
③
Heart icon detecting the heart rate

Display battery capacity when the device is in internal battery powered mode
④ Battery capacity
This flag is not displayed when the device uses the network power mode.
Display the current time.
⑤ System time
System time can be set by the operator
Displays the current analysis mode:
a. In the automatic redirection mode, the automatic redirection time of each
lead is displayed, for example, the retransmission time is 3 seconds, shows
⑥ Operation mode “automatic 3 s”;
b. In manual redirection mode, shows "manual";
c. In 1 lead 1-minute mode, shows "1 lead 1 minute"
d. In rhythm analysis mode, shows "rhythm analysis".
Displays current sensitivity (2.5,5,10,20mm/mV):
Example 1: The sensitivity of the system setting is 2.5mm/mV, shows
2.5mm/mV;
⑦ Sensitivity Example 2: The sensitivity is automatically adjusted in the automatic
commutation mode. When the signal is normal, the sensitivity is
10mm/mV, shows 10mm/mV; when the signal amplitude is too large, it
will be automatically halved, the sensitivity is 5mm/mV, shows 5mm/mV.
AC Filter Freq：50Hz/60Hz
⑧ Filters setting EMG Filter：25Hz/35Hz/45Hz/75Hz/100Hz/150Hz
High pass filter：0, 0.05, 0.5Hz
Press this key to enter menu settings.
⑨ Function setup

Display the current lead (I, II, Ⅲ, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6)
⑩ Current lead If the C1 lead falls off, the line mark of the off-lead wire is displayed in the
interface, which is displayed as “lead off V1”

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3.3 Content on keyboard as follows

Button
Function
Symbol

ON/OFF
Being used for power switch on and charging in standby condition.

Mark/ Function Keys:

Under MAN mode, press this key to record a 1mV calibration pulse at any time
while recording.
You can combine this key with the left and right direction keys to set automatic
redirection mode and interval.
Forward/backward switch key:
Use to switch or exit settings between different functions on the button during
function setting. It can be used to select different leads during manual redirection, 1
lead 1 minute or rhythm analysis.

Recording mode:
Transform from different recording mode: automatic, manual, 1 lead 1 minute or
rhythm analysis.

Start/stop button:
Start or stop recording.

4. Operation preparation
WARNING :
Check the main unit and its accessories carefully before operating the ECG. Replacement should be taken if
there is any evident defectiveness or aging symptom which may impair the safety or performance. Make sure that
the equipment is in proper working condition.

4.1Connecting to power
WARNING :
To avoid any possible electric shock, please connect the ECG with AC power by a three-phase power cable.
Don’t open the ECG while it is powered on.

WARNING :
If the integrity of external protective conductor in installation or arrangement is in doubt, the ECG should be
operated from the built-in rechargeable battery.

Insert one end of the 3-cord power cable into the device and the other end into the power socket in wall. Then bridge the
grounding cable between the grounding terminal of the device and ground.
1) Mains Supply
The mains socket is on the left upper side of the ECG. Properly connect the ECG with mains supply.
Rated voltage: 100V-120V/220V-240V
Rated frequency: 50Hz/60Hz
Rated input power: 60A
Make sure the mains supply meets the above requirements before power on.
2) Built-in Rechargeable Battery
The built-in rechargeable battery pack is used, because of the consumption during storage and transport, the capacity of
battery may not be full. In this case please recharge the battery first. Replace the battery when the battery has been
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recharged over 300 times.

NOTE :
The battery is put into the battery compartment without connecting to the battery socket at
factory. After receiving the ECG, if built-in rechargeable battery is to be used, connect the
battery to the socket first.

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4.2 Paper loading

Fig. 1 Fig. 2 Fig.3

Step 1: Push the Open Button to open the paper compartment cover.

Step 2: Take out the paper rollers, remove remaining paper if necessary. Insert the rollers into the new roll paper and put

the paper with rollers back into the paper compartment. Be sure that the paper is installed with the paper’s grid

side facing downward.

Step 3: Pull about 2cm of the paper out, and close the cover gently.
➢ The recording paper applied to the device is 80mm three channel roll thermal paper.

➢ Cover the paper cabinet, and leave the beginning of paper.

➢ Make the square side downward.

4.3 Connection of patient cable

Connection of patient cable is involved whether record ECG is accurate or not. Please ensure to connect the
patient cable well. New and old electrodes or reusable and disposable electrodes can’t be used synchronously.
Different type of electrodes can’t be used together, which will have great influence on ECG record. Electrodes or
cable plug can’t touch other surface or conductor, such as metal bed. Renovate all the electrodes together.
1) Patient Cable Socket

Definition of corresponding pins:

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Pin Signal Pin Signal Pin Signal

1 C2 (input) 6 SHIELD 11 F (input)

2 C3 (input) 7 RF 12 NC

3 C4 (input) 8 FG 13 C1 (input)

4 C5 (input) 9 R (input) 14 NC

5 C6 (input) 10 L (input) 15 Lead Check (input)

Patient Cable Definition of Pins

2) Placement of limb electrodes
a) Ensure the electrodes are clean;
b) Align lead wires of patient cable to avoid twisting, and connect the electrode connectors to corresponding
electrodes according to the color and identifier;
c) Clean electrode area on a short distance above the ankle or wrist with alcohol;
d) Daub the electrode area on limb with gel evenly;
e) Place a small amount of gel on the metal part of limb electrode clamp;
f) Connect the electrode to limb, and be sure that the metal part be placed on the electrode area above the ankle
or wrist. Attach all limb electrodes in the same way.

R(RA) for right arm

L(LA) for left arm

RF(RL) for right leg

F(LL) for left leg

It shows as the right picture:

3) Placement of chest electrodes

a) Ensure the electrodes are clean;

b) Align all lead wires of patient cable to avoid twisting, and connect the associated electrode connectors with

corresponding electrodes according to the color and identifier;

c) Clean electrode area on chest surface with alcohol;

d) Daub the round area of 25mm diameter on each electrode site with gel evenly;

e) Place a small amount of gel on the brim of chest electrode’s metal cup;

f) Place the electrode on chest electrode site and squeeze the suction bulb. Unclench it and

then the electrode is adsorbed on chest. Attach all chest electrodes in the same way.

The chest electrode should be placed on body surface as shown below.

V1: Fourth inter-costal space at right border of sternum.

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V2: Fourth inter-costal space at left border of sternum.

V3: Midway between V2 and V4.

V4: Fifth inter-costal space at left mid-clavicles line.

V5: Left anterior axillary line at the horizontal lever of V4.

V6: Left mid-axillary line at the horizontal lever of V4.

Attention
Tangling of electrodes or overlap from one place to another of ECG cream is not
allowed to avoid short circuit. If there is no ECG scream, inspecting ECG can be used
75% alcohol to clean each electrode, and connect the electrodes to related position
immediately to ensure that the attached skin is wet. Don’t use normal saline instead
of ECG scream to avoid rusting electrodes.

Attention

Patient cable plug should be screwed down to insert to the

socket!

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4) Electrode connection definitions and color code

European American

Socket
Electrodes Identifier Color code Identifier Color code Number

9
Right arm R Red RA White

10
Left arm L Yellow LA Black

Right leg RF Black RL Green 14

11
Left leg F Green LL Red

Chest 1 C1 White/red V1 Brown/red 12

Chest 2 C2 White/yellow V2 Brown/yellow 1

2
Chest 3 C3 White/green V3 Brown/green

3
Chest 4 C4 White/brown V4 Brown/Blue

Chest 5 C5 White/black V5 Brown/orange 4

Chest 6 C6 White/violet V6 Brown/ violet 5

5) ECG lead sequence:

two options for lead mode: standard lead, European lead.
The lead mode is defined as follows:

No. 1 2 3 4 5 6 7 8 9 10 11 12

Standard leads I II III aVR aVF aVF V1 V2 V3 V4 V5 V6

European lead aVL I -aVR II aVF III V1 V2 V3 V4 V5 V6

CABRERA

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4.4 Inspection before Startup

In order to avoid safety hazards and get good ECG record, the following inspection procedures are recommended

before turning on the ECG and beginning operation.

1) Environment:

◆ Check and make sure that there is no electromagnetic interference source around the equipment, especially

large medical electrical equipment such as electrosurgical equipment, radiological equipment and magnetic

resonance imaging equipment etc. Switch off these devices when necessary.

◆ Keep the examination room warm to avoid muscle action voltages in ECG signal caused by cold.

2) Power Supply:

◆ If mains power used, please check whether the power cord has been connected to the ECG and it is properly

grounded.

◆ Recharge the battery first before use when the battery capacity is low.

3) Grounding:

◆ Check the grounding cable is properly connected.

4) Patient Cable:

◆ Check whether the patient cable has been connected to the ECG firmly, and keep it far away

from the power cord.

5) Electrodes:

◆ Check whether all electrodes have been connected with lead wires of patient cable correctly according to the

identifier and color.

◆ Be sure that all electrodes have been connected to the patient correctly.

◆ Ensure that the chest electrodes haven’t contacted with each other.

6) Recorder Paper:

◆ Ensure that there is enough recording paper loaded.

◆ Make sure the case of the recorder has been secured.

7) Patient:

◆ The patient should not contact with conducting object such as earth, and metal part of bed etc.

◆ Ensure the patient is warm and relaxed, and breathe calmly.

8) AC Filter Frequency
◆ Check the setup of AC Filter Frequency and make sure is identical with the local regulations, or it will influence

the anti-jamming effect.

WARNING :
The ECG is provided for the use of qualified physicians or personnel professionally trained. The operator is supposed

to be familiar with the contents of this Operation Manual before use.

5. Operation Instructions

NOTE :
◆ Whether boot or shutdown should hold down the ON / OFF key a few seconds. Hold the boot until the display
shows information on manufacturers, equipment model and version, shut down until the screen display closed.

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5.1 Operation mode

5.1.1 Manual Mode

➢ Press key to choose “Manual Mode”, which will be displayed in the lower left corner of the LCD screen.

➢ Set the recording format of the “Manual Mode” in the menu.

➢ Press the “Manual Mode” to select the sensitivity (wave gain), filter according to the requirement before recording.

➢ Press arrow key to select the leads to be recorded.

➢ Press RUN/STOP to start recording; manually switch the leads while recording.

➢ Press during recording to stop recording at any time.

Patient ID will be changed automatically if the recording is interrupted. If the ID number needs to be unchanged, the
operator should adjust patient ID before continuing recording.
5.1.2 Auto Mode (Auto 3s Mode)

➢ Press key to choose “Auto 3s Mode”, which will be displayed in the lower left corner of the LCD screen.

➢ Set the recording format of the “Auto 3s Mode” in the menu.

➢ Press the “Auto 3s Mode” to select the sensitivity (wave gain), filter according to the requirement before recording.

➢ After the waveform and heart rate are stabilized, press to print a complete ECG waveform.

➢ During printing, the operator can press key to stop recording any time.

5.1.3 One channel one minute mode ( 1ch 1min Mode)

➢ Press key to choose “1ch 1min Mode”, which will be displayed in the lower left corner of the LCD screen.

➢ Set the recording format of the “1ch 1min Mode” mode in the menu.
➢ Touch the “1ch 1min Mode” to select the sensitivity (wave gain), filter according to the requirement before recording.

➢ Press arrow key to select the leads to be recorded.

➢ Press to start collecting ECG data for 48 seconds then print it out.

➢ Automatic stop after printing. During printing, the operator can press key to stop recording any time.

5.1.4 Rhythm Mode

➢ Press key to choose “Rhythm Mode”, which will be displayed in the lower left corner of the LCD screen.

➢ Set the recording format of the “Rhythm Mode” mode in the menu.
➢ Press the “Rhythm Mode” to select the sensitivity (wave gain), filter according to the requirement before recording.

➢ Press arrow key to select the leads to be recorded.

➢ Press to start collecting ECG data for 240 seconds then print it out.

➢ Automatic stop after printing. During printing, the operator can press key to stop recording any time.
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5.2 Operation Menu

5.2.1 Function Setup

Press or touch “Function Setup” in the lower right corner of the LCD screen go to main menu. Touch the
corresponding position of the screen then go to the submenu.

5.2.2 Save ECG

Extended storage can be supported. Select “SAVE ECG” from the Function setup. Only the ECG which has

been printed out the report normally can be saved. The saved cases can be played back or print it out.

Enter the corresponding patient information to save the ECG report.

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5.2.3 Open ECG

Press “ Open ECG”, all saved ECG reports can be viewed, printed, and deleted.

5.2.4 Set filter

Press “Set filter”, AC Filter, EMG Filter and DFT Filter can be setup.

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5.2.5 Working Mode

Press “Working Mode”, wave speed, wave gain, load sequence, sampling mode, open demo and priority

storage can be setup.

5.2.6 System setup

Press “System setup”, beat vol, language, server IP and local IP can be setup.

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5.2.7 Printer setup

Press “Printer setup”, auto REC format, analysis result, avg wave, rhythm lead can be setup.

5.2.8 Version

Press “Version” can check the ECG info.

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5.2.9 Load default

Press “Load default” can restore the factory settings.

6. Daily maintenance

6.1 Battery charging, capacity indicator and replacement

ECG device is built in rechargeable battery to realize AC/DC operation. The illustration on charging, indicating capacity

and replacement are as follows:

➢ Charging battery

ECG device is designed with a charger and protector for the rechargeable battery. It is required to charge & discharge

the battery at least every 3 months, and device is in spare condition. Charging indicator will blink while charging, and

keep in light when charging is completed.

➢ Capacity indicator

Whenever the machine is powered by DC battery, there will be a prompt, in the middle of first line on the LCD screen,

to indicate battery capacity as follows.

Sufficient battery capacity

Insufficient battery capacity, charging is required.

Battery capacity is running out, immediate charging is demanded.

➢ Battery replacement

Battery replacement shall be carried out by a service engineer as follows.

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a. Power switches off and disconnects power cable.

b. According to the bottom figure of device, open the cover of battery cabinet.

c. Pull out the plug of battery and remove the damaged battery.

d. Replace the battery with a new one and plug in the battery socket to connect well.

e. Reassemble the instrument.

Notice:

➢ Don’t connect directly anode and cathode of the battery with lead otherwise may cause fire hazard.

➢ Don’t put battery near to open fire, otherwise may cause explosion hazard.

➢ Don’t disassemble battery without allowance.

➢ Please take and put battery gently, don’t fall it to the ground or strike on other items.

6.2 Recording paper

For the sake of recording quality of ECG trace, please use the recommended or provided thermal paper. If purchase other

thermal paper, maybe shorten the life time of thermal lattice printing head, cause recording trace to blur, or bad paper

running.

Please do notice!

a. Avoid use of grayish and blackish paper or with wax; otherwise may cause printer head damaged.

b. High temperature, high humidity and direct sunshine will cause paper color to change. Please keep the paper in a dry

and cool place;

c. Do not expose the paper in fluorescent light for a long time, otherwise will have influence on recording quality.

d. Do not store the paper with PVC to avoid color change;

e. Do not pile up the recorded paper for a long time to avoid waveform transfer.

f. Please pay highly attention to the specification of recording paper. The thermal lattice printing head or the silicon-rubber

axis will damage by the wrong paper.

6.3 Maintenance Following Operation

After using ECG device, please notice:

a. Turn “ON/OFF” to power off the control panel before turning off the power switch.

b. While pulling out the leads and power cable, please grasp the plug to pull out, don’t grasp the cable.

c. Clean the machine as well as accessories and cover the instrument with a shade.
d. Place the device in a dry and shading environment. Vibration in the process of transportation should be avoided.

e. Don’t immerse the device into cleaner while cleaning the device, please cut off power supply while cleaning the shell of

device. Please use neutral solvent to clean which doesn’t contain alcohol or bactericide.

6.4 Patient cable maintenance

➢ Check the patient cable continuity with a multi-meter. The resistance should be less than 10

ohms.

Following table is the continuity of the patient cable.

Electrode R L F RF C1 C2 C3 C4 C5 C6
Patient Lead 9 10 11 14 12 1 2 3 4 5

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Please periodic inspecting patient cable to keep it well, any piece of the cable is damaged will occur corresponding or

all lead to appear false wave. Patient cable can be cleaned with water or soap, or disinfected by 75% alcohol. (Don’t

immerse patient cable into the liquid).

➢ Curve or tie patient cable will shorten its life time, please make it in line and then connect with electrodes.

➢ All the electrodes should be kept well, after being used for a long time, the surface of electrodes will be oxidized to

effect on recording the trace, and please renew electrodes.

6.5 Silicon rubber axis maintenance

Silicon rubber axis should be kept smooth and clean, otherwise will have an influence on the effect of ECG record. Please

use clean and soft cotton with few alcohols to clean the smear on the silicon rubber axis along portrait, and rotate to the

direction of conveying the recording paper until make it clean.

6.6 Thermal Printer Maintenance

Residue and dirt on the thermal printer could affect the clarity of printing out ECG trace.

To clean the thermal printer, you are required to open the paper magazine and clean the printer with cotton dipped with

alcohol. It is not permitted to operate on the printer with a sharp object. Otherwise, permanent damage could be resulted.

After the alcohol is volatilized completely, close the cabinet. Thermal printer maintenance should be done at least once a

month.

6.7 Fuse Replacement

Switch on AC power, turn on the power switch on the right device, the power indicator doesn’t light up and press the

ON/OFF button on the control panel but cann’t realize boot-strap or the signal of battery is showed like“ ”after boot-strap .

This may be caused by a burnt fuse.

⚫ Disconnect the power cable., switch off the power.

⚫ Discover the fuse holder with a screw-driver.

⚫ Take out the damaged or burned fuse.

⚫ Install a new fuse before recovering the fuse holder as shown in the following figure.

Notification

If a newly replaced fuse is burnt again, please power off the device and contact our service department or

appointed maintenance center.

Attention
Don’t use undefined fuse.
Specification of fuse：AC220V±10% 2*Φ5×20mm, T2A/250V AC time lag
AC110V±10% 2*Φ5×20mm, T4A/125V AC time lag

Danger
Please ensure to pull out power cable and then replace fuse.

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7. Troubleshooting and solution

7.1 Some lead without waveform

➢ When the cables are connected well with the patient, the device usually needs several seconds to get ready.Press

RESET and start recording after 2~3 seconds to solve the problem.

➢ Patient cabel is at fault.checking the patient cable according to 5.4,if patient cable breaks down,please connect with

our after-sale department or appointed maitenance center.

➢ Excluded the above cause,the device still exist problem,normally it is resulted from the problem of signal channel,

please connect with our after-sale department or appointed maitenance center.

7.2 Vertical broken track of printed waveform

Whenever a printer fault occurs, which manifests itself as not continuous trace on the recording paper; you are required to

clean the thermal printer with soft cotton with alcohol. If this action does not work, certain thermal emitting component is

probable damaged, and you are required to contact the manufacturer or the local agent for help.

7.3 Control Panel Failure

Control panel failure is probably caused by bad continuity between the panel and the Keyboard Control Module due to

transportation or vibration. If a reconnection of the control panel to the Keyboard Control Module does not work, you are

required to contact a service engineer.

7.4 AC Interference

In the process of recording ECG trace,there are some interference and apparent wobble of baseline as follows:

Please check the following:

1. Make sure that the unit is properly grounded according to instructions.

2. Check for good electrode attachment and patient cable connection.

3. Check the cleaning of electrode and patient body surface.

4. Make sure that the exam bed is properly grounded.

5. The patient shall not be in touch with the metal parts of the exam bed.
6. The patient shall not be in touch with anybody else.

7. There shall be no large power electric equipment working nearby.

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8. The patient shall put off such things as ring and the like.

Please use AC filter if still exists above-mentioned interference.

7.5 EMG interference

EMG interference may cause irregular wobble of waveform.

Please check the following:

⚫ Make sure that the exam room is comfortable for examination.

⚫ Soothe the patient from irritation or excitement.

⚫ Make sure the exam bed shall be in suitable size.

⚫ Never have talks with the patient during ECG trace is recorded.

Please apply EMG filter if still exists above-mentioned interference. The waveform will be weakened a little more, which

will decline obviously on R wave.

7.6 Baseline drift
There is irregular movement on the baseline of wave, shown as below:

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Check the following:

⚫ Verify the electrode attachment and lead wire performance.

⚫ Check the connection between patient cable and electrodes.

⚫ Check the cleaning of electrode and patient body surface.

⚫ Is there enough ECG cream on skin and electrodes?

⚫ Keep the patient from motion or hyperventilation.

⚫ Old electrodes and new ones mixed up

If still exists, Please contact with our service department or appointed maitenance center.

8. Specifications

Main technical specification

Items specification

Lead standard 12 leads

lead acquisition synchronously 12 leads

Input circuit Floating; Protection circuit against Defibrillator effect

Input Impedance ≥50MΩ

Input circuit current ≤0.0.05μA

Record mode Automatic: 3CH×4+1R, 3CH×4,

3CHx2+2CHx3,3CHx2+2CHx3+1R,6CHX2;

Manual: 3CH, 2CH, 3CH+1R, 2CH+1R;

Rhythm: Any lead selectable.

Filter EMG Filter: 25 Hz / 30 Hz / 40Hz/75 Hz / 100 Hz / 150Hz

DFT Filter: 0.05 Hz/ 0.15 Hz

AC Filter: 50 Hz / 60Hz

CMRR >100dB

Patient current leakage ＜10μA

Input Circuit Current ＜0.05µA

Frequency Response 0.05Hz~150Hz (-3dB)

Sensitivity 2.5mm/mV, 5 mm/mV, 10 mm/mV, 20 mm/mV

Anti-baseline Drift Automatic

Time constant ≥3.2s

Noise level ＜15μVp-p

Paper speed 12.5 mm/s, 25 mm/s, 50 mm/s

Recording mode Thermal printing system

Paper specification 80mmx20m paper roll

LCD display 7” graphic LCD

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Digital Electrocardiograph Operation Manual Meditech

Safety classification IEC60601-1 class I, type CF

Power supply AC: 100~240V, 50/60Hz, 30VA~100VA

DC: 14.8V/2200mAh, built-in lithium battery

Fuse AC220V±10% 2*Φ5×20mm,T2A/250V AC time lag

AC110V±10% 2*Φ5×20mm,T4A/250V AC time lag

Environment requirement

Storage

Temperature -10℃～+40℃

Humidity 30％～80％

Pressure 700hPa~1060hPa

Operation

Temperature +5℃~+40℃

Humidity 25％～95％

Pressure 860hPa~1060hPa

EXT & CRO (if required)

EXT

Input impendence > 100kΩ

Sensitivity 10mm/V (±5%)

CRO

Output impendence ≤100Ω

Sensitivity 1V/mV (±5%)

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9. Accessory List
In order to obtain a good ECG trace, you are required to use the accompanying accessories of this unit. Following is the
demonstration of the standard accessories for the unit.

29

Item Description Quantity

1 Patient Cable 1
2 Limb Electrode 4pcs/set
3 Chest Electrode 6pcs/set
4 Three plugged power cable 1
5 Grounding Cable 1
6 Paper Shaft 1
7 Thermal Recording Paper 1

Responsibility of Manufacturer
Meditech Equipment Co., Ltd. Only takes the responsibility on reliability and security of the device under the
below conditions:
1. The device is assembled and maintained by the service engineer which is appointed by Meditech Equipment
Co., Ltd.
2. The device is strictly operated according to user manual.

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Appendix A

The Minnesota Code Classification System for Electrocardiographic Findings Q and QS Patterns
(Do not code in the presence of WPW code 6-4-1.) To qualify as a Q- or QS-wave, the deflection should be at least 0.1
mV (1 mm in amplitude).
Anterolateral site (leads I, aVL, V6)
1-1-1 Q/R amplitude ratio ≥ 1/3, plus Q duration ≥ 0.03 sec in lead I or V6.
1-1-2 Q duration ≥ 0.04 sec in lead I or V6.
1-1-3 Q duration ≥ 0.04 sec, plus R amplitude ≥ 3 mm in lead aVL.
1-2-1 Q/R amplitude ratio ≥ 1/3, plus Q duration ≥ 0.02 sec and < 0.03 sec in lead I or V6.
1-2-2 Q duration ≥ 0.03 sec and < 0.04 sec in lead I or V6.
1-2-3 QS pattern in lead I. Do not code in the presence of 7-1-1.
1-2-8 Initial R amplitude decreasing to 2 mm or less in every beat (and absence of codes 3-2, 7-1-1, 7-2-1, or 7-3
between V5 and V6. (All beats in lead V5 must have an initial R > 2 mm.)
1-3-1 Q/R amplitude ratio ≥ 1/5 and < 1/3, plus Q duration ≥ 0.02 sec and < 0.03 secin lead I or V6.
1-3-3 Q duration ≥ 0.03 sec and < 0.04 sec, plus R amplitude ≥ 3 mm in lead aVL.
Posterior (inferior) site (leads II, III, aVF)
1-1-1 Q/R amplitude ratio ≥ 1/3, plus Q duration ≥ 0.03 sec in lead II.
1-1-2 Q duration ≥ 0.04 sec in lead II.
1-1-4 Q duration ≥ 0.05 sec in lead III, plus a Q-wave amplitude ≥ 1.0 mm in the majority of beats in lead aVF.
1-1-5 Q duration ≥ 0.05 sec in lead aVF.
1-2-1 Q/R amplitude ratio ≥ 1/3, plus Q duration ≥ 0.02 sec and < 0.03 sec in lead II.
1-2-2 Q duration ≥ 0.03 sec and < 0.04 sec in lead II.
1-2-3 QS pattern in lead II. Do not code in the presence of 7-1-1.
1-2-4 Q duration ≥ 0.04 sec and < 0.05 sec in lead III, plus a Q-wave ≥ 1.0 mm amplitude in the majority of beats in aVF.
1-2-5 Q duration ≥ 0.04 sec and < 0.05 sec in lead aVF.
1-2-6 Q amplitude ≥ 5.0 mm in leads III or aVF.
1-3-1 Q/R amplitude ratio ≥ 1/5 and < 1/3, plus Q duration ≥ 0.02 sec and < 0.03 sec in lead II.
1-3-4 Q duration ≥ 0.03 sec and < 0.04 sec in lead III, plus a Q-wave ≥ 1.0 mm amplitude in the
majority of beats in lead aVF.
1-3-5 Q duration ≥ 0.03 sec and < 0.04 sec in lead aVF.
1-3-6 QS pattern in each of leads III and aVF. (Do not code in the presence of 7-1-1.)
Anterior site (leads V1, V2, V3, V4, V5) 12345
1-1-1 Q/R amplitude ratio ≥ 1/3 plus Q duration ≥ 0.03 sec in any of leads V2, V3, V4, V5.
1-1-2 Q duration ≥ 0.04 sec in any of leads V1, V2, V3, V4, V5.
1-1-6 QS pattern when initial R-wave is present in adjacent lead to the right on the chest, in any of leads V2, V3,V4,V5,
V6.
1-1-7 QS pattern in all of leads V1-V4 or V1-V5.
1-2-1 Q/R amplitude ratio ≥ 1/3, plus Q duration ≥ 0.02 sec and < 0.03 sec, in any of leads V2, V3, V4, V5.
1-2-2 Q duration ≥ 0.03 sec and < 0.04 sec in any of leads V2, V3, V4, V5.
1-2-7 QS pattern in all of leads V1, V2, and V3. (Do not code in the presence of 7-1-1).
1-2-8 Initial R amplitude decreasing to 2.0 mm or less in every beat (and absence of codes 3-2, 7-1-1, 7-2-1, or
7-3)between any of leads V2 and V3, V3 and V4, or V4 and V5. (All beats in the lead immediately to the right on
the chest must have an initial R > 2 mm.)
1-3-1 Q/R amplitude ratio ≥ 1/5 and < 1/3 plus Q duration ≥ 0.02 and < 0.03 sec in any of leads V2, V3, V4, V5.
1-3-2 QS pattern in lead V1 and V2. (Do not code in the presence of 3-1 or 7-1-1.)
QRS Axis Deviation(Do not code in presence of low-voltage QRS, code 9-1, WPW 6-4-1, ventricular conduction
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defects, or 7-1-1, 7-2-1, and7-4.)

2-1 Left.QRS axis from -300 through -900 in leads I, II, III. (The algebraic sum of major positive and major negative
QRS waves must be zero or positive in I, negative in III, and zero or negative in II.)
2-2 Right. QRS axis from +1200
through -1500 in leads I, II, III. (The algebraic sum of major positive and major
negative QRS waves must be negative in I, and zero or positive in III, and in I must be one-half or more of that in
III.)
2-3 Right (optional code when 2-2 is not present). QRS axis from +900 through +1190
in leads I, II, III. (The algebraic sum of major positive and major negative QRS waves must be
zero or negative in I and positive in II and III.)
2-4 Extreme axis deviation (usually S1, S2, S3 pattern). QRS axis from -900 through -1490 in leads I, II, and III(The
algebraic sum of major positive and major negative QRS waves must be negative in each of leads I, II, andIII.)
2-5 Indeterminate axis QRS axis approximately 900 from the frontal plane. (The algebraic sum of major positive and
major negative QRS waves is zero in each of leads I, II and III, or the information from these three leads is
incongruous.)
High Amplitude R Waves
3-1 Left: R amplitude > 26 mm in either V5 or V6, or R amplitude > 20.0 mm in any of leads I, II, III, aVF, or
Ramplitude > 12.0 mm in lead aVL. (All criteria measured only on second to last complete normal beat.)
3-2 Right: R amplitude ≥ 5.0 mm and R amplitude ≥ S amplitude in the majority of beats in lead V1, when Samplitude is >
R amplitude somewhere to the left on the chest of V1 (codes 7-3 and 3-2, if criteria for both arepresent).
3-3 Left (optional code when 3-1 is not present): R amplitude > 15.0 mm but ≤ 20.0 mm in lead I, or R amplitude in V5
or V6, plus S amplitude in V1 > 35.0 mm. (Measured only on second to last complete normal beat.)
3-4 Criteria for 3-1 and 3-2 both present.ST Junction (J) and Segment Depression
ST Junction (J) and Segment Depression
(Do not code in the presence of codes 6-4-1, 7-1-1, 7-2-1 or 7-4. When 4-1, 4-2, or 4-3 is coded,
then a 5-code must also be assigned except in lead V1.)
Anterolateral site (leads I, aVL, V6)
4-1-1 STJ depression ≥ 2.0 mm and ST segment horizontal or downward sloping in any of leads I, aVL, or V6.
4-1-2 STJ depression ≥ 1.0 mm but < 2.0 mm, and ST segment horizontal or downward sloping in any of leads I,aVL, or
V6.
4-2 STJ depression ≥ 0.5 mm and < 1.0 mm and ST segment horizontal or downward sloping in any of leads I,aVL, or
V6.
4-3 No STJ depression as much as 0.5 mm but ST segment downward sloping and segment or T-wave nadir ≥ 0.5mm
below P-R baseline, in any of leads I, aVL, or V6.
4-4 STJ depression ≥ 1.0 mm and ST segment upward sloping or U-shaped, in any of leads I, aVL, or V6.
Posterior (inferior) site (leads II, III, aVF)
4-1-1 STJ depression ≥ 2.0 mm and ST segment horizontal or downward sloping in lead II or aVF.
4-1-2 STJ depression ≥ 1.0 mm but < 2.0 mm and ST segment horizontal or downward sloping in lead II or aVF.
4-2 STJ depression ≥ 0.5 mm and < 1.0 mm and ST segment horizontal or downward sloping in lead II or aVF.
4-3 No STJ depression as much as 0.5 mm, but ST segment downward sloping and segment or T-wave nadir ≥0.5 mm
below P-R baseline in lead II.
4-4 STJ depression ≥ 1.0 mm and ST segment upward sloping, or U-shaped, in lead II.
ST Junction (J) and Segment Depression (continued)
Anterior site (leads V1, V2, V3, V4, V5)
4-1-1 STJ depression ≥ 2.0 and ST segment horizontal or downward sloping in any of leads V1, V2, V3, V4, V5.
4-1-2 STJ depression ≥ 1.0 mm but < 2.0 mm and ST segment horizontal or downward sloping in any of leads V1,V2, V3,
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Digital Electrocardiograph Operation Manual Meditech

V4, V5
4-2 STJ depression ≥ 0.5 mm and < 1.0 mm and ST segment horizontal or downward sloping in any of leads V1,V2, V3,
V4, V5.
4-3 No STJ depression as much as 0.5 mm, but ST segment downward sloping and segment orT-wave nadir ≥ 0.5 mm
below P-R baseline in any of leads V2, V3, V4, V5.
4-4 STJ depression ≥ 1.0 mm and ST segment upward sloping or U-shaped in any of leads V1, V2, V3, V4, V5.T-Wave
Items(Do not code in the presence of code 6-4-1, 7-1-1, 7-2-1 or 7-4.)
Anterolateral site (leads I, aVL, V6)
T-Wave Items
(Do not code in the presence of code 6-4-1, 7-1-1, 7-2-1 or 7-4.)
Anterolateral site (leads I, aVL, V )6
5-1 T amplitude negative 5.0 mm or more in either of leads I, V6, or in lead aVL when R amplitude is ≥ 5.0 mm.
5-2 T amplitude negative or diphasic (positive-negative or negative-positive type) with negative phase at least 1.0mm
but not as deep as 5.0 mm in lead I or V6, or in lead aVL when R amplitude is ≥ 5.0 mm.
5-3 T amplitude zero (flat), or negative, or diphasic (negative-positive type only) with less than 1.0 mm negative phase
in lead I or V6, or in lead aVL when R amplitude is ≥ 5.0 mm.
5-4 T amplitude positive and T/R amplitude ratio < 1/20 in any of leads I, aVL, V6; R wave amplitude must be ≥10.0 mm.

Posterior (inferior) site (leads II, III, aVF)

5-1 T amplitude negative 5.0 mm or more in lead II, or in lead aVF when QRS is mainly upright.
5-2 T amplitude negative or diphasic with negative phase (negative-positive or positive-negative type) at least 1.0mm
but not as deep as 5.0 mm in lead II, or in lead aVF when QRS is mainly upright.
5-3 T amplitude zero (flat), or negative, or diphasic (negative-positive type only) with less than 1.0 mm negative phase
in lead II; not coded in lead aVF.
5-4 T amplitude positive and T/R amplitude ratio < 1/20 in lead II; R wave amplitude must be ≥ 10.0 mm.
Anterior site (leads V , V , V , V ) 2 3 4 5
5-1 T amplitude negative 5.0 mm or more in any of leads V2, V3, V4, V5.
5-2 T amplitude negative (flat), or diphasic (negative-positive or positive-negative type) with negative phase at least 1.0
mm but not as deep as 5.0 mm, in any of leads V2, V3, V4, V5.
5-3 T amplitude zero (flat), or negative, or diphasic (negative-positive type only) with less than 1.0 mm negative phase,
in any of leads V3, V4, V5.
5-4 T amplitude positive and T/R amplitude ratio < 1/20 in any of leads V3, V4, V5; R wave amplitude must be ≥10.0
mm.A-V Conduction Defect
A-V Conduction Defect
6-1 Complete (third degree) A-V block (permanent or intermittent) in any lead. Atrial and ventricular complexes
independent, and atrial rate faster than ventricular rate, with ventricular rate < 60.
6-2-1 Mobitz Type II (occurrence of P-wave on time with dropped QRS and T).
6-2-2 Partial (second degree) A-V block in any lead (2:1 or 3:1 block).
6-2-3 Wenckebach's Phenomenon (P-R interval increasing from beat to beat until QRS and T dropped).
6-3 P-R (P-Q) interval ≥ 0.22 sec in the majority of beats in any of leads I, II, III, aVL, aVF.
6-4-1 Wolff-Parkinson-White Pattern (WPW), persistent. Sinus P-wave. P-R interval < 0.12 sec, plus QRS duration
≥0.12 sec, plus R peak duration ≥ 0.06 sec, coexisting in the same beat and present in the majority of beats in any
of leads I, II, aVL, V4, V5, V6. (6-4-1 suppresses 1-2-3, 1-2-7, 1-2-8, 1-3-2, 1-3-6, all 3, 4, 5, 9-2, 9-4, 9-5codes.)
6-4-2 WPW Pattern, intermittent. WPW pattern in ≤ 50% of beats in appropriate leads.
6-5 Short P-R interval. P-R interval < 0.12 sec in all beats of any two of leads I, II, III,aVL, aVF.
6-6 Intermittent aberrant atrioventricular conduction. P-R > 0.12 sec (except in presence of 6-5 or heart rate greater
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than 100); wide QRS complex > 0.12 sec; normal P-wave when most beats are sinus rhythm. (Do not code in
the presence of 6-4-2.)
6-7 Artificial pacemaker.
Ventricular Conduction Defect
7-1-1 Complete left bundle branch block (LBBB). (Do not code in presence of 6-1, 6-4-1, 6-8, 8-2-1 or 8-2-2.) QRS
duration ≥ 0.12 sec in a majority of beats in any of leads I, II, III, aVL, aVF, plus R peak duration ≥ 0.06 sec in
amajority of beats (of the same QRS pattern) in any of leads I, II, aVL, V5, V6. (7-1-1 suppresses 1-2-3, 1-2-7,
1-2-8, 1-3-2, 1-3-6, all 2, 3, 4, 5, 9-2, 9-4, 9-5 codes. If any other codable Q-wave coexists with the LBBB
pattern,code the Q and diminish the 7-1-1 code to a 7-4 code.)
7-1-2 Intermittent left bundle branch block. Same as 7-1-1 but with presence of normally conducted QRS complexes of
different shape than the LBBB pattern.
7-2-1 Complete right bundle branch block (RBBB). (Do not code in the presence of 6-1, 6-4-1, 6-8, 8-2-1 or 8-2-2.)QRS
duration ≥ 0.12 sec in a majority of beats in any of leads I, II, III, aVL, aVF, plus: R' > R in V1 or V2;or QRS mainly
upright, with R peak duration ≥ 0.06 sec in V1 or V2; or S duration >R duration in all beats in lead I or II. (7-1
suppresses 1-2-3, 1-2-7, 1-2-8, 1-3-2, 1-3-6, all 2, 3, 4, 5, 9-2, 9-4, 9-5 codes.
7-2-2 Intermittent right bundle branch block. Same as 7-2-1 but with presence of normally conducted QRS complexes of
different shape than the RBBB pattern.
7-3 Incomplete right bundle branch block. QRS duration < 0.12 sec in each of leads I, II, III, aVL, aVF, and R' > R in
either of leads V1, V2 .(Code as 3-2 in addition if those criteria are met. 7-3 suppresses code 1-2-8.)
7-4 Intraventricular block. QRS duration ≥ 0.12 sec in a majority of beats in any of leads I, II, III, aVL, aVF. (7-4
suppresses all 2, 3, 4, 5, 9-2, 9-4, 9-5 codes.)
7-5 R-R' pattern in either of leads V1, V2 with R' amplitude ≥ R.
7-6 Incomplete left bundle branch block. (Do not code in the presence of any codable Q- or QS-wave.) QRS
duration≥ 0.10 sec and < 0.12 in the majority of beats of each of leads I, aVL, and V5 or V6.5 6
7-7 Left anterior hemiblock (LAH). QRS duration < 0.12 sec in the majority of beats in leads I, II, III, aVL, aVF, plus
Q-wave amplitude ≥ 0.25 mm and < 0.03 sec duration in lead I, plus left axis deviation of -450 or more negative.(In
presence of 7-2, code 7-8 if axis is < -450 and the Q-wave in lead I meets the above criteria.)
7-8 Combination of 7-7 and 7-2.
Arrhythmias
8-1-1 Presence of frequent atrial or junctional premature beats (10% or more of recorded complexes).
8-1-2 Presence of frequent ventricular premature beats (10% or more of record complexes).
8-1-3 Presence of both atrial and/or junctional premature beats and ventricular premature beats (so that individual
frequencies are < 10% but combined premature beats are ≥ 10% of complexes).
8-1-4 Wandering atrial pacemaker.
8-1-5 Presence of 8-1-2 and 8-1-4.
8-2-1 Ventricular fibrillation or ventricular asystole.
8-2-2 Persistent ventricular (idioventricular) rhythm.
8-2-3 Intermittent ventricular tachycardia. Three or more consecutive ventricular premature beats
occurring at a rate≥100. This includes more persistent ventricular tachycardia.
8-2-4 Ventricular parasystole (should not be coded in presence of 8-3-1).
8-3-1 Atrial fibrillation (persistent).
8-3-2 Atrial flutter (persistent).
8-3-3 Intermittent atrial fibrillation (code if 3 or more clear-cut, consecutive sinus beats are present in any lead).
8-3-4 Intermittent atrial flutter (code of 3 or more clear-cut, consecutive sinus beats are present in any lead).
8-4-1 Supraventricular rhythm persistent. QRS duration < 0.12 sec; and absent P-waves or presence of abnormal
P-waves (inverted or flat in aVF); and regular rhythm.
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8-4-2 Supraventricular tachycardia intermittent. Three consecutive atrial or junctional premature beats occurring at
arate ≥ 100.
8-5-1 Sinoatrial arrest. Unexpected absence of P, QRS and T, plus a R-R interval at a fixed multiple of he normal
interval, + 10%.
8-5-2 Sinoatrial block. Unexpected absence of P, QRS and T, preceded by progressive shortening of P-P intervals.
(R-R interval at a fixed multiple of the normal interval, + 10%.
8-6-1 A-V dissociation with ventricular pacemaker (without capture). Requires: P-P and R-R occur at variable rates with
ventricular rate as fast as or faster than the atrial rate, plus variable P-R intervals, plus no capture beats.
8-6-2 A-V dissociation with ventricular pacemaker (with capture).
8-6-3 A-V dissociation with atrial pacemaker (without capture).
8-6-4 A-V dissociation with atrial pacemaker (with capture).
8-7 Sinus tachycardia (over 100/min).
8-8 Sinus bradycardia (under 50/min).
8-9 Other arrhythmias. Heart rate may be recorded as a continuous variable.
ST Segment Elevation
Anterolateral site (leads I, aVL, V6)
9-2 ST segment elevation ≥ 1.0 mm in any of leads I, aVL, V6.
Posterior (inferior) site (leads II, III, aVF)
9-2 ST segment elevation ≥ 1.0 mm in any of leads II, III, aVF.
Anterior site (leads V 1, V2 , V3 , V4 , V5 )
9-2 ST segment elevation ≥ 1.0 mm in lead V5 or ST segment elevation ≥ 2.0 mm in any of leads V1, V2, V3, V4.
Miscellaneous Items
9-1 Low QRS amplitude. QRS peak-to-peak amplitude < 5 mm in all beats in each of leads I, II, III, or < 10 mm in all
beats in each of leads V1, V2, V3, V4, V5, V6. (Check calibration before coding.)
9-3 P-wave amplitude ≥ 2.5 mm in any of leads II, III, aVF, in a majority of beats.
9-4-1 QRS transition zone at V3 or to the right of V3 on the chest. (Do not code in the presence of 6-4-1, 7-1-1, 7-2-1 or
7-4.)
9-4-2 QRS transition zone at V4 or to the left of V4 on the chest. (Do not code in the presence of 6-4-1, 7-1-1, 7-2-1 or
7-4.)
9-5 T-wave amplitude > 12 mm in any of leads I, II, III, aVL, aVF, V1, V2, V3, V4, V5, V6. (Do not code in the presence
of 6-4-1, 7-1-1, 7-2-1 or 7-4.)
9-8-1 Technical problems which interfere with coding.
9-8-2 Technical problems which do not interfere with coding.
Incompatible Codes
The codes in the left column suppress codes in the right column.
Code Suppress this code(s)
All Q-, QS-codes 7-6
Q > 0.03 in lead I 7-7
3-1 1-3-2
3-2 1-2-8, 7-3
6-1 All other codes except 8-2
6-4-1 All other codes
6-8 All other codes
7-1-1 1-2-3, 1-2-7, 1-2-8, 1-3-2, 1-3-6, all 2-, 3-, 4-, and 5- codes, 7-7, 9-2, 9-4, 9-5
7-2-1 1-2-8, all 2-, 3-, 4-, and 5-codes, 9-2, 9-4, 9-5
7-3 1-2-8
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7-4 All 2-, 3-, 4-, and 5-codes, 9-2, 9-4, 9-5
8-1-2 8-2-4
8-1-4 8-1-1, 9-3
8-2-1 All other codes
8-2-2 All other codes
8-2-3 8-1-2
8-3-1 8-1-1, 8-1-2
8-3-2 6-2-2, 8-1-1, 8-1-2
8-3-3 8-1-1, 8-1-2
8-3-4 6-2-2
8-4-1 6-5
8-4-1 + heart rate≧140 All other codes except 7-4 or 6-2
Heart rate > 100 6-5
8-4-2 8-1-1
9-1 All 2-codes
Categories of Minnesota ECG Abnormalities
Diagnostic ECG:
(any ECG may be used for this classification)
D1. An ECG record with any Diagnostic Q-code (Minn. code 1-1-1 through 1-2-5 plus 1-2-7).
D2. An ECG record with ST-segment elevation code 9-2 PLUS (T-wave inversion code 5-1 or
5-2 in the absence of 7-2-1 or 7-4).
Equivocal ECG:
(any ECG may be used for this classification)
E1. An ECG record with an Equivocal Q-code [(Minn. code 1-2-8 in the absence of a 7-1-1 or
7-3 or (any 1-3-code)].
E2. An ECG record with ST-segment depression (code 4-1-x or 4-2 or 4-3 in the absence of 7-
2-1 or 7-4), or 1-3-x.
E3. An ECG record with T-wave inversion (code 5-1 or 5-2 or 5-3 in the absence of 7-2-1 or 7-
4).
E4. An ECG record with ST-segment elevation code 9-2.
Other ECG:
01. Reference ECG coded 7-1-1.
02. Any ECG coded 7-1-1.
03. Normal ECG(s), defined as 1 in “clear” field of all ECGs.
04. Other findings including 1-2-6.
Uncodable ECG:
U1. Technical errors coded 9-8-1 by Minnesota Code.
Absent ECG:
A1. No ECG available for coding.
Prineas R, Crow R, Blackburn H. The Minnesota Code Manual of Electrocardiographic
Findings. John Wright-PSG, Inc. Littleton, MA, June 1982.

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Appendix B
Diagnosis Code Table

Code Item
SR Sinus Rhythm
SR-1 Sinus Arrhythmia
SR-2 Sinus Tachycardia
SR-3 Sinus Bradycardia
SR-0 Sinus Rhythm
ER Ectopic rhythm(refer to M-code-8)
AE Atrial Enlargement
LAE-1 Left Atrial Enlargement
LAE-2 Possibly Left Atrial Enlargement
RAE-1 Right Atrial Enlargement
RAE-2 Possibly Right Atrial Enlargement
BAE-1 Biatrial Enlargement
BAE-2 Possibly Biatrial Enlargement
PA P-wave Axis Abnormality
PA-1 Probably Leads Reversed
PA-2 Probably Dextrocardia
AD Axis Deviation
LAD-1 Mild Left Axis Deviation
LAD-2 Marked Left Axis Deviation
RAD-1 Mild Right Axis Deviation
RAD-2 Right Axis Deviation
RAD-3 Marked Right Axis Deviation
AD? Indeterminate Axis
S1S2S3 S1-S2-S3 Pattern
LOWV Low Voltage
LOWV-1 Low Voltage(Limb Leads)
LOWV-2 Low Voltage(Chest Leads)
LOWV-3 Low Voltage(All Leads)
VH Ventricular Hypertrophy

RVH -1 Right Ventricular Hypertrophy

RVH-2 Possibly Right Ventricular Hypertrophy
LVH-1 Left Ventricular High Voltage
LVH-2 Left Ventricular Hypertrophy
LVH-3 Possibly Left Ventricular Hypertrophy
BVH-1 Biventricular Hypertrophy
BVH-2 Possibly Biventricular Hypertrophy
W Pre-exciting Syndrome
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S-PR Shortened PR Internal

W-1 W-P-W Syndrome(Type A)
W-2 W-P-W Syndrome(Type B)
W-3 W-P-W Syndrome
AVB A-V Block
AVB-1 A-V Block(Type I)
AVB-2-1 A-V Block(Type II)(Mobitz)
AVB-2-2 A-V Block(Type II)(Wenckbach)
AVB-3 A-V Block(Type III)
LBBB Left Bundle Branch Block
LBBB-1 Complete Left Bundle Branch Block
LBBB-2 Incomplete Left Bundle Branch Block
RBBB Right Bundle Branch Block
RBBB-1 Complete Right Bundle Branch Block
RBBB-2 Incomplete Right Bundle Branch Block
AFB Left Anterior Fascicular Block
PFB Left Posterior Fascicular Block
RSR’ RSR’(QR) Pattern InV1/V2, Right Ventricular Conduction Delay
MI Myocardial Infarction
AMI-1 Can’t Exclude Anterior Myocardial Infarction
AMI-2 Anterior Myocardial Infarction
AMI-3 Possibly Anterior Myocardial Infarction
SMI-1 Can’t Exclude Septal Myocardial Infarction
SMI-2 Septal Myocardial Infarction
SMI-3 Possibly Septal Myocardial Infarction
ASMI-1 Can’t Exclude Anteroseptal Myocardial Infarction
ASMI-2 Anteroseptal Myocardial Infarction
ASMI-3 Possibly Anteroseptal Myocardial Infarction
ALMI-1 Can’t Exclude Anterior-Lateral Myocardial Infarction
ALMI-2 Anterior-Lateral Myocardial Infarction
ALMI-3 Possibly Anterior-Lateral Myocardial Infarction
LMI-1 Can’t Exclude Lateral Myocardial Infarction
LMI-2 Lateral Myocardial Infarction
LMI-3 Possibly Lateral Myocardial Infarction
EAMI-1 Can’t Exclude Extensive Anterior Myocardial Infarction
EAMI-2 Extensive Anterior Myocardial Infarction
EAMI-3 Possibly Extensive Anterior Myocardial Infarction
IMI-1 Can’t Exclude Inferior Myocardial Infarction
IMI-2 Inferior Myocardial Infarction
IMI-3 Possibly Inferior Myocardial Infarction
PMI-1 Can’t Exclude Posterior Myocardial Infarction
PMI-2 Posterior Myocardial Infarction
PMI-3 Possibly Posterior Myocardial Infarction
- MI Age

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-A Acute
-B Subacute
-C Obsolete
-? Undetermined
STE ST Elevation
STE-1 ST Elevation (Consider Early Repolarization, Injury or Acute Pericarditis)
STE-2 ST Elevation (Consider Early Repolarization )
STE-3 Early Repolarization
STE-4 ST Elevation (Consider Acute Pericarditis)
STE-5 Acute Pericarditis
STE-? ST Elevation( Nonspecific)
STD ST Depression
STD-1 ST Depression(Possibly Subendocardial Injury, Anterior)
STD-2 ST Depression(Possibly Subendocardial Injury, Septal)
STD-3 ST Depression(Possibly Subendocardial Injury, Anterior-Septal)

STD-4 ST Depression(Possibly Subendocardial Injury, Lateral)

STD-5 ST Depression(Possibly Subendocardial Injury, Anterior-Lateral)
STD-6 ST Depression(Possibly Subendocardial Injury, Inferior)
STD-? ST Depression (Nonspecific)
T Myocardial Ischemia
T-1 T-wave Abnormality, Possibly Myocardial Ischemia( Anterior )
T-2 T-wave Abnormality, Possibly Myocardial Ischemia( Lateral )
T-3 T-wave Abnormality, Possibly Myocardial Ischemia(Anterior-Lateral)
T-4 T-wave Abnormality, Possibly Myocardial Ischemia( Inferior )
T-5 High T-wave, Possibly Hyperkalemia
T-? T-wave Abnormality(Nonspecific)
ST-T ST-T Abnormality
ST-T-1 Abnormal QRS-T Angle
ST-T-2 ST-T Abnormality, Probably Digitalis Effect
ST-T-3 Digitalis Effect
ST-T-? ST-T Abnormality(Nonspecific)
QT QT Interval Abnormality
QT-1 Shortened QT
QT-2 Prolonged QT

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