Journal Publication of International Research for Engineering and Management (JOIREM)

Volume: 10 Issue: 04 | june-2023

Real time ECG monitoring circuit and discharging circuit.

Shalaka Payal Omkar Shridhar

Bose Pagere Sangpal Subramaniam
Electronics and Electronics and Electronics and Electronics and
telecommunication telecommunication telecommunication telecommunication
Engineering Engineering Engineering Engineering
MET’s Institute Of MET’s Institute Of MET’s Institute Of MET’s Institute Of
Engineering Nashik, Engineering Nashik, Engineering Nashik, Engineering Nashik,
India India India India
shalakabose2001@gm payalpagere123@gma sangpal.omkar2811@ shridharsubramaniam
ail.com il.com gmail.com 663@gmail.com

Abstract: professionals to promptly identify and address

Real-time electrocardiogram (ECG) monitoring cardiac abnormalities. The discharge control

plays a vital role in the diagnosis and management functionality enhances patient care by offering a
of cardiovascular diseases. This abstract presents a reliable and efficient method for intervention in
novel design for an ECG monitoring and
critical situations.
discharging circuit that enables continuous
monitoring of a patient's heart activity and provides
.Keywords: ECG monitoring, Sudden Cardiac
a safe and efficient mechanism for electrical
discharge, if necessary. Arrest, Discharging Circuit, Pan-Tompkins

The proposed circuit consists of three main

components: ECG sensing, signal processing, and
discharge control. The ECG sensing module I. INTRODUCTION
incorporates high-precision electrodes to capture the Amongst the most impending health challenges of
electrical signals generated by the heart. These modern society, the Sudden Cardiac Arrest (SCA)
signals are then amplified, filtered, and digitized by is probably one of the most deadly. SCA alone is
the signal processing module to extract relevant responsible every year for over 300’000 deaths in
information and eliminate noise interference. the United States. As a mean of comparison, this
The discharge control module is designed to assess number is greater than the combined number of
the patient's condition based on the ECG data and those who die from Alzheimer’s disease, assault
trigger an electrical discharge, if required. This with firearms, breast cancer, cervical cancer,
module includes a comprehensive algorithm that colorectal cancer, diabetes, HIV, house fires, motor
analyses the ECG waveform and detects critical vehicle accidents, prostate cancer, and suicides.
events, such as arrhythmias or abnormal heart SCA is a condition in which the heart suddenly and
rhythms. Upon detection, the circuit initiates a unexpectedly stops beating in an ordered fash
controlled discharge process to restore normal
cardiac function.

The proposed ECG monitoring and discharging

circuit offers several advantages over traditional

systems. Its real-time capabilities provide

continuous monitoring, enabling healthcare
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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

ion way, and instead start exhibiting a chaotic Pan and Tompkins algorithm, but applying a new,
behaviour. When this happens, blood stops flowing simple, and efficient technique in the detection
to the brain and other vital organs. In these
conditions the patient may be considered to all stage. The new method is based on the centered
effects dead, and will remain so unless someone derivative and the intermediate value theorem, to
help him/her immediately. The most effective way locate the QRS peaks. The proposed architecture has
to treat a SCA is with defibrillation, namely a
been implemented on FPGA using the Xilinx
therapeutic dose of electrical energy. The necessity
of performing defibrillation as soon as possible -in System.
order to significantly raise the chance of
resuscitation has led to the development of In [3] Liang-Hung Wang, Member, IEEE, Yi-Mao
Automated External Defibrillators (AED). Hsiao, Member, IEEE, Xue-Qin Xie, and Shuenn-

. Yuh Lee The current paper presents an outdoor

monitoring system for elderly people, which can
LITERATURE SURVEY transmit information on physiological signals and

In [1] Paulo Barbosa and Yang Medeiros describes falling events to a healthcare center at any time and

Due to complex safety requirements, medical from any place. To detect simultaneously the

devices must obey rigorous standards. In the occurrence of any falling event, as well as the

development of these devices, modeling techniques relative electrocardiogram (ECG) signal of the user,

must be used to analyze the design decisions in a multithread method is proposed with the objective

agreement with such standards. In this paper, we of enhancing the response time and the accuracy of

present a Matlab/Simulink specification as an detection. A healthcare box is used to determine the

analytical model for Automated External relative position of the patient through a global

Defibrillators (AEDs) and its integration with a positioning system for fall detection; moreover, an

Model Based Systems Engineering (MBSE) ECG signal acquisition thread is adopted to increase

approach through descriptive models. The proposed the precision of the fall detection system. Integrating

model allows us to analyze algorithms for decision a precise map into the monitoring system facilitates

of shock application, performance of circuits when understanding of a client user of the correct location

obtaining the required voltage, safety of the and surrounding environment using the portable

produced energy for shock delivery and display. According to experimental results based on
characteristics of signals produced at the output of 4,000 samples, successful detection time with the

the AED. The model is composed of modules with multi-thread method was reduced by 38%, thereby

interfaces specification, allowing safe module increasing rescue opportunities for elderly patients

replacement and the assessment of the module who are at risk.

influence over the system at a technical level In [4] Dr. Ganesh V Bhat and Bhimasen G

In [2] Karim Meddah , Malika Kedir Talha , Tasaganva This paper describes Biosignals are

Mohammed Bahoura , HadjerZairi describes The recorded as potentials, voltages, and electrical field

continuous monitoring of cardiac patients requires strengths generated by nerves and muscles. The
an ambulatory system that can automatically detect measurements involve voltages at very low levels,

heart diseases. This study presents a new field typically ranging between and , with high source

programmable gate array (FPGA)-based hardware impedances. Bio signals need to be amplified to

implementation of the QRS complex detection. The make them compatible with devices such as

proposed detection system is mainly based on the displays, recorders, or A/D converters for
computerized equipment. Amplifiers adequate to
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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

measure these signals have to satisfy very specific establish whether he/she is suffering from the fatal
requirements. They have to provide amplification condition of Sudden Cardiac Arrest (SCA), and
selective to the physiological signal, reject noise and subsequently allows the release of a therapeutic dose
interference signals. This paper, deals with some of of electrical energy (i.e. defibrillation). SCA is
the prominent aspects involved in the design of responsible for over 300,000 deaths per year both in
Electrocardiogram (ECG) acquisition system has Europe and in USA, and immediate clinical
been discussed with furthermore design and assistance through defibrillation is fundamental for
implementation of instrumentation amplifier with recovery. In this context, an open-source approach
appropriate filtering circuits are discussed. The can easily lead in improvements to the distribution
design circuit is tested in real time and results and efficiency of AEDs. The proposed Open-Source
obtained from the test and analysis of result are AED (OAED) is composed of two separate electric
presented. The main challenge in ECG acquisition boards: a high voltage board (HV-B), which
system is to detect the desired potential and contains the circuitry required to perform
attenuation of the amidst undesired biopotentials, defibrillation and a control board (C-B), which
noise and 50Hz electrical interference. The ECG detects SCA in the patient and controls the HVB.
acquisition system consisting of instrumentation Computer simulations and preliminary tests show
amplifier amplifies the potentials and which is used that the OAED can release a 200 J biphasic
to reject the common mode signals collected from defibrillation in about 12 s and detects SCA with
electrodes with the gain of 364. This is followed by sensitivity higher than 90% and specificity of about
a Low pass filter (LPF), High pass filter (HPF) with 99%. The OAED was also conceived as a template
the cut-off frequency of 220Hz and 0.16Hz and teaching tool in the framework of UBORA, a
respectively to attenuate the noise amidst from platform for design and sharing medical devices
electrodes. Followed by the notch filter is used for compliant to international standards.
attenuation of 50Hz line interference.
In [7] Sunil Kumar, Gurmohan Singh, Manjit Kaur
In[5]Avishek Paul and Jahnavi Jha describe An This paper describes the design and implementation
ECG is a measurement of the electrical activity of of ECG signal processing on FPGA. Lot of research
the heart muscle as obtained from the surface of the work has been carried out for implementation of
skin. The aim of this project is to sense the ECG ECG signal processing circuitry on FPGA. In this
voltage from an individual, using a three lead ECG research work all the work is carried out using Xilinx
system, and process the signal to extract necessary Spartan-3E FPGA starter kit which is taken as a
information. The purpose is to approach close to a central processing unit. On board Programmable
medical opinion by measuring abnormalities in the preamplifier, ADC and quad DAC on Spartan-3E
ECG parameters. The system consists of two main FPGA kit have been employed for amplification,
modules; the hardware module containing the data A/D conversion and D/A conversion respectively.
acquisition card and the software module containing To generate the necessary control signals for on
a graphical user interface which processes the ECG board Pre-amplifier, A/D converter and D/A
signal and displays the necessary information. Converter, we have designed different HDL
modules. The digital output of A/D converter is
In [6] Jacopo Ferretti a , Licia Di Pietro a , Carmelo
applied to the low pass FIR digital filter for
De Maria describes The Automated External
processing the ECG signals. All the designed
Defibrillator (AED) is a medical device that
modules are integrated in a single TOP level entity.
analyzes a patient’s electrocardiogram in order to
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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

All modules are designed, functionally verified, explanted because of infection; the patient can use
synthesized, placed & routed using Xilinx 14.3i ISE the WCD until the infection resolves, and a new ICD
tool. can be implanted. The role of the WCD is emerging
as an important therapeutic option to protect patients
In [8] Tomoya Shirane Bristol-Myers Squibb This
at elevated risk of sudden cardiac death (SCD)
paper describes According to the 2019 annual report
by Fire and Disaster Management Agency (FDMA)
in Japan, the survival rate of patients with Out-of-
Hospital cardiac arrest (OHCA) who were rescued
by Automated External Defibrillators (AED) was II. PROPOSED SYSTEM
6.2 times higher than those who were not treated
The system consists a 2 controller setup where the
appropriately. Unmanned Aerial Vehicles (UAV)
first controller is used to acquire ECG signal form
have been evaluated as the means of delivering
ECG module AD8232 while the other is used to
medical equipment and goods. This study was
drive the H-Bridge circuit. The Ad8232 is interfaced
therefore designed to evaluate the effectiveness of
with Arduino NANO controller and then the data
UAV technology applied to AED delivery through a
from the AD8232 is sent serially over computers
systematic review methodology. METHODS:
display while when the patient experiences
Preferred Reporting Items for Systematic Reviews
arrhythmia the secondary controllers activates the
and Meta- Analyses (PRISMA) statement was
H-bridge circuit necessary for defibrillation.
utilized to guide the review.

In [9] Peter Magnusson, Joseph V. Pergolizzi and Jo

Ann LeQuang This paper describes The wearable
cardioverter-defibrillator (WCD) is a rechargeable
external device that can be worn under the clothing
all day long and protects the wearer from potentially
life-threatening ventricular tachyarrhythmias. When
a dangerous arrhythmia is detected, the WCD can
deliver high-energy shocks. The WCD has been
shown to be effective in accurately detecting and
appropriately treating ventricular tachycardia (VT)
and ventricular fibrillation (VF). It is intended for
temporary use as a bridge to an implantable 3.1 Proposed System Diagram

cardioverter-defibrillator (ICD), heart

transplantation, or left ventricular assist device;
patients with heart failure with reduced ejection
fraction may benefit from the WCD while their METHODOLOGY

condition improves. It can be used temporarily after

explant of an ICD until reimplantation is deemed
1. Real time ECG acquisition
possible. In select patients with myocardial
infarction, a WCD may be useful during the 2. Serial plotting of ECG data
immediate period after infarction. It is indicated for 3. SCA detection using Pan Tompkins
use when a permanently implanted ICD must be
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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

4. Biphasic Discharging using H-bridge. placed on the left shoulder. This results in a 0
degree angle of orientation.[4]

Real time ECG acquisition

 Lead II — This axis goes from the right arm to
The AD8232 is an integrated signal conditioning the left leg, with the negative electrode on the
shoulder and the positive one on the leg. This
block for ECG and other biopotential measurement
results in a +60 degree angle of orientation.[4]
applications. It is designed to extract, amplify, and
filter small biopotential signals in the presence of
noisy conditions, such as those created by motion or
remote electrode placement. This design allows for  Lead III — This axis goes from the left
shoulder (negative electrode) to the right or left
an ultralow power analog-to-digital converter
leg (positive electrode). This results in a +120
(ADC) or an embedded microcontroller to acquire
degree angle of orientation.[4]
the output signal easily. The AD8232 can implement
a two-pole high-pass filter for eliminating motion
artifacts and the electrode half-cell potential. This
filter is tightly coupled with the instrumentation
architecture of the amplifier to allow both large gain
and high-pass filtering in a single stage, thereby
saving space and cost. An uncommitted operational
amplifier enables the AD8232 to create a three-pole
low-pass filter to remove additional noise. The user
can select the frequency cutoff of all filters to suit
different types of applications.

To improve common-mode rejection of the line

frequencies in the system and other undesired
interferences, the AD8232 includes an amplifier for
driven lead applications, such as right leg drive
(RLD). The AD8232 includes a fast restore function Serial Plotting of ECG data
that reduces the duration of otherwise long settling
tails of the high-pass filters. After an abrupt signal The Arduino Nano and the ECG AD8232 module
change that rails the amplifier (such as a leads off
have distinct functions and work together to measure
condition), the AD8232 automatically adjusts to a
higher filter cutoff. This feature allows the AD8232 and interpret the electrocardiogram (ECG) signals.
to recover quickly, and therefore, to take valid
measurements soon after connecting the electrodes The Arduino Nano:
to the subject

Three Lead Setup The Arduino Nano is a microcontroller board based

on the ATmega328P chip. It provides the processing

Einthoven's triangle is an imaginary formation of

three limb leads in a triangle used in
electrocardiography, formed by the two shoulders
and the pubis.[1] The shape forms an inverted power and I/O capabilities necessary to interface
equilateral triangle with the heart at the centre. It is with external devices and perform tasks based on
named after Willem Einthoven, who theorized its
programmed instructions.
existence.

 Lead I — this axis goes from shoulder to The Arduino Nano reads the analog voltage values
shoulder, with the negative electrode placed on from the AD8232 module and can perform various
the right shoulder and the positive electrode
operations on them, such as filtering, analyzing heart

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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

rate, detecting abnormalities, or transmitting the data

to other devices.

ECG AD8232 Module:

The ECG AD8232 module is specifically designed

to measure and amplify the electrical signals
generated by the heart. It is equipped with integrated
amplifiers, filters, and other components necessary
to capture and condition the ECG signals. The SCA detection using Pan-Tompkins Algorithm
module takes the weak electrical signals from the
body and amplifies them to a measurable level. The Pan-Tompkins algorithm is generally used for
pre-processing and as a QRS detection algorithm in
The AD8232 module provides an analog voltage real-time approaches. This algorithm utilises the
output that represents the ECG waveform. This amplitude, slope, and width of an integrated window
analog signal is then connected to an analog input to identify the Rpeaks in QRS complexes. The
pin on the Arduino Nano, which can read and algorithm consists of two stages, which are pre-
process the voltage values. processing and decision. In pre-processing, the raw
ECG signal is prepared as input to the detection
By connecting the Arduino Nano and the AD8232 process. Pre-processing includes noise removal,
module, you enable the Arduino to receive and signal smoothing, and width and QRS slope
interpret the ECG signals. The Arduino can then increasing. Then, the thresholds are used to only
perform further processing, analysis, or transmission consider the signal peaks and eliminate the noise
of the ECG data based on the program you have peaks in the decision stage. The algorithm consists
written. of a band-pass filter (Low Pass and High Pass
Filters), derivatives, a squaring function, a moving
The output you will get from the provided Arduino window integration (WMI), threshold, and decision,
code is a stream of numbers representing the ECG as shown in the diagram in Figure. In this algorithm,
signal. The code reads the analog value from the the false detection produced by the noise and artefact
ECG pin (connected to A0 in this example) using the
analogRead() function and prints it to the serial
monitor using the Serial.println() function.
Present in the ECG signal was reduced using a
digital band-pass filter. To adapt to the changes in
QRS morphology and heart rate, the thresholds were
Each number represents the voltage value of the automatically adjusted with the parameter in the
ECG signal at a particular moment in time. The decision stages. The detailed algorithm process flow
range of the values depends on the resolution of the is presented in the flowchart of Figure
analog-to-digital converter (ADC) of the Arduino
Nano. The ADC on most Arduinos has a 10-bit
resolution, meaning it can represent values from 0 to
1023.

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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

Negligible for the purpose of defibrillation, but vital

to ensure a time margin on Relay switching.

4 CONCLUSION

Biphasic discharging using H-bridge In the present study, it was also aimed to use the
defibrillator remotely by the expert in addition to
An H-Bridge is a circuit commonly used in robotic
sending the data of the patient who are at risk of
and power electronics applications -as an inverter-
heart attack to the specialist. However, automatic
to control DC motors. In Figure there are the
control of the defibrillator from a remote unit
schematics that describe the operation of a generic
appears as a limitation at the time of heart attack.
H-Bridge. From those is also evident the name
Incase data packets are transferred incorrectly or a
origin, in fact the circuit representation resemble
failure occurs in this transfer, repetition of transfer
an”H”.
request causes instant delays in communication. For
this reason, a delay occurs for the computer-
controlled remote control of the defibrillator. The
timing errors at the time of defibrillation give rise to
different arrhythmias instead of placing the heart
into normal rhythm. In such a situation, it is
impossible for the patient to survive. It is impossible
for semi-automatic defibrillator devices to work
An H-Bridge is built with four switches. As we can independently from an expert or a healthcare team.
see in Figure by opening and closing them in a In critical situations, the specialist intervenes in the
controlled manner, it is possible to revert the current patient on telephone communication with the
flowing through the load. Thus, closing Φ1 switches medical team waiting by the patient. Despite this
while Φ2 are still open, a positive voltage will be limitation, Automatic External Defibrillators
appied across the load. By opening Φ1 switches and (AEDs) are capable of automatic or semi-automatic
closing the Φ2 ones instead, a negative voltage will decision-making and improving arrhythmia rapidly.
It is not necessary for the user to be trained in manual
defibrillators as well as in ECG and arrhythmias.
The user attaches the electrodes to the body, turns on
be applied, reverting the current. As a last the AED, and signal-processing circuits decide
observation, it is extremely important to notice that whether or not it is necessary to perform a
closing both Φ1 and Φ2 switches in the same branch defibrillation. The user follows the ECG signal on
will cause a short circuit with devastating effects. To the monitor and watches the process. It is not
ensure that this would never happen I used possible to use automatic AEDs manually. In semi-
redundant controls on Φ1 and Φ2 piloting signals, automatic models; however, the confirmation of the
and a short pause between voltage reversions – specialist is required for the process. Another

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 Journal Publication of International Research for Engineering and Management (JOIREM)
Volume: 10 Issue: 04 | june-2023

limitation is that the connections of the defibrillator [6] Jacopo ferretti a , Licia di pietro a , Carmelo de
are carried out by the patient or by his/her relatives. maria "Open-source automated external defibrillator
People like relatives of patients, firefighters, " Department of Ingegneriadell’Informazione,
policemen, hostesses, and airport employees must be University of Pisa, Italy
trained for using such devices. It is recommended
[7] Sunil kumar, Gurmohansingh, Manjit
that Automatic External Defibrillators are
kaur"FPGA Implementation of Electrocardiography
commonly available in places where people exist in
(ECG) Signal Processing " ACS Division, Centre for
crowds like airports, airplanes, shopping centres,
Development of Advanced Computing (CDAC),
stadiums, entertainment areas etc
Mohali, 160071, India.
VII. REFERENCES
[8] Tomoya Shirane Bristol-Myers Squibb “A
[1] Paulo barbosa and Yang medeiros" A MODEL Course in Electrical and Electronic Measurements
FOR ARCHITECTURE CENTRIC and Instrumentation”, 18th revised and enlarged
DEVELOPMENT OF AUTOMATED edition by A.K Sawhney, Dhanpat Rai & Co., 2009
EXTERNAL DEFIBRILLATORS ". Electrical pp. 1130-1132.
Engineering Department Federal University of
[9] Peter Magnusson, Joseph V. Pergolizzi and Jo
Campina Grande Campina Grande, PB. Brazil;2015.
Ann LeQuang “A Designer’s Guide To
[2] Karim meddah , Malika kedirtalha, Mohammed Instrumentation Amplifiers “, 3rd ed. by Charles
bahoura , Hadjerzairi"FPGA BASED Kitchen and Lew Counts, Analog Devices Inc., 2006
SYSTEMFOR HEART RATE MONITORING" Chapter 1 pp. 1-9.
Department of electronics and computer science,
university of sciences and technology
houariboumediene, usthb, bp32 el alia 16111
babezzouar, algiers, algeria, 2019.

[3] Yanqi huang, Xin wen, Jianfei wang, Lian jin, li

qian, and Xiaomeiwu" Toward Miniaturization of
Defibrillators: Design of a Defibrillation
Charge/Discharge Circuit"

[4] Bambang guruhirianto, Tri bowoindrato"Design

of DC Shock Simulator " Journal of Electronics,
Electromedical, and Medical Informatics (JEEEMI)
Vol. 1, No. 2, October 2019

[5] Avishek paul and Jahnavijha. "ECG Signal

Acquisition and Processing System "Department of
Applied Electronics and Instrumentation, Techno
India College of Technology, Rajarhat, Kolkata,
West Bengal, India (Received 15 October, 2013
Accepted 01 December, 2013).

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