VIETNAM NATIONAL UNIVERSITY HCMC

INTERNATIONAL UNIVERSITY
SCHOOL OF BIOMEDICAL ENGINEERING

Practice 1: Reverse Engineering

REPORT
ECG

Instructor: Dr. Nguyen Thanh Qua

Team members: Trần Đào Như Quỳnh BEBEIU24065

Nguyễn Hoàng Vân Chi BEBEIU24020
Nguyễn Hoàng Phú BEBEIU24063

Ho Chi Minh City

May, 2024
 HCMC International University – School of Biomedical Engineering

Table of Contents
I. Introduction ...................................................................................................................... 3
1. Brief History ................................................................................................................ 3
2. Application ................................................................................................................. 3
3. How to use................................................................................................................. 3
II. Working principles [3], [4], [5] ............................................................................................. 5
III. Block diagram................................................................................................................ 6
IV. Disassemble sequence ................................................................................................... 7
V. Experiment ...................................................................................................................... 8
VI. Further information ....................................................................................................... 9
VII. References .................................................................................................................. 10

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List of Figures
Figure 1. Willem Einthoven - “the father” of ECG [1] ......................................................... 3
Figure 2. Irregularly irregular ventricular rate without visible P waves [2] ......................... 3
Figure 3. The power socket is located on the side of the ECG machine ............................. 4
Figure 4. The electrodes and clips ....................................................................................... 4
Figure 5. Illustrative image of attaching the clips to the patient's arms and legs ............... 4
Figure 6. Illustrative image of placing the electrodes around the patient's chest ................ 4
Figure 7. Overview image of the ECG machine's lead wires .............................................. 5
Figure 8. Illustrative image of the electrocardiogram recording after the measurement has
been taken ............................................................................................................................ 5
Figure 9. Anatomical and physiological components behind ECG [6] ................................ 6
Figure 10. Block diagram of an ECG machine [7]............................................................... 6
Figure 11. Overview image of the ECG machine ............................................................... 7
Figure 12. Compartment for changing the ECG printout .................................................... 7
Figure 13. Inside the electrocardiogram machine .............................................................. 8
Figure 14. Details of the components in an ECG ................................................................ 8
Figure 15. Result after measuring ....................................................................................... 9
Figure 16. Overview of the normal electrocardiogram [10] ................................................ 10

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I. Introduction

1. Brief History

Willem Einthoven, a Dutch scientist, devised the electrocardiogram (ECG/EKG).

In 1901, he invented the "string galvanometer" technique, which resulted in the
ECG. In 1924, he received the Nobel Prize in Medicine, which marked a watershed
moment in contemporary cardiovascular medicine.

Figure 1. Willem Einthoven - “the father” of ECG [1]

2. Application

The electrocardiogram (ECG) is used by doctors to assess the electrical activity

of the heart when a patient presents with symptoms such as chest pain, shortness of
breath, or other signs indicative of cardiac issues. With the help of an ECG, doctors
can diagnose conditions like myocardial infarction, arrhythmias, or ischemic heart
disease. This allows for timely interventions to manage cardiovascular conditions
and prevent complications.
For example, a patient who experiences frequent palpitations may undergo an
ECG, which detects atrial fibrillation, enabling the doctor to initiate appropriate
treatment to reduce the risk of stroke.
Atrial fibrillation is a supraventricular arrhythmia characterized by electrical
disturbances and irregular atrial contractions, with ECG findings including irregular
R-R intervals (when AV node conduction remains intact), absent P waves, and
fibrillatory f waves.

Figure 2. Irregularly irregular ventricular rate without visible P waves [2]

3. How to use

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Step 1: Lie the patient down on a flat surface (e.g., a bed, etc.).
Step 2: Plug in the power source and turn on the machine.

Figure 3. The power socket is located on the side of the ECG machine
Step 3: Apply gel to the electrodes and large clips to improve conductivity.

Figure 4. The electrodes and clips

Step 4: Attach the large clips to the patient's arms and legs.

Figure 5. Illustrative image of attaching the clips to the patient's arms and legs
Step 5: Attach the electrodes around the patient's chest.

Figure 6. Illustrative image of placing the electrodes around the patient's chest
Step 6: Connect the ECG lead wires to the electrodes and clips.

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Figure 7. Overview image of the ECG machine's lead wires

Step 7: Begin the measurement.

Figure 8. Illustrative image of the electrocardiogram recording after the measurement has been taken

II. Working principles [3], [4], [5]

ECG (electrocardiography) is a technique used to assess the electrical activity

of the heart using electrodes placed to the skin. The sinoatrial (SA) node, the heart's
natural pacemaker, generates electrical impulses known as cardiac action
potentials. These signals pass via the heart's conduction system, changing the
membrane voltage of heart muscle cells (cardiomyocytes), allowing the heart to
contract and cycle. The electrical signals then travel through the surrounding
tissues to the skin's surface, where electrodes pick them up. The ECG machine
processes these impulses to generate a trace that depicts the electrical activity of
the heart.
The heart's conduction system ensures that the atria and ventricles cooperate
to properly pump blood. The process begins in the sinoatrial (SA) node, a
collection of specialized cells in the right atrium's wall near the superior vena cava.
This node produces an electrical impulse, which causes the atria to contract and
pump blood into the ventricles. After then, the impulse travels to the
atrioventricular (AV) node, where it is temporarily delayed, enabling the ventricles
to fill with blood. The signal then travels along the His bundle, splitting into right

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and left bundle branches before spreading across the Purkinje fibers in the
ventricular walls. This synchronized mechanism ensures that the ventricles
contract properly, pushing blood to the lungs and throughout the body.

Figure 9. Anatomical and physiological components behind ECG [6]

An ECG (electrocardiogram) involves carefully placing electrodes on the body
to record the electrical activity of the heart. The operation begins with electrode
implantation on the patient, who stays comfortable throughout. Electrodes are
placed to both arms, both legs, and six precise areas of the chest near the heart. A
specific gel is used to increase skin-electrode contact and reduce electrical
resistance, allowing for more precise signal detection. These electrodes measure
electrical potential changes across the body induced by the depolarization and
repolarization of heart muscle cells during the cardiac cycle. The ECG machine
then interprets these impulses and turns them into visual representations. While
traditional ECG devices used a sensitive lever to record on paper, modern
equipment displays and stores the data digitally, often on an oscilloscope.

III. Block diagram

Figure 10. Block diagram of an ECG machine [7]

Surface Electrodes: In an ECG, electrodes placed on the skin pick up the
heart’s electrical activity and send it to the machine to create a heart tracing. These
electrodes are put on the arms, legs, and chest to give different views of the heart,
helping doctors check the heart’s rate, rhythm, and any problems.
Lead selector circuit: The lead selector circuit in an ECG machine chooses
which electrodes to use to create the different views, or "leads," of the heart. It

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combines signals from certain electrodes to show how the heart's electrical activity
looks from various angles, giving a complete picture of how the heart is working.
Pre-amplifier: Makes the weak signals from the electrodes stronger so they can
be processed.
Isolation circuit: Keep the current through the electrodes at safe levels. The
amplifier's output resistance should be very low so it can handle external devices
without distorting the signal. [8]
Band-pass filter: Removes unwanted noise by only letting through signals in a
specific range that come from the heart.
Amplifier: ECG signals are very small, ranging from microvolts to millivolts.
Because they are so weak, they need to be amplified in order to be better interpreted
Band Reject filter: Blocks certain unwanted signals, like electrical
interference, without affecting the heart signals.

IV. Disassemble sequence

The electrocardiogram (ECG) machine is a rectangular device that includes a

display screen, a series of control buttons, and a compartment for inserting the
ECG paper roll.

Figure 11. Overview image of the ECG machine

When pressing the box labeled "push," you will see a recessed area for
replacing the ECG paper rolls.

Figure 12. Compartment for changing the ECG printout

After opening the outer casing, the inside of the ECG device contains complex
components. Specifically, it includes microprocessors and processing circuits, a

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power supply unit, an ECG printout machine, and a display screen. These
components are tightly and clearly connected to one another.

Figure 13. Inside the electrocardiogram machine

After removing the metal plate that holds the LCD display, we can clearly see
the MCU (Microcontroller Unit) – the core of the signal processing and control of
the ECG. It is responsible for everything from collecting sensor signals and
processing data to communicating with other components. Next, we have an
extremely important part that amplifies the heart’s electrical signals. Since the
electrical signals in the human body are very weak and prone to interference during
collection, there are white transistors that play a crucial role in filtering out noise
when measuring the heart's electrical activity. This ensures more accurate and
clearer heart measurements, making the process easier. This is one of the essential
components of the ECG.

Figure 14. Details of the components in an ECG

V. Experiment

Background knowledge [9]

The electrocardiograph shows one graph per lead, with voltage on the vertical
(Y) axis and time on the horizontal (X) axis.
The ECG paper comprises small squares (1 mm²) and bigger squares
composed of 5 small squares. Under typical conditions, 10 mm on the vertical axis

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equals 1 mV, hence 1 mm = 0.1 mV. The height of a wave is measured from its
highest point to the baseline (also known as the isoelectric line).
The paper usually moves at a speed of 25 mm/s or 50 mm/s, and 10 mm/s can
be used for longer recordings. The speed used in the experiment below is 25 mm/s.
Experiment: In this experiment, we use the ECG-9620L of Nihon Kohden to
measure a male member in our group.

Figure 15. Result after measuring

a. Result
This ECG result is normal and shows a sinus rhythm, with the following
details:
Heart rate (ventilation rate): 84 beats per minute, which is within the typical
adult range (60-100 bpm).
PR Interval: 134 milliseconds, which falls within the usual range of 120-200
ms.
QRS Duration: 84 milliseconds, which is within the normal range (70–100
ms).
QT/QTc Interval: 330/370 milliseconds, both within the normal corrected
range (QTc < 450 ms for men).
P/QRS/T axis: 60/ 67/ 33°, which are all normal electrical axes.
RV5/SV1 Amplitude: 1.635/ 0.585 mV, both are normal for a standard ECG
b. Discussion
This ECG shows no signs relating to heart problems. It indicates a healthy
heart with normal electrical activity.

VI. Further information

a. Reading ECG result

ECG records the heart's electrical signals through 12 leads, with each lead
capturing signals from a specific viewpoint. Therefore, to effectively interpret the
ECG results, it is essential to read and analyze the waves, including:

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P Wave: Represents the contraction of the atria during depolarization.

QRS Complex: Indicates the contraction of the ventricles during
depolarization.
T Wave: Reflects ventricular relaxation during repolarization.
PR Interval: Measures the time it takes for the electrical signals to travel from
the atria to the ventricles.

Figure 16. Overview of the normal electrocardiogram [10]

b. Future development
Thanks to advancements and breakthroughs in artificial intelligence, compact
and real-time ECG devices are being developed, with increasing accuracy. This
progress enables patients to actively monitor their health status. [11]

VII. References
[1]
New Scientist. (n.d.). How Willem Einthoven gave doctors a window on the
heart. Retrieved December 10, 2024, from
https://www.newscientist.com/article/2203921-how-willem-einthoven-gave-
doctors-a-window-on-the-heart/
[2]
Life in the Fast Lane. (n.d.). Atrial fibrillation – ECG Library. Retrieved
December 10, 2024, from https://litfl.com/atrial-fibrillation-ecg-library/
[3]
Respbuy. (n.d.). Working principle of ECG machine. Retrieved December
10, 2024, from https://respbuy.com/working-principle-of-ecg-machine/
[4]
Online Biology Notes. (n.d.). Electrocardiogram (ECG): Working principle,
normal ECG wave, application of ECG. Retrieved December 10, 2024, from
https://www.onlinebiologynotes.com/electrocardiogram-ecg-working-principle-
normal-ecg-wave-application-of-ecg/
[5]
Arrow Vascular. (n.d.). Principles of ECG. Retrieved December 10, 2024,
from https://www.arrowvascular.com/vpseducation/pre-trial/principles-of-
ecg.html

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[6]
Arrow Vascular. (n.d.). Principles of ECG. Retrieved December 10, 2024,
from https://www.arrowvascular.com/vpseducation/pre-trial/principles-of-
ecg.html
[7]
Berne, M. (2014, July 23). Electrocardiographs (ECG) part 3. SlideServe.,
from https://www.slideserve.com/berne/electrocardiographs-ecg-part-3
[8]
Group 03. (2013). Electrocardiography circuit design. Michigan State
University. ,from https://www.egr.msu.edu/classes/ece480/capstone/spring13/gr
oup03/documents/ElectrocardiographyCircuitDesign.pdf
[9]
Berne, M. (2014, July 23). Electrocardiographs (ECG) part 3. SlideServe,
from https://www.slideserve.com/berne/electrocardiographs-ecg-part-3
[10]
ECG Waves. (n.d.). ECG: Normal P wave, QRS complex, ST segment, T
wave, J point. Retrieved December 10, 2024, from
https://ecgwaves.com/topic/ecg-normal-p-wave-qrs-complex-st-segment-t-wave-
j-point/
[11]
Martínez-Sellés, M., & Marina-Breysse, M. (2023). Current and future use
of artificial intelligence in electrocardiography. Journal of Cardiovascular
Development and Disease, 10(4), 175, from https://doi.org/10.3390/jcdd10040175

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