Bioinstrumentation II
Lecture 4: ECG Machine
Hundessa Daba & Stephen Dria
ECG Basics
• ECG or EKG is an instrument used to record electrical activity of
heart from the surface of body
• Conductive tissues in the heart
Sino-atrial (SA) node
Internodal tracts
AV node
Bundle of His
Purkinje fibers
Purpose: To diagnose the condition of heart muscle and its nerve
system and for continuous monitoring on patient monitoring machine.
Gives valuable information about various cardiac disorders
Anatomy of Heart
How it works
• 10 electrodes placed on the patient body ( 6 on chest and four
on arm and leg)
• The device measures potential difference between selected
electrodes
• The resulting characteristics ECG tracing will be displayed or
printed
ECG Waveform Features
P: Atrial depolarization
QRS: Ventricular depolarization
T: Ventricular repolarization
Typical heart rate: 72 BPM
Amplitude range: 0.5 to 4mV
Frequency range: 0.01 to 250HZ
ECG Intervals
The square box helps to
calculate the duration
and amplitude
In addition to the 4
intervals , there are two
segments
Disorders
• Sinus tachycardia
• Sinus bradycardia
• AV Block
• Premature contraction
• Ventricular fibrillation
Lead configuration for ECG measurement
• Bipolar leads (Lead I, II and III)
• Augmented leads(aVR, aVL and aVF)
• Unipolar or chest leads( V1, V2,V3,V4,V5,V6)
Einthoven’s triangle
Augmented lead: aVR
Unipolar chest leads
v1: fourth intercostal space, at right
sternal margin.
v2: fourth intercostal space, at left
sternal margin.
v3: midway between v3 and v4.
v4: fifth intercostal space, at mid
clavicular line.
v5: same level as v4, on anterior
axillary line.
v6: same level as v4, on mid
axillary line.
Main Parts of ECG machine
Major Components
• Leads • Power Cable
- Electrodes
• Power inlet
- Connecting wires
• Fuse
- ECG Cables
• On/off Switch
• Printing
• Socket
Mechanism/display
• Circuit Board/Control Board Screen, or:
• LCD Display • Motor
• Keypad • Gears
• Power Supply • Stylus
Leads
o Electrode with connecting wires to interface with ECG
machine
o Electrodes often use Ag or Ag-Cl for conduction
• 2 Types: Disposable or Reusable
• Most common source of error/malfunction
Electrode: Disposable
• Often have adhesive for good
connection
• Look like large buttons, snap
onto reusable connecting wire
• Disposable leads cannot be
used more than once
(conducting solution dries and
causes poor signal)
• Cannot be returned to original
state
Electrodes: Reusable
• Welch cup or Plate electrode
• Welch cup: suction bulb with
cup-shaped metal
• Plate electrode: large plate
tied secured by large rubber
belt or clip
• Should have conducting gel
or saline between metal and
skin
• Disinfect before & after each
use and before inspection
Connecting wires
• Snap onto electrode
• Wire with shielding; unshielded at the patient end of the wire
for several inches
• Common point of break – users should handle wires with care
to lengthen lifespan of wire/cables
• Can repair breaks in the unshielded portion
ECG cable
• All lead wires connected to a single shielded cable, which
plugs into socket
• Common point of break – users should handle wires with
care to lengthen lifespan of wire/cables
• Difficult to repair if the location
of break is here
Socket
• Interface between leads and ECG machine
• Plug the ECG cable into socket
• Damaged socket a common problem
Circuit board
• Isolates ECG lead inputs
• Amplifier
• Processor
• Inputs/outputs to
- LCD display,
- keypad, and
- display screen or printer
LCD Display
• Indicates to user which leads are being printed/displayed,
patient information, and other inputs for/from the keypad
• Not to be confused with the ECG display or printout
Keypad
• Select lead(s) to display or print;
• Input patient information
• Some allow printing speed or gain
adjustment
Power inlet & Fuse
• Removable casing
• Fuse a common problem as many devices have no circuit
breaker
Display
• Can display either by a CRT screen or printout
Printing mechanism
• Printout types:
• Thermal paper (most common)
• Ink (less common)
• Clay (very rare)
• Wax (very rare)
• Printout mechanism requires constant
maintenance
Common problems
1. Poor ECG readout
A. Poor conduction with patient’s skin
1. Ensure not reusing disposable electrodes
2. Apply ECG gel or saline (or tap water, if neither is available) between skin and electrode
3. Ensure good contact
a. Clean skin & electrode
b. Shave hair at location of electrode
c. If corrosion on electrode, clean off corrosion or replace
d. If Welch cup bulb, make sure there is good suction
e. If plate electrode, may need to tighten belt
f. Reposition electrode
4. Don’t place electrode on scar tissue
Common problems
B. Lead wire damage
1. Confirm by exchanging lead wires with working lead
2. Find the location of wire breakage by wiggling the length of the wire while reading data
a. Replace or repair
C. Socket damage (can be confirmed if same problem for multiple lead sets)
a. Replace or reconstruct socket
b. If cannot replace/repair (and device is needed) solder ECG leads to machine
D. Interference from other electrical signal
1. Ensure electrodes from same or different devices are >5cm apart
2. Unplug ECG and run from battery supply or plug into different AC outlet (AC current or poor AC ground may be
offsetting or creating artifacts in signal)
Common problems
2. No trace appears
A. Incorrect brightness settings (display screen models)
1. Select correct settings & consult user manual
B. Stylus positioning is too far from paper
1. Reposition stylus
C. Heat setting for stylus is too low (thermal print models)
1. Increase heat setting (consult user or service manual)
D. Bore tubing from ink supply may be blocked (ink print models)
a. Flush tubing with alcohol (very messy)
E. Ink supply out (ink print models)
1. Replace ink cartridge or refill ink supply (not all inks may work well)
F. Power supply issues
1. Ensure battery is charged or plug into AC supply
2. Other typical power supply troubleshooting
Common problems
3. Trace is too wide
A. Heat setting for stylus is to high (thermal print models)
B. Stylus positioning applies too much pressure to paper
1. Reposition stylus
C. Stylus has worn unevenly (ink print models)
1. Run the stylus over very fine emery paper 2 or 3 times
D. Stylus has picked up pieces of lint (ink print models)
1. Clean tip of stylus with lint-free cloth
Common problems
4. Printing feed problems (can also result in poor trace)
A. Ensure paper is loaded correctly (check user manual)
B. Paper roller may be out of place or uneven
Repair or replace paper roller
5. Incorrect trace appears/wrong settings
A. User error in setting selection (many devices can have complicated settings)
1. Review user manual for proper setup, setting selection, and use of the device
6. Device does not turn on
A. Check power inlet and fuse
Replace fuse if necessary
B. Repair poor connections
C. Check voltage requirement
D. Normal power troubleshooting
