Shahjalal University of Science and

Technology
Department of Electrical and Electronic
Engineering
EEE 408

Design and Implementation of 12-Channel

Electrocardiogram Device

Students

Md. Ragib Shaharear Md. Farhanul Islam

Reg. No.: 2012338016 Reg. No.: 2012338038
4th year, 2nd Semester 4th year, 2nd Semester
Dept. of Electrical & Electronics Dept. of Electrical & Electronics
Engineering Engineering

January 6, 2018
 Certificate of Approval
The thesis titled Design and Implementation of 12-Channel Electrocardiogram Device
submitted by Md Ragib Shaharear and Md Farhanul Islam, Registration No.: 2012338016
and 2012338038. Session: 2012-13, has been accepted as satisfactory in partial fulfill-
ment of the requirement for the degree of Bachelor of Science in Electrical and Electronic
Engineering on 8th January.

Chairman of Exam Committee Supervisor

Dr. Muhammed Zafar Iqbal Md Saiful Islam
Professor & Head Assistant Professor
Department of EEE Department of CSE
 Declaration
It is hereby declared that this Thesis Title: Design and Implementation of 12-Channel
Electrocardiogram Device or any part of it has not been submitted elsewhere for the
award of any degree or diploma.

Supervisor
Md Saiful Islam
Assistant Professor
Department of CSE
.

Author 1 Author 2
Md Ragib Shaharear Md Farhanul Islam
Reg. No: 2012338016 Reg. No: 2012338038
Department of EEE, SUST Department of EEE, SUST
Session : 2012-13 Session : 2012-13
 Acknowledgements

We would be very grateful to our thesis supervisor Dr Refat Kibria and Md Saiful
Islam for their valuable guidance and inspiration. Our work flow becomes smooth by the
weekly meeting arranged by them.
We would like to thanks to all the students of department of Electrical & Electronics
Engineering , department of Computer Science & Engineering, department of Software
Engineering and some other school going students and general people who help us by
giving their ECG signal data. Our thesis might be uncompleted if we didn’t get their data.

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 Abstract

Heart disease is a very common disease in all over the world. One is six death is caused
for cardiovascular disease[1]. According to the latest WHO’s (World Health Organization)
data published in may 2014, coronary heart disease deaths in Bangladesh reached 50,708
or 6.96% of total deaths. People have to check electrocardiogram (ECG or EKG) in the
different diagnostic center to know the electrical activity of the heart. It is very costly for
the most of the people of our country. To make it cost effective we planned to make an
ECG machine, that will give an instant update if any abnormalities are found and will give
a comment if it is necessary to contract with a doctor. To make it possible, we began to
work on Electrocardiogram device. As the ECG signal is a very low voltage (10µV to
5mV whose typical value is 1mV ) signal, which is multiple times bellow the noise level,
so we designed different types of filters and amplifiers to remove the unexpected signal
and to amplify the desired ECG signal. The goal of this thesis is to make a cost-efficient
electrocardiogram device that will give an instant update about the heart activity.

Keywords: Electrocardiogram (ECG), Heart disease, Electrodes, Amplifier, Filter, Sig-

nal Analysis, Software development, Android app.

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 Contents

Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II
Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III
List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VI

1 Introduction 1
1.1 ECG Signal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.1 What is an ECG? . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.2 How an ECG signal is detected ? . . . . . . . . . . . . . . . . . . 3
1.2 Limb Leads and Augmented Limb Leads . . . . . . . . . . . . . . . . . 3
1.3 Precordial Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.4 Motivation to work for ECG . . . . . . . . . . . . . . . . . . . . . . . . 5
1.5 Synopsis of our work . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2 Background and Related Work 7

3 Biological Significance 9
3.1 The First Recording of Electrocardiogram . . . . . . . . . . . . . . . . . 10
3.2 Electrocardiogram Details . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.2.1 Conducting System of Heart . . . . . . . . . . . . . . . . . . . . 15
3.2.2 Heart Function . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

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4 System Design and Simulation 18
4.1 General Topology of Design . . . . . . . . . . . . . . . . . . . . . . . . 18
4.1.1 Patient Protection . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4.2 Designing Amplifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.2.1 Input Buffer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.2.2 instrumentation Amplifier . . . . . . . . . . . . . . . . . . . . . 20
4.2.3 Non-inverting Op-Amp Amplifiers . . . . . . . . . . . . . . . . 21
4.3 Designing Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.4 Wilson’s Central Terminal (WCT) . . . . . . . . . . . . . . . . . . . . . 25
4.5 Right Leg Drive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
4.6 Sudden Voltage Drift Correction . . . . . . . . . . . . . . . . . . . . . . 28
4.7 DC voltage level correction . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.8 Input Signal Controller . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.9 Complete Circuit Diagram . . . . . . . . . . . . . . . . . . . . . . . . . 34

5 Practical Hardware Implementation 36

5.1 Components used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
5.2 Designing PCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

6 Software and Android App Development 45

6.1 Data Collection and transmission . . . . . . . . . . . . . . . . . . . . . . 45
6.2 Software Development . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
6.2.1 filtering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
6.2.2 Peak detection and heartbeat rate calculation . . . . . . . . . . . 47
6.2.3 Signal Pattern Matching . . . . . . . . . . . . . . . . . . . . . . 47
6.2.4 Graphical user interface design . . . . . . . . . . . . . . . . . . . 50
6.3 Android App Development . . . . . . . . . . . . . . . . . . . . . . . . . 51

7 Result and Comparison 52

7.1 The Final Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

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 7.1.1 Comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
7.1.2 Doctor’s comment . . . . . . . . . . . . . . . . . . . . . . . . . 56

8 Conclusion 58

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 List of Figures

1.1 ECG signal[2] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.2 Limb leads and augmented Leads[3] . . . . . . . . . . . . . . . . . . . . 3
1.3 Precordial Leads[4] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

3.1 Einthoven First ECG Recording Part 1[5] . . . . . . . . . . . . . . . . . 10

3.2 Einthoven First ECG Recording Pat 2[6] . . . . . . . . . . . . . . . . . . 11
3.3 First step of developing ECG[7] . . . . . . . . . . . . . . . . . . . . . . 12
3.4 Heart Four Chamber Picture[8] . . . . . . . . . . . . . . . . . . . . . . . 14
3.5 Heart Picture[9] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

4.1 Single Channel Block Diagram . . . . . . . . . . . . . . . . . . . . . . . 19

4.2 Buffer circuit diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.3 Instrumentation Amplifier . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.4 Non-Inverting Op-Amp amplifier . . . . . . . . . . . . . . . . . . . . . . 21
4.5 Sallen-Key Low-Pass Filter . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.6 Band Pass Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4.7 Without filter (simulation) . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.8 With filter (simulation) . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.9 Wilson Central Terminal Circuit . . . . . . . . . . . . . . . . . . . . . . 25
4.10 Right Leg Drive Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
4.11 Oscilloscope data Without RLD . . . . . . . . . . . . . . . . . . . . . . 27
4.12 Oscilloscope data With RLD . . . . . . . . . . . . . . . . . . . . . . . . 27

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4.13 Integrator Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4.14 Sudden Voltage Drift . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.15 Sudden Voltage Drift Removed . . . . . . . . . . . . . . . . . . . . . . . 29
4.16 Voltage Summer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.17 Voltage Summer Simulation Graph . . . . . . . . . . . . . . . . . . . . . 31
4.18 Input Signal Controller Circuit . . . . . . . . . . . . . . . . . . . . . . . 32
4.19 Complete circuit diagram . . . . . . . . . . . . . . . . . . . . . . . . . . 34

5.1 Some components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

5.2 Arduino Mega 2560 Rev3 . . . . . . . . . . . . . . . . . . . . . . . . . 37
5.3 Bluetooth Module, HC-05 . . . . . . . . . . . . . . . . . . . . . . . . . 38
5.4 Electrocardiogram Leads . . . . . . . . . . . . . . . . . . . . . . . . . . 38
5.5 Input Controller PCB layout . . . . . . . . . . . . . . . . . . . . . . . . 39
5.6 Amplifiers and Filters PCB layout . . . . . . . . . . . . . . . . . . . . . 40
5.7 Voltage summer PCB layout . . . . . . . . . . . . . . . . . . . . . . . . 40
5.8 3D view of Input handler . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.9 3D view amplifier and filter . . . . . . . . . . . . . . . . . . . . . . . . 41
5.10 PCB top view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
5.11 PCB bottom view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
5.12 Components added on PCB . . . . . . . . . . . . . . . . . . . . . . . . . 43
5.13 Components added on PCB . . . . . . . . . . . . . . . . . . . . . . . . . 43
5.14 Complete device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

6.1 Android App showing data from the device . . . . . . . . . . . . . . . . 46

6.2 Signal Peak detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
6.3 Creating Dataset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
6.4 Rescaling user’s data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
6.5 83.72% match found to the database . . . . . . . . . . . . . . . . . . . . 49
6.6 User Interface of the control section . . . . . . . . . . . . . . . . . . . . 50

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6.7 Complete 12 channel graph with with pattern matching and controlling GUI 50
6.8 Start screen and the signal graph in the android app . . . . . . . . . . . . 51

7.1 Complete 12 channel graph with with pattern matching and controlling GUI 53
7.2 Commercial machine’s output graph . . . . . . . . . . . . . . . . . . . . 54
7.3 Final output graph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
7.4 Comparison between 1st 6 channels data . . . . . . . . . . . . . . . . . . 55
7.5 Comparison between last 6 channels data . . . . . . . . . . . . . . . . . 56
7.6 Comment from the doctors . . . . . . . . . . . . . . . . . . . . . . . . . 57

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 Chapter 1

Introduction

Now a days people are getting sick with different kind of diseases. Medical science is
also improving day by day. The global burden of disease estimated that about 29.6% of all
deaths worldwide(15616.1 million deaths) were caused by Cardiovascular diseases[10].
Cardiovascular diseases are one of the leading diseases in the world. Myocarditis is caused
due to inflammation ofthe heart muscle[11]. According to the 2012 report of WHO about
the cardiovascular diseases results in 7.4 million deaths globally. So it is a concerning issue
for medical science. An unhealthy diet, lack of exercise, being overweight and smoking
are the main reasons for cardiovascular diseases. Cardiac arrhythmia, defined as abnormal
heart rhythms, is a very common type of CVD and is thought to be responsible for most
of the sudden cardiac deaths that occur every year[12].
To know any kind of abnormality of the heart, people need to do ECG. But ECG
machine is available in only a few hospitals in our country.
So, people sometimes feel problem for ECG testing. In order to make it accessible
and portable, we developed an Electrocardiogram device, which will be cost efficient and
helpful for poor people of Bangladesh.

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1.1 ECG Signal

1.1.1 What is an ECG?

ECG (Electrocardiography) is a very sophisticated process to measure the electrical

activity of the heart over a certain period of time. ECG is a bipolar and very weak sig-
nal[13]. The normal frequency of the signal is 0.05-100Hz [14]. An ECG shows the
electrical activity of heart as line tracking on paper. The graph is plotted in the paper is
voltage versus time graph. Normally ECG is recorded for 10 seconds. The most straight-
forward measure of these changes is the heart rate variability(HRV), is a small variations
of beat duration[15]. Electrocardiogram is a graph of voltage versus time.An ECG signal
is consist of various parts such as P wave, QRS complex and T wave which are waveforms
of various electrical activity of various part of the human heart[16].

Figure 1.1: ECG signal[2]

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1.1.2 How an ECG signal is detected ?

ECG signal is a very weak signal. Its amplitude ranges from 10µV to 5mV. At the same
time, there will be some noises. That’s amplitude is about 50mV. To measure the heart’s
electrical potential ten electrodes is placed in different part of the body. The magnitude
of the heart of electrical potential is measured from 12 different angles. So we called
it 12 Channel or 12 Lead ECG. There are three kinds of leads. They are Limb Leads,
Augmented Limb Leads and Precordial Leads.Modern electrocardiography is based on
the traditional Einthoven-Wilson model[17].

1.2 Limb Leads and Augmented Limb Leads

Figure 1.2: Limb leads and augmented Leads[3]

The upper three pictures are the picture of Limb Leads. Limb leads are divided into
three parts, Lead I, Lead II and Lead III. To measure the electric potential of heart, for the
lead I left arm is considered as the positive pole and right arm is considered as the negative
pole. For lead II left leg is considered as the positive pole and right arm is considered as

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the negative pole. For lead III left leg is considered as the positive pole and left arm is
considered as the negative pole.
The lower three pictures are the pictures of Augmented Limb Leads.There are three
kinds of Augmented Limb Leads. They are Augmented Vector Foot (AVF), Augmented
Vector Left(AVF), Augmented Vector Right(AVR).For Augmented Vector Foot (AVF)
Left Leg has the positive electrode and the average voltage between Left Arm and Right
Arm are considered as the negative pole. For Augmented Vector Left (AVL) Left Arm
has the positive electrode and the average voltage between Left Leg and Right Arm are
considered as the negative pole. For Augmented Vector Right (AVR) Right Arm has the
positive electrode and the average voltage between Left Leg and Left Arm are considered
as the negative pole.

1.3 Precordial Leads

Figure 1.3: Precordial Leads[4]

Precordial leads are perpendicular to others six leads. Here Wilson’s central terminal
(WCT) is considered as the negative pole. Wilson’s central terminal is the average voltage

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of left leg, left arm and right arm. Wilson’s Central Terminal can be written as,

1
V w = (RA + L A + LL) (1.1)
3

And V1, V2, V3, V4, V5 and V6 are considered as positive electrodes to measure the
electrical potential of heart. In the 12 leads ECG, Limb leads are considered as bipolar
leads as here one electrode is positive and another one is negative. And the rest of the nine
leads are considered as unipolar leads because there one pole is considered as the common
voltage.

1.4 Motivation to work for ECG

ECG machine was invented in 1901 by Willem Einthoven. It was a very great inven-
tion.He used P,Q,R,S and T letters to determine different wave pattern of heart to know
the condition of heart.This pattern is still using. We can detect any king of abnormality
by using these patterns. According to WHO 2012 report,about cardiovascular diseases
results in 7.4 million deaths globally.
In the developing country like Bangladesh, the electrocardiograph machine is not
available.So we started to make a cost effective ECG machine that will be very sophis-
ticated and useful for people of all ages. Our machine can be used at the rural areas of
Bangladesh where electricity is not found.It can be used for instant ECG testing and people
will know about the heart condition instantly and we will include a digital display that will
show a comment for the instant testing report.Our main goal is to make a cost effective 12
channel ECG machine with appropriate data analysis.

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1.5 Synopsis of our work
In the first chapter we discussed about the basic of ECG signal,the definition,How
ECG works using different leads and the motivation to work with ECG signal.
In the second chapter background and related work is discussed, the research of ECG
was very ancient it started at England and many researchers then continued their research
work about ECG and now it is more and more developed.
In the third chapter the full biological significance of ECG is discussed. First electro-
cardiogram recording procedure,Functions of four chambers of heart and how the doctors
detect abnormality from the ECG tracing paper.
In the forth chapter design and simulations work are discussed.We had designed dif-
ferent kinds of filters for noise reduction and used instrumentation amplifier for amplifi-
cations and because of its high common mode rejection ratio.
In the fifth chapter we discussed about the practical implementation procedure of our
design and different difficulties we faced during to implement this design successfully.
In the sixth chapter we discussed software and android application development pro-
cedure. To make our ECG device portable we designed a android application so that we
could see real time data graph of ECG in an android application.
The seventh chapter is named Result and comparison.We compared our machine result
with the commercial machine and we seen it to doctors and doctors gave their opinion
about the accuracy of the graph data.
In the eighth chapter we gave a short conclusion of our overall design,working proce-
dure and future work thinking of our thesis.

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 Chapter 2

Background and Related Work

ECG is a very low amplitude biosignal and it can be easily corrupted by other sig-
nals[18]. There are lots of works done in the last 25 years about the ECG signal analysis.
And recently many work is going in Europe and America about for ECG performence
analysis.
In 1901 Willem Einthoven who is a physician and physiologist first invented ECG
machine. He studied many about many clinical matters and observe his machine perfor-
mence by testing different animals ECG and finally he gave a decidation about theoretical
decision from ECG to heart.Because of his theoritical framework he received nobel prize
in 1924, from the time different companies began to make and sell the ECG machine by
using the idea of Willem Einthoven.
Willem Einthoven first gave a theory that heart is an elecric generator and acts as
a dipole. He gave us a idea about Einthoven triangle which is very popular in medical
science. In the furter Einthoven gave a low which is known as Einthoven’s law.In those
days the term lead has a special meaning that the voltage difference between the electrodes.
If a lead 1 is connected at the left leg , lead 2 to is connected at the left arm and lead 3 is
connected at the right arm. then lead 1 +lead 3 =lead 2. This law is known as Einthoven’s
law.
The shape of nurve fiber and muscle fiber is cylindrical. When we are busy with dif-

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ferent types of works then the fiber become active and they creat a potential that propagate
through the cylinder with a certain velocity. Because of this potential a current is produced
and it is assumed this is created because the potential creats a dipole.
The cardiac muscle cells are connected in a way that it is considered a cell is like
a structure that is full of nuclei. When a active signal propagates through the heart a
waveform is found on the suface of body named QRS complex. When the excitation is
recovered then depolarization is found and this depolarization create T wave.
In the year of 1920 South African William H. Craib started his research in the field
of muscle preparations in the spherical conductor. In his experiment he found that the
validity of Einthoven’s concept of dipole.
From this time various research related word started in the advance countries 13 years
later in the year of 1933 Frank N. Wilson get success for the theory to relate current source
from heart to external, unipolar and potentials.
In modern days 12 leads ECG is developed.The 12-lead ECG is so called because
produces twelve ECG signals from ten electrodes: a reference electrode placed on the
right leg (RL), and nine exploring electrodes of which three are placed over the limbs, on
the right arm (RA), left arm (LA) and left leg (LL); and six electrodes are placed over the
torso near the heart often addressed as precordials (V1 to V6)[19].

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 Chapter 3

Biological Significance

Man are very curious about knowledge todays Invention is a clear indication that some-
one started the journey many years ago. In the 19th century the physician played a vital
role to discover many new things that was helpful to change the world. First of all the dis-
covery of chest X-ray and then the electrocardiogram device added a new dimensions in
the technology. The starting of thinking about ECG machine was very ancient. It started
at 17th century, there was a physician named William Gilbert who was in the service of
Queen Elizabeth I, He is the creator of magnetic philosophy and he first used a term named
‘Electrica’ and a concept of static charge . After 46 years later Sir Thomas Browne used
the term ‘Electricity’ and he defines it for those objects that have the power of attracting
something. William Gilbert gave the concept of static electric charge and Otto Von Guer-
icke generated the static electric charge for the fist time. Dr. Luigi Galvani he first saw the
electrical current could be recorded from muscles. He also measure the electrical activity
from dissected muscles.
A legendary work done by Swammerdam , he first remove the heart of a frog and saw
that the frog was still alive. After about 250 years later British physiologist Augustus D.
Waller first published the human electrocardiogram. He recorded the electrocardiogram
by using a capillary electrometer. Then many research went on about Capillary electrom-
eter and finally British physiologists William Bayliss and Edward Starling They connect

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the terminals to the right hand and to the skin over the apex beat and show a ”triphasic
variation accompanying (or rather preceding) each beat of the heart”. These deflections
are later called the P, QRS and T signal.

3.1 The First Recording of Electrocardiogram

At the year of 1895 Einthoven used a developed electrometer and a correction formula
to separate five deflections. He named the deflections ABCDE. To specify a perfect In-
ertia, he followed a mathematical correction which brought the curve we see today. He
maintained a mathematical tradition Introduced by Descartes he used the name of termi-
nals PQRST.

Figure 3.1: Einthoven First ECG Recording Part 1[5]

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 Figure 3.2: Einthoven First ECG Recording Pat 2[6]

String Galvanometer was improved a lot to make it more practical, at the early age
five electrodes was used to record the electrocardiogram, four in the edge and one in the
mouth. By using different combinations formula Einthoven was able to discover 10 lead
electrodes to measure the electrocardiogram. In this method the heart signal was measured
from ten different angles. Einthoven was able to reduce the number of electrodes to three
by using Einthoven Triangle formula. And this was very big Invention for modern science
and Einthoven received noble prize for this invention. The three lead electrocardiogram
was very popular when it was made portable.

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 Figure 3.3: First step of developing ECG[7]

Although the abnormal rhythm was detected by using three leads but there was a my-
ocardial Infarction that can not be detected. To remove this Dr. Frank N. Wilson first
developed a concept of central terminal by connecting the three limb electrodes, a refer-
ence ground terminal was created. By using this central terminal an electrode connected
in the body can measure the potential difference between body and ground. There were
two kinds of leads, the unipolar leads and the bipolar leads. The unipolar leads can be
placed at any part of the body and was named as exploring leads. The American Heart
Association and the Cardiac Society of Great Britain research and gave opinion to place
the exploring leads from six sites named V1 through V6 across the precordium.
This was the starting of using chest leads. Three leads electrocardiogram was helpful
to cover the frontal plane with 60 increment. But there was some segments that was not

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covered and because of this electrically silent myocardial pathology. Using the central
terminal as reference or zero voltage and connected the additional positive unipolar leads
to left arm , right arm and right leg. This method was helpful because it covers the frontal
plane with 30 degree increments. Goldberger designed a to process to augment these
signals and he named these as augmented unipolar limb leads a-VL, a-VR, and a-VF. In
this process the bipolar leads cover the frontal plane with 60 degree interval and unipolar
lead cover the frontal plane with 30 degree increments.

3.2 Electrocardiogram Details

Electrocardiogram is a very quick, safe and painless process :

• It check the heart rhythm of our heart.

• It will check if there is any shortage of blood in the heart and oxygen of the heart.

• If there is any chance of heart attack of the patient.

• Check things that are abnormal.

The heart has itself four chambers : the right and left atrium , the right and left ventricle.
The right portion of heart collect blood from the body and pumps it to the lungs and left
side of the heart receive blood from the lungs and then pumps it to the body.

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 Figure 3.4: Heart Four Chamber Picture[8]

Blood flowing process through the body : Using the pulmonary veins oxygen rich
blood from the lungs enter the left atrium. Blood then flows to the left ventricles where it
is pumped through the aorta and supply the blood throughout body. This blood supplies
organs and cells with oxygen. Blood that return to the heart is exhausted of oxygen and is
full of carbon dioxide and waste product of metabolism then the blood enter to the right
atrium by the help of vena cava and then it is pumped to right ventricle. The right ventricle
pump the blood by using pulmonary artery to lungs where the carbon dioxide mixer blood
is removed, oxygen is replaced and the cycle begins again.

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 Figure 3.5: Heart Picture[9]

Heart needs oxygen and nutrients same as muscle to perform. Arteries that is originate
from the aorta it is helpful to supply Oxygen and nutrients. Then these vessels are spread
out to supply oxygen rich blood throughout all regions of the heart.
In the sense of Electrical knowledge , the heart can be divided into two parts : Upper
and lower chambers. An electrical impulse that is generated in the upper chamber of the
heart, That helps atria to become compress and allow blood to flow through the ventricles.
There is a delay to allow ventricles to fill with blood. The ventricles then contract to pump
blood to the body and lungs.

3.2.1 Conducting System of Heart

The heart itself has its own pacemaker called sinoatrial or SA node which is situated in
the right atrium. The heart works independently as a part of brain which generate electric-
ity for the heart to beat. The impulse generated by sinoatrial node go through the heart’s
electrical grid and its give signal to the muscular cell which is situated in the atria to build
simultaneously. In the mean time coordinate squeeze of the heart is running fully and be-
cause of this contraction atria pushes blood to the ventricles. The electrical signal which
was generated in sinoatrial node travel through a junction box between atria and ventricles
and there is a delay time of few microseconds to allow the ventricles full with blood.

-15-
 After that the electrical signal travels through the ventricles and it stimulates heart
muscle cells to contract. Ventricular contraction pumps blood to the body from left ven-
tricle and lungs from the right ventricle.And there is a short time allocated to return blood
to the heart and fill before the electrical cycle repeat for the next heartbeat.

3.2.2 Heart Function

Electrical leads that are situated in the chest can detect electrical impulses which is
generated from the heart. Multiple leads provide data from different point of view of
heart. By interpreting the meaning of the signal of the heart the doctors trace them in the
paper and can know about the heart rate , rhythm and blood flow to the ventricles. To
know how fast the heart beats the sinoatrial node generate an electrical impulse 50-100
times per minutes. Bradycardia(Brady=slow+ cardia=heart) can describe a heart less than
50 beats per minutes and Tachycardia (( tachy=fast +cardia=heart)) helps us to know if
the heart rate is faster then 100 beats per minutes.
Rhythm means type of heartbeat it is. Generally, the heart beats in a sinus rhythm and
impulse is generated by sinoatrial node and which causes the ventricular is being decreased
in size. We can see many abnormal electrical rhythms, some are from normal variation and
some are very dangerous. Sometimes some electrical rhythms do not produce a heartbeat
and that is one of the major cause of death.
In the heart data there are some features:

• Normal sinus rhythms

• Sinus tachycardia

• Sinus bradycardia

• Atrial fibrillation

• Atrial flutter

• Ventricular tachycardia

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 • Ventricular fibrillation

There can also be delayed in the transmission of the electrical impulse anywhere in
the parts of body such as in the SA node , the atria , the AV node . Same impulses that
are aberrant causes normal variation and some impulses are very harmful which is life
threatening. Some examples of abnormalities are :

• 1st degree AV block

• 2nd degree AV block, type I (Wenckebach)

• 2nd degree AV block, type II

• 3rd degree AV block or complete heart block

• Right bundle branch block

• Left bundle branch block

To know about the details results about the ECG, the ECG tracing paper can provide
information’s about the muscle cells are conducting electricity properly or not. By analyz-
ing the electrical signal wave the doctors can detect if there is any problems for decreasing
blood flow in the any part of the body.

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 Chapter 4

System Design and Simulation

The basic requirements of this part or the thesis is to build a stable device which can
amplify the heart signal to a measurable voltage. The electrical signal from the heart
is very low, typically which is below 1 mV. The human body act as a source of noise,
which is generally a lot more than that. Which makes very is it difficult get the actual
electrocardiogram signal. A sharp low pass filter needs to be derived to remove the noise
and only to keep the original signal.

4.1 General Topology of Design

The device consists of three main units :

1. Power.

2. Amplifiers and filters.

3. Signal processing.

The whole system has been powered by using 4 cell lithium polymer battery, which
can provide +8 volts, -8 volts with a reference of zero volt.
The signal processing unit consists of the amplifiers, buffers, noise reduction, right leg

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drive etc. Some special safety system is also required as the device will be directly con-
nected to the patient’s body.

Figure 4.1: Single Channel Block Diagram

4.1.1 Patient Protection

Patient safety is the first requirement for any kind of medical device. Generally, the
ECG leads are connected directly to the human body. So, limiting current and voltage is
the first requirement. In this device, a low voltage battery (Maximum voltage difference
16 volts) is used as a power source, which makes the system risk free for the patient. As
well as a current limiting resistor of 100k ohm is used in series with every ECG leads.
Additionally, this series connection goes to the input of an op-amp which has a very high
input impedance, which makes the current almost zero. The right leg drive output is also
passed through a 100k ohm resistor.

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4.2 Designing Amplifiers

4.2.1 Input Buffer

The input signals taken from the electrodes are very weak signal. They could be ma-
nipulated very easily by the other circuits. A buffer circuit is used in every electrode to
increase the strength of the signal.

Figure 4.2: Buffer circuit diagram

Input buffer also provide proper separation between different external circuits. Which
makes it possible to share the electrodes between the channels.

4.2.2 instrumentation Amplifier

Instrumentation amplifier is used as the primary amplifier of the device. It is a special

type of differential amplifier which dose not require any impedance matching. Addition-
ally, it has a very high common mode rejection ratio (CMRR), which is an assertional
part of this device. Unlike other differential amplifiers, the gain of an instrumentation
amplifier can be controlled by varying the value of only one resistor.

-20-
 Figure 4.3: Instrumentation Amplifier

Typically Rgain is used to control the gain, while other resistors are kept constant.

( )
V out 2R1 R3
= 1+ (4.1)
V2 − V1 Rgain R2
Vref is used for changing the output DC voltage level.

4.2.3 Non-inverting Op-Amp Amplifiers

The figure 4.4 showing a non-inverting amplifier using using op-amp TL-072. Non
inverting amplifier has very high input impedance. And most importantly there is no
feedback to the input terminal. So, the input signal dose not get affected by the feedback.

Figure 4.4: Non-Inverting Op-Amp amplifier

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 V out R2
Av = =1+ (4.2)
Vin R1
( )
R2
V out = 1 + Vin (4.3)
R1

4.3 Designing Filters

Figure 4.5: Sallen-Key Low-Pass Filter

This is very popular second order Sallen-Key Low-Pass Filter. The cut off frequency
of the filter is 33.86 Hz. The op-amp used here is for gain control and the RC elements are
used for tuning.Frequency less then 33.86Hz will become attenuate by using this circuit.
To determine the cut off frequency of the second order low pass filter following equation
is used.

-22-
 1
fc = √ (4.4)
2π R1C1R2C2

Transfer function:

1
V out(s) R1C 1 R2C 2
= ( ) (4.5)
Vin(s) s2 + s R21C 1 + R11C 1 + 1
R1C 1 R2C 2

Where, R1 = R2 = 47K and C1 = C2 = 100nF

Figure 4.6: Band Pass Filter

A low pass filter and a high pass filter in combined work as a bang pass filter. Fre-
quency between 0.15Hz to 33.86Hz can pass through that filter.

-23-
Figure 4.7: Without filter (simulation)

Figure 4.8: With filter (simulation)

-24-
 This is the simulation output signal figure 4.7.Here lots of noise is seen because there
is no filter.
The figure 4.8 is the simulation output signal when filter is added.This signal is noise
free and very smooth signal.

4.4 Wilson’s Central Terminal (WCT)

Wilson’s Central terminal is used in the Precordial leads. WCT is the average voltage
of left leg, left arm and right arm. In clinical electrocardiography, the zero-potential is
commonly defined by the Wilson central terminal. In the electrocardiographic forward
and inverse problem, the zero-potential is often defined in a different way, e.g., by the
sum of all node potentials yielding zero[20].

Figure 4.9: Wilson Central Terminal Circuit

1
V wct = (RA + L A + LL) (4.6)
3

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 Theoretically, it is located in the electrical center of heart or in the zero potential point
[21].

4.5 Right Leg Drive

The driven-right-leg circuit is used with biopotential differential amplifiers to reduce
common mode voltage so that it can reduce the unwanted noise[22]. Noises from right
arm, left arm and left leg are being averaged then they passed through a buffer circuit.
Then the noise signal is being inverted and given input to the right leg[23].The right leg
driven circuit has been used about 50 years to reduce the interference due to common
mode voltage in biopotential amplifier[24] This eliminate the body noises.

Figure 4.10: Right Leg Drive Circuit

-26-
Figure 4.11: Oscilloscope data Without RLD

Figure 4.12: Oscilloscope data With RLD

-27-
 The figure 4.11 shows the output in the oscilloscope without right leg drive circuit.
And the figure 4.12 showing the output graph in the oscilloscope with proper right leg
drive circuit. It is clear to see that the figure 4.12 has less noise compared with the figure
4.11.

4.6 Sudden Voltage Drift Correction

By this section the RLD and other filters has been implemented and the ECG signal
has been obtained. But still there are some other kind of noise. Organic part inside the
body has always some movement, which creates a sudden drift in the output.
The blue circle in the graph of figure 4.14 showing that kind of drift.

Figure 4.13: Integrator Circuit

To overcome this problem, a feedback circuit has been attached to the reference of the

-28-
instrumentation amplifier. Which is actually an integrator circuit. It integrate the changes
in output voltage in inverse order and give the feedback. The figure 4.13 showing the
integrator circuit.

Figure 4.14: Sudden Voltage Drift

Figure 4.15: Sudden Voltage Drift Removed

The figure 4.15 showing the same simulation graph shown in figure 4.14 after giving

-29-
the feedback. It is clear to see that the voltage drift has been removed.

4.7 DC voltage level correction

Figure 4.16: Voltage Summer

Analog to digital converter(ADC) can only read positive part of the of signal but the
amplified signal has both positive and negative part.So a voltage summer circuit is used.
Voltage summer circuit shift the whole signal to the positive part. Arduino Mega is used
here as analog to digital converter.

-30-
 Figure 4.17: Voltage Summer Simulation Graph

The figure 4.17 is the graph of voltage summer simulation graph. Here the red signal
is the output signal and the green signal is the input signal.Here in the output signal, there
is only positive part of the signal.

-31-
4.8 Input Signal Controller

Figure 4.18: Input Signal Controller Circuit

-32-
 In the electrocardiogram 12 graphs are generated using 10 leads only. Some leads are
used to generate multiple graph in that case. So, extracting data for multiple graph from
the same lead in the same time could cause input signal distortion. A controller circuit is
designed to overcome this problem. The controller circuit create duplicate to the original
signal through buffering and the next part of the system use those duplicate signals. So,
doing operations on any signal dose not affect any other signals.

-33-
4.9 Complete Circuit Diagram

Figure 4.19: Complete circuit diagram

-34-
 The figure 4.19 showing the complete circuit diagram of the device. A total number
of 71 op-ams and 12 Instrumentation amplifiers are used in the circuit.

-35-
 Chapter 5

Practical Hardware Implementation

After completing the design and the simulation, the hole system has been practically
implemented and tested every section individually using oscilloscope and some other mea-
suring equipments. All the components were carefully tuned to get the best result.

5.1 Components used

There are a lots of components used in total. Some important components are de-
scribed below.

• Power Supply - A 4 cell Li-Po battery is used as the source of power. The 2 cell
supply the positive voltage and the next 2 cells are used to produce same amount of
negative voltage.

• INA-118 - It is an instrumentation amplifier. It has very high Common Mode Re-

jection Ratio (CMRR). Typically, the CMRR is 130 dB.

• AD-620 - It is also an instrumentation amplifier. It has very high Common Mode

Rejection Ratio (CMRR). Typically, the CMRR is 130 dB.

• TL-072 - JFET input op-amp. It’s a dual channel low noise op-amp.

-36-
 Figure 5.1: Some components

• Arduino Mega - This is the main processor situated in the device. It is responsible
for collecting and sending data to the laptop. Figur 5.2 showing an Arduino mega
board. It is based on atmega2560 microcontroller and it’s processing speed is 16
MHz.

Figure 5.2: Arduino Mega 2560 Rev3

• HC-05 Bluetooth Module - A bluetooth module is used to transfer data from ECG
device to the android smart phone.

-37-
 Figure 5.3: Bluetooth Module, HC-05

• Resistors and capacitors - Various value’s resistors and capacitors are used in the
device to set the bandwidth of filters and amplifiers gain.

• Electrocardiogram Leads - A total number of 10 leads are used for 12 channel elec-
trocardiogram. Among them 6 leads are connected in chest and other 4 are in arms
and legs.

Figure 5.4: Electrocardiogram Leads

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5.2 Designing PCB
After completing the simulation, all of these circuits has been tested in the bread board
and then the Printed Circuit Board (PCB) has been designed.

Figure 5.5: Input Controller PCB layout

-39-
 Figure 5.6: Amplifiers and Filters PCB layout

Figure 5.7: Voltage summer PCB layout

Proteus PCB designer is used for the designing. All of them are double layer PCB.
The figure 5.5, 5.6 and 5.7 are showing the layout of designed PCB.

-40-
 Figure 5.8: 3D view of Input handler

Figure 5.9: 3D view amplifier and filter

The figure 5.8 and 5.9 are showing the 3D view of the designed PCB. This helps to
identify any mistakes before the actual printing.

-41-
 Figure 5.10: PCB top view

Figure 5.11: PCB bottom view

The figure 5.10 and 5.11 showing the top layer and bottom layer of a PCB.

-42-
 Figure 5.12: Components added on PCB

Figure 5.13: Components added on PCB

And then all the necessary components are soldered in the board. The figure 5.12
showing the full complete module of input handler and figure 5.13 showing the complete
module of filters and amplifiers.

-43-
 Figure 5.14: Complete device

And finally, after combining all the modules, the the hardware part has been completed.
The figure 5.14 showing a picture of fully completed Electrocardiogram device.

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 Chapter 6

Software and Android App

Development

6.1 Data Collection and transmission

All the analog data has been converted to the digital form using ADC (Analog to Dig-
ital Converter). Arduino mega is used here as it has 16 ADC pin on it. Data has been
recorded in a special format. An example data set is shown below,
416:408:421:532:501:562:411:408:409:356:294:354:22311
413:401:413:534:511:533:409:407:407:354:292:353:22326
407:400:416:534:530:517:410:409:409:357:292:353:22340
418:403:413:530:516:536:409:406:408:356:293:354:22354
416:406:411:533:508:541:409:406:407:355:291:352:22369
420:401:404:532:509:534:408:408:408:357:292:352:22383

Here every value corresponds to the amplitude of the output signal of a specific chan-
nel. the ’:’ is used to separate each channel data. And the last data corresponds to the time
(milliseconds).
In the example dataset, the data for channel 1 are: 416, 413, 407, 418, 416, 420. They

-45-
are the amplitude of the signal (10 bit signal) at the time 22311 to 22383 milliseconds.
So, in 72 milliseconds the total set of data taken are 6. So, in every 72/6 = 12 millisec-
ond one new dataset is received.
All of the data are processed and transmitted through an arduino board and a bluetooth
module. The desktop software and the android app receive the data and complete the
further required process.

6.2 Software Development

A software has been developed using python which can communicate with the device
and receive data. Then it do some analysis and apply some filters. And finally it shows
12 channels graph in real time.

6.2.1 filtering

Figure 6.1: Android App showing data from the device

A 10th order low pass FIR filter has been implemented. This filter makes the signal
smooth, remove any remaining noise and increase the readability. The figure 6.1 showing
the frequency response of this filter.

-46-
6.2.2 Peak detection and heartbeat rate calculation

A peak detection algorithm is used to find the peak position of the signals and identify
the times when any peak occurs.

Figure 6.2: Signal Peak detection

For the peak detection purpose, first average amplitude has been calculated for differ-
ent parts of the signal, then subtracting the averages from all of the values another signal
is found which is the signal without DC offset. The the maximum value of the signal has
been calculated. And finally another algorithm applied which find if the signal cross stay
to above the 90% of that maximum value and if the staying time is between a certain range,
the middle position of that upper 90% is considered as a peak.
Calculating the time between two peaks, the heartbeat rate can be found.

6.2.3 Signal Pattern Matching

6.2.3.1 Creating dataset

Datasets are created and each dataset is saved in a specific file. Each dataset is cropped
from a well known signal. The dataset contain all the values between any two identical
peaks. All the values are scaled to 100 data point and the maximum magnitude of 100 also

-47-
 Figure 6.3: Creating Dataset

The fig. 6.3 shows the process of creating dataset.

6.2.3.2 Rescaling user’s data

First of all the algorithm finds the values between two peaks and rescale them in the
dataset format. The x axis converted to 100 scale and the magnitude (y axis) is also con-
verted to the 100 scale.

-48-
 Figure 6.4: Rescaling user’s data

6.2.3.3 Finding match to the dataset

By comparing the value of rescaled user’s data to the datasets value, the algorithm
find out the total absolute error and from the total absolute error the algorithm find out the
parentage of match to the dataset.
Then the program repeat this task to all of the dataset stored in the database. Program
find out the best matching dataset and show the result.

Figure 6.5: 83.72% match found to the database

-49-
 If there more than 80% match to a dataset, it can be assumed that the output signal has
similar characteristic to the database signal.

6.2.4 Graphical user interface design

A simple controller GUI has been designed for the device. The fig. 6.6 is showing
the GUI of the control section. The GUI has 5 main sections for displaying and selecting
some important options.

Figure 6.6: User Interface of the control section

The first section if for choosing the filter to be used. Each filter has a different fre-
quency response. The time and BPM are shown in the second section. There is a drop-
down lint in the GUI, using that the analyzing channel can be selected. There is a button
named ”Analyze Data”, pressing that button will initiate the pattern matching algorithm
and show the pattern matching graph and details result in the fifth section of the GUI.

Figure 6.7: Complete 12 channel graph with with pattern matching and controlling GUI

-50-
6.3 Android App Development
An android app has been developed also for the device.The application can show graph
of ECG signal data in the user’s phone. It makes the device portable and simple to use. A
wearable watch which is served as portable monitor and android based system is devel-
oped[25].
Our system is more updated and smart because the heart rate in beats per minutes and
pattern matching can perform by our device.

Figure 6.8: Start screen and the signal graph in the android app

The app has basically two screen, the start screen and the signal screen. In the start
screen it gives option to connect to the appropriate bluetooth device. And in the second
screen, it shows the graph of the user’s heart activity.

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 Chapter 7

Result and Comparison

There are many algorithms for to measure the ECG data distortion. For example
weighted diagnostic distortion(WDD) is designed for comparing between original signal
and reconstructed signal and four compression algorithms (AZTEC,SAPA2, LTP, ASEC)
were used [26].There are algorithm for automatic R peak detection from a single lead digi-
tal ECG data and the square double difference signal is used for QRS region detection[27].
Some use algorithm and derivative of the signal to remove P wave and T wave from the

signal[28]. To compare data we used here Heart rate detector (HRD) algorithm and the
algorithm can detect if there is any distortion in the data graph. It works very efficiently
and people of all ages will get benefited because of its reliability and simplicity. It can
compare the graph result with previously recorded result and give a feedback if any kind
of difference is found between the the data graph. It will help the patient because patient
could know the condition of own heart and finally can make a decision if it is necessary
to go to the doctor for further checkup.

7.1 The Final Result

The software developed in python analyzed the data and show the final output result.
The result contain the real-time electrocardiogram graph, real-time BPM of the selected

-52-
channel and the matching data.

Figure 7.1: Complete 12 channel graph with with pattern matching and controlling GUI

The figure 7.1 showing the final output graph of this Electrocardiogram machine, the
real-time BPM and the graph of matching data.

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7.1.1 Comparison

7.1.1.1 Output graph of Commercial Machine and the developed machine

Figure 7.2: Commercial machine’s output graph

Figure 7.3: Final output graph

-54-
 The reading in figure 7.2 is taken from a commercial Electrocardiogram machine form
”National Heart Foundation, Sylhet”.

7.1.1.2 Side by side comparison

Figure 7.4: Comparison between 1st 6 channels data

-55-
 Figure 7.5: Comparison between last 6 channels data

The figure 7.4 and 7.5 showing the comparison with commercial ECG machine. From
these two figure it is clear to see that both machines are providing similar data.

7.1.2 Doctor’s comment

Two doctors has been requested to give some comparative feedback about the ma-
chine’s output. Dr, jubayer ahmed, MBBS, MMC said “There is not much difference.
Lines should be more smooth and thin. But will not cause any diagnostic error.”
Ashik Iqbal student of Rangpur Medical College (RpMC) said ”The small square and
large square lines are clear.For the lead I and lead II T wave is evaluated. Isoelectric line
is seen in the V1 and V2 leads and the rest of the things are okay”

-56-
Figure 7.6: Comment from the doctors

-57-
 Chapter 8

Conclusion

Analyzing the patterns of ECG signals is a vital step in detecting abnormal conditions
of the heart. Early detection of cardiac arrhythmia could avoid sudden cardiac death.
Artifacts like power line interference and muscle contraction degrades the quality of the
recorded ECG signals[29]. Our main goal is to make a digital 12 Channel Electrocardio-
gram Device with instant data analysis. For the very beginning 12 Channel Electrocar-
diogram machine has been developed. Machine had a very little amount of error. The
error is removed and we now got very smooth twelve channels data. We collected many
ECG data and added to the machine for learning so that machine can give some analytical
review. We developed a android application to make it portable and now patient can get
instant updates about their ECG report. Android smart phone is helpful because it has dy-
namic link libraries(DLL) and open GL ES graphics[30]. A software is developed using
python programming and We analyze the ECG data and detected heart rate in beats per
minutes(BPM) for clearly understanding if there is any abnormality in the signal data. The
proper performance of computerized ECG analysis is highly dependent on the accuracy of
extracted fiducial points[31]. Finally we went to doctors for checking the data comparison
graph.

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