ECG Acquisition and Automated Remote Processing PDF
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Rajarshi Gupta · Madhuchhanda Mitra Jitendranath Bera ECG Acquisition and Automated Remote Processing ECG Acquisition and Automated Remote Processing Rajarshi Gupta Madhuchhanda Mitra • Jitendranath Bera ECG Acquisition and Automated Remote Processing 123 RajarshiGupta MadhuchhandaMitra Jitendranath Bera Department of AppliedPhysics Universityof Calcutta Kolkata, WestBengal India ISBN 978-81-322-1556-1 ISBN 978-81-322-1557-8 (eBook) DOI 10.1007/978-81-322-1557-8 SpringerNewDelhiHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2013942977 (cid:2)SpringerIndia2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purposeofbeingenteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthe work. Duplication of this publication or parts thereof is permitted only under the provisions of theCopyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the CopyrightClearanceCenter.ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Foreword I am glad to note that a monograph entitled ‘‘ECG Acquisition and Automated Remote Processing,’’ is published by M/s. Springer India. This is really a very timely and state-of-the-art publication in the area of Biomedical Instrumentation. Theauthorsofthismonographareagroupofdedicatedfacultymembersattached to the ‘‘Biomedical SignalAcquisition and Processing’’ unit inthe Department of Applied Physics, University of Calcutta. If the twentieth century has seen spectacular advances in the area of Physical Sciences,then thetwenty-first century isgoing tobedominated bythe Biological Sciences.OneoftheveryimportantfocalareasintheBiologicalSciencesmustbe related to Healthcare and Medical Science. As a consequence, a new multidisci- plinary area of study has emerged, as Biomedical Engineering. ModerndayBiologicalScienceandEngineeringhasbeenhighlydependenton developments in Physics and Electrical Engineering, as has been found during the last few decades. The advances in Electron Microscopy, Nuclear Magnetic Resonance, Tomography, Laser Technology, Control Engineering, Solid State Electronics, Computer Technology, Sensor Technology, Signal processing, and Image processing are some of the areas that have immensely helped Biomedical Researchers from both the therapeutic and diagnostic points of view. Heart, being a vital and complex organ of the human body, needs special attention for its monitoring. A very useful noninvasive technique to monitor the activity of the heart system is to study the ECG signals and get analytical information about its functioning. This monograph is dedicated to the acquisition, analysis, and transmission of electrical signals generated by the activities of the cardiovascular organ. ECG signalsneedcomplexanalysistoextractusefulinformationaboutthehealthofthe heart. Although for a pretty long time, it is being attempted to gather this infor- mation for diagnostic purposes, shortcomings in the analytical tools create some problems. This is why this topic has attracted the attention of researchers, world over, who are equipped with such modern analytical tools to attack this problem. Inthismonographtherearesixchaptersandattheendofeachindividualchapter there are references, which give the future workers scope for study in this field. v vi Foreword Students at the undergraduate and postgraduate levels in Biomedical Engineering and Biomedical Instrumentation will find this monograph very useful for their coursework.I mustthank the authors for their endeavor. Kolkata, India, May 19, 2013 Prof. Dr. Dilip Kumar Basu Former Vice Chancellor, Burdwan University Bardhaman, West Bengal India Former Vice Chancellor, Tripura University Agartala India Preface Healthcare has been identified as one of the emerging areas of research in the currentcentury.Inspiteoftheremarkabledevelopmentofscienceandtechnology in the last four decades, the average mortality rates have increased in most countries. Cardiovascular Diseases (CVD) remain as the dominant killer all over theworld.AsperstatisticsfromWorldHealthOrganization(WHO),anestimated 17.3millionpeoplediedfromCVDin2008,representing30%ofallglobaldeaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke. It is predicted that by the year 2030, 23.6 million peoplewilldiefromCVDs,andtheworstaffectedregionwillbeSouthEastAsia. Medical science has achieved significant progress in the recent years, mainly contributed by research from bioinformatics, molecular biology, genetics, nano- technology,drugresearch,andperipheralsciences.Asaresult,humancivilization hasbeenabletooverpowermanyincurablediseases.Atthesametime,newerand complex forms of diseases have come out and put tougher challenges before the medical scientists. Themarriagebetweenmedicalscienceandtechnologyhasgivenbirthtoanew discipline,namedbiomedicalengineering, which iscontributedbysomecoreand multidisciplinary engineering disciplines like Electrical, Electronics and Com- munication, Instrumentation, Mechanical, and VLSI. Technologists have devel- oped diagnostics tools and devices to extract pathological information from patients and present them in a suitable format as an aid to the medical expert to support his therapeutic actions. Electrocardiogram (ECG), the small potentials generatedbytheheartmuscles,isperhapsthemostexploredmedicalsignalbythe biomedical research community, due to its importance in overall healthiness of a human being. Invention of the ECG machine by Willem Einthoven in the early twentiethcenturyisconsideredasoneofthepioneeringlandmarksinthehistoryof biomedical science. After that, various types of biomedical equipments and deviceshavebeendevelopedwhicharecapableofprovidingaveryhighdegreeof accuracy. A major impetus to this was development of imaging equipments like ultrasonograph, computed tomography, etc., which are completely noninvasive in nature. Poor doctor to patient ratio is one of the persistent problem in the underde- veloped and developing nations. Due to various socio-economic factors and lack vii viii Preface of proper healthcare policies, the number of qualified medical professionals for catering the need of rural patients is inadequate. A remedial measure toward this problem was introduction of telehealth services, where the physician is supplied with the medical signals from a remote patient using various communication technologies.Inadvancednations,thisremotehealthcareserviceisnowastandard practice extended to the remotest primary clinics in rural areas. However, in developing nations this facility is not so widespread in regular service. Develop- ment of smart, powerful, miniature devices is still an active area of research with the objective ofeasy acquisition,fastprocessing,andseamless communication of medicaldatatotheremoteendphysician.Inthecontextofdevelopingnationslike India, easy operability and affordability are the key driving factors which should drive the technology for delivering healthcare service to the general population. Many Indian institutions are engaged in this area of research. ThismonographisasmallandhumblecontributionfromtheBiomedicalSignal Acquisition and Processing Research Group at Department of Applied Physics, University of Calcutta, India. This book is written with the outcome of some experimental developments of a prototype telecardiology system. The book is addressed to a broad audience. It is expected to be useful to undergraduate and postgraduate students of Biomedical Engineering, Electrical Engineering, Instru- mentation Engineering, and researchers working in the similar area. One advan- tageousfeatureforthereadersisthatallthealgorithmoutlinesarepresentedatthe end of chapter appendix, so that new researchers can develop or customize their own applications. A brief review of the main focal subjects is provided in the respectivechapters.Thepublicationsfromourresearchgrouprelevanttothetopic areindicatedattheendofeachchapter.Thisbookisonlymeanttocreateinterest andinitiatemoreworkamongtheresearchersandcarrytheconceptfurther.Some pictures, tables, and illustrations are reproduced from earlier publications and the copyrights will rest with the original publishers. The authors welcome comments and suggestions from the readers. Kolkata, India Rajarshi Gupta Madhuchhanda Mitra Jitendranath Bera Acknowledgments The authors are thankful to the faculty members and staff of Department of Applied Physics, University of Calcutta for the support and cooperation. The experiments, a few results of which are shown in some chapters, are supported by equipments purchased from Technical Education Quality Improvement Pro- gramme (TEQIP) Phase-I at UCT, CU. Our research group received support from SAP DRS-I programme from University Grants Commission (UGC) and FIST project from Department of Science and Technology (DST), Government of India. A special mention of Prof. Samarjit Sengupta, former Head, Depart- ment of Applied Physics for his advice, encouragement, and close association with our research group. The authors extend their thanks to Prof. Dilip Kumar Basu, former Vice Chancellor, Tripura University, India for writing the Fore- word of this book. The authors express their sincere gratitude to Springer India for publication of this book. Theauthorsalsoacknowledgethesupportreceivedfromtheirfamilymembers. Rajarshi Gupta Madhuchhanda Mitra Jitendranath Bera ix Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Heart and Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . 1 1.3 Genesis of the Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . 3 1.4 ECG Clinical Signatures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.5 ECG Lead System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.6 ECG Recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.7 Evolution and Practice of Telemedicine and Telecardiology. . . . 10 1.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2 ECG Signal Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.2 Computerized Analysis of ECG. . . . . . . . . . . . . . . . . . . . . . . . 15 2.3 Review on Computerized ECG Processing Techniques . . . . . . . 18 2.3.1 Denoising Techniques . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.3.2 R-peak Detection Methods. . . . . . . . . . . . . . . . . . . . . . 21 2.3.3 Feature Extraction from ECG Signal. . . . . . . . . . . . . . . 24 2.4 Method of ECG Signal Analysis. . . . . . . . . . . . . . . . . . . . . . . 26 2.4.1 QRS Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.4.2 Baseline Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.4.3 Determination of Fiducial Points. . . . . . . . . . . . . . . . . . 35 2.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 3 ECG Acquisition in a Computer. . . . . . . . . . . . . . . . . . . . . . . . . . 51 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 3.2 ECG Acquisition in a Clinical Setup . . . . . . . . . . . . . . . . . . . . 51 3.3 ECG Acquisition Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 3.3.1 ECG Signal Characteristics and Artifacts. . . . . . . . . . . . 52 3.3.2 Functional Blocks of a Digital ECG Acquisition System. . . . . . . . . . . . . . . . . . . . . . . . . . . 54 3.3.3 ECG Amplifier and their Design Enhancements. . . . . . . 55 xi
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