CHAPTER 2

ECG PARAMETER EXTRACTION In order for a mobile ECG recorder to be able to classify a heart rhythm online, the significant parameters must be extracted. The relevant parameters are the beginning, peak and end of the QRS-complex, the P- and T-waves, the ST-segment and other significant intervals, such as the RR-interval. The aim of the development was, firstly, stable, realtime-capable QRS detection, which finally achieved values for sensitivity of 98.9% and a positive predictivity of 99.9% on standard ECG databases. Also, a filter-based detection of P- and T-waves was implemented, which can also be performed in real-time on a microcontroller platform. PQRST Wave A general indication of the P-wave, QRS complex, T-wave, and U-wave as well as the PR, QT, ST, and QRS interval is shown in figure 1 for a normal ECG beat. Fig. 1 ECG components A set of efficient techniques are used to extract important features from the digital ECG data that can be RR interval & so on. The features extracted are heart rate, PR interval, P, T and Q amplitude. The R-R interval is the distance between two subsequent QRS complexes and represents the Heart Rate (HR) A general indication of the P-wave, QRS complex, Twave, and U-wave as well as the PR, QT, ST, and QRS interval is shown in figure 1 for a normal ECG beat. Fig. 1 ECG components A set of efficient techniques are used to extract important features from the digital ECG data that can be RR interval & so on. The features extracted are heart rate, PR interval, P, T and Q amplitude. The R-R interval is the distance between two subsequent QRS complexes and represents the Heart Rate (HR) than 0.2 seconds. Careful attention should be paid to the P wave and P-R interval when assessing ECG rhythm. After the extraction of these important parameters, they are used to train the neural network from which the arrhythmias are detected and these are Ventricular tachycardia, sinus Tachycardia, sinus Bradycardia, Prominent P, Exogenic catecholamine, Abnormal intraventricular, Heart Block.

Leads
the word lead may refer to the tracing of the voltagedifference between two of the electrodes and is what is actually produced by the ECG recorder. Each will have a specific name. For example "Lead I" (lead one) is the voltage between the right arm electrode and the left arm electrode,

whereas "Lead II" (lead two) is the voltage between the right limb and the feet. (This rapidly becomes more complex as one of the "electrodes" may in fact be a composite of the electrical signal from a combination of the other electrodes (see later). Twelve of this type of lead form a "12-lead" ECG To cause additional confusion the term "limb leads" usually refers to the tracings from leads I, II and III rather than the electrodes attached to the limbs.

Q wave
Normal Q waves, when present, represent depolarization of the interventricular septum. For this reason, they are referred to as septal Q waves and can be appreciated in the lateral leads I, aVL, V5 and V6. [edit]R

wave progression

Looking at the precordial leads, the r wave usually progresses from showing a rS-type complex in V1 with an increasing R and a decreasing S wave when moving towards the left side. There is usually an qR-type of complex in V5 and V6 with the R-wave amplitude usually taller in V5than in V6. It is normal to have a narrow QS and rSr' patterns in V1, and so is also the case for qRs and R patterns in V5 and V6. Thetransition zone is where the QRS complex changes from predominately negative to predominately positive (R/S ratio becoming >1), and this usually occurs at V3 or V4. It is normal to have the transition zone at V2 (called "early transition"), and at V5 (called "delayed transition").[5] The definition of poor R wave progression (PRWP) varies in the literature, but a common one is when the R wave is less than 24 mm in leads V3 or V4 and/or there is presence of a reversed R wave progression, which is defined as R in V4 < R in V3 or R in V3 < R in V2 or R in V2 < R in V1, or any combination of these.[5] Poor R wave progression is commonly attributed to anterior myocardial infarction, but it may also be caused by left bundle branch block, Wolff ParkinsonWhite syndrome, right and left ventricular hypertrophy as well as by faulty ECG recording technique.[5] [edit]J-point The point at which the QRS complex meets the ST segment is known as the J-point. The J-point is easy to identify when the ST segment is horizontal and forms a sharp angle with the last part of the QRS complex. However, when the ST segment is sloped or the QRS complex is wide, the two features do not form a sharp angle and the location of the J-point is less clear. There is no consensus on the precise location of the J-point in these circumstances.[6] Two possible definitions are:

The "first point of inflection of the upstroke of the S wave" [6] The point at which the ECG trace becomes more horizontal than vertical.[7]

P-R Interval The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It reflects the time taken by the impulse to travel the entire distance from the SA Node to the ventricular muscle fibers. The normal duration for this is 0.12-0.20 seconds. Normally this interval varies with heart rate and is shorter at faster rates. Under certain circumstances, for instance if the conduction system is diseased or affected by Digitalis, the P-R interval may lengthen as the rate increases. Also if the atria are paced, the interval lengthens as the paced rate increases. A prolonged interval, beyond normal limits (0.12-0.20 sec.), is considered evidence of AV block. An abnormally short P-R interval is cause for alarm as it is often seen in asociation with hypertension and paroxysms of tachycardia. The P-R interval is shortened when the impulse originates in the AV node rather than the SA node or when the passage of the impulse to the ventricle is accelerated as in Wolff-Parkinson-White syndrome (WPW). S-T Segment The S-T segment follows the QRS complex. The point at which it begins is called the J (junction) point. There are two aspects that should always be examined: Its level relative to the baseline (elevated or depressed and how much). Its shape. Under normal circumstances the S-T segment is isoelectric or level with the T-P segment. It normally gently curves into the T wave. T Wave The T wave represents the period of recovery for the venticles (repolariztion). Generally we are concerned with three features: 1.) direction, 2.) shape, and 3.) height. The direction of the normal adult T wave is upright in leads I, II and V3-V6. It is inverted in aVr. And it is inverted in leads III, aVl, aVf, V1 and V2. The normal shape of the T wave is slightly rounded and slightly asymetrical. Sharply pointed or grossly notched T waves should cause suspicion, although either feature can occur as a normal variant of the precordial leads. Notching can be an indication of

pericarditis, and sharply pointed symmetrical T waves should make one suspicious of myocardial infarction(MI). The height of the T wave also has diagnostic importance. Normal height in the limb leads is not above 5 mm and is not above 10 mm in any precordial lead. Unusually tall T waves indicate MI, but can be seen in ischemia without infarction. Tall T waves are also seen in patients with hyperkalemia, CVAs, and sometimes in psychotic patients. BLOCK DIAGRAM , FLOWCCHART FROM PPT

CHAPTER 3 Tool kit used in ecg parameter extraction