es Biosignals analysis (heart, phonatory system, and muscles) Rita Q. Fuentes-Aguilar’, Humberto Pérez-Espinosa’, and Maria A. Filigrana-de-la-Cruz"* *Tecnologico de Monterrey, Escuela de Ingenieria y Clencias, Guadalajara, Mexico “Instinto Nacional de Astofisca, Optica y Eectinica, Puebla, Mexico SCICESE-UP?,Tepi, Mexico * Centro de Investigacién y Estudioe Avancados del Instiuto Polienico Nacional (CINVESTAV), Mesico City, Mesico 2.1 Introduction The data of a biological phenomenon that allows describing a system can be of electrical, mechanical, acoustic, thermal, optical nature, and so forth, All of these arc referred to as biosignals. In brief, 10 determine how a system behaves, biomedical data is acquired by measuring these signals. A biosig- nal is, then, any signal that can be measured and recorded from biological beings. A biosignal can be electrical or non-electrical. The most common of the biosignals are bioelectrical, usually taken (© be electric currents produced by the sum of electrical potential differences across a specialized tissue, ‘organ or cell system, such as the nervous system. These signals are measured with a differenti am- piles, which registers the difference between two electrodes attached to the skin, Blectrical currents and changes in electrical resistances across tissues ean also be measured from plants. Examples of electrical biosignals are electroencephalogram (EEG), electrocorticogram (ECoG), electrocardiogram (ECG), electromyogram (EMG), electrogastrogram (EGG), electroretinogram (ERG), electrooculo- ‘gram (OG), phonocardiogram (PCG), galvanic skin response (EDA), among others. Metabolic signals (such as infrared measurements), gases interchange, photopletismography, emotion recognition, sound identification, or odor identification are some examples of nonelectrical biosignals. A heart signal is a record of electrical activity of the heart. The contraction activity of the heatt is driven by the electric natural pacemaker (cardiac cells that have the property of automatic generation of action potentials). ‘Myocardial cells have the unique property of transmitting active potentials from one cell to an adjacent cell by means of direct current spread. Another biosignal that comes from the heart is the ballisto- cardiogram (BCG). A ballistocardiography is the noninvasive record of repetitive motions from the sudden ejection of blood into the great vessels with each heartbeat. It is caused by the mechanical ‘movement of the heart. Complementary to the BCG, the phonocardiogram (PCG) is the record of sounds and murmurs made during a cardiac cycle by various cardiac structures pulsing and moving blood. Both biosignals, BCG and PCG are measured using piezoelectric transducers as well as blood pressure. While ECG is one of the most studied of the biosignals because of its deterministic nature, periodic response and wide studied characteristics, the other given examples are still under study and search for characterization to use them in diagnosis and other applications. A brain signal isa record of the electrical signal generated by the cooperative action of brain cells, or more precisely, the time ‘gal rece leon ng Captain Learn tlie brn .0680750 2061.09 78 Chapter 2 Biosignals analysis (heart, phonatory system, and muscles) ‘course of neuronal extracellular field potentials generated by their synchronous action. Ifthe signal ean, be measured by means of electrodes placed on the scalp or directly on the cortex, the obtained signals are called BEG; in the case of the use of invasive electrodes, it is called ECoG or iEEG (intracranial EEG). Brain electric field generated as a response to external or internal stimulus is called an event- related potential (ERP). Flectric fields measured intracortical with electrodes implanted in the brain structures were named local fields potentials (LEP). An emerging technology for the direct monitoring of brain activity is the functional near-infrared spectroscopy (£NIRS). It is a non-invasive method t0 record the hemodynamic response that use, instead of electrodes, optical sensors in the range of red ‘and infrared spectrum, Near-infrared spectrum light (700-900 nm) is the optical window, in which ‘haemoglobin (Hb) and deoxygenated-haemoglobin (deox-Hb) are stronger absorbers of light. The dif- ferences between the absorption of Hb and deox-Hab allow the measurement of changes in oxygen ‘concentration in blood. This property makes it possible to detect when a cerebral region is presenting activity. The electromyogram (EMG) isa record of electrical muscle activity. In the book, only EMG of striated muscles will be discussed, the electrical activity of specific smooth muscles, such as stomach (clectrogastrogram (EGG)), will not. On the other hand, there is a great variety of acoustic biosignals, both originated by internal or- ‘guns, such as the heart, lungs, and intestines, and originated by the speech apparatus, such as speech, crying, and coughing. This type of biosignal includes essential information about a person's current state, indicating pathologies, and emotional or physical state. In this chapter, two types of acoustic biosignals generated by the human phonatory system are addressed, infant crying and speech. Both biosignals transmit information about the state of health, emotional state and physical characteristics ‘of the individual. Capturing the acousti signal of erying and speech is very simple and does not require sophisticated equipment, as it is usually done with a conventional microphone. The analogue signal is converted to digital using a sample rate of 16,000 hertz, which is enough to capture the frequency range ‘ofthe human phonatory system’s sounds. Finally, in Part 5 “Applications and Reviews" ofthis book, the readers can find three chapters, each ‘one focused on the analysis of ECG signals (see Chapter 16), voice-based emotion recognition (see ‘Chapter 15), and EMG signals (see Chapter 19), respectively. 2.2 Sensing the heart 2.2.1 Electrocardiogram (ECG) Inthis chapter, we will be explaining whats the cloctrocardiogram and how the electrical signal ofthe heart works in the human body. In this way, we can understand how the electtocardiogram measures this electrical signal Later, in the chapter, Trends and Applications of ECG Analysis and Classification, sn example is presented of how an ECG signal (after being recorded) i filtered and analyzed to detect the ECG waves [Link] History of the electrocardiogram ‘The electrocardiogram (ECG) isthe oldest and the most common procedure used in cardiology due to the fact that is non-invasive, easy to record and the cost is minimal compared to, for example, an MRL Ithas remained to be used for over 100 years. Willem Binthoven (1860-1927), who was professor of physiology at the University of Leiden in the Netherlands, was the first to record ECG signal with @2.2 Sensing the heart = 9 string galvanometer of his design. His first article was published in 1901, which included ECG signal recordings taken with his new instrument Einthoven developed the system of standardization of electrocardiography that is still used today. He was able to establish uniformity in the ECG recording by introducing the triaxial bipolar system with 3 limb leads, and conceived the famous equilateral triangle with leads I, I and III and the caleu- lation of the electrical axis (in the frontal plane) that is represented graphically as a single vector with ‘an arrow at the center ofthe triangle. He has been named the founder of modern electrocardiography ‘and was awarded the Nobel Prize in 1924 in physiology medicine, “fr the discovery of the mechanism of the electrocardiogram” [5] [Link] The electrocardiogram ‘The ECG represents in a graphical recording the electrical signals generated by the heart. The graphical recordings of the signal are the final outcome of a complex series of physiologic and technological pro- ccesses, The signals are generated when cardiac muscles depolarize in response to electrical impulses ‘generated by pacemaker cells. Upon depolarization, the muscles contract and pump blood throughout the body. The electrical impulses, produce currents that are synchronized by cerdiae activation and re- covery sequences to generate a cardiac electric field that varies with time during the cardiac eycle. This electrical field goes through other structures, such as Iungs, blood, and skeletal muscle. When these ‘currents reach the skin they are then detected by electrodes placed in specific locations on the extremi- ties and torso that are configured to produce leads. The outputs of these leads are measured, amplified, filtered, and displayed to produce an electrovardiographic recording. In computational systems, these ECG signals are digitized, stored, and processed. It can be processed by different algorithms using segmentation techniques, pattern recognition that are used for diagnosis and to produce an interpreta: tion by the computer or by a human, The waveforms and intervals that conform a standard ECG are displayed in Fig. 2.1. The ECG is described by waves, segments, and intervals (1) + Waves are labeled using the letters P, QRS, T, and U. The typical ECG may not show a U wave. + Scgments are time durations between waves, ¢.g., P-R segment is the duration between the P and R ‘waves (or P and Q waves, when the Q wave is presen) + Intervals are time durations that include waves and segments, e.g, P-R interval is made of the P wave and the P-R segment ‘When the S wave is not present, the junction where the R-wave joins the S-T segment is called J-point, as seen in Fig. 2.1, P-wave corresponds to the depolarization of the atrial myocardium (muscles of upper chambers of the heart), and indicates the start of atrial contraction that pumps blood to ventricles, The P-R segment represents the duration of atrioventricular (AV) conduction, the QRS complex is formed by the waves Q, R, and S and is treated as one single wave. Its produced by the activation of the two ventricles, and indicates the start of ventricular contraction that pumps blood to the lungs and. the rest of the body. And the ST-T wave reflects ventricular recovery; the T wave corresponds to the repolarization of the ventricular myocardium and the T wave indicates the end of ventricular contraction. ‘The origin of U wave is still uncertain, and when present is thought to indicate the repolarization of ‘endocardial structures or late depolarization of the ventricular myocardium (Fig, 2.2)10 Chapter 2 Biosignals analysis (heart, phonatory system, and muscles) R RR interval eV ninety —4 soint cnsintenat Ft FIGURE 2.1 "Normal elesocardiogram waveforms Superior Vena cave Puimonary anery Fight Fight) vente FIGURE 2.2 ‘aman hear. [Link] The action potential "The muscles are formed by contractile tissue, When this tissue is triggered by an electrical impulse (or ‘other mechanical, chemical stimulus, etc.) it depolarizes and contracts (1). Each mechanical heartbeat is triggered by an action potential, which originates from a rhythmic pacemaker with the heart and is conducted rapidly throughout the organ to produce a coordinated contraction. The myocardial cell at rest has a transmembrane potential, Vj, of about 80 to —90 mV with respect to its surrounding fluid, When a stimulus, such as an ionic current raises the cell internal potential beyond its threshold of ~70 m, the cell depolarizes, and the cell membrane becomes permeable, This is when an exchange of ions (sodium, potassium, calcium and chloride) takes place across the membrane called Phase 0. The potential within the cell rises and reaches to +20 mV, and at2.2 Sensing the heart = 11 Time (ms) wo} | ‘ «0 4 0 Milvalts FIGURE 2.3 ‘Acton potential of a myocardial ell ° Time (rms) 40 ivol FIGURE 2.4 ‘Retion potential ofa pacemaker eel this point the membrane becomes impermeable to ions. Repolarization stars and charge pumps within the cell force out unwanted ions, restoring the ion concentration of the cell back to resting equilibrium; this process involves phases 1-3. Finally, the action potential drops to its resting potential of -90 mV, phase 4 The cardiac pacemaker cell has a different shaped action potential from the rest of the myocardial cells Its resting potential does not remain constant, but inereases steadily with time (phase 4, as shown in Fig. 2.3). This gradual increase is duc to the slow output of ions (a trickle of sodium and calcium ions) across the cell membrane at rest, which leads to a gradual diminution of the voltage across the cell membrane. Once the cell potential overpasses the threshold voltage, the cell depolarizes and if the slope of the resting potential is inereased, the automaticity (the ability to spontaneously depolarize and function as pacemaker cells for the rest ofthe heart), the cell develops an action potential similar to phase 0, but ‘mediated by calcium exchange at a much slower rate. Following the action potential, the membrane potential returns to the resting level and the cycle repeats [32]. In Fig, 2.3 and Fig. 2.4 is shown the action potential of a myocardial cell and the action potential of a pacemaker cell.12 Chapter 2 Biosignals analysis (heart, phonatory system, and muscles) (av nose at tn of bone ote FIGURE 2.5, (Conduction system of the bear [1]. ‘The action potential can propagate to other regions by traveling across a combination of conducting. ‘fibers and myocardium. An action potential, once initiated in a cardiac cell, will propagate along the cell membrane until the entire cell is depolarized. [Link] The heart's conduction system ‘The understanding of how the electrical current is propagated throughout the heart, makes it easier to understand how the waves that are recorded by an ECG are generated. The heart's electrical cells are similar (0 & net that carries a conduction system, where the electrical impulse i transmitted (0 every part ofthe organ, as shown in Fig. 2.5 ‘The way the electrical current is propagated across the conduction system ensures that the atria contracts before the ventricles, and thatthe ventricular contraction is coordinated and efficient [37] The blood must frst fill the atria, and then be pumped into the ventricles before being forcefully ejected. This control starts with an intrinsic self-excitable cardiac pacemaker, which sets the rate of the heartbeats. The pacemaker spontancously generates regular electrical impulses, that are spread through the conduction system of the heart and initiate contraction ofthe myocardium. This pacemaker cell is called sino-atrial (S-A) node. From the sinus node, the electrical impulse spreads across the atria, causing the atrial myocytes to depolarize, The impulse arrives to the AV node, where itis slower than through the surrounding ‘muscle. This slowness in conduction allows the atria to finish the contracting before the impulse passes into the ventricles. From the AV node, the electrical impulse enters the bundle of His, The AV node and the bundle of His are the only route of electrical conduction from atria to ventricles in the normal heart. The bundle ‘of His divides within the septum to produce (the left and right) bundle branches. These branches carry the electrical impulse into the left and right ventricles. The bundle branches terminate in & branching2.2 Sensing the heart 13 1 ear lib oN siti Veron Gr Te) FIGURE 2.6 ECG recording of different leas, The vertical ines ofthe grid represent ime and th horizontal Hines represent voltage amplitude. network of Purkinje fibers that carry the electrical impulse to every part of the ventricle almost at the same time, which ensures rapid and effective contraction of the chamber [37] ‘A conduction disorder can be observed in an ECG. For example, a heart block, where if the con- duction system is damaged by ischaemic heart disease, the conduction tothe ventricles may be delayed ‘or fail completely. A complete heart block occurs when the electrical impulses cannot travel from the atria to the ventricles, this often results in bradycardia, [Link] ECG leads ‘The potentials generated by the cardiac electrical activity are sensed by electrodes placed on the skin, but these potentials are affected by different causes: properties of the dermal and epidermal layers of the skin, by the paste that is used to place the electrode to the skin, by the electrode itself, and by the ‘mechanical contact between the electrode and the skin [26]. This mechanical contact can be seen as ‘a net effect that is equivalent to an clectrical circuit that includes resistances, capacitors, and voltages produced by different components and the interfaces between them. The electrodes are connected to form leads, The ECG leads are bipolar leads that record the pote tial differential between two electrodes. One electrode is designated as the positive input. The potential at the other, or negative, electrode is subtracted from the potential at the positive electrode to gener ‘ate the bipolar potential. The actual potential at each electrode is not measured, only the difference between them is recorded. Depending on the number of electrodes that are placed in the body and the type of ECG machine that is used, multiple views of the hear’ electrical activity can be recorded. The standard clinical ECG includes recordings from 12 leads, which means 12 different electrical views of the heart, as shown in Fig, 2.6, As it can be observed in Fig. 2.6, the ECG paper is marked with a grid of small and large squares. The small squares represent 40 milliseconds (ms) in time towards the horizontal axis and the14 Chapter 2 Biosignals analysis (heart, phonatory system, and muscles) ih9 fio Lead ead Lead it FIGURE 2.7 ‘Bleewode connection for ibs lead, and ML ‘Table 2.1 Location of electrodes and lead connections for the standard 12-Lead ECG and additional leads [37]. ‘Lead type Positive input Negative input Standard lead limbs Ted [ueivarm Bigham Lead |Leftiee Right arm Lead ut | Left ice Left arm ‘Augmented limb leads WR [Righearm Taft arm pls Teh Teg ave |Leftarm ight arm plus lft leg av Lefties Left arm pls sight arm record ads vi Fourth intercostal space-ight steral margin] Wilson Cental Terminal v2 Fourth intercostal space-Ieft sternal margin | Wilson Central Terminal vs Midway between V2 and V4 Wilson Central Terminal va Left midelavicula line, Sth intercostal space | Wilson Central Terminal vs Left enerice axilla ine Wilson Centra Terminal ve Left midaxilary line Wilson Central Terminal vi Posterior axillary line Wilson Central Terminal vs Posterior seapula ine Wilson Central Terminal yo. Left border of spine Wilson Central Terminal larger squares contain 5 small squares, thus representing 200 ms. These standard paper and square ‘markings allow an easy manual measurement for cardiologists of cardiac timing intervals. These 12 leads include three standard limb leads (leads I, TI, and IID, six precordial leads (leads V1-V6), and three augmented limb leads (leads aVR, aVL, and aVF). In Fig. 2.7 is found the definition for each lead and where each is located in the body. The limb leads ate called as such, because the electrodes are attached tothe limbs (Table 2.1). Lead represents the potential difference between the left arm (positive electrode) and right arm (negative clectrode), lead II displays the potential difference between the left leg (positive electrode) and right ‘arm (negative electrode), and lead IIL represents the potential difference between the left leg (positive