Biomedical Engineering

AJEESH S
ASSISTANT PROFESSOR
MLMCE
Heart and Cardiovascular system
• Cardiovascular system is a closed hydraulic system with 4
chamber pump.

• Transportation of oxygen,CO2,chemical compounds

and the blood cells.
• In some part of the system diameter of the arteries are changed
to control pressure.

AKHIL KUMAR S
 Cardiovascular system
Transport oxygen, carbon dioxide, hormones, chemical compounds

and blood cells to and from the cells

Heart

 2 upper atria- the receiving chambers

 2 lower ventricles- the discharging chambers

4 valves

 Tricuspid Valve Control blood flow from the atria to the ventricles

 Mitral Valve

 Aortic Valve Control blood flow out of the ventricles

 Pulmonary Valve
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 Heart
Heart is an isolated two stage synchronized chamber

1. The first stage collects blood from the system and pump it in to
2nd stage.

2. The 2nd stage then pump these blood to the system.

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Three layers
1. Pericardium:
• Outermost layer
• Keeps outer surface moist, prevents friction

2. Myocardium:
• Middle layer
• Main muscle of heart
• Made up of short cylindrical fibres

3. Endocardium:
• Inner layer of heart
• Provides smooth lining for blood flow
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Heart Valves

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4 valves
1. Tricuspid valve
 Between RA and RV
 Prevents blood flow from RV to RA

2. Bicuspid/ Mitral valve

 Between LA and LV
 Prevents blood flow from LV to LA

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3. Pulmonary valve
 At RV to lungs
 It has 3 cusps

4. Aortic Valve
 Between LV and aorta
 It has 3 cusps.

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 Blood Flow inside the heart
Blood act as communication and supply network for all parts
of the body
Right heart collects blood from the body and pump it
through oxygenation system(Lungs).
Left heart receives blood from oxygenation system (Lungs)
and pump blood to main hydraulic system.
The blood is carried out to the various parts of the body
through blood vessels.

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Three types of blood vessels

1) Arteries --> Thick

--> carries oxygenated blood

2) Veins --> Thin

carries Deoxygenated blood

3) Capillaries--> Smallest
--> Last level of blood vessels
--> 800000 km of capillaries
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Circulatory system

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 Heart->opening aortic valve through Aorta->aorta curves
along backbone->Abdomen->larger arteries to head,digestive
organs,arms & legs->through tiny capillaries to cells.

 Blood discharges dissolved food and oxygen into cells

 Cells deposit waste like CO2 into blood.

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 Back to heart->from capillaries to venules-
>veins->to larger veins above and below
heart->vena cava->RA->through tricuspid
valve to RV->pulmonary artery->opening
pulmonary valve to lungs
 From lungs gets oxygenated
 lungs->LA->through bicuspid valve to Lv-
>aorta

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Heart pumps blood through

 Pulmonary circulation to the lungs

 Venous blood (deoxygenated) flows from right
ventricle through pulmonary artery to lungs.
 The arterial (oxygenated) blood flows to left atrium
through pulmonary veins.

 Systemic circulation to the other parts of the body.

 In systemic circulation blood flows from left auricle to
left ventricle and it is pumped to aorta and its branches

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 Electro Conduction System of the
Heart
• Heart creates it's own electrical impulses and control the
path of the impulses
• The conducting system of the heart consists of cardiac
muscle cells and conducting fibers that are specialized for
initiating impulses and conducting them rapidly through
the heart.
• They initiate the normal cardiac cycle and coordinate the
contractions of cardiac chambers.
• Both atria contract together, as do the ventricles, but atrial
contraction occurs first.

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The conduction pathway is made up of 5 elements:

1. The sino-atrial (SA) node

2. The atrio-ventricular (AV) node
3. The bundle of His
4. The left and right bundle branches
5. The Purkinje fibres

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• Electrical impulses from heart muscle (the myocardium)
cause heart to beat (contract).
• This electrical signal begins in the sino atrial (SA) node,
located at the top of the right atrium.
• The SA node is sometimes called the heart's "natural
pacemaker."
• When an electrical impulse is released from this natural
pacemaker, it causes the atria to contract.

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• The electrical stimulus from the SA node eventually reaches
the AV node and is delayed briefly by the delay line so that
the contracting atria have enough time to pump all the
blood into the ventricles.
• The impulse leaves the AV node through bundle of His.
• The fibers in this bundle known as Purkinje fibers after a
short distance split into two branches to initiate action
potentials simultaneously in the two ventricles.

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 Electrocardiograph
• Bio electric potentials generated by heart muscles
constitute Electro Cardio Gram.

• ECG is an interpretation of the electrical activity of the heart

over a period of time.

• Electrocardiograph is the instrument that records the

electrical activity of the heart

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The recording produced by this non-invasive (instruments are
not inserted into the body) procedure is termed as
electrocardiogram (also ECG or EKG).

Gives information about various cardiac disorders

Measure pd between given points of the body
Useful freq. range.05 Hz to 150Hz

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ECG machine block diagram

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• Lead Selector Switch:
 Potentials picked up by the patient electrodes are taken to the
lead selector switch.
 Electrodes are selected two by two according to the lead
program.
 Connected to preamplifier through capacitive coupling

Preamplifier:
Preamplifier prepares the signal for further amplification or
processing.
Usually 3 or 4 stage dual input unbalanced output
differential amplifier.
-ve current feedback for stabilization

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• Power Amplifier:
 Push pull differential amplifier.
 Single ended output from preamplifier is given to power
amplifier.
 Another input is from frequency selective network.
 Output is single ended
 Output of PA is fed to the pen motor which deflects the
writing arm of the paper.

• Frequency selective network:

 R-C network-->provides necessary damping of the pen.

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• Auxiliary Circuits:
 Provide a 1 mV calibration signal and automatic
blocking of the amplifier during change in the position
of the lead switch.
 It also includes a speed control circuit for the chart driver
motor.
• Pen motor:
 Stylus moves in response to signals on a stationary paper

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 Graph paper
 Time & Heart rate measurement done horizontally
 Amplitude measurements vertically in millivolts
 Recording speed-->25 mm/s
 Sensitivity :10mm/mv

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 ECG lead configuration
Leads Electrodes connected to ECG machine using wires
Tracing of potential difference between any two points
Leads measure the difference in potential between either:
1. Two different points on the body (bipolar leads)
2. One point on the body and a reference point with zero
electrical potential, located in the center of the heart
(unipolar leads).
ECG measured from the surface of the body depends on
placement of electrodes
Normally 12 electrodes are connected to the patient so that no
detail is missed

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 Classification
1. Standard Limb Leads or Bipolar Leads or
Einthoven Leads:
I, Il & III
2. Augmented Limb Leads or Unipolar Leads:
aVR, aVL & aVF
3. Precordial Leads:
V1- V6

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1. Standard Bipolar Leads
 Display a graph of the potential difference recorded

between two limbs at a time.

 One limb carries a positive electrode and the other

limb, a negative one.

 Potential difference is measured with reference to a

third point Right Leg

For each lead ECG is recorded from 2 electrodesBipolar

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 Lead I:

Left Arm+ve electrode

Right Arm-ve electrode

Lead II:

Left Leg +ve electrode

Right Arm -ve electrode

Lead III:

Left Leg+ve electrode

Left Arm-ve electrode

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Einthoven’s Equilateral Triangle
The three limb electrodes, I, II and III form a

triangle at the right arm (RA), left arm

(LA) and left leg (LL).

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At any instant of the cardiac cycle the electrical axis of the

heart is a two dimensional vector.

ECG measured from any of the three limb leads is a time

variant single dimensional component of that vector.

Electric field of heart can be represented as a an equilateral

triangle with heart located at its center

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Sides of the triangle  lines along which 3 projections of ECG

vectors are measured.

Instantaneous voltage measured from any of the 3 limb leads

is approximately equal to algebraic sum of the other two

Lead II = Lead I +Lead III
ie., vector sum of projections on all 3 lines =0

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2. Augmented Limb Leads (Unipolar)

Unipolar:

Between a single exploratory electrode and a central terminal

Central terminal Three limb leads are tied together through

resistors and has potential corresponding to center of the body

Potential at connection point is the average of potentials at 3

electrodes

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One of the limb leads is exploratory and also contribute to

central terminal
ECG with less amplitude

Two limb leads are tied together and recorded with respect to

the third limb increase amplitude

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aVR (augmented Vector Right)  RA is recorded with
respect to a reference obtained by joining LA and LL

aVL (augmented Vector Left)  LA is recorded with

respect to junction of RA and LL

aVF (augmented Vector Foot)  LL is recorded with

respect to RA and LA tied together

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Augmented Leads Averaging leads

Averaging resistances resistance connected between

electrodes and machine

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 3. Precordial leads
Unipolar chest leads

Records potential of heart action on the chest at 6 different

positions
‘V’ followed by a subscript(indicates position on

pericardium)
V1 to V6

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All 3 limb electrodesCentral terminal

Chest electrode Exploratory electrode

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 Chest Leads V1- V6
V1: 4th intercostal space to the right of
sternum
V2: 4th intercostal space to the left of sternum
V3: midway between v2 to v4
V4: 5th intercostal space to midclavicular line
V5: On anterior axillary line at the same level
as V4
V6: Mid-axillary line at the same level as V4
and V5

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An electrocardiologist utilizes all the 12 lead selections
3 standard bipolar leads(I,II,III),
3 augmented unipolar leads(aVR, aVL, aVF)
6 chest leads(V1 to V6)

When analyzing the ECG waveform as each ECG recording

will differ in shape as well as amplitude.

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 Analysis of ECG Signals
ECG

quasi periodical

rhythmically repeating signal synchronized by the

function of the heart

Electric field vector changing periodically in time & space and

its effects are measured on the surface.

Helps in clinically diagnosing various diseases and

conditions of heart

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The waveform is standardized in terms of amplitude and

phase relationship
Any deviation in the shape & duration is the presence of

abnormality.
Normal heart rate60 to 100 beats/minute

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P wave  De polarization of Auricles.
Produced by contraction of atrial muscles
Shape & durationatrial enlargement
0.25mV

QRS waveRe-polarization of atria and depolarization of

ventricles
0.09 to 0.1 s

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R wave
Ending of atrial contraction & beginning of ventricular
contraction
0.1 mV to 1.5 mV
Narrow& high R waveStrong heart

T wave  Ventricular repolarization.

Normally slightly round
Tall & pointedabnormal
0.1 to 0.5 mV

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PR Interval

Atrio ventricular conduction time is the Time taken by the

impulse to travel from atria(SA node) to AV node
It’s the atrio-ventricular conduction time.
Measured from the start of the P wave to beginning of the
QRS complex.
Duration is from 120 to 200 ms.
Prolonged PR interval>0.20 secs is first degree heart
blockblockage of AV node

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QRS Complex
Time taken by the heart impulse to travel first through the
intro-ventricular system and then through the free walls of the
ventricles.
Measured from the onset of Q wave to end of S wave.
Duration  0.05 to 0.10 secs.
Amplitude is 1 mv
Since the ventricles contain greater muscle mass than the atria,
the QRS complex is larger than the P wave.

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BLOOD PRESSURE MEASUREMENTS
Good indicator of status of cardiovascular system

Vital indication in treatment and management of critically ill

patients

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Systolic pressure
The maximum pressure in an artery when the heart is pumping

blood through the body.

Maximum during one heart beat

Diastolic pressure
The lowest pressure in an artery in the moments between beats

when the heart is resting(ventricular relaxation).

Minimum in between two heart beats
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Systolic:
95 to 140 mm Hg Average 120 mm Hg

Subjected to Age, Climate, dietary habits etc.

Diastolic:
 60 to 90 mm Hg Average 80 mm Hg
80/120 mm Hg

If either one is raised high blood pressure (hypertension).

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Arterial B.P. waveform

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Two methods

1. Indirect
2. Direct

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 Direct Method
Direct method of pressure measurement is used when the
highest degree of accuracy and continuous monitoring is
required.
Used to measure the pressure in deep regions inaccessible
by indirect means.
Invasive Blood vessel gets punctured by introducing
sensor

Direct measurement of blood pressure is usually obtained by

one of the three methods :
1. Percutaneous insertion.
2. Catheterization.
3. Implantation of aAKHIL
transducer
KUMAR S in a vessel or in the heart
 1. Percutaneous insertion
For percutaneous insertion, a local anaesthetic is injected
near the site of invasion
A hollow needle is inserted at a slight angle towards the vessel.
When the needle is in place, a catheter is fed through the
hollow needle with some metal guide.
When the catheter is securely placed in the vessel, the needle
and guide are withdrawn.
Blood pressure is sensed directly by attaching a transducer
built into the tip of the catheter.

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Catheters are medical devices that can be inserted in the body
to treat diseases or perform a surgical procedure.

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 2. Catheterization
A catheter is a long tube that is introduced into the heart or a
major vessel by way of a superficial vein or artery.
Measurement of blood pressure with a catheter can be
achieved in two ways.
The first method
To introduce a sterile saline solution into the catheter so
that the fluid pressure is transmitted to a transducer
outside the body.
This transducer converts the exerted pressure to electrical
signals.
The electrical signals can be amplified and displayed or
recorded
Can use either a resistance strain gauge (unbounded) or a
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LVDT
In the second method
 The pressure measurements are obtained at the source
(Measurement at site).
The device used is a catheter tip blood pressure
transducer.
Here the transducer is introduced into the catheter and
pushed to the point at which the pressure is to be measured
or the transducer is mounted at the tip of the catheter.
The pressure exerted on the transducer are converted to
the proportional electrical signals.
Uses either a LVDT or a resistance bonded strain guage.

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AKHIL KUMAR S
3. Implantation of a transducer in a vessel or heart
Implantation of a transducer in a vessel or heart is a technique
in which the transducer is more permanently placed in the
blood vessel or the heart by surgical methods.

Transducer fixed in place in the appropriate vessel for long

period - so continuous recording of BP can be made.

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 Indirect Method
Simple equipment

Cause very little discomfort to the patient

Less informative and Intermittent

Somewhat subjective

Often fails when the blood pressure is very low (eg:when a

patient is in shock).
Noninvasive

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1. Auscultatory
From the Latin word "listening.

Uses Sphygmomanometer with a Stethoscope.

2. Oscillometric
First demonstrated in 1876

Observe oscillations in the sphygmomanometer cuff

pressure caused by the oscillations of blood flow, i.e., the

pulse.
3. Ultrasonic
 1. Auscultatory Method
Blood pressure measurements using sphygmomanometer
Korotkoff ,s method
Millimeters of mercury

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Sphygmomanometer consist of pressure cuff / rubber cuff

which is applied to arm.

It also consist of Mercury manometer to measure the

pressure inside the cuff.

A cuff (rubber bladder) is placed around the arm and inflated

with a pump until the circulation is cut off.

A release valve slowly deflates the cuff and using a stethoscope,

placed over the arm, listen to the sound of blood (korotkoff

sounds) pulsing through the arteries.

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Sound hearing at the time of measuring the blood is

Korotkoffs sound.
That first sound of rushing blood refers to systolic blood

pressure.
Once the sound fades, the second number indicates the

diastolic pressure.

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 2. Oscillometric Method
Similar to ordinary sphygmomanometer method.

Sound is not used for measurement and environmental noise

will not hamper the measurement.

Observe oscillations (small fluctuations) in the

sphygmomanometer cuff pressure, caused by the oscillations

of blood flow, i.e., the pulse
When the cuff deflates from a level above systolic pressure

artery wall vibrates or oscillates. These vibrations are sensed by

a pressure transducer.
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As cuff pressure decreases further the oscillations increases

and reaches a maximum amplitude and then decreases until

the cuff fully deflates and the blood flow returns to normal.
Cuff pressure at the point of maximum amplitude is the

Mean arterial pressure.

Point above mean pressure at which oscillations decrease

rapidly is Diastolic.
A typical oscillometric blood pressure monitor is

microprocessor controlled and is designed to periodically

inflate and slowly deflate the cuff.
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Over the deflation period, the extracted oscillometric pulses
form a signal
Oscillometric waveform (OMW)

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Measurement sites:
Upper arm
Forearm
Wrist
Thigh
Finger

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 3. Ultrasonic Method
Ultrasonic waves are acoustical waves in the range above
human hearing (ie, more than 20 KHz).
Like all acoustical waves, ultrasonic waves are subject to
Doppler shift that is a slight alteration of frequency (AF)
when reflected from a moving object.
If piezoelectric ultrasound sensors are placed over the artery,
under the cuff, then they can perform Doppler detection of the
blood flowing in the artery
A transmit crystal sends a sine-wave beam into the tissue.

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When it encounters a fluctuating vessel wall, some of its
energy is reflected back ("backscattered") to the receive
crystal, which is located close to the transmit crystal.
If ∆F is the Doppler shift, F±∆F describes the frequency
content of the backscattered wave
The existence of the ∆F component alerts the circuit to the
turbulent flow that corresponds to Korotkoff sounds, and it
diminishes when near-laminar flow resumes.

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 Blood flow measurement
Blood flow is an important physiological parameter

Adequate blood supply is necessary for organs

Most difficult to measure accurately.

Average velocities of blood flow vary depending on diameter of

blood vessel(2cm to mm).

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Rate of flowVolume in given unit of time
Cm3/min

Measured for:

Inspecting block in blood flow.

Testing artificial blood vessels during organ

transplantation.
Techniques:
1. Invasive (surgical)
2. Non invasive (through the skin)

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Commonly used:

1. Electromagnetic blood flow meter

2. Ultrasonic blood flow meters
 Measure velocity

 During surgery

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ELECTROMAGNETIC BLOOD FLOWMETER
Measures instantaneous pulsatile flow of blood

Principle of electromagnetic induction

When a conductor is moving in a magnetic field a voltage

induced which is proportional to the velocity of the

conductor
The conductive blood is the moving conductor

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A permanent magnet or

electromagnet is positioned
around the blood vessel

Generates a magnetic field perpendicular to the direction of

the flow of the blood.

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The blood stream which is a conductor cuts the magnetic

field and voltage is induced in the blood stream.

Measured with stationary electrodes located on opposite sides

of the blood vessel and perpendicular to the direction of the

magnetic field.
Electrodes  Stainless steel or platinum

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The magnitude of the voltage picked up is directly proportional to:

strength of the magnetic field

diameter of the blood vessel

velocity of blood flow

The induced voltage is amplified and displayed.

Requires that the blood vessel be exposed so that the measuring

probe can be put across it.

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Induced voltage

e=CHVd

If H and d are constant, then e=C1V

Flow rate through a tube Q=VA

V=Q/A

Then e = C1V = C1Q/A = C2Q

ie., induced voltage is directly proportional to flow rate

through the vessel

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Blood flow probes
DC flow meters  DC magnetic field

Electrode polarization

Amplifier drift

AC flow meters  Electromagnets driven by AC

Based on shape of the energizing current waveform :

1. Sine wave flow meter.

2. Square wave flow meter.

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Magnetic blood flow meter
Probe magnet is energized with an alternating current

Change of Magnetic Field causes transducer to act as transformer

Induces error voltage exceeds signal level

This voltage is 90° out of phase with the original signal

corresponding to flow of blood .

A method for eliminating transformer voltage is using a gated

amplifier(amplify signal only during flow induced voltage is

maximum).
This type of instrument is gated sine wave flow meter
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Magnetic blood flow meter
Transducer
It consist of:
An electromagnet
Pair of electrodes.
Electrodes may be in contact with either flowing blood or outer
surface of the blood vessel
Preamplifier
Low noise differential amplifier
through a capacitive coupling
Must have a very high CMRR and input impedance
Oscillator provides an excitation current to the electromagnet

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Gating circuit
Removes spurious error voltages generated during magnet
current reversal
Oscillator Provide Control signal
Amplification of signal only when the flow induced voltage is
maximum
Transformer induced voltage is like a spike
Separation is easier as amplification can be gated for a short
period of time
Balancing is required only when the current in the magnet is
reversing its direction

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Oscillator
It drives the magnet and provide control signal for the gate
circuit(60-400Hz)

Detector
A phase sensitive detector is used to recover the signal
It also helps in the rejection of interfering voltages at
frequencies below the carrier frequency

Low pass filter and output stage

Demodulated signal is given to an RC LPF, which provides a
uniform frequency response and a linear phase shift
Provide output corresponding to the mean flow
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ULTRASONIC BLOOD FLOW METERS

Ultrasonic energy is used to measure the velocity of flowing

blood
1. Transit time Ultrasonic flow meter
2. Doppler-shift type flow meter

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 [Link] time Ultrasonic flow meter
To diagonally canoe across a river with the current flow needs
less time than against the current flow.

The stronger the current,

the faster the crossing

This difference between the

travel times with and against
the current is directly proportional to the flow velocity of
the river.
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This effect is exploited by ultrasonic flow meters

Measure volume flow rate

Consists of a pair of ultrasonic transducers mounted along

an axis aligned at an angle with respect to the fluid-flow axis

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Each transducer has a transmitter–receiver pair

Transmitter emits ultrasonic energy

Travels across to the receiver on the opposite side of the vessel

Ultrasonic elements piezoelectric oscillators

Blood flowing in the vessel causes a time difference between

the transit times of the beams travelling upstream and

downstream
Measure this difference

Proportional to flow velocity

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[Link]-shift Flow-velocity Meters
Non-invasive

Measure blood velocity in a vessel from the surface of the

body.
Analyze echo signals from the erythrocytes

Due to Doppler effect, the frequency of echo signals

changes relative to the transmitted frequency.

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Doppler frequency shift is the measure of direction of the

flow velocity

The incident ultrasound is scattered by the blood cells

Received by the second transducer

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The frequency shift proportional to the velocity of scatterers

AKHIL KUMAR S
The piezo-electric crystal A generates ultrasonic waves

with frequency F, which enter the blood.

Ultrasound scattered from the moving blood cells excites the

receiver crystal.
Signal received at B  F+FD

AKHIL KUMAR S
The detector produces a sum & difference of the frequencies

Low-pass filter selects difference frequency audio

frequencies
Each time the audio wave crosses the zero axis, a pulse appears

at G
The filtered output is proportional to the blood velocity

AKHIL KUMAR S