CARDIAC MONITOR

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CARDIAC MONITOR

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The human heart pumps blood by the contraction and relaxation of the heart. Specifically, a small group of specialized muscle cells located in the upper right-hand corner of the right atrium (upper part of the heart) called sinoatrial (SA) node. Cells in the SA node generate their electrical signals more frequently than cells elsewhere in the heart. On the other hand, the ventricle which is the lower part of the heart pumps blood with much more force because of the thick muscle which it’s walls are composed of. Both the atrium and the ventricle perform their operations with the help of cells. These atrium cells in the cause of discharging their duties generate electrical signals which is passed through the help of some connected tissues partitioned by a small bridge of muscle called the atrio-ventricular conduction system down to the ventricle. The delay (lag time) between the signals reaching the ventricle is about two-tenth of a second. This delay allows time for the blood in the artria to empty into the ventricle before the ventricle begins contracting.

It is therefore paramount to note that the atrium and the ventricle do not pump blood simultaneously but take turns to do so. The activities of cells in the heart can be monitored by a heartbeat monitor called an Electrocardiogram (ECG or EKG). Electrocardiogram is derived from the Greek word “electro” for “electric”; “kardio” for “heart” and “graph” for “to write”) and the German word “electrocardiogram”. An ECG machine is used to detect and record electrical activity for diagnostic purposes. An ECG records the heart’s own electrical impulses to create an electrocardiograph, a reading that helps physicians learn more about the heart. It is important to note that the ECG is not a form of treatment but allows physicians diagnose heart diseases by taking a close look at the heart and its activities.

An electrocardiogram can:

i) Evaluate damaged and diseased tissue or other physical irregularities.

ii) Monitor any surgical repairs, pacemakers, or effects of drugs used to treat existing heart conditions.

iii) Determine whether the heart is performing normally or suffering from abnormalities (extra or skipped heartbeats cardiac arrhythmia).

iv) Indicate acute or previous damage to heart muscle (heart attack).

v) Be used for detecting potassium, calcium, magnesium and other electrolyte disturbances.

vi) Allow the detection of conduction abnormalities (heart block). vii) Suggest non-cardiac disease (pulmonary embolism).

The ECG records electrical activity by the aid of electrodes that are connected at strategic points on the body of the patient. These strategic placements which give the readings are recorded in pairs and these pairs are called leads. There are 3 types of leads which are 3-lead, 6-lead and 12-lead.

Each lead views the heart from a different angle. 3 and 6-lead ECGs, record limited heart activity, and are primarily used to monitor a patient’s heart during surgery, and can be used to diagnose early heart conditions. 12-lead machines look at the heart from twelve different angles and provide the type of readings necessary to diagnose and monitor patients with advanced heart conditions [4].

In a 12-lead ECG, six electrodes are attached to the skin on the chest around the heart. Four more electrodes are added, one on each arm and leg. The ten electrodes combine in twelve different ways to read twelve different angles on the heart.

When the heart depolarizes which occurs when the heart muscle which is negative at rest moves closer to a neutral charge with each heartbeat, the electrodes sense the tiny electrical impulses on the skin that are created as a result. The impulses travel back to the machine where they are interpreted and printed on a graph.

A healthy heart will print out an orderly wave of progression with each heartbeat, while a heart with diseased or damaged tissue will show certain irregularities in the heart’s rhythm, size, or position.

1.2 The normal ECG

A typical ECG tracing of a normal heartbeat consists of a P wave, a QRS complex and a T wave.

Axis: The axis is the general direction of the electrical impulse through the heart. It is usually directed to the bottom left.

P wave: The P wave is the electrical signature of the current that causes atrial (top chamber of the heart) contraction. Both the left and right atria contract simultaneously.

Fig. 1: Drawing of the EKG, with Labels of Intervals; P=P Wave, PR=PR Segment, QRS=QRS Complex, QT=QT Interval, ST=ST Segment, T=T Wave [5].

QRS: The QRS complex corresponds to the current that causes contraction of the left and right ventricles, causing a greater

ECG deflection due to more muscle mass.

The Q wave, when present, represents the small horizontal (left to right) current as the action potential travels through the inter-ventricular (lower chamber of the heart) septum.

The R and S waves indicate contraction of the myocardium (the thickest muscular wall of the heart around the ventricle where the pressure is greatest).

T wave: The T wave represents the repolarization of the ventricles, which is when the heart muscles go back to their negative state at rest after a heartbeat. The QRS complex usually obscures the atrial repolarization wave so that it is not usually seen. In most leads, the T wave is positive. Negative T waves can be signs of diseases; however an inverted T wave is common amongst black people.

The ST segment connects the QRS complex and the T wave.

An ECG is not usually performed as a preventative measure that is prior to any symptoms of possible heart conditions, it is only utilized to diagnose or rule out the presence of diseases, disorders, and other irregularities. ECG machines are often found in general practice clinics, as well as in ambulances, emergency rooms, hospitals, and cardiology centers [5]. Strong indications have emerged that people in under-developed countries are now at great risk of developing cardiovascular (heart) diseases which currently accounts for one-third of all deaths worldwide. Cardiovascular disease (CVD) is an umbrella term that refers to any of a number of diseases affecting the heart and blood vessels [7]. Electrocardiographs (results of ECG analysis) are usually complex and can only be interpreted by medical practitioners. This leaves the patients in the dark regarding the meaning of their ECG results. Also, most ECG machines print out the result in a sinusoidal wave form on a special tracing paper which makes subsequent accessibility rather tedious and traditional.

Consequently, the need for a device that addresses this issue is needed hence the birth of this project. The aim of this project is to provide the average person suffering from a heart condition with a portable device that can be used to monitor the heart, with results that are easily understandable to the patient and a form of storage for perusal later and analysis by medical personnel. Objectives of this project are to reduce the size of the heartbeat monitoring device currently available and making it more portable, furthermore, interpreting results to an extent and making it easily understood by non-medical personnel (layman), also to provide storage for heartbeat readings on the device which when connected to a computer system, can be analyzed by a doctor or printed for documentation.

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