75

Basic Diagno
7. Basic Diagnostics in Cardiology

Part B 7
Rüdiger Kramme

7.7 Complications ...................................... 84

The term basic cardiology diagnostics refers to
the noninvasive measurement of the cardiac 7.8 Technical Safety Aspects of ECG Systems .. 84
electrical action potential at rest and under
7.9 Long-Term ECG ..................................... 84
stress, in order to assess heart function. Due
7.9.1 Leads.......................................... 84
to technical developments in ECG systems, the
informative value of (basic) diagnostic assess- 7.10 Long-Term ECG Systems......................... 85
ments of the cardiovascular system has improved 7.11 Computer-Based Assessment ................. 85
enormously with ever-increasing accuracy. This
chapter introduces equipment-based diagnostic 7.12 Heart Rate Variability
methods: Sect. 7.1 ECG, Sect. 7.9 Holter Monitoring and Heart Rate Turbulence .................... 87
and Sect. 7.19 Exercise ECG. 7.13 Indications
for Long-Term Electrocardiography ........ 87
7.1 Electrocardiography .............................. 75 7.14 The Significance of the Long-Term ECG ... 87
7.2 Electrocardiograph Equipment 7.15 The Exercise ECG ................................... 88
Technology and PC ECG.......................... 76 7.16 Equipment Technology.......................... 88
7.2.1 Physical 7.16.1 Physical
and Technological Principles.......... 76 and Technological Principles.......... 88
7.2.2 Equipment Classification ............... 77 7.16.2 Ergometry Measuring Station ......... 88
7.2.3 Recording Systems........................ 78 7.16.3 Types of Ergometers...................... 88
7.2.4 Electrode Technology .................... 78
7.2.5 System Properties......................... 79 7.17 Reduced Exercise ECG Leads ................... 89
7.2.6 Operating Modes .......................... 79
7.18 Automatic ST Measuring Programs.......... 90
7.3 ECG Methods ........................................ 79
7.19 Exercise Test ........................................ 90
7.4 Lead Systems........................................ 80 7.19.1 Stress Intensity ............................ 90
7.4.1 Measurements from the Surface
7.20 Methodological Notes ........................... 93
of the Body ................................. 80
7.4.2 Standard Leads ............................ 80 7.21 The Diagnostic Value of Ergometry ......... 93
7.4.3 Augmented and Reduced Leads
7.22 Indications .......................................... 93
from the Surface of the Body ......... 82
7.4.4 Invasive Leads ............................. 83 7.23 Abort Criteria and Safety Measures ......... 93
7.5 Methodological Notes ........................... 83 7.24 Technical Safety Aspects ........................ 94
7.6 The Diagnostic Value of the ECG ............. 83 7.25 Notes on Planning ................................ 94

7.1 Electrocardiography
Electrocardiography (ECG) is a method of recording spatial profiles of the electrical excitation processes in
electrocardiograms – which record the temporal and the myocardium in the form of waves, peaks and lines

R. Kramme et al. (eds.), Springer Handbook of Medical Technology

© Springer-Verlag Berlin Heidelberg 2011
 76 Part B Functional Diagnostics Devices
Part B 7.2

Electroarteriogram Electroventriculogram
Nomenclature P wave PQ interval QRS complex ST segment T wave U wave
Electrical heart Depolarization Transition Depolarization Complete Repolarization
activity of atria of ventricles depolarization of ventricles

T 1/8 – 2/3 of R
Q = 0.04 s; <1/4 of R
P < 0.25 mV

R 0.6 – 2.6 mV

S < 0.06 mV
J-point

Isoelectric 0.05 – 0.1 s Isoelectric

line 0.1 s line

PQ time QT duration
0.12– 0.2 s Frequency dependent

Fig. 7.1 Nomenclature of the electrocardiogram (ECG)

(Fig. 7.1) – and performing diagnostic analyses of these face of the body, which make up only a fraction of the
electrocardiograms. potential generated by the heart. The heart is thus inter-
Every instance of depolarization through cardiac preted as a source of potential, so the ECG ultimately
fibres is the source of an electric potential. These provides an image of the generation of electricity (po-
noninvasive measurements generally measure potential tential shift) and reflects the excitation processes in the
differences that occur across an electric field on the sur- measurements selected.

7.2 Electrocardiograph Equipment Technology and PC ECG

Electrocardiographs (ECG devices for short) and PC are set for an ECG preamplifier when compared to usual
ECG modules are diagnostic devices for recording, amplifier technology: interfering high-frequency AC
amplifying, storing, processing, analysing and docu- voltages are attenuated by means of a high-frequency
menting (registering) an electrocardiogram. Noninva- filter upstream of the preamplifier input, so that no
sive electrocardiography has been a standard procedure overamplification or self-excitation can occur. Extreme
for a number of decades, and ECG equipment is there- interference voltages are likewise blocked by means of
fore as good as is mandatory in both hospitals and small discharge sections and antiparallel diodes. A relatively
private practices. high input resistance (generally 10 MΩ and above)
keeps the input currents very low. Capacitively coupled
7.2.1 Physical and Technological Principles mains-frequency AC voltages are eliminated through
high common mode rejection. Following a 20- to 30-
ECG systems are low-noise differential amplifiers; in fold preamplification, the ECG signal is separated from
other words, they consist of a strongly coupled DC am- the direct current via a high-pass filter. The time con-
plifier with a high amplification factor and inverting stant of this filter is 1.5 or 3.2 s. Whereas the processed
(reversed) and noninverting inputs. The output voltage ECG signal is fed to the respective channel ampli-
is a multiple of the voltage present at the input termi- fiers (1 . . . > 12) via an lead selector in analogue ECG
nals. It is the differential voltage of the two voltages equipment, this step is omitted in digital ECG equip-
present at the same pole. Particularly high requirements ment. The recorded signals are instead connected to 12