International Journal of Advanced Health Science and Technology

Multidisciplinary : Rapid Review : Open Access Journal eISSN: 2808-6422

RESEARCH ARTICLE OPEN ACCESS

Manuscript received September 10, 2021; revised October 3, 2021; accepted October 4, 2021; date of publication November 20, 2021;
Digital Object Identifier (DOI): https://doi.org/10.35882/ijahst.v1i1.3
This work is an open-access article and licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0)

Digital ECG Phantom Design to Represent the

Human Heart Signal for Early Test on ECG
Machine in Hospital ECG
Sella Octa Ardila, Endro Yulianto, and Sumber
1
Departement of Electromedical Engineering Poltekkes Kemenkes, Surabaya, Indonesia

Corresponding author: Sella Octa Ardila (e-mail: [email protected]).

ABSTRACT Electrocardiograph (ECG) is a diagnostic device that can record the electrical activity of
the human heart. By analyzing the resulting waveforms of the recorded electrical activity of the heart,
it is possible to record and diagnose disease. Given the importance of the ECG recording device, it is
necessary to check the function of the ECG recording device, namely by performing a device
calibration procedure using the Phantom ECG which aims to simulate the ECG signal. The purpose
of this research is to check the ECG device during repairs, besides that the Electrocardiograph (EKG)
tool functions for research purposes on ECG signals or for educational purposes. Electrocardiograph
(EKG) simulator or often called Phantom ECG is in principle a signal generator in the form of an ECG
like signal or a recorded ECG signal. This device can be realized based on microcontroller and analog
circuit. The advantage of this simulator research is that the ECG signal displayed is the original ECG
recording and has an adequate ECG signal database. ECG This simulator also has the advantage of
providing convenience for research on digital signal processing applications for ECG signal processing.
In its application this simulator can be used as a tool to study various forms of ECG signals. Based on
the measurement results, the error value at BPM 30 and 60 is 0.00% at the sensitivity of 0.5mV, 1.0mV,
and 2.0mV, then the measurement results for the error value at BPM 120 are 0.33% and at the BPM
180 value, the error value is 0.22%. From these results, it can be concluded that the highest error value
is at BPM 120 with sensitivities of 0.5mV, 1.0mV, and 2.0mV.

INDEX TERMS Phantom ECG, BPM, Sensivitas

I. INTRODUCTION V2, V3, V4, V5, and V6. as well as sensitivity selection of
The heart is a muscular organ located in the space between 0.5 mV, and 1.0 mV. Using the heart signal formation method
the lungs (mediastinum) in the middle of the chest cavity. with dac type mcp4921 which later is expected to be used for
About two-thirds of the heart lies to the left of the mid-sternal learning given the importance of studying ECG signals and
line. The heart is covered by a membrane[1]. ECG is a the timing of ECG equipment on campus.
diagnostic tool that can record the electrical activity of the
human heart. By analyzing the waveform generated from the In 2016 a research entitled ECG simulator was also
recording of the electrical activity of the heart, it can be seen conducted by Anna Dawatus Solichah. The device uses
from several aspects such as knowing the rhythm arduino uno atmega 328P and DAC R/2R ladder. The results
abnormalities in the heart, knowing the effect of drugs on the of this study did not mention the range of BPM values. The
heart, knowing heart muscle abnormalities, estimating the results and changes in this study include testing the R/2R
enlargement of the heart, the value of the pacemaker ladder with a sine wave at a frequency of 1-100Hz. In a
function[2]. Based on the identification results from the previous study by Willa Olivia and Arfian Ahmad in 2017
background of the problem above, the author wants to with the title design of an electrocardiogram calibrator using
develop a phantom ECG tool that is equipped with BPM, the AT89S51 microcontroller with 0800 series DAC to form
sensitivity and frequency selection with 12 channels a heart signal. However, the tool only has a heart rate of 30.60
including lead I, lead II, and lead III, aVR, aVL, and aVF, V1, and 120 BPM. Gregory Mario Tani in 2017 with the title ECG

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International Journal of Advanced Health Science and Technology
Multidisciplinary : Rapid Review : Open Access Journal eISSN: 2808-6422

simulator phantom electrocardiograph. The method used is to A. Experimental Setup

use a Digital To Analog (DAC) IC type MCP4921 to form This study uses measurements of BPM values in the range of
the desired heart signal. However, the device only has a heart 30, 60, 120, and 180. The sensitivity values are in the range
rate value in the range of 30-110 BPM[3]. of 0.5mV, 1.0 mV, 2.0 mV. With data retrieval repeated for 6
Furthermore, in 2017 Ni Nyoman Sri Malini also made an times.
ECG simulator tool using the formation of an ECG signal 1) MATERIALS AND TOOL
with a 4017 IC counter and a NE555 clock. Unlike the DAC This research uses ATMega 2560 microcontroller as data
IC which can be formed according to plotting the original processing. The ATMega 2560 output is in the form of a
image of the heart signal, however, the 4017 IC counter used display on a 2.4 Inc TFT as a display. This research uses the
by Ni Nyoman Sri Malini still has a weakness in the use of MCP4921 DAC IC as a signal formation with 12-bit
capacitors, causing an imperfect ECG waveform in the ST resolution and a networking circuit that functions as a voltage
segment and the large capacitor value affecting segment distribution between leads.
width and interval on the PQRST wave. [4] addition to this,
related to BPM, there are also weaknesses in the frequency 2) EXPERIMENT
issued by the microcontroller so that the BPM is unstable. In In this study, after the design was completed, testing was
2018 the ECG simulator was also created by M. Ziko carried out using an ECG recorder, namely by looking at the
Alamanda with the title phantom ECG. The method used is to suitability of the sensitivity 0.5 mV, 1.0 mV and 2.0 mV and
use a DAC type MCP4921 to form the desired heart signal. BPM 30, 60, 120, and 180.
The ECG simulator has a BPM range of 30 - 240 but the
sensitivity selection is only 0.5 and 1.0 mV. In 2019 I Dewa B. The Diagram Block
Gede Budi Whinangun with the title microcontroller-based When the device is turned on, the display will start to
ECG simulator. The ECG simulator made is a 12 channel initialize as shown in FIGURE 1 which will display the
ECG tool which includes lead I, lead II, lead III, aVR, aVF, sensitivity and BPM selection then we can set the BPM and
aVL, V1, V2, V3, V4, V5, and V6 which will be displayed sensitivity to issue a PQRST signal output, then the processed
on the ECG paper, and complete it with a selection selector. results from the MCU will be displayed on the TFT display. .
sensitivity and BPM as well as using the method of forming While blocks LA, RA, LL, RL, aVR, aVL, AVF, V1, V2, V3,
cardiac signals through the MCP 4921 type DAC.[2] V4, V5 and V6 will receive the form of signals issued by the
DAC in analog form which has previously been processed in
Based on the weaknesses in previous studies that have the resistor network circuit block. This resistor network
been mentioned, among others, in 2016 a study was held with circuit block serves to provide a difference in impedance for
the title ECG simulator the weakness was that the range of each Lead.
BPM values was not stated. The results and changes in this
study include testing the R/2R ladder with a sine wave at a
frequency of 1-100Hz. In 2017 with the title design of an
Sensitivity
electrocardiogram calibrator using the AT89S51
microcontroller with a 0800 Series DAC. However, the tool Selection
only has a heart rate of 30, 60 and 120 BPM. in 2017 with the Thin Film
ATMEGA2560
title ECG phantom electrocardiograph simulator. The method Transistor
used is to use a DAC type MCP4921 to form the desired heart BPM
signal. However, the device only has a heart rate value in the Selection
range of 30-110 BPM. In 2017 Ni Nyoman Sri Malini also
made an ECG simulator tool using the formation of an ECG
signal with a 4017 IC counter and a NE555 clock. still has a
weakness in the use of capacitors, causing the ECG waveform Digital to
to be less than perfect in the S-T segment and the large Analog
capacitor value affects the segment width and interval on the Converter Output:
PQRST wave. In 2018 ECG simulator the ECG simulator has (DAC)
a BPM range of 30 – 240 but the sensitivity selection is only LL, LA RA, RL,
0.5 and 1.0 mV. Year 2019 with the title microcontroller- V1, V2,V3, V4,
based ECG simulator. Based on the results of the V5, V6
Resistor
identification of problems that exist from existing research, Network
the authors want to develop and overcome these shortcomings
by making a final project research entitled phantom ECG FIGURE 1. The diagram block of the Phantom ECG
equipped with 12 leads and sensitivities 0.5mV, 1.0mV and
2.mV appear on the TFT display where the author is still C. The Flowchart
using IC DAC MCP4921 for the formation of the output.
The arduino program is built based on the flowcarty as
II. MATERIALS AND METHODS shown in FIGURE 2 When the tool is turned on in the initial
conditions, an initialization process occurs on the TFT
display. After that we can make the selection of BPM and

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International Journal of Advanced Health Science and Technology
Multidisciplinary : Rapid Review : Open Access Journal eISSN: 2808-6422

sensitivity as desired. Furthermore, the selection of the data 2) Circuit of DAC MCP4921
will be input into the microcontroller to be processed and The DAC circuit is a circuit used for the microcontroller to
forwarded to the DAC circuit to be converted from digital to communicate with the MCP4921 DAC through PIN CS,
analog, which will later be forwarded to the networking SCK and SDI. The microcontroller will provide a digital
resistor then the incoming voltage will be distributed to each signal form through the program and the MCP4921 DAC
output in the circuit. will translate it into analog data with 12-bit resolution
START (FIGURE 4).

BPM Selection

Sensitivity
Selection

Converting digital
signal to analog

Current Distribution
FIGURE 4. Circuit of DAC MCP4921

Output LL, LA, 3) Circuit of Resistor Networking

RA, RL, V1, V2,
V3, V4, V5, V6 This circuit is used to divide the value of the ECG signal
according to the impedance of the body. Here is a breakdown
END
of the connector pins: pin1 = LA, pin2 = LL, pin3 = RA, pin4
= RL, pin5 = V4, pin 6 = V3, pin 7 = V5, pin8 = V6, pin9 =
FIGURE 2. The Flowchart of the Arduino Program V1, and pin10=V2. (FIGURE 5)

D. The Circuit
1) Main Circuit
On the TFT display there is a button for the regulation of
bpm, Sensitivity, which will later be entered into the program
command on the atmega 2560 which functions as a processor
of the tool. Where the pins used are MOSI, MISO, SCK RST
and GND which function to upload programs. Atmega 2560
can work when given a voltage of 4.5 - 5.5 Vdc. (FIGURE
3).

FIGURE 5. Circuit of Resistor Networking

III. RESULT
This study, the Phantom Ecg has been tested using a ECG
Recorder (Digital Electrocardiograph, Model : ECG-9012A,
SN : ECG-9012A120435). The result shows that the
recording is feasible to record the ECG signal from the human
body. The proposed design is shown in FIGURE 6.
1) THE PHANTOM ECG DESIGN
FIGURE 3. Main Circuit
Analog photos and design series photos of phantom ecg are
shown in FIGURE 6. The analog circuit section consists of a
resistor circuit and a DAC circuit. The voltage divider circuit
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International Journal of Advanced Health Science and Technology
Multidisciplinary : Rapid Review : Open Access Journal eISSN: 2808-6422

consists of 18 resistors and the DAC circuit consists of a 1 TCCR2B |= (1 << CS22) | (1 << CS20); // mengatur berapa bit yang
capacitor circuit, a voltage divider circuit and the MCP4921 di pakai
TCCR2B &= ~(1 << CS21);// clear bit
IC. There is also a variable resistor (multiturn 10k) for tcnt2 = 130;// simpan nilai untuk digunakan lagi di ISR
adjusting the sensitivity value of the result to produce the
same amplitude.
4) THE LISTING PROGRAM TIMER INTERRUPT
The listing program for calibration and leak test was shown
in the Pseucode 2. This program uses milliseconds as timer.

5) MEASUREMENT RESULTS OF EACH INCREASE IN

BPM
The error value on the Phantom ECG is obtained from the
measurement results 5 times with BPM 30, 60, 120, and 180
with a sensitivity of 0.5 mV, 1.0 mV, and 2.0 mV. The error
value at the BPM value of 0.5 mV is shown in Table I, the
error value at the BPM 1.0 mV value is shown in Table II,
FIGURE 6. The Phantom Ecg design and the error value at the BPM value of 2.0 mV is shown in
table I.
2) THE LISTING PROGRAM FOR ARDUINO
TABLE 1
PHANTOM ECG Calculation of Error Value at Each BPM Sensitivity 0.5 mV
The listing below shows the void setup which functions as a
function that can be executed only once when the program is Setting BPM Mean (BPM) Error (BPM)
started, and also contains the initialization functions used in 30 30.00 0.000
the program such as the pins of the Arduino IC. 60 60.00 0.000
120 119.0 0.333
3) THE LISTING PROGRAM DAC INTERFACE 180 179.0 0.222
The listing contained in Pseucode 1. shows the program to
send data that has been processed by the microcontroller to TABLE I above is the result of calculating the average value
the DAC circuit for conversion into analog data. and error value at BPM 30, 60, 120, and 180 using a
sensitivity of 0.5 mV. In the table above it can be seen that
the highest error value is at BPM 120 with an error value of
Pseucode: 1 Program DAC interface
0.33% and BPM 180 with error value of 0.22%.
void DTOA_Send(unsigned short DtoAValue) {
byte Data = 0; // memeilih pin out untuk D/A TABLE 2
chip(low) Calculation of Error Value at Each BPM Sensitivity 1.0 mV
digitalWrite(53, 0); // chip select low
//pertama mengirim bit dahulu 0011xxxx Setting BPM Mean (BPM) Error (BPM)
Data = highByte(DtoAValue); 30 30.00 0.000
Data = 0b00001111 & Data; 60 60.00 0.000
Data = 0b00110000 | Data;
SPI.transfer(Data); 120 119.0 0.333
//Selanjutnya mengirim bit low xxxxxxxx 180 179.0 0.222
Data = lowByte(DtoAValue);
TABLE 2 above is the result of calculating the average
SPI.transfer(Data);
digitalWrite(53, 1); value and error value at BPM 30, 60, 120, and 180 using a
} sensitivity of 1.0 mV. In the table above it can be seen that
the highest error value is at BPM 120 with an error value of
0.33% and BPM 180 with error value of 0.22%.
Pseucode: 2 Timer program
TABLE 3
Calculation of Error Value at Each BPM Sensitivity 2.0 Mv
TIMSK2 &= ~(1 << TOIE2); // Mematikan timer overflow interrupt
saat mengirim
TCCR2A &= ~((1 << WGM21) | (1 << WGM20)); // configurasi Setting BPM Mean (BPM) Error (BPM)
timer2 dalam normal mode ( hanya berfungsi untuk menghitung tidak 30 30.00 0.000
ada pwm etc
TCCR2B &= ~(1 << WGM22);
60 60.00 0.000
ASSR &= ~(1 << AS2); // memeilih internal clock 120 119.0 0.333
TIMSK2 &= ~(1 << OCIE2A);// menonaktifkan pembanding 180 0.222
overflow interupsi( hanya overflow)
179.0
// konfigurasi presclaer ke CPU clock di bagi 128

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International Journal of Advanced Health Science and Technology
Multidisciplinary : Rapid Review : Open Access Journal eISSN: 2808-6422

TABLE 3 above is the result of calculating the average value value so that the shape of the AVl signal is not reversed, using
and error value at BPM 30, 60, 120, and 180 using a a larger TFT screen.
sensitivity of 0.5 mV. In the table above it can be seen that
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Attachment:
a. Skematik :
https://drive.google.com/file/d/164PhgW2hF8j7OhOH_kPavIa
d_v11ueT8/view?usp=sharing

b. Board :
https://drive.google.com/file/d/1a1kneI0vwQLSY8VGCS-
VdMxpMWZJB53H/view?usp=sharing

c. Listing Progam :
https://drive.google.com/drive/folders/1-pazRuwPboHjUg2-
ib2kNPKEJMbWFWu0?usp=sharing

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