Table of Contents

CHAPTER ONE........................................................................................................................................ 5

INTRODUCTION AND REVIEW................................................................................................................ 5

CHAPTER ONE....................................................................................................................................... 6

INTRODUCTION AND REVIEW................................................................................................................ 6

1.1 INTRODUCTION...........................................................................................................................................................6
1.2 LITERATURE REVIEW....................................................................................................................................................6
1.3 CONDITIONS OF THE ARTERIES.......................................................................................................................................7
1.4 AIM OF THE WORK.....................................................................................................................................................9
1.5 PROJECT OUTLINES...................................................................................................................................................10

CHAPTER TWO...................................................................................................................................... 9

LITERATURE THEORETICAL REVIEW........................................................................................................ 9

2.1 INTRODUCTION...........................................................................................................................................................9
2.2 ELECTROCARDIOGRAM.................................................................................................................................................9
2.3 SCALE AND CALIBRATION OF TIME................................................................................................................................11
FIGURE(2-4)................................................................................................................................................................. 15
2.4 NORMAL VOLTAGE ON THE ELECTROCARDIOGRAM...........................................................................................................15
2.5 GENERATIONS OF ECG DEVICES...................................................................................................................................18

CHAPTER THREE................................................................................................................................... 20

RESEARCH METHODOLOGY.................................................................................................................. 20

CHAPTER THREE.................................................................................................................................... 9

RESEARCH METHODOLOGY.................................................................................................................... 9

3.1 INTRODUCTION...........................................................................................................................................................9
3.2 CERTAIN HEART DISEASES ABNORMAL ATRIAL RHYTHMS.....................................................................................................9
3.3 MYOCARDIAL INFARCTION (HEART ATTACK)....................................................................................................................12
FIGURE(3-2)................................................................................................................................................................. 14
3.4 DIZZINESS AND SYNCOPE............................................................................................................................................14
3.5 POSSIBLE TACHYCARDIA PATIENTS................................................................................................................................18
3.6 ATRIAL FLUTTER........................................................................................................................................................19

1
 CHAPTER FOUR................................................................................................................................... 22

RESULTS AND DISCUSSION................................................................................................................... 22

CHAPTER FOUR RESULTS

AND DISCUSSION................................................................................................................................................ 9

4.1 INTRODUCTION...........................................................................................................................................................9
4.2 THE SIMPLIFIED EXPLANATION OF THE MATLAB PROGRAM: -...............................................................................................9
4.3 DATABASE:..............................................................................................................................................................10
4.4 EXPLANATION OF THE PROGRAM STEPS:........................................................................................................................10
4.5 FACADE BUILD:.........................................................................................................................................................17
4.6 FUTURE PROSPECTS:-.................................................................................................................................................25

REFERENCES....................................................................................................................................... 27

2
 List Of Figures

Figure 1-1:Basic Design and operation of BCI system.........................................7

Figure 0-1 :Experimental Procedure...................................................................11
Figure 0-2 :Electrode positions.............................................................................11
Figure 0-3 :Schematic flowchart for (ICA) data decomposition and back
projection........................................................................................................18
Figure 3-1 :Scalp distribution of power during left hand imagery...................23
Figure 3-2 :Scalp distribution of power during right hand imagery................23
Figure 3-3 :channel ERPs at electrode positions C1, C2, C3, C4, C5, C6
during right....................................................................................................24
Figure 3-4 :channel ERPs at electrode positions C1,C2,C3,C4,C5,C6 during
left hand imagery...........................................................................................25
Figure 3-5 :Comparison of ERP averages of right and left imagery at
electrodes positions C1, C2, C3, C4, C5, C6................................................25
Figure 3-6 :Mean properties of cluster 1.............................................................26
Figure 3-7 :Mean properties of cluster 2.............................................................27
Figure 3-8 :Average scalp map for all clusters...................................................27
Figure 3-9 :ERSP plot of cluster 1.......................................................................27
Figure 3-10 :ERSP plot of cluster 2.....................................................................28
Figure 3-11 :Mean properties of cluster 1...........................................................28
Figure 3-12 :Mean properties of cluster 2...........................................................29
Figure 3-13 :ERSP plot of cluster 1.....................................................................29
\Figure 3-14 : Top view, Saggital view, Coronal view of dipole source
localization of left hand imagery..................................................................30
Figure 3-15 :Top view,Saggital view,Coronal view of dipole source localization
of right hand imagery....................................................................................30

3
Figure 4-1 :Start Matlab.......................................................................................31
Figure 4-2 :The blue main EEGLAB window....................................................31
Figure 4-3 :Biosemi format data..........................................................................32
Figure 4-4 :Load Data...........................................................................................32
Figure 4-5 :channel locations................................................................................33
Figure 4-6 :Filter the Data....................................................................................34
Figure 4-7 :Extract Data.......................................................................................34
Figure 4-8 :Run ICA.............................................................................................35
Figure 4-9 :Creating a STUDY............................................................................36

4
 Chapter One

Introduction And Review

5
 1 Chapter One

Introduction And Review

1.1 Introduction

History and a short review of the Anatomy of the human body and heart will
be introduced in this chapter. However, more details will be shown deeper than
others since this project will deal with reading the heart wives using the MATLAB
package and designing an interface inside the MATLAB environment to simplify
the process of reding, this chapter shows outlines of the whole project as well as
the aim of the project.

1.2 Literature review

The arteries are the blood vessels that deliver oxygen-rich blood from the
heart to the tissues of the body Each artery is a muscular tube lined by smooth
tissue and has three layers. The inner layer is lined by a smooth tissue called the
endothelium [1]. The media is a layer of muscle that lets arteries handle the high
pressures from the heart [2] . The adventitia connective tissue anchoring arteries to
nearby tissues

The largest artery is the aorta, the main high-pressure pipeline connected to
the heart's left ventricle . The aorta branches into a network of smaller arteries that
extend throughout the body. The arteries' smaller branches are called arterioles and
capillaries. The pulmonary arteries carry oxygen-poor blood from the heart to the
lungs under low pressure, making these arteries unique [3].

6
1.3 Conditions of the Arteries

Atherosclerosis: The buildup of cholesterol a waxy substance into what are

called plaques in the arteries walls [4]. Atherosclerosis in the arteries of the heart,
brain, or neck can lead to heart attacks and strokes. Vasculitis arteritis:
Inflammation of the arteries, which may involve one or more arteries at the same
time. Most vasculitis is caused by an overactive immune system. Amaurosis Loss
of vision in one eye is caused by a temporary loss of blood flow to the retina [4],
the light-sensitive tissue that lines the back of the eye. It usually occurs when a
portion of a cholesterol plaque in one of the carotid arteries (the arteries on either
side of the neck that supply blood to the brain breaks off and travels to the retinal
artery the artery that supplies blood and nutrients to the retina. Stenosis of the
arteries: Narrowing of the arteries, usually caused by atherosclerosis. When
stenosis occurs in arteries in the heart, neck, or legs, the limitations in blood flow
can cause serious health problems [5]

Peripheral artery disease: Atherosclerosis that causes narrowing of the

arteries in the legs or groin. The limitation in blood flow to the legs may cause pain
or poor wound healing. Arterial thrombosis: A sudden blood clot in one of the
arteries, stopping blood flow. Immediate treatment is necessary to restore blood
flow in the artery. Myocardial infarction heart attack: A sudden blood clot in one
of the arteries supplying blood to the heart. Cerebrovascular accident (stroke): A
sudden blood clot in one of the arteries supplying blood to the brain Strokes may
also occur when one of the arteries in the brain bursts, causing bleeding. Temporal
arteritis: Inflammation of the temporal artery in the scalp. Pain in the jaw with
chewing and pain over the scalp are common symptoms.

7
 Coronary artery disease: Atherosclerosis with narrowing of the arteries
supplying blood to the heart muscle. Coronary artery disease makes a heart attack
more likely Carotid artery disease: Atherosclerosis with narrowing of one or both
of the carotid arteries in the neck. The disease of the carotid arteries makes stroke
more likely. Tests of the Arteries

Angiogram angiography: [6] A thin, flexible tube is inserted into the arteries,
a special dye is injected, and an X-ray shows blood flow through the arteries.
Areas of narrowing or bleeding in the arteries can often be identified through
angiography. Computed tomographic angiography (CT-A scan): A CT scanner
takes multiple X-rays, and a computer compiles them into detailed images of the
arteries. A CT-A scan can often show narrowing or other problems in the arteries
with less risk than regular angiography.

Stress test: Either with exercise or medicines, the heart is stimulated to beat
rapidly. As this stress increases blood flow through the heart's narrowings, the
coronary arteries may be identified through various testing techniques. Magnetic
resonance angiography (MRA scan): An MRI scanner uses a high-powered magnet
and a computer to create highly detailed images of structures inside the body.
MRA is a setting that allows an MRI scanner to best display images of the arteries.
[6]

Cardiac catheterization: A catheter thin, flexible tube is inserted into one of

the arteries in the groin, neck, or arm and advanced into the heart. A dye that
improves image contrast is injected through the catheter so that blood flow through
the coronary arteries can be seen on an X-ray screen. Blockages in the arteries may
then be found and treated. Artery biopsy: A small piece of an artery is removed
and examined under a microscope, usually to diagnose vasculitis. The temporal
artery in the scalp is most often biopsied. Treatments for the Arteries
8
 Statins: Cholesterol-lowering,medicines taken by mouth, including
atorvastatin (Lipitor) Fluvastatin (Lescol) lovastatin (Altoprev, Mevacor),
pitavastatin, (Livalo) pravastatin(Pravachol),rosuvastatin(Crestor) and simvastatin
(Zocor).Taken daily, statins can lower the risk of a heart attack or stroke [6].

Aspirin: In addition to its pain-reducing and fever-reducing properties,

aspirin interferes with blood clotting. Taken daily, aspirin can help prevent heart
attacks and strokes. Plavix clopidogrel. A medicine that interferes with blood
clotting, similar to aspirin. Plavix is commonly prescribed after heart attacks or
strokes to prevent future ones. Arterial stenting: A stent small mesh tube is placed
inside an artery to hold it open. Stenting is most often performed on the coronary
arteries .

Angioplasty: During catheterization of one of the arteries, a balloon is

inflated inside the artery to help open it up. Corticosteroids: Anti-inflammatory
medicines [7]like prednisone or methylprednisolone (Solu-Medrol) are used to
treat vasculitis affecting the arteries.

Biologics: A biologic drug called tocilizumab (Actemra) may be used.

Tocilizumab is given as an injection under the skin. This medicine may be used
along with steroids [8]. Thrombolytics: Powerful "clot-busting" drugs may be
injected into the body to dissolve a blood clot causing a heart attack or stroke.
Cilostazol (Pletal) and pentoxifylline (Trental): Medicines that help increase blood
flow through the arteries of the legs. In people with peripheral artery disease, these
drugs can reduce the pain of walking

9
1.4 Aim of the Work

This project aims to design and implement an interface package, to simplify

the analysis of the heart wives signal using MATLAB It is required to design the
Interface such that the heart wave signal generated by ECG analyzed using an
algorithm for detecting electrical heart signal compounds (PQRST), and this
includes determining the time and peak of each of these compounds and the use of
these properties

1.5 Project Outlines

The outlines of the project can be described as follows:

 Chapter Two shows the theory review behind electrocardiograms

performed by Circular sensors
 Chapter Three The research Methodology and introduction to heart
disease Abnormal atrial rhythms
 Chapter Four gives the results and their discussions, where an
analysis of EEG data using EEGLAB was given and
recommendations for future work.

10
 Chapter Two

Literature Theoretical Review.

 2 CHAPTER TWO

Literature Theoretical Review.

2.1 Introduction

In this chapter, the operation theory of Electrocardiogram systems, in

general, will be introduced, then the Generations of ECG devices will be given.

2.2 Electrocardiogram

As part of a routine check-up, if middle-aged or older. As a way of

evaluating symptoms that could be caused by heart problems, such as chest pain,
difficulty breathing, rapid or irregular heartbeat, or swelling in the legs, Is an
electrocardiogram performed Circular sensors (electrodes) attached to the skin are
placed on the arms, legs and chest. Wires connected to the sensors are connected to
a device. When, the heart beats, the sensors measure the electrical currents of the
heart,The device records the information received from each sensor and draws the
electrocardiogram squiggly line with bumps for the doctor to read.

Are there any side effects of an electrocardiogram .There are no side effects
of this examination, and it does not cause any harm at all during or after it. An
electrocardiogram helps a doctor learn many things about a person's heart, such as:
If you have had or are having a heart attack in the pas [9] the patient has a heart
rhythm disturbance ,If the heart is not getting enough blood and oxygen If the
muscular wall of the heart is too thick ,If there are bulges in weak areas of the
walls of the heart (called an aneurysm . Are the electrical connections to the
device ?They are the electrodes or electrical sensors that are connected to wires
and connected to the device and are divided into the terminal connections that
connect to the four ends and the chest connections [10]. The colors of the terminal
connections have been agreed upon as follows. The white colour , which is
connected to the right hand and written on it (RA). The black color, which is
connected to the left hand and written on it (LA) . The green colour, which is
attached to the right foot and is written on it (RL . The red color that connects to
the left foot and writes (LL) on it ,It is connected to the chest and its colour is
brown and written on it [11](c) In addition to the bipolar terminal connections
BIPOLAR . They are I, II, III and it is called EINTHOVEN TRIANGLE It is
connected as shown in (Fig 2-1)

Figure(2-1)
 As for the chest connections, they are divided into:

V 1 ,V 2 ,V 3 , V 4 , V 5 ,V 6

Figure(2-2)

2.3 Scale and calibration of time

ECB play works electric heart structure on the recording of electrical

signals in your heart, It is a common and painful test, used to discover heart
problems and control your health quickly [12]. Early heart capacity is being carried
out at the doctor's clinic or in a hospital room. ECB is standard equipment in
operating rooms and ambulances. Some personal devices, such as smartwatches,
are also available in the computer-cutting field. Ask your doctor if that's an option
Why a heart capacity is being conducted painful and impartially used to help
diagnose many of the problems of the heart of people of all ages [13], [14]. Your
medicine may use a special heart card planning to determine or discover:My
abnormal heart systems .carditis disorder If the cultivated or narrower in your heart
the coronary artery disease caused you Alma in the heart or a heart attack . whether
you have abducted a heart attack by the successful ice-risk treatments, such as the
heartbeat may be required to make a cardiac [14] .

EcCE if you have any of the following indicators and symptoms . The pulse
of the pulse Dumping speed Diffuser The weight of the exercise does not
recommend the American heart Society using an ECA to evaluate the adult case
and do not have any symptoms and have risk rates have low. But if you have a
family history of heart disease, your doctor may propose a cardiac planning test as
testing, even though you do not feel any symptoms. If your symptoms tend to
appear and disappear, it may not pick up the heart card in the standard recording.
In this case, your doctor may recommend using the power-or-heart-wide network
organs. There are several different types of her.

Holter device. The Holler device is a small wearable device that recorded the
steady electrophilic chart continuously, usually for 24 to 48 hours. Monitoring of
heart attack events. This mobile device is similar to the Holter device, but it is only
recorded at certain times for a few minutes at a time. As you can wear it longer
than the Holter device, usually for 30 days. In general, you must click the button
when you feel symmetries. Some devices are automatically recorded at a time-out
of a ridiculous rhythm of the hearts. Risk The action of the heat capacity is a safe
action. There is no risk of electric shock during the test because the electrical
electrodes used do not produce electricity. Electrical electrodes recorded the
electrical activity in your heart only. You may feel slightly disturbed, such as the
disturbance you feel during the removal of the bandage when removing the
electrodes. Some people get a slight skin surface in the place of leisure leather. The
results may discuss your doctor with the results in the same day on which the heart
card is planned or on the next date. If the results of the heart card is a natural heart,
the f does not need to make more tests. If the results show the presence of a
heartfelt, you may need to make a cardiac card planning again or undergo other
diagnostic tests such as an echo scheme. The treatment method depends on the
cause of indicators and symptoms you show. Your doctor will record the
information recorded by the heart card planning and will search for any in-heart
problems, including * Heart of heartbeat. The heart rate can not be measured by
losing the pulse. Early heart planning can help if the feeling of mankind is difficult,
or the pulse was very fast or irregularly largely prevented its account accurately.

It can help the heart of your doctor in the identification of abnormal

heartbeat abnormal (heart acceleration) or inner dinars plunged (slow heart). *
Heart systems. An Early Cardiology Character Cardiac can disorder heart attacks (.
These cases may occur because of a bug in the functions of any part of the power
system of the heart. In other cases, some medications, such as beta, cocaine,
amphetamine, and cold and sensitive drugs available, can not be met to stimulate
heart attacks. * Cardiac. An early heart chart may show evidence of exposure to
the earlier heart and having a piece of bread in its beginning. The patterns that
appear on the heart card have indicated the heart to the damage in your heart and
the degree to which this damage has been reached. (Fig 2-2)
 Figure(2-3)

Lack of heart supply blood and oxygen. Action cardiac cardio during the
symmetrical feeling can help your doctor to determine whether chest pain is about
the low blood flow of the heart attack, as with the chest pain due to unstable action.
Brownian distortions. The heart card show may show evidence of the heart or
walls, as well as the hearts of the heart and other problems. If your doctor finds any
problem in the heart of the heart you have made, you may be required to take
additional tests to determine whether the necessary treatment is necessary (Fig 2-
3).
 Figure(2-4)

2.4 Normal voltage on the electrocardiogram

Electrocardiography or ECG records the electrical activity of the heart, as

the heart produces small electrical impulses that spread through the heart muscle
and cause contraction, and these impulses can be detected through the
electrocardiograph, and resort to The doctor usually performs an
electrocardiogram to help him find the cause of some symptoms such as
palpitations or chest pain, and sometimes this examination is done as part of
routine examinations, for example, before surgery. No damage or pain is caused
by the electrocardiogram test. Electrocardiogram (Fig 2-4)
 Figure(2-5)

Electrocardiography in normal sinus rhythm .General information on types

of medical tests, tests and procedures for diagnosing heart diseases. The planning
is done with the patient lying on a comfortable table and completely relaxed. The
contact between the electrodes and the skin must be good and this is done by
applying a special ointment. The chart is done on chart paper, and the chart
reflects the electrical events that occur in the heart and all its parts. Electrodes
placed on different parts of the body detect electrical impulses coming from
different directions within the heart, and show normal diagrams for each
electrode.The ECG test is good, it can sometimes diagnose the heart problem
accurately, but the EKG cannot identify and diagnose all heart diseases, some
diseases cannot be detected by the electrocardiogram. Medicinal uses edit.

The general purpose of an electrocardiogram is to obtain information about

the electrical function of the heart. Medical uses for this information are varied
and often need to be combined with knowledge of the heart's structure and physical
examination signs to be interpreted. Some ECG indications include:Chest pain or
suspected myocardial infarction (heart attack), such as ST-segment elevation
myocardial infarction or non-ST-segment elevation myocardial infarction.
Symptoms such as shortness of breath, heart murmurs, fainting, seizures, strange
symptoms, or arrhythmias including new palpitations or observation of a pre-
existing arrhythmia.

Monitor drug effects eg, drug-induced QT prolongation, digoxin toxicity

and manage overdose eg, tricyclic antidepressant overdosag. Electrolyte
disturbances, such as hyperkalemia. Perioperative monitoring in which any form of
anaesthesia is used eg, controlled anaesthetic care, general anesthesia. This
includes preoperative evaluation and intraoperative and postoperative
monitoring.Cardiac stress test. Programmed tomography angiography and cardiac
magnetic resonance angiography (the ECG is used to "prime" the imaging process
so that the anatomical position of the heart is stable.Clinical electrophysiology of
the heart. A catheter is inserted through the femoral vein and may contain several
electrodes along its length to record the direction of electrical activity within the
heart. Electrocardiograms can be recorded for intermittent brief tracking or
continuous monitoring. Continuous monitoring is used for critically ill patients,
patients under general anaesthesia, and patients with arrhythmias that are difficult
to see on a traditional ten-second electrocardiogram. Continuous monitoring can
be performed using an electrical heart pressure monitor (Holter monitor),
defibrillators, internal and external artificial pacemakers, and/or telebiometrics.

[7][6] . Uses edit Having chest pai, In the event of an irregular heartbeat
Shortness of breath. Constant fatigue and stressHaving an abnormal heartbeat.
Diagnosis of some heart diseases Routine cardiac examination if there is a family
history Monitor the efficacy of heart medications

2.5 Generations of ECG devices

The means of quoting the heart signal have multiplied and evolved
significantly. They generally relied on ordinary galvanic scales in the beginning,
but did not provide the desired purpose, until transistors appeared and recorded on
paper and even process amplifiers, as these signals could be amplified and filtered
on the screens of the signal pars. With the advent of the computer, the mechanism
of the display, storage and processing developed, where it became possible to
compare several references and know the dysfunction more accurately. The latest
conclusion of science is to quote the heart signal by small mobile devices that the
patient puts in his pocket and they are in direct contact with him, where they store
the information first and show it and then transfer it to the computer if he wants.
(Fig 2-5)
 Figure(2-6)

It is an electrical planning device carried in the pocket or can be worn on

the wrist, belt or shoulder strap, which records 24 hours to monitor the planning
during the practice of all daily activities and work to discover the relationship
between these activities and works and any change that may appear on the ECG
and be abnormal. The planning report is read after 24 hours using a computer,
which determines the presence of any difference in the pulse, an increase in the
heartbeat or the presence of abnormal blows, and then the patient is given
appropriate treatment either with medicines or by installing a pacemaker in the
event of a stop or impairment in the heart's electricity.( Fig 2-6)
 Chapter Three

Research Methodology
 3 Chapter Three

Research Methodology
3.1 Introduction

Comparisons between theoretical (simulation using MATLAB) and the

practical results will be given in this chapter. The theory of operation in chapter
two was used to design the circuit diagrams of chapter three. Thus, in this chapter,
the results of the project will be discussed in details by comparing the practical and
simulated results. It should be that the practical matches the simulation result.

3.2 Certain heart diseases Abnormal atrial rhythms

Cardiac arrhythmia, cardiac arrhythmias, or cardiac arrhythmias are the

differences in the heart rate and the electrical signal transmission systems in the
heart muscle. Arrhythmia is called arrhythmia for short. These differences in heart
rhythm can manifest themselves as acceleration or slowing of the heart rate, and
symptoms can appear as an irregular heartbeat, or as palpitations.

Disorders of the system differ among themselves in their importance and

danger to the patient's life. Some of them are considered a manifestation of
diversity that has no satisfactory value, and some of them pose a threat to the
patient's life, or a disease that must be treated Most cases of arrhythmia are
harmless, but some can be serious or even life-threatening. When the heartbeat is
too slow, too fast, or irregular, the heart may not be able to pump enough blood to
the body and thus leads to ischemia of these organs, which in turn damages the
brain, heart, and other vital organs and may lead to periodic shock. Diagnosis of
arrhythmia begins with hearing the medical history, where some patients narrate
tachycardia or palpitations, sometimes patients feel the heart acceleration, then
they are asked about its precursors, if any, how it starts suddenly or the pulse
accelerates gradually, and in cases of slow heart, the patient tells For drowsiness or
syncope or fainting of the patient. This is followed by palpation of the pulse, where
the speed and regularity of the pulse can be assessed or not, and heart contractions
and diastoles can be heard using a stethoscope.

The most important tool for diagnosing arrhythmias is the

electrocardiogram (ECG) since arrhythmias cannot be diagnosed without an
Megamedia his to Justice. This gives an impression of: Some patients notice
tachycardia, some patients feel palpitations and some feel systole, others can
describe tachycardia. The extent of affected and the degree of suffering of the
patient. Conditions that accompany disturbances of fatigue and rest, or stimulants.
Frequency of disturbances: daily, weekly or monthly? Describe the onset and end
of rhythmic episodes, beginning suddenly or gradually? A description of the
precursors to systemic seizures. Accompanying symptoms such as dizziness or
lightheadedness, and slow heartbeat is sometimes accompanied by drowsiness and
general weakness. Did the patient faint? And how often? What are the
circumstances that accompanied it? The pathological history varies according to
the type of arrhythmia, as tachycardia has symptoms that differ from those of
cardiac decelerations, and some arrhythmias pose a threat to the patient's life, and
sudden cardiac arrest may be the first symptom in rare cases. justice. Main article:
Electrocardiogram The electrocardiogram gives important information about heart
rhythm and detects many arrhythmias. It is considered the main tool in diagnosing
arrhythmias, especially if it is possible to obtain an electrocardiogram at the
moment the patient feels disturbed. There are types of examination, including

Chart at rest or during the shift Justice It is a chart that is drawn in the clinic
in a state of rest, and it shows the current rhythm of the heart, and it can also detect
many arrhythmias that appear during the resting period of the heart, and the chart
can be drawn in moments when the patient feels arrhythmia, then the drawing is
called an attack chart, given that it was drawn during the show's frenzy.
Paroxysmal arrhythmias vary with each other in the frequency of the disturbance,
there are disturbances that the patient feels daily, here it is sufficient to record for
24 hours, but in cases where arrhythmias occur varying by weeks or months, it is
necessary to analyze the electrocardiogram for periods ranging according to the
frequency of attacks From weeks to years. There are several devices developed to
diagnose such cases, including the "Holter examination" or electrocardiogram over
24 hours, and is used by planning a three-electrode electrocardiogram to analyze
the electrocardiogram over an entire day, and note the disturbances in the rhythm
during that period. “Spider ECG”: It is called so because the device is fixed on the
patient’s chest, and then the wires are attached to the patient’s chest in a spider-like
or spider web. Such devices record the electrocardiogram for periods of up to
several weeks. The Event Recorder: This is a hand-sized device that the patient
carries with him, and when he feels arrhythmia, he places the device on his chest to
record an electrocardiogram for 30 seconds, for example. Implanted Loop
Recorder or Implanted Event Recorder:

These devices are the size of a USB flash drive, which is implanted under
the skin, and they analyze the ECG and record any disturbances that the device
notices. Some of these devices enable the patient to record the disturbances
believed to be occurring in minutes retrospectively, and the measurements are
analyzed periodically.

3.3 Myocardial infarction (heart attack)

Myocardial Infarction MI or Acute Myocardial Infarction AMI, also known

as a heart attack[4] or heart attack, is an acute life-threatening heart disease caused
by blood retention caused by a blockage of a coronary artery resulting in damage
or complete death to part of the heart muscle. A seizure is often a life-threatening
medical emergency that calls for immediate medical attention. The condition is
diagnosed by the patient’s medical history and results of an ECG and blood heart
enzymes. The most necessary procedure to take immediately is to restore blood
flow to the heart, so you should quickly transfer the injured person immediately to
a hospital or a doctor or bring the doctor to the patient's site to treat him. Time here
plays a very important role. It is necessary to speed up for blood flow in the
coronary artery to be reflowed with one or both: thrombus (which is blood clogged
blood) with anticoagulants, and angioplasty (also called arterial dilated artery
dilation), which is the penetration of a balloon on board to the blocked blood
vessel, so that the balloon swells when it is along with the thrombus and the
thrombus recedes towards the sides and the vessel space expands after it narrowed,
allowing blood to flow through it. The coronary care unit should closely monitor
the patient for various developments and provide secondary prevention measures
to remove factors that may trigger further seizures (Fig 3-1)
 Figure(3-1)

The right and left coronary arteries feed the same heart muscle for the heart
to function. A drawing shows myocardial infarction, and blood not reaching part of
the heart muscle through the left coronary artery, while the right coronary artery is
properly indicated in the diagram above. Zone 1 has a black-shown blockage inside
a branch of the left coronary artery that feeds the lower part of the heart muscle.
The zone is the anterior wall of the heart muscle, which is not reached by blood
after the blockage in the area. The artery can be seen after the and changed color
due to the lack of blood flow, as well as the color of the area below the heart
affected by the blockage of the artery is variable as a result of ischemia and
therefore lack of oxygen snugly (Fig 3-2)
 Figure(3-2)

3.4 Dizziness and syncope

(SINK-a-pee) is another word for fainting or passing out. Someone is

considered to have syncope if they become unconscious and go limp, then soon
recover. For most people, syncope occurs once in a great while, if ever, and is not a
sign of serious illness. However, in others, syncope can be the first and only
warning sign before an episode of sudden cardiac death. Syncope can also lead to
serious injury. Talk to your physician if syncope happens more often. Pre-
syncope is the feeling that you are about to faint. Someone with pre-syncope may
be lightheaded dizzy or nauseated, have a visual "gray out" or trouble hearing,
have palpitations, or feel weak or suddenly sweaty. When discussing syncope with
your doctor, you should note episodes of pre-syncope as well. Becoming
unconscious due to a seizure, heart attack, head injury, stroke, intoxication, blow to
the head, diabetic hypoglycemia, or another emergency condition is not considered
syncope. Someone who faints should be moved so they are lying down to allow
blood to flow to the brain. If they do not regain consciousness promptly, start
CPR. What causes syncope? Syncope occurs when there is not enough blood flow
to the brain. There are many potential causes, but the most common ones
include: Serious Cardiovascular Conditions(Cardiac Syncope)If fainting occurs
frequently and is not because of dehydration or sudden postural change, you may
need to be tested for a serious heart or vascular condition.

Cardiac syncope often occurs suddenly, without dizziness or other pre-

syncope symptoms. Common causes of cardiac syncope: Arrhythmia and abnormal
heart rhythm: During episodes of heart arrhythmia, the heart works inefficiently,
and not enough oxygenated blood can circulate to the brain. Many types of cardiac
arrhythmias may cause syncope. These include bradyarrhythmia (the heart beats
too slowly) and tachyarrhythmias (the heart beats too fast). Aortic dissection is a
tear in the large artery that carries blood from the heart to the rest of the body. This
is a very rare but life-threatening condition. Aortic valve stenosis is a narrowing of
the valve between the heart and the aorta. Aortic valve stenosis can
be congenital and present from birth or can develop in old age. Reflex Syncope
(Naturally Mediated Syncope, Vasovagal Syncope, Vasodepressor Syncope, the
Common Faint) Reflex syncope is the result of a reflex response to some trigger, in
which the heart slows or blood vessels dilate widen. This causes blood pressure to
drop, so less blood flows to the brain and fainting syncope or near-fainting (pre-
syncope) occurs. Reflex syncope is the most frequent cause of fainting. Vasovagal
syncope the common faint occurs in one-third of the population. It is by far the
most common form of reflex syncope. Vasovagal syncope is often triggered by a
combination of dehydration and upright posture.
 But it can also have an emotional trigger such as seeing blood or "fainting at
the sight of blood. Some Vasovagal Syncope Triggers Seeing blood not considered
a serious symptom Getting an injection or having blood drawn not considered
serious Standing up quickly (a "head rush" is considered pre-syncope) Standing
upright for a long time Sudden and unexpected trauma, stress or pain, such as
being hit Blood donation Other types of reflex syncope include: Situational
syncope, a sudden reflex response to a trigger other than those listed above.
Triggers include Coughing, sneezing, laughing, swallowing Pressure on the chest
after exertion or exercise Defecating Urinating (post-micturition syncope: occurs in
men while standing to urinate)Eating a meal Sudden abdominal pain Blowing a
brass instrument or lifting weights.

Carotid Sinus Syncope is a response in older adults that occurs when

pressure is applied to the carotid artery in the neck. A hard twist of the neck,
wearing a tight collar, and pressing on the artery are triggers for carotid sinus
syncope. Orthostatic Hypotension Orthostatic (upright) hypotension (low blood
pressure when standing) can also cause fainting because blood has trouble going
against gravity to reach the brain. Orthostatic hypotension is defined as a fall in
systolic blood pressure of 20 mms Hg or more on standing, resulting in syncope or
pre-syncope. Orthostatic hypotension is common in elderly individuals and is often
exacerbated by dehydration or medications that lower blood pressure, such as
diuretics. Less commonly, orthostatic hypotension can be caused by a neurologic
condition such as Parkinson’s disease or multisystem atrophy, formerly known as
Shy-Drager syndrome. Postural Orthostatic Tachycardia Syndrome
(POTS)Postural orthostatic tachycardia syndrome increased heart rate when
standing, or POTS is a rare clinical syndrome characterized by an increase in heart
rate of at least 30 beats per minute on standing and orthostatic intolerance. when
standing brings on symptoms such as palpitations, lightheadedness, and fatigue.

POTS generally appears in young women. After excluding other causes, the
diagnosis is made on physical examination, medical history, and tilt-table test.
Treatment usually consists of increased salt and fluid intake, recumbent exercise
not standing upright, and education in avoiding triggers. POTS does not usually get
worse with age How is syncope diagnosed? It's important to identify the cause of
syncope, if possible, to rule out a dangerous heart condition. Depending on your
symptoms and circumstances, the following tests may be used to find the
cause: On-site Diagnostic Tests. Electrocardiogram (ECG or EKG): wires taped to
various parts of your body to create a graph of your heart’s electrical rhythm
Exercise: ECG recorded while strenuously exercise sing .
Echocardiogram or transesophageal echocardiogram: ultrasound of the
heart Physical examination, including orthostatic vital signs and carotid sinus
massage.

Tilt table test measurement of heart rate and blood pressure in response to
upright tilt, which simulates prolonged standing Electrophysiology (EP): test that
examines the heart’s electrical activity from the inside; used to diagnose many
heart rhythm disorders In-home Diagnostic Monitors Holter: a portable ECG you
wear continuously for one to seven days to record your heart rhythms over time
Event: a portable ECG you wear for one or two months, which records only when
triggered by an abnormal heart rhythm or when you manually activate it.How is
syncope treated? The treatment for syncope will depend upon the underlying
condition but may include: Catheter: a procedure to cauterize the specific heart
cells that cause abnormal heart rhythms Pacemakers: device inserted under the skin
below the collarbone to deliver regular electrical pulses through thin, highly
durable wires attached to the heart; used to treat bradycardia, heart block and some
types of heart failure Implantable: a small implanted device that delivers an
electrical pulse to the heart to reset a dangerously irregular heartbeat; often used to
treat ventricular tachycardia or heart failure Avoiding known triggers

3.5 Possible tachycardia patients

Tachycardia may not cause any symptoms or complications. But if left

untreated, some forms of tachycardia can lead to serious health problems,
including heart failure, stroke, or sudden cardiac death. Treatment for tachycardia
may include specific maneuvers, medication, cardioversion, or surgery to control a
rapid heartbeat. Types. There are many different types of tachycardia. Sinus
tachycardia refers to a typical increase in the heart rate often caused by exercise or
stress. Other types of tachycardia are grouped according to the part of the heart
responsible for the fast heart rate and the cause. Common types of tachycardia
caused by irregular heart rhythms (arrhythmias) include Atrial fibrillation (A-fib).

This is the most common type of tachycardia. Chaotic, irregular electrical

signals in the upper chambers of the heart (atria) cause a fast heartbeat. A-fib may
be temporary, but some episodes won't end unless treated. Atrial flutter. Atrial
flutter is similar to A-fib, but heartbeats are more organized. Episodes of atrial
flutter may go away themselves or may require treatment. People who have atrial
flutter also often have atrial fibrillation at other times. Ventricular tachycardia.
This type of arrhythmia starts in the lower heart chambers ventricles The rapid
heart rate doesn't allow the ventricles to fill and squeeze contract to pump enough
blood to the body. Ventricular tachycardia episodes may be brief and last only a
couple of seconds without causing harm. But episodes lasting more than a few
seconds can be life-threatening. Supraventricular tachycardia (SVT).
 Supraventricular tachycardia is a broad term that includes arrhythmias that
start above the ventricles. Supraventricular tachycardia causes episodes of a
pounding heartbeat (palpitations) that begin and end abruptly. Ventricular
fibrillation. Rapid, chaotic electrical signals cause the ventricles to quiver instead
of contracting in a coordinated way. This serious problem can lead to death if the
heart rhythm isn't restored within minutes. Most people who have ventricular
fibrillation have underlying heart disease or have experienced serious trauma, such
as being struck by lightning Mayo Clinic Minute: Identifying and treating atrial
fibrillation . Mayo Clinic electrophysiologist Fred Kusum, M.D., explains what
happens in the heart to create atrial fibrillation and what can be done to fix it.
When the heart beats too fast, it may not pump enough blood to the rest of the
body. As a result, the organs and tissues may not get enough oxygen

3.6 Atrial flutter

is a type of abnormal heart rhythm, or arrhythmia. It occurs when a short

circuit in the heart causes the upper chambers (atria) to pump very rapidly. Atrial
flutter is important not on because of its symptoms but because it can cause a
stroke that may result in permanent disability or death. What happens during atrial
flutter? A normal heartbeat begins with an electrical impulse from the sinus node, a
small area in the heart's right atrium (right upper chamber). During atrial flutter,
the short circuit of a circular electrical pathway allows the electrical impulse to
quickly move around the right atrium, causing between 240 and 340 contractions
per minute. Rapid contractions prevent the chambers from filling between beats.
The ventricle's lower chambers also beat faster, though not usually quite as fast.
The rate is based on the ratio of atrial beats to ventricular beats. For example, a 2:1
block means that for every two beats in the atria, the ventricles beat once. An
arrhythmia centered in the upper chambers of the heart is called supraventricular
tachycardia (SVT), literally "fast heartbeat above the ventricles." Note that when
you feel your pulse for example, at your wrist or neck you are feeling the beat of
the left ventricle as it pumps blood to your arteries. A normal heart rate is between
60 and 100 beats per minute. What are the different types of atrial flutter? Atrial
flutter is classified as typical or atypical (non-typical) depending on the location of
the short circuit the pathway that allows the electrical signal to move too fast
around the heart. While the symptoms are similar, the treatments may differ.
Typical atrial flutter is localized to the right atrium. This type of atrial flutter can
be cured with a short outpatient catheter ablation procedure. Atypical atrial flutter
refers to atrial flutter arising in the left atrium. Most types of atypical atrial flutter
can also be treated with catheter ablation, but the procedure is longer and more
involved.

Blood left to pool in the upper chambers after an inefficient heartbeat

increases the risk of clot formation. If a blood clot travels from the heart into the
bloodstream, it could become lodged in an artery and cause a stroke.

If the heart beats very quickly over a long time, it may lead
to cardiomyopathy, a weakening of the heart muscle. How is atrial flutter
diagnosed Atrial flutter is normally diagnosed in your physician's office using
an electrocardiogram (ECG or EKG). If the diagnosis is still in question, your
doctor may recommend a Holter monitor, an event monitor, or
an electrophysiological study, during which a narrow, flexible tube called a
catheter is threaded through a vein to your heart under light sedation. Fine wires
inside the catheter can help pinpoint the abnormal signal. How is atrial flutter
treated?
 Sometimes, atrial flutter goes away by itself and no further action is needed.
If it persists, your doctor may pursue any of the following treatments: Treatment of
any underlying conditions Catheter ablation — procedure to destroy the errant
electrical pathways; performed together with an electrophysiological study

Cardioversion — small, controlled shock to the chest done under anesthesia

to provide short-term correction of the heart rhythm Medications to control the
heart rhythm called antiarrhythmics, may be less effective than catheter ablation
Medications to prevent blood clots
 4 Chapter Four

Results And Discussion

 Chapter Four
Results And Discussion
4.1 Introduction

In this chapter, we will talk about the practical application of the proposed
algorithm and explain the database The method used, how to read it on the Matlab
program and display the resulting practical results of the application algorithm.

4.2 the simplified explanation of the Matlab program: -

It is a software development environment for computational tasks, in which

there are many functions Internally built mathematics that facilitates the solution of
various types of mathematical equations. It also helps Matlab enables you to write
functions and special programs, in addition to many other features such as
developing

Algorithms, data acquisition, and building user interfaces for prepared

applications 1 2 7 Matlab windows: 1. Command Window: Through which
commands are entered into the program. Work Space: It shows all the variables
used in the work session current. Command History window: where all previous
commands are displayed entered in previous sessions. Current Directory
(Browser): In this browser, all are displayed The files are in the current working
folder. 5. A library for building a graphic user interface. Simulink Simulation
Library: For Modeling and Simulation Applications Figure (4_1)shows the main
interface of MATLAB and its main parts:

9
 Figure(4_1)Letters, letters, answers, letters, letters, texts, letters, alphabets

4.3 Database:

Databases or databases are an important part through which to test the

effectiveness and efficiency The proposed algorithm, and in this project a database
in the form of Excel files was used.

4.4 Explanation of the program steps:

1-The first part is a database reading that was previously stored as an excel file
with a graphic

10
 [FileName,PathName] = uigetfile('*.xls','Select the Excel file');

FileName = [PathNameFileName]; x = xlsread(FileName);

x = x'; x1 = x;

x1 = [x1 x]; x1 = x1';

t = 0:0.004:0.004*(length(x1) - 1);

figure, plot(x1),ylabel('mV'),xlabel('Seconds (sec)'),title('Lead II')

Figure(4-2)shows the ECG signal after entering it from the database

2-We start by analyzing the signal by calculating the highest value of the derivative
and reserving the initial values for all the variables -ECG signals first compound
that can be determined is (R - ) by the maximum value of the derivative. Figure (4-
2) The position of R and the values of the derivative before and after it

11
3- Then we define (-Q), which is the minimum value of the derivative before (R),
which we take before (R) on the inverse axis. Time in the same window as
searching for the minimum value of the derivative and its location, and when the
derivative is absentee have obtained QRS_start

4- Then we define (S), which is the minimum value of the derivative after (R),
where we take the dimension (R) with an axis with timeIn the same window,
search for the minimum value of the derivative and its location,and when the
derivative is absent, we areWe got QRS_end .Thus, we have obtained whereabouts
(QRS_top, Q,S, QRS_start, QRS_end,) for eachsignal and store it.))

y_diff = gradient(x1);

figure

subplot(2,1,1),plot(x1);

subplot(2,1,2),plot(y_diff);

y_max = zeros(1,length(y_diff)/200);

y_min = zeros(1,length(y_diff)/200);

fori = 1:length(y_max),

y_max(i) = max(y_diff((i-1)*200 + 1: i*200));

y_min(i) = min(y_diff((i-1)*200 + 1: i*200));

end

qrs_top = zeros(1,length(y_max));

qrs_start = zeros(1,length(y_max));

12
qrs_end = zeros(1,length(y_max));

Q = zeros(1,length(y_max));

S = zeros(1,length(y_max));

beat_begin = zeros(1,length(y_max));

fori = 1:length(y_max),

qrs_top(i) = ceil(mean(find(y_diff((i-1)*200 + 1: i*200) == y_max(i)) + (i-1)*200));

if(qrs_top(i) > 30)

temp = find(y_diff(qrs_top(i)-30:qrs_top(i))==0);

ifisempty(temp) == true,

temp =1;

end

qrs_start(i) = qrs_top(i) - temp(1);

else

qrs_start(i) = 1;

end

%Search for Q Point

temp = find(y_diff(qrs_start(i):qrs_top(i)) == min(y_diff(qrs_start(i):qrs_top(i))));

Q(i) = qrs_start(i) + temp(1);

temp = find(y_diff(qrs_top(i):qrs_top(i)+30)==0);

ifisempty(temp) == true,

13
 temp = 30;

end

qrs_end(i) = qrs_top(i) + temp(1);

5-We define (-p) with the same principle as the method of determining (R),
where we take the time reversal axis starting from( QRS_start (when the derivative
value becomes) QRS_start=0 (In the same way as before, we have we got
(P_top,P_start,P_end )

%% P wave

p_top = zeros(1,length(qrs_top));

p_start = zeros(1,length(qrs_top));

p_end = zeros(1,length(qrs_top));

j = 1;

fori = 1:length(qrs_top)

if (beat_begin(i) > 0)

segment = x1(beat_begin(i):qrs_start(i));

max_seg = max(segment);

idx = find(segment == max_seg);

p_top(i) = beat_begin(i) + idx(1);

segment = x1(beat_begin(i):p_top(i));

14
 min_seg = min(segment);

idx = find(segment == min_seg);

p_start(i) = beat_begin(i) + idx(length(idx));

segment = x1(p_top(i):qrs_start(i));

min_seg = min(segment);

idx = find(segment == min_seg);

p_end(i) = p_top(i) + idx(1);

end

end

6-We define T (with the same principle of calculating R) where we take the time
axis starting from (QRS_end)When the value of the derivative of (QRS_end=0)
becomes, in the same way as before, we have we got) T_ top, T_start, T_end )

%% T wave

a = [1 -2 1];

b = [1 0 0 0 -2 0 0 0 1];

T_top = zeros(1,length(qrs_top));

T_start = zeros(1,length(qrs_top));

T_end = zeros(1,length(qrs_top));

fori =1:length(qrs_start) - 1,

15
segment = x1(qrs_end(i)+2:p_start(i+1)-5);

y_T_diff = segment;

%% T Top

t=max(y_T_diff);

idx = find(y_T_diff == t);

T_top(i) = idx(length(idx)) + qrs_end(i) + 1;

%% T end

seg = y_diff(T_top(i):p_start(i+1)-5);

idx1 = find(seg< 0);

ifisempty(idx1) == 1,

idx1 = 1;

end

T_end(i) = T_top(i) + idx1(length(idx1)) - 1;

%% T start

seg = y_diff(qrs_end(i):T_top(i));

idx2 = find(seg> 0);

if length(idx2) > 1,

idx2 = idx2(1);

end

T_start(i) = qrs_end(i) + idx2 - 1;

16
 end

T_Width = mean(T_end(1:length(T_end) -1) - T_start(1:length(T_start)-1))*4;

T = mean(x1(T_top(1:length(T_top) - 1)));

P_width = mean(p_end-p_start)*4;

QRS_width = mean(qrs_end - qrs_start)*4;

7- Since all the locations of the vehicles are known

{QRS_top, Q, S, QRS_start, QRS_end, P_top, P_start, p_end, T_top, T_start, T

_end}

For each parameter, the arithmetic meantime with the passage of the waves is
calculated and . is calculated scattering; Dispersion expresses the extent to which
the real values change from the average. The greater the dispersion, the greater the
change. If we assume that the dispersion of the RR measurement was large, the
real values will change significantly from the mean and thus Heartbeat changes
will be rapid

4.5 Facade build:

Matlab contains libraries that support building a user interface to hide the
complexities of the functions Written and easy to handle the project. Programming
in the case of interfaces differs from traditional programming in that it is event-
based programming, and here we mean every means for the user to communicate
with the computer, such as the keyboard, moving Mouse, pressing one of the
mouse buttons and other events. In the help interface of Matlab, write the
following instruction: guide or click the guide button located in- :) Toolbar, the
following window will appear in the figure( Figure (3-7):
17
 Figuer(4-3) Help window - Guide.

We choose Save new figure as and then put the name of the file in which we want
to save the interface, for example untitled2, Matlab generates two files with the
same name, but they differ in the suffix and the two suffixes are: Fig: This file
contains the shape of the interface (Controlls.) m : It contains the function of each
of the microcontrollers in the previous file. Figure (4-7) shows the design window:

18
 Figure (4-4): Design window

To the left of this window are the controllers that we can put in the interface we
want to designIt contains most of the Windows controllers and allows the designer

to use external libraries as well.To run the window, we press the Run button :- ,
(we get the figure 4-5 )

19
 Figure (4-5): When the Run button is pressed.

To demonstrate event-driven programming, we add a button to the interface and

the required function of it is to show a message Welcome when pressed, and this is
done through the following stages:

First: Adding a Push Button: When you click on this button, we get to the welcome

20
 message, and this shows Figure (4-6(

Figure (4-6): Adding a Push Button Second: The name of this button must be
changed, so we double-click the button, and the Inspector window will open as It
is shown in Figure (4-6), and we search within it for the - String box and give it the
name we want ECG

21
 Figure (4-7): Window – Inspector

Figure (4-7) shows the shape of the interface after changing the name of the button
from - Push to ECG

22
 Figure ( 4-8): The appearance of the interface after changing the name of
the button from - Push to ECG

When running and pressing the previous button, nothing happens. To add the
desired function, we pressButton in the design window with the right mouse button
and from the menu select View Callbacks, from which we choose Callback

23
Figure (4-9) shows the shape of the interface that was designed in this
project

24
 Figure(4-10) ) shows the designed interface after the signal is entered and
analyzed

4.6 Future prospects:-

It is important that the design submitted for any model performing a particular
medical function be scalable and modernization, which enables the user to respond
effectively and smoothly to most requirements and medical needs that arise as a
result of scientific developments, without the need to replace the entire system.

Thus without relatively high costs. The model presented in our project is
characterized by the simplicity of the algorithm, which saves time and effort for

25
the user ,it is characterized by a high capacity for development thanks to the
computer infrastructure that it includes in analysis and demonstration which in turn
offers high flexibility in design to keep pace with all developments in this field,
which dictated by the need.

Here are some personal suggestions that could be developed for this algorithm:

1. Establishing a developed algorithm that is capable of handling and processing all

accompanying noise signals. The electrical signal of the heart and the possibility of
connecting it directly with the electrocardiogram The patient's ECG and signal
analysis can be obtained at the same time.

2. The ability to connect with the available information network, whether in the
hospital or clinic, which gives High flexibility and speed in data transmission and
the ability to store all data.

3. The possibility of expanding the algorithm and adding many heart diseases and
abnormalities (especially thoseIllnesses that are in changes from the normal or less
pathologically severe sign state Small changes (and analyzed and shown on the
computer.In the end, we hope that we have succeeded in this project and that it will
achieve success on the practical levelAnd be a second assistant to doctors in clinics
and hospitals to detect disease cases In a fast and easy way after the signal is
entered and analyzed

26
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