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Design and Analysis of a PCG Acquisition and Denoising Circuit

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 Turkish Journal of Physiotherapy and Rehabilitation; 32(3)
ISSN 2651-4451 | e-ISSN 2651-446X

DESIGN AND ANALYSIS OF A PCG ACQUISITION AND DENOISING

CIRCUIT

Ravindra Manohar Potdar1, Mekhram Meshram2, Ramesh Kumar3

1
Research Scholar, Electronics and Telecommunication Engineering Department, Bhilai Institute of
Technology, Durg, India
Corresponding Author: potdar.bit@gmail.com
2
Associate Professor, Electronics and Telecommunication Engineering Department, Engineering
College, Bilaspur, India meshram66@gmail.com
3
Professor, Computer Science & Engineering Department,
Bhilai Institute of Technology, Durg, India
rk_bitd@rediffmail.com

ABSTRACT

Phonocardiography is a technique to acquire Heart Sound Signals (HSS), the audio record of which is
commonly known as Phonocardiogram (PCG). Auscultation is the technique of hearing the HSS for analysis
and initial detection of any disorder present in the cardiovascular system. It is low cost and fast technique for
diagnosis. Acquisition of HSS in electronic format eases the diagnosis process by using machine-learning
algorithms. However, the major challenge in such automatic diagnosis is the corruption of the HSS during
acquisition. The present work aims to develop an electronic system for the acquisition of HSS and further
denoise the signal using electronic means.

HSS can be portrayed by its various audio parameters like pitch, intensity, duration and tone. Various types
of noises evolved during acquisition add to the actual HSS and make it difficult to fix up the problem, if any,
in the cardiovascular system. Hence, it is necessary to denoise the HSS after acquisition to make it acceptable
for further processing leading to automated diagnosis.

A slight modification and attaching required electronic circuit in the conventional stethoscope has been
designed and fabricated to acquire the HSS electronically. Further, the acquired HSS being of very low
amplitude is amplified using low noise preamplifier stages. In order to denoise, the amplified signal filters of
active type have been applied, and their performances have been measured in terms of Signal-to-Noise Ratio
(SNR). Mainly three types of active filters, namely Butterworth filter of 3rd order and Chebyshev filter of
type I and Chebyshev filter of type II, are utilized for denoising purpose. After denoising, the signal has been
further amplified using an output amplifier. Results obtained revealed that the performance of the Chebyshev
filter of type I in denoising the HSS supersedes the performance of other types of filters.

Keywords: PCG Denoising, Heart sound Acquisition Circuit, SNR

I. INTRODUCTION
HSS, a very weak and feeble audio signal generated due to mechanical activities of the heart during its different
phases of pumping actions, carries certain physiological information regarding the status of the cardiovascular
system.

Vibrations created due to movement of the heart valves and blood flow produce audible sounds that can be heard
through a stethoscope placing on the chest. Vibrations increase along with blood flow turbulence and depend on
the diameter of the blood vessel and the viscosity, density and velocity of blood inside the vessels. Cardiac
auscultation is the art of listening to heart sounds by putting a stethoscope in the chest and back region. Four
basic types of sounds can be heard through a stethoscope. The sources of such sounds are the mechanical
vibrations originated due to normal and abnormal opening and closure of heart valves, turbulent flow of blood

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within the chambers of the heart, and the cardiac vessels like arteries and veins, mechanical tension vibration
created on the walls of the heart.

Listening to internal sounds of the body or auscultation is an important part of physical examination to diagnose
the patients. Aortic, Pulmonary, Tricuspid and Mitral are the prominent points for auscultation. Normal heart
sound is composed of “LUP-DUP” caused due to closure of heart valves. Apart from the murmurs, the heart
sounds are marked as S1, S2, S3 and S4 while S1 and S2 are the most important sounds as far as the clinical
aspects are concerned [1].

S1: The commencement of the isovolumetric ventricular contraction with the closing of the mitral and tricuspid
valves is responsible for generating the sound S1 having frequency components in the range 10 – 140 Hz. The
gap between tricuspid valve closure and mitral valves introduces a split (~0.04 sec) in S1.

S2: It is felt at the initiation of the ventricular relaxation due to closure of aortic and pulmonic valves in turn. S2
contains the audio signals in the range 10 – 400 Hz. S2 also exhibits split in its characteristic of variable duration
which depends on the physical sate of the body.

S3: It is very weak signal and hard to hear in adults except in case of systolic ventricular failure. It is heard during
ventricular filling due to stretching of the chordae tendineae and the atrioventricular (AV) ring. However, it is
prominent in children.

S4: It is caused due to vibration of the ventricular wall during atrial contraction. It is very feeble and represents
the low ventricular compliance. It is common in older adults and persons having ventricular hypertrophy or
myocardial ischemia.

Heart Murmurs: Apart from the normal sound generated by heart marked as “LUB” and “DUB”, a noise pattern
like whooshing, roaring, or rumbling is also heard, commonly known as murmurs. It is very common among
young children due to heavy turbulence created by the blood flow. In adults it carries lot of significance and
indicates the presence of many heart diseases. They are of very low frequency and can be easily distinguished
from other heart sounds. The origins of such murmurs are the presence of turbulence in the flow of blood,
vibrations in the heart walls and cardiac vessels coming out of the heart [2].

Before 19th century, doctors used to hear the heart sound directly from patients’ chest by putting their ears on the
chest or by putting a hollow pipe over the various locations of the chest to pay attention to the sound created by
the heart during its operation. However, such techniques sometimes cannot detect the actual sound due to various
types of external noise present in the ambient and the minute sounds produced by the heart often used to be
missed due to very poor audibility thus leading to inaccurate diagnosis. Such approaches were very unscientific
since the heart sound cannot be audible to other persons except the doctor carrying the test. Laennec invented a
pneumatic arrangement known as clinical stethoscope in 1816 to somewhat eliminate external noises and
accurately listen to the heart sounds [3]. This instrument is still widely used in the medical field for immediate
auscultation to diagnose most CVDs. Longer experience and sincere practices are required to gain mastery in
making out the disorder in the activities of the heart using a simple clinical stethoscope. Hence, a scientific and
ethical approach is required, and a technique called Phonocardiography was developed [4]. The electrical signal
generated by the phonocardiography system, known as phonocardiogram (PCG), can be visualized graphically
and can be heard using high fidelity microphones. However, a phonocardiography system is costly and is out of
the reach of common people seeking diagnosis related to cardio vascular disorder. Hence there becomes an
immense need to develop a low-cost system with the performance at par with phonocardiography.

Different types of noises corrupt the HSS during capturing using microphone placed at the auscultation area on
the chest. The major sources of noise include: power line interference, shot noise created by the discrete devices
used in forming the circuit and thermal noise. In the signal processing section of the electronic stethoscope, filters
and mostly active filters are used to get rid of such corrupting noises. The frequency range extends between 20
Hz – 200 Hz for a normal HSS [5]. After acquiring the signal in electrical form using sensor, it is passed through
signal conditioner circuits consisting of preamplifier and filters with cut off frequencies selected as per the
frequency range of the HSS. The filter bank is consisted of a Low Pass Filter (LPF) having a cut off frequency of
200Hz and a High Pass Filter (HPF) having a cut off frequency of 20 Hz so that these two filters in combination

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will form a band pass filter with a pas band between 20Hz to 200Hz which the range of HSS. The filters used are
all active filter type to introduce a gain, which also helps amplify the HSS.

The level of the signal captured by conventional acoustical stethoscope is very low. The proposed electronic
stethoscope employs advanced technology to amplify the low-level signal captured by stethoscope to a higher
level through amplification. However, amplifier employed also amplifies the ambient noise and thus the captured
sound gets embedded into noise. Hence proper signal conditioning circuit is utilized to clean up the captured
HSS. Such stethoscope has the advantages of ease in further processing in analog and digital format, providing
audio-visual output that can be transmitted for telemedicine, displayed for better understanding, recorded for
future use, and optimized for listening. The acoustic signal can be converted into electrical signal by attaching
transducer at the output of the stethoscope for conversion and utilizing required signal conditioning circuit for
amplification and filtering out the embedded noise. The output then is applied to a digital processing system
where it can be further denoised for better decision making. The present study includes: (i) the modification of
the stethoscope for capturing the HSS in electrical form, (ii) processing the signal using proper signal processing
circuit, (iii) applying the output to a computer, (iv) design of various types of filters in MATLAB environment
and (v) make a comparison of performances of various filters designed in terms of SNR for various types of heart
sound captured from various types of persons under various physical state as well as from databases of HSS from
open sources available and (v) identification of the filter offering best performance. The following flowchart
depicts the flow of the work carried out:

Various types of
Design of the HSS captured by Performances of The best
denoising filters
electronic circuit the electronic the denoising performing filter
have been
to be attached circuit is applied filters have been has been chosen
designed in
with pneumatic to processing compared based for CVD
MATLAB
stethoscope system on SNR detection
environment

II. RELATED WORK

Adaptive Chebyshev IIR bandpass filter of type I was employed to remove noise from the PCG acquired by a
digital stethoscope developed by Ying-Wen Bai and Chao-Lin Lu. However, the input to the filters designed was
only from a real-time signal acquisition circuit. No PCG signals from an open-source database for testing the
filters were employed [6].

In order to monitor heart murmurs and to differentiate innocent murmurs and pathological murmurs, Haibin
Wang, Jian Chen and Yuliang Hu developed a heart sound monitoring and analysis. No performance analyses of
the filters have been carried out. They mainly focused on the analysis part. Also, detail of the design of the
stethoscope has not been provided in the reported work [7].

Using the Zigbee module, an HSS monitoring system was developed by Kadam Patil D.D. and Shastri R. K. by
transmitting the signal wirelessly to the concerned physician. However, the performance analysis of the system
was not monitored [8].

The ARM processor was utilized by Yuan-Hsiang Lin, Chih-Fong Lin, Chien-Chih Chan, and He-Zhong You to
acquire, preprocess, and transmit HSS to the processing unit through a USB interface. Nevertheless, they have
not used discrete components in the system's design; hence control over the performance is obtained only through
programming [9].

A digital stethoscope with signal processing capability using Peripheral Interface Controller (PIC) was proposed
by Ashish Harsola et al. in which a recording facility was provided using EEPROM for further use [10].

To differentiate normal and abnormal heart sounds, Wang Haibin et al. utilized autoregressive power spectral
density [11].

In order to recognize the abnormal heart sounds and murmurs, Jinqun Liu et al. employed homomorphic filtering
and Shanon entropy as envelope extraction methods [12].

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Digital Signal Processor (TMS320C6713) was utilized by D. Mandal et al. to design and develop a low-cost
digital stethoscope with an HSS processing facility using endpoint detection methods to identify cardiac
symptoms disorders [13].

D. Balasubramaniam and D. Nedumaran used TMS320C6711 as the processor to develop a digital stethoscope.
Further processing was carried out employing Short-time Fourier transform (STFT) to generate the spectrogram
of HSS for early detection of abnormalities in the functioning of the heart [14].

R. Nivethika and N. Kirthika [15] developed a digital stethoscope with a heart defect detection algorithm
involving a condenser microphone, preprocessing circuit, and DDSP kit (TMS320C5515) noise cancellation
algorithm to remove noise and classified the heart sounds as normal or abnormal. In their work they have not
defined the performance parameters, as well as no comparison, have been made with the existing techniques.

Potdar R. M. et al. [16] proposed adaptive filters for denoising PCG signal based on two parameters, namely
Signal to Noise Ratio (SNR) and Mean Squared Error (MSE). They observed that the adaptive filter limits the
MSE between the PCG under consideration and reference input.

Potdar R. M. et al. [17] reviewed the performance of an electronic stethoscope that detects and investigates the
heart's activity based on HSS. It consisted of the procedures such as identifying the HSS using a transducer, then
amplifying the signal using amplifiers, subsequently converting the signal into digital form using ADC.

Potdar R. M. et al. [18] reviewed the performances of adaptive filtering algorithm in denoising the PCG. They
observed that the LMS algorithm remains a well-liked choice for its stable performance, higher speed capability
& higher convergence rate.

III. RESEARCH PROBLEM IDENTIFICATION

From the brief literature review reported in the present communication as well as an extensive literature review
carried out on the design of the HSS acquisition circuit and subsequent denoising of the HSS, the following
research gaps have been detected, which are resolved in the present work:

i. Hardware design of the HSS acquisition circuit using discrete components

ii. Hardware design of the signal processing unit

iii. Software design of denoising filters in the analogue domain using MATLAB

iv. Acquisition of HSS in real-time using the designed hardware

v. Performance evaluation of the filters designed using software employing the acquired HSS as well as HS
obtained from the open-source database

Cardio Vascular disease is one of the major problems leading to a maximum number of causalities among human
beings worldwide. Hence accurate and timely detection of CVD poses a challenge to the physician. Listening to
sounds generated by the heart due to its mechanical operation carries much prior information in detecting the
CVD at first sight. An attempt has been made in the present work to develop such a system that can generate an
audio-visual output of the heart sound to ease the analysis of HSS using high-performance software and
processing systems with the advice of expert physicians. The first step in this direction is to acquire the HSS and
to make it noise-free. The present work resolves these issues by designing the acquisition circuit, which is very
cost-effective and less complicated and then designing suitable filters using proper software to denoise the
captured HSS. Performances of the system development needed to be measured using real-time HSS and the
PCG signals obtained from the open-source database to enhance the system's reliability.

IV. DESIGN METHODS AND TECHNIQUES

Acquisition of HSS is the prerequisite for automatic analysis and decision-making process for detecting disorder
in the functioning of the cardiovascular system. Challenges faced by the designers in acquiring and making it
suitable for further analyses are the strength of the low signals of HSS, conversion of the audio signal into an
electrical signal, removal of external and internal noises embedded in the HSS.

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A judicious mixture of hardware and software arrangements can be the best choice to overcome such challenges.
In the present work, hardware circuits are used to acquire and signal conditioning of the HSS to make it
acceptable to the software handling system. On the other hand, software arrangements are designed to further
preprocessing the captured HSS to make it suitable for the decision-making process. Hence the present work has
been divided into two parts: (i) a Signal acquisition unit based on hardware and (ii) a Signal Processing unit
based on software.

Signal Acquisition Unit Based on Hardware

Before using computational systems in analyzing heart sound, physicians used to depend on the audio signal
generated by the stethoscope, which suffers from the record, storage and display facilities. In order to detect the
abnormalities in heart sound vis-à-vis the cardiovascular system, expertise and experienced is very much required
if the physicians are to depend only on the audio signal. Hence to acquire the HSS, converting the audio signal
into an electrical signal is designed and developed. However, the acquired signal suffers from contamination by
external noises, which are not a part of the noise created by the heart during its functioning. Cleaning up the
acquired signal from external noises is duly taken care of. The signal acquisition unit is comprised of an acoustic
stethoscope slightly modified to pick up the sound from the chest area fitted with a sensor to convert the audio
signal into its equivalent electrical form followed by hardware circuitry consisting of a preamplifier to amplify
the weak signal, filter section to extract the heart sound signal rejecting most of the external noises, an output
amplifier to amplify the signal after noise removal further and finally the interfaces to connect the output signal to
the processing system or recording system or transmission unit or audio-visual display unit. A schematic block
diagram of the hardware arrangement is shown below in Fig. 1.

Sensor Pre Filter Output Output

Unit Amplifier Section Amplifier
Fig.1: Block Schematic of the Hardware Arrangement

The resonance created by the air-filled hollow tubes fitted with the clinical stethoscopes is the underlying
phenomenon for detecting heart sound. The chest piece of the acoustical stethoscope contains two distinct parts:
the bell part detects the low-frequency sounds, and the diaphragm is responsible for picking up the high
frequencies present in the heart sounds. The major problem with the acoustical stethoscope is that the detected
signal is of deficient level hence difficult to process further directly using electronic circuitry arrangement. By
placing a sound detection sensor like a microphone on the chest piece, the heart sound can be easily detected and
converted into an equivalent electrical signal. The microphone is generally mounted on the stethoscope diagram
to convert an audio signal into an equivalent electrical signal. However, diaphragms in the stethoscope itself and
in the microphone introduce additional noise pick up, making the circuit inefficient acoustic energy transfer
system [19].

Two types of sensors are used with microphones for sensing weak audio signals: Piezoelectric sensors and
condenser-based sensors. Piezoelectric sensors, an active type of sensor, produce an electric signal whenever a
mechanical distortion occurs in the crystal due to vibration or mechanical stress. The audio signal picked up by
the stethoscope diaphragm creates a mechanical thrust on the crystal producing an electric signal. However, the
mechanism of conversion also produces distortion in the signal. Thus, the output is somewhat distorted compared
to the audio signal generated by the stethoscope's diaphragm and limits its suitability to be used in an electronic
stethoscope [20]. Condenser based sensors work on the simple principle of variation in capacitance due to
variation in the distance of separation between a fixed charged metal plate and a moveable plate attached to a
diaphragm. Such microphones are light and capable of capturing high frequencies and low frequencies of the
audio signal, hence providing a flat frequency response. They have high sensitivity. However, being a passive
transducer, it requires an external power source for its operation. They are affected by ambient conditions like
temperature and humidity. Careful microphone selection may make the microphone suitable for converting the
audio signal into an electrical signal.

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To make the signal detected and converted by the sensor in an acceptable form by the acquisition circuit,
amplifiers and filters are deployed. The output obtained from the sensor attached to the acoustic stethoscope is
very weak and hence need to be amplified by an active filter comprised of an operational amplifier (OPAMP)
having very high input impedance providing better impedance matching. However, the amplifier's bandwidth
restricts the frequencies present in the HSS to appear at the output. Hence, the bandwidth and gain of the
amplifier need to be chosen so that the bandwidth and gain-bandwidth product (GBW) of the amplifier does not
disturb the HSS. Usually, the preamplifier employed is having a small gain to suppress the noise due to power
line interference. The frequency range of HSS lies in the band of 20 Hz to 200 Hz.

For denoising purpose, filters are required to be connected to the preamplifier's output so that the output contains
the signal within the required frequency range of 20 Hz to 200Hz. Noise generated due to breathing, movements
of the subject, voice and external noise pick up also contaminate the acquired signal, and such noises need to be
eliminated. An analogue filter based on OPAMP is used in the circuit. Due to the inherent advantages of the
Butterworth filter, like sharp frequency response compared to its counterparts, a 3rd order Butterworth filter is
employed as the first filter in the filter bank [21].

The output signal from the filter is then applied to an audio amplifier to drive the audio speakers like headphone
or similar instruments. Moreover, the output of the audio amplifier can be directly applied to the serial input of
the PC for display, acquisition, storage and processing.

As intended and shown in the block diagram, accordingly, the hardware is designed to capture real-time heart
sound. The hardware implementation of the acquisition system developed system is shown in figure 2.

Fig. 2: The complete Hardware Set-up

In the present work, heart sound is captured by a stethoscope with slight modification. As the captured heart
sound signal is feeble and noisy too, it is pre-amplified to reduce noise and increase the signal strength using a
dual OPAMP (LM 358) with a gain setting of 10 based on the values of the feedback and series resistor.
Moreover, after the pre-amplification process heart sound signal is allowed to pass through the Butterworth BPF
of 3rd order.

The Butterworth filter has been designed as a combination of OPAMP based 1st order active LPF with a gain of
10 and in cascade with another OPAMP based active HPF with a gain of 10 so that the passband of the 3rd order
Butterworth BPF with an overall gain of 100 and passband between 6 Hz to 250 Hz. The passband has been
designed so that the HSS can be allowed to the next stage, and the noise beyond the specific band gets rejected.

The output of the filter section has then been applied to an equalizer circuit to adjust the bass, and the treble part
of the HSS can be adjusted according to the requirements.

A stereo audio amplifier has been employed as the output stage to boost the HSS obtained from the stethoscope.
The audio amplifier circuit has been realized using LM4044 IC.

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All the amplifiers and filters have been designed using dual OPAMP IC (LM358), and the gain has been realized
by connecting resistances of 10K (Feedback resistance Rf) and 1K (Series resistance Rs). The LM 358 OPAMP
has the advantages that it does not need any offset null setting, and being a FET input amplifier has a higher input
impedance suitable for impedance matching required for maximum power transfer.

A 12V DC source has powered the whole circuitry.

The amplifier and filter sections are shown below, along with component values used in the circuit (Fig. 3).

Fig. 3: The circuit diagram of the amplifier and filter section

The output of the acquisition unit is shown in the following figure 4.

Fig. 4: The output of the HSS acquisition unit

Signal Processing Unit Based on Software

Signal employing the designed hardware set up now to be processed to extract the features of the HSS. For this
purpose, software platform is used for better handling and ease of operation, and variations to be made on design
parameters depending on the interest in the parameters of the signal. As a part of the processing of the signal,
denoising has been done to extract the critical parameters of the signal using various analogue filters, namely
Butterworth filter (3rd order), Chebyshev (Type I) and Chebyshev (Type II).

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The following computational resources have been utilized for the implementation of the processing of the signal
acquired:

Item Specification

CPU Intel(R) core(TM) i5-7200U CPU @ 2.50 GHz 2.70

GHz

RAM 8 GB

Storage capacity (HD) 2TB

Signal acquired by the PC Serially via com port4

Software Platform and R2019a version of MATLAB®

tools

Filter Section
a) Butterworth Filter:
To shape the frequency spectrum in communication and control engineering the shape of transition band is too
wide hence these active filters are designed in higher orders basically nth order filters. But due to increase of the
filter order the complexity of the filter design increases. Third, fourth, and fifth-order filters called high-order
filters are usually designed with cascading together. In such filters the cutoff frequency is calculated by the much
familiar equation shown below.

(1)

An ideal filter provided special characteristics like as maximum pass band and minimum stop band attenuation,
unique gain and flatness and it allows transmission of signals of certain frequencies with no attenuation or with
very little attenuation, and it rejects or heavily attenuates signals of all other frequencies. In general, the nth order
Butterworth filter response is shown below.

(2)
√ ( )

The frequency response of the Butterworth filter is also an important consideration for the filter design and is shown in

figure 5.

Fig.5: Ideal Frequency Response for a Butterworth Filter

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b) Chebyeshev Filter:
Chebyshev filters having a steeper roll-off and more passband ripple (type I) or stopband (Type II) than
Butterworth filters. The property of Chebyshev filters is that they minimize the error between the actual filter and
idealized characteristic over the range of the filters, as shown in figure 6

Fig. 6: Third-order Butterworth Low Pass Filter

The frequency response of Type I Chebychev filter is given by

(3)
√ ( )

and the filter frequency response of Type II Chebyshev filter is given by

(4)
√ ( )

The above design equations have been used to design the filters on the software platform.

V. RESULTS
As per the diagram provided, the heart sound signal has been conveniently captured by the acquisition circuit.
The acquired HSS is displayed through the speakers connected. It has been observed that the acquired sound still
contains unwanted sounds, not about the functioning of the heart. To make the HSS free from contaminated
noise, the acquired HSS has been applied filtered using active filters. Three different filters have been used in the
MATLAB platform. The filters used in turn are Butterworth filter, Chebyshev Filter of type I, and Chebyshev
Filter of type II to observe the effectiveness of the filters in removing the noise from HSS.

Real-time HSS have been captured from subjects of different age groups, sex and physical state. Moreover, data
from open sources have also been utilized for measuring the performances of the filters designed through
software.

Error sensitivity and Quality assessment are the common types of measures to evaluate the performances of
filters. Error sensitivity measure metric includes Mean Squared Error (MSE), Peak Signal to Noise Ratio (PSNR)
and Signal to Noise Ratio (SNR) [22]. MSE is used to measure the average of the squares of the errors between
the output signal and the signal inputted to the filter. Reduction of MSE converges the input signal to the desired
signal. PSNR represents the ratio between the maximum possible power of a signal and the peak power of the
noise, distorting the quality of the signal. It is a measure of peak error. The parameter SNR is used to measure the
ratio between the average signal power to average noise power. Higher the value of SNR, the better the filter's
performance in removing the noise part embedded in the signal. As has been mentioned in the earlier paragraphs,
the performances of three different active filters, namely Butterworth LPF of 3rd Order, Chebyshev LPF Type I
and Chebyshev LPF Type II, have been studied in the present work. The outputs of various filters are presented
in the following figures [6(a) – 6(c)].

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Fig. 6(a): Output of Butterworth Filter (Software based design)

Fig. 6(b): Output of Chebyshev (Type I) filter (Software based design)

Fig. 6(c): Output of Chebyshev (Type II) filter (Software based design)

As such there are no significant visual differences among the outputs of various filters under consideration as is
clear from figures [6(a) – 6(c)]. Hence quantitative analysis is required to measure the performance of these

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filters for their suitability to act as denoising filter. The results obtained from the performance analysis test for
various filters in denoising HSS acquired through the hardware circuit designed and reported in the present work
are presented in the following tables [1(a) – 1(c)]:

(PUO: Person Under Observation, M: Male, F: Female)

(Data Source: Real time data collected from various persons)

Table 1(a): MSE values of various filters under consideration

Butterworth Chebyshev Chebyshev

PUO SEX AGE Filter (Type I) filter (Type II) filter

#1 M 19 0.000082 0.000012 0.000024

#2 M 22 0.000019 0.000009 0.000090

#3 M 25 0.000028 0.000008 0.000018

#4 F 27 0.000019 0.000031 0.000042

#5 M 28 0.000027 0.000022 0.000035

#6 M 30 0.000029 0.000011 0.000087

#7 F 32 0.000057 0.000032 0.000045

#8 F 38 0.00011 0.000008 0.000015

#9 M 40 0.000092 0.000048 0.000065

#10 M 44 0.000088 0.000041 0.000067

#11 F 47 0.000024 0.000007 0.000021

#12 M 48 0.000068 0.000039 0.000056

#13 M 51 0.000019 0.000015 0.000012

#14 M 54 0.000095 0.000009 0.000051

#15 M 58 0.000058 0.000011 0.000042

#16 M 61 0.000067 0.000017 0.000045

#17 F 70 0.000017 0.000021 0.000011

#18 F 75 0.000054 0.000008 0.000026

Average 5.29 e-05 1.94 e-05 4.18 e-05

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Table 1(b): PSNR values of various filters under consideration

Butterworth Chebyshev Chebyshev

PUO SEX AGE Filter (Type I) filter (Type II) filter

#1 M 19 25.0526 27.1995 31.6850

#2 M 22 24.5105 31.5625 25.5968

#3 M 25 22.5246 28.3512 27.5481

#4 F 27 23.5550 24.1685 23.6384

#5 M 28 21.0030 24.5167 22.8574

#6 M 30 30.1165 29.1994 31.2745

#7 F 32 29.5166 31.2351 29.8432

#8 F 38 29.4640 32.6514 29.1598

#9 M 40 26.8326 28.1119 24.7535

#10 M 44 26.4631 26.3552 25.8523

#11 F 47 27.2351 30.6985 29.3574

#12 M 48 32.9847 31.2418 30.1596

#13 M 51 21.2361 29.3215 22.6584

#14 M 54 19.5924 27.9845 27.5487

#15 M 58 26.3542 31.2941 28.1256

#16 M 61 28.5462 28.5598 27.9245

#17 F 70 31.8574 32.7541 30.9658

#18 F 75 30.6372 30.6689 28.3214

Average 26.5277 29.5121 27.6261

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Table 1(c): SNR values of various filters under consideration

Butterworth Chebyshev Chebyshev

PUO SEX AGE Filter (Type I) filter (Type II) filter

#1 M 19 7.6038 12.6458 9.0234

#2 M 22 5.3658 10.2845 10.2451

#3 M 25 4.0338 11.6984 9.8798

#4 F 27 3.9854 12.5471 9.8561

#5 M 28 6.7854 9.9835 8.5745

30 6.8765 10.4587 8.9985

#6 M

32 7.2541 9.1199 9.3654

#7 F

38 8.2032 10.6589 9.1125

#8 F

40 7.5546 9.5654 8.5546

#9 M

44 9.2917 11.2568 10.0125

#10 M

47 8.5767 10.5487
#11 F 12.8243

48 4.2347 9.2358
#12 M 9.0006

51 4.6985 10.8754
#13 M 8.5421

54 6.9167 9.2587
#14 M 9.5412

58 5.3245 9.5422
#15 M 10.2254

#16 M 61 4.9290 11.1876 9.1154

#17 F 70 7.1364 12.9137 8.9985

#18 F 75 8.4861 9.7357 8.0208

Average 6.5142 10.6772 9.4009

In order to measure the performances of the filter designed using software, PCG signals with identification
obtained from open sources have been applied to the filters. The performance measures are based on MSE, PSNR
and SNR values are presented in the following table [2], and the graphical representation has been provided in
figure 7:

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Table 2: MSE, PSNR and SNR values of various filters under consideration for the HSS obtained from open sources

MSE PSNR SNR

Type II Filter

Type II Filter

Type II Filter
Type I Filter

Type I Filter

Type I Filter
Butterworth

Butterworth

Butterworth
Chebyshev

Chebyshev

Chebyshev

Chebyshev

Chebyshev

Chebyshev
Sound Type

Filter

Filter

Filter
3rd Heart Sound 0.000036 0.000009 0.000021 26.52 27.22 31.53 5.82 32.84 24.15

Aortic
0.000026 0.000028 0.000024 14.34 16.71 12.91 19.58 44.61 22.55
Regurgitation

Aortic Stenosis 0.000033 0.000028 0.000040 37.64 39.61 38.22 47.62 55.95 35.78

Mitral
0.000039 0.000025 0.000076 18.65 19.89 18.20 20.57 26.98 24.94
Regurgitation

Mitral Stenosis 0.000051 0.000042 0.000050 57.69 79.33 69.68 68.58 74.66 59.28

Pulmonic Stenosis 0.00024 0.000009 0.000012 9.55 11.19 10.25 10.31 11.29 9.17

4th Heart Sound 0.000085 0.000069 0.000074 8.27 13.85 10.81 12.35 13.99 10.08

Normal Heart
0.000080 0.000051 0.000067 13.58 17.89 15.23 19.49 22.15 20.81
Sound

Average 0.0000738 0.0000326 0.0000455 23.28 28.21 25.85 25.54 35.309 25.845

35

30

25

20 Butterworth

15 Chebyshev Type I
Chebyshev Type II
10

0
MSE (e+05) PSNR SNR

Fig.7: Graphical comparison of performances of various parameters of the filters

VI. CONCLUSIONS
The present work deals with two aspects related to HSS: (i) Acquisition of HSS using cost-effective hardware
circuit including sensors for the detection of the HSS, amplification of the acquired signal, filtering of the signal
using filters based on hardware components to reduce the noise corrupting the HSS during acquisition and finally

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amplification of the signal using the audio amplifier for audiovisual display and (ii) Design of active analogue
filters based on software to clean further the acquired signal in which three different types of filters have been
designed, and the output of the hardware circuit has been inputted in MATLAB environment to measure the
performances of the filters in denoising the HSS in an effective manner. The MSE, PSNR and SNR are the
parameters under consideration for comparison. The corresponding results have been tabulated as well as
presented graphically. Having fulfilled the objectives of the present work, the following are the observations:

The designed hardware system for HSS acquisition is cost-effective and can be used for clinical purposes and
training purposes since it provides an audiovisual output. Based on the MSE parameter, it is concluded that the
Chebyshev (Type I) filter exhibits the lowest value among all the filters when the input is either real-time or
extracted from databases which are desired for an effective denoising filter. PSNR parameter is the highest for
Chebyshev (Type I) filter for all input HSS under consideration that reflects that this filter is the best among the
three filters under consideration. Chebyshev (Type I) filter exhibits the highest SNR values, which measure the
capability of a filter in denoising a signal. Overall, it can be concluded that among the three analogue filters under
consideration to denoise the HSS, Chebyshev (Type I) filter outperforms its counterparts. However, a detailed
study can further compare the effectiveness of digital filters as denoising filter for HSS.

REFERENCES
1. Debbal S.M. Amin & Bereksi-Reguig Fethi (2008), Recent Patents on Computer Science, 1, 1-8, Features for Heartbeat Sound Signal Normal and
Pathological, Geni-Biomedical Laboratory (GBM), Department of Electronic, Faculty of Science Engineering, University Aboubekr Belkaid Tlemcen,
BP 119, Tlemcen, Algeria
2. Bickley, L. S. & Szilagyi, P. G. (2005). "The Cardiovascular System", A Guide to Physical Examination and History Taking. 9h Ed.
3. Littmann D. (1961) "An approach to the ideal stethoscope", J. Am. Med Assoc., 178(5):504–5
4. Anand Bhaskar (2012), A simple electronic stethoscope for recording and playback of heart sounds, Adv Physiol Educ 36: 360–362
5. Badi-uz-Zama, Khalid & Attal, Abhishek & Verma, Abhijit, (2015), Electronic Stethoscope: Sound Extraction, Processing and Analysis, International
Journal of Engineering Research and. V4. 10.17577/IJERTV4IS060616
6. Ying-Wen Bai & Chao-Lin Lu (2005), The embedded digital stethoscope uses the adaptive noise cancellation filter and the type I Chebyshev IIR
bandpass filter to reduce the noise of the heart sound, Proceedings of 7th International Workshop on Enterprise networking and Computing in
Healthcare Industry, HEALTHCOM 2005., Busan, South Korea, pp. 278-281
7. Haibin Wang, Jian Chen & Yuliang Hu, Heart Sound Measurement and Analysis System with Digital Stethoscope, Sichuan Education Department
Natural Science Key Project
8. Ms. Kadam Patil D. D. & Mr. Shastri R. K (2012), “Design of wireless electronic stethoscope based on zigbee”, International Journal of Distributed
and Parallel Systems (IJDPS) Vol.3, No.1, pp. 351-359
9. Yuan-Hsiang Lin, Chih-Fong Lin, Chien-Chih Chan & He-Zhong You (2014), Design and Implementation Of Digital Ascultation System,
International Journal of Digital Application & Contemporary research, 2(10), pp. 10331-10339
10. Ashish Harsola, Sushil Thale & M. S. Panse (2011), Digital Stethoscope for Heart Sounds, 2nd International Conference and workshop on Emerging
Trends in Technology (ICWET), pp. 42-44.
11. Wang Haibin, Hu Yuliang ,Liu Lihan,Wang Yan and Zhang Jinbao (2010), Heart Sound Analysis based on Autoregressive Power Spectral Density,
2nd International Conference on Signal Processing Systems (ICSPS ), 2010
12. Jinqun Liu , Wuchang Liu, Haibin Wang,Ting Tao & Jinbao Zhang (2011) , A novel envelope extraction method for multichannel heart sound signal
detection , 2011 International Conference on Computer Science and Information Technology (ICCSIT 2011)
13. D. Mandal, M. Chattopadhyay, & I. Saha Mishra (2012), A low cost Non–Invasive Digital Signal Processor Based (TMS320C6713) Heart diagnosis,
System, 1st Int’l Conf. on Recent Advances in Information Technology [RAIT-2012]
14. D. Balasubramaniam & D. Nedumaran (2010), Efficient Computation of Phonocardiographic Signal Analysis in Digital Signal Processor Based
System, International Journal of Computer Theory and Engineering, Vol. 2, No. 4, pp. 660-664
15. R. Nivethika & N. Kirthika (2014), Design and Implementation of Digital Stethoscope with Heart Defect Detection Algorithm, International Journal
of Advanced Research in Electrical, Electronics and Instrumentation Engineering, Vol. 3, Issue 6, pp. 10327-10336
16. R. M. Potdar, N. K. Dewangan, M. R. Meshram, & R. Kumar (2015), Implementation of Adaptive Algorithm for PCG Signal Denoising. International
Journal of Innovative Research in Electrical, Electronics, Instrumentation and Control Engineering, 3(4), pp. 33-42
17. R. M. Potdar, M. R. Meshram & R. Kumar (2015), A Review Based Design and Implementation of Electronic Stethoscope for Heart Sound Analysis,
Int. Jou. of Eng. Development and Research, 3(1), pp. 1057-1064
18. R. M. Potdar, M. R. Meshram, R. Kumar & B. Chandrakar (2015), Review on Adaptive Filter Algorithm and Process of Echo Cancellation, Int. Jou.
of Advanced Research in Electronics and Comm. Eng. 4 (6), pp.1758-1761.
19. Smith C. Transducer for sensing body sounds. US patent: US6661897B2, 2003
20. Grundlehner B, Buxi D (2011), Methods to characterize sensors for capturing body sounds, International Conference on Body Sensor Networks
(BSN), p. 59–64
21. Oktivasari, Prihatin &, Riandini & Fitri, Rahmah & Malaon, Sungguh. (2019), Active Filter Analysis on Designing Electronic Stethoscope, Jurnal
Elektronika dan Telekomunikasi, 19, pp. 51-56
22. Y. Zhang, H. D. Cheng, J. Huang, & X. Tang (2012), An effective and objective criterion for evaluating the performance of denoising filters, Pattern
Recognit., 45 (7), pp. 2743–2757

www.turkjphysiotherrehabil.org 764

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