PHONOCARDIOGRAPHY

Prepared by A.Devasena, Associate Professor,

Dhanalakshmi College of Engineering, Chennai
 The human heart is a four-chambered pump with two atria
for collection of blood from the veins and two ventricles
for pumping out the blood to the arteries.
 The right side of the heart pumps blood to the pulmonary
circulation (lungs), and the left side pumps blood to the
systemic circulation (the rest of the body).
 The blood from the pulmonary circulation returns to the
left atrium (through the pulmonary veins), and the blood
from the systemic circulation returns to the right atrium
(through the superior/inferior vena cava).
 Two sets of valves control the flow of blood: the AV-
valves (mitral and tricuspid) between the atria and the
ventricles, and the semilunar valves (aortic and pulmonary)
between the ventricles and the arteries.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
The Electrical System

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
The periodic activity of the heart is controlled by an
electrical conducting system.
The electrical signal originates in specialized
pacemaker cells in the right atrium (the sino-atria
node), and is propagated through the atria to the AV-
node (a delay junction) and to the ventricles.
The electrical action potential excites the muscle cells
and causes the mechanical contraction of the heart
chambers.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
The Mechanical System

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
The contraction phase of the ventricles is called systole.
The ventricular systole is followed by a resting or filling
phase that is called diastole. The mechanical activity of
the heart includes blood flow, vibrations of the chamber
walls and opening and closing of the valves.

The systole is sub-divided into atrial sytole, isovolmic

contraction and ejection period.
The diastole is sub-divided into isovolmic relaxation,
rapid filling and diastasis.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Modulating Systems
The autonomous nervous system
The hormonal system
The respiratory system
Mechanical factors
Electrical factors

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
 The autonomous nervous system regulates the heart rate: the sympathetic system enhances
automaticity, while the parasympathetic system (vagus nerve) inhibits it. The nervous system
also modulates the mechanical contractility of the heart chambers.

 The hormonal system secretes hormones like insulin and epinephrine, which effect the
contractility of the heart muscle.

 The respiratory system causes periodic changes in the thoracic pressure, and thus effect the
blood flow, venous pressure and venous return, triggering a reflex responses (baroreceptor
reflex, bainbridge reflex) that modulates the heart rate. The heart rate is increased during
inspiration and decreased during expiration.

 Other mechanical factors are the peripheral resistance of the blood vessels, that can change due
to internal or external factors (stenosis), the resulting venous return, the state of the valves
(torn, calcified)

 Other electrical factors are ectopic pacemaker cells, conduction problems, reentry circuits

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Multi-System Interactions
arterial pressure
venous pressure
venous return

Hormonal Respiratory
Autnonomous
System System
Nervous
(Epinephrine, (thoracic
Sysetm
Insulin) pressure)

contractility
compliance resistance
pacemaker rate
preload, afterload compliance

Cardiac Cardiac Vascular

Electrical action potentials Mechnical blood flow Mechnical
System System System

Echocard
Electroca Phonocar Pressure
iogram/
rdiogram diogram wave
Doppler

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Multi-Signal Correlations
Ventricular pressure
Aortic pressure
Atrial pressure
Aortic blood flow
Venous pulse
Electrocardiogram
Phonocardiogram

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Prepared by A.Devasena Associate Professor,
Dhanalakshmi College of Engineering, Chennai
 The electrical R-wave, representing the ventricular depolarization,
precedes the beginning of ventricular contraction.
 The ventricular contraction causes a steep rise in the left ventricular
pressure. As soon as the ventricular pressure exceeds the atrium
pressure, the mitral valve closes. This is when the vibrations of S1
begin.
 When the ventricular pressure exceeds the aortic pressure, the aortic
valve opens, and the blood flows from the ventricle to the aorta.
 At the end of blood ejection, the pressure in the ventricle falls
below the aortic pressure, and the aortic valve closes, causing the
vibrations of S2.
 The ventricle pressure drops steeply, and when it falls below the
atrial pressure, the mitral valve opens, and the rapid filling phase
begins, with a possibility of an audible S3 at its end.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Heart Disease
Heart failure
Coronary artery disease
Hypertension
Cardiomyopathy
Valve defects
Arrhythmia

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Cardiac Diagnosis

The two major clinical indicators for heart failure are increased filling
pressure and decreased ejection fraction. The ability to measure, or to
estimate these indexes is crucial for early detection of the disease.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
The Swan-Ganz catheter can be safely passed from the
femoral vein through the inferior vena cava and then
through the right heart: the right atrium, right ventricle,
and pulmonary artery to the pulmonary capillary
wedge position.
 There, pressures in all right heart chambers can be
measured and oxygen saturation readings can be
obtained.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Invasive
Right heart catheterization (Swan-Ganz)
Angiography
Non-invasive
Electrocardiography
Echocardiography
Impedance cardiography
Auscultation & palpitation

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Prepared by A.Devasena Associate Professor,
Dhanalakshmi College of Engineering, Chennai
Echocardiography is the gold standard imagine technique for detecting
mechanical heart disease. It is used to measure ejection fraction, dimensions,
geometry, thickness
Prepared and movement
by A.Devasena of the ventricles.
Associate Professor,
Dhanalakshmi College of Engineering, Chennai
Prepared by A.Devasena Associate Professor,
Dhanalakshmi College of Engineering, Chennai
ANGIOGRAPHY
Angiography is the name of a procedure that uses X-
Rays to produce a picture (the "angiogram").  This is
an "invasive procedure, because it requires the
injection into the patient of a substance that is
radiopaque (absorbs X-Rays).

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Auscultation and palpitation are routinely preformed
by clinicians during physical examination. However,
the low frequency, low intensity and short duration of
the heart sounds and vibrations make the diagnosis by
human ear/hands very difficult

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Electrocardiography can identify arrhythmia,
conduction abnormalities and myocardial infraction.

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
IMPEDANCE CARDIOGRAPHY
Impedance cardiography is a technology that converts
changes in thoracic impedance to changes in volume
over time. In this manner, it is used to track volumetric
changes such as those occurring during the cardiac
cycle. It enables to measure SV, CO, PEP, LVET

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
HEART SOUNDS

S1 – onset of the ventricular contraction

S2 – closure of the semilunar valves
S3 – ventricular gallop
S4 – atrial gallop
Other – opening snap, ejection sound
Murmurs

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
 S1 – onset of the ventricular contraction
 S2 – closure of the semilunar valves
 S3 – ventricular gallop
 S4 – atrial gallop
 Other – opening snap, ejection sound
 Murmurs

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
The Origin of Heart Sounds
Valvular theory
Vibrations of the heart valves during their closure
Cardiohemic theory
Vibrations of the entire cardiohemic system: heart
cavities, valves, blood

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Prepared by A.Devasena Associate Professor,
Dhanalakshmi College of Engineering, Chennai
Heart Sounds as Digital Signals
Low frequency
S1 has components in 10-140Hz bands
S2 has components in 10-400Hz bands
Low intensity
Transient
50-100 ms
Non-stationary
Overlapping components
Sensitive to the transducer’s properties and
location

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Heart Sound Analysis Techniques

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai
Heart Sound Analysis Applications
Estimation of pulmonary arterial pressure
Estimation of left ventricular pressure
Measurement & monitoring of cardiac time intervals
Synchronization of cardiac devices

Prepared by A.Devasena Associate Professor,

Dhanalakshmi College of Engineering, Chennai