Phonocardiography, External Pulse Recordings, and Echocardiography Ara G. Tilkian, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS

Phonocardiography A graphic recording of cardiac sound A specially designed microphone on the chest wall Sound waves amplified, filtered and recorded Doppler Echocardiography has replaced the phonocardiography Maybe coming back in the future

Electrocardiogram Does not correlate exactly with ventricular systole and diastole Electrical event of depolarization precedes the mechanical contraction by approximately .02 sec.

Carotid Pulse Tracing (CPT) Reflects the pressure and possible small volume changes in a segment of the carotid artery with each cardiac cycle P (percussion wave) is the first peak and is related to aortic ejection. 80 msec after the first heart sound T (tidal wave) is the second wave and occurs late in systole D (dicrotic notch) coincides with aortic closure (A2), plus the traveling time of the pulse to the neck (.01-.05 sec)

Causes of Abnormalities in the Carotid Pulse

Jugular Pulse Tracing (JPT) Reflects volume change in the internal jugular vein and closely resembles the pressure changes in the right atrium A wave atrial contraction C wave onset of ventricular contraction X descent atrial diastole V wave atrial filling before AV valves open Y descent AV valves open filling of the ventricles

Apexcardiogram (ACG) Records low-frequency vibrations over the apical impulse Defections not delayed A wave reflects atrial contraction and is synchronous with the 4th heart sound IC represents isovolumic contraction and coincides with the first vibrations of the first heart sound E peak reflects the onset of ejection of blood from the ventricle into the aorta and coincides with 3rd heart sound O point reflects the opening of the mitral valve RFW (rapid filling wave) marks the 3rd heart sound and early rapid phase of ventricular filling

Echocardiography Echocardiography uses echoes from pulsed high-frequency sound waves to locate and study the movements and dimensions of various cardiac structures M-Mode angle of ultrasound kept stationary Two-Dimensional the angle issues very high-frequency sound waves to produce visual images of the anatomical structures of the heart (sector scan) Doppler explores the blood flow patterns in the cardiac chambers. It determines the direction of blood flow and measures its velocity within the heart and great vessels. The information is used to estimate gradients across cardiac valves and detect regurgitations.

THE END OF CHAPTER 4 Tilkian, Ara MD Understanding Heart Sounds and Murmurs, Fourth Edition, W.B. Sunders Company. 2002, pp. 34-42.