Phonocardiography, External Pulse Recordings, and Echocardiography

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Phonocardiography, External Pulse Recordings,
and Echocardiography

• Ara G. Tilkian, MD, FACC
• Instructor
• Patricia L. Thomas, MBA, RCIS

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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

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Electrocardiogram

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

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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)

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Causes of Abnormalities in the Carotid Pulse
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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

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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

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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.

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THE ENDOFCHAPTER 4

• Tilkian, Ara MD Understanding Heart Sounds and
  Murmurs,
• Fourth Edition, W.B. Sunders Company. 2002, pp.
  34-42.