For class I made this

1. Kazan State Medical
University
Phonocar
s i ol ogy Proj

2. nocardi ogr

3. Phonocardi ogram
• A Phonocardiogram is a recording of the heart
soundsand murmurs.
• Eliminates subjective interpretation of the heart
sounds
• Enables evaluation of the heart sounds and murmurs
with respect to the electric and mechanical events in
thecardiac cycle.
• Evaluation of the result is based on the basis of

4. Phonocardiogram

5. Roleof phonocardiography
• Areviewofthestatusofphonocardiographyisinorderatthepresenttimesinceits
popularityhasadmittedlydeclinedinrecentyears.
• Diminutionintheuseofphonosandpulsetracingscaninpartbeattributedtothe
explosivegrowthofnewerdiagnosticmethodssuchascardiaccatheterization,
echocardiographyandnuclearanddopplertechniques. Ourpurposeistoexamine
thepresentandfutureroleofphonocardiography.
• Hasitindeedbeensupercededbythesemoreglamorousmethodsordoesitprovide
informationthat. isusefulandvalidinitsownright?Historicallytheregistration
ofpulsatilemovementsofthechestwall, carotid

6. Frequency s pect rumof a
t ypi cal
Phonocardi ogram

7. Abs t ract
• In phonocardiography thesecond heart
sound isimportant in appraisal of
congenital heart diseaseand pulmonary
hypertension becauseit reflectstheduration
of right ventricular systoles.
• Thesystolic murmur in patientswith
intracardiac shunt decreasesaspulmonary
hypertension develops, and may eventually
disappear completely asthepulmonary

10. Wi ggers di agram of vari ous
event s of a cardi ac cycl e,
i ncl udi ng
a phonocardi ogram at bot t om

11. Digital
Phonocardiography
• Today, recording and analysisaredone
digitally using personal computersand
specialized softwareor by using custom
electronic devicesspecially designed for this
purpose.
• In addition, sophisticated analysissoftware,
featureextraction, and classification
algorithms(such asneural networks) may be
used for further interpretation of sounds.

12. • A visual presentation providesan opportunity
to study thetiming, frequency, and intensity of
different heart sound and murmur components.
• Spectral phonocardiography combined with
traditional phonocardiographic tracing
simultaneously depictsall of thesefeatures.
• Digital signal processing allowsaccuratefine-
tuning of thevisual representation in termsof
variousfrequencies, intensities, and timing.

13. Conventional
Phonocardiography• Pho no cardio graphy is a diagno stic technique
that graphically reco rds cardiac aco ustic
pheno mena.
• Visualizatio n o f heart so unds may help in
understanding cardiac events.
• Avisualreco rd may also help an
inexperienced listener reco gnize and classify
auscultato ry findings.
• The essentialelements o f the
pho no cardio graphic system are a transducer
(micro pho ne), an amplifier, a filter, and

14. Heartsoundevents representedgraphically. Theredbars representleft-sideevents,
andtheblackbars representright-sideevents. Thegrayareais normallyinaudible.
Thefirstheartsound(S1)contains twocomponents: themitralvalveclosuresound
(M1)andthetricuspidvalveclosuresound(T1). Thesecondheartsound(S2)
contains twocomponents: theaortic valveclosuresound(A2)followedbythe
pulmonaryvalveclosuresound(P2). Thepresystolic (atrial)gallopsound(S4)is
normallyinaudible. Theprodiastolic (ventricular)gallop(S3)maybeaudibleandis
normalinchildren. Innocentsystolic murmur(SM)is acommonnormalfinding,

15. HeartSoundAnalysis in
Children• Over90% of heartmurmurs inchildrenare
physiologic andbenign.
• Moreover, 75% of thesemurmurs are
innocentvibratorymurmurs.
• Visualanalysis of thephono-
spectrocardiographic recordenables
differentiationbetweenpathologic and
physiologic pediatric murmurs.
• Simplequantitativecriteriaappliedtothe
phono-spectrocardiographic recordmay
significantlyimprovethediagnostic accuracy

16. • Advancedsignalprocessingandpattern
recognitiontools haveyieldedevenbetter
diagnostic accuracy.
• Artificialneuralnetwork–basedscreening
has beenreportedtohavehigher
sensitivityandspecificitythanothersignal
processingmethods

17. HeartSoundAnalysis in
Adults• Pho no -spectro cardio graphic signalanalysis is
a pro mising clinicalapplicatio n in the
assessment o f the severity o f ao rtic o r caro tid
arterial steno sis.2,5,6 Furthermo re, as in
children, it can be used to differentiate
between patho lo gic and inno cent murmurs.
• Traditio nalpho no cardio graphy co mbined with
spectral digital analysis, also kno wn as
aco ustic cardio graphy, has been used to
reco gnize and quantify heart so unds S3 and
S4.
• Changes in the reco rded magnitude o f

18. Acoustic cardiographyreportandtime-frequencyanalysis of heartsounds froma
subjectwithasystolic murmur. Theupperpanel(A)shows atwo-dimensional
acoustic cardiographyreportforasubjectwithasystolic murmur(M)andthe
panels below(B)illustratethethree-dimensionalscalogramviews of atwobeats
fromtheacoustic cardiographyrhythmstripshownabove. Becausemurmurs
havehigherfrequencycomponents thandiastolic heartsounds, theydonothave
tobehighinintensitytobedetectedbythehumanear. Thus, inthis case, itis
easierforthehumaneartodetectthemurmurthanthelow-frequencythirdand

19. Heart sound recording syst em
wit h a hand-held elect ronic
st et hoscope.

20. Referances
ht t p:/ / m4.wyanokecdn.com/ da17293e98727bf a9ead2837402
ht t p:/ / www.healio.com/ pediat rics/ j ournals/ pedann/ 1997-
2-26-2/ %7B4ef b230a-be51-4933-9732-
ab24a5950958%7D/ what -makes-a-heart -murmur-
innocent
ht t p:/ / radiologykey.com/ phonocardiography/ # 8760709
ht t ps:/ / www.researchgat e.net / f igure/ 50214693_f ig1_Fig
-1-Digit al-phonocardiogram-dPCG-of -a-healt hy-Beagle-
wit h-simult aneous
ht t ps:/ / www.ncbi.nlm.nih.gov/ pmc/ art icles/ PMC3258229/
ht t p:/ / www.sciencedirect .com/ science/ art icle/ pii/ 016752
7383902097/ part / f irst -page-pdf

21. Thank you Very
much