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 highfrequency 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.