Apex beat.
Heart sounds (VI.)
Systolic time intervals
(XIII.)
Department of Physiology
Faculty of Medicine
Masaryk University
2015 © Kateřina Fialová, Eva závodná, Tibor Stračina
Apex beat
• External manifestation of heart function
• Maximum in 4th or 5th intercostal space on the left (1-2 cm from
medioclavicular line)
• Observation (inspection), palpation
Heart sounds
• 1st heart sound: Closing of mitral and tricuspid valves
• 2nd heart sound: Closing of aortic and pulmonary valves
• systolic pause: Time interval between 1st and 2nd heart sounds
• diastolic pause: Time interval between 2nd and 1st heart sounds
• 3rd heart sound: In first part of diastole, physiological in young
people; in elderly people sign of decreased
compliance of LV (hypertrophy)
Heart sounds
1st heart sound - CHARACTERISATION
• Vibration of mitral and tricuspid valves due to their rapid closure (because of
increase of pressure in ventricles above the pressure in atria in the beginning
of systole)
• Low-frequency sound takes 100 ms
• Circa 50 ms after beginning of QRS
• Maximum in region of apex beat (laying on left side)
• Clinically relevant: assessment of loudness of heart sound – intensification or
attenuation, or splitting
Heart sounds
2nd heart sound - CHARACTERISATION
• Vibration of aortic and pulmonary valves due to their rapid closure
(because of decrease of pressure in ventricles under the pressure in aorta
at the end of systole)
• High-frequency sound has two components – aortic and pulmonary;
physiological splitting in inspiration (unsplit when the subject is holding
his/her breath in expiration)
• Maximum in region of apex beat (laying on left side)
• Clinically relevant: assessment of loudness of heart sound –
intensification or attenuation, or splitting
Heart sounds
• Auscultation
– By ear
– By stethoscope
– By microphone - phonocardiography
Heart sounds
• Places of optimal audibility of particular valves
Aortic valve
Tricuspid valve
Mitral valve
Pulmonary valveA
T M
P
T
A P
M
Heart sounds
• Timing of heart sounds: ECG + phonocardiography
Heart cycle
SYSTOLE
DIASTOLE
Isovolumetric contraction (IVC)
Isovolumetric relaxation (IVR)
Ejection phase (EP)
Filling phase (FP)
POLYGRAPHY
– recording of several physiological quantities (signals) in the same time
PHONOCARDIOGRAPHY - recording of heart sounds (by microphone)
ELECTROCARDIOGRAPHY (ECG)
SPHYGMOGRAPHY - recording of arterial pulse wave
systole diastole
IVC
EP
IVR
FP
systole diastole
IVC
EP
IVR
FP
aorta
a. carotis
The record of pulse
wave from carotid
artery is shifted
against the record
from root of aorta!
systole diastole
IVC
EP
IVR
FP
How can we measure length of heart cycle?
systole diastole
IVC
EP
IVR
FP
RR interval
STK - STK
S1 - S1
DTK - DTK
How can we measure length of heart cycle?
systole diastole
IVC
EP
IVR
FP
How can we measure length of systole and diastole?
systole diastole
IVC
EP
IVR
FP
S1 – S2 S2 – S1
How can we measure length of systole and diastole?
systole diastole
IVC
EP
IVR
FP
How can we measure length of isovolumetric
contraction and ejection phase?
systole diastole
IVC
EP
IVR
FP
LVET
LVET = left ventricle ejection time = EP
IVC could be directly measured in sphygmorgaphy
recorded from root of aorta.
Due to shift of carotid artery record, we use calculation:
IVC = systole – ejection phase = S1S2 - LVET
How can we measure length of isovolumetric
contraction and ejection phase?
systole diastole
IVC
EP
IVR
FP
How can we measure length of
electromechanic systole a preejection
period?
systole diastole
IVC
EP
IVR
FP
QS2
Electromechanical systole: QS2
Preejection poriod - calculation:
PEP = QS2 - LVET
Electromechanical latency (EML)
EML = QS2 – S1S2
EML
How can we measure length of
electromechanic systole a preejection
period?