Comparison of first and second heart sounds after mechanical heart valve replacement

In this article, the spectral features of first heart sounds (S1) and second heart sounds (S2), which comprise the mechanical heart valve sounds obtained after aortic valve replacement (AVR) and mitral valve replacement (MVR), are compared to find out the effect of mechanical heart valve replacement and recording area on S1 and S2. For this aim, the Welch method and the autoregressive (AR) method are applied on the S1 and S2 taken from 66 recordings of 8 patients with AVR and 98 recordings from 11 patients with MVR, thereby yielding power spectrum of the heart sounds. Three features relating to frequency of heart sounds and three features relating to energy of heart sounds are obtained. Results show that in comparison to natural heart valves, mechanical heart valves contain higher frequency components and energy, and energy and frequency components do not show common behaviour for either AVR or MVR depending on the recording areas. Aside from the frequency content and energy of the sound generated by mechanical heart valves being affected by the structure of the lungs–thorax and the recording areas, the pressure across the valve incurred during AVR or MVR is a significant factor in determining the frequency and energy levels of the valve sound produced. Though studies on native heart sounds as a non-invasive diagnostic method has been done for many years, it is observed that studies on mechanical heart valves sounds are limited. The results of this paper will contribute to other studies on using a non-invasive method for assessing the mechanical heart valve sounds.     

Hemodynamics-driven mathematical model of first and second heart sound generation

We propose a novel, two-degree of freedom mathematical model of mechanical vibrations of the heart that generates heart sounds in CircAdapt, a complete real-time model of the cardiovascular system. Heart sounds during rest, exercise, biventricular (BiVHF), left ventricular (LVHF) and right ventricular heart failure (RVHF) were simulated to examine model functionality in various conditions. Simulated and experimental heart sound components showed both qualitative and quantitative agreements in terms of heart sound morphology, frequency, and timing. Rate of left ventricular pressure (LV dp/dt_max) and first heart sound (S1) amplitude were proportional with exercise level. The relation of the second heart sound (S2) amplitude with exercise level was less significant. BiVHF resulted in amplitude reduction of S1. LVHF resulted in reverse splitting of S2 and an amplitude reduction of only the left-sided heart sound components, whereas RVHF resulted in a prolonged splitting of S2 and only a mild amplitude reduction of the right-sided heart sound components. In conclusion, our hemodynamics-driven mathematical model provides fast and realistic simulations of heart sounds under various conditions and may be helpful to find new indicators for diagnosis and prognosis of cardiac diseases.New & noteworthyTo the best of our knowledge, this is the first hemodynamic-based heart sound generation model embedded in a complete real-time computational model of the cardiovascular system. Simulated heart sounds are similar to experimental and clinical measurements, both quantitatively and qualitatively. Our model can be used to investigate the relationships between heart sound acoustic features and hemodynamic factors/anatomical parameters.     

Measurement and theory of wheezing breath sounds

We measured the time and frequency domain characteristics of breath sounds in seven asthmatic and three nonasthmatic wheezing patients. The power spectra of the wheezes were evaluated for frequency, amplitude, and timing of peaks of power and for the presence of an exponential decay of power with increasing frequency. Such decay is typical of normal vesicular breath sounds. Two patients who had the most severe asthma had no exponential decay pattern in their spectra. Other asthmatic patients had exponential patterns in some of their analyzed sound segments, with a range of slopes of the log power vs. log frequency curves from 5.7 to 17.3 dB/oct (normal range, 9.8-15.7 dB/oct). The nonasthmatic wheezing patients had normal exponential patterns in most of their analyzed sound segments. All patients had sharp peaks of power in many of the spectra of their expiratory and inspiratory lung sounds. The frequency range of the spectral peaks was 80-1,600 Hz, with some presenting constant frequency peaks throughout numerous inspiratory or expiratory sound segments recorded from one or more pickup locations. We compared the spectral shape, mode of appearance, and frequency range of wheezes with specific predictions of five theories of wheeze production: 1) turbulence-induced wall resonator, 2) turbulence-induced Helmholtz resonator, 3) acoustically stimulated vortex sound (whistle), 4) vortex-induced wall resonator, and 5) fluid dynamic flutter. We conclude that the predictions by 4 and 5 match the experimental observations better than the previously suggested mechanisms. Alterations in the exponential pattern are discussed in view of the mechanisms proposed as underlying the generation and transmission of normal lung sounds. The observed changes may reflect modified sound production in the airways or alterations in their attenuation when transmitted to the chest wall through the hyperinflated lung.     

Segmentation of heart sounds based on dynamic clustering

The heart sound signal is first separated into cycles, where the cycle detection is based on an instantaneous cycle frequency. The heart sound data of one cardiac cycle can be decomposed into a number of atoms characterized by timing delay, frequency, amplitude, time width and phase. To segment heart sounds, we made a hypothesis that the atoms of a heart sound congregate as a cluster in time–frequency domains. We propose an atom density function to indicate clusters. To suppress clusters of murmurs and noise, weighted density function by atom energy is further proposed to improve the segmentation of heart sounds. Therefore, heart sounds are indicated by the hybrid analysis of clustering and medical knowledge. The segmentation scheme is automatic and no reference signal is needed. Twenty-six subjects, including 3 normal and 23 abnormal subjects, were tested for heart sound signals in various clinical cases. Our statistics show that the segmentation was successful for signals collected from normal subjects and patients with moderate murmurs.     

A robust heart sounds segmentation module based on S-transform

This paper presents a new module for heart sounds segmentation based on S-transform. The heart sounds segmentation process segments the PhonoCardioGram (PCG) signal into four parts: S1 (first heart sound), systole, S2 (second heart sound) and diastole. It can be considered one of the most important phases in the auto-analysis of PCG signals. The proposed segmentation module can be divided into three main blocks: localization of heart sounds, boundaries detection of the localized heart sounds and classification block to distinguish between S1 and S2. An original localization method of heart sounds are proposed in this study. The method named SSE calculates the Shannon energy of the local spectrum calculated by the S-transform for each sample of the heart sound signal. The second block contains a novel approach for the boundaries detection of S1 and S2. The energy concentrations of the S-transform of localized sounds are optimized by using a window width optimization algorithm. Then the SSE envelope is recalculated and a local adaptive threshold is applied to refine the estimated boundaries. To distinguish between S1 and S2, a feature extraction method based on the singular value decomposition (SVD) of the S-matrix is applied in this study. The proposed segmentation module is evaluated at each block according to a database of 80 sounds, including 40 sounds with cardiac pathologies.     

An electronic frequency shifting stethoscope for heart sounds

The predominating energy in the normal heart sounds has been found to be at frequencies below the normal hearing threshold. Because it was felt that significant clinical information was likely to be present at those frequencies, an instrument was designed and fabricated which would frequency shift the entire heart sound into the middle of the auditory frequency range. Clinical testing showed that changes were readily detected in a monitoring situation, and that use of the instrument was both simple and easy to learn.     

Low frequency sounds from sustained contraction of human skeletal muscle.

Low frequency audible vibrations are produced by human skeletal muscles undergoing sustained contraction. The effect is easily demonstrable with an electronic stethoscope which amplifies sound below 50 Hz. Autocorrelation analysis of the signal shows that it is periodic with a frequency 25 +/- 2.5 Hz. The quality of the sound is the same for all the skeletal muscles tested and is unaffected by changes in tension, ambient temperature, and blood flow. Electrically-stimulated contraction produces a sound which is indistinguishable from voluntary contraction. The amplitude of the sound increases linearly with tension. The sound signals are uncorrelated both in frequency and phase with electromyographic signals obtained simultaneously while the muscle is contacted. Arguments are presented to show that the sounds may be an intrinsic property of muscle contraction.     

Heart energy signature spectrogram for cardiovascular diagnosis

A new method and application is proposed to characterize intensity and pitch of human heart sounds and murmurs. Using recorded heart sounds from the library of one of the authors, a visual map of heart sound energy was established. Both normal and abnormal heart sound recordings were studied. Representation is based on Wigner-Ville joint time-frequency transformations. The proposed methodology separates acoustic contributions of cardiac events simultaneously in pitch, time and energy. The resolution accuracy is superior to any other existing spectrogram method. The characteristic energy signature of the innocent heart murmur in a child with the S3 sound is presented. It allows clear detection of S1, S2 and S3 sounds, S2 split, systolic murmur, and intensity of these components. The original signal, heart sound power change with time, time-averaged frequency, energy density spectra and instantaneous variations of power and frequency/pitch with time, are presented. These data allow full quantitative characterization of heart sounds and murmurs. High accuracy in both time and pitch resolution is demonstrated. Resulting visual images have self-referencing quality, whereby individual features and their changes become immediately obvious.     

A generating model of realistic synthetic heart sounds for performance assessment of phonocardiogram processing algorithms

A new model which is capable of generating realistic synthetic phonocardiogram (PCG) signals is introduced based on three coupled ordinary differential equations. The new PCG model takes into account the respiratory frequency, the heart rate variability and the time splitting of first and second heart sounds. This time splitting occurs with each cardiac cycle and varies with inhalation and exhalation. Clinical PCG statistics and the close temporal relationship between events in ECG and PCG are used to deduce values of PCG model parameters.In comparison with published PCG models, the proposed model allows a larger number of known PCG features to be taken into consideration. Moreover it is able to generate both normal and abnormal realistic synthetic heart sounds. Results show that these synthetic PCG signals have the closest features to those of a conventional heart sound in both time and frequency domains. Additionally, a sound quality test carried out by eight cardiologists demonstrates that the proposed model outperforms the existing models.This new PCG model is promising and useful in assessing signal processing techniques which are developed to help clinical diagnosis based on PCG.     

A new method for estimating voice sounds transmitted to the chest wall in children and adolescents

A new method for estimating voice sound transmission to the chest wall is proposed. The spectral characteristics of voice-transmitted sounds have been estimated in children and adolescents. A total of 37 subjects aged 7–17 yers were examined. The frequency of the first spectral peak of the voice-transmitted sounds “tree, tree” (M ± SD) is 263.7 ± 7.82 and 253 ± 4.29 Hz at ages of 7–11 and 12–14 years, respectively. In male adolescents aged 15–17 years, this frequency is decreased to 100–150 Hz. The slope of the descending segment of the spectrum on the high-frequency side of the peak steadily increases on moving from the upper to the lower zones of the lungs, which may be related to the increase in the air content of the lung tissue. The difference between the amplitudes of the first and second spectral peaks of voice-transmitted sounds over symmetric regions of the chest on the right and left sides (Me(Q75-Q25)) is ?0.1(11.0) dB and does not depend on age or sex, which can be interpreted as an average statistical symmetry of sound transmission.     

Neonatal heart rate variability and its relation to respiration

The heart rate and respiration signals from nine healthy full term neonates were studied using autoregressive spectral analysis and cross-correlation techniques. The heart rate spectra could be divided into three regions of activity: a very low frequency (VLF) region from 0-0.04 Hz; a low frequency (LF) band from 0.04-0.20 Hz; and a high frequency (HF) region above 0.20 Hz. The newborns exhibited very little respiratory sinus arrhythmia in their heart rate variability in contrast to the situation for adults and older infants. However, variations in heart rate correlated strongly with changes in the breath amplitude, leading to what may be termed a breath amplitude sinus arrhythmia. The neonatal heart rate behaviour under stable conditions of oscillation could be simulated with a nonlinear control model provided the delay time in the baroreceptor loop of the model was taken to be approximately 2 seconds longer than in adults. This is consistent with the immature neurological status of neonates.     

Cluster analysis and classification of heart sounds

Acoustic heart signals, generated by the mechanical processes of the cardiac cycle, carry significant information about the underlying functioning of the cardiovascular system. We describe a computational analysis framework for identifying distinct morphologies of heart sounds and classifying them into physiological states. The analysis framework is based on hierarchical clustering, compact data representation in the feature space of cluster distances and a classification algorithm. We applied the proposed framework on two heart sound datasets, acquired during controlled alternations of the physiological conditions, and analyzed the morphological changes induced to the first heart sound (S1), and the ability to predict physiological variables from the morphology of S1. On the first dataset of 12 subjects, acquired while modulating the respiratory pressure, the algorithm achieved an average accuracy of 82 ± 7% in classifying the level of breathing resistance, and was able to estimate the instantaneous breathing pressure with an average error of 19 ± 6%. A strong correlation of 0.92 was obtained between the estimated and the actual breathing efforts. On the second dataset of 11 subjects, acquired during pharmacological stress tests, the average accuracy in classifying the stress stage was 86 ± 7%. The effects of the chosen raw signal representation, distance metrics and classification algorithm on the performance were studied on both real and simulated data. The results suggest that quantitative heart sound analysis may provide a new non-invasive technique for continuous cardiac monitoring and improved detection of mechanical dysfunctions caused by cardiovascular and cardiopulmonary diseases.     

Acoustic communication in two freshwater gobies: the relationship between ambient noise,hearing thresholds and sound spectrum

Two freshwater gobies Padogobius martensii and Gobius nigricans live in shallow (5-70 cm) stony streams, and males of both species produce courtship sounds. A previous study demonstrated high noise levels near waterfalls, a quiet window in the noise around 100 Hz at noisy locations, and extremely short-range propagation of noise and goby signals. To investigate the relationship of this acoustic environment to communication, we determined audiograms for both species and measured parameters of courtship sounds produced in the streams. We also deflated the swimbladder in P. martensii to determine its effect on frequency utilization in sound production and hearing. Both species are maximally sensitive at 100 Hz and produce low-frequency sounds with main energy from 70 to 100-150 Hz. Swimbladder deflation does not affect auditory threshold or dominant frequency of courtship sounds and has no or minor effects on sound amplitude. Therefore, both species utilize frequencies for hearing and sound production that fall within the low-frequency quiet region, and the equivalent relationship between auditory sensitivity and maximum ambient noise levels in both species further suggests that ambient noise shapes hearing sensitivity.     

Early detection of pulmonary congestion and edema in dogs by using lung sounds

Five mongrel dogs (2 interstitial and 3 alveolar edema) were studied. Lung mechanics were measured by recording the flow, volume, and esophageal pressure according to the standard technique. Edema was produced by infusion of Ringer lactate solution. Lung sounds were recorded on tape from the dependent part of the chest wall. Lung sound signals were high-pass filtered at 100 Hz and subjected to fast Fourier transform. Samples of lung sounds were analyzed before (control) and at 5, 10, 20, 30, and 40 min after the infusion. The mean, median, and mode frequencies of sound power spectra at the control time were, respectively, 169.6 +/- 29.19, 129.6 +/- 29.81, and 136.0 +/- 29.87 (SD) Hz. These values increased significantly at 5 min after infusion to 194.0 +/- 26.08 (P less than 0.0037), 150.2 +/- 23.48 (P less than 0.0085), and 164.6 +/- 28.74 Hz (P less than 0.02), respectively. These values stayed significantly elevated at 10, 20, 30, and 40 min. The pulmonary wedge pressure, lung dynamic compliance, and pulmonary resistance were measured also at the same times. The mean, median, and mode frequencies correlated with pulmonary wedge pressure (P less than 0.00001, P less than 0.0001, P less than 0.0001), lung dynamic compliance (P less than 0.001, P less than 0.0001, P less than 0.0001), and pulmonary resistance (P less than 0.00001, P less than 0.00001, P less than 0.0001), respectively. There were no significant adventitious sounds up to 40 and 50 min after infusion. We concluded that pulmonary congestion and early edema alter the frequency characteristics of lung sounds early, before the occurrence of adventitious sounds. These altered lung sounds may be used as an index of pulmonary congestion and impending edema.     

Spectra of the voluntary first cough sounds

The voluntary cough sounds recorded according to Korpas and Sadlonova-Korpasova were sampled at a frequency of 20.000Hz and spectra of six consecutive windows of 50ms were estimated. To digitize signals an autotrigger mode was used. The subjects were healthy volunteers as well as patients with chronic bronchitis, asthma, bronchial carcinoma (growing intraluminarly in the 1st or in the 2nd or in the 3rd order bronchi), emphysema, laryngeal nerve paralyzis or laryngotomy. The duration of averaged cough sounds of patients was longer than that of healthy volunteers. The mean power of the spectra in the successive windows showed different patterns in the same group. In the third window of healthy volunteers (0.10 s-0.15 s) a high modulus broad bandwidth (between 1-2 kHz) spectrum was found which was considered as a bronchial "flute", and was probably related to the lowest resistance as well as to the velocity of airflow of cough manoeuvre. This pattern appeared with a delay and/or it was changed in the diseased groups compared to the healthy volunteers. Due to this delay, the spectra of the fifth window (0.20 s-0.25 s) showed somewhat higher harmonics (400-800 Hz) in the patients with chronic obstructive pulmonary diseases (COPD), carcinoma and laryngeal nerve paralyzis than in healthy volunteers. In emphysematous patients in the first (0.00-0.05 s), in the third (0.10-0.15 s) and in the fifth (0.20-0.25 s) windows the fundamental frequency was low (156-176 Hz) compared to that of the other groups. The paralyzed vocal cords functioning as an added resistance to the expiratory effort caused a phase-shift in the cough patterns, similarly to that seen in COPD patients. Due to the cannula, the spectra of patients having laryngotomy had a lot of high harmonics. They also had peaks nearly identical to that of bronchitic patients because they suffered from serious chronic bronchitis. It was found that by examination the cough spectra of series of voluntary cough sound signals it was possible to distinguish healthy volunteers from patients. This examination would therefore be useful for screening of bronchial diseases.     

Fluttering wing feathers produce the flight sounds of male streamertail hummingbirds

Sounds produced continuously during flight potentially play important roles in avian communication, but the mechanisms underlying these sounds have received little attention. Adult male Red-billed Streamertail hummingbirds (Trochilus polytmus) bear elongated tail streamers and produce a distinctive 'whirring' flight sound, whereas subadult males and females do not. The production of this sound, which is a pulsed tone with a mean frequency of 858 Hz, has been attributed to these distinctive tail streamers. However, tail-less streamertails can still produce the flight sound. Three lines of evidence implicate the wings instead. First, it is pulsed in synchrony with the 29 Hz wingbeat frequency. Second, a high-speed video showed that primary feather eight (P8) bends during each downstroke, creating a gap between P8 and primary feather nine (P9). Manipulating either P8 or P9 reduced the production of the flight sound. Third, laboratory experiments indicated that both P8 and P9 can produce tones over a range of 700-900 Hz. The wings therefore produce the distinctive flight sound, enabled via subtle morphological changes to the structure of P8 and P9.     

Influence of sound and light on heart rate variability

The effects of acoustic and visual stimuli and their synergistic effects on heart rate variability including gender differences were investigated. Of particular interest was the influence of visual stimulus on heart rate variability during listening to simple sounds of different characters. Twelve male and 12 female university students were selected as subjects. The subjects listened at rest to 7 different figures of sound at loudness levels averaging 60 dB. Beat-to-beat R-R intervals were continuously recorded under the closed-eye condition (CEC) and the open-eye condition (OEC) prior to, during, and immediately after the exposure to acoustic stimuli. Low frequency (LF) power was defined over 0.04-0.15 Hz and high frequency (HF) power over 0.15-0.40 Hz. Cardiac autonomic function was estimated by plotting LF/HF in standard measure against HF in standard measure and by plotting LF/HF (%) against HF (%), accompanied by a demarcated central area. Values of LF/HF tended to be smaller under CEC than under OEC. Values of HF while listening to a 110 Hz sine wave under CEC were significantly greater than values for 880 Hz and 3520 Hz sine waves, or for 110 Hz or 880 Hz sawtooth waves, under OEC. Under CEC, values of HF for 7 figures of sound were greater in females than in males. The value of HF of sine wave for 110 Hz under CEC and OEC was significantly greater than that for white noise under the OEC. The results suggest that the cardiac parasympathetic nervous activity during auditory excitation increases with elimination of visual stimuli and tends to be greater in females than in males.     

Formation of language-specific characteristics of speech sounds in early ontogeny

Heterochronic formation of basic and language-specific speech sounds in the first year of life in infants from different ethnic groups (Chechens, Russians, and Mongols) has been studied. Spectral analysis of the frequency, amplitude, and formant characteristics of speech sounds has shown a universal pattern of organization of the basic sound repertoire and “language-specific” sounds in the process of babbling and prattle of infants of different ethnic groups. Possible mechanisms of the formation of specific speech sounds in early ontogeny are discussed.     

Quantification of heart sounds interference with lung sounds

An index to quantify the contamination of lung sounds by heart sounds is described. Using the index, the efficacy of high pass filtering and adaptive filtering methods for the reduction of heart sounds is evaluated.